Stasis Dermatitis - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Stasis dermatitis develops when there is venous stasis (poor venous blood flow), resulting in a lack of nutrition to the skin. In response, the skin becomes irritated, red, scaly, and itchy. 

Symptoms

Stasis dermatitis refers to a rash that can subsequently develop due to venous stasis. This is often described as a “ruddy” red/brown, ill-defined pigment that develops on the lower legs. In the acute phase, this can be inflamed and have a more intense red appearance. The rash is often very itchy.


Venous stasis refers to stagnation of venous blood and an alteration or reduction of the normal venous flow of blood. This often manifests as edema or swelling, and can include the appearance of more prominent, enlarged and/or tortuous veins in the legs, or rarely other locations on the body. Several risk factors have been identified:[1,2] 

  •  Women are at higher risk than men although the reasons are not clear
  • Those working in professions that require prolonged standing 
  • People that are overweight or obese 
  • Those with a family history of venous stasis 
  • Those with a history of blood clots 
  • Those that are more physically active have a lowered risk

Causes

Venous stasis is caused by a combination of ineffective function of the one-way valves in the vein, increased pressure in the veins, and poor function of the calf muscle.  The one-way valves in the veins of the leg may not close all the way allowing some back flow of fluid leading to increased pressure. If the calf muscle is not active enough it cannot pump the fluids up the leg, and against gravity blood tends to pool more in the leg veins. In addition there are several other reasons for increased venous pressure in the body. Examples of this include prolonged standing or certain types of heart failure that result in increased pressure in the venous system. 

Treatments

  • The rash of stasis dermatitis can be treated with topical steroids to reduce the inflammation.
  • If venous stasis is occurring secondary to a known medical condition (such as heart failure), then there may be medical therapies that can help treat the condition and decrease venous pressure. This can be discussed with your physician to determine if the venous stasis present is due to another treatable condition. 
  • Compression stockings or socks are often the first treatment for venous stasis. The compression helps to push the blood up the leg. The level of compression should be determined by a qualified healthcare professional as some people are not healthy enough to wear medical grade compression. Stockings and socks come in different “grades” of compression depending on each individual's needs. Compression therapy can be dangerous if the blood flow into the leg is problematic (this is called peripheral vascular disease). Some research suggests that for people with dysfunctional calf muscle, engaging in physical therapy may be helpful.  
  • For some large, dilated veins, or varicose veins, a surgical intervention to remove these veins might be possible.  

​1.    Beebe-Dimmer JL, Pfeifer JR, Engle JS, et al. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol.2005;15(3):175-184; PMID: 15723761.

2.    Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebology.2008;23(3):103-111; PMID: 18467617.