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What is stasis dermatitis?
This condition is also known as eczema. In this setting, the eczema only occurs on the legs, usually below the knee. It can appear on one or both legs and is most common around the middle of the ankle. It can also appear over the course of a varicose vein.
Stasis dermatitis appears as a scaly red rash with sharp borders sometimes called nummular eczema. It can itch or burn and can improve without treatment only to relapse in a few weeks or months. In severe cases, blisters can form and ooze a yellowish fluid.
What causes it?
The cause is believed to be chronic venous hypertension due to varicose veins. The veins in the legs have one-way valves to prevent the backward (downward) flow of blood toward the feet which physicians call "reflux." If the valves become damaged from injury to the leg, strenuous exercise such as weight lifting, or in standing occupations, the blood flows downward and pools in the leg veins leading to venous hypertension. This high pressure prevents the natural clearing of toxins from the skin and proper nourishment of the skin. Over time, the toxins build up causing the skin to break down and develop eczema. If left too long, the skin breakdown can lead to brownish discoloration and a thickening of the skin similar to elephant hide. The medical term for this is lipodermatosclerosis or hardening of the skin. Longstanding skin damage will eventually lead to an ulcer or sore.
Is stasis dermatitis a signal of a more severe medical condition?
If the varicose veins and venous hypertension are the cause of the leg dermatitis, then reflux is present. Reflux of blood is a major cause of blood clots in the legs which can lead to breaking off and migration to the lungs. This is the most common cause of sudden death in the U.S. today.
How do I know if I have this problem?
See your physician. A dermatologist can usually diagnose stasis dermatitis; however, a specialist in the diagnosis and treatment of venous disease, a phlebologist, will be able to diagnose reflux disease (chronic venous hypertension). A special test called duplex ultrasound will be ordered which will confirm or rule out reflux.
What can be done about stasis dermatitis?
Most of the time, the varicose veins must be treated to clear up the high blood pressure in the leg veins. This is accomplished by one of several methods: endovenous laser ablation, foam sclerotherapy or removal of the varicose veins. When the reflux is corrected, the stasis dermatitis clears up within a week or so.
In the short term however, topical cortisone cream can be used along with care of the eczema. Avoid soap and use Cetaphil Gentle Skin Cleanser, Aquanil Cleanser, or Pureblend Cleanser. After bathing, a good emollient cream should be applied while the skin is still damp, such as Eucerin lotion, Eucerin Cream, CeraVe cream, Aveeno moisturizing cream, Bag balm, Crisco Shortening, and Vaseline Petroleum Jelly.
In addition, prescription compression hose should be worn during the day to help the muscles pump blood out the leg veins. Walking also is very beneficial in this condition; however, heavy exercise such as weight lifting can lead to varicose veins, so this should be stopped.
Care of the feet is also extremely important. Regular pedicures are advised to keep the skin of the feet soft and supple. Athlete's foot infection should be controlled with topical over-the-counter antifungal creams. These will prevent cracking of the skin which is very important in keeping bacteria from causing a cellulitis.
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