Use of a durometer to measure the degree of skin induration in lipodermatosclerosis

Abstract

Background: Chronic lipodermatosclerosis is characterized by indurated skin on the medial aspect of the leg and is common around venous ulcers. The severity of induration of lipodermatosclerosis has been associated with poor ulcer healing. Clinical assessment of lipodermatosclerosis presently relies on a clinical skin severity score adapted from studies of patientswith systemic sclerosis. Objective: It would be desirable for prognostic reasons to develop an objective method for measuring skin hardness in lipodermatosclerosis. Methods: The degree of skin induration at the midpoint between the upper and lower margin of lipodermatosclerosis in 30 sequential nonselected patients with lipodermatosclerosis was assessed by a blinded observer's clinical score and by quadruplicate determinations with a hand-held type O durometer. Skin induration on the medial aspect of the leg was similarly measured in five normal volunteers. Transcutaneous oxygen pressure was measured at the same sites. Results: A direct linear relation ( r = 0.962) was found between skin severity scores and durometer readings ( p < 0.01). A clinical skin score of 2 reflected a higher durometer reading compared with a skin score of 1 ( p = 0.0016) and, similarly, higher durometer readings were found in skin score of 3 compared with score 2 skin ( p = 0.0093). Transcutaneous oxygen pressure was uniformly reduced in lipodermatosclerosis ( p < 0.02). Conclusion: The durometer is a reliable instrument for measuring skin hardness in patients with lipodermatosclerosis. It may be used to test the prognostic value of lipodermatosclerosis on ulcer healing.