What causes stasis dermatitis and ulcers?

Stasis dermatitis is sometimes called gravitational dermatitis, venous stasis dermatitis, venous eczema, or varicose eczema. According to the National Eczema Association, stasis dermatitis occurs mostly in people aged 50 years or older and is more common in women than men.

In this article, we look at the causes, risk factors, and symptoms of stasis dermatitis. We also cover the diagnosis, treatment, and prevention of this condition.

Causes

Stasis dermatitis tends to develop in people with conditions that cause poor blood circulation in the legs, such as chronic venous insufficiency.

Chronic venous insufficiency is a condition in which the valves in the leg veins do not work correctly. As a result of the malfunctioning valves, blood can flow backward and pool in the lower legs. This pooling blood causes increased pressure and swelling in the veins, which can lead to the symptoms of stasis dermatitis.

Other conditions that can affect blood flow in the legs and feet and lead to stasis dermatitis include:

• DVT, which is a blood clot in the lower leg
• varicose veins, or enlarged and swollen veins
• injury to the lower leg
• any surgery that affects the veins in the lower leg
• congestive heart failure

Risk factors

Several known factors can increase a person's risk of developing stasis dermatitis, including:

• being female
• being over 50 years old
• being overweight or obese
• having any condition that affects blood circulation
• having high blood pressure
• having kidney disease
• giving birth
• standing or sitting for extended periods
• getting insufficient exercise

Symptoms

The early symptoms of stasis dermatitis primarily affect the lower legs and may include:

• irritated skin
• red, itchy, or swollen skin, particularly over any varicose veins
• a sensation of fullness, heaviness, or aching after extended periods of standing or walking
• swelling on the inside of the lower leg and ankle, particularly at the end of the day or after standing for prolonged periods

As stasis dermatitis progresses, these earlier symptoms can worsen. In addition, new symptoms can appear, including:

• swelling that spreads into the calves
• red or purple ulcers that may ooze or scab
• shiny, swollen skin
• itchy, dry, and cracked skin

In severe cases of stasis dermatitis, some areas of the lower leg may become intensely itchy, hardened, scaly, and prone to infection. In some people, the calves may shrink.

Diagnosis

A doctor will diagnose stasis dermatitis by asking about the person's symptoms and medical history. Previous or current conditions that they should be aware of include:

• problems with the heart or circulation
• blood clots
• surgeries
• injuries to the lower legs

The doctor may then examine the skin on the lower legs to check for visual signs of stasis dermatitis. They may also order a Doppler ultrasound, which is a noninvasive test that uses sound waves to check the blood flow through blood vessels. Additional tests that check for heart function, blood pressure, and allergies may also be necessary.

Treatment

The goal of treatment for stasis dermatitis is to relieve symptoms, improve circulation, and prevent the condition from progressing. Treatment can include:

• wearing compression stockings to promote circulation and relieve swelling
• sleeping with legs elevated
• elevating the legs for 15 minutes once every 2 hours
• taking medications to ease pain and reduce swelling, such as corticosteroids or topical calcineurin inhibitors
• using antihistamines to relieve itching
• using antibiotics and special dressings to treat infected ulcers
• applying emollients to moisturize and protect the skin

A doctor will also evaluate a person for any underlying conditions that may be contributing to their stasis dermatitis. This might include reviewing any medications that the person is taking. For people who are overweight, a doctor will often provide advice on weight loss techniques.

Complications

Without treatment, stasis dermatitis can worsen and lead to complications that include:

• chronic leg ulcers
• leg wounds that fail to heal
• abscesses
• cellulitis, which is a bacterial infection in the deep layers of the skin
• infection of the bone, known as osteomyelitis

Prevention

Stasis dermatitis is not always preventable. However, making the following lifestyle changes can reduce the risk of developing stasis dermatitis or making it worse:

• reaching and maintaining a healthy weight
• getting enough exercise
• elevating the legs above the heart regularly when seated
• limiting sodium consumption

The diagnosis and treatment of any underlying conditions that can cause stasis dermatitis will also help reduce a person's risk.

Outlook

Stasis dermatitis is a long-term condition that can cause a range of skin and circulation problems in the lower legs.

Treatment can help keep a person's symptoms under control and prevent the condition from progressing. Stasis dermatitis can lead to severe complications if the individual does not receive treatment.

Anyone with symptoms of stasis dermatitis should see a doctor.

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