Stasis dermatitis

Severe stasis dermatitis on the lower leg and foot: Poor blood flow leads to these skin changes.

Stasis dermatitis: Overview

Also called gravitational dermatitis, venous eczema, and venous stasis dermatitis

This condition develops in people who have poor circulation. Because poor blood flow usually occurs in the lower legs, this is where stasis dermatitis often develops. It may occur in one or both legs. Stasis dermatitis can develop in other areas, but this is rare.

Stasis dermatitis is most common in the lower legs because leg veins have one-way valves, which play an important role in circulating our blood. These valves push blood up the legs. As we age, these valves can weaken and stop working properly. Some blood can leak out and pool in the legs. Your dermatologist may refer to this as “venous (vee-nis) insufficiency.”
If you’ve been diagnosed with venous insufficiency, it does not mean that you will get stasis dermatitis. Watching for signs and symptoms of stasis dermatitis is important though. Treatment and self-care can prevent the stasis dermatitis from becoming severe.
Swelling around the ankle is often the first sign of stasis dermatitis. The swelling tends to clear while you sleep — and return during the day. Other early signs are discolored skin and varicose veins.
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Flugman, SL et al. (authors) and Elston DM et al (editors). “Stasis dermatitis.” Medscape. Last updated July 2014.
Fritsch PO and Reider N. “Other eczematous eruptions: Stasis dermatitis.” In: Bologna JL, Jorizzo JL, et. al. Dermatology (second edition), Elsevier Mosby, 2008:201-2.
Weaver J, Billings SD. “Initial presentation of stasis dermatitis mimicking solitary lesions: A previously unrecognized clinical scenario.” J Am Acad Dermatol. 2009 Dec;61(6):1028-32.
Trayes KP, Studdiford JS, et. al. “Edema: Diagnosis and management.” Am Fam Physician. 2013 Jul 15;88(2):102-10.

Stasis dermatitis on the lower leg: Some people develop sores that open and bleed. A dermatologist should examine all sores.

Stasis dermatitis: Signs and symptoms

Early signs and symptoms

Most people develop stasis dermatitis on their lower legs. When it begins in the legs, you may notice the following in one or both legs:

• Heaviness or aching when you stand or walk for a long time
• Swelling, often on the inside of the ankle, at the end of the day
• Swelling clears when you sleep, but re-appears during the day
• Varicose veins
• Itchy, dry skin over the varicose veins

• Skin may feel irritated — red, swollen, and sore

Signs and symptoms as disease progresses

As the stasis dermatitis progresses, people often notice the following:

• Swelling spreads beyond the ankle to the calf
• Dry, cracked, itchy skin
• Red to violet-colored open sores (medical term: venous ulcer), which can appear on the lower legs and tops of the feet
• Sores leak fluid and scab as they heal
• Sores can cause scars when they heal
• Shiny skin

Severe stasis dermatitis: Treatment and self-care can prevent stasis dermatitis from becoming severe.

Severe stasis dermatitis

Left untreated, stasis dermatitis can worsen over the years and cause the following:

• Area feels hard
• Lower part of the calf shrinks, often making the calf look like an upside-down wine bottle
• Skin becomes deeply pigmented
• Redness and scale cover the area, including the top of the foot
• Intensely itchy skin

Other medical conditions can develop where a person has stasis dermatitis. Two common conditions are:

• Contact dermatitis (skin becomes very sensitive to almost everything that touches it, including medicines and ingredients in moisturizers, such as lanolin)
• Cellulitis (a serious infection that extends deep into the skin)

Image #1 used with permission of Journal of the American Academy of Dermatology: 2009; 61:1028-32.

Image #2 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

References
Flugman, SL et al. (authors) and Elston DM et al. (editors). “Stasis dermatitis.” Medscape. Last updated July 2014.
Fritsch PO and Reider N. “Other eczematous eruptions: Stasis dermatitis.” In: Bologna JL, Jorizzo JL, et. al. Dermatology (second edition), Elsevier Mosby, 2008:201-2.
Habif TP, Campbell JL, et al. “Stasis dermatitis” (card #18). Dermatology DDxDeck. Mosby Elsevier 2006.
Trayes KP, Studdiford JS, et. al. “Edema: Diagnosis and management.” Am Fam Physician. 2013 Jul 15;88(2):102-10.
Weaver J, Billings SD. “Initial presentation of stasis dermatitis mimicking solitary lesions: A previously unrecognized clinical scenario.” J Am Acad Dermatol. 2009 Dec;61(6):1028-32.

Stasis dermatitis: Who gets and causes

Who gets stasis dermatitis?

Stasis dermatitis is most likely to develop in someone who has the following traits:

Age: Because poor circulation leads to stasis dermatitis, this type of dermatitis usually develops in people who are middle aged or older. In the United States, stasis dermatitis:

• Tends to develop in people 50 years of age and older
• Rarely occurs before 40 years of age

Gender: Women are slightly more likely to develop stasis dermatitis.

