Stasis Dermatitis - Causes, Symptoms, Diagnosis, Treatment, and Prevention

Introduction:

Stasis dermatitis is a common type of eczema that occurs in people with poor blood supply in the lower legs, mostly near the ankles or in arms, after radiation therapy of axillary lymph nodes. Stasis dermatitis is seen in patients with chronic swelling due to chronic venous insufficiency, heart failure, or enlargement of the lymph. Stasis dermatitis, chronic venous insufficiency, and leg ulcers are sometimes treated with various topical drugs. The common complication of stasis dermatitis is allergic contact dermatitis.

How Is It Otherwise Known?

It is also called:

• Gravitational dermatitis.

• Venous eczema.

• Varicose eczema.

• Venous stasis dermatitis.

What Causes Stasis Dermatitis?

Blood is continuously circulating throughout the body. When blood reaches the legs, valves in the legs allow it to flow back toward the heart. These valves weaken as a process of aging, leg injury, heart disease, or any other medical condition. As the valves weaken, a little amount of blood accumulates in the legs. This causes less venous return resulting in stasis dermatitis.

Who Gets Stasis Dermatitis?

Stasis dermatitis develops in people who have poor blood supply to the lower legs. More particularly, it is common in,

• People above 50 years of age.

• Women are more commonly affected than men.

• Obese individuals.

• People who do a little exercise and follow a sedentary lifestyle.

• Regularly sitting or standing for a prolonged time.

• Injury or surgery related to the lower leg.

• Underlying medical conditions related to the lower leg or cellulitis, kidney disease.

What Are the Symptoms of Stasis Dermatitis?

Early Signs and Symptoms:

The early signs and symptoms include:

• Itchy, dry, discolored skin swelling, especially over varicose veins. The swelling may not fade as the disease aggravates.

• Skin feels wound up, discolored, and sore.

• Heaviness or pain in one or both legs when standing or while walking.

• Swelling, often seen on the inside of the ankle. Swelling in the leg that clears when sleeping but reappears.

• Stasis dermatitis on the inner ankles can cause discolored, dry, and itchy skin.

• If stasis dermatitis extends to the top of the feet, wearing footwear can be painful even after treatment.

Advanced Stage Stasis Dermatitis:

Without proper treatment, stasis dermatitis can worsen and cause the following problems:

• Pain.

• Highly pigmented skin.

• Discolored scales on the skin on the lower legs and top of the feet.

• Skin hardening.

• Extreme itchiness of the skin.

• Wounds and boils.

• Decrease in the lower part of the calf.

Long-Standing Stasis Dermatitis:

Without treatment, stasis dermatitis changes the shape of the legs. The swelling no longer decreases while sleeping. The skin darkens, hardens, and becomes painful. The lower part of the calf shrinks, a condition called lipodermatosclerosis.

How to Diagnose Stasis Dermatitis?

• Complete and differential blood count.

• A Doppler ultrasound study is done to rule out a blood clot or any damage to the blood vessels.

• A patch test is done to check for allergic reactions affecting the skin.

How to Treat Stasis Dermatitis?

While treatment helps to alleviate pain and uneasiness at any stage, treatment cannot completely cure stasis dermatitis. The earlier diagnosis and treating it, the better is the outcome.

Treatments for stasis dermatitis due to insufficient blood flow are:

• Using elastic or compression to decrease swelling.

• Bland dressings like zinc oxide paste and other dressings like hydrocolloids are also effective.

• Leg elevation: While awake, the leg has to be kept elevated above the heart for 15 minutes every two hours. Legs may also need to be kept elevated while sleeping.

• Massage therapy can help reduce swelling.

• Varicose vein stripping or other surgical procedures like flush ligation and saphenectomy are done.

• Interventional therapy includes ultrasound-guided foam sclerotherapy and endovenous thermal ablation, which have replaced open surgical techniques.

Other treatment options to alleviate pain and symptoms include:

• Unna Boot: It is a wet compression dressing done only under the advice of the physician.

• Wound Care: Clean the area with saline, and wear bandages. Keep the wound moist, as it helps in healing.

• Apply moisturizer for dry, cracked skin.

• Topical steroid ointments or creams.

• Oral antihistamine to reduce itching.

• Oral antibiotics.

• Intense Pulsed Light (IPL) is used to treat discoloration of the skin.

• Good nutrition.

Things to avoid by patients with stasis dermatitis:

• Applying any topical antibiotics.

• Lotions for drying the lesion.

• Lanolin.

• Benzocaine and any anesthetics to numb the skin.

How to Prevent Stasis Dermatitis?

The following habits help prevent worsening stasis dermatitis.

1. Elevating the legs above the heart improves the blood flow.

2. Take breaks when sitting or standing for a longer time.

3. Exercise and walking improve blood circulation and strengthen the calf muscles.

4. Wear loose-fitting cotton clothing as the tight fabric irritates sensitive skin.

5. Use compression garments as advised by the dermatologist to improve blood circulation, prevent open sores, and reduce flare-ups.

6. Avoid irritating the skin affected with stasis dermatitis; avoid contacting pet hair, grass, cleaning products, perfume, or rough-textured towels.

7. Moisturize dry skin to prevent scaly skin and irritation.

8. Drinking eight glasses of water every day can improve circulation and reduce swelling.

9. Limiting salt can decrease blood flow. The recommended daily dose of sodium is 1,500 milligrams or less.

10. Go for regular check-ups with a dermatologist.

What Is the Prognosis of Stasis Dermatitis?

Stasis dermatitis is a long-term condition. The prognosis of stasis dermatitis is good when it is treated successfully with respect to its causative factors and prevention of complications.

What Are the Conditions That Resemble Stasis Dermatitis?

The other conditions that resemble stasis dermatitis are:

• Cellulitis.

• Contact dermatitis.

What Are the Complications of Stasis Dermatitis?

Complications of stasis dermatitis include:

• Bacterial infection of skin and bone.

• Permanent scarring.

• Skin cancer, particularly squamous cell carcinoma.

Conclusion:

Stasis dermatitis is blood vessel inflammation due to chronic venous hypertension and its effect on the adjacent skin. It resembles a ‘sprinkled cinnamon’ due to the leakage of blood into the dermis. When stasis dermatitis displays eczematous signs, it tends to spread to the rest of the body. Sometimes, stasis dermatitis and allergic contact dermatitis are found to be associated. Hence there is always a possibility of allergic contact dermatitis when analyzing stasis dermatitis.