Stasis dermatitis frequently presents with signs of CVI which persists regardless of the state of stasis dermatitis. This includes edema, atrophie blanche, varicosities and hyperpigmentation and reddish-brown discoloration due to deep dermal hemosiderin deposits. Most of these symptoms started in the medial ankle and gradually spread up the lower leg or down the foot. Patient may also complain of pruritis.

Along with these symptoms, patient may present with crusts, exudation and superficial ulcerations in acute cases of stasis dermatitis.

Chronically, physical examination may present with lichenification and hyperpigmentation from scratching and rubbing due to pruritis. There will also be gradual tightening of the skin as it becomes drier. Dermal fibrosis as discussed above will result to lipodermatosclerosis, scar-like changes in the fat and other soft tissues. This may also present with the classic inverted champagne appearance of the ankle.

In severe cases, ulceration occurs with oozing, crusted areas made worse with contact dermatitis and bacterial infection. Some chronic conditions develop violet plaques and nodules on the legs and dorsal foot that may undergo painful ulceration called pseudo-Kaposi sarcoma or acroangiodermatitis.

• Swelling

  An early case of stasis dermatitis showing redness and swelling Symptoms of stasis dermatitis (venous eczema, gravitational dermatitis) include: Swelling, especially around the ankles that goes away while sleeping but returns in the day Redness Discolored [nationaleczema.org]

  Evaluation also included subjective changes in tenderness, oozing, and pigmentation, and measurement of the circumference of the leg for swelling and malleolar edema (measured in millimeters). [ncbi.nlm.nih.gov]

  Treatment can include: wearing compression stockings to promote circulation and relieve swelling sleeping with legs elevated elevating the legs for 15 minutes once every 2 hours taking medications to ease pain and reduce swelling, such as corticosteroids [medicalnewstoday.com]

  Possibly ultrasonography Doctors diagnose stasis dermatitis in people who have the characteristic skin changes and other symptoms of leg swelling and chronic venous insufficiency. [msdmanuals.com]

• Pain

  Sometimes pain may persist from swollen tissues and may feel like "stabbing" or "needle pricks" The cracks and poor skin condition of this disorder predisposes the patient for the entry of bacterial infection, causing a cellulitis infection in the leg [en.wikipedia.org]

  Skip to content Enjoy a Pain Free Life! [novusspinecenter.com]

  The peppermint oil provides soothing pain relief. Antiseptic tea tree oil has natural cicatrizant properties, which may help support tissue development. [terrasilskinrepair.com]

  The clinical parameters were graded (0-4; 0, absent; 1, mild; 2, moderate; 3, severe; 4, very severe) both before and after therapy, and included pain, itching, tiredness, heaviness, paresthesia, cramps, and leg swelling. [ncbi.nlm.nih.gov]

  “When your legs are that swollen, they’re really painful to wear,” she said. “Patients will say, ‘Don’t you come near me with those TED hose.’ [mdedge.com]

• Weakness

  Deposition of fibrin around capillaries Microvascular abnormalities Ischemia Continuous presence of edema in ankles, usually present because of venous valve incompetency (varicose veins) Weakness of venous walls in lower extremities Trauma to edematous [unboundmedicine.com]

  Causes of Stasis Dermatitis When blood valves in the leg become weak, blood sometimes leaks out and puddles in the legs. This poor circulation syndrome is known as venous insufficiency. [abilenederm.com]

  Wearing Compression Boots Wearing compression stockings and boots during your waking hours can help circulation in the weak region. Avoiding Scratching In most Stasis Dermatitis cases, there are rashes and sores in the affected skin area. [hxbenefit.com]

  For example, congestive heart failure and kidney failure can both increase your risk, as can venous insufficiency, a condition in which the valves that direct blood to the heart are weak. [alphaveinclinic.com]

• Weight Loss

  Her suggestion is weight loss surgery. She didn't offer any treatment of the rash. It's now 2010 and four years later at approx 6am on March 3, I decided to look up exercises to increase lower leg circulation on SparkPeople. Eureka! [sparkpeople.com]

