Lipodermatosclerosis as a variety of lobular panniculitis: clinical features
Objective: to to study and reveal the diagnostic signs of lipodermatosclerosis (LDS) as one of the types of panniculitis (PN). Materials and methods. A total of 550 patients were examined; LDS with its duration of 18.97 ± 7.4 months was verified in 53 (9.6 %) pa- tients (3 men and 50 women; whose age was 18-80 years), including 32 overweight ones. All the patients underwent comprehensive clinical examination and laboratory and instrumental studies involving biochemical and immunological parameters, as well as chest computed to- mography and Doppler ultrasound (DUS) of the lower limb vascular bed. While characterizing the skin lesion, the extent, skin color, num- ber and intensity of pain were assessed using the visual analogue scale (VAS) in the affected areas. Chronic venous insufficiency (CVI) was evaluated in accordance with the international classification and the classification developed by V.S. Savel’ev et al. The skin and hypoder- mic tissue were biopsied from an area of the highest lesion and further pathomorphologically examined. КЛИНИЦИСТ 4’2015 ТОМ 9 THE CLINICIAN 4’2015 VOL. 9 Results. Thirty-seven (70 %) of the 53 patients with LDS were noted to have predominantly inflammation of the subcutaneous adipose layer of the leg (88.6 %) on its medial surface (54.7 %) with the development of the glass symptom (79.2 %) (p = 0.005). Main types of the disease course (acute, subacute, and chronic) were identified, which differed in clinical symptoms. ROC analysis indicated that the VAS sensitivity (86 %) and specificity (58 %) in the patients with LDS corresponded to a separation point of 40 mm. In 46 % of the cases, skin lesion was associated with polyarthralgias (n = 15) or myalgias (n = 12) in the presence of insignificant inflammatory activity. Twenty-eight patients (including 19 with chronic LDS) had CVI with a duration of 10.2 ± 1.3 years, which was verified by DUS of the lower limb vessels (p < 0.05). All the patients took venous tonics, nonsteroidal anti-inflammatory drugs, aminocholines, and antioxidants for 3 months. A thera- peutic effect was observed in 68 % of the cases. A therapeutic effect was absent in 23 % of the patients and worse health was seen in 9 %, which needed glucocorticoid therapy to be added. Conclusion. LDS is a clinical type of lobular PN, which requires an extensive diagnostic search. The factors contributing to the development of LDS are female sex, middle age, overweight, anamnestic predisposition, and CVI of the lower extremities. Asymmetric indurations with their characteristic color on the medial surface of the leg with the development of subcutaneous adipose layer dystrophy (the glass symptom) are a diagnostic sign of LDS.