stasis dermatitis; venous eczema; gravitational dermatitis
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Etiology
- chronic venous stasis
- possible contributing factors
Pathology
- inflammation of the skin (dermatitis) from venous stasis
- scarring, atrophy & hyperpigmentation of the skin
- fibrosis, lipodermatosclerosis
- associated with leg trauma & varicose veins
Clinical manifestations
- gradual manifestations can persist for months to years[3]
- most commonly on the legs below the knee, dorsal surface of the feet & around the medial malleolus
- edema, erythema, warmth
- petechiae
- hyperpigmentation (reddish-brown discoloration from hemosiderin)
- pruritus, weeping, scaling, erosions, excoriations from scratching
- ulcerations common around the medial malleolus
- sharp demarcation uncommon
- varicose veins generally visible
- pruritus may generalize over entire body (id reaction)
- crusting (dermatitis medicamentosa)
Laboratory
- complete blood count (CBC) - rule out cellulitis
- WBC is normal with statis dermatitis, but may be elevated with cellulitis
Differential diagnosis
- cellulitis
- factors favoring cellulitis vs stasis dermatitis
- fever/chills, myalgia variable with cellulitis
- absent with stasis dermatitis
- brown discoloration may occur with stasis dermatitis
- WBC count is normal with stasis dermatitis
Management
- topical agents
- glucocorticoids[7]
- becaplermin (Regranex) 0.1%
- Dovonex 0.005%, apply BID
- long-term non-pharmaceutical meaasures
- avoid topical antibiotics due to risk of allergic sensitization[4]
More general terms
More specific terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 878
- ↑ Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003
- ↑ 3.0 3.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17. American College of Physicians, Philadelphia 2009, 2012, 2015
- ↑ 4.0 4.1 Choosing Wisely. Feb 23, 2015 Infectious Diseases Society of America Five Things Physicians and Patients Should Question http://www.choosingwisely.org/doctor-patient-lists/infectious-diseases-society-of-america/
- ↑ 5.0 5.1 DermNet NZ. Venous eczema (images) http://www.dermnetnz.org/dermatitis/venous-eczema.html
- ↑ 6.0 6.1 Flugman SL, Elsto DM (images) Medscape: Stasis Dermatitis http://emedicine.medscape.com/article/1084813-overview
- ↑ 7.0 7.1 7.2 Weiss SC, Nguyen J, Chon S, Kimball AB. A randomized controlled clinical trial assessing the effect of betamethasone valerate 0.12% foam on the short-term treatment of stasis dermatitis. J Drugs Dermatol. 2005 May-Jun;4(3):339-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15898290
- ↑ Stasis dermatitis (image) American Academy of Dermatology https://www.aad.org/public/diseases/eczema/stasis-dermatitis