Lipodermatosclerosis
Wang L. Cheung, MD, PhD
Key Facts
Terminology
Sclerosing panniculitis, membranous lipodystrophy, sclerodermiform hypodermitis
Clinical Issues
Acute phase: Extremely painful, violaceous plaques in lower legs
Chronic phase: Hyperpigmented induration with contracted skin
Microscopic Pathology
Early lesion: Nonspecific showing septal and lobular panniculitis
Cysts of fat showing eosinophilic material (PAS positive) in arabesque pattern
Top Differential Diagnoses
Cellulitis
Subcutaneous fat necrosis of newborn
Factitial panniculitis
 End-stage lipodermatosclerosis in this patient shows “inverted wine bottle” deformity and distal, shrunken, indurated lower extremities. |
 Low-power view of LDS demonstrates distinct eosinophilic material  (feathery or arabesque pattern) in fatty cystic degeneration. |
TERMINOLOGY
Abbreviations
Lipodermatosclerosis (LDS)
Synonyms
Sclerosing panniculitis, membranous lipodystrophy, sclerodermiform hypodermitis
Definitions
Venous insufficiency leading to skin induration and ulceration
ETIOLOGY/PATHOGENESIS
Probably Venous Disease Leading to Skin Ulceration
Some association with obesity, hypercoagulable state (protein C and S deficiencies)
Some association with connective tissue disease
Excessive matrix metalloproteinases (MMP) activity
CLINICAL ISSUES
