Stasis Dermatitis (SD) is a chronic inflammatory skin condition primarily affecting the lower legs, causing redness, scaling, and discomfort. SD is a physical manifestation of Chronic Venous Insufficiency (CVI). CVI occurs when one-way valves within the leg veins weaken, allowing blood to pool in the lower extremities, a phenomenon called venous hypertension. Because the condition involves both a skin disorder and a vascular disease, effective management requires a coordinated approach from several medical professionals to address both the surface symptoms and the underlying circulatory problem.
Identifying the Condition and Initial Assessment
Diagnosis typically begins with a Primary Care Physician (PCP), who serves as the initial point of contact. SD often presents with early signs such as ankle swelling, leg heaviness, and a reddish or brownish discoloration of the skin near the ankles and shins. This color change, known as hemosiderin deposition, results from the leakage of red blood cells from compromised capillaries. The PCP focuses on a thorough physical examination and differential diagnosis.
It is important to distinguish SD from conditions like cellulitis, a serious bacterial skin infection, or allergic contact dermatitis. Cellulitis is often unilateral and accompanied by systemic symptoms like fever, while SD is typically bilateral and lacks these acute signs. Once stasis dermatitis is suspected, the PCP initiates conservative management aimed at reducing venous pressure. This includes recommendations for regular leg elevation and the use of compression garments. They may also prescribe a short course of a low-potency topical corticosteroid to manage acute inflammation and itching.
Specialized Care for Skin Symptoms
When skin symptoms are severe, persistent, or complicated by ulceration, the patient is referred to a Dermatologist. The Dermatologist manages the “dermatitis” component, treating inflammation, scaling, and potential open wounds, known as venous stasis ulcers. They tailor topical therapies to the fragile skin of the lower legs.
For acute flares, the Dermatologist may prescribe a medium-potency topical corticosteroid, such as triamcinolone 0.1% ointment. They advise against prolonged use of high-potency steroids due to the risk of skin thinning or atrophy. Alternative anti-inflammatory agents, like topical calcineurin inhibitors such as tacrolimus, may be used for long-term management as they do not carry the same risk of atrophy.
If the condition progresses to a weeping or crusted stage, the Dermatologist implements specific wound care protocols. This includes specialized compression wraps like the Unna boot, which combines a zinc-oxide-impregnated bandage with continuous compression. The goal is to dry the weeping lesions, reduce the risk of secondary bacterial infection, and promote the healing of established venous ulcers.
Specialized Care for the Underlying Cause
Addressing the root cause of Stasis Dermatitis—Chronic Venous Insufficiency—requires the expertise of a Vascular Surgeon or a Phlebologist, a physician specializing in vein disorders. These specialists focus on improving blood flow back to the heart by eliminating the faulty veins responsible for venous hypertension. Diagnosis begins with a Duplex ultrasound, a non-invasive test that uses sound waves to map the veins and measure blood flow to identify incompetent valves or obstructions. Treatment options are typically minimally invasive procedures targeting the malfunctioning veins directly.
Minimally Invasive Procedures
Endovenous thermal ablation, including techniques like Endovenous Laser Ablation (EVLA) or Radiofrequency Ablation (RFA), uses heat energy delivered via a small catheter to close off the damaged vein from the inside. Once treated, the body naturally reroutes blood through healthier veins. Another common method is sclerotherapy, where a liquid or foam chemical solution is injected into the affected veins, causing them to collapse and scar shut. These procedures aim to permanently eliminate the source of high venous pressure, removing the trigger for skin inflammation. Correcting the underlying venous reflux offers the best chance for long-term resolution of skin symptoms and prevention of future complications.
Core Treatment Strategies
The foundational treatment for Stasis Dermatitis centers on mechanical strategies to counteract venous hypertension. Compression therapy is the single most important intervention, as it externally squeezes the leg veins to prevent blood pooling and reduce swelling. This involves wearing specialized compression stockings, typically exerting a pressure of 20–30 mmHg or higher, which should be put on first thing in the morning before swelling occurs.
Leg elevation is also a highly effective protocol. Patients are advised to elevate their legs above the level of the heart for 15 to 30 minutes, three or four times daily, to assist in draining pooled fluid and lowering venous pressure. Meticulous skin care is necessary to maintain the compromised skin barrier and prevent irritation. This routine involves using bland, fragrance-free emollients, such as urea-containing moisturizers, applied liberally to prevent dryness and cracking. Avoiding harsh soaps and potential irritants is paramount, as the inflamed skin is susceptible to developing secondary allergic contact dermatitis.