Stasis Dermatitis Workup: Approach Considerations, Histologic Findings

Sections

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.

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.

Treatment & Management

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Media Gallery

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.
Patient with stasis dermatitis. The large scar on the calf resulted from military shrapnel. Injuries to the venous system due to trauma or surgery are common factors in the development of stasis dermatitis.

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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, 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: American Association for the Advancement of Science, American Society for Clinical Investigation, Alpha Omega Alpha, Wound Healing Society, American Academy of Allergy Asthma and Immunology, American Academy of Dermatology, Association of Clinical Scientists, New York Academy of Medicine, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

Stasis Dermatitis Workup

Approach Considerations

Doppler studies

Histologic Findings

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Approach Considerations

Doppler studies

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