  Lifestyle changes (eg, weight loss, regular exercise, reduction of dietary sodium) can decrease risk by decreasing lower extremity venous pressure. [owensboromedical.com]

  Lose weight Excess weight—especially obesity—can lead to the leaky veins that cause venous stasis dermatitis. (This is the absolute best diet for weight loss!) 7. [readersdigest.ca]

  For people who are overweight, a doctor will often provide advice on weight loss techniques. [medicalnewstoday.com]

• Surgical Procedure

  Venous stasis dermatitis can usually be resolved through noninvasive treatments, but sometimes minimally invasive surgical procedures are necessary, such as sclerotherapy, endovenous laser ablation or radiofrequency ablation. [docsdermgroup.com]

  procedures Some skin care treatments can make the problem worse. [nlm.nih.gov]

• Venous Insufficiency

  In 5 patients with pronounced changes of chronic venous insufficiency and in 5 control patients without chronic venous insufficiency the flufenamic acid content in skin sections parallel to the surface was determined by HPLC. [ncbi.nlm.nih.gov]

  Stasis dermatitis occurs in patients with chronic edema due to, for example, chronic venous insufficiency, right heart failure, or lymphedema. [merckmanuals.com]

  Typically, poor circulation is the result of a chronic (long-term) condition called venous insufficiency. Venous insufficiency occurs when your veins have trouble sending blood to your heart. [trufflesveinspecialists.com]

  […] to Stasis Dermatitis and Chronic Venous Insufficiency eVideo. [jaoa.org]

• Thrombosis

  […] sta·sis der·ma·ti·tis erythema and scaling of the lower extremities due to impaired venous circulation, seen commonly in older women or secondary to deep vein thrombosis, the latter with rapid onset and swelling. stasis dermatitis a common result of venous [medical-dictionary.thefreedictionary.com]

  […] from varicose veins, and deep vein thrombosis (DVT) can each contribute to CVI leading to venous hypertension (HTN) and cutaneous inflammation. [unboundmedicine.com]

  Blood Tests are only done if patient has venous thrombosis to test for hypercoagulability. They are also used if cellulitis or sepsis is suspected. Doppler Testing is used to detect for DVT or lesions from past thrombosis. [symptoma.com]

• Hypertension

  When pressure develops, we call this venous hypertension. Venous hypertension is typically the result of defective valves in the veins (valvular insufficiency). [myfootshop.com]

  This is a completely different condition from arterial hypertension which is the condition usually referenced when the word “hypertension” is used in medical discussions. [tennesseeveincare.com]

  These results support clinical experience that venous hypertension alone indeed can cause lower leg dermatitis. [ncbi.nlm.nih.gov]

  Fibrin cuffs are not found in ulcers due to causes other than venous hypertension. [emedicine.medscape.com]

• Vein Disorder

  disorders ultrasound is often employed to determine the location and extent of the venous insufficiency causing this problem. [reedervein.com]

• Dermatitis

  Stasis Dermatitis Pictures (Hardin MD Super Site Samples) Return to Hardin MD : Picture Gallery The links below go to sample pictures from DermNet.com hosted on the Hardin MD server. [hardinmd.lib.uiowa.edu]

  What is stasis dermatitis (venous eczema, gravitational dermatitis)? Stasis dermatitis is also called gravitational dermatitis, venous eczema, and venous stasis dermatitis. [nationaleczema.org]

  Stasis dermatitis Other names congestion eczema, gravitational dermatitis, gravitational eczema, stasis eczema, varicose eczema[1] Specialty Dermatology Stasis dermatitis refers to the skin changes that occur in the leg as a result of "stasis" or blood [en.wikipedia.org]

  Stasis dermatitis is sometimes called gravitational dermatitis, venous stasis dermatitis, venous eczema, or varicose eczema. [medicalnewstoday.com]

  Stasis dermatitis frequently presents with signs of CVI which persists regardless of the state of stasis dermatitis. [symptoma.com]

