Stasis dermatitis is an inflammatory reaction seen in the skin of the lower
leg caused by static (slow or delayed) venous flow of the leg. Stasis
dermatitis is common in patients 50 years and older. Factors that can
contribute to the early onset of stasis dermatitis include obesity, inactivity,
venous injury, dependency (lower than the heart) of the leg or infection of the
leg. The primary contributing cause of stasis dermatitis is valvular
incompentency of the veins of the leg resulting in chronic edema (swelling).
The appearance of venous stasis can range from simple swelling to severe
ulcerations (see symptoms, below).
Treatment of stasis dermatitis and venous stasis ulcers.
Central to the treatment of venous stasis dermatitis and venous stasis ulcers
is control of lower extremity edema. Edema can be controlled by
elevating the legs above the level of the heart, use of diuretics and the use of
compression hose. It's important to
realize that when using compression hose, the hose need to be put on first thing
in the morning in advance of any swelling. If swelling is allowed to occur
before applying the support hose, that swelling will likely be there the rest of
the day.
Eczematous changes (peeling and flaking) and lichenification (hardening of
the epidermis) can be treated with
skin softening agents. Inflammatory changes of the skin are common and
can be treated with topical or oral steroids. Discoloration of the skin is
difficult to treat. Discoloration or darkening of the skin is often due to
the deposition of hemosiderin (the iron component of red blood cells).
Once hemosiderin is deposited in the skin, is is much like a tattoo that stains
the skin from within.
Ulceration
of the skin is common, particularly at the medial (inside) ankle. The area
superficial to the origin of the great saphenous vein is the most common site of
ulceration. Ulcerations should be cultured and treated for infection if
necessary. Dome paste boots, also called an Unna boots are the gold
standard for treating venous stasis ulcerations. Dome paste boot are
saturated with zinc oxide that will moisturize the skin. Dome past boots
are applied on a one weekly basis to control lower extremity edema.
Treatment can take from one to many weeks to see complete closure of the venous
ulcer.
It is essential to realize that control of edema is necessary following
successful treatment of a venous stasis ulcer.
Compression hose should be worn daily to
prevent reoccurrence of ulcerations.
