Stasis Dermatitis – Causes, Symptoms and Treatment

Last Updated on August 9, 2021

Stasis dermatitis is a common inflammatory skin disease that occurs on the lower legs.

It is a chronic and recurring condition that causes swelling, inflammation, itchy skin, and ulcers on the lower legs.

It often occurs in people who have underlying conditions that affect blood flow in the legs, such as chronic venous insufficiency, varicose veins, deep vein thrombosis (DVT), and congestive heart failure.

It is also called gravitational dermatitis, venous stasis dermatitis, venous eczema, or varicose eczema.

It occurs mostly in people aged 50 years or older and is more common in women than men.

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Stasis dermatitis usually occurs in people with chronic venous insufficiency.  Chronic venous insufficiency occurs due to the weakening of the valves in leg veins (that help push blood back to the heart) and results in poor blood circulation in the legs.  As a result, blood can flow backward and pool in the lower legs causing swelling in the veins. The swelling produces pressure under the skin and does not allow sufficient blood and oxygen to reach the skin thus producing symptoms of stasis dermatitis.

The common causes of venous insufficiency include:

• Deep vein thrombosis (DVT) ( clotting of blood in the lower leg)
• Varicose veins (enlarged and swollen veins)
• Congestive heart failure
• Injury to the lower leg
• Any surgery that affects the veins in the lower leg

Risk Factors

• Persons above the age of 50 are at a greater risk
• Females are at a greater risk than males
• Being overweight
• Lack of exercise
• Multiple pregnancies
• Standing or sitting for prolonged periods
• Kidney disease
• Congestive heart failure
• Hypertension
• Any condition that affects blood circulation in the legs

Symptoms

• Swelling around the ankles is usually the first sign. The swelling gets better after sleep and comes back during the day with activity. In later stages, the swelling can spread into the calves.
• Heaviness of the legs or pain especially during standing or walking.
• Reddish or brownish discoloration of the skin around the ankles.
• Thickening of the skin around the shins and ankles.
• Red or swollen skin
• Itchy, dry, and cracked skin
• Scaly and oozing sores
• Pain and itching around the ankles
• Varicose veins (bulging, twisted, prominent dark purple or blue veins visible on the lower legs)
• Loss of hair on ankles or shin

In extreme cases, stasis dermatitis can result in permanent skin changes. These include a thick, hard, darkened skin having a cobblestone-like appearance.

Complications

• Chronic leg ulcers
• Impetiginisation – secondary bacterial infection resulting in yellowish crusts on the skin
• Abscess/Cellulitis – bacterial infection resulting in redness, swelling, pain, fever, and swollen nodes in the groin
• Osteomyelitis – bone infection
• Secondary eczema – eczema spreads to other parts of the body
• Contact allergy – to any components of the ointments or creams used for treatment
• Permanent scarring

• Heart disease
• Hypertension
• Blood clots
• Injuries to the lower legs
• Surgeries involving the lower leg

Doppler ultrasonography

It is a noninvasive test that uses sound waves to check the blood flow through blood vessels. It can help to detect a blood clot and show any damage to the blood vessels.

Home Remedies and Self-Care Tips

Take frequent breaks. If your work demands sitting or standing for long periods of time, you must take frequent breaks in between. Every half to one hour you should get up and walk around for 5 minutes. This will help to improve your blood circulation.

Be physically active. Exercise helps to strengthen the calf muscles and improves blood circulation. Walking is especially beneficial for people who have stasis dermatitis.

Wear loose-fitting cotton clothes. Rough, synthetic fabrics and woolen clothes can irritate the skin and may lead to a flare-up in patients with stasis dermatitis. So it is preferable to wear soft cotton clothing. Even in winters, do not let the woolen clothes come in direct contact with the skin. Always wear a layer of cotton clothing underneath the woolens.

Also, the clothes worn should be loose-fitting so that the blood circulation is not compromised.

Keep your legs elevated above the heart: It helps to improve blood flow. It should be done frequently throughout the day as well as at night during sleep (the legs can be elevated with the help of pillows).

Use compression garments. They help to improve the blood circulation in the legs and prevent open sores. They also reduce the swelling in the legs.

Avoid irritation of the skin. Skin having stasis dermatitis is very sensitive. Any injury or irritation to the area can lead to an infection or open sores. Hence contact with irritants or allergens like pet hair, plants, pollens, cleaning products, etc should be avoided.

