eMedicine Specialties > Dermatology > Diseases of the Vessels

Stasis Dermatitis: Differential Diagnoses & Workup

Author: Scott L Flugman, MD, Consulting Staff, Dermatology Associates of Huntington PC
Coauthor(s): Richard A Clark, MD, Professor of Biomedical Engineering, Dermatology and Medicine, Director of Center of Tissue Engineering, State University of New York at Stony Brook
Contributor Information and Disclosures

Updated: Mar 23, 2009

Differential Diagnoses

Asteatotic Eczema
Nummular Dermatitis
Atopic Dermatitis
Pigmented Purpuric Dermatitis
Cellulitis
Pretibial Myxedema
Contact Dermatitis, Allergic
Tinea Pedis
Contact Dermatitis, Irritant
Cutaneous T-Cell Lymphoma
Necrobiosis Lipoidica

Workup

Laboratory Studies

  • Blood tests are generally not helpful in the management of stasis dermatitis, except in a patient where cellulitis and/or sepsis are suspected. An exception is the patient with stasis dermatitis due to venous thrombosis; patients with venous thrombosis need a thorough hematologic workup to rule out underlying hypercoagulability states.

Imaging Studies

  • Radiologic/Doppler studies
    • In patients with acute new-onset stasis dermatitis or in a young patient, investigating the dynamics of the deep venous circulation is prudent.
    • Venous Doppler studies may reveal deep venous thrombosis or severe valve damage due to past thrombosis. Of course, the consequences of an unrecognized acute or subacute deep venous thrombosis may be catastrophic.

Histologic Findings

Skin biopsy of stasis dermatitis, although rarely indicated, shows an acute or subacute dermatitis. Acute lesions may exhibit a superficial perivascular lymphocytic infiltrate, epidermal spongiosis, serous exudate, scale, and crust. Chronic lesions may show epidermal acanthosis with hyperkeratosis. The dermis is characterized by deep dermal aggregates of siderophages due to uptake of hemosiderin from degraded erythrocytes. Dermal capillaries are frequently dilated; long-standing lesions show intimal thickening of small arterioles and venules along with dermal fibrosis.

A special consideration in chronic stasis dermatitis where biopsy may be necessary is the development of acroangiodermatitis (pseudo–Kaposi sarcoma). The violaceous plaques and nodules of acroangiodermatitis may be clinically indistinguishable from classic Kaposi sarcoma, especially when occurring in an elderly man. Biopsy samples show changes typical of stasis dermatitis, along with a proliferation of capillaries and fibroblasts. However, the vascular slits and the atypical endothelial cells that are seen in classic Kaposi sarcoma are absent.

More on Stasis Dermatitis

Overview: Stasis Dermatitis
Differential Diagnoses & Workup: Stasis Dermatitis
Treatment & Medication: Stasis Dermatitis
Follow-up: Stasis Dermatitis
Multimedia: Stasis Dermatitis
References
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References

  1. Cheatle TR, McMullin GM, Farrah J, Smith PD, Scurr JH. Skin damage in chronic venous insufficiency: does an oxygen diffusion barrier really exist?. J R Soc Med. Aug 1990;83(8):493-4. [Medline].

  2. Dodd HJ, Gaylarde PM, Sarkany I. Skin oxygen tension in venous insufficiency of the lower leg. J R Soc Med. May 1985;78(5):373-6. [Medline].

  3. Falanga V, Moosa HH, Nemeth AJ, Alstadt SP, Eaglstein WH. Dermal pericapillary fibrin in venous disease and venous ulceration. Arch Dermatol. May 1987;123(5):620-3. [Medline].

  4. Pappas PJ, You R, Rameshwar P, et al. Dermal tissue fibrosis in patients with chronic venous insufficiency is associated with increased transforming growth factor-beta1 gene expression and protein production. J Vasc Surg. Dec 1999;30(6):1129-45. [Medline].

  5. Peschen M, Lahaye T, Hennig B, Weyl A, Simon JC, Vanscheidt W. Expression of the adhesion molecules ICAM-1, VCAM-1, LFA-1 and VLA-4 in the skin is modulated in progressing stages of chronic venous insufficiency. Acta Derm Venereol. Jan 1999;79(1):27-32. [Medline].

  6. Cheatle TR, Scott HJ, Scurr JH, Coleridge Smith PD. White cells, skin blood flow and venous ulcers. Br J Dermatol. Sep 1991;125(3):288-90. [Medline].

  7. Coleridge Smith PD, Thomas P, Scurr JH, Dormandy JA. Causes of venous ulceration: a new hypothesis. Br Med J (Clin Res Ed). Jun 18 1988;296(6638):1726-7. [Medline].

  8. Herouy Y, Mellios P, Bandemir E, et al. Inflammation in stasis dermatitis upregulates MMP-1, MMP-2 and MMP-13 expression. J Dermatol Sci. Apr 2001;25(3):198-205. [Medline].

  9. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. Dec 1987;123(12):1638-43. [Medline].

  10. Weismann K, Krakauer R, Wanscher B. Prevalence of skin diseases in old age. Acta Derm Venereol. 1980;60(4):352-3. [Medline].

  11. Isoda H, Shimauchi T, Ogaki T, Nagano I, Baba H, Toshima Y. Stasis ulcer and dermatitis caused by artificial arteriovenous fistula created 33 years previously for the treatment of poliomyelitis. Clin Exp Dermatol. May 2006;31(3):470-2. [Medline].

