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Do I Have Venous Stasis Dermatitis?

Posted: April 2, 2014   |   Revised: October 19, 2016

Some patients develop a red rash or brownish skin discoloration near the ankles. These changes are subtle at first, but they progress to very obvious changes over time and reflect very unhealthy skin due to high pressures within the veins of the legs. The skin changes are called venous stasis dermatitis and the condition involving the high pressure in the veins is called chronic venous hypertension. This is a completely different condition from arterial hypertension which is the condition usually referenced when the word “hypertension” is used in medical discussions.

Stasis DermatitisIt is IMPORTANT to seek evaluation of venous stasis dermatitis since it reflects very abnormal changes in the skin and soft tissues developing over a long period of time. High pressure in the veins forces fluid, blood cells, and protein through the walls of the microscopic veins into the soft tissues. The continuing injury to the skin eventually results in infection, blood clotting, or venous stasis leg ulcers near the ankles.

Venous stasis leg ulcers may not heal or may heal very slowly and almost always are preventable with proper care. Because many patients do not experience much leg pain in the early stages, they often present with very advanced disease. In the early stages, many patients feel only some itching or burning discomfort.

Chronic venous hypertension leading to venous stasis ulcers may be a result of failure of the one-way valves in the veins of the leg (venous insufficiency), chronic dependency of the legs, or venous obstruction preventing flow of venous blood back to the heart. Combinations of these problems may cause particularly severe stasis dermatitis. Venous obstruction may be caused by old venous thrombosis (clotting) with residual scarring in the veins of the legs, pelvis, or abdomen or by compression due to obesity or compression by other abdominal or pelvic organs.

A careful lower extremity venous color duplex ultrasound exam is essential to identify the causes of venous stasis dermatitis or venous stasis leg ulcer. Sometimes abdominal and pelvic venous duplex ultrasound or other imaging is necessary as well. The only facility in the Clarksville area which we think provides an adequate venous ultrasound exam to treat these disorders is our vascular laboratory at VeinCare Centers of Tennessee.

The initial treatment of venous stasis dermatitis includes periodic elevation of the legs higher than the heart, rhythmic contraction and relaxation of the muscles of the calves, and elastic compression to help get the venous blood back to the heart. Elastic compression may be with support hose or elastic wraps, but other techniques and devices are available for those who struggle with support hose.

It is important to avoid prolonged sitting or standing when feasible and to do calf muscle pump exercises when one must sit or stand.
Treatment of the problems underlying the chronic venous hypertension is essential to improve the health of the skin and to avoid progressive infection, blood clotting, or venous stasis ulcers from forming. Techniques to treat chronic venous hypertension may include endovenous thermal or chemical ablation, foam sclerotherapy, or microphlebectomy. If veins of the abdomen or pelvis are obstructed, they may be re-opened by angioplasty and stenting through a needle stick approach.

Early detection of venous stasis dermatitis presenting as itching, a rash near the ankle, or a brownish skin discoloration of the lower calf, ankle area, or foot is important in order to treat and avoid more serious problems. With delay, the problems will only get worse.

If you or a loved one have skin changes suggesting venous stasis dermatitis, call VeinCare Centers of Tennessee at 931-551-8991 to schedule an appointment soon.

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