Blood Clot in Arm: Symptoms, Treatment, and Prevention
What Causes Stasis Dermatitis And Ulcers?
Stasis dermatitis is a type of eczema that causes inflammation, ulcers, and itchiness on the skin of the lower legs. It can result from conditions that affect blood flow in the legs, such as chronic venous insufficiency, varicose veins, and congestive heart failure.
Stasis dermatitis is sometimes called gravitational dermatitis, venous stasis dermatitis, venous eczema, or varicose eczema. According to the National Eczema Association, stasis dermatitis occurs mostly in people ages 50 years or older and is more common in women than men. It is a long-term, or chronic, condition.
An ulcer on the leg may be a sign of stasis dermatitis. A lack of circulation can affect the health of a person's skin. If the skin breaks, an ulcer can form. An ulcer develops when the skin breaks, and the exposed cells become inflamed, die, and shed.
In this article, we look at the causes, risk factors, and symptoms of stasis dermatitis. We also cover the diagnosis, treatment, and prevention of this condition.
The following pictures show how stasis dermatitis can develop and affect the legs.
Stasis dermatitis tends to develop in people with conditions that cause poor blood circulation in the legs, such as chronic venous insufficiency.
It happens when there is high blood pressure due to a blockage in the veins or faulty valves. This causes inflammation, which can lead to skin changes, such as ulcers.
For example, in chronic venous insufficiency, the valves in the leg veins do not work correctly. As a result, the blood can flow backward and pool in the lower legs. This pooling increases pressure and swelling in the veins and the symptoms of stasis dermatitis.
In addition to chronic venous insufficiency, various other conditions and risk factors can affect blood flow in the legs and feet and lead to stasis dermatitis.
They include:
The early symptoms of stasis dermatitis primarily affect the lower legs and include:
As stasis dermatitis progresses, these earlier symptoms can worsen. In addition, new symptoms can appear, including:
Permanent skin changes can occur. The skin may become:
A doctor will diagnose stasis dermatitis by asking about the person's symptoms and medical history. Previous or current conditions that they should be aware of include:
The doctor may then examine the skin on the lower legs to check for visual signs of stasis dermatitis.
They may also order a Doppler ultrasound, a noninvasive test that uses sound waves to check the blood flow through blood vessels. These tests can help identify underlying reasons for stasis dermatitis.
Additional tests to look for underlying causes include:
Other conditions with similar symptoms include:
The goal of treatment for stasis dermatitis is to relieve symptoms, improve circulation, and prevent the condition from progressing. Treatment can include:
In some cases, a doctor may recommend minimally invasive procedures, such as:
These are treatments for varicose veins that may be used to manage underlying problems leading to stasis dermatitis.
A person can take steps to manage stasis dermatitis by:
People with stasis dermatitis should prevent the following products from coming into contact with the affected area, as they can irritate the skin and may make symptoms worse:
Stasis dermatitis is not always preventable. However, making the following lifestyle changes can reduce the risk of developing stasis dermatitis or making it worse:
If a person is living with a condition that increases the risk of stasis dermatitis, they should be sure to follow their doctor's recommendations for treatment. Doing so can reduce their risk of developing this condition.
Without treatment, stasis dermatitis can worsen and lead to complications that include:
There is no cure for stasis dermatitis, but early treatment and preventive measures can stop it from progressing.
A person can improve their outlook by:
Stasis dermatitis is a long-term condition that can cause a range of skin and circulation problems in the lower legs.
Treatment can help manage symptoms and prevent them from progressing. Without treatment, stasis dermatitis can lead to severe complications and discomfort.
Anyone who believes they may have symptoms of stasis dermatitis should see a doctor.
What To Know About Varicose Eczema
Venous stasis dermatitis, or varicose eczema, involves swollen and itchy discolored skin on the lower legs. It usually occurs when venous insufficiency leads to varicose veins. It can lead to ulcerations or open sores.
Other names for the condition are gravitational dermatitis and venous eczema. It is a chronic condition that slowly develops and worsens over time.
