Definition

Stasis dermatitis is a skin disorder characterized by problems in the veins, particularly those located in the lower extremities. This issue affects blood circulation, causing an accumulation of fluid and pressure, resulting in blood leakage into the skin. This disease is alternatively referred to as venous eczema. This illness typically manifests gradually over a long period and can be effectively managed.

Causes

Stasis dermatitis is a result of elevated venous blood pressure. The venous blood flow flows in its actual direction, which results in elevated blood pressure. This error might be attributed to issues about the valve's closure, valve damage, or obstructions within the veins. In addition, the pooled blood contains iron ions that elicit inflammatory responses.

Risk factor

Various factors can elevate the susceptibility to stasis dermatitis, such as:

• Hypertension
• Prominent varicose veins or back veins on the skin
• Excessive weight and obesity
• Heart disease, such as congestive heart failure, is characterized by the accumulation of fluid in different regions of the body
• Kidney failure
• Blood clots, particularly in the lower extremities
• History of two or more pregnancies
• Medical history of surgical procedures or injuries to certain parts of the body
• Sitting or standing for extended durations
• Lack of physical activity 

Symptoms

Like other forms of dermatitis or skin inflammation, stasis dermatitis causes the skin to become itchy, swollen, dry, scaly, and flaky. It manifests as a red or brown rash on pale skin. Conversely, stasis dermatitis manifests as purple or gray rashes on dark skin, making it challenging to see.

Stasis dermatitis typically manifests as a chronic condition. Symptoms may improve during specific periods but deteriorate on other occasions. The legs may swell, particularly at night or after standing for an extended period. Varicose veins may also be visible on the skin.

Other symptoms may include:

• Discoloration of the affected skin
• Lipodermatosclerosis, a hardening of the skin texture
• Small, white scars known as atrophy blanche
• Pain and eczema that manifest in other parts of the body 

Diagnosis

The diagnosis of stasis dermatitis relies on the patient's medical history and the findings from the examination results. Your physician may inquire about any preexisting medical issues, such as:

• Varicose veins are characterized by the enlargement of veins in the legs, resulting in a twisted and bulging appearance
• Deep vein thrombosis, blockage of the veins by blood clots
• Wounds on the legs that do not heal
• Cellulitis, an infection of the connective tissue beneath the skin
• History of surgery or injury to the legs

The ankle-brachial index (ABI) can be assessed by measuring blood pressure in both hands and ankles. This is done to ensure that you can receive treatment with a stocking and to check for any issues with the arteries in your legs. If there is a substantial disparity in blood pressure between the ankles and hands, stockings for the treatment of stasis dermatitis will not be given.

If you have a prior history of venous thrombosis, your physician will perform blood tests to assess whether your blood thickens too easily, increasing the likelihood of vein blockages.

Based on availability, further evaluation or referral to a dermatologist, general surgeon, vascular surgeon, or cardiothoracic surgeon (based on availability) may be necessary if you exhibit symptoms such as varicose veins, crusts, or leg ulcers. If your disease does not improve with the current treatment or if the ABI test shows a large difference in blood pressure between your ankles and hands, you may also be referred to specialists.

Management

Because stasis dermatitis occurs due to vascular obstruction, your doctors could suggest surgical intervention to repair your blood vessels. Several other approaches can be performed to enhance blood circulation to the heart, specifically:

• Use compression stockings to enhance blood circulation and reduce swelling
• Keep your legs positioned above your heart. You can do this by lying down and placing your lower legs on stacked pillows. Ideally, you can engage in this activity for 15 minutes every 2 hours and throughout periods of sleep
• Avoid standing for long periods 

Your doctor may prescribe anti-inflammatory or topical medicines to alleviate discomfort, redness, or swelling in your legs. Antihistamine medicine can also be prescribed to alleviate itchiness.

It may be necessary to apply a gauze dressing to the affected area. You could be prescribed oral or intravenous antibiotics if your lower legs are infected.

It may be necessary to apply a gauze dressing to the affected area. You could be prescribed oral or intravenous antibiotics if your lower legs are infected. Moisturizer can also be applied to maintain skin moisture and soften the affected area. To prevent skin irritation, avoid moisturizers that contain fragrances, paraffin, or sensitizers. For example, you could choose petroleum jelly and thick creams as moisturizers.

Stasis dermatitis typically manifests gradually over a long time span, necessitating a lengthy treatment. Hence, steadfast dedication is required to address stasis dermatitis effectively. Individuals who experience skin discoloration may opt to use powder to conceal it.

Complications

Stasis dermatitis can lead to wounds that refuse to heal and cellulitis, an infection of the connective tissue beneath the skin. It can also lead to skin crusts, similar eczema on otherwise healthy legs, an increased risk of allergic contact dermatitis, and skin irritation brought on by contact with allergenic substances.

Prevention

Several preventive measures can be taken to minimize the occurrence or development of stasis dermatitis. These steps include:

1. Take breaks

If your job requires you to stand or sit for an extended period of time, allocate time to move around. Take ten minutes every hour for a walk.

2. Physical activity

Physical activity enhances the circulation of blood. It is advisable to seek guidance from your physician regarding the appropriate duration of exercise and the workouts that are deemed safe for you.

3. Wear Comfortable Clothing

Compression stockings can be worn for your lower legs, but it is advisable to wear looser clothing for the rest of your body. Tight or coarse fabrics could potentially cause skin irritation and hinder blood circulation.

4. Maintain proper skin care practices 

The skin is prone to irritation. When showering, using a mild cleanser and towel, followed by a fragrance-free moisturizer is advisable. It is also advisable to refrain from using cleaning products, perfumes, herbs, plants, animal hair, and other materials that could potentially harm your skin.

When to see a doctor?

If you experience pain in the legs along with swelling, you should visit a doctor right away. You should also seek medical attention if you have a history of cellulitis, varicose veins, or venous thrombosis before your symptoms. Stasis dermatitis typically develops gradually over a long period. Therefore, if the pain and swelling are sudden or new, it may indicate the presence of venous thrombosis, a medical emergency. Untreated venous thrombosis can result in the obstruction of pulmonary blood vessels, potentially leading to death.

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