Stasis Dermatitis

Stasis dermatitis occurs on the lower extremities in patients with chronic venous insufficiency (Fig. 33-32). Impaired function of the venous valves permits backflow of the blood from the deep venous system to the superficial system, causing increased venous hydrostatic pressure and increased permeability of dermal capillaries. The condition typically affects middle-aged and older-adult patients, except for patients with acquired venous insufficiency resulting from surgery, trauma, or thrombosis.

Stasis dermatitis can range from mild to severe. In all stages, reddish brown discoloration is caused by staining from hemosiderin that has leaked out of red blood cells in the overtaxed dermal capillaries. Pedal edema and scaling are also present in various degrees, and one leg can be more affected than the other. ACD is often superimposed on stasis dermatitis and can mislead the physician into suspecting cel-lulitis because of a sudden reddening, weeping, or induration of the area. Because of the impaired skin barrier and frequent use of OTC products and "home remedies," neomycin, lanolin, iodine, fragrances, and preservatives are common triggers for ACD in these patients.

Long-term treatment focuses first on reducing pedal edema with compression therapy, after assessing the integrity of the arterial circulation to prevent claudication or ischemic necrosis. Compression stockings are best applied early in the morning, before the patient rises from bed, when leg edema is at a minimum. For the pruritus and dermatitis, stasis dermatitis is treated in the same manner as other forms of acute eczematous dermatitis. Dry skin care with mild cleansers (Dove, Cetaphil) and bland emollients (petrolatum, Aqua-phor or Absorbase) should be used liberally. Medium-potency topical corticosteroids (e.g., triamcinolone 0.1% ointment) should be used twice daily when inflammation and pruritus are present. If infection is suspected, mupirocin should be used preferentially over other topical antibiotics. For severe cases with exuberant purulent drainage and induration, oral antibiotics with activity against Staphylococcus and Streptococcus should be used.

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