Vein Conditions

Venous Eczema

Causes & Treatments

Venous eczema, also known as gravitational dermatitis, is a prevalent type of eczema or dermatitis that predominantly impacts one or both lower extremities. It is closely linked to venous insufficiency, a condition where the veins struggle to send blood back to the heart effectively.
exzema skin

What Causes Venous Eczema?

The primary cause of venous eczema appears to be the accumulation of fluid in the tissues, which subsequently triggers the body’s innate immune response. Under normal circumstances, walking helps leg muscles pump blood upwards, while valves in the veins prevent blood from pooling.

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Who is at Risk of Developing Venous Eczema?

This condition most commonly affects middle-aged and elderly individuals.

Factors that increase the risk include:

  • A history of deep venous thrombosis (DVT) in the affected limb
  • Previous episodes of cellulitis in the affected area
  • Persistent swelling in the lower leg, often worsened by warm weather and extended periods of standing
  • Presence of varicose veins
  • Development of stasis ulcers

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Clinical Characteristics of Venous Eczema

Venous eczema can manifest as discrete patches or can merge to form larger, circumferential areas.

Key features include:

  • Itchy, red, blistered, and crusted plaques
  • Scaly patches on one or both lower legs
  • Orange-brown macular pigmentation
  • Atrophie blanche, characterised by white irregular scars surrounded by red spots
  • A champagne bottle appearance on the lower leg, marked by narrowing at the ankles and hardening of the skin (lipodermatosclerosis)

Complications Caused by Venous Eczema

  • Impetiginisation, a secondary infection caused by Staphylococcus aureus, leading to yellowish crusts
  • Cellulitis, an infection which may cause redness, swelling, pain, fever, a red streak up the leg, and swollen lymph nodes in the groin.
  • Secondary eczema, where the eczema spreads to other areas of the body.
  • Contact allergy to components in ointments or creams used for treatment.
leg exzema

Diagnosing Venous Eczema

The diagnosis of venous eczema is primarily clinical. However, patch tests may be conducted if a contact allergy is suspected.

Venous Eczema Treatments

To help minimise swelling in the affected leg, these precautions may provide relief.

  • Avoid standing for extended periods
  • Engage in regular walking
  • Elevate your feet when sitting; if your legs are swollen, they need to be above your hips for effective drainage
  • Raise the foot of your bed overnight
  • During acute eczema flare-ups, bandaging is essential to reduce swelling
  • Once eczema has subsided, wear graduated compression socks or stockings long-term.

Venous eczema may persist indefinitely if the root cause remains unaddressed. While topical corticosteroid creams can offer temporary relief from the symptoms, the condition is likely to keep returning unless the related varicose vein is eliminated.

Preventing Venous Eczema

While venous eczema cannot be entirely prevented, the frequency and severity of flare-ups can be minimised through the following measures:

  • Avoid prolonged standing or sitting with legs down
  • Wear compression socks or stockings
  • Prevent and treat leg swelling
  • Regularly apply emollients to dry skin
  • Avoid soap; use water alone or non-soap cleansers when bathing

By adhering to these guidelines, individuals can effectively manage and reduce the impact of venous eczema on their lives.

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