Comprehensive Venous Diagnosis and Treatment
Skin changes due to high pressure in the veins of the ankles, feet, or calves may range from a fine red rash to large dark brown patches of skin. The most common manifestation of stasis dermatitis is development of brown changes in the skin at the medial (inner) aspect of the ankle. These changes will worsen over time and will eventually result in development of open poorly-healing wounds called venous stasis ulcers. These changes usually take many years to develop and we often see patients who have been treated for years with creams and salves which cannot solve the problem.
The underlying cause of stasis dermatitis is venous insufficiency (valve failure) and/or obstruction of veins of the leg or pelvis. Reflux of blood toward the feet due to gravity or blockage of outflow due to obesity or mechanical obstruction cause venous hypertension (high pressure in the veins). Venous hypertension causes fluid, blood cells, and protein to weep through the walls of tiny veins into the tissues. The excess fluid in the tissues manifests as swelling. The protein and blood cells cause an inflammatory response which may cause pain, tenderness, redness, a rash, or the brown skin changes.
The key to treatment of stasis dermatitis is to lower the high pressure in the veins of the legs. Elastic compression, usually with support hose or special leg wraps, helps improve the ability of the calf muscles to pump venous blood out of the legs. Periodically elevating the legs higher than the heart uses gravity to lower the pressures in the leg veins and it allows the tissues to partially recover from the high venous pressures earlier in the day. Avoidance of prolonged sitting and standing is helpful as well. When one must sit or stand, repetitive ankle exercises with rhythmic contraction of the muscles in the back of the calves helps pump blood out of the legs lowering venous pressures at the ankle. For the same reason, exercise such walking or running is helpful.
Patients with stasis dermatitis should be evaluated with at least a lower extremity venous color duplex ultrasound exam with special testing for venous insufficiency and a clinical exam by an experienced phlebologist.
Most patients who have stasis dermatitis have underlying venous insufficiency or obstruction severe enough that they need treatment for their venous problems. Treatments may include foam sclerotherapy, endovenous thermal ablation, microphlebectomy, or angioplasty/stenting of obstructed pelvic veins.