Lipodermatosclerosis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Lipodermatosclerosis is a chronic skin inflammatory condition. Lipodermatosclerosis is most typically found in individuals with underlying poor leg circulation. It is often noticed in women.

The etiology of lipodermatosclerosis is unknown, and it is suggested that venous hypertension could be the causative factor. Sometimes, lipodermatosclerosis could be misdiagnosed as cellulitis based on clinical examination. Mainly, lipodermatosclerosis does not require a skin biopsy. The treatment of lipodermatosclerosis is done primarily to manage symptoms.

What Is Lipodermatosclerosis?

Lipodermatosclerosis is a chronic skin condition characterized by subcutaneous fat inflammation associated with chronic venous insufficiency. Lipodermatosclerosis is commonly seen on the inner aspect of the lower leg above the ankle. Lipodermatosclerosis is typed into acute and chronic phases. The acute phase presents pain, redness, warmth, and tenderness clinically. The chronic, fibrotic phase shows reddish-brown to violet-brown discoloration with firmness and skin atrophy, often seeming as an inverted “champagne bottle.” Other synonyms of lipodermatosclerosis are sclerosing panniculitis and hypodermitis sclerodermiformis.

What Are the Causes of Lipodermatosclerosis?

Lipodermatosclerosis is common, involving middle-aged or older adults. However, it is more typical in women and is associated with immobility, an individual with a high body mass index (BMI), and an obese person. It results from underlying venous insufficiency.

• Venous valve incompetency.

• Obstruction in the venous outflow.

• Calf muscle pump dysfunction.

Venous hypertension increases leukocytes within the veins, migrating into the surrounding tissue. The leukocytes get activated, drawing and releasing proinflammatory cells and cytokines. Then, it induces a chronic inflammatory condition. In addition, increased collagen production causes the fibrosis of subcutaneous fat. The exact reason is unknown, but evidence indicates that venous hypertension resulting in raised capillary permeability leads to fibrinogen leakage and white blood cells into the dermis. The fibrinogen assembles fibrin and cuffs around capillaries, which impedes oxygen exchange. This process eventually causes hypoxia, resulting in venous ulceration. Some other risk factors of lipodermatosclerosis are also present. The risk factors of lipodermatosclerosis are mentioned below.

• Age.

• Immobility.

• Obesity.

• Smoking.

• Family history.

• History of deep vein thrombosis.

• Trauma to the venous system.

What Are the Symptoms of Lipodermatosclerosis?

Lipodermatosclerosis is typed into acute and chronic phases. Chronic inflammatory state and fibrosis in lipodermatosclerosis are associated with poor wound healing resulting in venous ulcers, and may be challenging to treat. The symptoms of both phases of lipodermatosclerosis are mentioned below.

Symptoms in the Acute Phase of Lipodermatosclerosis

The symptoms of acute lipodermatosclerosis may imitate cellulitis. The skin features of acute lipodermatosclerosis are mentioned below,

• Induration.

• Erythema is called redness.

• Pain.

• Itch.

• Aching.

• The feeling of swelling.

• Heaviness in one or, more often, both lower limbs.

• Localized single plaque.

• Widespread.

• Commonly involved areas are the pretibial or medial aspect of the leg.

Symptoms in the Chronic Phase of Lipodermatosclerosis.

The chronic phase of lipodermatosclerosis is mentioned below.

• Induration.

• Erythema.

• Pain continues in the chronic phase of lipodermatosclerosis.

• Subcutaneous fibrosis.

• Leg resembles an upside-down champagne bottle.

• Hyperpigmentation of the skin due to hemosiderin deposition.

• Atrophie blanche.

• Varicose veins.

• Venous eczema.

• Venous ulcers.

How to Diagnose Lipodermatosclerosis?

Lipodermatosclerosis is usually diagnosed with clinical examination. However, underlying venous insufficiency may be confirmed using Doppler studies. A biopsy is helpful but should be executed cautiously because of the possibility of poor wound healing. The typical features are dependent on the phase of the disease and subcutaneous lobular and septal differences, including:

• Necrosis of adipocytes.

• Formation of the pseudocyst.

• Lipomembranous or fatty tissue change.

• Collection of macrophages.

• A nodule of inflamed fat cells around a foreign body forming lipogranulomas.

• Iron deposition.

Sometimes the symptoms of lipodermatosclerosis are misdiagnosed with cellulitis and morphea. The other differential diagnosis of lipodermatosclerosis is mentioned below.

Differential diagnoses for lipodermatosclerosis can include:

• Cellulitis: Cellulitis is a typical bacterial skin infection with redness, swelling, and pain in the skin. In severe cases, it can spread and cause serious health problems. Therefore, adequate wound care and hygiene are essential to prevent cellulitis.

• Erythema Nodosum: Erythema nodosum is represented by tender, red bumps, usually found symmetrically; it is a symptom of some other infection, disease, or drug sensitivity.

• Other Causes of Panniculitis: A group of disorders characterized by subcutaneous adipose tissue inflammation (the fatty layer beneath the skin - panniculus adiposus).

• Morphoea (localized Scleroderma): Morphea, or localized scleroderma, is a rare fibrous disease characterized by inflamed fibrous skin due to increased collagen deposition. As a result, normal skin texture is lost and shows a shiny appearance. Morphea can affect the skin, subcutaneous fat, deep fascia, underlying muscle, and bone. It is observed that females are affected more than males. Morphea is estimated with a high incidence rate among children.

• Cutaneous Vasculitis: Cutaneous vasculitis is a group of skin illnesses characterized by inflamed blood vessels. Capillaries, venules, arterioles, and lymphatics are examples of these.

What Is the Treatment for Lipodermatosclerosis?

The treatment is primarily done to manage the symptoms. The following are the various treatment modes of lipodermatosclerosis.

• General measures.

• Compression therapy.

• Medical therapy.

• Surgical therapy.

General Measures:

• Increased physical activity such as walking.

• Weight reduction.

Compression Therapy:

• Compression stockings or socks promote venous return and help with symptom control.

• Leg elevation can aid in reducing edema and pain.

Medical Therapy:

• For pain relief, Stanozolol has also been shown to reduce dermal thickness.

• Pentoxifylline is useful in venous ulcers in addition to compression.

• Combination therapy with Hydroxychloroquine.

• Intralesional steroid injection of Triamcinolone has been confirmed to alleviate symptoms.

• Tetracyclines, such as Doxycycline or Minocycline, can also be administered.

• Phlebotonic drugs may reduce edema and other symptoms, including Diosmin, Hydroxyethylrutoside, or horse chestnut seed extract (escin).

• Ultrasound therapy relieves erythema, hardness, and pain.

• Ultraviolet radiation (UVA1) therapy.

• Emollients and topical steroids help treat venous eczema.

Surgical Therapy:

• Endovenous ablation by laser.

• Sclerotherapy.

• Vein surgery.

What Is the Prognosis of Lipodermatosclerosis?

Venous insufficiency is a disorder that worsens over time. Although treatment can alleviate symptoms and reduce progression, related disorders such as lipodermatosclerosis are typically chronic and recurring.

Conclusion:

Lipodermatosclerosis is a chronic inflammatory condition, one type of panniculitis, characterized by inflamed fat under the skin. Lipodermatosclerosis commonly affects older people, and females are highly susceptible to males. Symptoms are acute and chronic and often mimic cellulitis. Correct diagnosis is made with clinical examination, and treatment is done to manage the symptoms.