A 46-Year-Old Woman with a Painful, Erythematous Plaque on Her Leg

Differential Diagnosis

• Lipodermatosclerosis
• Cellulitis
• Erythema nodosum
• Necrobiosis lipoidica

Diagnosis

This patient was diagnosed with lipodermatosclerosis, also known as lipomembranous panniculitis, sclerosing panniculitis, venous liposclerosis, and hypodermitis sclerodermiformis. This is an inflammation of subcutaneous fat, usually on the lower extremities, secondary to chronic venous insufficiency. 

Learnings/What to Look for

• Lipodermatosclerosis is classified as acute if present for less than 1 month and appears as a localized, exquisitely tender, erythematous, indurated plaque
• Subacute lipodermatosclerosis (present for 1 month to 1 year) and chronic lipodermatosclerosis (more than 1 year) appear as a nontender, hyperpigmented, sclerotic plaque which can contain venous ulcers
• Advanced lipodermatosclerosis on the lower leg has the appearance of an “inverted champagne bottle,” whereby the proximal leg is edematous from chronic venous stasis while the lower portion of the leg is atrophied and sclerotic from fat necrosis (or lipodystrophy) and scarred from chronic ulcerations

Pearls for Urgent Care Management

• First-line treatment for lipodermatosclerosis is compression therapy to improve venous insufficiency
• Anticlotting medications, weight loss in obese patients, and elevation are helpful for venous insufficiency in general
• Surgery may be required for persistent cases

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/jucm).