From the Guidelines
Physical exam findings that make stasis dermatitis less likely include absence of lower extremity edema, lack of dilated superficial collateral veins, and normal skin appearance in the affected area. The absence of hemosiderin deposition (brownish discoloration) on the skin would also decrease the likelihood of stasis dermatitis, as noted in the context of post-thrombotic syndrome assessment 1. If the rash is distributed in areas other than the lower legs, particularly above the knees or in a bilateral asymmetric pattern, stasis dermatitis becomes less probable. The absence of scaling, lichenification, or induration of the skin would point away from chronic stasis dermatitis. Additionally, if there is no history of venous insufficiency, deep vein thrombosis, or chronic leg swelling, stasis dermatitis is less likely, considering the pathophysiology of post-thrombotic syndrome involves venous hypertension 1.
Some key points to consider in the physical exam include:
- Absence of edema, which is a common sign of venous insufficiency and post-thrombotic syndrome 1
- Lack of dilated superficial collateral veins, which can indicate venous hypertension and increased risk of stasis dermatitis
- Normal skin temperature and appearance in the affected area, which would suggest less likelihood of chronic venous insufficiency
- Distribution of the rash, with stasis dermatitis typically affecting the lower legs in a symmetric pattern
- Presence of alternative dermatological findings, such as satellite lesions or sharp demarcation of the rash, which could suggest other diagnoses like contact dermatitis or fungal infection.
These findings are significant because stasis dermatitis typically results from venous hypertension causing fluid and red blood cell extravasation into surrounding tissues, leading to characteristic changes in the lower extremities, as understood in the context of post-thrombotic syndrome 1.
From the Research
Physical Exam Findings
The following physical exam findings would make stasis dermatitis less likely:
- Absence of edema, particularly dependent edema, as chronic accumulation of edema in one or both lower extremities often indicates venous insufficiency 2
- No signs of hemosiderin deposition, which is often present in stasis dermatitis due to chronic venous insufficiency 2
- Lack of eczematous plaques on the lower legs, particularly around the medial malleolus, which is a common presentation of stasis dermatitis 3
- No evidence of venous reflux or incompetence, which can be demonstrated by duplex ultrasound 3
- Absence of brawny, nonpitting skin with edema, which is more characteristic of lymphedema 2
- No signs of systemic disease that could cause generalized pitting edema, such as obstructive sleep apnea or pulmonary hypertension 2
Differential Diagnosis
Stasis dermatitis can be mimicked by other conditions, including: