In the CEAP classification of chronic venous disease, what does the number '4b' refer to?

• A Active venous ulcer
• B Healed venous ulcer
• C Skin hyperpigmentation or eczema
• D Lipodermatosclerosis or atrophie blanche ✓

Explanation

The CEAP Clinical classification grades chronic venous disease: C0 (no signs), C1 (telangiectases/reticular veins), C2 (varicose veins), C3 (oedema), C4a (pigmentation/eczema), C4b (lipodermatosclerosis/atrophie blanche), C5 (healed ulcer), C6 (active ulcer). C4b represents the pre-ulcerative skin changes — lipodermatosclerosis (woody induration of the lower leg from chronic inflammation) and atrophie blanche (white scarred areas indicating previous healed microinfarcts). These indicate advanced chronic venous insufficiency with high risk of ulceration. The subcategory b distinguishes these from hyperpigmentation/eczema (4a) which are less severe.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.