Stasis dermatitis and ulcers

Definition

Stasis dermatitis is a change in the skin that results for the pooling of blood in the veins of the lower leg. Ulcers are open sores that can result from untreated stasis dermatitis.

Alternative Names

Venous stasis ulcers; Ulcers - venous; Venous ulcer; Venous insufficiency - stasis dermatitis; Vein - stasis dermatitis

Causes

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

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 and inflammation, which cause more skin changes. The skin may then break down to form open sores.

Symptoms

You may have symptoms of venous insufficiency including:

• Dull aching or heaviness in the leg
• Pain that gets worse when you stand
• Swelling in the leg

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.

The skin may become irritated or crack if you scratch it. 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
• Skin turns dark brown

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

Exams and Tests

The diagnosis is primarily based on the way the skin looks. Your health care provider may order tests to examine the blood flow in your legs.

Stasis dermatitis can also be related to heart problems or other conditions that cause leg swelling. Your provider may need to check your general health and order more tests.

Treatment

Your provider may suggest the following to manage the venous insufficiency that causes stasis dermatitis:

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

Some skin care treatments can make the problem worse. Talk with your provider before using any lotions, creams, or antibiotic ointments.

Things to avoid:

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

Treatments your provider may suggest include:

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

Outlook (Prognosis)

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

Possible Complications

Complications of stasis ulcers include:

• Bacterial skin infections
• Infection of bone
• Permanent scar

When to Contact a Medical Professional

Call your provider if you develop leg swelling or symptoms of stasis dermatitis.

Watch for signs of infection such as:

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

Prevention

To prevent this condition, control the causes of swelling of the leg, ankle, and foot (peripheral edema).

Images

References

Henke PK. Venous pathology. In: Cronenwett JL, Johnston KW, eds. Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 12.

O'Donnell TF Jr, Passman MA, Marston WA, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S-59S. PMID: 24974070 www.ncbi.nlm.nih.gov/pubmed/24974070.

Usatine RP, Krejci-Manwaring J. Dermatology. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.