Avoid scratching. Scratching can aggravate stasis dermatitis and can lead to infection. Scratching can be avoided by regular moisturization, applying a cool compress on the itchy area, or taking a cool bath in colloidal oatmeal.

Moisturize regularly. It is important to keep the skin well-moisturized as dry skin causes irritation and itching. Petroleum jelly, skin creams, or any fragrance-free moisturizer can be used. It is best to apply these immediately after a bath when the skin is still damp so that the moisture gets locked within the skin.

Care while bathing

• Avoid frequent baths.
• Use a mild soap for bathing. The soap used should not rob the skin of its natural moisture or irritate the skin. Rinsing soap from other parts of the body can cause the soap to run down the body, which can irritate skin with stasis dermatitis.
• Cleansing agents or soaps used should have a low pH so as to maintain the acidic pH of the skin. This helps to preserve the skin barrier function and reduces skin irritation.
• Use lukewarm water for bathing in cold weather. Do not use hot water as it irritates the skin.
• Oatmeal can be added to water for bathing.
• Very dilute bleach baths (in a proportion of one quarter to one-half cup of bleach mixed with 150 liters of water bath) once or twice weekly can improve the rash and prevent skin infections.

Maintain a healthy weight. It helps to reduce swelling of the legs and improves blood circulation.

Drink adequate water. Consuming about 8 glasses of water every day helps to improve circulation and reduce swelling.

Limit salt intake. Excessive salt in the diet can decrease blood flow. It is recommended that no more than 1,500 mg of salt be consumed daily.

Treatment

Treatment for stasis dermatitis includes:

Compression treatment

Compression therapy using compression bandaging or graduated compression stockings is an important part of the treatment. It is used both in the active treatment for the healing of ulcers as well as in preventing recurrences of ulcers.

It works by applying controlled pressure to the surface veins. This helps to keep their caliber small and forces blood back into the deep vein system which in turn pushes the blood up towards the heart. This improved blood flow helps in the healing of ulcers and in preventing their recurrences.

Corticosteroids

Topical or local application of corticosteroids to the affected area helps to reduce inflammation, pain, and swelling. Triamcinolone acetonide 0.1% cream or ointment is commonly used.

Read more about Side Effects of Corticosteroid Therapy

Antibiotics

Antibiotics may be taken orally or applied locally to treat infections.

Antihistamine

These medicines help to treat intense itching.

Supplements

Multivitamins, vitamin C, and antioxidants help to improve overall vein health.

Immunosuppressants

Drugs like tacrolimus and pimecrolimus are found to be effective in stasis dermatitis. They act by reducing the body’s immune response.

Wounds or open sores should be cleaned with saline. After applying local antibiotics, they may be bandaged. Dressings with zinc oxide paste or hydrocolloids may be used.

After the wounds have healed, you should continue wearing compression stocking as it helps to prevent the development of new wounds.

Light therapy

Intense pulsed light (IPL) may be used to treat skin discoloration. Three to four treatment sessions may be required to get the desired result.

Vein surgery

Poor blood flow in a particular vein may be treated by a surgical procedure called flush ligation and saphenectomy.

Prognosis

It is a long-term chronic or recurring disorder. The underlying cause needs to be treated. It is also important to prevent and adequately treat complications.

References

• Sundaresan S, Migden MR, Silapunt S. Stasis Dermatitis: Pathophysiology, Evaluation, and Management. Am J Clin Dermatol. 2017 Jun. 18 (3):383-390.
• Bryan LJ, Callas PW, Criqui MH, Cushman M. Higher soluble P-selectin is associated with chronic venous insufficiency: The San Diego Population Study. Thromb Res. 2012 Aug 11.
• 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. J Vasc Surg. 1999 Dec. 30(6):1129-45.
• Cheatle TR, McMullin GM, Farrah J, Smith PD, Scurr JH. Skin damage in chronic venous insufficiency: does an oxygen diffusion barrier really exist?. J R Soc Med. 1990 Aug. 83(8):493-4.
• Dodd HJ, Gaylarde PM, Sarkany I. Skin oxygen tension in venous insufficiency of the lower leg. J R Soc Med. 1985 May. 78(5):373-6.