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Venostasis Dermatitis

Written by Megan Kinder - and big thanks go out to contributor Jeffrey A. Oster, DPM. [email protected]

So -- what exactly is Venostasis Dermatitis?

Venostasis dermatitis is an inflammatory reaction seen in the skin of the lower leg caused by static, slow or delayed venous flow of the leg. Venostasis dermatitis is common in patients 50 years and older. Factors that can contribute to the early onset of venostasis dermatitis include obesity, inactivity, venous injury, dependency (lower than the heart) of the leg and infection of the leg. The primary contributing cause of stasis dermatitis is valvular incompentency of the veins of the leg resulting in chronic swelling. The appearance of venous stasis can range from simple swelling to severe ulcerations.

Left untreated, venostasis dermatitis can progress to a venous ulceration.  The most common location for a venous ulceration of the lower extremity is over the medial aspect of the ankle.  Venous ulcerations vary in size and depth.

Treatment of Venostasis Dermatitis and venous stasis ulcers.

Central to the treatment of Venostasis Dermatitis and venous stasis ulcers is control of lower extremity edema. Edema can be controlled by elevating the legs above the level of the heart, use of diuretics and the use of compression hose. It's important to realize that when using compression hose, the hose need to be put on first thing in the morning in advance of any swelling. If swelling is allowed to occur before applying the support hose, that swelling will likely be there the rest of the day.

Eczematous changes (peeling and flaking) and lichenification (hardening of the epidermis) can be treated with skin softening agents. Inflammatory changes of the skin are common and can be treated with topical or oral steroids. Discoloration of the skin is difficult to treat. Discoloration or darkening of the skin is often due to the deposition of hemosiderin (the iron component of red blood cells). Once hemosiderin is deposited in the skin, is is much like a tattoo that stains the skin from within.

Ulceration of the skin is common, particularly at the medial (inside) ankle. The area superficial to the origin of the great saphenous vein is the most common site of ulceration. Ulcerations should be cultured and treated for infection if necessary. Dome paste boots, also called an Unna boots are the gold standard for treating venous stasis ulcerations. Dome paste boot are saturated with zinc oxide that will moisturize the skin. Dome past boots are applied on a one weekly basis to control lower extremity edema. Treatment can take from one to many weeks to see complete closure of the venous ulcer.  Negative pressure treatment of the wound along with skin grafting may be necessary in severe, non-healing ulcers.

It is essential to realize that control of edema is necessary following successful treatment of a venous stasis ulcer. Compression hose should be worn daily to prevent reoccurrence of ulcerations.

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