Medical history: Having one or more of the following increases your risk of developing stasis dermatitis:

• Venous insufficiency (your body has trouble returning blood from your legs to your heart, so some blood pools in your legs)
• Varicose veins (or blood relatives who have them)
• High blood pressure
• Previous blood clot, especially a blood clot in a leg like deep vein thrombosis
• Previous injury to the area
• Many pregnancies
• Surgery (to the area or removing a vein from the area)
• A heart condition, such as congestive heart failure (a weakened heart cannot pump blood effectively)
• Kidney failure
• Being very overweight

Lifestyle: Having any of the following also increase your risk of developing stasis dermatitis:

• Standing or sitting for long periods of time, such as at work
• Getting little or no exercise
• Excess body fat

You can reduce your risk

If you get little or no exercise, becoming more active may reduce your risk of developing stasis dermatitis. Exercise can improve your blood flow, help you shed excess body fat, and possibly reduce high blood pressure.

Before beginning any exercise, you should talk with your doctor to make sure it’s safe for you.

What causes stasis dermatitis?

Poor circulation leads to stasis dermatitis. Because poor circulation most commonly develops in the lower legs and feet, this is the most common area of the body for stasis dermatitis to develop.

If you have stasis dermatitis, an accurate diagnosis and treatment are essential. Treatment can prevent the disease from worsening.

References
Fritsch PO and Reider N. “Other eczematous eruptions: Stasis dermatitis.” In: Bologna JL, Jorizzo JL, et. al. Dermatology (second edition), Elsevier Mosby, 2008:201-2.
Sippel K, Mayer D, et. al. “Evidence that venous hypertension causes stasis dermatitis.” Phlebology. 2011 Dec;26(8):361-5.

Stasis dermatitis: Diagnosis and treatment

How do dermatologists diagnose stasis dermatitis?

To diagnose this condition, your dermatologist will examine your skin, looking closely at the skin that shows signs of stasis dermatitis. Your dermatologist will also want to know about your medical history.

It is important to mention the following:

• Past blood clot
• Injury to the area
• Heart disease
• Surgeries

Medical tests may be necessary to find out exactly why you have poor circulation in the area. Your dermatologist may refer you to another doctor or recommend one or more of following tests:

• Blood tests
• Doppler ultrasound (to look at how your blood flows)
• Tests to rule out problems with your heart
• Allergy testing (stasis dermatitis increases the risk of developing an allergic reaction on your skin)

If you have stasis dermatitis, your dermatologist will create a treatment plan that addresses your specific needs.

How do dermatologists treat stasis dermatitis?

When treating stasis dermatitis, the goal is to get it under control. Your treatment plan will include treatment for each of your signs and symptoms, which may include:
Swelling: To reduce the swelling in a lower leg, most patients wear a compression stocking, compression dressing, or Unna boot. Compression can reduce swelling as well as improve your circulation.

Because it is so important to reduce swelling, it helps to elevate your legs throughout the day. If possible, dermatologists recommend that you elevate your legs above your heart:

• Once every 2 hours for 15 minutes
• While you sleep (keep your legs elevated with pillows)

Inflammation (redness, swelling, and pain): To treat this, most patients apply medicine to the stasis dermatitis. Your dermatologist may prescribe a medicine called a corticosteroid or a topical calcineurin (cal-see-neur-in) inhibitor (TCI).
Infection: If you have an infection, taking an antibiotic or applying an antibiotic to the stasis dermatitis can help clear the infection.>
Wounds: You may need to apply a special dressing to the wound to help it heal.
Itch: Taking an antihistamine can help calm an intense itch.
Dry skin: Applying a moisturizer a few times per day can help get rid of the dry skin.
Because stasis dermatitis makes the skin so sensitive, you’ll want to use a moisturizer that is free of:

• Fragrance
• Dyes
• Perfumes

Good options include petroleum jelly and a thick cream that says “fragrance free” on the label. Your dermatologist may also recommend a moisturizer.
Varicose veins: Sometimes varicose veins — those large blue or purple veins that rise above the skin’s surface — can cause discomfort and pain. In rare cases, they can cause bleeding leg sores.
Removing troublesome vein can alleviate your discomfort and may reduce bleeding leg sores. If vein removal is recommended, your dermatologist can recommend an appropriate procedure for you. Many procedures are minimally invasive.

About the skin discoloration: Stasis dermatitis can cause the affected skin to turn a brownish color. This discoloration often remains even when the swelling, sores, and other signs clear. If the discoloration bothers you, ask your dermatologist about treatment options that could reduce the discoloration.

What is the outcome for a person who has stasis dermatitis?

