Stasis dermatitis (varicose eczema): symptoms, causes and treatment

The NHS describes varicose eczema as a long-term skin condition affecting the lower legs. It is also known as venous, gravitational or stasis eczema. The British Association of Dermatologists (BAD) says it is more common as people get older and occurs more often in women than in men. BAD says it is not hereditary.

The NHS says the affected skin can change colour and become itchy and swollen, dry and flaky, or scaly, crusty or blistered. On white skin it looks red or brown; on black or brown skin it tends to look dark brown, purple or grey and can sometimes be more difficult to see. There may be periods when symptoms improve and periods when they are more severe.

• Leg swelling, especially at the end of the day or after long periods of standing.

• Visible varicose veins on the legs.

• Tender, tight skin that can eventually become hardened (lipodermatosclerosis).

• Small, white scars (atrophie blanche).

• Pain, and sometimes eczema affecting other parts of the body.

• Leg ulcers, if it is not treated.

The NHS says varicose eczema is usually caused by increased pressure in the leg veins. When small valves in the veins stop working properly, it is difficult for blood to be pushed upwards against gravity and it can leak backwards. The pressure increases, which can cause fluid to leak into surrounding tissue, and it is thought the immune system reacts to this fluid. BAD says the increased pressure pushes blood and blood products into surrounding tissue, which triggers inflammation in the skin.

• being a woman

• obesity, which can increase pressure in the leg veins

• pregnancy

• a family history of venous insufficiency

• not being able to move for a long period of time

• having had a deep vein thrombosis (DVT) or leg ulcers or cellulitis

• increasing age

The NHS says a doctor can often diagnose it simply by looking at your skin, and will ask questions about whether you have a problem with blood flow in the leg veins. A GP may check the pulse in your feet and may do an ankle brachial pressure index (ABPI) test, which compares blood pressure at the ankles and upper arms, to see whether compression stockings are suitable. A difference in readings suggests a problem with arterial flow, in which case stockings may not be safe.

BAD says other causes of a rash on the lower leg include allergic and irritant contact dermatitis, and that further investigations may be needed when the diagnosis is not clear. You may be referred to a vascular specialist or a dermatologist.

The NHS says for most people, treatment involves a combination of self-help measures, emollients, topical corticosteroids and compression stockings. BAD says the problem with the valves cannot be cured, so the eczema does not clear completely if left untreated, but simple measures and treatments for the active eczema can greatly improve the skin and prevent complications such as leg swelling, infection and lipodermatosclerosis.

BAD advises avoiding knocks to the leg, for example on supermarket trolleys or cupboard doors, because minor injuries often take months to heal and can impair healing of the eczema. It also advises avoiding scratching, keeping weight within the normal range and staying physically active, and avoiding standing still or sitting for long periods.

BAD cautions that emollients contain oils and can catch fire more easily when in contact with dressings, clothing, bed linen or hair, even when dried, so people using them should take care near naked flames or cigarettes and wash clothing and bedding frequently.

The NHS says that if varicose eczema is not treated, leg ulcers can develop. These are wounds that form where the skin has become damaged. BAD says leg ulcers can develop, and that treatment keeps the eczema under control and helps prevent complications such as swelling, infection and lipodermatosclerosis.

The NHS says to see a GP if you have symptoms of varicose eczema. If the treatments do not help, a GP may refer you to a dermatologist in case there is another cause, or if they are concerned you may also have contact dermatitis. BAD says if the response is poor despite daily treatment, you should seek advice in case there is another cause, such as a fungal infection or a contact allergy to a topical treatment.

On the NHS, a GP or practice nurse can diagnose varicose eczema, prescribe emollients and steroid ointments, arrange an ABPI test and fit compression stockings, and refer you to dermatology or vascular services. Some people see a private dermatologist or vascular surgeon for assessment and varicose vein treatment. Compression stockings are available on prescription, according to BAD.