(Kiosk 5) Multimodal Pain Management for Chronic Pain & Dysfunction Secondary to Lipodermatosclerosis in an Elderly Woman: A Case Report

Case Diagnosis: A 73 year old woman with lipodermatosclerosis.

Case Description or Program Description: A 73 year old female presented with 6 months of atraumatic left distal tibial pain, hyperpigmentation, and erythema causing significant debility and pain with ambulation. Patient was initially treated with over-the-counter analgesics and meloxicam 7.5mg without relief. A walking boot was prescribed due to concern for a stress fracture, but it was not tolerated because of poor balance and a high fall risk, especially while caring for her grandchild. MRI revealed distal pretibial skin thickening and subcutaneous edema along the anterior tibial surface questionable for cellulitis. Patient was then treated with doxycycline for one week without improvement. Per dermatology recommendations, the patient underwent two sequential skin biopsies which confirmed lipodermatosclerosis. Pain management was recommended. The patient was treated with osteopathic manipulation treatment and gabapentin 100mg daily. Additionally, non-weight bearing exercise, compression stockings, and therapeutic ultrasound were recommended.

Setting: Outpatient Musculoskeletal Clinic at an Academic Medical Center.

Assessment/Results: At 8 weeks the patient noted improvement in pain levels which decreased from an initial 8/10 to a 5/10. More importantly, her function and quality of life improved substantially. Family noted increased ability to perform activities of daily living as well as reduced erythema and sclerosis of left lower extremity. Her ability to ambulate and perform child care significantly enhanced her wellbeing.

Discussion (relevance): Lipodermatosclerosis is a rare condition that not only affects the skin but also causes significant pain which contributes to debility, particularly in the elderly population. Due to the poorly understood underlying mechanisms and chronicity of this disease, it is frequently misdiagnosed, which can result in the progression of pain and deteriorating quality of life.

Conclusions: Physicians should emphasize a multimodal treatment approach to provide pain relief and improve functioning in patients with lipodermatosclerosis.