The term "abacterial hypodermitis" is synonymous with lipodermatosclerosis. Lipodermatosclerosis usually develops in the setting of chronic venous insufficiency, which may result from loss of venous valve function, obstruction of venous flow, or decreased functionality of the calf muscle pump.
Risk factors most commonly associated with the development of chronic venous insufficiency and lipodermatosclerosis include obesity, physical inactivity, age, history of deep vein thrombosis, family history of venous insufficiency (CVI), and tobacco use.
Chronic venous insufficiency (CVI) is more common in patients whose occupation involves prolonged standing. Immobilization of the ankle (e.g., after trauma) can also lead to symptoms similar to chronic venous insufficiency. Although chronic venous insufficiency appears to be the driving force for the development of lipodermatosclerosis, other factors may also play a role. An association between abnormalities of fibrinolysis and hypercoagulable states, such as protein C and protein S deficiency, and the development of lipodermatosclerosis has been suggested. The relationship has not been fully established. Individuals who use tobacco products or have a high body mass index are at increased risk of developing chronic venous insufficiency and subsequent lipodermatosclerosis. Therefore, weight loss and smoking cessation are also recommended measures.