1/6. Lipodermatosclerosis - report of three cases and review of the literature.We report 3 cases of lipodermatosclerosis (LDS) and discuss the nosology of similar disorders caused by venous insufficiency of the legs. These cases are characterized by (1) occurrence in middle-aged or aged woman, (2) painful, indurated erythema with hyperpigmented scleroderma-like hardening on the lower leg, (3) lobular panniculitis with membranocystic fat necrosis and various degrees of septal fibrosis. Although the designation LDS has been used particularly in the UK and in the USA, this entity is not familiar in other countries including japan. LDS clinically represents a wide spectrum from an acute, inflammatory phase to a chronic, fibrotic state. The clinicopathologic findings of LDS are similar or identical to the disease previously reported as chronic indurated cellulitis, hypodermitis sclerodermiformis, stasis panniculitis or sclerosing panniculitis. These diseases are probably related conditions, which depend upon the various stages.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
2/6. Topical capsaicin for the treatment of acute lipodermatosclerosis and lobular panniculitis.Topical capsaicin is well known to reduce nociceptive pain and neurogenic inflammation by depleting substance p. Its fibrinolytic and antithrombotic effects are less well known. We report two cases of acute lipodermatosclerosis which did not respond to several conventional treatment regimens and one case of acute lobular panniculitis in a pregnant woman with venous insufficiency, who were successfully treated within a short period of 3 weeks with topical 0.075% capsaicin cream.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
3/6. Chronic venous insufficiency - a potential trigger for localized scleroderma.Localized scleroderma is a cutaneous disease that is characterized by an initial inflammatory response, followed by sclerosis of the skin. The cause of localized scleroderma has not yet been determined. Seifarth et al. reported two cases of localized scleroderma at sites of chronic venous insufficiency. We document here three more patients in whom localized scleroderma was located at insufficient veins. Treatment of underlying chronic venous insufficiency (CVI) leads to a substantial clinical improvement of scleroderma at the site of insufficient veins, but not elsewhere. Experimental data support the concept of chronic venous insufficiency creating a microenvironment, which may lead to localized scleroderma. Local hypoxaemia, which is present in CVI, induces the release of endothelium-derived cytokines, such as IL-1. Subsequently, expression of endothelial adhesion molecules and consequently leucocyte extravasation are induced. Infiltrating leucocytes secrete a number of inflammatory mediators, including transforming growth factor beta, which is a potent stimulus for collagen synthesis. Therefore, it may well be that CVI is a potential trigger factor for localized scleroderma. In addition, localized scleroderma may only develop if a certain amount of trigger factors are present - and resolves if one or more of the contributing factors (i.e. CVI) can be treated.- - - - - - - - - - ranking = 7keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
4/6. Hypodermitis sclerodermiformis. Successful treatment with ultrasound.We report herein the successful use of ultrasound therapy in the treatment of hypodermitis sclerodermiformis (HS). It is a skin disease characterized by well-circumscribed, chronic, painful and tender, single or multiple, board-like, indurated, sharply bordered lesions, occurring on the legs of patients with venous insufficiency. Hypodermitis sclerodermiformis is a little-known clinical entity, often undiagnosed or misdiagnosed as phlebitis, cellulitis, or stasis dermatitis. It merits clinical recognition because of the gratifying and unique response it has to treatment with ultrasound therapy.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
5/6. Acute lipodermatosclerosis in a pendulous abdomen.A 54-year-old female developed tender, hot, erythematous skin at the apex of a large pendulous abdomen at the same time as she became symptomatic with congestive cardiac failure secondary to respiratory failure. Clinically and histologically the changes in the abdominal-wall skin resembled lipodermatosclerosis, a condition normally seen in the legs secondary to chronic venous insufficiency.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
6/6. Keratoderma with pseudo-Quincke's pulse.The physical examination sign known as Quincke's capillary pulse is elicited by pressing lightly on the distal edge of a fingernail. When the vasculature of the nailbed is partly blanched, Quincke's pulse appears as alternating flashes of red and white that reveal arterial pulsations. This sign is seen in many normal persons, but it is most prominent in individuals with widened pulse pressures, such as aortic insufficiency. This case report describes a patient with keratoderma and sclerodactyly whose fingernails exhibited rapid color changes, mimicking Quincke's pulse. The visible pulsations were due to sclerodactylous compression of the nailbeds, and not to any primary hemodynamic process.- - - - - - - - - - ranking = 0.00015834893720441keywords = insufficiency (Clic here for more details about this article) |