Stasis Dermatitis Follow-up

  • Author: Scott L Flugman, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 27, 2012
 

Further Outpatient Care

Stasis dermatitis is a chronic condition. Acute exacerbations of stasis dermatitis should be closely monitored with weekly office visits with careful observation for signs of infection. However, patients with long-standing stasis dermatitis may be able to manage the disease on their own, with the use of compression stockings, elevation, proper skin care, and short courses of topical steroids for inflammatory exacerbations. The clinician must be vigilant in treating any signs of cutaneous ulceration with close follow-up care to ensure that ulceration does not become a chronic problem.

Next

Complications

Complications of chronic stasis dermatitis include cellulitis and nonhealing venous ulcers. Direct consequences of stasis dermatitis include an increased incidence of allergic contact dermatitis, lower-extremity ulceration, lipodermatosclerosis, and id reaction (autoeczematization).[26, 27, 28, 29]

Previous
Next

Patient Education

Patients should be educated regarding the underlying cause of their stasis dermatitis and the permanent nature of venous valvular insufficiency.

For patient education resources, see the Skin, Hair, and Nails Center and Circulatory Problems Center, as well as Eczema and Blood Clot in the Legs.

Previous
 
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, Stony Brook University; Director of Burn, Nonscar Healing Program RCCC, Armed Forces Institute of Regenerative Medicine

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.

Specialty Editor Board

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.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at 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.

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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]. [Full Text].

  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]. [Full Text].

  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, et al. 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. Gosnell AL, Nedorost ST. Stasis dermatitis as a complication of amlodipine therapy. J Drugs Dermatol. Feb 2009;8(2):135-7. [Medline].

  13. Weaver J, Billings SD. Initial presentation of stasis dermatitis mimicking solitary lesions: a previously unrecognized clinical scenario. J Am Acad Dermatol. Dec 2009;61(6):1028-32. [Medline].

  14. Huang TM, Lee JY. Lipodermatosclerosis: a clinicopathologic study of 17 cases and differential diagnosis from erythema nodosum. J Cutan Pathol. Apr 2009;36(4):453-60. [Medline].

  15. David CV, Chira S, Eells SJ, Ladrigan M, Papier A, Miller LG. Diagnostic accuracy in patients admitted to hospitals with cellulitis. Dermatol Online J. 2011;17(3):1. [Medline].

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

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. 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].

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

  23. Schena D, Papagrigoraki A, Girolomoni G. Sensitizing potential of triclosan and triclosan-based skin care products in patients with chronic eczema. Dermatol Ther. Oct 2008;21 Suppl 2:S35-8. [Medline].

  24. 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].

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

  26. 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].

  27. 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].

  28. 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].

  29. 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].

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

  31. 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].

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

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

  34. 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].

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

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

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

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

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

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

  41. 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.

 
Previous
Next
 
This patient exhibits the classic hyperpigmentation and varicosities of stasis dermatitis. There is inflammatory eczematous change overlying the medial ankle, with healed scarring from recent ulceration.
This patient with chronic stasis dermatitis exhibits classic features, such as erythema, hyperpigmentation, and dilated superficial veins reflecting poor function of the deep venous system. The condition is typically confined to the lower leg, particularly the medial portion of the leg.
In this patient with stasis dermatitis, note the large scar on the calf that was caused by military shrapnel. Injuries to the venous system due to trauma or surgery are common factors that contribute to the development of stasis dermatitis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.