The degree of lipodermatosclerosis in chronic venous insufficiency was determined by high-resolution 20 MHz ultrasound. For comparison, skin biopsies were taken and examined by light microscopy. With increasingly extensive sclerosis, ultrasound showed increasing thickness of the dermis with a poorly defined border from the subcutaneous fat. In addition, an echolucent band appeared in the upper dermis, corresponding to regions of glomerular capillaries in histology. In our experience, high-resolution ultrasound examination allows rapid and objective quantification of lipodermatosclerosis.