Gravitational Eczema - An Overview

What Is Gravitational Eczema?

Gravitational eczema is a type of skin condition that typically occurs on the lower legs. It is also known as venous eczema or gravitational dermatitis. This is because the veins in your legs are not functioning properly, which leads to the pooling of blood.

As a result, the skin on your legs turns red, itchy, dry, and even scaly or swollen. In addition, it may also develop sores if it is left untreated. Those who have varicose veins or poor circulation are more likely to develop this condition. To treat it, one needs to elevate the legs, wear compression stockings, apply moisturizers, and, in some cases, creams to decrease inflammation.

Who Gets Gravitational Eczema?

Gravitational eczema is a skin disease most often seen in middle-aged and older patients. It is reported that it affects 20 percent of people above 70 years of age. It is associated with the following conditions:

• History of venous thrombosis on the lower leg.

• History of cellulitis on the lower leg.

• Chronic swelling is increased by hot weather and prolonged standing.

• Varicose veins (twisted and enlarged veins that are superficially seen under the skin).

• Stasis ulcers (open wounds around the ankle or lower leg).

What Causes Gravitational Eczema?

Gravitational eczema occurs due to fluid collecting in the tissues and also due to an innate immune response. Usually, during walking, the leg muscles pump the blood in an upward direction, and valves in the veins prevent blood pooling.

A clot in the deep leg veins or varicose veins damages the valves. Fluid collecting in the tissues and back pressure is developed with inflammatory reactions since it is caused by increased pressure in the leg veins. Some factors that increase the chance of causing this skin disease include:

• Gender- Gravitational eczema is more common in women.

• Obesity - Obesity can increase pressure in the leg veins.

• Pregnancy - Pregnancy also increases pressure in the leg veins.

• Increasing Age - Generally, people find it harder to move as they get older, affecting their circulation.

What Are the Clinical Features of Gravitational Eczema?

Venous eczema can appear as discrete patches or become confluent and circumferential. These clinical features include:

• Itchy redness.

• Blisters.

• Crusted papules or dry fissured and scaly plaques on one or both lower legs.

• Orange-brown macular pigmentation occurs due to hemosiderin deposition.

• Atrophie blanche (irregular white scars that are surrounded by red spots).

• The champagne bottle shape of the lower leg shows narrowing at the ankles and induration.

Sometimes legs may become swollen, and veins are visible on the legs at the day's end or after standing for a long time. Some patients may also have other symptoms, such as:

• Discoloration of the skin.

• Tender and tight skin, which becomes hardened.

• Pain.

• Eczema also affects other parts of the body.

If not treated, leg ulcers develop. In addition, long-lasting wounds are formed where the skin has been damaged.

How Is Gravitational Eczema Diagnosed?

The diagnosis of venous eczema or gravitational eczema is made clinically. Diagnosis is based on performing the following tests.

Patch Test: This test is taken when there is suspicion of contact allergy. The patch test is a type of skin test used to identify the cause of possible allergic reactions on the skin. This reaction is called allergic contact dermatitis. Contact dermatitis is one type of skin reaction to something that comes in contact with the skin. This kind of allergic reaction can usually cause inflammation, redness, and itching.

What Is the Treatment for Gravitational Eczema?

To manage gravitational eczema, treatment focuses on reducing swelling in the legs, caring for the skin, and treating any varicose veins.

Reduce Swelling in the Legs:

• Avoid standing for long periods.

• Take regular walks to improve circulation.

• Elevate your feet while sitting. If your legs are swollen, place them above hip level.

• Elevate your feet overnight while in bed.

• In the early stages of eczema, bandaging can help reduce swelling.

Treat the Eczema:

• Apply compresses using Condy’s solution (potassium permanganate) or dilute vinegar on gauze.

• Take oral antibiotics like Flucloxacillin if there is a secondary infection.

• Use strong topical steroid creams daily on affected patches until they flatten. Then switch to a milder cream, such as Hydrocortisone, to control itchiness.

• Avoid overusing steroid creams as they can thin the skin. Short courses of stronger creams can be used if necessary.

• Ointments like coal tar may also help.

• Apply moisturizing creams regularly to keep skin soft and smooth. Urea cream is useful for very dry, scaly skin.

• Protect the skin from injuries to prevent infections or ulcers.

Treatment for Varicose Veins:

• Consult a vascular surgeon for varicose vein treatment.

• Varicose veins can be treated with procedures like sclerotherapy or endovenous laser therapy.

• Because vein problems can come back, veins may need further treatment in the future.

How Can Gravitational Eczema Be Prevented?

One cannot prevent gravitational eczema completely, but treatment may reduce the disease's severity by following these measures.

• Avoid prolonged sitting with legs down or prolonged standing.

• Using compression socks or stockings for the legs.

• Gravitational eczema patients can apply emollients frequently and regularly to dry skin.

• Avoid using soaps. Instead, use water alone or non-soap cleansers when bathing.

Conclusion

Gravitational eczema tends to be a chronic and recurring disorder for life. Repeatedly treating with topical steroids may be helpful. Early treatment may prevent the severity of the disease. Talk to our skin specialist for a better understanding.

Key Takeaways

• Gravitational eczema occurs when the veins in the legs are not functioning properly.

• It is more prevalent in older people, women, and those who have varicose veins.

• Raising the legs, wearing compression stockings, and applying moisturizers help manage the condition.

• If not treated timely manner, eczema can cause ulcers, wounds, and changes in skin color.

• Managing varicose veins can help manage eczema symptoms and prevent them from occurring again.