Stasis Dermatitis

  • Element of chronic venous insufficiency of lower extremities (early sign or persist / recur throughout stages)
  • Prevalence increased with age

  1. Venous hypertension due to valvular incompetence of deep leg veins:
    • Decreased blood flow leading to distended capillaries and damage to capillary barrier 
    • Fluid and plasma proteins in tissue (edema) and leakage of erythrocytes (hemosiderin deposition and stasis purpura)
  2. Microangiopathy and chronic inflammation:
    • Fibrin cuffing 
      • Edema 
      • Limit oxygen diffusion/ metabolic exchange
    • Slow blood flow
      • Intercellular Adhesion Molecule-1 and Vascular Cell Adhesion Protein-1 activate neutrophils
      • Inflammatory mediators, free radicals and proteases release leading to pericapillary inflammation
    • Hemosiderin deposits release free iron ions 
      • matrix metalloproteinases activation
    • Fibrosis and tissue remodeling 
      • Lipodermatosclerosis
      • Lymphatic dysfunction
      • “Atrophie blanche” 
      • Increase risk of ulcers
    • Increased plasma homocysteine 
      • Increase risk of thromboses

  • Cushion-like pitting edema (worse at night)
  • Stasis purpura (petechiae on yellow-brown discoloration secondary to hemosiderin deposits)
  • Edema + inflammation of subfascia leading to acute lipodermatosclerosis
  • With the years, induration and adherence of subcutaneous and fascia leading to chronic lipodermatosclerosis
  • Inverted wine bottle appearance
  • “Atrophie blanche” (sclerotic / white scar with peripheral telangiectasias ± ulcers)
  • Venous ulcers (spontaneous or secondary to scratching/trauma)
  • Stasis dermatitis often develops when lipodermatosclerosis is present:
    • Erythema + scaling
    • Pruritus (congestion/decongestion, inflammatory mediators, scratching)
    • Oozing / crust
    • Vesicles uncommon: think contact sensitization

Signs of chronic venous hypertension:

  • Painful edema
  • Varicosities
  • Stasis purpura 
  • Stasis dermatitis
  • Lipodermatosclerosis
  • Stasis ulcerations
  • Acroangiodermatitis (pseudo-Kaposi)
  • “Atrophie blanche” 

Complicating factors:

  1. Allergic contact dermatitis (multiple)
    • Topical antibiotics
    • Lanolin
    • Emulsifiers
    • Antiseptics (iodine)
    • Preservatives
    • Balsam of Peru
    • Fragrances
    • Plant chemicals
    • Topical corticosteroids
    • Wound dressing
  2. Irritant contact dermatitis 
    • Secondary to wound exudate

  • Findings of acute / subacute/ chronic dermatitis
  • Venous hypertension signs
    • Fibrin cuff around capillaries
    • Hemosiderin deposits
    • Hyperplastic venules
    • Dermal fibrosis and subcutaneous sclerosis (later stages)

  • Management of venous hypertension:
    • Compression
    • Lifestyle changes and exercise of calf muscles
    • Surgery (but doesn’t replace compression)
    • Topical corticosteroids
    • Emollients