Non-Neoplastic Dermatopathology

5.4

L IPODERMATOSCLEROSIS VS TRAUMATIC PANNICULITIS

Lipodermatosclerosis

Traumatic Panniculitis

Age

Middle-aged adults; women affected more than men.

Any age.

Location

Lower legs.

Any site but most commonly involves shins, forearms, and breasts.

Etiology

Chronic venous insufficiency.

Blunt trauma in fatty zones.

Presentation

Early phase of red to violaceous, mildly tender plaques that evolve into indurated, thick, hyperpigmented skin involving the lower third of the leg. Constriction in the ankle region imparts an “inverted champagne bottle” appearance to the leg. May be associated with other features of chronic venous stasis including edema, varicosities, and ulceration. 1. Grouped, thick-walled vessels within the superficial dermis (Fig. 5.4.5) . 2. Erythrocyte extravasation and hemosiderin deposition may be evident in superficial dermis. 3. Subcutaneous septal fibrosis (Fig. 5.4.1) . 4. Membranocystic (lipomembranous) fat necrosis with lipogranuloma formation and xanthomatous macrophages (Figs. 5.4.2 and 5.4.3) . 5. Siderophages (hemosiderin-laden macrophages) in septae (Fig. 5.4.4) . Iron stain may be performed to detect siderophages. Compression therapy is the conventional treatment for chronic venous insufficiency and lipodermatosclerosis. Anabolic steroids are also utilized for their fibrinolytic properties in some cases. Progressive disease that is chronic and recurring. May be associated with other complications of chronic venous insufficiency including chronic ulceration and secondary infection.

Indurated, erythematous subcutaneous plaques or nodules. Hypertrichosis has been reported in some cases.

Histology

1. Normal epidermis and dermis. 2. Lobular infiltrate of histiocytes, including foamy histiocytes and giant cells, surrounding fat microcysts (Figs. 5.4.6 and 5.4.9) . 3. Microcysts vary in size and shape (Figs. 5.4.6 and 5.4.7) . 4. Lipomembranous change with variable fibrosis and dystrophic calcification (Fig. 5.4.7) . Lipomembranous change consists of feathery eosinophilic material at the periphery of cystic spaces. 5. Fibrosis may form a capsule around the fat necrosis (Fig. 5.4.8) .

Special studies

None.

Treatment

Symptomatic treatment only.

Self-limited disorder. May recur in individuals susceptible to repeat trauma. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

Prognosis

253