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PubMed This is a summary of 11 peer-reviewed journal articles Updated
Wound care

Complications, Ulcers, and When to Seek Urgent Care

At a Glance

Lipodermatosclerosis can be complicated by venous leg ulcers. Worsening pain, pus-like drainage, spreading redness, or fever needs prompt review; sudden one-sided swelling may signal a deep-vein blood clot, while shortness of breath, chest pain, or fainting requires emergency care.

While lipodermatosclerosis (LDS) is a chronic condition, it can lead to serious complications that require prompt medical attention. Knowing how to distinguish stable symptoms from an emergency is vital for protecting your health.

Venous Leg Ulcers (VLUs)

A venous leg ulcer is a shallow, open sore that develops when chronic high pressure prevents healthy blood flow to the skin [1]. These ulcers typically appear on the inner side of the ankle.

  • Standard Care: Proper wound care involves keeping the ulcer moist but not “soggy,” protecting the surrounding skin from drainage, and—most importantly—using compression therapy to address the underlying pressure [2].
  • Signs of Infection: It is normal for an ulcer to be colonized by some bacteria (which can cause odor), but that does not always mean it is infected [3]. You should contact your doctor if you notice clinical indicators of a true infection:
    • A new, foul odor alongside other symptoms [3].
    • Pus-like (purulent) drainage or a change in drainage color.
    • New or rapidly increasing pain in or around the wound [3].
    • The ulcer suddenly gets larger or the edges start breaking down.
    • Spreading redness, warmth, or red streaks extending away from the wound [3].

When an Ulcer Requires Reassessment

If a venous ulcer does not improve over a locally defined interval of excellent care and compression, it requires reassessment. A chronic, non-healing wound can occasionally transform into a type of skin cancer called a Marjolin ulcer (usually squamous cell carcinoma), although this generally develops over a much longer period [4].

Your doctor should perform a biopsy or specialist review if the ulcer:

  • Fails to improve over a significant period of optimal treatment [5].
  • Develops rolled, indurated, thick, or everted edges [4].
  • Bleeds easily or has “cauliflower-like” growths (exuberant granulation tissue).
  • Displays an unusual appearance or disproportionate pain.

Cardiovascular Red Flags

Lipodermatosclerosis is a sign of advanced venous disease. While LDS alone does not establish a high probability of a new blood clot, many patients have a history of prior clots (which caused their LDS), and factors such as recent surgery, immobility, active cancer, or pregnancy can increase the risk of Venous Thromboembolism (VTE).

Deep Vein Thrombosis (DVT)

A DVT is a blood clot in the deep veins of the leg [6].

  • Red Flags: Sudden, new swelling in one leg; calf or thigh pain that feels like a “cramp” or “charley horse”; and skin that is unusually warm or red in a specific area [6][7].

Pulmonary Embolism (PE)

A PE occurs when a blood clot breaks loose and travels to the lungs. This is a life-threatening emergency [8].

  • Red Flags: Sudden shortness of breath, sharp chest pain (especially when taking a deep breath), coughing up blood, severe weakness, confusion, or feeling severely dizzy or fainting [8][9].

Emergency vs. Urgent Care

Situation Where to Go
Emergency: Sudden shortness of breath, chest pain, confusion, fainting, or coughing blood [8]. Emergency Room (Call 911)
Emergency: Sudden, severe swelling and pain in only one leg, or a cold/blue limb (possible DVT) [6]. Same-Day Medical Assessment / ER (Note: Many urgent care clinics cannot perform same-day duplex imaging for DVT).
Urgent: Fever, chills, severe systemic illness, or a rapidly spreading red/hot leg [10]. Same-Day Doctor / Urgent Care
Prompt Care: A new open ulcer, or an ulcer that has a significant change in pain or drainage [11]. Wound Clinic / Specialist Promptly

