VARICOSE ECZEMA

What is Varicose Eczema?

Varicose eczema, also known as stasis eczema, is a skin rash often linked with varicose veins or other issues related to venous insufficiency, though it can occur independently of varicose veins. This condition is frequently seen in older individuals. If left untreated, it can progress to ulcer formation, leading to greater health challenges. It's advisable to seek consultation with a dermatologist if you suspect varicose eczema.

What is varicose veins?

Veins in our body play a crucial role in transporting blood from various body parts back to the heart. These veins are equipped with valves, known as the venous pump, which ensure that the blood flows in the direction towards the heart. However, in certain situations (as explained below), the veins in the legs struggle to maintain this flow towards the heart, leading to the accumulation of blood in the veins due to gravity. This stagnant blood causes the veins to dilate and swell, resulting in varicose veins. Additionally, the pressure from this accumulated blood can cause it to leak into the skin through capillaries, leading to changes in the skin.

What are causes of varicose eczema?

Varicose eczema is associated with heightened pressure resulting from disrupted blood flow in the veins around the legs. This increased pressure forces blood into the skin and surrounding structures through capillaries. Our immune system responds to this abnormal blood presence, leading to eczema. Factors that could contribute to the development of varicose veins and varicose eczema include:

• Obesity
• Pregnancy
• Prolonged standing or sitting in one position
• Deep vein thrombosis
• Heart failure
• Hypertension

What are the symptoms of varicose eczema?

The symptoms of varicose eczema or stasis eczema resemble those of other types of eczema and can vary in severity based on underlying venous insufficiency. Typically, it begins with persistent itching, particularly on the inner aspects of the legs and ankles. Chronic and severe itching can lead to darkened and thickened skin. Advanced cases may exhibit inflammation, redness, swelling, fluid oozing, blistering, scaling, and crusting. In some instances, ulcers may form, which can be challenging to heal and may result in white depressed scars upon healing. Older eczema lesions may show hyperpigmentation due to blood component deposition, along with scaling and noticeable thickening of the skin known as lipodermatosclerosis, giving the legs a resemblance to an inverted champagne bottle.

How do dermatologist diagnose varicose eczema?

Dermatologists diagnose varicose eczema through visual examination of the skin on the legs and inner ankle, along with considering the patient's medical history related to venous insufficiency such as varicose veins and leg swelling. In uncertain cases, a skin biopsy may be performed to assess skin changes and rule out other types of eczema, although this is typically avoided due to poor healing associated with venous insufficiency. Color Doppler assessment may also be recommended by a dermatologist to evaluate the severity of venous insufficiency. While blood tests are not usually necessary for diagnosing eczema, they may be conducted to assess the risk of deep vein thrombosis. If a patient shows resistance to standard antibiotics, bacterial culture from infected wounds or ulcers may be conducted to identify the responsible pathogens.

What is the treatment for varicose eczema or stasis eczema?

Treating varicose eczema is complex due to the likelihood of recurrences. Management involves addressing various aspects such as treating the underlying venous insufficiency, managing eczema symptoms, addressing superimposed infections, and treating ulcers.

Treatment of underlying venous problem:

Sure, here are the rewritten points:

• Elevating the legs regularly and engaging in daily walking and exercises.
• Striving for weight reduction and being cautious to avoid trauma to the legs.
• Refraining from prolonged standing in one position and using continuous compression therapy such as stockings.
• Taking oral medications as prescribed and under the supervision of a doctor.
• Considering ablation therapy as a treatment option.

Treatment of eczema

• Maintain regular skin hygiene with thorough cleaning.
• Apply moisturizer to keep the skin hydrated.
• Use topical steroids for acute episodes of skin eczema.
• Apply wet dressings periodically to soften and remove adherent crust (2-3 hours daily).
• Consider using compression bandages as directed.
• Oral steroids may be necessary for stubborn cases of stasis eczema.
• Address any superadded infections promptly if present.

Treatment of ulcer

• Perform surgical debridement to freshen the edges and floor of the ulcer.
• Apply platelet-rich fibrin dressing to aid in wound healing.
• Consider using epidermal growth factor creams to promote skin regeneration.
• Explore grafting or surgical interventions under the guidance of a surgeon for appropriate treatment.