Varicose Eczema

varicose eczema

Varicose eczema is a skin condition caused by increased pressure in the veins of the legs. It usually affects older people and takes a long time to heal. Conditions such as infection and contact dermatitis can hamper progress. Surgery is occasionally required.

What do you understand by varicose eczema?

Varicose eczema is the skin changes that happen when venous pressure (the pressure in the veins of the legs) increases. It is also called as gravitational eczema, stasis eczema or venous eczema.

What is the presentation of varicose eczema?

Affected skin becomes red, scaly and flaky. The redness can sometimes be mistaken for infection (cellulitis). Dirty brown or rusty brown patches of discolouration may develop, which may get blisters or ulcers and the skin may feel hard or tight.

The changes are usually seen on the inner side of the calf. Skin hardening and tightening are more obvious in the lower part of the leg. This can change the shape of the leg and cause an appearance that is like an inverted champagne bottle shape.

You may get some scarring in the later stages. Sometimes healed ulcers can leave a star-shaped white mark.

Who are more prone to get varicose eczema?

Older people are affected more. People most at risk are those who have varicose veins, who have had varicose vein surgery, or who have had a thrombosis in a deep leg vein (a DVT - deep vein thrombosis).

What are the reasons for the development of varicose eczema?

Varicose eczema is caused when pressure the veins increases, causing a build-up inback  pressure makes it difficult for the blood to flow back up the legs against gravity. This restriction to blood flow causes increased pressure in the veins in the legs. This can cause pigment to leak into the skin, inflammation, eczema, scarring and ulceration.
Varicose eczema can also occur if the veins are blocked  after a thrombus (blood clot) forms in the deep veins.

How is it treated?

Treatment includes

  • General advice given is:
    • Avoid injuring the skin (for example, against furniture).
    • Put your legs up on a pouffe or footstool when sitting.
    • Keep active and go for regular walks.
    • Make sure the skin does not become too dry by using regular emollients (moisturising creams).
  • Steroids are applied to the skin when skin becomes inflamed;a topical steroid is advised by a doctor (steroid creams or ointments applied to the skin). Topical steroids work by reducing inflammation in the skin. The steroid is applied as an ointment rather than a cream if the skin is very dry. A moderate-strength steroid is usually prescribed unless the skin is very inflamed, in which case a very strong ointment may be needed.

Topical steroids are usually applied once a day (sometimes twice a day - your doctor will advise). Rub a small amount thinly and evenly just on to areas of skin which are inflamed. (This is in contrast to emollients described earlier, which are applied liberally.)

To work out how much you should use each dose: squeeze out some ointment from the tube on to the end of an adult finger - from the tip of the finger to the first crease. This is called a fingertip unit. One fingertip unit is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together. Gently rub the cream or ointment into the skin until it has disappeared. Then wash your hands.

  • Compression stockings, works by applying pressure from outside the veins, preventing leakage of blood into the surrounding tissues. This will require a test first to check that the circulation through the arteries of your legs is normal. Compression stockings come in light, medium or strong material (Class 1, 2 or 3) and are worn below the knee. Most people can tolerate Class 2; otherwise, Class 1 is prescribed. If Class 2 stockings do not work it may be necessary to try Class 3, although many people find these difficult to wear for any length of time.

What does one do if the treatment doesn't work?

If your condition does not seem to be responding to treatment, your doctor may consider patch testing to check if you have developed contact dermatitis. This is usually done by a dermatologist (skin specialist).

Lack of progress sometimes means that infection has set in: antibiotic tablets may then be needed.

Your may require surgery if:

  • Your varicose eczema will only get better if underlying varicose veins are treated.
  • You have a leg ulcer which is not responding to medical treatment.
  • You have a blockage in the arterial circulation of the leg.

Alternative treatments like herbal preparations applied to the skin have been known to cause allergic reactions and are best avoided

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