In a review article, Rossi and Vergnanini described the multifactorial basis for the etiology of GLD. The process would originate with the deterioration of cutaneous vascularization, particularly in response to alterations in the pre-capillary arteriolar sphincter of the affected areas, along with the deposition of hyper polymerized glycosaminoglycans on the wall of dermal capillaries and between the collagen and elastic fibers. The increase in capillary pressure would lead to increased permeability of venular capillaries and the retention of excess fluid in the dermis, among adipocytes and interlobular septa, causing cellular alterations and tissue hypoxia. 10