• Ulcer

  If the skin condition deteriorates further and breaks down, a venous ulcer (also known as a stasis ulcer) may form. Diagnosis[edit] This section is empty. You can help by adding to it. [en.wikipedia.org]

  Ulceration can be a complication. Diagnosis is clinical. Treatment is directed at the causes of edema and preventing ulceration. [merckmanuals.com]

  Compression therapy Compression therapy is referred for both edema and venous ulcers. Excessive edema can delay healing and risk infection. For venous ulcers, compression therapy is coupled with bland (zinc oxide paste) or colloid-type dressings. [symptoma.com]

• Eczema

  Stasis dermatitis Other names congestion eczema, gravitational dermatitis, gravitational eczema, stasis eczema, varicose eczema[1] Specialty Dermatology Stasis dermatitis refers to the skin changes that occur in the leg as a result of "stasis" or blood [en.wikipedia.org]

  What is stasis dermatitis (venous eczema, gravitational dermatitis)? Stasis dermatitis is also called gravitational dermatitis, venous eczema, and venous stasis dermatitis. [nationaleczema.org]

  For other pictures at DermNet.com, choose links for Stasis on this page: Eczema DermNet.com is developed & maintained by Alan N. Binnick & Thomas P. Habif, Dartmouth Medical School, New Hampshire. Image & content, Copyright DermNet.com. [hardinmd.lib.uiowa.edu]

  Stasis dermatitis (also known as "Congestion eczema," "Gravitational dermatitis," "Gravitational eczema," "Stasis eczema," and "Varicose eczema") refers to the skin changes that occur in the leg as a result of "stasis" or blood pooling from insufficient [knihy.heureka.cz]

  Stasis Dermatitis (also called Stasis Eczema, Gravitational Eczema, or Varicose Eczema) is a common skin disorder characterized by an itchy rash on the lower legs. [yinyangdermatology.com]

• Eruptions

  We report a case of leukaemia cutis presenting as stasis dermatitis-like eruption in a patient with myelodysplastic syndrome progressing to acute myelogenic leukaemia. [ncbi.nlm.nih.gov]

  Stasis dermatitis is a skin eruption which involves the lower legs. It is due to poor vein circulation in the legs. [sandlakedermatology.com]

• Dry Skin

  Soap should not be used on dry or sensitive skin. Most of us use far too much soap. Actually, plain water is often just enough to cleanse the skin. [randyjacobsmd.com]

  This is because there are many small cracks in the skin. An element of very dry skin. When the rash is infected it can ooze fluids, and crusts form on the top of the skin. [what-is-eczema.com]

  Some herbs work on the dermatitis and help to heal the dry skin and ulcers on your legs. Other herbs attempt to heal the blood stasis, or pooling blood, by improving circulation and treating the cause, which is venous insufficiency. [livestrong.com]

• Suggestibility

  Furthermore, these results are the first to suggest that the application of effective topical anti-inflammatory therapy can lead to improvement in HRQL. [ncbi.nlm.nih.gov]

  This observation suggests changes in capillary permeability. After a few days of treatment, new reddish petechiae did not appear suggesting that the capillary fragility was controlled. [jmedicalcasereports.com]

  Her suggestion is weight loss surgery. She didn't offer any treatment of the rash. It's now 2010 and four years later at approx 6am on March 3, I decided to look up exercises to increase lower leg circulation on SparkPeople. Eureka! [sparkpeople.com]

• Tingling

  Symptoms: The rash associated with stasis dermatitis can have the following characteristics: * Thin, inflamed, tissue-like skin * Itching, which can be severe * Tingling * Red skin spots, caused by small deposits of hemosiderin from the breakdown of red [sparkpeople.com]

  Treating the rash itself is centered on relieving the pain, tingling, and itching, and preventing any open sores and secondary infection from developing. [dermaharmony.com]

