DERMAL EDEMA IN LIPODERMATOSCLEROSIS - DISTRIBUTION, EFFECTS OF POSTURE AND COMPRESSIVE THERAPY EVALUATED BY HIGH-FREQUENCY ULTRASONOGRAPHY

Although leg oedema is believed to contribute to the pathogenesis of l ipodermatosclerosis and leg ulcer, little is known about the cutaneous distribution of water in lipodermatosclerosis. In lipodermatosclerosi s accompanied by leg ulceration, a subepidermal low echogenic band is seen in the high-frequency echograms of the skin at the boundary of th e wound. Since skin echogenicity is inversely related to the amount of water contained, it has been assumed that the subepidermal low echoge nic band corresponds to oedema in the papillary dermis. In this study we evaluated dermal oedema in lipodermatosclerosis by quantifying chan ges of skin echogenicity in 20 patients with lipodermatosclerosis and 20 age- and sex-matched controls, In order for us to evaluate the infl uence of the upright posture on skin water content, echogenicity was d etermined three times a day in various regions of the lower and upper extremities. Next morning, after ultrasound examination of the ankle s kin, a compressive stocking was applied for 12 h and then the measurem ents of echogenicity were repeated. At any time of the day, ankle and calf skin was less echogenic in Lipodermatosclerosis than in the contr ol. The low echogenic area was confined to the subepidermal region. Du ring the day the low echogenic area expanded in patients with lipoderm atosclerosis. This phenomenon was reversed by leg compression. These r esults indicate that in lipodermatosclerosis oedema is located mainly in the papillary skin. An upright position causes aggravation of oedem a, whereas application of compression protects against accumulation of water in the skin during the day.