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Lipodermatosclerosis refers to a skin change of the lower legs that often occurs in patients who have venous insufficiency. It is a type of panniculitis (inflammation of subcutaneous fat). Two-thirds of affected patients are obese. Affected legs typically have the following characteristics:

- Skin induration (hardening)

- Increased pigmentation

- Swelling

- Redness

- “Inverted champagne bottle” or “bowling pin” appearance

Lipodermatosclerosis has also been called hypodermitis sclerodermiformis and sclerosing panniculitis.

The lower inner leg of one or both legs may be involved. Lipodermatosclerosis may present as an acute or as a chronic (longstanding) condition.

Acute lipodermatosclerosis generally occurs without any preceding illness or local injury. It presents as episodes of painful inflammation in the inner leg above the ankle, resembling cellulitis. The affected area is red, tender and warm, and may be scaly. Some thickening of the skin can be felt but this is not sharply demarcated as in chronic lipodermatosclerosis.

Patients with acute lipodermatosclerosis are mainly middle-aged.

Chronic lipodermatosclerosis may follow an acute episode or develop gradually. Common findings in chronic lipodermatosclerosis include:

- Pain
- Hardening of the skin
- Localised thickening
- Moderate redness
- Increased pigmentation
- Small white scarred areas (atrophie blanche)
- Increased fluid in the leg (oedema)
- Varicose veins
- Leg ulcers

Chronic lipodermatosclerosis also predisposes to venous or stasis eczema.

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