Stasis dermatitis - treatment, symptoms and cause of Stasis dermatitis

Stasis dermatitis develops on the lower extremities secondary to venous incompetence and chronic edema. Early findings in stasis dermatitis consist of mild erythema and scaling associated with pruritus. The typical initial site of involvement is the medial aspect of the ankle, often over a distended vein. As the disorder progresses, the dermatitis becomes progressively pigmented, due to chronic erythrocyte extravasation leading to cutaneous hemosiderin deposition.

As with other forms of dermatitis, stasis dermatitis may become acutely inflamed, with crusting and exudate. Chronic stasis dermatitis is often associated with dermal fibrosis that is recognized clinically as brawny edema of the skin. Stasis dermatitis is often complicated by secondary infection and contact dermatitis. Severe stasis dermatitis may precede the development of stasis ulcers.

Treatment of Stasis dermatitis

Avoidance of irritants and use of emollients and/or midpotency topical glucocorticoids are the cornerstones of therapy for stasis dermatitis. Control of chronic edema is important to prevent leg ulcers. Patients should be encouraged to elevate the affected extremity when sitting. A compression stocking with a gradient of at least 30 to 40 mmHg is most effective for edema control and is much more effective for preventing chronic edema than is antiembolism hose.

Stasis ulcers are difficult to treat, and resolution of these lesions is slow even under the best of circumstances. It is extremely important to elevate the affected limb as much as possible. The ulcer should be kept clear of necrotic material by gentle debridement and covered with a semipermeable dressing under pressure.

Glucocorticoids should not be applied to ulcers, since they may retard healing. Secondarily infected lesions should be treated with appropriate oral antibiotics, but it should be noted that all ulcers will become colonized with bacteria, and the purpose of antibiotic therapy should not be to clear all bacterial growth. Some ulcers may take months to heal or require skin grafting.