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Lipodermatosclerosis (LDS) is a sclerosing panniculitis thought to be associated with venous insufficiency that affects the lower leg. The acute form presents with erythema and pain and can mimic cellulitis, while the more common chronic form is hyperpigmented with a bound down woody indurated appearance often resembling an “upside down champagne bottle.” It can often be diagnosed clinically. Skin biopsy should be avoided if possible due to the risk of nonhealing, and a venous duplex ultrasound should be considered to rule out venous reflux. Referral to vascular surgery is indicated if reflux is present. Compression therapy (20-30 mmHg knee-high stockings) and oral pentoxifylline 400 mg 3 times a day are my first-line treatments. I add hydroxychloroquine to recalcitrant cases.
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Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from ≥1 randomized controlled trial; level IIA evidence includes evidence from ≥1 controlled study without randomization; level IIB evidence includes evidence from ≥1 other type of experimental study; level III evidence includes evidence from nonexperimental descriptive studies, such as comparative studies, correlation studies, and case control studies; and level IV evidence includes evidence from expert committee reports or opinions or clinical experience of respected authorities, or both. See Table 61-1.
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