You may have stasis dermatitis for life. Many patients are able to manage the disease on their own once they get the stasis dermatitis under control. Managing the disease often involves:

• Wearing compression stockings
• Elevating your legs as needed
• Following a skin care plan
• Applying medicine when you have a flare

You’ll also need to see your dermatologist for follow-up appointments.
Self-care plays an important role in getting stasis dermatitis under control. It is essential to keep it under control.

References
Flugman, SL et al. (authors) and Elston DM et al. (editors). “Stasis dermatitis.” Medscape. Last updated July 2014.
Fritsch PO and Reider N. “Other eczematous eruptions. “Stasis dermatitis.” In: Bologna JL, Jorizzo JL, et. al. Dermatology (second edition), Elsevier Mosby, 2008:201-2.
Habif TP, Campbell JL, et al. “Stasis dermatitis” (card #18). Dermatology DDxDeck. Mosby Elsevier 2006.
Maroo N, Choudhury S, et. al. “Oral doxycycline with topical tacrolimus for treatment of stasis dermatitis due to chronic venous insufficiency: A pilot study.” Indian J Pharmacol. 2012 Jan-Feb;44(1):111-13.
Trayes KP, Studdiford JS, et. al. “Edema: Diagnosis and management.” Am Fam Physician. 2013 Jul 15;88(2):102-10.

Elevating your legs above your heart can reduce the swelling in your legs. When you raise your legs above your heart, your blood can circulate easier and you reduce the swelling caused by blood and other fluids accumulating in your lower legs.

Stasis dermatitis: Tips for managing

If you have stasis dermatitis, self-care is essential for getting stasis dermatitis under control and preventing it from worsening. Dermatologists often recommend the following tips to their patients who have stasis dermatitis:

Elevate your legs above the heart: You’ll want to do this throughout the day. If possible, dermatologists recommend that you elevate your legs above your heart:

• Once every 2 hours for 15 minutes
• While you sleep (keep your legs elevated with pillows)

Take breaks when you must sit or stand for long periods. If you must sit or stand for long periods, take a break every hour and walk briskly for 10 minutes.
Get physical. Exercise can improve your circulation and strengthen your calf muscles. Ask your dermatologist how often you should exercise.
Wear loose-fitting cotton clothing. Wearing cotton clothes help to avoid irritation. Rough fabrics like wool, polyester, and rayon can irritate your skin.
Loose-fitting clothing is important, too. Tight waistbands and snug pants interfere with your circulation. When clothing rubs against the stasis dermatitis, it can irritate the sensitive skin.
Wear your compression garment if your dermatologist recommends one. Compression can:

• Improve the circulation in your legs
• Prevent open sores
• Reduce your risk of another flare.

Most patients stop wearing a compression garment (compression stockings or Unna boots) because it feels uncomfortable. The discomfort tends to lessen as the swelling subsides.
Avoid anything that could aggravate the stasis dermatitis. The skin with stasis dermatitis is very sensitive, so you want to prevent the stasis dermatitis from touching anything that could irritate it, such as:

• Pet hair
• Plants
• Grass
• Cleaning products
• Perfume
• Any skin care product that does not say “fragrance free.”

Apply moisturizer when your skin feels dry. Moisturizer helps prevent scaly skin and irritation. Petroleum jelly works well for most patients. If you prefer to use another moisturizer, choose an ointment or thick cream that says “fragrance free” on the container.

Avoid scratching the stasis dermatitis. Scratching can worsen stasis dermatitis and lead to an infection. To reduce the itch, apply your medicine as directed. Other ways to calm the itch include:

• Applying a cool compress
• Spreading on a fragrance-free moisturizer
• Adding colloidal oatmeal to a cool bath

Take care when bathing. Soaps and rough-textured towels can irritate the stasis dermatitis. Dermatologists recommend the following to their patients with stasis dermatitis:

• Use a mild, fragrance-free cleanser rather than soap. When you shower or take a bath, use this cleanser. Rinsing soap from other parts of your body can irritate the stasis dermatitis.
• After bathing, gently pat the water from your skin with a clean towel. You’ll want to keep a bit of water on the skin with stasis dermatitis.
• Within 2 minutes of bathing, apply petroleum jelly or a thick, creamy moisturizer that is fragrance free. This helps to keep moisture in your skin. Keeping your skin moisturized helps to prevent scaly skin and irritation.

References
Flugman, SL et al. (authors) and Elston DM et al. (editors). “Stasis dermatitis.” Medscape. Last updated July 2014.
Fritsch PO and Reider N. “Other eczematous eruptions: Stasis dermatitis.” In: Bologna JL, Jorizzo JL, et. al. Dermatology (second edition), Elsevier Mosby, 2008:201-2.
Trayes KP, Studdiford JS, et. al. “Edema: Diagnosis and management.” Am Fam Physician. 2013 Jul 15;88(2):102-10.

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