Publish date: Posted on
Last updated: October 23, 2023
Keywords #
stasis dermatitis
venous stasis dermatitis
cutaneous vascular disease
ulcers
Diagnosis #
Stasis dermatitis, also known as venous stasis dermatitis (VSD), is a cutaneous vascular disease that occurs in the setting of chronic venous insufficiency or venous hypertension.[1] It is an eczematous eruption characterized by erythematous, scaly plaques, usually involving the lower third of the legs above the ankles.[1] It is often bilateral.[2] Classically, hemosiderin deposition from high venous pressures results in a brown, orange, or red discoloration of the overlying skin.[3] Stasis dermatitis may be complicated by ulceration or infection.[3]
Key Concepts #
- VSD is a complication of chronic venous insufficiency and/or venous hypertension.[3]
- It can be unilateral but is often bilateral.[2]
- Treatment of VSD involves treating both the dermatitis and the underlying venous insufficiency.[2]
- Leg elevation and compression therapy are mainstays of therapy, but compression should be avoided if there is suspicion of underlying arterial disease.[4]
- Long term use of topical antibiotics should be avoided in the treatment of open wounds, excoriations, or ulcers if possible as their chronic use may lead to contact sensitization and secondary allergic contact dermatitis.[3,5]
Epidemiology #
Risk factors for venous insufficiency include older age, family history, female sex, pregnancy, congestive heart failure, obesity, prolonged standing, prior injury or surgery, prior DVT, and sedentary lifestyle.[6] Skin changes secondary to venous insufficiency, including dermatitis and ulceration, are common.[6,7]
Clinical Features #
- It is often bilateral, but can be unilateral.
- Pruritis is often present and lichenification can develop from mechanical trauma.
- Pitting edema, varicose veins, and telangiectasias are often present.
- Pedal pulses are palpable.
- Hemosiderin deposition may cause a red, yellow, orange, or brown discoloration to overlying skin.
- Ulceration and infection may complicate VSD.
- Lipodermatosclerosis and venous thrombosis can be late signs of venous insufficiency and may secondarily complicate VSD.
- Venous ulcers are typically tender, shallow, and have overlying fibrinous exudate.
Differential Diagnoses #
- Cellulitis
- Atopic dermatitis
- Contact dermatitis (allergic or irritant)
- Xerosis
- Tinea (corporis or pedis)
- Lichen simplex chronicus
- Arterial (ischemic) ulcer
- Neurogenic (diabetic) ulcer
- Pressure (decubitus) ulcer
- Pyoderma gangrenosum
- Infectious ulcer (e.g. ecthyma)
For VSD:
For Venous Ulcers:
Diagnostic Workup #
Diagnostic workup is not generally indicated for venous stasis dermatitis, as it is considered a clinical diagnosis.[8] However, there are notable exceptions. If arterial disease is suspected, an ankle-brachial index (ABI) should be obtained.[1,4] Likewise, if an underlying DVT is suspected, a doppler ultrasound should be performed. An abnormal ABI or doppler ultrasound should prompt a referral for further evaluation.[4] A skin biopsy is rarely indicated, but may be performed if there is diagnostic uncertainty.[1]
Treatment #
Treatment of VSD and venous stasis ulcers involves treating both the dermatitis and the underlying venous insufficiency.[2,8] Treatment of the dermatitis should involve the application of high or mid potency topical steroids (e.g. clobetasol, triamcinolone) to affected areas.[9] Topical antibiotics can be used to treat open wounds, excoriations, or ulcers but long term use should generally be avoided as this may lead to contact sensitization to the antibiotic. [1,3,5] Elevation of the leg should be employed to reduce edema. External compression of the affected area with a multilayer bandage or paste-containing bandage, applied over a primary dressing, is a mainstay of treatment.[2] Compression wraps should be changed weekly.[9] Importantly, compression therapy should be avoided if there is any suspicion of arterial disease.[4] Patients should be encouraged to follow up with a primary care physician or vascular surgeon if there is evidence of underlying vascular disease.[8]
Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/References #
- Eczematous rashes. In: James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 13th ed. Elsevier; 2019.
- Sundaresan S, Migden MR, Silapunt S. Stasis Dermatitis: Pathophysiology, Evaluation, and Management. Am J Clin Dermatol. 2017;18(3):383-390. doi:10.1007/s40257-016-0250-0
- Cutaneous vascular disease. In: James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 13th ed. Elsevier; 2019.
- Bolognia J, Schaffer JV, Cerroni L. Dermatology. Fourth edition.. Philadelphia, Pa: Elsevier; 2018.
- Machet L, Couhé C, Perrinaud A, Hoarau C, Lorette G, Vaillant L. A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975-2003 data. Br J Dermatol. 2004;150(5):929-935. doi:10.1111/j.1365-2133.2004.05917.x
- Criqui MH, Denenberg JO, Bergan J, Langer RD, Fronek A. Risk factors for chronic venous disease: the San Diego Population Study. J Vasc Surg. 2007;46(2):331-337. doi:10.1016/j.jvs.2007.03.052
- Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-184. doi:10.1016/j.annepidem.2004.05.015
- Newman SA. Cutaneous Changes in Arterial, Venous, and Lymphatic Dysfunction. In: Kang S, Amagai M, Bruckner AL, et al., eds. Fitzpatrick’s Dermatology. 9th ed. McGraw-Hill Education; 2019. accessmedicine.mhmedical.com/content.aspx?aid=1161351033
- Stasis dermatitis – UpToDate. https://www.uptodate.com/contents/stasis-dermatitis?search=venous%20stasis%20dermatitis&source=search_result&selectedTitle=1~49&usage_type=default&display_rank=1#H312177
