Stasis dermatitis is skin inflammation caused by blood pooling in the veins in your legs. Pooling of blood in the veins of the legs is called venous insufficiency or venous stasis.
Venous pooling causes the pressure inside the veins to be higher than normal (venous hypertension). This elevated pressure in the veins causes damage to your capillaries. When capillaries are damaged, a protein called fibrinogen leaks out into your tissues. Your body converts fibrinogen to fibrin. The buildup of fibrin (fibrin cuffs) is thought to cause a decrease in oxygen supply to the skin, resulting in cell death. This inflammatory process causes your skin to change in its appearance.
Stasis dermatitis is a chronic condition that can cause considerable discomfort. This condition is most likely to occur in people over the age of 50. About six to seven percent of people in that age group have stasis dermatitis. Incidence of this condition may be as high as 20 percent in those over age 70. Women are slightly more likely than men to have stasis dermatitis. This is thought to be due to increased stress on leg veins caused by pregnancy. (Flugman & Clark, 2010)
Inside the veins in your legs are one-way valves that keep blood flowing in the right direction—toward your heart. These valves become weak with age. This allows blood to flow back across the valves toward the feet and pool in your legs (venous stasis) instead of continuing to flow toward your heart. Venous stasis leads to stasis dermatitis. Varicose veins and congestive heart failure are also known to cause leg swelling and stasis dermatitis. Common causes of stasis dermatitis that are unrelated to age are:
- surgery (such as using a leg vein for bypass surgery)
- deep vein thrombosis (DVT, blood clots in the leg veins)
Symptoms of stasis dermatitis include skin darkening, itching, scaling, and ulcers.
You may also have symptoms of venous stasis including:
- leg swelling
- calf pain and tenderness
- dull ache or heaviness in the 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 itch. Scratching may cause the skin to crack, and fluid may seep out. The changes eventually become permanent. The skin becomes thick and hard (lipodermatosclerosis). Your skin becomes dark brown and may look lumpy. In the final stages, your skin breaks down, and an ulcer (sore) forms. Ulcers from stasis dermatitis most commonly form on the inside of your ankle.
You should call your doctor if you notice leg swelling or any of the symptoms of stasis dermatitis. Other symptoms that you should seek immediate help for include:
- open wounds or ulcers
- pus-like drainage
Stasis dermatitis is diagnosed mostly from the appearance of the skin on your legs. Your doctor may order a venous Doppler. This is a noninvasive ultrasound test that uses sound waves to check the blood flow in your legs.
There are several things you can do to treat stasis dermatitis:
- avoid prolonged standing and sitting
- prop your feet up when sitting
- wear compression stockings
Ask your doctor about what kinds of skin creams and ointments to use. You should avoid using the following products:
- calamine and other lotions that dry your skin
- topical antibiotic ointments such a neomycin
- benzocaine and other numbing agents
Your doctor might tell you to apply wet dressings or may prescribe oral antibiotics or topical steroid creams and ointments. Medications are used to control congestive heart failure and leg swelling. Surgery may be recommended to correct varicose veins.
Stasis dermatitis that is allowed to progress untreated can result in:
- chronic leg ulcers
- bone infection (osteomyelitis)
- bacterial skin infections
- permanent scarring
Control of peripheral edema (swelling in the legs, ankles, and feet) can prevent stasis dermatitis.