Types of Eczema
Stasis Dermatitis

Developing in the lower legs, this common eczema occurs when circulation becomes sluggish. Poor blood flow causes fluids to build up, and the legs swell. Over time, this build up of fluids affects the skin, causing a rash that usually itches, painful sores, as well as thinning and discolored skin. Effective treatment involves treating not only the dermatitis but the circulatory problem as well.

Other Names

• Gravitational dermatitis

• Venous eczema

• Venous stasis dermatitis

Signs and Symptoms
Stasis dermatitis can begin so slowly that it is barely noticeable or so rapidly that it seems to develop overnight. Signs and symptoms include:

• Swelling in one or both lower legs. In severe cases, the swelling can include the foot and extend to just beneath the knee.

• Leg pain

• Thin and inflamed skin

• Itching (can be severe)

• Open sores that can be painful and heal slowly

• Patches of skin can be dry and scaly or ooze

• Reddish brown discoloration of the skin

• Honey-colored crusting when the skin becomes infected

• Skin thickens and darkens with repeated scratching and rubbing

• Violet-colored lesions may appear on lower legs and tops of the feet

Who Gets

• As poor circulation leads to stasis dermatitis, this type of dermatitis typically develops in people who are middle-aged or older. In the United States, about 15 – 20 million people over 50 years of age have stasis dermatitis.
   

• Rarely occurs before 40 years of age.
   

• Females are slightly more likely than males to develop the condition.

Causes
Poor circulation in the lower legs leads to stasis dermatitis. One of the primary causes of poor circulation is advancing age. A deep vein thrombosis, surgery, or injury that damages the veins in the lower leg also can cause stasis dermatitis.

Risk Factors
The risk of developing stasis dermatitis increases with advancing age and the following:

• Varicose veins

• Blood clot, including deep vein thrombosis

• High blood pressure

• Sedentary lifestyle

• Obesity

• Heart condition, such as congestive heart failure (a weakened heart cannot pump blood effectively)

• Kidney failure

People who develop stasis dermatitis have an increased risk of developing other medical conditions, including contact dermatitis (a common type of eczema) and cellulitis (a skin infection that extends deeper than the surface of the skin).

Duration
Stasis dermatitis often is a long-term condition that requires care even when the skin clears.

How Diagnosed
Diagnosis begins with a complete medical history and visual examination of the skin. The following tests may be ordered because another skin condition can be present and effective treatment includes improving the circulation in the lower legs:

• Blood tests

• Doppler testing to evaluate blood flow to the legs

• Patch testing to determine if the patient has developed an allergy(ies) that causes the skin to react

• Biopsy of the affected skin

Treatment
Getting signs and symptoms under control requires that the patient follow a comprehensive treatment plan that may involve:

• Elevating the legs above the heart. When sitting and sleeping, this can improve circulation in the legs and decrease swelling.
   

• Wearing a compression stocking while awake. Sometimes compression boots are prescribed. Both the stockings and the boots can improve circulation.
   

• Treating congestive heart failure. Treatment may involve taking a low-dose diuretic to treat congestive heart failure or high blood pressure.
   

• Applying a low-dose topical steroid. This can reduce inflammation.
   

• Applying a topical antibiotic. This is necessary if the skin becomes infected.
   

• Avoiding scratching. This is necessary to clear the skin.
   

• Taking an oral antibiotic if cellulitis develops. An oral antibiotic can help heal open sores and prevent tissue damage.
   

• Following wound-care instructions.
   

• Getting the recommended bedrest. Sometimes strict bedrest is necessary.

Once the signs and symptoms have cleared, the patient may require lifelong preventive maintenance that includes:

• Taking regular walks

• Not standing for long periods

• Elevating the legs when sitting or sleeping

• Wearing compression stockings while awake

• Moisturizing the legs regularly, usually with petroleum jelly

References:
Clark RAF et al. “The Other Eczemas.” In: Moschella SL et al. Dermatology (third edition). WB Saunders Co.: Philadephia, 1992:473-476.

Flugman SL et al. “Stasis Dermatitis.” eMedicine. Last updated September 2, 2005. Last accessed August 2006.

An educational program brought to you by the American Academy of Dermatology.