Gniadecka M
Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
Acta Derm Venereol. 1995 Mar;75(2):120-4. doi: 10.2340/0001555575120124.
Although leg oedema is believed to contribute to the pathogenesis of lipodermatosclerosis and leg ulcer, little is known about the cutaneous distribution of water in lipodermatosclerosis. In lipodermatosclerosis accompanied by leg ulceration, a subepidermal low echogenic band is seen in the high-frequency echograms of the skin at the boundary of the wound. Since skin echogenicity is inversely related to the amount of water contained, it has been assumed that the subepidermal low echogenic band corresponds to oedema in the papillary dermis. In this study we evaluated dermal oedema in lipodermatosclerosis by quantifying changes of skin echogenicity in 20 patients with lipodermatosclerosis and 20 age- and sex-matched controls. In order for us to evaluate the influence of the upright posture on skin water content, echogenicity was determined three times a day in various regions of the lower and upper extremities. Next morning, after ultrasound examination of the ankle skin, a compressive stocking was applied for 12 h and then the measurements of echogenicity were repeated. At any time of the day, ankle and calf skin was less echogenic in lipodermatosclerosis than in the control. The low echogenic area was confined to the subepidermal region. During the day the low echogenic area expanded in patients with lipodermatosclerosis. This phenomenon was reversed by leg compression. These results indicate that in lipodermatosclerosis oedema is located mainly in the papillary skin. An upright position causes aggravation of oedema, whereas application of compression protects against accumulation of water in the skin during the day.
尽管腿部水肿被认为与脂膜皮肤硬化症和腿部溃疡的发病机制有关，但关于脂膜皮肤硬化症中皮肤水分的分布情况却知之甚少。在伴有腿部溃疡的脂膜皮肤硬化症中，在伤口边界处皮肤的高频超声图像中可见表皮下低回声带。由于皮肤回声性与所含水量呈负相关，因此推测表皮下低回声带对应于乳头层真皮中的水肿。在本研究中，我们通过量化20例脂膜皮肤硬化症患者和20例年龄及性别匹配的对照者的皮肤回声性变化，来评估脂膜皮肤硬化症中的真皮水肿。为了评估直立姿势对皮肤含水量的影响，每天在下肢和上肢的不同区域测定三次回声性。次日早晨，在对踝部皮肤进行超声检查后，应用压力袜12小时，然后重复测量回声性。在一天中的任何时候，脂膜皮肤硬化症患者的踝部和小腿皮肤回声性均低于对照组。低回声区域局限于表皮下区域。在白天，脂膜皮肤硬化症患者的低回声区域扩大。这种现象通过腿部加压得以逆转。这些结果表明，在脂膜皮肤硬化症中，水肿主要位于乳头层皮肤。直立姿势会导致水肿加重，而应用压力可防止白天皮肤中积水。
