Leg Discoloration Stasis Dermatitis

Stasis dermatitis also is known as venous stasis dermatitis because it happens when this is an issue with the veins, generally in the lower legs. These problem veins cause pressure to build-up as the blood tries to

 

flow through the body and heart. The pooling of blood in the veins of the lower leg can lead to many different types of symptoms.

 

 

 

This pressure causes fluid flow out of the veins and into the skin, which the causes:

  • Redness
  • Scaling
  • Itching or pain
  • Swelling

In severe causes of stasis dermatitis can be:

  • fluid discharge
  • Open areas ( large ulcers develop/ skin cracking)
  • Infection

Over time, chronic stasis dermatitis can result in more permanent changes in the skin including:

  1. Lipodermatosclerosis: scar-like shifts in the fat and other soft tissues
  2. Atrophie Blanche: white scars encircled by tiny capillaries
  3. Lichenification – thickened due to chronic scratching or rubbing.

What causes stasis dermatitis
Stasis dermatitis affects people with poor circulation. It is common among adults over the age of 60. Women are more likely to get it than men.
Some conditions can increase your risk for developing stasis dermatitis.

These include:

  • High blood pressure
  • Congestive heart failure
  • Kidney failure
  • Obesity
  • Blood clots in leg veins
  • Many pregnancies
  • Varicose Veins

Venous insufficiency is a long-term (chronic) ailment in which the veins have difficulties carrying blood from the legs back to the heart. This is due to damaged valves that are in the veins.

Some people with venous insufficiency develop stasis dermatitis blood pools in the veins of the lower leg. Can cause leakage out of vines into the skin and other issues. This may lead to itching and inflammation, which causes more skin discoloration. The skin may break down and form open sores.

Stasis dermatitis treatment
Because the problem starts with poor circulation, your doctor may recommend treating the damaged veins in your legs by surgery. However, Oc Cassian ly the surgery for the veins is not possible or is not able to repair the veins completely.

Pressure stockings or wrap can be used to help mechanically move the liquid out of the skin and soft tissues. Raising the feet when possible can also help along these lines.

Similar to other forms of eczema, a topical steroid can be applied to calm the inflammation and itching. Occasionally covering the steroid with wet or dry wraps or an Unna boot can greatly assist in severe1 cases. An Unna boot is a kind of gauze bandage with recovery medications within it and provided compression to help with fluid build up.

In situations where corticosteroids are not appropriate, or when they have been used for a prolonged period, a known-corticosteroid topical medication such as tacrolimus Protopic or pimecrolimus (Elidel) may be prescribed.

Stasia dermatitis tends to come back until the underlying cause (damaged veins) is addressed.

Additional Approach Considerations to Treatment
Even though extensive work has been completed in the study of venous ulcer treatment, no significant, well-controlled experiments have investigated the treatment of stasis dermatitis. The overall mainstay of therapy has perpetually been directed at reducing the clinical influence of the latent venous insufficiency and edema, a goal that is accomplished with high-level compression therapy.

Ligation

Stasis dermatitis associated with an arteriovenous fistula or incompetent perforators may respond to ligation of the vessels.
Light

Blending therapy with autologous platelet-rich plasma and light-emitting diodes displays some promise in the treatment of refractory stasis ulcers.

Stasis pigmentation, following hemosiderin deposition, is particularly challenging to manage and typically does not resolve even when the latent stasis dermatitis is well controlled with topical therapy. Nonetheless, some scholars have described recovery of stasis pigmentation after treatment with a noncoherent intense pulsed light (IPL) source.

Compression Therapy
Evaluating the patient’s peripheral arterial circulation (clinically or with a Doppler study) before prescribing compression therapy is essential. Combining compression to a leg with compromised arterial circulation could develop claudication and put the patient in danger of ischemic damage.
Compression accomplished using specialized stockings that deliver a controlled pressure gradient (measured in mm Hg) to the affected leg is proper for long-term control of edema, but not for the healing of stasis ulcers. Compression stockings should be used early in the morning, before the patient rises from bed, to support application when leg edema is at its lowest point.
High-level compression can be achieved by applying elastic wraps, compression (Unna) boots, and more advanced devices, such as end-diastolic compression boots. Most of these modalities require guidance within a physician’s office or wound care center. Frequent leg elevation is a necessary supplement to leg compression.
Grafting

Allogeneic cultured dermal substitutes have been used, but are costly. Most patients respond to high-level compression alone.

Patient compliance

Counseling patients about the use of compression therapy are vital to the helpful management of stasis dermatitis. Although the advantages of compression therapy are widely recognized, patient noncompliance about compression stockings persists as a primary obstacle to treatment. Difficulty in stocking application and patient anxieties about appearance are just one of the many reasons why patients may fail to comply with this therapy.
Also, patients frequently resist the idea of using compression dressings and stockings because these modalities may create significant discomfort when first used to edematous, inflamed lower extremities. However, it is imperative to reassure patients that the pain lessens considerably as leg edema is diminished and to inform them that this therapy must be maintained permanently to prevent a recurrence of dermatitis and leg ulcers.

Topical Therapy
Topical treatment of stasis dermatitis has significant overlap with the therapy of other forms of acute eczematous dermatitis. Weeping lesions can be dressed with wet to damp gauze bandages saturated with water or with a drying agent, such as aluminum acetate. Topical corticosteroids are commonly used to reduce inflammation and itching in acute flares; mid-potency corticosteroids, such as triamcinolone 0.1% ointment, are effective.
Be careful of the use of high-potency topical corticosteroids in stasis dermatitis, since the chronically swollen skin can raise the prospect of systemic intake and because steroid-induced cutaneous atrophy can affect the patient to ulceration. Furthermore, continued use of topical steroids can cause their efficacy to decrease, a phenom identified as tachyphylaxis. (Systemic steroid hormones are not a part of stasis dermatitis treatment, although they can be needed in very severe cases of extensive autoeczematization.)

Nonsteroidal treatment

The nonsteroidal calcineurin inhibitors tacrolimus and pimecrolimus may show to be useful tools in the control of stasis dermatitis. Even though these topical medications are approved only for atopic dermatitis, they have been shown to be useful in many steroid-responsive dermatoses. Since the calcineurin inhibitors do not carry the risks of skin atrophy or tachyphylaxis, they have the potential to grow into valuable elements in the treatment of chronic dermatoses such as stasis dermatitis.
A single-arm, interventional preliminary study by Maroo et all showed that combination therapy with topical tacrolimus and oral doxycycline might be effective against stasis dermatitis. The study evaluated treatment results in 15 patients with stasis dermatitis resulting from a chronic venous insufficiency in the lower limbs. The patients were treated for four weeks with topical tacrolimus 0.1% and oral doxycycline 100 mg.
The researchers found that 86.6% of the patients expressed improvement of the dermatitis area, while 6.7% exhibited no improvement, and another 6.7% encountered deteriorating dermatitis. Two patients showed adverse effects.
The doctors also found that patients had a meaningful improvement in pain, edema, erythema, pigmentation, and exudation, as well as a statistically meaningful decline in ulcer size.

Long-term management

People with chronic, quiescent stasis dermatitis can be treated with bland topical emollients to increase epidermal moisture. Plain white petrolatum is an economical occlusive moisturizer that is very efficient and, importantly, does not contain any contact sensitizers.

Health Life Media Team