Sclerous atrophic cellulitis

The author deals only with the sclerous subcutaneous inflammation caused by venous stasis. There is no clear distinction between inflammation, and tissular sclerosis, the final stage of its development. There may be a certain lesional reversibility. The term "scleroinflammatory cellulitis" is therefore quite apt. Physiopathology. Pathology venous reflex results in a flood of proteins in the interstitial tissue, and this shows in signs of tissular pain, especially at the level of the hypoderm and dermis (anatomical reasons). Clinical. This is most often in the case of women with varicose affections or with post-phlebitic syndromes causing a painful, inflamed plaque, on the surface of the inside leg, at the junction of the middle and lower thirds. As well as the inflammation of this area, adhesion to the subjacent layers and induration are also confirmed. Venous dilations may be detected at the centre of this scleroinflammatory plaque. To begin with, the skin is red and taut, but later becomes dry and atrophic. It is prone to eczema and sometimes to ulceration. The development of subcutaneous inflammation is marked by sudden manifestation of inflammation which may be extensive and results in circular suffing, in extreme cases. Varicose sclerosis can provoke sudden manifestations of inflammation and especially if the technique is faulty (excessive dosage, lack of compression, insufficient compression). Treatment. 1. Local. Bandaging and walking are imperative. The bandage must be compressive, immovable, durable, and should be reinforced as necessary at the site of the induration, by latex rubber pads. Once the object of these slightly or non-elastic pads has been achieved they can be replaced by elastic contention. 2. General. Corticoids and phenylbutazone in short courses of treatment. Other products constitute auxiliary remedies. Thermal cures are always indicated in difficult cases. Medical treatment is often enough. In certain perverse cases a surgical treatment may be required, such as hypodermal resection and ligation of the perforants. Grafts (Vigoni). Certain severe cases remain unresponsive to all treatment and in such cases it is regrettable that suitable treatment was not administered at an earlier stage.