Varicose veins occur when veins of the legs become twisted, swollen, and more visible. They develop due to a weakening of the valves and walls of the veins. This weakening causes blood to collect in the vessels, which can result in varicose veins and swelling that develops into stasis dermatitis.
This article gives an overview of the possible causes of venous stasis dermatitis and the treatment options.
Estimates suggest that 6–7 million people in the United States have poor circulation in the legs, known as venous insufficiency. Every year, about 150,000 people receive a new diagnosis of the condition.
According to the National Eczema Association, varicose eczema is more common in females than in males and tends to affect people over the age of 50 years. It appears to be less common in non-Western countries.
A 2020 study looked at the incidence of chronic venous insufficiency, which can lead to varicose eczema. In this study, which involved 66,621 people, mild chronic venous insufficiency affected up to 55% of white people and 28% of Hispanic people. More severe symptoms occurred in up to 61% of white people and 21% of African American people.
In a 2016 study involving more than 20,000 people with advanced chronic venous insufficiency, 85% of the participants were white, and 15% were African American. The African American participants presented with more severe symptoms. As a result, they had to undergo more treatment than the white participants and incurred more hospital charges.
The veins in the legs have valves that help push blood back toward the heart. With age, these valves can weaken. Weakened valves can cause fluid and blood to leak out and pool into the lower leg, leading to a condition known as venous insufficiency.
Over time, if a person does not receive treatment, venous insufficiency can develop into venous stasis dermatitis. In this condition, the skin becomes irritated and starts to break down due to the fluid that collects under the skin.
Risk factors include:
Venous stasis dermatitis can affect one or both ankles or lower legs. The skin may become extremely sensitive and painful to the touch.
The symptoms, which may be more noticeable throughout the course of the day, include:
Without treatment, venous stasis dermatitis can progress and worsen, causing:
Early recognition of the symptoms of venous stasis dermatitis may help a doctor diagnose a possibly life threatening condition, such as heart or kidney failure.
The doctor will ask a person about their symptoms and medical history. People with a history of high blood pressure, heart disease, blood clots, or previous leg injuries should make the doctor aware of this information.
The doctor will also perform a physical examination and check the skin on the lower legs, looking for signs of venous stasis dermatitis. In many cases, they will easily tell that a person has stasis dermatitis due to the symptoms, particularly the appearance of the affected skin and its location.
Another indication is the presence of certain chronic conditions, such as congestive heart failure or kidney failure, which can predispose a person to varicose eczema.
In some cases, stasis dermatitis may look similar to a skin allergy, so a doctor may do a patch test to rule this out.
Once the doctor has confirmed the diagnosis, they will likely refer the person to a specialist or another doctor, who will carry out several tests to determine the cause.
These tests may include:
The treatment will focus on relieving the symptoms. The options may include:
People with venous stasis dermatitis will usually have it for the rest of their life.
The following lifestyle adjustments may help prevent this condition:
Typically, itchy legs do not indicate a serious problem. They may be a sign of an allergic reaction or chemical irritation. Other possible causes include dry skin, rashes, insect bites, folliculitis, irritation from shaving, or stress.
However, if a person has other symptoms or there is no improvement over time, they should talk with a doctor to rule out underlying medical conditions.
Venous stasis dermatitis is a chronic condition that affects the skin. The cause is poor circulation in the lower legs which leads to varicose veins. The veins eventually leak fluid and blood into the legs.
The initial symptoms are usually mild and include itchiness and irritation. Without treatment, the skin may become painful, swollen, and discolored. In more severe cases, the skin may become scaly and develop sores that weep and crust.
There is no cure for venous stasis dermatitis, but lifestyle changes may help improve the symptoms and prevent further complications.
If a person thinks that they may have venous stasis dermatitis, they should consult a doctor as soon as possible for a diagnosis and treatment.
Below, we answer some common questions about varicose eczema.
How can I treat varicose eczema at home?Prevention is the best cure. Things that can help improve and prevent symptoms include wearing compression stockings, keeping the legs elevated, and getting regular exercise.
In addition, some natural remedies that some people use to treat venous insufficiency are:
A person should discuss these natural remedies with a doctor before using them.
