Stasis dermatitis and ulcers

Definition

Stasis dermatitis is changes in the skin that occur when blood collects (pools) in the veins of the lower leg.

Alternative Names

Venous stasis ulcers; Ulcers - venous; Venous ulcer

Causes, incidence, and risk factors

Venous insufficiency is a long-term (chronic) condition in which the veins have problems sending blood from the legs back to the heart.

Some people with venous insufficiency develop stasis dermatitis. Blood pools in the veins of the lower leg. Fluid and blood cells leak out of the veins into the skin and other tissues. This may lead to itching, which causes more skin changes.

Symptoms

You may have symptoms of venous insufficiency, which include a dull aching or heaviness in the leg and pain that gets worse when you stand.

At first, the skin of the ankles and lower legs may look thin or tissue-like. You may slowly get brown stains on the skin.

If you scratch the area, the skin may become irritated or crack. It may also become red or swollen, crusted, or weepy.

Over time, some skin changes become permanent:

  • Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
  • A bumpy or cobblestone appearance of the skin
  • Dark brown color

Skin sores (ulcers) may develop (called a venous ulcer or stasis ulcer). These most often form on the inside of the ankle.

Signs and tests

The diagnosis is primarily based on the appearance of the skin. Your doctor may order tests to examine the blood flow in your legs.

Treatment

You may take the following steps to manage venous insufficiency, which is causing stasis dermatitis:

  • Use elastic or compression stockings to reduce swelling
  • Avoid standing or sitting for long periods of time and keep the leg raised when you sit
  • Try varicose vein stripping or other nonsurgical procedures

Caring for and treating the skin can help the problem, or may make it worse. Talk with your health care provider before using any lotions, creams, or antibiotic ointments. Avoid:

  • Topical antibiotics, such as neomycin
  • Drying lotions, such as calamine
  • Lanolin
  • Benzocaine and other products meant to numb the skin

Treatments your health care provider may suggest include:

  • Wet dressings (use only when instructed)
  • Topical steroid creams or ointments
  • Oral antibiotics

Support Groups

Expectations (prognosis)

Stasis dermatitis is often a long-term (chronic) condition.

Complications

  • Bacterial skin infections
  • Chronic leg ulcers
  • Infection of bone
  • Permanent scar

Calling your health care provider

Call for an appointment with your health care provider if you develop leg swelling or symptoms of stasis dermatitis. Watch for signs of infection:

  • Drainage that looks like pus
  • Open skin sores (ulcers)
  • Pain
  • Redness

Prevention

To prevent this condition, control the causes of peripheral edema.

References

Habif TP. Eczema and hand dermatitis. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 3.