ABC of Vascular Disease

Lipodermatosclerosis (LDS)

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Lipodermatosclerosis (LDS) is a condition that affects the skin just above the ankle in patients with long-standing venous disease resulting in chronic venous insufficiency. LDS literally means "scarring of the skin and fat" and is a slow process that occurs over a number of years.  LDS affects the skin just above the ankle, usually on the inside surface.  Over time the skin becomes brown, smooth, tight and often painful.  The precise mechanism of LDS is not fully understood, but the root cause is known.  LDS is caused by an excessively high venous pressure in the subcutaneous veins in the lower leg.  This high venous pressure is the result of two things

  1. The upright posture

  2. An inefficient calf muscle pump

LDS is a warning sign!! 
Unless the underlying cause of the LDS is treated then the patient is at high risk of developing a painful and potentially chronic  venous leg ulcer.  Once LDS is established, the skin has been permanently and irreversibly damaged and treatment at that stage can only hope to prevent progression of the LDS to an open leg ulcer.  A patient with LDS warrants referral to a vascular surgical clinic for full assessment of the venous system.

Treatment of LDS
The mainstay of treatment of LDS is the use of compression socks.  These are designed to exert a greater pressure on the skin at the ankle and less pressure on the calf.  The pressure exerted by the socks helps to counteract the excess pressure in the veins that is the result of standing and walking.  However, the compression socks do not cure the underlying problem and once prescribed they normally have to be worn for life.
  If the LDS is partially or wholly the result of severe varicose veins then surgery to remove the abnormal veins does at least offer the potential for cure.

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S.R.Dodds 2001

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