Objective: To assess the effect of elastic stockings on reducing the area of lipodermatosclerosis in patients with healed venous ulceration.Design: Patients in this study were part of a randomised. controlled trial to assess elastic stockings in preventing venous ulcer recurrence.Setting: Leg ulcer clinic at a tertiary teaching hospital.Patients: Consecutive consenting patients with leg ulcers due to venous disease alone, that had healed 2 weeks previously.Interventions: Patients were randomised to below-knee graduated compression stockings (Venosan 2003) or no stockings.Main outcome measures: Patients had the area of lipodermatosclerosis measured on admission to the study and at 6-monthly intervals. Time to ulcer recurrence was also recorded for a 2-year follow-up period.Results: One hundred and fifty-three patients were randomised to the main study (stockings 72, no stockings 81); 52 had re-ulcerated by 6 months (15 stockings, 37 no stockings). Lipodermatosclerosis was significantly reduced after 6 and 12 months in those patients wearing stockings but not in the control group (repeat measures ANOVA p = 0.01, p = 0.04). The initial area, of lipodermatosclerosis was significantly larger in those: patients who re-ulcerated within 2 years of entering the study compared with those who did not re-ulcerate (re-ulceration, 293 cm(2); no re-ulceration, 50 cm(2)).Conclusions: Elastic stockings alone can improve the skin changes of lipodermatosclerosis and lower the rate of ulcer recurrence.