Anyone with lipodermatosclerosis knows how painful this condition can be. Some patients are not candidates for definitive vein treatments because of existing health problems. Fortunately, conservative treatments can bring significant relief from the pain and discomfort of lipodermatosclerosis.
What Is Lipodermatosclerosis?
Lipodermatosclerosis is a condition of the skin affecting the lower legs. It involves the formation of hardened, tight, red skin above the ankles.
This condition is a form of panniculitis (inflammation of the fat layer under the skin). It is also known as “sclerosing panniculitis.” “Sclerosing” means causing or characterized by sclerosis, a pathological hardening of the tissue.
Essentially, lipodermatosclerosis is an inflammation of the subcutaneous fat. It often affects people with venous insufficiency, a condition in which the flow of blood through the veins is inadequate, which causes blood to pool in the legs.
What Are the Symptoms of Lipodermatosclerosis?
One or both legs may be affected by lipodermatosclerosis. It is often a gradual process that occurs slowly over a span of years. Signs and symptoms may include:
- Thickening and/or hardening of the skin
- Varicose veins
- Small areas of white, scarred skin (known as atrophie blanche)
- Leg ulcers (breaks in the skin that allow bacteria into the underlying tissues)
- Tapering of the legs above the ankles (similar to a bowling pin)
What Causes Lipodermatosclerosis?
The exact cause of this condition is unknown. However, it may be related to certain vein abnormalities and/or obesity. This condition can be associated with raised pressure in the legs (venous hypertension) and with leaky valves in the veins (venous incompetence). Approximately two-thirds of individuals with lipodermatosclerosis suffer with obesity.
Although the exact mechanisms are not fully understood, it is known that lipodermatosclerosis is mainly caused by an excess of pressure in the veins of the lower legs. This high pressure is usually the result of standing or walking for long periods of time, or an unproductive calf muscle pump.
What Is the Calf Muscle Pump?
The calf muscle pump is often referred to as the secondary heart of the body. It only takes one heartbeat to pump oxygen-rich blood from the heart to the lower legs and feet. However, it takes several heartbeats to get the blood back up from the feet and lower legs to the heart.
This is where the calf muscle pump comes in. When it is active and functioning effectively, it helps propel the blood back to the heart.
However, the calf muscle pump only works when the leg is active, with optimal function during regular walking exercise. When the leg is at rest, the calf muscle pump shuts down and blood circulation is significantly reduced.
What Conservative Treatments Are Available for Lipodermatosclerosis?
Conservative treatments are measures patients can take that do not involve any medical procedures. They may be the only treatment available for patients who should not undergo surgery due to some risk associated with overall health condition.
As lipodermatosclerosis is a progressive condition, these treatments are also recommended for patients who have undergone medical procedures for this disease. Conservative treatments for lipodermatosclerosis include:
Walking or Other Cardiovascular Exercise for the Legs
Regular exercise such as walking or swimming is recommended for individuals with vein problems or advancing lipodermatosclerosis. This type of exercise tones the lower leg muscles, resulting in more effective functioning of the calf muscle pump.
When muscle tone is not good in the lower legs, blood can accumulate, increasing venous pressure. Regular exercise can help relieve pressure in the veins of the lower legs along with painful or uncomfortable lipodermatosclerosis symptoms.
Avoiding Prolonged Sitting or Standing
Sitting or standing for long periods of time can cause blood to pool in the veins of the legs. This increases the pressure in the veins, which can weaken the walls and damage the valves. If your job requires you to sit or stand for extended periods of time, take a 5-minute walk every 30 to 40 minutes to lower pressure in the veins and provide pain relief for lipodermatosclerosis.
Elevating the Legs
Placing the legs in an elevated position helps promote normal blood circulation in the legs. This can lead to significant improvement of swelling and symptoms. Try to keep your legs elevated above your hips as often as possible during the day. Sleep with a pillow under your feet to elevate your legs above your hips.