  12. Kirsner RS, Pardes JB, Eaglstein WH, Falanga V. The clinical spectrum of lipodermatosclerosis. J Am Acad Dermatol. Apr 1993;28(4):623-7. [Medline].

  13. Dillon RS. Treatment of resistant venous stasis ulcers and dermatitis with the end-diastolic pneumatic compression boot. Angiology. Jan 1986;37(1):47-56. [Medline].

  14. Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. Nov 2007;21(6):790-5. [Medline].

  15. Cheatle TR, Scurr JH, Smith PD. Drug treatment of chronic venous insufficiency and venous ulceration: a review. J R Soc Med. Jun 1991;84(6):354-8. [Medline].

  16. Dissemond J, Knab J, Lehnen M, Franckson T, Goos M. Successful treatment of stasis dermatitis with topical tacrolimus. Vasa. Nov 2004;33(4):260-2. [Medline].

  17. Wilkinson SM, English JS. Hydrocortisone sensitivity: clinical features of fifty-nine cases. J Am Acad Dermatol. Nov 1992;27(5 Pt 1):683-7. [Medline].

  18. Wilkinson SM. Hypersensitivity to topical corticosteroids. Clin Exp Dermatol. Jan 1994;19(1):1-11. [Medline].

  19. Pimentel CL, Rodriguez-Salido MJ. Pigmentation due to stasis dermatitis treated successfully with a noncoherent intense pulsed light source. Dermatol Surg. Jul 2008;34(7):950-1. [Medline].

  20. Pascarella L, Schonbein GW, Bergan JJ. Microcirculation and venous ulcers: a review. Ann Vasc Surg. Nov 2005;19(6):921-7. [Medline].

  21. Dooms-Goossens A, Degreef H, Parijs M, Maertens M. A retrospective study of patch test results from 163 patients with stasis dermatitis or leg ulcers. II. Retesting of 50 patients. Dermatologica. 1979;159(3):231-8. [Medline].

  22. Gooptu C, Powell SM. The problems of rubber hypersensitivity (Types I and IV) in chronic leg ulcer and stasis eczema patients. Contact Dermatitis. Aug 1999;41(2):89-93. [Medline].

  23. Jappe U, Schnuch A, Uter W. Frequency of sensitization to antimicrobials in patients with atopic eczema compared with nonatopic individuals: analysis of multicentre surveillance data, 1995-1999. Br J Dermatol. Jul 2003;149(1):87-93. [Medline].

  24. Morris SD, Rycroft RJ, White IR, Wakelin SH, McFadden JP. Comparative frequency of patch test reactions to topical antibiotics. Br J Dermatol. Jun 2002;146(6):1047-51. [Medline].

  25. Browse NL, Burnand KG. The cause of venous ulceration. Lancet. Jul 31 1982;2(8292):243-5. [Medline].

  26. Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. Oct 1973;48(4):839-46. [Medline].

  27. Droller H. Dermatologic findings in a random sample of old persons. Geriatrics. Sep 1955;10(9):421-4. [Medline].

  28. Farber EM, Barnes VR. The stasis syndrome. AMA Arch Derm. Mar 1956;73(3):277-82. [Medline].

  29. Helfman T, Falanga V. Stanozolol as a novel therapeutic agent in dermatology. J Am Acad Dermatol. Aug 1995;33(2 Pt 1):254-8. [Medline].

  30. Kasteler JS, Petersen MJ, Vance JE, Zone JJ. Circulating activated T lymphocytes in autoeczematization. Arch Dermatol. Jun 1992;128(6):795-8. [Medline].

  31. Lever WF, Schaumburg-Lever. Lever's Histopathology of the Skin. 7th ed. Philadelphia, Pa: Lippincott-Raven; 1990:111, 690.

  32. Lotti T, Fabbri P, Panconesi E. The pathogenesis of venous ulcers. J Am Acad Dermatol. Apr 1987;16(4):877-9. [Medline].

  33. Pardes JB, Nemeth AJ. Adverse sequelae of venous hypertension. Semin Dermatol. Jun 1993;12(2):66-71. [Medline].

  34. Rook A, Wilkinson DS, Ebling FJ. Textbook of Dermatology. 4th ed. London, England: Blackwell Science; 1986:391-3.

  35. Thomas PR, Nash GB, Dormandy JA. White blood cells and venous ulceration. BMJ. Sep 10 1988;297(6649):685. [Medline].

  36. White JW. Localized eczematous disease. In: Sams WM, Lynch PJ, eds. Principles and Practice of Dermatology. 2nd ed. New York, NY: Churchill Livingstone; 1996:451-4.

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Further Reading

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Keywords

stasis dermatitis, venous ulcer, venous eczema, chronic venous insufficiency, venous hypertension

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Contributor Information and Disclosures

Author

Scott L Flugman, MD, Consulting Staff, Dermatology Associates of Huntington PC
Scott L Flugman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Richard A Clark, MD, Professor of Biomedical Engineering, Dermatology and Medicine, Director of Center of Tissue Engineering, State University of New York at Stony Brook
Richard A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Allergy Asthma and Immunology, American Academy of Dermatology, American Association for the Advancement of Science, American Dermatological Association, American Society for Clinical Investigation, Association of Clinical Scientists, New York Academy of Medicine, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Medical Editor

Jean-Hilaire Saurat, MD, Chair, Professor, Department of Dermatology, University of Geneva, Switzerland
Jean-Hilaire Saurat, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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