Generality
Stasis dermatitis is an inflammatory disease of the skin that occurs in the lower limbs . The cause of this disorder is to attribute to chronic venous insufficiency, which prevents normal blood flow and causes fluid stagnation in the skin and subcutaneous districts of the legs.
Stasis dermatitis is manifested by hyperpigmentation of brown-reddish skin, swelling, itching and scaling. These signs are associated with reduced elasticity, hypotrophy and fibrosis of the skin, from which they can, over time, achieve chronic edema and lipodermatosclerosis (painful hardening resulting from panniculitis).
Usually, the course of the pathology is benign, but, if neglected from a therapeutic point of view, it can lead to the formation of ulcers and infections.
The diagnosis of stasis dermatitis is clinical. The treatment is essentially directed at chronic venous insufficiency, therefore it involves the lifting and compression of the limbs, as well as a pharmacological therapy.
What's this
Stasis dermatitis is a skin disease due to chronic insufficiency of the venous system of the lower limbs (in practice, the blood has difficulty returning to the heart). This pathology manifests itself, in fact, when varicose veins or other circulatory conditions cause an accumulation of blood or fluids under the skin .
The blood and lymphatic stagnation contribute to increase the pressure and the swelling which, in turn, hinder the exchange between oxygen and blood.
Causes
Stasis dermatitis is a cutaneous and subcutaneous pathology that presents a rather complex pathogenic mechanism, still partially unknown.
At the origin of the disorder, it is known that there is an altered tissue metabolism that derives from chronic venous insufficiency . This pathological condition of veins or venous valves prevents, in fact, the normal blood flow and causes stasis dermatitis.
In practice, the stagnation of blood in the lower portion of the legs compromises the endothelial integrity of the microcirculation; the consequences of this phenomenon are the release of fibrin, local inflammation and cellular necrosis.
Therefore, the affected skin is eczematous and is usually oedematous, with hyperpigmented reddish-brown spots.
Stasi dermatitis: what is it caused by?
Stasis dermatitis is an inflammation of the skin of the lower limbs, generated by the slowed venous and lymphatic blood circulation. Vascular stasis is at the origin of the eczematous, pigmented and / or dystrophic manifestations of the skin of the legs.
Triggering or aggravating factors
- Stasis dermatitis is a pathological condition typical of patients suffering from circulatory disorders involving leg veins.
- Stasis dermatitis affects both sexes. The disease is observed mainly in elderly patients.
- Stasis dermatitis tends to occur mainly in subjects who present:
- Repeated episodes of thrombophlebitis and swelling (edema) of the legs;
- Varicose veins (ie dilated and convoluted venous blood vessels);
- Overweight and obesity;
- Metabolic diseases.
- Stasis dermatitis recognizes predisposing factors of a genetic and constitutional nature, including:
- Previous venous thrombosis;
- Excessive sedentariness;
- Atopy.
- Stasis dermatitis can be exacerbated by:
- Edema of the lower limbs;
- Contact dermatitis due to the use of topical medicaments;
- Scratching.
Symptoms and Complications
The first signs of stasis dermatitis include:
- Erythema ;
- Itching ;
- Slight peeling ;
- Exudation and crusts ;
- Excoriations and vesicular lesions ;
- Lichenification (thickening and hardening of the skin).
At least in the early stages, stasis dermatitis does not tend to cause pain.
However, patients complain of burning, a feeling of heat and constricting tension .
Over time, stasis dermatitis typically involves:
- Edema of the legs (or swelling of the lower limbs caused by an accumulation of liquids);
- Hemosiderin pigmentation (ie the skin of the lower extremities shows a reddish-brown pigmentation);
- Dilation of superficial venules around ankles.
Stasi dermatitis: which sites are involved?
Stasis dermatitis usually occurs at the ankles and lower legs, but can go up to the knees.
Course of Stasis Dermatitis
The evolution of stasis dermatitis is slowly progressive:
- In a first phase, on the skin of the lower limbs appear eczematous lesions in the form of erythema (redness), desquamation, exudation and crusts. Each of these lesions may worsen due to bacterial superinfection or contact dermatitis (often related to various topical treatments often used to relieve symptoms).
- Over a few weeks or months, the skin becomes hyperpigmented, ie it takes on a reddish-dark brown color. Note : hyperpigmentation may occur secondarily to venous stasis or is evident before the development of stasis dermatitis.
