What are the other Names for this Condition? (Also known as/Synonyms)

• Gravitational Dermatitis
• Stasis Dermatitis
• Venous Stasis Dermatitis

What is Venous Eczema? (Definition/Background Information)

• Venous Eczema is an itchy skin condition affecting the lower legs that is mostly caused by chronic venous insufficiency. The condition is also known as Venous Stasis Dermatitis and is usually observed in middle-aged and older adults
• In venous insufficiency, there is poor blood circulation from the veins to the heart; typically, the veins in the lower legs are unable to send blood back to the heart for recirculation. This results in pooling of blood in the leg veins (venous stasis) leading to many associated signs and symptoms, including skin manifestations

Who gets Venous Eczema? (Age and Sex Distribution)

• Venous Eczema is a common condition that is generally observed after middle-age and in older age groups. 1 in 5 adults over the age of 70 years may be affected
• Both males and females are affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Venous Eczema? (Predisposing Factors)

The risk factors for Venous Eczema may include:

• Advancing age
• Blood clot
• Cellulitis involving the lower limb
• Deep vein thrombosis (DVT) affecting the lower limb
• High blood pressure
• Kidney failure   
• Multiple pregnancies
• Prior history of heart disease
• Standing for long time due to certain jobs causing swelling in the legs
• Surgical scars near or below the knee
• Varicose veins
• Venous insufficiency - it is the most important risk factor for the condition
• Venous leg ulcers due to chronic venous insufficiency

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Venous Eczema? (Etiology)

• Venous Eczema is caused from an inflammatory reaction of the leg veins due to accumulation of fluid in the tissues of the lower legs (pedal edema)
• The fluid collection may occur from various factors, such as venous insufficiency, varicose veins, or deep vein thrombosis
• In venous insufficiency, there is usually an associated upward lymphatic flow insufficiency, worsening the typical edema

What are the Signs and Symptoms of Venous Eczema?

The signs and symptoms of Venous Eczema may vary from one individual to another. It may be mild or severe and may include:

• Presence of itchy red skin lesions on one or both legs, typically just above the ankles
• These irregular lesions appear as plaques, may blister, ooze discharge, and present crust formation
• Orange-brown skin patches may be noted
• Atrophic scars that are white with red spots, termed atrophie blanche. This is possibly an indication of a component of arteriolar insufficiency
• Fibrosis of skin
• Narrowing at the ankles and swollen shins give the lower limbs the shape of a ‘Champagne bottle'. This is a characteristic sign of the more complex problem of lipodermatosclerosis
• Heavy legs - difficulty in standing or walking

Additionally, the signs and symptoms of the underlying condition, if any present, may be noted.

How is Venous Eczema Diagnosed?

A diagnosis of Venous Eczema may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation; a visual examination of the condition is sufficient to establish a diagnosis in most cases
• Skin biopsy, if necessary: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Tests and exams to diagnose an underlying condition, if needed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Venous Eczema?

The possible complications due to Venous Eczema include:

• Emotional stress due to cosmetic issues
• Superimposed bacterial and fungal skin infections
• Cellulitis from bacterial infection
• Secondary dermatitis, where dermatitis spreads to other body regions
• Recurrence of the condition following treatment
• Treatment complications and medication side effects

How is Venous Eczema Treated?

The treatment measures available for Venous Eczema may include:

• Treating the underlying causative condition is very important
• Treating the skin signs and symptoms:
  • Use of potassium permanganate solution or dilute vinegar
  • Use of topical steroidal creams
  • Administration of oral antibiotics
  • Use of moisturizing creams for dry skin
  • Protect the skin lesion using clean gauze
  • Wash the skin with lukewarm water (avoid using soap)
• Leg care:
  • Avoid standing for prolonged periods
  • Increase blood circulation by walking regularly
  • Elevate feet above hips while sitting or sleeping
  • Use pressure bandages to reduce swelling
  • Wear compression stockings after leg wound heals

Regular follow up visits with the healthcare provider is important and recommended.

How can Venous Eczema be Prevented?

Venous Eczema may be prevented by considering the following measures:

• Physical activity is important in improving venous circulation and preventing stasis of blood in the lower limbs
• Early recognition and suitable treatment of underlying cause
• Maintain good body hygiene and skin care
• Avoid standing for long durations

What is the Prognosis of Venous Eczema? (Outcomes/Resolutions)

The prognosis of Venous Eczema is generally good with prompt and adequate treatment. However, it is known to recur and become a chronic condition.

Additional and Relevant Useful Information for Venous Eczema:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/