Hypostatic eczema, also called ‘stasis dermatitis’, ‘venous eczema’, ‘gravity eczema’ or ‘varicose vein eczema’ (because the eczema is often seen over a varicose vein), occurs on the lower legs and ankles in patients with a less well-functioning venous system in the legs (chronic venous insufficiency). Blurred red spots with flaking appear on the lower legs that can be very itchy, causing scratching effects. Treatment consists of tackling the underlying cause and caring for the skin with a pH-neutral cream.
- What is hypostatic eczema?
- Cause of hypostatic eczema
- Symptoms of hypostatic eczema on legs and ankles
- Examination and diagnosis
- Treatment of hypostatic eczema
- Address underlying cause
- Lifestyle measures
- Cream or ointment
- Prognosis
Normal vein and venous insufficiency (right) / Source: Decade3d – anatomy online/Shutterstock.com
What is hypostatic eczema?
Hypostatic eczema is a form of eczema on the lower legs and ankles that occurs in people with a less well-functioning vein system in the legs, or with chronic vein failure of the legs (medical term: ‘chronic venous insufficiency’). This is a chronic disorder of the draining veins, in which valves that are present in the veins to prevent the return of blood to the feet are damaged. If these valves no longer close properly, blood flows back easily, causing pressure in the veins and capillaries to increase. This condition is also seen in middle-aged and older women, which may be associated with an increased risk of thrombosis after pregnancy or use of the contraceptive pill and other hormonal factors. This form of eczema is characterized by a (moist) rash on the lower legs and ankles with redness, crusts and flaking. The lower legs may also be swollen. Hypostatic eczema can sometimes disappear spontaneously, but it can also suddenly flare up or come back.
Cause of hypostatic eczema
Hypostatic eczema is localized exclusively to the lower legs and ankles. As a result of chronic vein failure of the legs, blood is not sufficiently drained from the legs. This leads to pooling of blood. This engorgement increases the pressure in the veins and capillaries and various breakdown products, inflammatory proteins and immune cells are present in the blood that remains. These factors play a role in the development of hypostatic eczema through an as yet unknown mechanism. Scratching and rubbing can maintain or even worsen the eczema.
Symptoms of hypostatic eczema on legs and ankles
Blurred red spots with flaking appear on the lower legs and possibly the ankles, which can itch considerably, causing scratching effects. In addition, small blisters and wounds may occur in the eczema area. Furthermore, signs of chronic venous insufficiency may be visible, such as pitting edema (an compressible swelling, you can press a hole in it), varicose veins and discoloration or hardening of the skin. The eczema can spread to the other leg, even if this leg does not suffer from vein failure. A ‘spread reaction’ can also occur to the upper legs and torso as a result of secondary contact allergic eczema, which may be caused by the ointments used (corticosteroids/hormone ointments) or by the compression and/or Therapeutic Elastic Stockings (tek) used, in often colloquially referred to as ‘support stockings’.
Atopic eczema in a child with scratch effects / Source: Eisfelder, Wikimedia Commons (CC BY-SA-3.0)
Examination and diagnosis
The doctor can often make the diagnosis by sight, although it can sometimes be difficult to make a good distinction between atopic eczema (constitutional eczema), nummular eczema, dehydration eczema (crackle eczema) and psoriasis. If contact allergy is suspected, tests (patch tests) can be used to determine whether and to what you are allergic. During this examination, the doctor will apply a sticker with a low concentration of the suspected substance to the skin. After about 2 to 3 days we will check whether this has caused eczema.
Treatment of hypostatic eczema
Address underlying cause
The most important thing in treatment is tackling the underlying cause: chronic venous insufficiency. There are ways to deal with it, such as:
- Compression therapy: Wear compression stockings or bandages to improve blood flow and reduce swelling. 🧦
- Lifestyle adjustments: Exercise regularly, keep your weight under control and avoid standing or sitting for long periods of time. 🚶 ♀️ 🥗
- Leg raise: Very simple – raise your legs above the level of your heart to reduce swelling. 💆 ♀️
- Medications: Sometimes medications are necessary to relieve symptoms. Listen to your doctor. 💊
- Endovenous procedures: If the problem involves your vein valves, procedures such as laser therapy or radiofrequency ablation may be needed to repair them. 💡
- Surgery: If it is really serious, surgery may be considered. Fortunately this is rare. 💉
Moving is healthy! / Source: Istock.com/monkeybusinessimages
Edema in the affected leg can be controlled by first bandaging it for a few weeks. When the moisture has been sufficiently removed, elastic stockings can be fitted. You often have to wear such stockings for life. Try to get an extra half hour of exercise every day by walking or cycling or taking the stairs instead of the elevator. By walking you use your leg muscles and this essentially pumps the fluid from your legs back to the blood vessels.
Lifestyle measures
It is extremely important to maintain a ARTICLE=184148]healthy lifestyle[/ARTICLE], such as avoiding standing or sitting for long periods of time, and moving your legs regularly. Wearing comfortable clothes and avoiding extreme temperatures can also help.
Cream or ointment
In addition to compression, the skin can be cared for with a pH-neutral cream. In case of severe complaints, a corticosteroid ointment can be temporarily applied to the eczema areas. However, watch out for the side effects, because the skin becomes even thinner with long-term use of hormone ointment, which can cause new defects to arise. Sometimes superficial varicose veins play an important role in the development of hypostatic eczema. In that case these can be treated.
Prognosis
Hypostatic eczema is a chronic skin condition that usually occurs in older adults. The prognosis varies from person to person. When you’re on the couch, it’s a challenge to deal with it.
The prognosis is fair, but it often requires ongoing care and management. Always talk to your doctor for specific advice and treatment options. Stay healthy and take good care of your skin!
read more
- Eczema (types of eczema): symptoms, cause and treatment
- Itchy legs: causes of itchy legs
- Itchy skin or itching: causes of itching and types of itching
- Atopic eczema: symptoms, causes, treatment, prognosis
- Eczema herpeticum: symptoms, causes and treatment
