Lipodermatosclerosis

Lipodermatosclerosis is a long-term (chronic) skin condition that affects your legs. It develops when high pressure in leg veins over time causes inflammation in your underlying skin and fat. This causes swelling, pain, skin discoloration and fat hardening. 

It’s a type of panniculitis. Panniculitis means inflammation of the fat beneath your skin.

Treatment focuses on improving blood flow and reducing pressure in your legs.

Types of lipodermatosclerosis

There are two types based on when symptoms occur:

• Acute: Symptoms occur suddenly with discoloration, warmth and pain. It usually affects your inner leg. It may look like an infection and is often tender to the touch. Symptoms may come and go (wax and wane).
• Chronic: Your skin becomes tight, thick, firm and dark in color. Pain may persist. Your leg may narrow near your ankle with swelling above it.

Lipodermatosclerosis symptoms

There is a range of skin and leg changes that can worsen over time, including:

• Dry, itchy or flaky skin
• Pain in your legs (burning or aching), especially when standing or walking for long periods
• Skin discoloration (darker than your natural tone, red, purple or brown)
• Skin thickening that feels firm and hard to the touch
• Swelling around your ankles and calves

As the condition progresses, the underlying fat in your skin hardens. Your legs may start to change shape. The area near your ankle can narrow while your foot and upper calf stay swollen. This gives your legs a look often described as a “champagne bottle.”

Lipodermatosclerosis causes

This condition follows long-term venous (vein) insufficiency in your legs, often from chronic venous insufficiency. This means your veins have trouble sending blood up to your heart.

Normally, veins have small valves that keep blood moving in the right direction. When these valves weaken, blood can pool in your legs. This raises pressure in your veins and allows fluid and blood cells to leak into nearby tissue. Over time, inflammation occurs with skin damage and hardening of the fat under your skin.

Risk factors

Several factors contribute to this condition, like:

• A biological family history of vein problems
• A past blood clot in the leg (deep vein thrombosis)
• Having overweight or obesity
• Limited ankle movement or little leg activity
• Sitting or standing for long periods
• Smoking

Complications

Complications may develop over time, especially if blood flow is compromised or sluggish. These include:

• Ulcers: Your skin can break down and form open sores and ulcers, especially around your ankles. These ulcers may heal slowly and can come back (recur).
• Poor wound healing: As your skin and tissue are thick and inflamed, even small cuts or scratches produce chronic wounds.
• Infection risk: Open sores and slow-healing wounds increase the likelihood of infections.
• Chronic leg pain: Pain may be severe initially, then long-lasting, aching pain as the condition progresses.

How doctors diagnose lipodermatosclerosis

A healthcare provider can usually diagnose this condition after reviewing your symptoms during a physical exam. They’ll review your medical history, especially problems with leg swelling or long-term vein issues. Your provider may order an ultrasound of your leg veins to check blood flow, valve problems or signs of past blood clots.

In most cases, the diagnosis is straightforward. A biopsy usually isn’t necessary.

Lipodermatosclerosis treatment

There isn’t a cure for this condition. But treatment focuses on improving blood flow in your legs, reducing swelling and pain, and preventing skin damage. Your healthcare provider might recommend:

• Compression therapy: Wearing compression stockings helps blood move back up your legs. This helps reduce swelling, pain and pressure in your veins.
• Leg elevation: Raising your legs above heart level when resting helps reduce swelling and pressure.
• Topical steroid creams: Steroid creams, and in some cases, short courses of an oral steroid, may reduce discoloration, pain and inflammation during painful flare-ups.
• Pain management: Treating pain may improve comfort and mobility, which supports healing.
• Regular walking and physical activity: Moving your legs may help your calf muscles pump blood back to your heart.
• Vein-focused care: Treating underlying vein conditions, like varicose veins, may improve long-term outcomes.

When should I see my healthcare provider?

See a healthcare provider if any of the following occur:

• New or worsening skin changes to your leg
• Open sores or signs of infection (drainage, discoloration, fever)
• Symptoms that aren’t getting better

Even when symptoms are stable, regular check-ups are essential to monitor the condition.

What can I expect if I have lipodermatosclerosis?

This is a long-term condition that usually persists at least to some degree. Long-term, ongoing care is essential, like wearing compression stockings, elevating your legs and staying active.

With treatment, pain and swelling often improve, and skin damage may decrease. Some skin changes, like hardening or skin discoloration, may stick around.

Your healthcare provider can help explain what to expect, as care and symptoms can vary from person to person.

Can lipodermatosclerosis be prevented?

Prevention is difficult. But certain measures may help, including:

• Avoiding smoking
• Staying active and maintaining a weight that’s healthy for you
• Treating vein conditions early
• Watching for early skin changes