Lipodermatosclerosis vs. Cellulitis: What’s the Difference?

Felicity Burnell
Jan 2
3 min read

At Oxfordshire Chiropody & Podiatry, I often see patients with red, swollen, and tender lower legs. This is frequently misdiagnosed as bilateral cellulitis by GPs... a condition that is incredibly rare, and requires hospitalisation. So if you've got two hot, red legs and have been given antibiotics by your doctor but otherwise feel fine, it's most likely NOT cellulitis. One of the most common concerns is whether it's a serious infection like cellulitis—or something else, like lipodermatosclerosis, a chronic condition linked to circulation issues.

These two conditions can look very similar, but they have very different causes and require different treatments. Understanding the differences is key to getting the right diagnosis and care.

Here’s a clear breakdown to help you understand what’s going on with your legs—and when to seek help.

📌 What Is Cellulitis?

Cellulitis is a bacterial skin infection that spreads quickly if left untreated. It most often affects the lower legs and is typically caused by bacteria (like Streptococcus or Staphylococcus) entering through a break in the skin.

Common signs of cellulitis:

Sudden redness, warmth, and swelling
Skin that feels tight or tender to the touch
Fever or chills
Rapid spreading of redness
One leg is usually affected

Source: https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-cellulitis

Cellulitis is a medical emergency when symptoms escalate. It requires prompt treatment with antibiotics to prevent serious complications.

📌 What Is Lipodermatosclerosis?

Lipodermatosclerosis (LDS) is a chronic inflammatory skin condition that usually develops in the lower legs due to long-term venous insufficiency (poor blood flow in the veins). It’s part of a broader condition called chronic venous disease, where veins struggle to return blood to the heart.

Common Signs of Lipodermatosclerosis

Gradual darkening or hardening of the skin on the lower leg
Tapered appearance of the leg, sometimes described as an "inverted champagne bottle"
Pain or tightness, especially when standing for long periods
Skin may appear red or brown, thickened, and leathery
Often affects both legs, though not always equally

Source: https://www.pcds.org.uk/clinical-guidance/lipodermatosclerosis1

Unlike cellulitis, LDS is not caused by an infection and does not respond to antibiotics.

Instead, it’s treated with strategies to improve circulation, such as compression therapy, leg elevation, and management of underlying venous disease.

🔍 Key Differences at a Glance

Feature	Cellulitis	Lipodermatosclerosis (LDS)
Cause	Bacterial infection	Chronic venous insufficiency
Onset	Sudden	Gradual (weeks to months)
Skin appearance	Red, warm, swollen	Brownish-red, tight, thickened
Fever/Systemic signs	Often present	Rare
Pain	Tender and acute	Dull, aching, or tight sensation
Response to antibiotics	Yes	No
Laterality	Usually one leg	Often both legs

💡 Why This Matters

Misdiagnosis is common—lipodermatosclerosis is frequently mistaken for cellulitis. Repeated unnecessary antibiotics won’t help LDS and can even contribute to antibiotic resistance. That’s why an accurate diagnosis from a podiatrist or vascular specialist is so important.

🦶 How a Podiatrist Can Help

If you're experiencing leg swelling, skin discoloration, or recurring “cellulitis-like” symptoms, a thorough vascular and dermatological assessment is essential. At Oxfordshire Chiropody & Podiatry, I can: -

Differentiate between cellulitis and LDS
Recommend appropriate imaging (e.g., venous Doppler studies)
Develop a tailored treatment plan—whether you need antibiotics, compression therapy, or lifestyle support