Common questions in this guide

What changes suggest that a venous leg ulcer is infected?
An ulcer can contain bacteria and have some odor without being infected. Infection is more concerning when there is a new foul odor with other changes, pus-like or newly discolored drainage, increasing pain, rapid enlargement, spreading redness or warmth, or red streaks; contact a clinician promptly.
When should I go to the emergency room for lipodermatosclerosis symptoms?
Call emergency services for sudden shortness of breath, chest pain, coughing up blood, confusion, severe dizziness, or fainting, because these may signal a pulmonary embolism. Sudden severe swelling and pain in one leg or a cold or blue limb also requires same-day assessment, often in an emergency department.
Could new one-sided leg pain be a deep-vein blood clot?
It could be, especially if it begins suddenly and comes with swelling in one leg, cramp-like calf or thigh pain, warmth, or localized redness. These symptoms cannot be diagnosed safely at home, so seek same-day medical assessment.
When should a chronic venous ulcer be checked for skin cancer?
A long-lasting nonhealing ulcer can rarely develop into a skin cancer called a Marjolin ulcer, usually squamous cell carcinoma. Ask about a biopsy or specialist review if the ulcer does not improve after excellent wound care and compression, or if it has rolled, thick, firm, or turned-out edges, bleeds easily, develops cauliflower-like tissue, looks unusual, or causes disproportionate pain.
How are venous leg ulcers treated when I have lipodermatosclerosis?
Care usually includes keeping the wound moist but not soggy, protecting the surrounding skin from drainage, and using compression therapy to reduce the underlying venous pressure. A clinician can recommend dressings suited to the amount of drainage and guide consistent care.
Does a bad smell always mean my leg ulcer is infected?
No. Bacteria can colonize an ulcer and cause odor without causing a true infection. A new foul smell is more concerning when it occurs with pus-like drainage, worsening pain, rapid wound changes, spreading redness or warmth, red streaks, fever, or feeling severely unwell.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does my ulcer look like it has healthy 'granulation tissue,' or are there signs of infection or necrosis?
  2. 2.How can we tell if my new leg pain is related to venous inflammation or a new blood clot (DVT)?
  3. 3.My ulcer hasn't improved in several weeks; at what point should we perform a biopsy to check for atypical conditions?
  4. 4.Are there specific wound dressings you recommend for the amount of drainage my leg is currently producing?
  5. 5.If I develop a fever or the redness starts spreading quickly, which clinic or emergency department should I go to for immediate evaluation?

Questions For You

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References

References (11)
  1. 1

    Vascular assessment in venous leg ulcer diagnostics and management in Australian primary care: Clinician experiences.

    Weller C, Richards C, Turnour L, et al.

    Journal of tissue viability 2020; (29(3)):184-189 doi:10.1016/j.jtv.2019.12.005.

    PMID: 31879057
  2. 2

    Venous Ulcers: Diagnosis and Treatment.

    Bonkemeyer Millan S, Gan R, Townsend PE

    American family physician 2019; (100(5)):298-305.

    PMID: 31478635
  3. 3

    The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice.

    Bui UT, Finlayson K, Edwards H

    International wound journal 2019; (16(3)):601-620 doi:10.1111/iwj.13069.

    PMID: 30697930
  4. 4

    Immune Checkpoint Inhibition in Marjolin Ulcer: A Case Series.

    Shalhout SZ, Kaufman HL, Sullivan RJ, et al.

    Journal of immunotherapy (Hagerstown, Md. : 1997) 2021; (44(6)):234-238 doi:10.1097/CJI.0000000000000376.

    PMID: 34100836
  5. 5

    Angiosarcoma Presenting as a Chronic Non-Healing Lower Extremity Ulcer in Lymphoedema: A Challenge.

    Koch M, Hani L, Friedman E, Ross FL

    International wound journal 2026; (23(9)):e71002 doi:10.1111/iwj.71002.

    PMID: 42657873
  6. 6

    Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.

    Chopard R, Albertsen IE, Piazza G

    JAMA 2020; (324(17)):1765-1776 doi:10.1001/jama.2020.17272.

    PMID: 33141212
  7. 7

    Deep vein thrombosis: update on diagnosis and management.

    Kruger PC, Eikelboom JW, Douketis JD, Hankey GJ

    The Medical journal of Australia 2019; (210(11)):516-524 doi:10.5694/mja2.50201.

    PMID: 31155730
  8. 8

    Heparin-Induced Thrombocytopenia at the Emergency Department Due to Intermittent Heparin Flush in a Patient Undergoing Stem Cell Transplant.

    Thein KZ, Elsaim SA, Ma MQ, et al.

    Cureus 2022; (14(11)):e31798 doi:10.7759/cureus.31798.

    PMID: 36569714
  9. 9

    Diagnosis of Venous Thromboembolism.

    Canas A, Epstein J, Chen T, Dunn AS

    The Medical clinics of North America 2025; (109(4)):787-801 doi:10.1016/j.mcna.2025.01.006.

    PMID: 40500082
  10. 10

    [Non-Necrotizing Acute Dermo-Hypodermal Infections: Erysipela and Infectious Cellulitis].

    Rodrigues MA, Caetano M, Amorim I, Selores M

    Acta medica portuguesa 2021; (34(3)):217-228 doi:10.20344/amp.12642.

    PMID: 33971117
  11. 11

    Post-treatment course of acute lipodermatosclerosis.

    Suehiro K, Morikage N, Harada T, et al.

    Phlebology 2023; (38(2)):73-79 doi:10.1177/02683555221147473.

    PMID: 36529929

This page is for informational purposes about lipodermatosclerosis complications and does not constitute medical advice. Contact a clinician for wound changes, and seek emergency help for sudden shortness of breath, chest pain, fainting, or coughing blood.

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