Stasis Dermatitis (Venous Eczema)

How stasis dermatitis develops

Leg veins carry blood back to the heart against gravity. One-way valves inside the veins and the pumping action of the calf muscles keep blood moving upward. When valves are damaged, blood flows backward and pools in the lower legs. This is chronic venous insufficiency.

The raised pressure, called venous hypertension, pushes fluid, proteins and red blood cells out of small vessels into the skin. This triggers inflammation, which shows up as eczema. Iron released from the red blood cells leaves brown staining (hemosiderin).

Symptoms

Symptoms usually start around the inner ankle and spread up the shin. Both legs are often affected, though one may be worse.

• itching, sometimes intense
• dry, scaly or cracked skin
• red, purple or brown discoloration; on darker skin, the color may look dark brown, gray or purple
• swelling of the ankles and lower legs, worse in the evening and better after a night's rest
• aching or heaviness in the legs
• weeping, oozing and crusting during flares
• visible varicose veins

Long-term skin changes

• Lipodermatosclerosis: the skin above the ankle becomes hard, tight and shiny, and the leg can narrow there like an upside-down champagne bottle. In its early stage it can be very painful and red.
• Atrophie blanche: smooth, white, star-shaped scars with tiny red dots.
• Venous ulcers: open sores, usually above the inner ankle, that heal slowly. See venous leg ulcers.

Stasis dermatitis vs cellulitis

Red, warm lower legs are often treated as infection when they are actually stasis dermatitis. Telling them apart prevents unnecessary antibiotics.

Causes and risk factors

• varicose veins and chronic venous insufficiency
• a previous deep vein thrombosis (post-thrombotic syndrome)
• obesity
• age over 50
• several pregnancies
• long periods of standing or sitting
• heart failure and kidney disease, which cause fluid buildup
• limited mobility, which weakens the calf muscle pump
• leg injury or surgery

Diagnosis

A doctor usually recognizes stasis dermatitis by its appearance and location. They may also:

• check pulses and measure the ankle-brachial index (ABI), comparing blood pressure in the ankle and arm, to rule out poor arterial circulation before recommending strong compression
• order a venous duplex ultrasound to look for valve failure, varicose veins or old clots
• do patch testing if a contact allergy to creams or dressings is suspected
• take a biopsy only if the diagnosis is unclear

Treatment

Compression

Compression is the foundation of treatment. It counteracts the pressure in the veins, reduces swelling and helps the skin heal.

• Graduated compression stockings, typically 20 to 30 mm Hg, or 30 to 40 mm Hg for more severe disease, prescribed after an arterial check.
• Put them on in the morning before swelling builds up.
• Wraps with Velcro closures or bandages are alternatives if stockings are hard to put on.

Strong compression can be harmful if you have significant peripheral artery disease, so do not start high-pressure stockings without advice.

Elevation and movement

• Raise your legs above heart level for 30 minutes three or four times a day.
• Walk regularly and do ankle pumps and calf raises to activate the calf muscle pump.
• Avoid standing or sitting still for long periods.

Skin care

• Apply a thick, fragrance-free emollient (moisturizer) at least once or twice daily.
• Use soap substitutes and lukewarm water.
• For flares, a topical corticosteroid ointment prescribed by your doctor, usually for 1 to 2 weeks.
• For weeping skin, cool wet compresses before applying treatments.
• Treat infection only when there are clear signs, such as pus, honey-colored crusts or spreading pain.

Avoid common skin allergens

People with stasis dermatitis are especially prone to contact dermatitis from products applied to the legs. Common culprits include neomycin and bacitracin ointments, lanolin, fragrances, preservatives and some dressings. Use simple, fragrance-free products.

Treating the veins

Procedures that close or remove faulty veins, such as endovenous laser or radiofrequency ablation, foam sclerotherapy or vein surgery, reduce venous pressure, help skin heal and lower the risk of ulcers coming back. A vascular specialist can advise whether you are a candidate.

Complications

• venous leg ulcers
• skin infection (cellulitis)
• contact allergy to treatments
• spread of eczema to other areas of the body (autoeczematization)
• permanent skin hardening and discoloration

Outlook and prevention

Stasis dermatitis is long-lasting because the underlying vein problem usually persists. With daily compression, elevation, skin care and activity, most people keep it under control and avoid ulcers. Brown staining may fade slowly but often remains. Maintaining a healthy weight, staying active and wearing compression on long flights or long days on your feet help prevent flares.

Frequently asked questions

What does stasis dermatitis look like?

It appears as itchy, dry, scaly skin on the lower legs, often around the inner ankles, with red, purple or brown discoloration and swelling. In darker skin the color can look gray or deep brown. Varicose veins are often visible, and long-standing cases show hard, shiny skin above the ankles.

What is the best treatment for stasis dermatitis?

The most effective treatment is compression with stockings or wraps, combined with leg elevation, regular walking and daily moisturizers. Short courses of prescription steroid ointment calm flares. Treating faulty veins with procedures such as ablation can improve the skin and prevent ulcers.

Is stasis dermatitis serious?

It is not dangerous by itself, but it signals poor vein circulation and can lead to leg ulcers, infections and permanent skin changes if untreated. It can also be confused with cellulitis. Seeing a doctor for diagnosis and a compression plan helps prevent complications.

Can stasis dermatitis be cured?

It usually cannot be cured completely, because the vein damage behind it is long term. It can be controlled well with compression, skin care and activity. Vein procedures that correct reflux can greatly improve the skin, and some people have long symptom-free periods.

How is stasis dermatitis different from cellulitis?

Stasis dermatitis usually affects both legs, develops slowly, itches and causes scaling and brown staining. Cellulitis is a bacterial infection that almost always affects one leg, develops over hours to days, is painful and tender, and often comes with fever. Elevation fades the redness of stasis dermatitis but not cellulitis.