Stasis Dermatitis - Causes, Symptoms and Treatment

Stasis dermatitis is a skin condition due to the build up of fluid (swelling) under the skin. Stasis dermatitis refers to the skin changes that occur in the leg as a result of "stasis" or blood pooling from insufficient venous return, the common cause of this being from varicose veins leads to the alternative name of varicose eczema. Stasis refers to a stoppage or slowdown in the flow of blood (or other body fluid such as lymph). A stasis ulcer is an ulcer (a crater) that develops in an area in which the circulation is sluggish and the venous return (the return of venous blood toward the heart) is poor. A common location for stasis ulcers is on the ankle. Stasis dermatitis occurs as a direct consequence of venous insufficiency. Disturbed function of the 1-way valvular system in the deep venous plexus of the legs results in backflow of blood from the deep venous system to the superficial venous system, with accompanying venous hypertension. This loss of valvular function can result from an age-related decrease in valve competency. Alternatively, specific events, such as deep venous thrombosis, surgery (eg, vein stripping, harvesting of saphenous veins for coronary bypass), or traumatic injury, can severely damage the function of the lower-extremity venous system. The hypoxia/stasis theory was refuted by evidence that instead of pooled, stagnant blood with low oxygen tension, leg veins in patients with venous insufficiency have increased flow rates and high oxygen tension. Arteriovenous shunting could have accounted for these findings, but no evidence of shunting in patients with venous insufficiency was found. The complete lack of evidence to support a hypoxia/stasis theory has led many investigators to advocate the abandonment of the term stasis dermatitis.

The mechanism by which venous hypertension causes the cutaneous inflammation of stasis dermatitis has been extensively studied for decades. The cracks and poor skin condition of this disorder predisposes for the entry of bacterial infection causing spreading cellulitis infection in the leg. If the skin condition deteriorates further and breaks down, a venous ulcer may form. This is most likely due to the fact that pregnancy results in significant stress on the lower-extremity venous system, with many women experiencing earlier and more severe derangement of lower-extremity valvular function. The risk of developing stasis dermatitis steadily increases with each passing decade; when considering only adults older than 70 years, the prevalence of stasis dermatitis may be greater than 20%. The well-publicized aging of the population will undoubtedly result in a significant increase in cases of stasis dermatitis over the next few decades. Poor circulation in the veins (venous insufficiency) can lead to stasis dermatitis and ulcers (craters) in the skin. Varicose veins , congestive heart failure , and other conditions can cause the arms and legs to swell, especially the feet and ankles. Stasis dermatitis can begin so slowly that it is barely noticeable or so rapidly that it seems to develop overnight. Signs and symptoms include is 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 , Violet-colored lesions may appear on lower legs and tops of the feet, Skin thickens and darkens with repeated scratching and rubbing and Itching (can be severe).

Causes of Stasis Dermatitis

Common Causes and Risk factors of Stasis Dermatitis

Chronic venous insufficiency.
Allergic contact.

Sign and Symptoms of Stasis Dermatitis

Common Sign and Symptoms of Stasis Dermatitis

Swelling of legs , ankles, or other areas
Skin spots, red.
Darkening of skin at the ankles or legs.
Open sores, ulcers.
Superficial skin irritation of the legs.
Itching.
Leg pains.

Treatment for Stasis Dermatitis

Common Treatment for Stasis Dermatitis.

Topical therapy: Using wet-to-damp gauze dressings soaked with water or with a drying agent, such as aluminum acetate. Topical corticosteroids are frequently used for reducing inflammation and itching in acute flares.
Oral antibiotics are useful when cellulitis (inflammation and redness) is present; topical antibiotics are useless and often cause contact dermatitis (eczema).
When swelling subsides, split-thickness skin grafts (a kinds of plastic surgery) may be useful.
Applying a moisturizing cream such as cetaphil moisturizing cream twice daily.
For the red, itchy areas, applying 1% hydrocortisone cream (available over the counter) twice daily will help.
Proper skin care includes using only mild soaps or cleansers and applying a moisturizer (such as petrolatum) after each bath on the legs.
Antihistamine such as Atarax (generic form is hydroxyzine). I give it in small, easier to tolerate doses such as 10mg 1-2 every 4-6 hours. This makes it less likely the patient will become too
Simply applying a topical antifungal cream such as Lamisil cream helps keep the fungus in the nail.

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