Lipodermatosklerose

Lipodermatosklerose, also known as lipodermatosclerosis, is a chronic inflammatory condition of the skin and subcutaneous tissue that arises in the setting of venous hypertension and long-standing venous insufficiency. It involves fibrosis of the dermis and subcutaneous fat with hemosiderin deposition and is most commonly seen on the lower legs, particularly the medial aspect, in people with varicose veins, obesity, or chronic edema.

Clinically, lipodermatosklerose often has two phases. The acute inflammatory phase presents with redness, warmth, tenderness, and swelling of the leg, sometimes mimicking cellulitis. The chronic phase features indurated, tight, and hyperpigmented skin with fat pad fibrosis that can give a tapering “inverted champagne bottle” appearance of the lower leg. Ulcers may develop at the medial malleolus and surrounding skin changes are common.

Diagnosis is typically clinical, supported by duplex ultrasonography to assess venous reflux or obstruction and to exclude other causes such as cellulitis or deep venous thrombosis. A skin biopsy is not routinely required but may be performed if the diagnosis is uncertain or to exclude alternative conditions.

Management focuses on correcting venous hypertension and protecting the skin. Compression therapy is the mainstay, combined with leg elevation and skin care to prevent dermatitis. Wound care is essential for ulcers. Weight management and treatment of underlying venous disease (such as endovenous ablation or surgery for reflux) may help. The condition is chronic and recurrent, but symptoms improve with appropriate compression and venous treatment. Possible complications include venous ulcers, infection, and persistent edema.