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Swollen ankles are often the first symptom of stasis dermatitis (also known a venous eczema or gravitational dermatitis), a type of eczema caused by venous insufficiency, or poor circulation in the lower legs. Venous insufficiency happens when the valves in leg veins that help push blood back to the heart weaken and leak fluid. This allows water and blood cells to pool in the lower legs.
“Skin absorbs the leaking fluid like a sponge, causing swelling and inflammation; this in turn starts to break down the skin barrier, leading to development of stasis dermatitis,” said Dr. Jenny Murase, associate clinical professor of dermatology at the University of California, San Francisco.
Venous insufficiency can be caused by aging, but it can also signal a serious underlying medical condition, such as heart or kidney disease, said Murase, who is the director of Medical Consultative Dermatology at the Palo Alto Medical Foundation in Mountain View, California.
“Recognizing stasis dermatitis early may help reveal a life-threatening condition and prevent the skin condition from progressing from swelling, redness and itching to open, oozing ulcerations that are vulnerable to infection,” she noted.
Stasis dermatitis, also called gravitational dermatitis, venous eczema and venous stasis dermatitis, can affect the feet or lower legs on one or both sides. It can appear on other parts of the body, but this is uncommon.
Besides ankle swelling, early signs include orange-brown speckles of discoloration sometimes called cayenne pepper spots. These spots develop when pressure and swelling cause capillaries, the smallest blood vessels, to burst.
“Red bloods cells then enter the skin and deposit iron, which stains the skin,” Murase said.
Other symptoms of stasis dermatitis include redness in lighter skin tones that may appear brown, purple, gray or ashen in darker skin tones, itching, scaling, dryness and a heavy or achy feeling after long periods of sitting or standing. And, according to Murase, stasis dermatitis increases the likelihood of developing contact dermatitis.
If stasis dermatitis goes untreated, swelling can move beyond the ankle to the calf and skin can become shiny. Open sores, called venous ulcers, can form on the lower legs and tops of feet. These ulcers can bleed, ooze and leave scars once they’ve healed.
Severe stasis dermatitis can cause permanent skin changes, including thickening, hardening, darkening, or a bumpy, cobblestone-like appearance.
Physicians typically diagnose stasis dermatitis by examining the skin but may also run tests to check blood flow and to help identify the root causes of poor circulation.
Not everyone with venous insufficiency develops stasis dermatitis, but poor circulation and some other medical conditions increase risk.
Varicose veins, high blood pressure, obesity, vein surgeries, multiple pregnancies and a history of blood clots in the legs also increase risk, as do congestive heart failure and kidney failure. More women than men to develop chronic venous insufficiency and stasis dermatitis.
Certain lifestyle factors, such as getting little physical activity or having a job that involves hours of sitting or standing, also raise risk.
Healthy, fit adults in their 40s and beyond, however, can also develop venous insufficiency and stasis dermatitis, Murase said.
“You might, for example, be in a hot environment where you’re walking all day, which can also cause leg swelling, and notice skin discoloration, such as the cayenne pepper spots,” she said. “That’s a sign that you need to take some preventive steps.”
Treatment for stasis dermatitis is aimed at controlling its various symptoms.
Compression stockings are the first line of defense against swelling. These stockings apply evenly distributed pressure that helps moves blood from the legs to the heart, reducing swelling and discomfort.
The stockings are made with various levels of compression, and should fit without bunching, which can worsen circulation. Those with lower levels of compression (up to 20 mm Hg) are available over the counter, while higher levels require a prescription. Consult with your dermatologist to determine the right amount of compression for you.
Elevating your legs above your heart every two hours or so can also help reduce swelling, as can avoiding foods high in salt. Supplementing your diet with vitamin C and rutin, a plant pigment and antioxidant, might also help keep blood vessels flexible and healthy.
Dermatologists may prescribe a topical corticosteroid to calm inflammation. If skin is infected, you may need a topical or oral antibiotic.
The contact dermatitis that can occur along with stasis dermatitis means that some people develop allergies to ingredients in topical medications, including over-the-counter and prescription topical steroids and antibiotics.
If this happens, your dermatologist can prescribe a medication that’s less likely to cause an allergic reaction, Murase said. She also advised moisturizing dry skin daily with petroleum jelly or a heavy, fragrance free cream.
“Prevention and diligence are key to controlling stasis dermatitis,” according to Murase, who emphasizes the importance of identifying and treating underlying conditions.
“Looking for the reasons stasis dermatitis is happening may uncover potentially life-threatening but treatable conditions, such as heart and kidney disease,” she said.