OVERVIEW

What is Varicose Eczema?

Varicose eczema or stasis eczema is a type of skin rash, which is most of the time associated with varicose veins or other venous insufficiency. Although people may have this eczema without varicose veins too. It is more common in old age people. If underlying cause is not managed at time, it can lead to ulcer formation and increased morbidity. You should visit dermatologist if you suspect varicose eczema.

What is varicose veins?

We have veins in our body to bring blood from body parts to heart. These veins have valves (venous pump) to maintain flow in direction towards heart. Due to some reasons (described below) leg veins are not able to maintain this flow to heart and blood starts collecting in veins due to gravity. Because of stagnating of blood, veins dilate and swollen which is called varicose veins. This collected blood start leaking in skin through capillaries because of pressure and cause skin changes.

Cause

What are causes of varicose eczema?

As discussed above varicose eczema is linked with increased pressure due to disturbed flow of blood in leg veins around the leg. This increased pressure push blood in skin and surrounding structure through capillaries. Our immune system reacts to this abnormal presence of blood in skin and causes eczema. Factors, which may be responsible for development of varicose vein and varicose eczema are:

• Obesity
• Pregnant woman
• Standing or sitting at one position for long time
• Deep vein thrombosis
• Heart failure
• Hypertension

Symptoms

What are the symptoms of varicose eczema?

Symptoms of varicose eczema or stasis eczema are similar to other eczema. It can be mild, moderate, and severe according to underlying venous insufficiency.
Usually it starts with persistent itching at legs especially at inner aspect of legs and ankle. Due to chronic severe itching skin become dark and thick. Rapidly progressing eczema may have inflammation, redness, swelling, oozing of fluid, blistering, scaling and crusting. Sometimes ulcerations can also develop which heal with difficulty and may leave white depressed scars.
Old eczema have hyperpigmentation (due to deposition of blood components), scaling and significant thickening of skin (lipodermatosclerosis) giving the legs an appearance of an inverted champagne bottle.

Treatment

How do dermatologist diagnose varicose eczema?

Dermatologists diagnose varicose eczema by looking at skin changes of legs, inner side of ankle and medical history of venous insufficiency like varicose veins, swelling in feet and legs. In doubtful cases skin biopsy can be done to look for skin changes and to rule out other eczema. Although skin biopsy is avoided because of poor healing due to venous insufficiency.
Color Doppler assessment can be advised by dermatologist to look for severity of venous insufficiency.
Blood test are usually not required for diagnosis for eczema but it can be advised to look for deep vein thrombotic profile.
From infected wounds or ulcers bacterial culture can be done if patient is not responding to routine antibiotics.

What is the treatment for varicose eczema or stasis eczema?

Treatment of varicose eczema is not easy as there is high chance of recurrences. Management includes multiple approaches to treat underlying venous insufficiency, treatment of eczema, superadded infections and ulcers.

Treatment of underlying venous problem:

• Leg elevation, daily walking, exercises, weight reduction, avoid trauma.
• Avoid standing in one position
• Continuous compression therapy (stockings)
• Oral medicines under supervision of doctor
• Ablation therapy

Treatment of eczema

• Regular cleaning of skin
• Moisturizer
• Topical steroids for acute skin eczema
• Wet dressings to remove adherent crust (2-3 hours daily)
• Compression bandage
• Oral steroids for recalcitrant statis eczema
• Treatment of superadded infection if present

Treatment of ulcer

• Surgical debridement to freshen the edges and floor of ulcer.
• Platelet rich fibrin dressing
• Epidermal growth factor creams
• Grafting or surgical treatment under guidance of surgeon

Tips

How to prevent stasis eczema or varicose eczema?

It needs some life style changes to reduce pressure on veins. It can be done by:

• Avoiding prolonged standing
• Putting legs on some support while sitting for long time
• During sleep Leg elevation (put extra pillow on feet side or elevate leg side of bed)
• Regular physical exercise
• Weight reduction
• Stockings (if risk factors present)
• Avoid local trauma
• Visit dermatologist at early stage

FAQs

Is varicose eczema painful?

Usually mild varicose eczema is not painful. Moderate and severe eczema may have painful swelling in affected leg or foot. Among other causes secondary infection in eczema can lead to painful swelling or cellulitis. Scratching or local trauma can lead to painful ulcer formation.