Lipodermatosclerosis is a medical condition that affects the skin just above the ankles. It is classified as a form of panniculitis (inflammation of subcutaneous fat) (The clinical spectrum of lipodermatosclerosis, Kirsner RS, Pardes JB, Eaglstein WH, Falanga V, Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, U.S. National Library of Medicine and the National Institutes of Health). It is characterized by extremely smooth skin that turns brown in color, becomes very tight, and is quite painful. People with chronic vein problems (venous insufficiency or venous stasis) and constriction of blood flow to this area are those generally affected by the disease. Lipodermatosclerosis can either be acute (quick onset) or chronic in nature.
Cause of Lipodermatosclerosis
Lipodermatosclerosis (LDS) usually happens over a period of years, but in rare instances has been acute in onset. While not every aspect of the cause of the disease is known, it is certain that LDS is affected by high venous pressure in the subcutaneous veins in the lower legs. This can be caused by poor calf circulation due to the calf muscles not pumping sufficiently and/or standing on your feet for long periods of time. LDS predominantly strikes middle-aged people and those suffering with obesity.
Diagnosing LDS is based mainly on clinical presentation. A dermatologist will sometimes order an MRI scan or ultrasound to establish the extent of the disease. Blood tests are rarely ordered to aid in diagnosis, but sometimes coagulation is tested (DermNet NZ, May 31, 2008).
The classical lesions that characterize LDS include the following:
- Early lesions: Infiltrate of lymphocytes (WBCs) and tissue death in fibrous tissue dividing the fat (septa).
- Intermediate lesions: A mix of lymphocytes and new fibrous tissue in the septa.
- Advanced lesions: Severe fibrosis in the fat with reduced or absent inflammatory cells.
Complications of Lipodermatosclerosis
The complications of LDS are serious and should not be overlooked. Leaving LDS untreated, an individual can acquire a venous leg ulcer. Such an ulcer is caused by the loss of skin and tissue due to poor circulation in the legs. This can be avoided by treating the underlying cause of the disease, such as improving calf muscle function or restraining from standing on your feet for too long.
Treatment of Lipodermatosclerosis
Treating is LDS is a matter of controlling the underlying causes of the disease, as well as much emphasis on compression therapy to correct venous insufficiency. Compression therapy includes either tight bandaging around the affected area or the use of compression stockings. Other treatment options include:
- Vein surgery
- Weight loss
- Medications that increase blood flow
- Ultrasound therapy
- Pain relievers
It is always best to communicate progress with a dermatologist, so he can prescribe treatment that works for you and make changes in treatment when necessary.