Venous stasis ulcers

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Alternative names
Stasis dermatitis and ulcers; ulcers - venous

Definition
Stasis dermatitis is a skin condition caused by fluid building up under the skin. This fluid buildup, or swelling, is caused by poor circulation in the veins (venous insufficiency). Eventually, poor circulation can lead to ulcers (craters) in the skin.

Causes, incidence, and risk factors

Varicose veins, congestive heart failure, and other conditions can cause the arms and legs to swell, especially in the feet and ankles. This swelling is caused when plasma (the fluid portion of blood) leaks out of the blood vessels and into the tissues.

The excess fluid in the tissues interferes with the blood’s ability to feed the tissue cells and dispose of cellular waste products. The tissue becomes poorly nourished and fragile, resulting in stasis dermatitis. The disorder is common on the ankles because there is less supportive tissue in this area.

The skin becomes thin and inflamed, and open ulcers may form and heal slowly. The skin may darken. The skin, initially thin, may later thicken, perhaps because of itching and scratching of the area.

Symptoms

• Swelling of legs, ankles, or other areas
  
• Skin appears thin, tissue-like
  
• Skin lesion: macule or patch
  
• Skin spots, red
  
• Darkening of skin at the ankles or legs
  
• Thickening of skin at the ankles or legs
  
• Open sores, ulcers (may develop)
  
• Superficial skin irritation of the legs
  
• Itching (of the affected area)
  
• Leg pains (in the affected area)

Signs and tests
The diagnosis is primarily based on the appearance of the skin. Your doctor may order tests to examine the blood flow in your legs.

Treatment
The underlying condition and swelling must be controlled. This may include surgical correction of varicose veins, medications to control heart failure, or diuretics to remove excess fluid.

Circulation in the area may improve as swelling is reduced. This can be aided by raising the legs above the level of the heart until the swelling goes down. Gradually increasing gentle activity, such as walking, can improve circulation.

Elastic stockings may be recommended to improve venous blood return from the legs, which will reduce swelling.

Treatment of the skin may include wet dressings and topical antibiotics to control infection in open ulcers.

The skin area should be kept clean and observed for signs of infection (pain, redness, drainage that looks like pus).

Expectations (prognosis)
Stasis dermatitis is often a chronic condition. Symptoms may be minimized if the underlying condition and swelling can be controlled.

Complications

• Secondary bacterial skin infections
  
• Permanent scar formation
  
• Chronic leg ulcers
  
• Infection of underlying bone

Calling your health care provider
Call for an appointment with your health care provider if leg swelling or stasis dermatitis develops.

Prevention
Prevention is the control of underlying causes of peripheral edema.

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