What is Stasis Dermatitis?

The primary role of the venous system is to remove un-oxygenated blood and waste products from the body back to the heart and lungs. When blood collects or pools in the veins of your lower legs, the pressure on the veins increases. The increased pressure damages your capillaries, which are very small blood vessels. This allows proteins to leak into your tissues. This leakage leads to a buildup of blood cells, fluid, and proteins, and that buildup causes your legs to swell. This swelling is called peripheral edema.

People with stasis dermatitis usually experience swollen legs and feet, open sores, or itchy and reddish skin.

One theory is that a protein called fibrinogen may be responsible for the changes you see in your skin. When fibrinogen leaks into your tissues, your body converts it to the active form of the protein, which is called fibrin. As it leaks out, the fibrin surrounds your capillaries, forming what are known as fibrin cuffs. These fibrin cuffs may prevent oxygen from entering your tissues. And when your cells don’t receive enough oxygen, they can become damaged and die. Often those with stasis dermatitis also suffer from the other symptoms of venous insufficiency such as leg swelling, leg pain, dry skin, leg cramps at night and frequent night time urination. 

The symptoms of stasis dermatitis include:

• skin discoloration
• itching
• scaling
• ulcers

You may also experience symptoms of venous insufficiency, including:

• leg swelling
• calf pain
• calf tenderness
• a dull ache or heaviness in your legs that gets worse when you stand

In the early stages of stasis dermatitis, the skin on your legs may look thin. Your skin may also itch, but try not to scratch it. Scratching can cause the skin to crack and fluid to seep out.

Over time, these changes can become permanent. Your skin may eventually thicken, harden, or turn dark brown. This is called lipodermatosclerosis. It may also look lumpy.

In the final stages of stasis dermatitis, your skin breaks down and an ulcer, or sore, forms. Ulcers from stasis dermatitis usually form on the inside of your ankle.

Poor circulation causes stasis dermatitis. 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.

There are one-way valves inside your leg veins that keep your blood flowing in the right direction, which is toward your heart. In people with venous insufficiency, these valves become weak. This allows blood to flow back toward the feet and pool in your legs instead of continuing to flow toward your heart. This pooling of blood is what causes stasis dermatitis.

Varicose veins and congestive heart failure are also known causes of leg swelling and stasis dermatitis.

Most of the conditions that cause stasis dermatitis usually develop in people as they get older. However, there are also several causes that are unrelated to age, including:

• surgery, such as using a leg vein for bypass surgery
• deep vein thrombosis in your leg
• traumatic injury to your lower legs

Stasis dermatitis affects people with poor circulation. It’s common among adults over the age of 50. Women are more likely to get it than men.

A number of diseases and conditions can increase your risk for developing stasis dermatitis, including:

• high blood pressure
• venous insufficiency (occurs when your veins have difficulty sending blood from your legs to your heart)
• varicose veins (swollen and enlarged veins that are visible under your skin)
• congestive heart failure (occurs when your heart doesn’t pump blood efficiently)
• kidney failure (occurs when your kidneys can’t remove toxins from your blood)
• obesity
• injury to your lower legs
• numerous pregnancies
• deep vein thrombosis in your leg (a blood clot in your leg vein)

Your lifestyle can also affect your risk. You may be at a higher risk of getting stasis dermatitis if you:

• are very overweight
• don’t get enough exercise
• sit or stand without moving for long periods of time

To diagnose stasis dermatitis, your doctor will closely examine the skin on your legs. Your doctor may also order a venous Doppler ultrasound. This is a noninvasive test that uses sound waves to check the blood flow in your legs. Hopefully they will order the test at a dedicate vein center like Truffles and not through the hospital system.  Venous insufficiency testing is very technical and not all venous ultrasounds are equal. 

There are several things you can do at home to help treat stasis dermatitis:

• Avoid standing and sitting for long periods of time.
• Prop up your feet when sitting.
• Wear compression stockings.
• Wear loose-fitting clothing to avoid irritating your skin.

Ask your doctor about the types of skin creams and ointments you can use. Avoid using the following products:

• lanolin
• calamine and other lotions that dry your skin
• topical antibiotic ointments such a neomycin, due to possible allergic reactions
• benzocaine and other numbing medications

Your doctor might tell you to put wet bandages on your skin and might prescribe topical steroid creams and ointments. Your doctor may also prescribe antibiotics if your skin becomes infected. Treating conditions that cause venous insufficiency (such as high blood pressure and congestive heart failure) can also help control your stasis dermatitis.

If you are diagnosed with venous insufficiency this must be treated. Minimally invasive endovenous thermal ablation, VenaSeal and Ultrasound Guided Foam Sclerotherapy have revolutionized the treatment of venous insufficiency and varicose veins. 

If it’s left untreated, stasis dermatitis can result in:

• chronic leg ulcers
• osteomyelitis, which is a bone infection
• a bacterial skin infection, such as abscesses or cellulitis
• permanent scarring

Stasis dermatitis is usually the result of a chronic illness, such as untreated venous insufficiency, congestive heart failure and renal failure. Early treatment of venous insufficiency should be considered, especially if you have a family history of venous ulcers, stasis dermatitis and varicose veins. 

However, you can reduce your risk by preventing the swelling in your legs (the peripheral edema) that causes it. Using compression socks, support hose and or athletic socks may reduce your risk as well as exercising. Exercise is a great way to improve your circulation and reduce your body fat. Limiting the amount of sodium you consume can also help.

Are you at risk for developing venous insufficiency?  Find out by taking this quick assessment.