People with symptoms of stasis dermatitis should consult a doctor for a diagnosis and seek their advice on the best alternative treatment options.
What exercises can help varicose eczema?Walking is the best exercise for venous stasis dermatitis, as it helps increase blood flow to the lower legs. Other forms of low impact exercise, such as biking, swimming, and calf stretches, are also good.
Is varicose eczema dangerous?Although this condition can be uncomfortable, it is not usually dangerous. It may, however, indicate an underlying medical condition. A person should discuss any concerns with a doctor.
Is venous stasis dermatitis curable?There is no cure for venous stasis dermatitis. However, treatment can relieve the symptoms.
What is the difference between venous stasis dermatitis and cellulitis?Cellulitis is a bacterial skin infection that can cause similar symptoms to venous stasis dermatitis.
Cellulitis can lead to serious complications and usually requires treatment with IV antibiotics.
What causes venous stasis dermatitis to flare up?Prolonged sitting or standing, lack of exercise, a poor diet, stress, or tight-fitting clothing may cause venous stasis dermatitis to flare up.
The Wolly Culprit: Lanolin Revealed As An Uncommon Cause Of Dermatitis On Normal Skin
Christen Mowad, MD, FAAD
Excitement surrounding the "Allergen of the Year" may only be truly appreciated by those immersed in the field of contact dermatitis and patch testing, but each year the announcement is met with enthusiasm from the wider dermatology specialty. The Allergen of the Year is used by the contact dermatitis world to highlight allergens that may be new or emerging; sometimes this announcement highlights allergens that get significant attention but are not substantial clinical problems in terms of allergenicity.
The 2023 allergen of the year is lanolin.
Lanolin is used primarily for its emollient properties and is found in many personal care products; it is also used in the industrial arena. As such, it can be seen as an allergen in allergic contact dermatitis to personal care products and in occupational contact dermatitis cases, respectively. Lanolin is a complex mixture derived from secretions of the sebaceous glands of sheep. It contains high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons. Its components and allergenicity depend in part on the breed of sheep, geographic location as well as the processing method and level of purification. The allergenic components of lanolin are felt to be the free lanolin alcohols.Purification does impact the allergenicity of a lanolin product with medical grade lanolin and highly purified medical grade lanolin having less allergenicity.
The most appropriate lanolin concentration to use when patch testing for lanolin allergy has been debated over time. The North American Contact Dermatitis Group (NACDG) has used lanolin alcohol 30% and more recently Amerchol L101 50% in petrolatum. The NACDG study of their group experience over 17 years from 2001-2018 found lanolin sensitivity to be common, relevant, and typically linked to personal care products. The distribution was most common on the hands, followed by a scattered distribution and then the face. Lanolin allergy was also more common in children in their study. The most recent NACDG cycle data from 2019-2020 used Lanolin alcohol (Amerchol L101) 50% petrolatum and found 3.7% of their patients had a positive reaction; lanolin was the 18th most common allergen in their most recent cycle.
Lanolin is extracted from sheared sheep wool.
Certain populations may have a higher incidence of lanolin allergy, including those with compromised skin such as those with stasis dermatitis, chronic leg ulcers, or those with perianal and genital dermatitis. Children, due to atopic dermatitis, and the elderly, due to stasis dermatitis, more commonly have lanolin allergy.
The lanolin paradox, a term coined by Dr. Ronni Wolf, describes those that patch test positive to lanolin but can tolerate this allergen on normal skin. It is felt that individuals may become sensitized to lanolin through products used on compromised skin. These same patients do not have problems when using the lanolin-containing product on normal skin. The repeat open application test (ROAT) can often help direct the use of lanolin-containing products in those that patch test positive to lanolin.
Patch testing materials have been debated over the years and are often either lanolin alcohols 30% or Amerchol-L101 (50%). False negative patch tests on normal skin, even when patients are sensitized through damaged skin, can be challenging. The ROAT test helps determine if patch test positive patients can use lanolin on normal skin. Lastly, lanolin patch test positivity does not mean that wool clothing is off the table for patients deemed allergic to lanolin, as wool textiles do not contain lanolin though patients may still be irritated by coarse wool fibers.
