Stasis Dermatitis

Stasis dermatitis also called gravitational dermatitis, venous eczema, and venous stasis dermatitis is skin inflammation that develops in people with poor circulation. Typically, poor circulation is the result of a long-term condition called chronic venous insufficiency. Venous insufficiency occurs when your veins have trouble sending blood to your heart. It most often occurs in the lower legs because that’s where blood typically collects. Very rarely, Stasis dermatitis may involve the upper limbs in patients with artificial arteriovenous (AV) fistulas for hemodialysis, or congenital AV malformations. It is seen more in female population and it may be most likely due to the fact that pregnancy results in significant stress on the lower-extremity venous system.

Stasis Dermatitis is usually a precursor to more problematic conditions, such as venous leg ulceration. At first, symptoms seen are those affecting the ankles. There may be swelling that appears toward the end of the day and lessens after sleeping overnight. Eventually it leads to heavy or aching legs when standing for a prolonged period.

In the early stage, the skin may become red, swollen, which may later turn weeping and crusty. This can be made worse by bacterial superinfection or by contact dermatitis caused by the many topical treatments often applied.

When the red blood cells breakdown from the pooled blood, it leads to deep dermal deposit of hemosiderin (a protein from hemoglobin). This causes diffuse, red-brown discoloration. These spots can also be itchy. Sometimes, loss of hair may also accompany.

A number of diseases and conditions can increase your risk for developing stasis dermatitis but main factors are venous insufficiency, obesity, multiple pregnancies for females.

Diagnosis is usually based on good history and physical examination. Lower-extremity duplex ultrasound can be used to measure ankle-brachial index.

Treatment includes leg elevation, compression, and dressings. Sometimes topical or oral antibiotics may be recommended. Petroleum jelly or fragrance free creams can help reduce dry skin.

Stasis dermatitis tends to come back until the underlying cause (damaged veins) is addressed. Hence venous interventions like varicose vein closure or treatment for DVT –are needed to address the underlying cause.

Primary prevention involves adequate anticoagulation after DVT and use of compression stockings for up to 2 years after DVT or lower extremity venous trauma. Lifestyle changes (eg, weight loss, regular exercise, reduction of dietary sodium) can decrease risk by decreasing lower extremity venous pressure.