• Paresthesia

  The clinical parameters were graded (0-4; 0, absent; 1, mild; 2, moderate; 3, severe; 4, very severe) both before and after therapy, and included pain, itching, tiredness, heaviness, paresthesia, cramps, and leg swelling. [ncbi.nlm.nih.gov]

• Blood Tests are only done if patient has venous thrombosis to test for hypercoagulability. They are also used if cellulitis or sepsis is suspected. 
• Doppler Testing is used to detect for DVT or lesions from past thrombosis. It is also to assess the blood flow of new-onset acute stasis dermatitis or a young patient.
• Patch Testing is used to test for contact allergies or skin sensitivities.
• Skin Biopsy is rarely indicated

Acute lesions may present with:

• Epidermal spongiosis – inflammatory, intercellular edema
• Superficial perivascular lymphocytic infiltrate
• Serous exudate 
• Scale and crust 

Chronic lesions

• Skin biopsy is necessary if necessary if patient has acroangiodermatitis (pseudo-Kaposi sarcoma). Findings are similar with biopsy of Kaposi sarcoma but with the absence of atypical endothelial cells and vascular slits.
• Dermal fibrosis is evident by dilated dermal capillaries with intimal thickening and hyperkeratosis of stratus spinosum .
• Aggregates of siderophages in the deep dermis due to hemosiderin uptake.

Treatment for stasis dermatitis is more focus on the clinical effects of CVI since it directly causes the condition.

Compression therapy

Compression therapy is referred for both edema and venous ulcers. Excessive edema can delay healing and risk infection. For venous ulcers, compression therapy is coupled with bland (zinc oxide paste) or colloid-type dressings. Even after the ulcers heal, compression therapy must be continued as a lifetime habit to prevent recurrence.

Arterial function must first be assessed through physical examination or ancillary procedures. Compression therapy, a treatment for CVI leg edema, can exacerbate the patient’s condition if patient also has arterial dysfunction. Compression therapy is done through:

• Specialized stockings or compression stockings with controlled pressure gradient as a long-term management. For venous problems, pressures of 30-40 mmHg are commonly used. Compression stocking must be put by the patient in the morning as this is when limbs are smallest with the lowest venous pressure.
• Intermittent mechanical compression (IVC) pump and sleeve is used if patient has significant edema.
• Unna boot provides wound cover, compression and calf pump support in pumping venous blood from the lower extremity. This treatment is best for the ambulatory.
• Elastic wraps can be used by the patient after being trained by a professional on how to wrap them and best for non-ambulators.

Surgery

Ligation of the arteriovenous fistula or incompetent perforators can be effective if directly related to stasis dermatitis.
Varicose vein stripping is used when severe signs of stasis dermatitis such as liperdermatosclerosis, ulceration, atrophie blanche or hyperpigmentaton is present. Allogenic dermal substitutes can be used for intractable venous ulcers but are expensive and not necessary if patient responds to high-compression therapy [14]. Emergency surgery is also done if patient’s condition worsens to cellulitis to necrotizing fasciitis.

Light

Autologus platelet-rich plasma (PRP) coupled with light-emitting diode (LED) was found to be effective in treating recalcitrant ulcerating stasis dermatitis [10]. Pigmentation caused by stasis dermatitis was also found to be successfully treated with noncoherent intense pulsed light (IPL) [11].

Topical corticosteroids

Topical corticosteroids are used to alleviate pruritis and inflammation. Midpotency corticosteroids are used to avoid systemic absorption and induced cutaneous atrophy that may lead to ulceration. Tachyphylaxis is a phenomenon where the corticosteroid’s efficacy decreases due to prolonged used.
Nonsteroidal treatment do not carry the risks of corticosteroids such as cutaneous atrophy and tachyphylaxis. Calcineurin inhibitors such as tacrolimus and pimecrolimus may prove to be effective.

Topical antibiotics

Topical antibiotics are used if venous ulcers became infected. Mupirocin and silver sulfadiazine are some of the antiobiotics used. Beware of contact dermatitis caused by multiple topical medications. Any antibiotic used must first be approved by a physician. Triclosan has been shown to have low risk for contact dermatitis [12].

