Stasis dermatitis
Background
Stasis dermatitis is a chronic inflammatory skin condition caused by venous insufficiency, typically affecting the lower legs. It results from sustained venous hypertension that leads to capillary leakage, inflammation, and skin breakdown. It is commonly seen in older adults or individuals with a history of varicose veins, obesity, immobility, or deep vein thrombosis (DVT). Though not an emergency itself, patients often present to the ED for evaluation of suspected cellulitis, ulceration, or non-healing wounds, making differentiation critical.
Clinical Features
- Usually bilateral (but can be asymmetric)
- Skin findings:
- Erythema, hyperpigmentation (hemosiderin deposition)
- Scaling, weeping, or crusting
- Lichenification or thickening over time
- Pruritus is common
- Associated signs:
- Pitting edema
- Varicosities
- Chronic atrophic or ulcerated skin
- Lipodermatosclerosis (woody induration in chronic cases)
Differential Diagnosis
- Cellulitis (often unilateral, systemic symptoms present)
- Contact dermatitis
- Tinea corporis or tinea incognito
- Autoimmune vasculitis
- Lymphedema
- Erythema nodosum
- Necrobiosis lipoidica diabeticorum
- Cutaneous lymphoma (rare but important mimic)
Evaluation
Workup
Diagnosis
Management
- Compression therapy (unless contraindicated, e.g., ABI < 0.8)
- Topical corticosteroids (low- to mid-potency for inflammation and pruritus)
- Emollients to restore barrier function
- Leg elevation
- Avoidance of trauma or scratching
- If secondary infection suspected:
- Topical antibiotics (e.g., mupirocin) for localized impetiginization
- Systemic antibiotics only if signs of infection are present
- Educate patient on chronicity and importance of vascular follow-up