Lipodermatosclerosis: from pathophysiology to treatment

Abstract

Lipodermatosclerosis (LDS), also known as sclerosing panniculitis, is a chronic inflammatory condition of the skin and subcutaneous tissue caused by longstanding venous insufficiency. Often misdiagnosed as cellulitis due to overlapping clinical features, it requires accurate diagnosis and a multifaceted management approach. This clinical review explores the epidemiology, pathophysiology, clinical presentation, diagnostic challenges and management strategies for LDS. Acute LDS manifests with erythema and induration similar to cellulitis, while chronic LDS is characterised by fibrosis and skin tightening. Key management strategies include compression therapy, lifestyle modifications and interventions targeting venous insufficiency. Challenges such as delayed diagnosis, poor adherence to therapy and limited evidence for systemic treatments may compromise the quality of patient care. Future directions emphasise novel therapeutic approaches, evaluation of current treatments and the integration of artificial intelligence to enhance diagnostic decisions. Increased clinician awareness and research into the epidemiology, pathogenesis and treatment of LDS remain essential to improve patient outcomes.