Stasis Dermatitis Leg and Foot Condition
Stasis Dermatitis Leg and Foot Condition
Stasis dermatitis is a skin condition that develops in people with poor circulation. It typically occurs in the lower legs. In serious cases, stasis dermatitis can progress into ulcers.
Stasis dermatitis is skin inflammation that develops in people with poor circulation. It most often occurs in the lower legs because that’s where blood typically collects.
People over the age of 50 are most at risk for developing stasis dermatitis, especially if they have heart disease, are very overweight, or frequently sit for long periods of time.
Preventing swelling in your lower legs, or peripheral edema, is the best way to avoid getting stasis dermatitis.
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, which 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.
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. According to the Cleveland Clinic, these fibrin cuffs may prevent oxygen from entering your tissues. When your cells don’t receive enough oxygen, they can become damaged and die.
Risk Factors for Stasis Dermatitis
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:
- venous insufficiency, which occurs when your veins have difficulty sending blood from your legs to your heart
- varicose veins, which are swollen and enlarged veins that are visible under your skin
- congestive heart failure, which occurs when your heart doesn’t pump blood efficiently
- kidney failure, which occurs when your kidneys can’t remove toxins from your blood
- injury to your lower legs
- numerous pregnancies
- a deep vein thrombosis in your leg, which is 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’re very overweight, don’t get enough exercise, or if you sit or stand without moving for long periods of time.
Common Causes of Stasis Dermatitis
Poor circulation causes stasis dermatitis. Typically, poor circulation is the result of a chronic, or 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
Symptoms of Stasis Dermatitis
The symptoms of stasis dermatitis include:
- skin discoloration
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.
Seeing Your Doctor About Stasis Dermatitis
You should see your doctor if you notice leg swelling or any symptoms of stasis dermatitis, especially if the symptoms include:
- open wounds or ulcers
- pus-like drainage
Diagnosis of Stasis Dermatitis
A diagnosis of stasis dermatitis is made based on the patient’s medical history, investigating any conditions that may cause the swelling, as well as observation of the skin rash. Testing for other skin conditions as well as circulation patterns of the body may include:
- Blood tests
- Blood flow to the legs is evaluated a by Doppler ultrasound: This is a noninvasive test that uses sound waves to check the blood flow in your legs.
- Patch testing to determine contact allergies and/or other skin sensitivities
- Biopsy of infected skin
Treatment of Stasis Dermatitis
There are several things you can do at home to treat stasis dermatitis. You should:
- avoid standing and sitting for long periods of time
- prop up your feet when sitting
- wear compression socks
- wear loose-fitting clothing to avoid irritating your skin
Ask your doctor about the types of skin creams and ointments you can use.
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. Surgery may be recommended to correct varicose veins if they become painful.
Treating conditions that cause venous insufficiency, such as high blood pressure and congestive heart failure, can also help control your stasis dermatitis.
In some cases, all-natural herbal methods can be used to help soothe the pain and itching associated with milder forms of stasis dermatitis. For best results, however, they should always be used under the guidance of a qualified herbalist or licensed naturopathic healthcare provider.
These herbs have antiseptic and anti-inflammatory properties, which may help to relieve the symptoms:
- Calendula (flower heads), licorice root, and ginkgo all have antiseptic and anti-inflammatory properties. They can be used topically, in lotions, oils or ointment form, on the affected area to reduce itching and inflammation.
- Aloe vera gel and the juice from common plantain leaves (Plantago major) can be applied topically to the affected areas to help soothe skin irritations associated with dermatitis.
Herbal pastes can also be prepared to help relieve the itching associated with dermatitis:
- Green clay and goldenseal root in equal parts
- Equal parts salt, water, clay, and peppermint oil
Pyrithione zinc has been recognized for centuries for its unique healing properties. Included in those healing properties are alleviation of itching and burning associated with dermatitis symptoms. Pyrithione zinc also has antifungal and antibacterial properties, which may help reduce skin inflammation associated with dermatitis.
Topical zinc pyrithione is generally recognized as a safe and effective treatment for reduction in the symptoms associated with certain forms of dermatitis.
Unna Boot Treatment
In the case of stasis dermatitis, zinc is often used in connection with an Unna’s paste boot, a moist, zinc-impregnated paste bandage that provides both compression and topical treatment.The classic Unna boot entails a stretched wrap filled with calamine, zinc oxide, glycerine, sorbitol, gelatin and magnesium aluminum silicate, to be applied to the affected area. Once applied, the boot will harden to a level that is slightly less than that of a cast.
The compressive, supportive nature of the boot helps to reduce the swelling, and the gelatin/zinc mixture protects the skin from irritation and hastens the healing process. In the beginning the boot needs to be changed every two to three days; however after the initial healing it can be left on for a week at a time.
One drawback of the Unna boot is that it does not accommodate changes in leg swelling particularly well. Many comparative studies of different management techniques, including compression with Unna boot, traditional paraffin gauze dressings, and other occlusive dressings, have been made.
In some cases, studies report better patient comfort and compliance when treated with a combination of compression and a moist, occlusive dressing, such as a hydrocolloid dressing, to heal venous stasis ulceration.
Possible Complications of Stasis Dermatitis
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
Preventing Stasis Dermatitis
Stasis dermatitis is usually the result of a chronic illness, such as congestive heart failure, so it’s difficult to prevent if you’re already ill. However, you can reduce your risk by preventing the swelling in your legs, or peripheral edema, that causes it. You can also lower your risk by 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.
In summary, the condition of stasis dermatitis can be quite serious and chronic, with numerous complicating factors and sequelae. However, with careful evaluation, follow-up, and a maintenance program tailored to an individual’s needs, along with education and counseling to improve understanding of the condition, most stasis dermatitis patients can be kept comfortable and free of ulceration.
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