Lipodermatosclerosis is a medical condition that affects the lower legs between ankle and calf muscle. This area of the leg is classically called the “gaiter” area, as it is the position where bishops used to wear gaiters on their lower legs. It is basically an inflammation of the skin and subcutaneous tissues of the lower leg.
The skin becomes discoloured due to inflammation. It can be pink or red when there is active inflammation, or a light or dark brown colour (haemosiderin) if the condition has been present for longer.
The underlying tissue becomes harder due to the inflammation.
The word lipodermatosclerosis is very descriptive of the condition.
“Lipo” means fat, “Dermato” means skin and “Sclerosis” means hardening. Hence lipodermatosclerosis literally means a hardening of the skin and underlying fat. These changes occur due to inflammation.
The most common cause of lipodermatosclerosis is venous reflux due to varicose veins or “hidden varicose veins“. In the past these have been called various things such as “SVI” (superficial venous incompetence), “CVI” (chronic venous incompetence) or “SVR” (superficial venous reflux). However, since writing the book “Understanding Venous Reflux – the cause of varicose veins and venous leg ulcers” Mark Whiteley has advocated the use of “varicose veins” and “hidden varicose veins” as this more obvious to the public and medical professionals.
The constant reflux of blood falling down varicose veins or hidden varicose veins causes inflammation just above the ankle. If a reflux is not treated (i.e. the varicose veins are not treated) then over time the inflammation increases. Slowly this increases the damage. The skin and subcutaneous fat around the ankle.
This can manifest in several different ways, but one of the commonest is lipodermatosclerosis.
If the lipodermatosclerosis (LDS) is left untreated, then the inflammation in the lower leg continues to increase. In some patients, this causes the skin and tissue of the lower leg between calf and ankle to get harder and tighter. The calf muscle often expands above this constriction. This then it looks like an inverted champagne bottle.
Hence, “champagne bottle leg” is representative of severe lipodermatosclerosis (LDS). It shows a progression towards venous leg ulceration.
Yes. Lipodermatosclerosis (LDS) constitutes skin damage due to the varicose veins and hidden varicose veins. Therefore, it is classified as CEAP C4. Failure to treat it allows progression to venous leg ulceration CEAP C6.
Patients with lipodermatosclerosis (LDS) should be referred for a venous duplex ultrasound scan and treatment of their veins by the NICE clinical guidelines CG 168.
The best way to treat lipodermatosclerosis (LDS) is to treat the underlying venous reflux. This means treatment of the varicose veins or “hidden varicose veins”. These may be refluxing saphenous veins, incompetent perforating veins or pelvic veins.
Treatment is usually by endovenous surgery to the saphenous veins, TRLOP closure to incompetent perforators and rarely, embolisation of pelvic veins. It is rare for pelvic veins to cause lipodermatosclerosis (LDS) although we have seen it.
As with varicose veins and leg ulcers, compression stockings do not replace curative endovenous surgery. They should only be used on patients who are awaiting assessment or surgery, or as part of the treatment after foam sclerotherapy, or in patients who have been fully investigated and found to have incurable venous disease. Fortunately these days such patients are rare provided they have been investigated by a specialist unit such as The Whiteley Clinic.