A Complex Case of Lipodermatosclerosis, Atrophie Blanche, Nail Fungus & Adult Acne: Comprehensive Dermatologic Care in Katy & Houston, Texas
At Village Dermatology in Katy and Houston, Texas, our dermatology team routinely manages complex cases involving multiple skin, nail, and vascular conditions. Today’s case report highlights a 45-year-old female who presented as a new patient with concerns about a chronic leg rash, discolored toenails, and asymptomatic bumps on the cheek. Her clinical history—including a prior deep vein thrombosis (DVT)—added complexity to her evaluation and treatment plan.
This case demonstrates the importance of thorough assessment, individualized treatment, and patient education in achieving long-term dermatologic improvement.
Patient Overview
Chief Complaints
Rash on the left leg
Nail disorder affecting both great toenails
Bumps on the left cheek
Relevant Medical History
History of left-leg DVT (2010–2011)
Known Factor V Leiden mutation
Intermittent swelling of the left leg
Previous use of clobetasol and sunflower/vitamin E oils
Clinical Findings
1. Lipodermatosclerosis with Atrophie Blanche (Left Lower Leg)
The patient reported worsening discoloration, burning sensations, occasional oozing, and long-standing swelling. Clinical exam showed:
Scarring and fibrosis
Hyperpigmentation
Erythematous, tender plaques
Classic “inverted champagne bottle” morphology
Angular, white, depressed plaques characteristic of atrophie blanche
These findings were consistent with lipodermatosclerosis, a chronic inflammatory and sclerosing condition associated with venous insufficiency.
2. Onychomycosis (Toenail Fungus)
Both great toenails showed:
Yellow and green discoloration
Onycholysis (lifting of the nail)
Subungual debris
3. Adult Acne (Comedonal & Inflammatory)
The patient also displayed:
Comedonal papules
Inflammatory papules and pustules
Distribution across both malar cheeks
Treatment Plan
1. Lipodermatosclerosis & Atrophie Blanche Management
A structured management strategy was initiated:
Discontinue oils (sunflower & vitamin E)
Start Vaseline as a plain moisturizer
Begin Triamcinolone 0.1% ointment, applied twice daily in 2-week cycles
Apply Duoderm bandages daily to the superficial wound
Daily compression stockings to support venous return
Strong counseling on:
Leg elevation
Long-term expectations
Chronicity and irreversible fibrosis
The patient was advised to return in 6 weeks for follow-up.
2. Onychomycosis (Nail Fungus)
The patient declined oral antifungal therapy (terbinafine), so we recommended conservative management:
OTC Gold Listerine foot soaks
Education on:
Fungal longevity
Slow rate of nail improvement
High relapse rate
Differences between oral vs. topical treatment effectiveness
3. Acne Treatment Plan
To address comedonal and inflammatory acne:
Start tretinoin 0.025% cream
Apply pea-sized amount at bedtime
Start 2–3 nights per week, increase to nightly as tolerated
Use non-comedogenic skincare
Emphasize expectations: acne may take 2–3 months to show significant improvement
Why Early Dermatologic Evaluation Matters
This case demonstrates how seemingly unrelated symptoms—rash, nail discoloration, facial bumps—can reflect deeper dermatologic or systemic processes. Conditions like lipodermatosclerosis often go untreated for years, leading to irreversible skin changes.
At Village Dermatology, we prioritize:
Early identification
Comprehensive evaluation
Personalized treatment strategies
Patient education for long-term success
Dermatology Care in Katy & Houston, Texas
Whether you’re experiencing chronic leg discoloration, toenail changes, acne, or other skin concerns, our board-certified dermatologists provide advanced, compassionate care tailored to your needs.
📍 Village Dermatology – Katy, TX
📍 Village Dermatology – Houston, TX
