Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Stasis dermatitis

INTRODUCTION

Stasis dermatitis, or stasis eczema, is a common inflammatory dermatosis of the lower extremities occurring in patients with chronic venous insufficiency, often in association with varicose veins, dependent chronic edema, hyperpigmentation, lipodermatosclerosis, and ulcerations. Stasis dermatitis may rarely involve the upper limbs in patients with artificial arteriovenous (AV) fistulas for hemodialysis or congenital AV malformations [1].

This topic will discuss the pathogenesis, clinical presentation, complications, and treatment of stasis dermatitis. The pathophysiology, clinical and diagnostic evaluation, and treatment of lower extremity chronic venous disease are discussed separately. (See "Pathophysiology of chronic venous disease" and "Diagnostic evaluation of chronic venous insufficiency" and "Post-thrombotic (postphlebitic) syndrome" and "Medical management of lower extremity chronic venous disease".)

EPIDEMIOLOGY

Skin changes related to chronic venous insufficiency, including edema, hyperpigmentation, eczema, fibrosis, atrophy, and ulceration, are reported in 1 to 20 percent of women and in 1 to 17 percent of men [2]. In one study, stasis dermatitis was reported in 6.2 percent of patients over the age of 65 [3]. Established risk factors for varicose veins and chronic venous insufficiency include age, family history of venous disease, female sex, standing occupation, obesity, and history of deep vein thrombosis [2,4]. Heart failure and hypertension are aggravating factors.

The epidemiology of chronic venous insufficiency is discussed separately. (See "Overview and management of lower extremity chronic venous disease", section on 'Epidemiology'.)

PATHOPHYSIOLOGY

The final common pathway that leads to chronic venous insufficiency is the development of venous hypertension. In most cases, venous hypertension results from dysfunction of the venous valves, obstruction to the venous flow, or failure of the "venous pump" [5]. If the valves of deep or perforator veins are incompetent, the increased pressure generated during standing or calf muscle contraction causes blood to reflux into the superficial venous system, converting it into a high pressure system. (See "Pathophysiology of chronic venous disease", section on 'Genesis and consequences of chronic venous hypertension'.)

