What are the discharge instructions for a patient with stasis dermatitis?

Discharge Instructions for Stasis Dermatitis

For patients with stasis dermatitis, discharge instructions must focus on compression therapy, elevation of affected limbs, proper skin care, and monitoring for complications to effectively reduce morbidity and mortality associated with this condition.

Compression Therapy

• Apply prescribed compression stockings or bandages daily, putting them on first thing in the morning before getting out of bed when swelling is minimal 1
• Wear compression garments throughout the day and remove only at night when elevating legs
• Ensure proper fit of compression garments - they should be snug but not painful
• Replace compression stockings every 3-6 months as they lose elasticity with washing and wear

Elevation and Activity

• Elevate affected limbs above heart level for 30 minutes, 3-4 times daily 1
• Avoid prolonged standing or sitting
• Perform regular ankle exercises (ankle pumps, ankle circles) when sitting to promote venous return
• Maintain regular walking exercise as tolerated to improve calf muscle pump function

Skin Care

• Use a dispersible cream as a soap substitute instead of regular soaps or detergents that remove natural skin lipids 1, 2
• Take short, lukewarm baths or showers with emollient bath oils 1
• Pat skin dry gently rather than rubbing 1
• Apply fragrance-free, hypoallergenic moisturizers with petrolatum or mineral oil multiple times daily, especially immediately after bathing while skin is still damp 1
• Avoid scratching affected areas to prevent secondary infection
• Avoid using greasy creams that may occlude follicles and worsen the condition 1

Medication Instructions

• Apply prescribed topical corticosteroids (such as triamcinolone 0.1%) as a thin film to affected areas twice daily 1
• Limit use of topical corticosteroids to 2 weeks to avoid skin atrophy 1
• If prescribed topical antimicrobials for secondary infection, apply as directed (typically clindamycin 2% or erythromycin 1% cream) 1
• Take any prescribed oral antibiotics for the full course if secondary infection is present

Monitoring for Complications

• Watch for signs of infection:
  • Increased redness, warmth, swelling
  • Increased pain
  • Purulent drainage
  • Fever
• Monitor for signs of skin breakdown or ulceration:
  • New open areas
  • Drainage
  • Increased pain
• Be alert for signs of topical steroid side effects:
  • Skin thinning (atrophy)
  • Visible blood vessels (telangiectasia) 1

Follow-up Care

• Schedule follow-up appointment with dermatology within 2-4 weeks 1
• Maintain regular follow-up with vascular specialist if recommended
• Continue compression therapy and skin care regimen even after acute phase resolves to prevent recurrence 1
• Continue daily moisturizing to prevent skin dryness and cracking 1

When to Seek Immediate Medical Attention

• If rash spreads beyond the initial area 1
• If ulceration develops
• If signs of infection develop (increased redness, warmth, pain, purulent drainage, fever)
• If severe itching or pain develops that is not relieved by prescribed medications

Common Pitfalls to Avoid

• Discontinuing compression therapy once symptoms improve
• Inadequate moisturization of affected skin 1
• Overuse of topical steroids leading to skin atrophy 1
• Missing secondary infection 1
• Using fragranced products or potential irritants on affected skin

By following these discharge instructions, patients can effectively manage stasis dermatitis, prevent complications such as ulceration, and improve their quality of life. Consistent adherence to compression therapy and proper skin care are essential for long-term management of this chronic condition.