Venous insufficiency is a condition which causes pooling or accumulation of blood in the leg veins. This leads to inflammation of the skin on the legs. Inflammation of the skin occurring, as a result of blood pooling in the veins of legs is known as Stasis Dermatitis. This is a chronic condition and causes quite some discomfort to the patient. Individuals over the age of 50 more commonly suffer from this condition. Women are also at a slightly increased risk for having stasis dermatitis. The most likely cause for this is increased pressure in the leg veins due to pregnancy.
As mentioned above, untreated stasis dermatitis commonly leads to venous leg ulcer. An ulcer is a break in the skin of the legs permitting bacteria to get into the tissues beneath. Common injury usually heals up without causing any problem. However, if there is any underlying medical problem, such as stasis dermatitis, then the skin does not heal and the break in the skin increases resulting in chronic leg ulcer.
Causes and Pathophysiology of Stasis Dermatitis
The leg veins have one-way valves which ensure that the blood flows towards the heart and does not flow backwards towards the feet. With age, these valves become weak or can be damaged due to which the blood flows in the wrong direction, i.e. towards the feet and pools or accumulates in legs known as venous stasis, which in turn leads to stasis dermatitis. Pooling of the blood in the leg veins causes venous hypertension i.e. increased pressure inside the veins. This causes damage to the capillaries resulting in leakage of fibrinogen (a protein) into the tissues. This fibrinogen gets converted into fibrin which starts to accumulate leading to decreased oxygen supply to the skin resulting in death of the cells. This inflammatory process causes your skin to change its appearance which is known as Stasis Dermatitis.
Venous Disease can lead to Leg Ulcers as the veins in the legs are like tubes which carry back blood from the foot and up towards the heart. The leg veins have one-way valves to ensure that the blood flows up the leg and does not flow back down. In some individuals, these valves may be damaged or ineffective due to clots or vein thrombosis. Damaged valves causes the blood to flow in the wrong direction, i.e. back down the veins resulting in increased venous pressure upon standing up. This abnormally increased vein pressure causes skin damage to the legs and leads to chronic leg ulcers.
Other Common Causes Of Stasis Dermatitis Are:
- CHF or congestive heart failure.
- Varicose veins.
- Surgical procedures, such as using the leg vein for bypass surgery.
- Trauma to the leg.
- DVT or Deep Vein Thrombosis.
Leg Ulcers Are Commonly Caused By Disease Of The Leg Veins Or Venous Disease And Also:
- Arterial Disease which results from improper functioning of the arteries is responsible for around 15% of chronic leg ulcers.
- Venous Disease which occurs when the veins are not functioning properly is the major cause of leg ulcers
- Other causes include medical conditions, such as diabetes, rheumatoid arthritis and other rare medical conditions.
Symptoms of Stasis Dermatitis
- Skin darkening.
- Skin thinning.
- Swelling in the legs.
- Scaling and ulcers.
- Pain and tenderness in the calf.
- Feeling of heaviness or a dull ache in the legs which worsens upon standing.
- Scratching causes the skin to crack and ooze fluid.
- These changes slowly become permanent.
- Later on the skin becomes hard and thick (lipodermatosclerosis).
- The skin turns dark brown in color and looks lumpy in appearance.
- The final stages of stasis dermatitis comprises of breaking of the skin and formation of a sore or ulcer (leg ulcers).
- These ulcers commonly develop on the inside of the ankle.
- Serious Symptoms Include: Pain in the legs, redness and presence of open ulcers or wounds which drain pus.
Investigations for Stasis Dermatitis & Leg Ulcers
- Physical examination is sufficient for diagnosis.
- A venous Doppler ultrasound can also be done to check the blood flow in the legs.
Treatment for Stasis Dermatitis & Leg Ulcers
Conservative Treatment Comprises Of:
- Patient should strictly avoid prolonged sitting and standing.
- Whenever you are sitting, keep your feet elevated by propping them up on a low stool.
- Wearing compression stockings also helps.
- Application of wet dressings.
- Doctor may prescribe oral antibiotics and topical steroids.
- Your doctor will prescribe medications to control leg swelling and congestive heart failure.
Surgery may be needed for correction of varicose veins
- Treatment of comprises of controlling the increased pressure in the leg veins and treating the ulcers.
- The man line of treatment in venous leg ulcers is using compression stockings or bandages.
- Patient should keep his/her affected leg(s) elevated. This will decrease the pressure in the leg veins when the foot is raised above the heart level.
- Compression stockings or bandaging helps in keeping the pressure in the leg and ankle veins controlled and low upon standing.
- Many layers of bandages are usually needed to get the required pressure for controlling the veins. After the ulcers have healed, compression stockings should be used for preventing the recurrence of the ulcers.
- Depending on the ulcer, different types of dressings are used.
- Surgery may be required for large ulcers or for those ulcers which do not heal. Skin grafting can be done or surgery on the veins may be done if needed, especially if the ulcer occurs as a result of varicose veins.
- The ulcers take some time to heal, around 3 to 4 months, but some ulcers may take even longer time to heal.
Patient Should Strictly Avoid Using The Following Products:
- Lotions, such as lanolin and calamine, which dry the skin.
- Numbing agents, such as benzocaine, lidocaine etc.
- Topical antibiotics, such as neomycin.
Complications of Stasis Dermatitis & Leg Ulcers
Stasis Dermatitis That Is Allowed To Progress And Is Left Untreated Can Result In:
- Chronic leg ulcers (as mentioned above).
- Osteomyelitis (bone infection).
- Permanent scarring.
Prevention of Stasis Dermatitis & Recurrence of Leg Ulcers
- Keep your legs elevated as much as possible.
- Always wear compression stockings/ bandages.
- Lose the excess weight.
- Moisturize your skin using good moisturizing creams in order to prevent dryness.
- Consume healthy diet comprising of fresh fruits and vegetables.
- Exercise daily.
- If you are a smoker, quitting smoking helps a great deal in healing of the ulcers.
- Controlling the peripheral edema i.e., swelling in the legs, feet and ankles, helps in preventing the stasis dermatitis.