Oral/intravenous antibiotics

When patient acquires cellulitis, oral antibiotics are often prescribed such as cephalosporins and dicloxacillin.

Systemic therapy

The use of drugs, pentoxyfylline and flavonoids, may act on leukocyte activation and diminish the inflammatory response that leads to stasis dermatitis and venous ulceration [13]. However, even if these drugs prove to be effective, they may only be used on venous ulcer patients unresponsive to other treatments.

Stasis dermatitis is a chronic condition. The possibility of venous ulcer prevention and healing depend on the person’s health, age and state of CVI. If not treated properly, there would be an increase incidence of lichenification, lipodermatosclerosis, cellulitis and contact allergy dermatitis.

Chronic venous insufficiency (CVI) causes stasis dermatitis. Valvular dysfunction of the deep venous system causes venous hypertension and blood backflow into the superficial venous system. This results to swelling and later on, skin breakdown and irritation.

Aging, deep venous thrombosis (DVT), surgery and traumatic injury can directly cause valvular dysfunction that in time would result into CVI. Other factors that can affect the lower extremity venous system are varicose veins, hypertension (HTN), kidney failure, obesity, sedentary lifestyle, drugs and hear conditions such as congestive heart failure (CHF). Female gender, pregnancy and family history of venous disease are also established risk factors [1] [2]. Amlodipine, an antihypertensive drug, can also trigger stasis dermatitis through its common side effect lower leg edema [3].

The risk of stasis dermatitis also increases with age as one study shows that stasis dermatitis prevalence in 6.2% of patients over 65 years of age [4]. Another study shows that stasis dermatitis affects an estimate of 20% of people over 70 years of age [5].

In a comprehensive review in the prevalence of CVI and varicose veins, reports of CVI prevalence vary from < 1% to 40% in females and from < 1% to 17% in males. A higher prevalence of varicose veins was seen in reports varying from <1% to 73% in females and 2% to 56% in males [1]. CVI and varicose veins are more prevalent in women due to the stress pregnancy puts on the veins of the lower extremities.

Stasis dermatitis is a direct cause of CVI. However, the mechanism behind venous insufficiency remains unclear. The most accepted theory is the fibrin cuff theory. This theory was derived in the 1970s and 1980s’ studies where it was found that increased venous hydrostatic pressure transmits to the dermal microcirculation. With the increased dermal capillary permeability, macromolecules such as fibrinogen, leak out to the pericapillary tissues.

Fibrinogen then polymerizes into fibrin which forms into a fibrin cuff around the capillaries, preventing oxygen diffusion and resulting to hypoxia and cell damage [6].

Fibrin cuffs alongside with decreased fibrinolytic activity are then hypothesized to cause dermal fibrosis, the hallmark of stasis dermatitis. Trapped activated leukocytes release not only inflammatory mediators but mediators such as transforming growth factor beta1, an important mediator for dermal fibrosis [7]. This mechanism supports a direct relationship between venous dysfuntction and cutaneous inflammation with fibrosis [8].

Chemoacttractants that keep the leukocytes active are also present in the upregulation of vascular intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) [9].

Control of peripheral edema is helpful in the prevention of stasis dermatitis. Proper treatment is necessary to prevent complications.

Stasis dermatitis is an inflammatory cutaneous vascular disease due to chronic venous insufficiency. It is characterized by edema, erythema, pruritus and scaling of the skin. It commonly starts on the medial ankle on one or both lower extremities.

Lipodermatosclerosis, lichenification, ulceration and bacterial infection follow in severe cases. This condition is a direct consequence of chronic venous insufficiencyy (CVI) and affects women more than men aged 50 years and above.

Stasis dermatitis is also known as gravitation dermatitis, varicose eczema and congestion eczema.

Stasis dermatitis is skin irritation and breakdown due to fluid accumulation. Stasis causes leg swelling due to poor circulation and fluid buildup. Dermatitis is skin irritation with scaling, dryness, redness and itching.

