STASIS DERMATITIS

By Gary M. White, MD

Stasis dermatitis


Stasis dermatitis represents an inflammatory rash of the lower legs in the setting of leg swelling and poor circulation.

Clinical

The skin about the inner ankle is red and scaly. These changes may extend up the lower leg to the knee. Edema is always present and may be severe. Varicosities may be seen about the lower leg. An ankle flare may be present. Over time, the skin may take on a brownish discoloration due to hemosiderin deposition. In chronic and/or severe cases, ulceration may occur.

Stasis Dermatitis vs. Cellulitis

Lower extremity cellulitis is more likely if there is asymmetry (one sided), tachycardia, leukocytosis and age > 70 [JAAD 2017;76;618].

Treatment

Daily use of support hose to prevent swelling is key. Instruct the patient to wear them whenever s/he is not in the shower and not in bed. Buy just one pair initially to see if they fit and are relatively comfortable. Many patients complain of heat and pain during use. A lot of support and encouragement is needed as patients usually are not too fond of wearing support hose but they are key!!

Before starting compression therapy, the following should be excluded as they are contraindications [JEADV 2017;31;1562]:

Complications to compression therapy include:

A medium-to-high-potency topical steroid ointment to calm any inflammatory component is indicated. Sometimes applying it at night is helpful so as not to grease up the hose during the day. On the other hand, applying a grease to the legs beforehand can allow the hose to slide on much easier.

Some recommend strengthening the calf muscles to reduce edema. The may be done with standing heel rises (e.g. 20-30) performed several times a day or full-stride walking or stair climbing.

Use Vaseline, Aquaphor or moisturizing cream ongoing to prevent future outbreaks.

If there are any wounds or ulcer, the dressing/bandage should be applied under the hose.

For patient's with chronic lymphedema and recurrent cellulitis, the use of an advanced pneumatic compression device may be beneficial. In one study, there was an approximate 75% reduction in cellulitis over the course of a year in patients with chronic lymphedema using an advanced pneumatic compression device (Flexitouch System) [JAMA Derm 2015;151;1183].

Additional Pictures

Stasis dermatitis Stasis dermatitis

Edema and stasis of the left foot, but not the right.
Stasis dermatitis Stasis dermatitis

Unusual inflamed area on the shin of a very old man that on biopsy showed stasis dermatitis.
Stasis dermatitis Stasis dermatitis

Stasis dermatitis

Rarely, stasis dermatitis may present as an isolated red patch or plaque on the leg, mimicking a neoplasm.
Stasis dermatitis

At times, massive edema may lead to blisters and constant dripping of body fluids.
Massive edema leading to bulla in stasis dermatitis

Id reaction on the arm from stasis.
An id reaction of the arm from stasis dermatitis of the leg

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