Lipodermatosclerosis is a chronic inflammation of the fatty tissue under the skin, or the subcutaneous fatty tissue. Pain is often the first symptom of lipodermatosclerosis. People with lipodermatosclerosis have tapered legs above the ankles. The legs then have the shape of an upside-down champagne bottle: thick at the top, narrow and fibrotic (increased amount of connective tissue) at the bottom. In addition, brown-red pigmentation and hardening may be seen on the lower legs. The exact cause of lipodermatosclerosis is unknown in 2020. Venous disorders, such as chronic venous insufficiency, pulmonary venous hypertension and (significantly) overweight or obesity, can contribute to the development of the disease.
- What is lipodermatosclerosis?
- Synonyms
- Who gets it?
- Symptoms of lipodermatosclerosis
- Phenomena
- Description
- Complications
- Causes
- Examination and diagnosis
- Physical examination
- Differential diagnosis
- Therapy
- Prognosis
- Prevention
What is lipodermatosclerosis?
Lipodermatosclerosis is a skin condition that affects the lower legs. This causes inflammation of the fat layer under the epidermis of the lower legs. So it is an inflammation of the subcutaneous fat. This condition affects people with venous insufficiency, which indicates the continuous failure of the veins and is caused by causes from within and outside the body. Symptoms of lipodermatosclerosis include increased pigmentation (discoloration) and hardening of the skin; your skin feels hard. Redness and swelling may also occur. The narrowed area may resemble an upside-down champagne bottle in the way it tapers down the leg, i.e. thick above and the lower part narrow and fibrotic.
Synonyms
Lipodermatosclerosis is also known as:
- hypodermatitis sclerodermiformis
- sclerosing panniculitis
Lipodermatosclerosis is more common in overweight people / Source: Kurhan/Shutterstock.com
Who gets it?
Lipodermatosclerosis is relatively common and mainly affects middle-aged and elderly people. It occurs more often in women than in men and is associated with immobility (inability to move or insufficient exercise) and a high body mass index or BMI (significantly overweight or obese).
Symptoms of lipodermatosclerosis
Phenomena
Lipodermatosclerosis is characterized by the following symptoms:
- pain in the lower legs
- hardening and/or thickening of the skin
- varicose veins (dilated blood vessels in the legs)
- changes in skin color (redness)
- white discoloration with red macula (spot) near an ulcer (atrophy blanche)
- swelling
Varicose veins / Source: Zlikovec/Shutterstock.com
- leg ulcers or sores on the legs
- narrowing of the legs above the ankles
Description
Pain may be the first symptom you notice. Then there is a narrowing of the legs above the ankles and a tight band is formed that resembles an inverted champagne bottle: thick at the top, narrow and fibrotic at the bottom. Furthermore, skin discoloration and hardening occur.
Complications
Lipodermatosclerosis may be associated with poor wound healing due to the chronic inflammatory state and fibrosis or connective tissue formation which is a consequence of inflammation and tissue damage. Venous ulcers or leg ulcers (ulcus cruris venosum) are also common and may be difficult to treat.
Causes
The exact cause of lipodermatosclerosis is still unknown in 2020. Venous diseases such as venous insufficiency, increased blood pressure in the veins and being significantly overweight or obese can play a role in the development of the condition. Increased blood pressure in the veins, or venous hypertension, can lead to diffusion or movement of substances, including fibrin, from the capillaries. Fibrin is a blood clotting protein in the blood plasma that plays an important role in normal wound healing and blood clotting. Fibrotic tissue is more susceptible to ulcer formation. Recurrent ulcers and death of fatty tissue (fat necrosis) are associated with lipodermatosclerosis. Several factors are likely to play a role in the development of lipodermatosclerosis, such as tissue hypoxia (where tissues in the body do not receive enough oxygen and the cells begin to die), leakage of proteins into the interstitium or extracellular space (the space outside the cells of a tissue ) and activation of leukocytes (white blood cells).
Blood test / Source: WathanyuSowong/Shutterstock.com
Examination and diagnosis
Physical examination
The diagnosis is often made immediately. A biopsy (a minor procedure in which tissue is removed and examined under a microscope) or blood tests are rarely required. Imaging research using ultrasound and/or an MRI scan can be used to obtain more information about the severity of the condition and to determine which treatment is preferable.
Differential diagnosis
The following conditions must be excluded:
- hypostatic eczema (an eczema that occurs low on the lower leg, due to venous insufficiency)
- contact dermatitis
- cellulitis (acute bacterial infection of the skin)
- eosinophilic cellulitis (Wells syndrome)
Initial rash in eosinophilic cellulitis / Source: Ioannis D Bassukas, Georgios Gaitanis, Aikaterini Zioga, Christina Boboyianni and Christina Stergiop, Wikimedia Commons (CC BY-2.0)
- erythema nodosum (a skin condition with painful red bumps)
- morphea (the term for a localized form of scleroderma, in which the connective tissue in the body becomes inflamed and therefore becomes stiffer)
- necrobiosis lipoidica (a granulomatous inflammation, usually of the lower legs)
- other causes of panniculitis (collective term of skin abnormalities that are based on inflammation of the subcutaneous fatty tissue)
Therapy
Treatment of lipodermatosclerosis focuses on venous insufficiency by elevating the legs and using elastic support stockings or bandaging; in some difficult cases the condition can be improved by the use of the fibrinolytic agent stanozole, a synthetic anabolic steroid derived from dihydrotestosterone. It has an enzymatic effect to break down blood clots and stimulates muscle formation. The drug is injected directly into the affected area. It is also known that venous ablation increases blood flow and can improve symptoms. Dermovate cream or ointment is prescribed in the acute inflammatory stage (hypodermatitis).
Prognosis
Venous insufficiency is a progressive disease. This means that it is a chronic disease that is becoming increasingly serious. Treatment can alleviate the resulting complaints and conditions such as lipodermatosclerosis and slow the progression of the disease.
Quit smoking / Source: Serhiy Kobyakov/Shutterstock.com
Prevention
The following measures reduce the risk of developing venous insufficiency:
- eat varied and healthy
- quit smoking
- exercise regularly
- do not wear tight clothing, such as tight girdles or belts.
- losing weight if you are overweight/obese
- maintain a healthy weight
- avoid sitting or standing for long periods of time
read more
- Necrobiosis lipoidica: symptoms, cause and treatment
- Skin spots: innocent spots on the skin – red and brown
- Skin disorders AZ: symptoms, cause and treatment
- Skin rash: causes and treatment of rash on the skin
- Itchy bumps and pimples on the body: causes