What is dermatitis stasis?

Stasis Dermatitis: Definition, Pathophysiology, and Management

Stasis dermatitis is an inflammatory skin condition of the lower extremities that occurs as a cutaneous manifestation of venous hypertension caused by chronic venous insufficiency. 1, 2

Pathophysiology

• Stasis dermatitis results from venous hypertension (sustained ambulatory venous pressure) due to retrograde blood flow caused by incompetent venous valves, valve destruction, or obstruction of the venous system 1
• The impaired venous drainage leads to extravasation of inflammatory cells across the vascular endothelium, causing leukocyte trapping in the microcirculation and perivascular space 1
• Inflammatory cells influence the remodeling of the extracellular matrix by inducing the secretion of proteinases such as matrix metalloproteinases (MMPs), which are associated with the formation of venous leg ulcers and lesions 1
• Hemosiderin deposition from extravasated red blood cells contributes to the characteristic skin discoloration 3

Clinical Presentation

• Initially presents as poorly demarcated erythematous plaques on the lower legs bilaterally, classically involving the medial malleolus 3
• In the acute phase, characterized by erythema and vesiculation; in the chronic phase, by dryness, lichenification, and fissuring 4
• May present as a solitary lesion mimicking neoplastic processes in early stages, which is an often unrecognized clinical scenario 5
• Common symptoms include:
  • Swelling of the legs (edema) 2
  • Itching and burning sensation 1
  • Skin discoloration (hyperpigmentation) 3
  • Scaling and dryness 4
  • In advanced cases, venous ulcerations may develop 2

Diagnostic Considerations

• Diagnosis is primarily clinical, based on characteristic appearance and distribution of lesions 2
• Duplex ultrasound is useful in demonstrating venous reflux when the clinical diagnosis is unclear 3
• Differential diagnosis includes:
  • Cellulitis 4
  • Contact dermatitis 4
  • Pigmented purpuric dermatoses 3
  • Neoplastic processes (when presenting as a solitary lesion) 5

Management

Conservative Treatment

• Compression therapy is the cornerstone of treatment, directed at improving ambulatory venous pressure 3
  • Graduated compression stockings
  • Pneumatic compression devices
  • Compression bandages
• Elevation of the affected limbs to promote gravity drainage of edema and inflammatory substances 4
• Topical treatments for secondary skin changes:
  • Topical corticosteroids for acute inflammatory phases 4
  • Emollients to maintain skin hydration and prevent cracking 4
  • Topical tacrolimus has shown promise in case reports for treating stasis dermatitis 6

Interventional Treatment

• Minimally invasive techniques to correct underlying venous reflux:
  • Endovenous thermal ablation 3
  • Ultrasound-guided foam sclerotherapy 3
• These have largely replaced open surgical techniques 3

Prevention of Recurrence

• Addressing underlying venous insufficiency 2
• Maintaining good skin hydration with emollients 4
• Consistent use of compression therapy 3
• Treatment of any predisposing conditions such as venous eczema 4

Special Considerations

• Stasis dermatitis is more common in older individuals 2
• Each episode of inflammation can cause lymphatic damage, potentially leading to lymphedema if severe or recurrent 4
• Early recognition and treatment can prevent painful complications such as leg ulcers, which are at risk for development of squamous cell carcinoma 5
• Inflammation is a key driver of symptoms, making anti-inflammatory treatments important in management 1