Treatment of Stasis Dermatitis
The best treatment approach for stasis dermatitis combines compression therapy as the cornerstone with moderate-potency topical corticosteroids for acute inflammation, emollients applied liberally at least twice daily, and treatment of any underlying venous insufficiency. 1
Immediate Management: Assess for Infection First
Before initiating treatment, examine for signs of bacterial superinfection including golden-yellow crusting, weeping, increased warmth, or spreading erythema. 1 If infection is suspected, obtain bacteriological swabs before starting antibiotics. 1 Reserve systemic antibiotics (such as flucloxacillin or cephalexin) for systemic infection with fever, lymphangitis, lymphadenopathy, or erysipelas—not for localized colonization. 2, 1 Watch for grouped vesicles or punched-out erosions suggesting herpes simplex superinfection, which requires immediate acyclovir. 1
Compression Therapy: The Foundation
Compression is the single most important intervention because it directly addresses the underlying venous hypertension driving stasis dermatitis. 3, 4 Start compression therapy to improve ambulatory venous pressure and reduce edema. 4 Educate patients that compression is lifelong therapy, not just for acute flares. 1 Elevation of the affected extremity hastens improvement by promoting gravity drainage of edema and inflammatory substances. 2
Common pitfall: Patients often discontinue compression due to discomfort or poor understanding—provide clear written instructions and demonstrate proper application technique. 1, 5
Topical Anti-Inflammatory Treatment
Apply moderate-potency topical corticosteroids (such as triamcinolone 0.1% or mometasone 0.1%) to affected areas 1-2 times daily until inflammation resolves. 1 Use the least potent preparation required to control the eczema. 2, 1 Avoid steroid phobia—educate patients that appropriate use is safe and that undertreatment leads to worse outcomes. 1
For recalcitrant cases where corticosteroids are unsuitable or ineffective, topical tacrolimus 0.1% ointment may be considered as an alternative, though evidence is limited to case reports. 6
Emollient and Barrier Restoration
Apply emollients liberally and frequently, at least twice daily, most effectively immediately after bathing to trap moisture and restore the skin barrier. 1 Replace soaps with dispersible cream cleansers (soap substitutes) to prevent removal of natural skin lipids. 2, 1 Use lukewarm water and limit bath time to 5-10 minutes, avoiding temperature extremes which exacerbate inflammation. 1
Address Underlying Venous Disease
Treat any predisposing conditions including tinea pedis, trauma, or the venous insufficiency itself. 2 Consider duplex ultrasound to demonstrate venous reflux when clinical diagnosis is uncertain. 4 Interventional therapy options include minimally invasive techniques such as endovenous thermal ablation and ultrasound-guided foam sclerotherapy for correcting underlying venous reflux. 3, 4
Patient Education and Monitoring
Explain that stasis dermatitis is a chronic condition requiring ongoing management. 3, 5 Demonstrate proper application of topical treatments and provide written instructions. 1 Educate patients about infection signs requiring immediate medical attention: increased pain, spreading redness, fever, or rapid deterioration. 1
Critical caveat: Stasis dermatitis can mimic cellulitis, contact dermatitis, and pigmented purpuric dermatoses—maintain diagnostic vigilance. 4 If symptoms persist despite 4 weeks of appropriate treatment, consider referral to dermatology for diagnostic uncertainty or need for second-line treatments. 1