Lipodermatosclerosis Diagnosis and Treatment in London

Understanding Lipodermatosclerosis

Lipodermatosclerosis is a long-term inflammatory condition that affects the skin and subcutaneous tissue of the lower legs. It is strongly associated with chronic venous insufficiency (CVI) and varicose veins, where faulty vein valves impair blood return to the heart, causing venous hypertension. Over time, this leads to tissue fibrosis, hardening of the skin, and chronic inflammation.

The condition is sometimes misdiagnosed as cellulitis due to its red, inflamed appearance. Unlike cellulitis, lipodermatosclerosis is not an infection but a consequence of vascular changes.

Causes and Risk Factors

The root cause is venous hypertension caused by:

• Faulty venous valves
• Previous deep vein thrombosis (DVT)
• Varicose veins
• Obesity and reduced mobility
• Prolonged standing occupations

Other contributing factors include smoking, genetic predisposition, and poorly managed hypertension.

Symptoms of Lipodermatosclerosis

The condition develops gradually and is characterised by:

• Pain and tenderness: Aching or throbbing in the lower legs
• Red to brown discolouration: Hyperpigmentation due to hemosiderin deposition
• Skin hardening: Thickened, woody texture of the calves
• Leg contour changes: Narrowing above the ankles producing an “inverted champagne bottle” shape
• Restricted mobility: Skin tightening reduces ankle flexibility

Lipodermatosclerosis Diagnosis

A dermatologist or vascular specialist will examine the skin and assess risk factors. Duplex ultrasound is commonly used to confirm venous insufficiency. Biopsy is rarely needed but may help differentiate it from panniculitis or cellulitis in atypical cases.

Lipodermatosclerosis Treatment Options

Management focuses on reducing venous hypertension and controlling inflammation. Treatment may include:

• Compression therapy: Medical-grade compression stockings improve blood return and reduce swelling.
• Leg elevation: Raising legs above heart level helps relieve venous pressure.
• Exercise and mobility: Regular walking improves circulation.
• Topical treatments: Corticosteroid creams may relieve skin inflammation and tenderness.
• Systemic therapy: In some cases, medications like pentoxifylline or aspirin may be prescribed.
• Vein treatments: Endovenous ablation, sclerotherapy, or surgery for severe venous disease.

Living with Lipodermatosclerosis

With proper treatment, symptoms can be controlled and progression slowed. Patients are encouraged to maintain a healthy weight, avoid prolonged standing, and wear compression daily. Without intervention, complications such as venous ulcers and chronic pain may develop.

Your first visit — what to expect

1. History taking: Assessment of symptoms, lifestyle, and risk factors.
2. Physical examination: Skin inspection and palpation to check for thickening and pigmentation.
3. Vascular studies: Duplex ultrasound to assess venous flow and valve function.
4. Management plan: Individualised recommendations including compression, lifestyle changes, and possible vascular referral.
5. Prevention advice: Guidance on weight control, exercise, and skin care.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025