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lipodermatosclerosis

Etiology: - chronic venous insufficiency, stasis dermatitis - lymphedema Pathology: - capillary proliferation - fat necrosis - fibrosis of cutaneous & subcutaneous tissues Clinical manifestations: - skin becomes reddish or brown because of hemosiderin deposition - induration from fibrosis -> non-pitting, indurated skin - painful, red-brown, atrophic nodules of adipose tissue - indurated hyperpigmentation, may appear 'woody' in appearance & to palpation - erythema is present [2] - telangiectasias, varicosities, venous ulcers, & atrophie blanche may be present [2] - frequently bilateral [2] - legs may have an inverted bottle shape * images [3,4,9] Differential diagnosis: - stasis dermatitis - pitting edema favors stasis dermatitis over lipodermatosclerosis, especially in the absence of significant induration or fibrosis [6-9] Management: - for localized masses, (i.e. abdomen, thighs, upper arms) surgical resection has met some success

General

sclerosis

References

  1. Brown KE eMedicine: Chronic venous insufficiency http://emedicine.medscape.com/article/461449-overview
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 18. American College of Physicians, Philadelphia 2009, 2018. - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  3. DermNet NZ. Lipodermatosclerosis (images) http://www.dermnetnz.org/vascular/lipodermatosclerosis.html
  4. Rashid RM, Barros BS (image) Hidden Heart Disease: 19 Dermatologic Clues You Should Know. Medscape. June 13, 2017. http://reference.medscape.com/slideshow/hidden-heart-disease-6004452
  5. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Bruce AJ, Bennett DD, Lohse CM, Rooke TW, Davis MD. Lipodermatosclerosis: review of cases evaluated at Mayo Clinic. J Am Acad Dermatol. 2002 Feb;46(2):187-92. PMID: 11807428
  7. Choonhakarn C, Chaowattanapanit S, Julanon N. Lipodermatosclerosis: a clinicopathologic correlation. Int J Dermatol. 2016 Mar;55(3):303-8. PMID: 26275890
  8. Walsh SN, Santa Cruz DJ. Lipodermatosclerosis: a clinicopathological study of 25 cases. J Am Acad Dermatol. 2010 Jun;62(6):1005-12. PMID: 20466175
  9. Vivas A, Lev-Tov H, Kirsner RS. Venous Leg Ulcers. Ann Intern Med. 2016 Aug 2;165(3):ITC17-ITC32. PMID: 27479227 Review https://www.acpjournals.org/doi/10.7326/AITC201608020