Point to Remember: Lanolin is the 2023 Allergen of the Year and is present in many personal care and industrial products. For those who have a positive patch test to lanolin, it is important to remember the "lanolin paradox" where patients have a positive patch test but tolerate lanolin on normal skin.
Our expert's viewpoint: Bruce A. Brod, MD, MHCI, FAAD, Associate Dean of Continuing Medical Education. Clinical Professor of Dermatology, University of Pennsylvania Perelman School of Medicine
Lanolin is a highly complex mixture of esters, di-esters, and hydroxyl esters of high molecular weight lanolin alcohols and high molecular weight lanolin acids. The name is derived from Latin meaning lana (wool) and oleum (oil). Lanolin, also called wool grease, may constitute 5% to 25% of the weight of sheared wool, so it's a major component of wool and makes for a great emollient. It is important, however, not to confuse wool fiber intolerance among patients with atopic dermatitis, with lanolin hypersensitivity being more prevalent among atopic patients. The two are unrelated. Certain Merino wool fabrics, produced using modern textile manufacturing techniques, are well tolerated by atopic patients and sometimes provide better tolerance than our default recommendation of cotton and silk.
The reason lanolin is used in personal care products is due to its unique tenacity for the skin making it ideal for skin creams and lipsticks. It makes for a very good emollient because of its excellent water holding capacity. The composition varies based on the breed of sheep, geographic location, method of extraction, and level of purification. While this variability has led to uncertainty about the relevance of lanolin to allergic contact dermatitis, we can make a few firm conclusions based on the evidence.
If you've seen one type of lanolin, you've seen one type of lanolin. Lanolin is highly variable in its composition due to many factors.
Lanolin is a cause for allergic contact dermatitis more commonly in children, patients with atopic dermatitis, and in conjunction with certain skin conditions including stasis dermatitis, ulcers, and pre-existing dermatitis.
Applying personal care products containing lanolin on normal skin does not pose much risk for allergic contact dermatitis even in patients who test positive to lanolin or Amerchol L 101. This is the lanolin paradox and has been recognized as a phenomenon for several decades.
The alcoholic fraction of lanolin is responsible for most of the allergic contact dermatitis, although one specific allergen has not yet been identified.
Lanolin alcohol or Amerchol L 101 is generally a weak sensitizer.
Along the way we have been socialized through our medical literature to shy away from lanolin or wool wax alcohol because of its potential allergenicity. Likely this is why industry is incorporating less lanolin into personal care products which may account for the slight decrease in positive patch test reactions. Emollients in general are very therapeutic for skin conditions associated with barrier dysfunction. Emollients create a thin layer on the skin to prevent water evaporation and maintain the skin's flexibility. The ideal emollients are sebum and lipid. Analytical chemistry has revealed that lanolin has several important chemical and physical features like the lipids in human stratum corneum, so it is no wonder that it is incorporated into products used to preserve the skin barrier.
As a dermatologist specializing in contact dermatitis, I frequently encounter challenges with weak positive patch test reactions, which make it difficult to counsel patients about the significance of the reaction in terms of avoidance or its role in their existing dermatitis. Patch testing, our gold standard for diagnosing allergic contact dermatitis, is flawed because it often fails to confidently differentiate between allergic and irritant reactions. In my practice, Amerchol L 101, which is de facto lanolin, is a common culprit that contributes to this dilemma. Ideally, we would have a reliable method to distinguish between irritant and allergic reactions during patch testing. A small study conducted in 2022 measured the expression of allergic marker genes and found that most patients with positive patch test reactions to Amerchol L 101 exhibited gene expression indicative of allergy, and the strength of the patch test correlated with the level of gene expression. However, a few patch test reactions did not display allergic gene expression. From this study, I conclude that Amerchol L 101 allergy is indeed real, but false positive reactions should be considered. While I will still refrain from overconfidently diagnosing allergic contact dermatitis to Amerchol L 101 based solely on a positive patch test, I will feel more justified in maintaining a healthy degree of uncertainty.
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