Venous Eczema, also known as varicose eczema or stasis dermatitis, is an inflammatory condition of the skin seen in association with venous reflux.
Venous Eczema Explained
Venous reflux occurs when the valves in the veins fail and blood travels toward the feet instead of the heart. This increases the pressure in the veins, which can cause fluid to leak into the surrounding tissues. It is thought that varicose eczema may develop as a result of the immune system reacting to this fluid.
Varicose eczema is more common in people with varicose veins, but not all patients with venous reflux and venous eczema will have visible varicose veins, as the varicose veins may be “hidden”.
The skin becomes itchy, red and swollen, dry and flaky or scaly and crusty. It is usually found around the ankles or lower legs and frequently misdiagnosed by general practitioners as cellulitis or simple eczema.
Patients frequently have had this condition for many years with a chronic relapsing course. Often some initial response to steroid creams may occur, but with long term use, the skin becomes fragile and more prone to break down or ulcerate. Antibiotics may be prescribed, but are not helpful unless the skin has become secondarily infected.
Anyone with the above symptoms (with or without varicose veins) should undergo a venous Doppler study for venous incompetence performed at a specialised vein clinic.
If venous reflux is identified in proximity to the skin changes, a venous eczema diagnosis and treatment of the underlying venous reflux is usually curative.
Right: Venous eczema 37yr female left leg due to "hidden" varicose veins.
Key Messages about Venous Eczema
- Chronic skin irritation below the knee – 1st exclude venous eczema as a cause
- Venous eczema is often misdiagnosed and inappropriately treated.
- A phlebologist or vein specialist uses a Doppler Ultrasound study to confirm the diagnosis.
- Venous eczema may lead to chronic skin ulceration
- Venous eczema is easily cured by treating the underlying reflux with endovenous techniques.
Above: Venous ulcers now healed (pigmentation persists) following ablation of great saphenous and 2mm incompetent perforator vein adjacent to ulceration.
Above: Venous eczema has completely healed following ultrasound guided foam sclerotherapy to underlying incompetent vessels.