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Lipodermatosclerosis (LDS) is a form of chronic panniculitis associated with chronic venous insufficiency (CVI). It represents inflammation and fibrosis of the skin and subcutaneous fat of the lower leg, typically affecting the medial ankle and lower calf.

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Pathophysiology

Caused by chronic venous hypertension, usually due to incompetent venous valves or deep venous obstruction.
Leads to:
- Capillary leak, leukocyte activation
- Fibrin cuff formation
- Dermal fibrosis and fat necrosis
- Progressive induration and inverted champagne bottle deformity

Clinical Features

Feature	Description
Location	Medial lower leg above the ankle
Skin Changes	Induration, hyperpigmentation (hemosiderin), scaling
Texture	Hardened, woody, bound-down skin
Shape	Inverted champagne bottle appearance due to distal constriction
Symptoms	Pain, tightness, and tenderness
Chronic Phase	Risk of venous ulceration, often in the gaiter area

Phases of lipodermatosclerosis:

Phase	Description
Acute	Painful, erythematous swelling; may mimic cellulitis
Chronic	Fibrosis, induration, pigmentation, and atrophy of the skin and fat

Complications

Venous leg ulcers (VLUs)
Secondary infection (e.g., cellulitis)
Severe scarring
Functional limitation due to skin rigidity

Pathophysiology

Clinical Features

Complications

Radiology