Stasis dermatitis

Skin changes due to high vein pressure in the ankles, feet or calves may range from a fine red rash to large, dark brown patches. The most common changes are brown patches around the ankle. These changes will worsen over time, leading to open, poorly-healing wounds called venous stasis ulcers. These problems usually take many years to develop.

The underlying cause of stasis dermatitis is venous insufficiency (valve failure) or obstruction of leg or pelvis veins. Reverse flow of blood toward the feet due to gravity or blockage of outflow due to obesity or vein defects cause venous hypertension, which is high pressure in the veins. This causes fluid, blood cells and protein to weep through the walls of tiny veins into the tissues. This excess fluid then leads to swelling. Pain, tenderness, redness, rashes and brown skin patches usually follow.

Lowering leg vein pressure is the most important treatment for stasis dermatitis. Elastic compression, usually with support hose or special leg wraps, helps the calf muscles to pump venous blood out of the legs. Elevating the legs above the heart uses gravity to lower leg vein pressure. This allows the tissues to partially recover from high venous pressures earlier in the day. Avoiding long periods of sitting or standing may also help. If you can't avoid this, repetitive ankle exercises including the calf muscles may bring relief. Exercises such walking or running may help.

Patients with stasis dermatitis need to have a special ultrasound exam where a dye injection helps veins show up in the images. Doctors with special training can view these images to look for other problems.

Most patients with stasis dermatitis also have venous insufficiency or obstruction severe enough that they need treatment. This may include foam sclerotherapy, endovenous thermal ablation, microphlebectomy or angioplasty/stenting of obstructed pelvic veins.