Stasis Dermatitis: A Varicose Eczema

Published November 20, 2014 by teacher dahl

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Stasis dermatitis is skin inflammation caused by blood pooling in the veins in your legs. Pooling of blood in the veins of the legs is called venous insufficiency or venous stasis.

Venous pooling causes the pressure inside the veins to be higher than normal (venous hypertension). This elevated pressure in the veins causes damage to your capillaries. When capillaries are damaged, a protein called fibrinogen leaks out into your tissues. Your body converts fibrinogen to fibrin. The buildup of fibrin (fibrin cuffs) is thought to cause a decrease in oxygen supply to the skin, resulting in cell death. This inflammatory process causes your skin to change in its appearance.

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Stasis dermatitis is a chronic condition that can cause considerable discomfort. This condition is most likely to occur in people over the age of 50. About six to seven percent of people in that age group have stasis dermatitis. Incidence of this condition may be as high as 20 percent in those over age 70. Women are slightly more likely than men to have stasis dermatitis. This is thought to be due to increased stress on leg veins caused by pregnancy. (Flugman & Clark , 2010)

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What are the symptoms of Varicose Eczema (Stasis Dermatitis)?

Symptoms of eczema may include itching, which is the most common symptom, dry skin and rash usually consisting of red or scaly areas of skin.

Areas infants are commonly affected by eczema are face, neck, extensor surfaces, trunk and groin. In children front of elbows and behind the knees and in adults the front of elbows, behind knees, face, neck and upper chest are most affected.

Common Causes of Stasis Dermatitis
Inside the veins in your legs are one-way valves that keep blood flowing in the right direction—toward your heart. These valves become weak with age. This allows blood to flow back across the valves toward the feet and pool in your legs (venous stasis) instead of continuing to flow toward your heart. Venous stasis leads to stasis dermatitis. Varicose veins and congestive heart failure are also known to cause leg swelling and stasis dermatitis. Common causes of stasis dermatitis that are unrelated to age are:
• surgery (such as using a leg vein for bypass surgery)
• deep vein thrombosis (DVT, blood clots in the leg veins)
• trauma

Symptoms of Stasis Dermatitis
Symptoms of stasis dermatitis include skin darkening, itching, scaling, and ulcers.
You may also have symptoms of venous stasis including:
• leg swelling
• calf pain and tenderness
• dull ache or heaviness in the legs that gets worse when you stand
In the early stages of stasis dermatitis, the skin on your legs may look thin. Your skin may itch. Scratching may cause the skin to crack, and fluid may seep out. The changes eventually become permanent. The skin becomes thick and hard (lipodermatosclerosis). Your skin becomes dark brown and may look lumpy. In the final stages, your skin breaks down, and an ulcer (sore) forms. Ulcers from stasis dermatitis most commonly form on the inside of your ankle.
When to Call the Doctor
You should call your doctor if you notice leg swelling or any of the symptoms of stasis dermatitis. Other symptoms that you should seek immediate help for include:
• pain
• redness
• open wounds or ulcers
• pus-like drainage
How Is Stasis Dermatitis Diagnosed?
Stasis dermatitis is diagnosed mostly from the appearance of the skin on your legs. Your doctor may order a venous Doppler. This is a noninvasive ultrasound test that uses sound waves to check the blood flow in your legs.
Home Treatments
There are several things you can do to treat stasis dermatitis:
• avoid prolonged standing and sitting
• prop your feet up when sitting
• wear compression stockings

basic therapyAsk your doctor about what kinds of skin creams and ointments to use. You should avoid using the following products:
• lanolin
• calamine and other lotions that dry your skin
• topical antibiotic ointments such a neomycin
• benzocaine and other numbing agents
Your doctor might tell you to apply wet dressings or may prescribe oral antibiotics or topical steroid creams and ointments. Medications are used to control congestive heart failure and leg swelling. Surgery may be recommended to correct varicose veins.

histaminesLong-Term Consequences of Untreated Symptoms
Stasis dermatitis that is allowed to progress untreated can result in:
• chronic leg ulcers
• bone infection (osteomyelitis)
• bacterial skin infections
• permanent scarring
How Can Stasis Dermatitis Be Prevented?
Control of peripheral edema (swelling in the legs, ankles, and feet) can prevent stasis dermatitis.
More symptoms can occur that include rash may develop oozing or crusting of the skin, thickening and leathery quality of skin with chronic eczema (known as lichen simplex chronicus), paleness around the mouth, extra fold of skin beneath lower eyelid (Dennie’s or Morgan’s line) and/or increased number of skin creases on the palms.
The cracks and poor skin condition of this disorder predisposes for the entry of bacterial infection causing spreading cellulitis infection in the leg. If the skin condition deteriorates further and breaks down, a venous ulcer (also known as statis ulcer) may form.

Immediate medical attention is recommended if redness and swelling occur, a yellowish crusting is present or drainage of pus is observed.

In addition to physical discomfort, people with eczema may develop emotional problems, such as depression or anxiety, and may experience social difficulties due to visible skin rashes. Eczema and its treatment may be particularly difficult for children, especially when skin involvement is quite severe.

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