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Aug 22, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Deguchi E, Imafuku S, Nakayama J. Ulcerating stasis dermatitis of the forearm due to arteriovenous fistula: a case report and review of the published work. J Dermatol 2010; 37:550.
  2. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15:175.
  3. Yalçin B, Tamer E, Toy GG, et al. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol 2006; 45:672.
  4. Fiebig A, Krusche P, Wolf A, et al. Heritability of chronic venous disease. Hum Genet 2010; 127:669.
  5. Bergan JJ, Schmid-Schönbein GW, Smith PD, et al. Chronic venous disease. N Engl J Med 2006; 355:488.
  6. Stasis dermatitis. In: Weedon's Skin Pathology, Third edition, Weedon D. (Ed), Churchill Livingstone Elsevier, 2010.
  7. Pappas PJ, DeFouw DO, Venezio LM, et al. Morphometric assessment of the dermal microcirculation in patients with chronic venous insufficiency. J Vasc Surg 1997; 26:784.
  8. Belsito DV. Autosensitization dermatitis. In: Fitzpatrick's Dermatology in General Medicine, Seventh, Wolff K, Goldsmith Lowell A, Katz SI, et al. (Eds), McGraw Hill Medical, New York, NY 2008. Vol I, p.167.
  9. Bendl BJ. Nummular eczema of statis origin. The backbone of a morphologic pattern of diverse etiology. Int J Dermatol 1979; 18:129.
  10. HAXTHAUSEN H. Generalized ids autosensitization in varicose eczemas. Acta Derm Venereol 1955; 35:271.
  11. Belsito DV. Autosensitization dermatitis. In: Fitzpatrick's Dermatology in General Medicine, Seventh edition, Wolff K, Goldsmith LA, Katz SI, Gilchrest BA. (Eds), McGraw Hill Medical, New York, NY 2008. Vol I, p.167.
  12. Barbaud A, Collet E, Le Coz CJ, et al. Contact allergy in chronic leg ulcers: results of a multicentre study carried out in 423 patients and proposal for an updated series of patch tests. Contact Dermatitis 2009; 60:279.
  13. Machet L, Couhé C, Perrinaud A, et al. A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975-2003 data. Br J Dermatol 2004; 150:929.
  14. Tavadia S, Bianchi J, Dawe RS, et al. Allergic contact dermatitis in venous leg ulcer patients. Contact Dermatitis 2003; 48:261.
  15. Smart V, Alavi A, Coutts P, et al. Contact allergens in persons with leg ulcers: a Canadian study in contact sensitization. Int J Low Extrem Wounds 2008; 7:120.
  16. Jankićević J, Vesić S, Vukićević J, et al. Contact sensitivity in patients with venous leg ulcers in Serbia: comparison with contact dermatitis patients and relationship to ulcer duration. Contact Dermatitis 2008; 58:32.
  17. Lim KS, Tang MB, Goon AT, Leow YH. Contact sensitization in patients with chronic venous leg ulcers in Singapore. Contact Dermatitis 2007; 56:94.
  18. Reichert-Pénétrat S, Barbaud A, Weber M, Schmutz JL. [Leg ulcers. Allergologic studies of 359 cases]. Ann Dermatol Venereol 1999; 126:131.
  19. Ebner H, Lindemayr H. [Leg ulcer and allergic eczematous contact dermatitis incidence of contact allergies induced by topical therapy (author's transl)]. Wien Klin Wochenschr 1977; 89:185.
  20. Bahmer FA, Lesch H. Density of Langerhans' cells in ATPase stained epidermal sheet preparations from stasis dermatitis skin of the lower leg. Acta Derm Venereol 1987; 67:301.
  21. Scott HJ, Coleridge Smith PD, Scurr JH. Histological study of white blood cells and their association with lipodermatosclerosis and venous ulceration. Br J Surg 1991; 78:210.
  22. Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol 2010; 11:373.
  23. Gooptu C, Powell SM. The problems of rubber hypersensitivity (Types I and IV) in chronic leg ulcer and stasis eczema patients. Contact Dermatitis 1999; 41:89.
  24. Sasseville D, Tennstedt D, Lachapelle JM. Allergic contact dermatitis from hydrocolloid dressings. Am J Contact Dermat 1997; 8:236.
  25. Chang HY, Wong KM, Bosenberg M, et al. Myelogenous leukemia cutis resembling stasis dermatitis. J Am Acad Dermatol 2003; 49:128.
  26. Weiss SC, Nguyen J, Chon S, Kimball AB. A randomized controlled clinical trial assessing the effect of betamethasone valerate 0.12% foam on the short-term treatment of stasis dermatitis. J Drugs Dermatol 2005; 4:339.
  27. Weaver J, Billings SD. Initial presentation of stasis dermatitis mimicking solitary lesions: a previously unrecognized clinical scenario. J Am Acad Dermatol 2009; 61:1028.
  28. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S.
  29. http://dermnetnz.org/dermatitis/standard-patch.html (Accessed on July 27, 2011).
  30. Henry M, Hanks G, Whelan A. A randomized, double-blind therapeutic trial of 0.25% desoxymethasone and 0.1% hydrocortisone 17-butyrate in the treatment of varicose eczema. Curr Med Res Opin 1980; 6:502.
  31. http://www.wrongdiagnosis.com/symptoms/ankle_swelling/side-effects.htm (Accessed on 10/12/2011)
  32. Mirande LM, Landolfi JM, Pedemonte LH. [Multiple applications of closed permanent wet dressings. Their mode of action]. Med Cutan Ibero Lat Am 1981; 9:67.
  33. Tomljanović-Veselski M, Lipozencić J, Lugović L. Contact allergy to special and standard allergens in patients with venous ulcers. Coll Antropol 2007; 31:751.
  34. Jindal R, Sharma NL, Mahajan VK, Tegta GR. Contact sensitization in venous eczema: preliminary results of patch testing with Indian standard series and topical medicaments. Indian J Dermatol Venereol Leprol 2009; 75:136.
  35. Bernstein SC, Roenigk RK. Surgical pearl: erythromycin ointment for topical antibiotic wound care. J Am Acad Dermatol 1995; 32:659.
  36. Schena D, Papagrigoraki A, Girolomoni G. Sensitizing potential of triclosan and triclosan-based skin care products in patients with chronic eczema. Dermatol Ther 2008; 21 Suppl 2:S35.