Lipodermatosclerosis

Vascular Atlas

A 67 year old female with long standing lower extremity venous insufficiency presented with progressively worsening pain in both legs associated with increasing discoloration. She also noticed that the skin on her legs had been dry and harder than they had been previously. Examination reveled tough, indurated, and hyperpigmented skin with pulses present bilaterally. Duplex ultrasound did not show evidence of deep vein thrombosis bilaterally, however, a venous reflux study showed significant venous valuvular incompetency.

Lipodermatosclerosis (LDS) refers to subcutaneous fibrosing panniculitis which can be seen as a complication of severe chronic venous insufficiency, often following an episode of deep vein thrombosis. The overlying skin is typically hyperpigmented and tethered to the underlying subcutaneous tissue. The appearance of the leg is typically described as an “inverted champagne bottle” or “inverted bowling pin”. Presenting symptoms are commonly pain, edema, ulcerations, and erythema, and may be misdiagnosed as cellulitis.

The most important tool in managing LDS is external compression therapy to help correct the underlying venous stasis. Ultrasound therapy has also been described as well as fibrinolytics and pentoxyfylline. Steroid creams, such as clobetasol, can be used to treat dermal inflammation. More invasive therapies including venous sclerosis and ablation may be required if conservative measures are inadequate.

References:

  • Bergan JJ, Schmid-Schonbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med 2006; 355:488.
  • Kirsner, Robert S et al. The clinical spectrum of Lipodermatosclerosis. J Am Acad Dermatol 1993; 28, 4: 623-627.

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About Author

Ari J. Mintz, DO

Ari J. Mintz, DO is an internal medicine resident at Lahey Hospital and Medical Center in Burlington, MA. His clinical interests include peripheral arterial disease, noninvasive imaging, and advanced therapeutic approaches to venous thromboembolism. 

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