The pathogenesis of lipodermatosclerosis: facts, uncertainties and theories

Lipodermatosclerosis is the accepted term for describing induration of the skin and subcutaneous layers of the legs in patients with venous insufficiency. The pathogenic processes leading from venous insufficiency to lipodermatosclerosis are poorly understood. Based on their clinico-pathological studies of different subcutaneous indurative disorders, the authors suggest that lipodermatosclerosis exhibits similarities to eosinophilic fasciitis and other fasciitis-panniculitis syndromes. The theories of the pathogenesis of lipodermatosclerosis are reviewed and a unifying pathogenetic concept is proposed. The underlying principle of all theories is that there is regional micro-angiopathy secondary to severe venous hypertension. Lipodermatosclerosis is best conceived as a fasciitis-panniculitis reaction evolving in the calf of the patient with venous insufficiency.