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Stasis Dermatitis

This is a common condition caused by poor functioning of the deep veins in the legs. This includes swelling, varicose veins, brownish discoloration of the lower legs, and at times itchy red scaly skin, firm tender or achy legs, and even slow healing and chronic ulcerations.

Cause

Blood returning from the legs to the heart has to flow up hill against gravity. Ordinarily it does
this as the muscles in the legs squeeze around the veins, and then one-way valves in the veins prevent back
flow. With aging, and also after blood clots in the legs these valves wear out. When this happens blood
backs up and pressure in the veins increases.

Results

Varicose or dilated/enlarged veins then occur in the legs and feet. If this back flow gets worse fluid begins to leak out of the capillaries causing swelling around the ankles especially after long periods of sitting or standing. If this gets worse still, small amounts of blood leak out causing speckled discoloration of the lower legs that initially appears pink or red, and then brown as the blood breaks down (sort of like a bruise). As this continues to occur this can become a darker brown color. If swelling and leakage becomes particularly bad the legs can become red, itchy, inflamed and scaly. This is then called stasis dermatitis which can be very bothersome, and sometimes difficult to treat. It can be further irritated by dryness and soaps. In severe cases the legs can develop firm deep scar tissue or fibrosis and pain. Additionally, any cuts, scratches or sores can be very slow to heal, or may even not heal and become chronic ulcerations.

Treatment

To treat any of these problems the most important and helpful step is to decrease the swelling and improve blood flow back to the heart.

  • Elevate the legs as much as possible. Lay down or prop the legs up when sitting.
  • Wear compression support stockings. These come in two types.
    • Those available over the counter are low strength. They are less expensive and easier to put on, but not highly effective.
    • Moderate to high strength support stockings can be obtained with a prescription from your doctor at medical supply stores. Supply stores measure the legs for exact fit. They are more difficult to put on, but much more effective. If you have particular troubles putting them on contact the supply store for various devices such as a stocking butler (wire frame) that can be purchased to help. Before these are prescribed we have to be sure you have good pulses or good arterial inflow into the legs as well. With either type these are usually worn daily when out of bed to keep swelling down.
  • Horse Chestnut is an herbal supplement that has been shown in many studies to be beneficial and comparable to compression stockings. This is generally available in health food stores and should be taken twice a day. Always consult your physician before starting new oral treatments.
  • Your primary care physician should evaluate you to be sure there is no other cause or problems such as heart disease (congestive heart failure), or kidney failure that can cause fluid overload or back up.
  • For severe cases resulting in redness, scaling and itching prescription creams can be used and measures for dry skin followed, as described in the dermatitis handout

Problems with venous stasis are usually not cured, but should at least be improvable and controllable with the above measures.