Wearing Compression Hose
Compression therapy is the number one treatment for lipodermatosclerosis. The best way to apply external pressure is graded compression elastic stockings. These garments apply greater pressure at the ankles, lighter pressure at the calves, and even lighter pressure at the thighs.
There are many different types of compression stockings. They can vary according to length, texture, and pressure applied at the ankles. Your doctor can recommend the right compression hose in your individual case to achieve the best results without creating a negative impact on your quality of life.
Maintaining a Normal Weight
Lipodermatosclerosis can be associated with excess weight. A large percentage of patients with this condition suffer with obesity. Significant weight loss can be an effective, non-surgical treatment to help relieve the pain and discomfort of lipodermatosclerosis.
Types of Lipodermatosclerosis
One or both of your legs may be affected by lipodermatosclerosis. This condition can be either acute or chronic.
Chronic lipodermatosclerosis develops gradually over time. Symptoms include pain, edema (watery fluid collecting in the tissues), localized thickening of the skin, varicose veins, and leg ulcers.
Acute lipodermatosclerosis occurs without any preceding illness or injury to the area. This form of lipodermatosclerosis mostly affects people who have reached middle-age. It resembles cellulitis (inflammation of subcutaneous connective tissue) and involves painful inflammation in the inner leg above the ankle. The affected area is red, scaly, and tender.
How Is Lipodermatosclerosis Diagnosed?
Lipodermatosclerosis is typically diagnosed clinically and based on patient history. It may be helpful to establish how skin changes have evolved and how the appearance of the lower legs has changed. Hardening of the skin, hyperpigmentation, edema, and an inverted champagne bottle appearance of the lower leg are symptoms that suggest lipodermatosclerosis.
Clinical diagnosis may involve a biopsy. Magnetic resonance imaging (MRI) and ultrasound technology may be used to determine the extent of the condition. Certain changes affecting the subcutaneous fat may indicate the phase of the disease:
- Early lesions reveal white blood cell infiltration and spots of tissue death within the fibrous tissue separating the fat.
- Intermediate lesions reveal new fibrous tissue in the fat and infiltration of white blood cells.
- Late lesions reveal obvious fibrosis (thickening and scarring of connective tissue) in the fibrous tissue separating the fat. Changes in the dermis (the deeper layer of skin) at this stage may include inflammation, atrophy, increased fibrous cells, and twisted veins with thick walls.
Who Is a Good Candidate for Conservative Lipodermatosclerosis Treatment?
Due to certain health conditions, some patients will not be good candidates for vein surgery or definitive treatments. In such cases, conservative treatments are the only treatment option for some patients with lipodermatosclerosis.
Insurance companies often require documentation of conservative treatments in the patient’s medical record before authorizing definitive treatment such as vein surgery. Even after a patient receives definitive treatment, exercise, maintaining a healthy weight, and wearing compression hose during travel or periods of immobility can help maintain vein health.
See a Vein Doctor for Lipodermatosclerosis Treatment
For patients suffering with lipodermatosclerosis, it is important to see a physician who has extensive knowledge and experience in this area. At South Texas Vein Institute, our practice is dedicated to the treatment of veins.
In addition to conservative treatment for vein problems and lipodermatosclerosis, we deliver medical services that include:
- Sclerotherapy: A minimally-invasive treatment that involves injecting varicose veins with a product that causes chemical irritation on the inside of the vein, causing it to collapse.
- Radiofrequency Ablation (RFA): An alternative, minimally-invasive method for treating varicose veins using radiofrequency heat energy to destroy the vein.
- Endovenous Laser Ablation: Minimally-invasive, in-office treatment involving a laser fiber inserted directly into the vein, causing it to collapse, shrink, and eventually disappear.
- Laser Treatment: ELVeS® laser treatment for varicose veins is a popular treatment option for maximum patient comfort and excellent cosmetic and medical results.
Each patient we treat receives quality, personalized care. After an in-depth consultation and careful evaluation, our highly-trained vein doctor can custom-tailor a lipodermatosclerosis and vein treatment plan consisting of the right combination of conservative and definitive treatments to bring relief in your individual case.