Lipodermatosclerosis describes a skin change of the lowe legs very often occurs in patients who possess venous insufficiency. It is a type of panniculitis (swelling of subcutaneous fat). Two-thirds of affected clients are overweight. Affected legs typically have the characteristics which can be following.
- Skin induration (hardening)
- Increased pigmentation
“Inverted champagne container” or “bowling pin” appearance
- Lipodermatosclerosis has also been called hypodermis sclerodermiformis and panniculitis that is sclerosing.
What are the apparent symptoms of lipodermatosclerosis?
The reduced leg that is inner of or both legs could be included. Lipodermatosclerosis may present being acute or being a chronic (longstanding) condition.
Acute lipodermatosclerosis happens without any preceding illness or injury that is a neighborhood. It presents as episodes of painful infection in the internal leg above the ankle, resembling cellulitis. The area that is affected red, tender and warm, and may be scaly. Some thickening associated with the epidermis can be felt, but this is not sharply demarcated as in chronic lipodermatosclerosis.
Patients with acute lipodermatosclerosis are mainly middle-aged.
Chronic lipodermatosclerosis may follow an episode that is severe develop gradually. Typical findings in chronic lipodermatosclerosis include:
- Hardening of the skin
- Localised thickening
- Moderate redness
- Increased pigmentation
- Small white scarred areas Blanche that is(atrophy
- Increased fluid in the leg (edema)
- Varicose veins
- Leg ulcers
- Chronic lipodermatosclerosis additionally predisposes to venous or stasis eczema.
The main cause of lipodermatosclerosis isn’t well understood. It appears to relate to hypertension that is venousraised pressure in the leg veins), venous incompetence (leaky valves) and obesity.
It has been proposed that it has a severe inflammatory stage of lipodermatosclerosis, which will be followed by many months or simply even years with a stage that is chronic. This is characterized by substantial fibrosis or sclerosis (scarring) within the epidermis and tissue that is subcutaneous. Nonetheless, not all patients with chronic lipodermatosclerosis recall a phase that is acute.
The stage that is acute of can occur before there are visible signs of venous illness. Right back pressure into the capillaries outcomes in the activation of cells and factors that are soluble encourage inflammation.
On the other hand, two-thirds of those with belated fibrotic phase have apparent venous incompetence and hypertension that is venous.
Subtle changes in clotting (blood clotting) may also be a factor.
Investigations in lipodermatosclerosis
Lipodermatosclerosis is ordinarily diagnosed clinically, and skin biopsy is not done frequently. Dermatopathology shows modifications that are histological affect the fat and depend regarding the stage of the condition.
Early lesions display an infiltrate of lymphocytes (a type of white cell) and regions of tissue death in the tissue that is fibrous the fat (septa).
Intermediate lesions show a mixed infiltrate of white cells and new tissue that is fibrous the septa. Fibrous areas exist in the fat.
Late lesions show pronounced fibrosis in the fat with diminished or inflammatory that is absent. Changes in the dermis include a inflammatory that is blended infiltrate, advanced fibrous cells, atrophy, or both and twisting thick-walled veins. Fibrin cuffs are present around the capllaries by absolute immunofluorescence.
The histology stages correlate well with the 2 stages seen clinically.
Blood tests are not normally required in lipodermatosclerosis but coagulation might be tested.
Ultrasound scans and resonance that is magnetic enables you to define the level of the disease and to ascertain whether there is just a role for vascular surgery.
Management of lipodermatosclerosis
The main part of management is compression therapy to correct stasis that is venous. Management could also include:
- Vein surgery, endovenous laser ablation or sclerotherapy
- Weight reduction
- Ultrasound therapy
- Fibrinolytic agents such as for instance stanozolol
- Pentoxyfylline to increase blood flow
- Clobetasol(ultrapotent that is propionate steroid) or intralesional triamcinolone injections to reduce swelling
- Capsaicin to lessen discomfort