What is stasis dermatitis (venous eczema, gravitational dermatitis)?
Stasis dermatitis is also called gravitational dermatitis, venous eczema, and venous stasis dermatitis. It happens when there is a problem with circulation in the veins, generally in the lower legs. These problem veins cause pressure to build up as the blood tries to flow upward through the body and heart. This pressure makes fluid leak out of the veins and into the skin.
An early case of stasis dermatitis showing redness and swelling
Symptoms of stasis dermatitis (venous eczema, gravitational dermatitis) include:
- Swelling, especially around the ankles that goes away while sleeping but returns in the day
- Discolored skin
- Scaling and dryness
- Varicose veins
- Leg ache
In severe cases of stasis dermatitis (venous eczema, gravitational dermatitis), there can be:
- Open areas (cracking or larger ulcers)
- Shiny skin
- Scars where ulcers healed
- Infection, most notably, cellulitis
Over time, recurrent stasis dermatitis (venous eczema, gravitational dermatitis) can result in more permanent changes in the skin including:
- Lipodermatosclerosis: scar-like changes in the fat and other soft tissues
- Atrophie blanche: white scars surrounded by tiny capillaries
- Lichenification: thickened skin due to chronic scratching or rubbing
People with stasis dermatitis are at increased risk of developing contact dermatitis.
What causes stasis dermatitis (venous eczema, gravitational dermatitis)?
Long-standing stasis dermatitis and varicose veins associated with swelling and inflammation in the skin.
Stasis dermatitis affects people with poor circulation. It usually affects people over the age of 50. Women are more likely to get it than men.
There are a number of conditions that can increase your risk for developing stasis dermatitis. These include:
- High blood pressure
- Varicose veins
- Congestive heart failure
- Kidney failure
- Many pregnancies
- Blood clots in leg veins
Stasis dermatitis (venous eczema, gravitational dermatitis) treatment
Because the problem starts with poor circulation, your doctor may recommend treating the damaged veins in your legs by surgery. However, sometimes the surgery for the veins is not possible, or is not able to repair the veins completely.
Lower leg with poor vein function (stasis) that has developed red, itchy dermatitis as well as swelling.
Pressure stockings or wraps can be used to help mechanically move the fluid out of the skin and soft tissues. Elevating the legs at heart level once every two hours for 15 minutes and while you are sleeping will also help with swelling. For open sores or skin ulcers, a special dressing may need to be applied to promote healing.
Like in other forms of eczema, a topical steroid can help calm the inflammation and itch. Sometimes covering the steroid with wet or dry wrap or an Unna boot can greatly assist in severe cases. An Unna boot is a type of gauze bandage with healing medications in it and provides compression to help with fluid build up.
In cases where corticosteroids are not appropriate, or when they have been used for a prolonged period, a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel) may be prescribed. The provider may also review medications that are known to have edema (swelling from fluid in the tissues) as a side effect, which can contribute to stasis dermatitis.
Stasis dermatitis tends (venous eczema, gravitational dermatitis) to come back until the underlying cause (damaged veins) is addressed.