It is caused by prolonged poor blood circulation on the veins commonly in the legs usually due to aging. This causes itching, redness, swelling and dry skin starting on the inside ankle of the foot and gradually spread to the lower leg or down the foot.

If not treated, the affected leg or foot may develop ulcers, skin hardening and discoloration which may lead to infection and hardening of tissues.

Stasis dermatitis is confirmed through physical examination and history. A blood test may be given if bacterial infection through ulcers is suspected.

Stasis dermatitis is treated by compression therapy and limb evaluation to decrease swelling. One recommended treatment is wearing of compressive stockings in the morning up to the end of the day. The compressive stocking may feel uncomfortable at first but the discomfort will lower as the edema lessens.

Skin and would care is also advised to prevent further ulceration of the leg through compression, topical medicine and wound dressing. Surgery may be prescribed in severe cases.

1. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfel D. The epidemiology of chronic venous insufficiency and varicose veins. Annals of Epidemiology. 2005; 15(3):175-84.
2. Fiebig A, Krusche P, Wolf A, Krawczak M, Timm B, Nikolaus S, Frings N, Schreiber S. Heritability of chronic venous disease. Human Genetics. 2010 Jun; 127(6):669-74.
3. Gosnell AL, Nedorost ST. Stasis dermatitis as a complication of amlodipine therapy. J Drugs Dermatol. Feb 2009; 8(2):135-7.
4. Yalçin B, Tamer E, Toy GG, Oztaş P, Hayran M, Alli N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. International Journal of Dermatology. 2006 Jun; 45(6):672-6.
5. Nazarko L. Diagnosis and treatment of venous eczema. British Journal of Community Nursing. 2009 May;14(5):188-94.
6. Pappas PJ, You R, Rameshwar P, et al. Dermal tissue fibrosis in patients with chronic venous insufficiency is associated with increased transforming growth factor-beta1 gene expression and protein production. Journal of Vascular Surgery. 1999; 30(6):1129-45 
7. Peschen M, Lahaye T, Hennig B, et al. Expression of the adhesion molecules ICAM-1, VCAM-1, LFA-1 and VLA-4 in the skin is modulated in progressing stages of chronic venous insufficiency. Acta dermato-venereologica. 1999; 79(1):27-32
8. Coleridge Smith PD, Thomas P, Scurr JH, Dormandy JA. Causes of venous ulceration: a new hypothesis. Br Med J (Clin Res Ed). Jun 18 1988;296(6638):1726-7.
9. Peschen M, Lahaye T, Hennig B, Weyl A, Simon JC, Vanscheidt W. Expression of the adhesion molecules ICAM-1, VCAM-1, LFA-1 and VLA-4 in the skin is modulated in progressing stages of chronic venous insufficiency. Acta Derm Venereol. Jan 1999;79(1):27-32.
10. Park KY, Kim IS, Yeo IK, Kim BJ, Kim MN. Treatment of refractory venous stasis ulcers with autologous platelet-rich plasma and light-emitting diodes: a pilot study. J Dermatolog Treat. Oct 2013;24(5):332-5.
11. Pimentel CL, Rodriguez-Salido MJ. Pigmentation due to stasis dermatitis treated successfully with a noncoherent intense pulsed light source. Dermatol Surg. Jul 2008;34(7):950-1.
12. Schena D, Papagrigoraki A, Girolomoni G. Sensitizing potential of triclosan and triclosan-based skin care products in patients with chronic eczema. Dermatol Ther. Oct 2008;21 Suppl 2:S35-8.
13. Pascarella L, Schonbein GW, Bergan JJ. Microcirculation and venous ulcers: a review. Ann Vasc Surg. Nov 2005; 19(6):921-7.
14. Taniguchi T, Amoh Y, Tanabe K, Katsuoka K, Kuroyanagi Y. Treatment of intractable skin ulcers caused by vascular insufficiency with allogeneic cultured dermal substitute: a report of eight cases. J Artif Organs. Mar 2012;15(1):77-82.