- Over time, if adequate therapy is not undertaken for chronic venous insufficiency and stasis dermatitis, these signs are typically associated with reduced elasticity, hypotrophy and fibrosis of the cutaneous and subcutaneous districts.
Stasis dermatitis: possible complications
- The course of stasis dermatitis is substantially benign, but, if not treated properly, it can lead to the formation of varicose ulcers, as well as to predispose to bacterial superinfections . In the advanced stages of the disease, in fact, some areas of the fibrotic skin can break, giving rise to open sores. Usually, these lesions appear near the ankle and are very painful.
- Moreover, over time, the skin can become stiff and thicken. Therefore, chronic edema and lipodermatosclerosis may develop. This last complication of stasis dermatitis consists in a painful hardening deriving from the panniculitis, which, if serious, gives the legs an upside-down "bowling pin" appearance, with calf enlargement and ankle thinning.
Diagnosis
The diagnosis of stasis dermatitis is clinical, therefore it is based on the evaluation of the appearance of the skin and on the finding of the characteristic variations of the pathology and of other signs of chronic venous insufficiency.
To learn more about the general picture, a more in-depth specialist visit may be indicated, supported by diagnostic imaging tests (such as an ultrasound).
Treatment and Remedies
The treatment of stasis dermatitis involves, first of all, the management of venous insufficiency with the adoption of useful measures to avoid blood stasis in the legs, thus improving circulation and favoring venous return . At the same time, it is necessary to alleviate dermatitis symptoms and prevent skin ulceration with specific dressings or an elastic-compressive bandage.
In cases where it is possible, it is also necessary to change the lifestyle, gradually starting to practice a regular physical activity: it is sufficient even just a daily half-hour walk, at a brisk pace, to obtain an improvement in the situation. This habit also contributes to achieving and maintaining the ideal weight.
Treatment of chronic venous insufficiency
The long-term management of stasis dermatitis aims to treat chronic venous insufficiency, avoiding blood stagnation in the veins of the legs.
In particular, the doctor can indicate the use of compression stockings and elastic bandages appropriate for blood stasis and swelling reduction; these should be purchased in stores specializing in sanitary ware. Compression can be continuous or intermittent.
Another useful measure for the patient is to keep the legs elevated, at least at the level of the heart, when sitting, to facilitate venous return.
Treatment of Stasis Dermatitis
In recent-onset stasis dermatitis, symptoms can be alleviated with wet compresses, in the form of gauze tablets soaked in tap water or aluminum acetate (Burow's solution). These must be applied first in a prolonged (or permanent) manner, then at intervals.
Maintaining clean skin helps prevent infections.
In the case of exudative lesions, the best treatment involves colloidal dressings, generally applied under elastic support. If stasis dermatitis gets worse, as shown by an increase in heat, redness, small ulcers or pus, more absorbent agents are used, possibly associated, on the advice of the doctor, with the use of antibiotics .
In addition, corticosteroids in cream or ointment, often indicated in association with a zinc oxide paste, can be applied in a thin layer in a thin layer (note: the two products can be incorporated into one another at the time of the drafting). These drugs, however, should not be used directly on stasis dermatitis ulcers that may be present, since they delay healing.
Some people have to be treated with Unna's bandage, that is, a knee-high leg medicated with zinc gelatin, which is applied to the ankle and the lower part of the leg, where it hardens in a similar way to a plaster. Unlike the latter, however, the "stivaletto" remains soft, limiting swelling and protecting the skin from irritation. Unna's bandage should be replaced regularly.
Regardless of the bandage used, the reduction of swelling (usually with compression) is essential for healing.
Important! In stasis dermatitis, the skin is easily irritated and is less resistant to the action of contact allergens (such as bacitracin, neomycin and perfumes), direct irritants and potentially sensitizing topical agents. For this reason, antibiotic creams, anesthetics, alcohol, witch hazel, lanolin or other chemicals should not be used, as they can make the disease worse.
Treatment of stasis ulcers
- Stasis dermatitis ulcers should be treated with specific dressings, such as moisturizing bandages containing hydrocolloids or hydrogels, light wraps and bandages. After ulcer healing, an elastic support must be applied before the person gets up in the morning.
- If signs of an overlapping infection (celllulitis) appear, oral antibiotics (eg cephalosporin, dicloxacillin, etc.) or topical antibiotics (eg mupirocin and silvery sulfadiazine) may be used.
- In some cases, once the edema and inflammation are reduced, very large or extensive ulcers require full-thickness grafting of skin taken from other areas of the body.
