Stasis Dermatitis Workup

Updated: Apr 17, 2017
  • Author: Scott L Flugman, MD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Approach Considerations

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

Doppler studies

Radiologic/Doppler studies may be helpful. 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.

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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.

In chronic stasis dermatitis, biopsy may be necessary if acroangiodermatitis (pseudo–Kaposi sarcoma) has developed. The violaceous plaques and nodules of acroangiodermatitis may be clinically indistinguishable from classic Kaposi sarcoma, especially when they occur 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.

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