A patient with chronic venous insufficiency has CEAP classification C4b. This corresponds to which clinical finding?

• A Varicose veins
• B Skin changes limited to pigmentation and eczema
• C Lipodermatosclerosis or atrophie blanche ✓
• D Active venous ulcer

Explanation

The CEAP classification for chronic venous disease: C0 = no visible disease; C1 = telangiectasias; C2 = varicose veins; C3 = edema; C4a = pigmentation and/or eczema; C4b = lipodermatosclerosis and/or atrophie blanche; C5 = healed venous ulcer; C6 = active venous ulcer. Lipodermatosclerosis (fibrosing panniculitis with skin induration) and atrophie blanche (stellate white scars with surrounding telangiectasias) represent more advanced skin changes at C4b, indicating significant underlying venous hypertension at high risk of progression to ulceration.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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