What are the other Names for this Condition? (Also known as/Synonyms)

• Acute Lipodermatosclerosis
• Hypodermitis Sclerodermaformis
• Sclerosing Panniculitis

What is Lipodermatosclerosis? (Definition/Background Information)

• Lipodermatosclerosis is a chronic condition affecting the lower legs commonly arising due to obesity and venous insufficiency. It results in redness, inflammation, ulceration, and hardening of skin (subcutaneous fat) on the lower limbs
• A treatment of the condition involves the use of topical agents, administration of medications, compression therapy, invasive procedures, and lifestyle changes such as increased physical activity (walking). Typically, the prognosis of Lipodermatosclerosis depends on its severity

Who gets Lipodermatosclerosis? (Age and Sex Distribution)

• Lipodermatosclerosis is a chronic disorder and the presentation of symptoms mostly occur into adulthood (mostly middle-aged and older adults are affected)
• Both males and females may be affected
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Lipodermatosclerosis? (Predisposing Factors)

The risk factors for Lipodermatosclerosis may include:

• Obesity (about 66% of the affected individuals are obese) - especially when the body mass index is very high
• Fibrinolysis, a key component of regulation of clotting is abnormal in most Lipodermatosclerosis patients
• Protein S and protein C deficiencies are sometimes present, making micro-clotting problems more likely
• Increased blood pressure in leg veins
• Increases in collagen production are seen, leading to a diffuse scar-like process, which constricts the skin and further decreases blood flow by compression 
• Venous insufficiency
• Immobility

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lipodermatosclerosis? (Etiology)

• Presently, the exact cause of development of Lipodermatosclerosis is not known
• An association of Lipodermatosclerosis is noted with several conditions including obesity, chronic venous insufficiency, venous hypertension, and changes in blood coagulation

What are the Signs and Symptoms of Lipodermatosclerosis?

The signs and symptoms of Lipodermatosclerosis may be mild or severe and can vary from one individual to another. There are two phases of the condition, namely acute and chronic.

• Acute signs and symptoms may include:
  • Appearance of skin lesions on the legs; one or both legs may be involved
  • Usually a solitary lesion (plaque) is noted, which slowly progresses to involve more regions of the skin
  • Redness of skin, especially observed in the shin region
  • Itching, pain, and discomfort may be noted
  • The lower limbs may feel heavy due to fluid accumulation
• Chronic signs and symptoms may include:
  • Formation of hardened skin (induration and fibrosis); thickened skin. This is most prominent at the margin, with normal texture just outside the pathology. Inside the involved area, the skin has a very hard, bound down character
  • This may cause narrowing of the lower portion of the leg (above the ankle), but thickened portion just below the knee, giving it an “upside down bottle” appearance
  • The leg may present reddish discolored skin and pain

The signs and symptoms of any underlying condition may be noted.

How is Lipodermatosclerosis Diagnosed?

Lipodermatosclerosis is diagnosed on the basis of the following information:

• Physical examination of the individual and medical history evaluation; a visual examination of the condition is sufficient to establish a diagnosis in most cases
• Laboratory tests which may include coagulation studies
• Imaging studies (ultrasound and magnetic resonance imaging)
• Skin biopsy, if necessary: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Tests and exams to diagnose an underlying condition, if needed

A differential diagnosis may be necessary to eliminate other conditions that present similar signs and symptoms. This may include:

• Cellulitis
• Cutaneous vasculitis
• Erythema nodosum
• Morphea (localized scleroderma)
• Necrobiosis lipoidica

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lipodermatosclerosis?

The complications of Lipodermatosclerosis may include:

• Emotional stress and cosmetic issues
• Superimposed bacterial and fungal skin infections
• Severe pain
• Difficulty in standing or walking
• Extensive scarring
• Poor wound healing
• Chronic leg ulcers that may be resistant to therapy
• Recurrence of the condition

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Lipodermatosclerosis Treated?

The treatment for Lipodermatosclerosis may include the following measures:

• Treating the underlying conditions, including considering weight loss in case of obesity
• Use of compression stockings, including elevation of legs. These can be helpful, but the pain may make compliance understandably poor
• Administration of pain and anti-inflammatory medication; symptomatic treatment such as antibiotic therapy
• Oral pentoxifylline to make red blood cells more flexible and able to migrate through compressed capillaries
• Topical steroids and emollients (moisturizers)
• Intralesional steroid injections
• The anabolic steroids, danazol or oxandrolone, can be effective in some cases
• Blood clotting medications
• Phototherapy using ultraviolet radiation
• Surgical procedures that may include
  • Sclerotherapy
  • Venous surgery
  • Endovenous laser ablation

How can Lipodermatosclerosis be Prevented?

The exact cause of Lipodermatosclerosis is not known, and therefore, no methods or guidelines are available for its prevention.

• However, identifying and addressing certain risk factors, such as obesity and hypertension, and venous hypertension affecting the leg veins, may decrease the severity of signs and symptoms, and delay progression of the condition
• Avoiding standing for long periods frequently is also important
• Regular medical screening at periodic intervals with tests and physical examinations are recommended

What is the Prognosis of Lipodermatosclerosis? (Outcomes/Resolutions)

• The prognosis of Lipodermatosclerosis is dependent upon the severity of the signs and symptoms and associated complications, and of the underlying condition it is associated with
• Individuals with mild conditions have better prognosis than those with severe symptoms and complications. The prognosis may be assessed on a case-by-case basis

Additional and Relevant Useful Information for Lipodermatosclerosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/