Stasis dermatitis and ulcers

Answer 1

Definition

Stasis dermatitis is a skin condition due to the buildup of fluid (swelling) under the skin.

Alternative Names

Venous stasis ulcers; Ulcers - venous

Causes, incidence, and risk factors

The extra fluid that builds up in the body makes it hard for the blood to feed cells and get rid of waste products. The tissue becomes poorly nourished and fragile, resulting in stasis dermatitis. The disorder is common on the ankles because there is less supportive tissue in this area.

Poor circulation in the veins (venous insufficiency) can cause stasis dermatitis and craters (ulcers) in the skin. Varicose veins, congestive heart failure, and other conditions can cause the arms and legs to swell, especially the feet and ankles.

Symptoms

• Darkening of skin at the ankles or legs
• Itching
• Leg pains
• Open sores, ulcers
• Skin appears thin, tissue-like
• Skin irritation of the legs
• Skin lesion: macule or patch
• Skin spots, red
• Swelling of legs, ankles, or other areas
• Thickening of skin at the ankles or legs

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

The condition that is causing the problem and swelling must be controlled. Treatments may include:

• Surgery to correct varicose veins
• Medications to control heart failure
• Diuretics to remove excess fluid

Circulation in the area may improve as swelling goes down. Raising the legs above the level of the heart can help reduce the swelling. Gradually increasing gentle activity, such as walking, can improve circulation.

Elastic stockings may be recommended to improve blood flow from the legs, which will reduce swelling.

Treatments for the skin may include wet dressings and topical antibiotics to control infection in open ulcers. Keep the skin area clean.

Expectations (prognosis)

Stasis dermatitis is often a long-term (chronic) condition. You may minimize symptoms by controlling the condition and swelling.

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
• Pain
• Redness

Prevention

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

Answer 2

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

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.

Reviewed By

Review Date: 10/14/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.