Venous insufficiency refers to a condition where there is impaired flow of blood from the veins of the leg to the heart. Varicosities are most commonly heard of, which, as we all know are swollen veins in the legs, generally seen in those who stand for prolonged periods.
Lipodermatosclerosis is a similar condition that refers to skin changes in the lower portion of the legs; however, is not related to varicose veins. The condition is a form of panniculitis (sclerosing panniculitis), which means inflammation of the layer of fat under the skin.
a progressive fibrotic process that gradually leads to hyperpigmentation and
induration (hardening) of skin. The exact cause of the condition is unknown but
may be assumed to be caused due to raised
pressure in the leg veins (venous hypertension or venous incompetence). This
may cause fluid and proteins to leak out of the veins ultimately leading to fibrosis and inflammation of the
underlying skin. Possibly, there could be lack of oxygen and nutrient delivery
to the tissue as well. There is limited data regarding prevalence of the
condition. Nonetheless, among the other conditions associated with venous
insufficiency such as varicose veins, venous eczema; lipodermatosclerosis is
patient may experience pain, swelling in the legs, and notice hardening and
discoloration of skin. Itching, scaling of skin may also be seen. Acute
lipodermatosclerosis presents as painful, erythematous, purple indurated
plaques – well demarcated from normal skin –possibly with white scale. Chronic
conditions may reveal tapering of legs above the ankle, resembling an inverted
champagne bottle. In long-standing cases, ulcerations may be seen.
has been reported as one of the chief causes for lipodermatosclerosis. Being
over-weight or obese exerts pressure on the vessels, especially those
associated with weight-bearing structures; thereby leading to damage in patency
over time. Therefore, weight management/lifestyle modification is the main
aspect to consider in the treatment of this condition.
the chief therapeutic approach is graduated compression. Pharmacological and
surgical interventions have also been indicated, with varying results. Patients
should be instructed to avoid standing or sitting for prolonged periods. Leg
elevation along with regular physiotherapy exercises will aid in improving the
blood flow. Some patients may be advised medicines to prevent clotting of blood
(aspirin etc.). However, in severe cases, surgery of the affected vein (s) may
newer, more effective form of treatment for lipodermatosclerosis is cell-based
therapy. Mesenchymal cells in our body have the capacity to self-renew and
possess anti-inflammatory, immunomodulatory properties. When these cells are implanted
in the area surrounding the affected vein, they are capable of differentiating
into vascular endothelial cells and smooth muscle cells. Through this, we can
achieve thickening of the layer of collagen and also improve the elasticity of
the vein walls. Mesenchymal
stem cells also have the ability to migrate to the site of injury or
inflammation and participate in
of damaged tissues. These cells stimulate proliferation and differentiation of
surrounding cells and promote recovery of injured cells through growth factor
secretion and matrix
remodeling. Supplementary treatment with hyperbaric oxygen ensures adequate
perfusion of hypoxic tissues, which facilitates healing.
We hereby present a
case of lipodermatosclerosis successfully managed with cell-based therapy:
78 years old female
patient, Mrs. Lalita, reported to our hospital in May 2017 with complaints of
pain and swelling in both legs (left more than right) since 2 years. She also
had lesions on her legs with suppuration. The patient was diagnosed as a case
of Lipodermatosclerosis with vasculitis before 2 years. She also complained of
itching all over the body with occasional fever, nausea and loss of appetite
since 2 weeks. The patient is known hypertensive and in under medication since
The patient underwent
three sessions of cell-based therapy with cells and growth factors sourced from
the patient’s own body, which were administered intravenously as well as in
areas surrounding the lesions.
Improvement in the
patient’s condition was noticed as early as 3 days following cell based therapy
and results have been maintained over a period of 6 months. The patient is now
able to walk comfortably and does not have pain or swelling in her legs.
Indurated and erythematous lesions have healed with minimal scarring and
softening of fibrotic areas is observed. Eczematous areas have healed and the
patient no longer has itching sensation.