What's to know about varicose eczema?
Other names for the condition are gravitational dermatitis and venous eczema.
In statis dermatitis, poor circulation leads to a skin condition.
Image credit: Keith Ciampa, Healthline
Stasis dermatitis happens when blood flow in the lower legs becomes compromised, and the valves in the veins weaken, causing a leakage of blood into body tissues.
This is called venous insufficiency, and it can cause the symptoms of stasis dermatitis to develop.
At first, symptoms will affect the ankles. There may be:
- Heavy or aching legs when standing for a prolonged period
- Swelling that appears toward the end of the day and lessens after sleeping overnight
- Varicose veins covered with dry, itchy, or irritated skin
- Red, swollen, and painful skin, which may be weeping and crusty
In time, these problems extend upward to the calf of the leg, and other symptoms develop.
- Skin that is dry, cracked, shiny, and itchy
- Purple or red sores, or venous ulcers, on the lower legs and the tops of the feet
The skin becomes scaly with sores that weep and crust. Bacterial infection may develop, and the skin color changes. As the sores heal, they form scabs and scars.
In some people, eczema may affect other parts of the body.
Untreated, the condition can gradually worsen.
This can lead to:
- Hard areas of thickened, fibrotic skin
- Shrinking of the lower part of the leg
- Deeply pigmented skin
- Red and scaly skin in the affected area
- Intense itching in the skin
Further complications can then arise.
The cracks and poor skin condition make it possible for bacterial infection to enter the skin. Cellulitis can develop and spread through the leg. Cellulitis is a serious infection that affects the deeper body tissues.
The effect of stasis dermatitis on the skin, together with the application of different medications, can cause it to become extremely sensitive and painful to touch. This is known as contact dermatitis.
Causes and risk factors
People with varicose veins are more likely to develop varicose eczema.
The legs have valves that enable blood to be pumped upward toward the heart. As people get older, these valves weaken, and the blood can leak out and pool in the lower leg, causing swelling and a condition known as venous insufficiency.
These circulatory problems can lead to blood leakage and cell death, and it can develop into stasis dermatitis.
At increased risk are those who have, or have had:
- Venous insufficiency
- Varicose veins
- High blood pressure or a heart condition
- A blood clot, for example, deep vein thrombosis (DVT)
- Surgery to the area
- Kidney failure
Lifestyle factors include:
- Standing or sitting for a long time, for example, at work
- A lack of exercise
- Excess body fat
Those at higher risk include people who are overweight or obese, and women who have had several pregnancies. Extra weight and pregnancy put additional strain on the veins in the legs.
The physician will carry out a physical examination. The visible signs and symptoms will indicate the condition. They will ask about the patient's history of blood clots, surgery, heart disease, and previous injury to the affected area.
Tests may be carried out to find the reason for the poor circulation.
These may include:
- Blood tests
- Ultrasound to detect any blood flow problems
- Heart function tests
Allergy tests may be carried out, because a person with stasis dermatitis will have a higher chance of a skin allergy.
Treatment will focus on relieving the symptoms.
Compression stockings or dressings can help to reduce swelling and boost circulation. The patient should also keep their legs raised above the level of the heart.
Raising the legs can help. The American Academy of Dermatology (AAD) advises patients to elevate the legs for 15 minutes every 2 hours, and to prop them up on a pillow while sleeping.
Medications such as a corticosteroid or a topic calcineurin inhibitor (TCI) may be prescribed to reduce inflammation, including redness, swelling, and pain.
Ulcers or weeping lesions may need special dressings. At first, the dressing must be changed every 2 to 3 days, but in time, once or twice a week will be enough.
Antibiotics will be necessary in the case of cellulitis, erosions and ulcers, and other types of infection. A large ulcer may need a skin graft.
Antihistamine medication can reduce itching.
Moisturizers and emollients can help reduce dry skin. The ADD recommend using petroleum jelly or a thick cream that is clearly marked "fragrance free." A physician, dermatologist, or pharmacist can advise about options.
Surgery can remove varicose veins that lead to pain, discomfort, and sores.
If the skin becomes discolored, a dermatologist may offer advice about how to reduce this.
Prevention and management
Sitting or standing for long periods increases the risk.
People with stasis dermatitis will usually have it for the rest if their life.
Management of the condition involves:
- Using compression stockings
- Keeping the legs raised when possible
- Using medication for skin care and when symptoms flare up
Taking care of the legs can help prevent stasis dermatitis.
- Not standing or sitting for prolonged periods
- Using emollients or moisturizers to keep the skin supple
- Avoiding bath products and soaps that dry the skin
A healthy lifestyle with exercise and a balanced diet can help prevent stasis dermatitis and a range of other conditions from developing later in life.