Varicose Eczema is classified as a skin condition most frequently seen in the elderly. The initial symptom of this disease is the appearance of pale red skin on the lower legs. The skin will eventually turn a darker red or brown. The skin becomes bumpy and slightly thicker. Although there is no pain, the skin often becomes itchy. Due to the redness, many individuals confuse varicose eczema with an infection. The recommendations are to elevate the legs while seated, remain active and use moisturisers. In some cases, a physician may prescribe a steroid ointment.
The Symptoms of Varicose Eczema
Varicose eczema occurs when the blood flowing to the lower legs is compromised. This causes a weakening in the veins leading to blood leaking into the body tissues. This can result in the development of stasis dermatitis symptoms. These symptoms generally appear in the ankles first.
These symptoms include:
- Aching or heaviness in the legs when standing for a long period of time.
- Painful, swollen and red skin, often with a crusty and weeping appearance.
- Swelling appearing near the end of the day and decreasing by the morning.
- Varicose veins with a covering of irritated, itchy or dry skin.
- Over time, these issues move upwards to the calf and leg. This leads to the development of additional symptoms.
The Risk Factors of Varicose Eczema
Individuals with varicose veins are at a higher risk of developing this condition. There are valves in the legs enabling the blood to be pumped back to the heart. These valves weaken as people age. The blood can begin leaking out of the valves to settle in the lower legs. This results in a medical condition called venous insufficiency. This causes circulation issues that may lead to the death of the cells and blood leakage. This development can lead to stasis dermatitis. Individuals with the highest risk for varicose eczema include those who have had or have:
- Varicose veins
- Surgery on the lower legs
- High blood pressure
- Venous insufficiency
- Kidney failure
- A heart condition
- A blood clot or (DCVT) deep vein thrombosis
The lifestyle factor risks include:
- Not getting enough exercise
- Sitting or standing for too long when at home or work
- An excess of body fat
The individuals at the highest risk are obese or overweight and women who have had several children. This is due to the additional weight from the pregnancy placing more strain on the leg veins. The majority of individuals with varicose eczema are older. The estimate is one in every five individuals above the age of seventy will develop this condition. Most individuals at risk have had (DVT) deep vein thrombosis is one of the deeper leg veins, have had surgery for varicose veins or currently have varicose veins.
The Causes of Varicose Eczema
This condition is caused by an increase in pressure in either the deeper muscles in the legs or the veins located beneath the skin. The increase in pressure results from leaky valves located within the veins. When the valves fail to function properly, the blood experiences difficulty fighting gravity to flow up the legs. This means there is too much blood causing a much higher pressure. The veins start to leak due to this increase in pressure.
Both blood cells and fluid start to leak from the veins beneath the skin. This causes a reaction to occur beneath the skin resulting in inflammation. This is what leads to varicose eczema. Since the scaliness of this skin often leads to breakage, the development of ulcers is fairly common. This condition can also be the result of the formation of thrombosis or a blood clot forming deep in the veins.
Diagnosis of Varicose Eczema
The diagnosis begins with a physical examination from a doctor. The condition is indicated by the visible symptoms and signs. The physician will ask about the individual’s history of surgery, previous injuries to the area being impacted, blood clots and heart disease. Tests are generally performed to determine the cause of the poor circulation to the legs. The tests may include:
- An ultrasound for the detection of any issues with blood flow
- Heart function testing
- Blood tests
- Allergy tests are often recommended because the chance of a skin allergy is much higher for an individual with varicose eczema
Treatment for Varicose Eczema
Providing general advice is usually the first step for the treatment of this condition. Placing the legs in the highest position possible is extremely important. The typical footstool or pouf is not nearly high enough. The feet need to be at least as high as the hips and even higher whenever possible. When the legs are in a higher position, the blood flowing up the legs is assisted by gravity. The individual needs to be careful not to injure the skin on anything including furniture.
The individual should remain active and take walks on a regular basis. When there is activity in the leg muscles, the blood in the veins is pushed back up the legs. Standing still for a long period is highly discouraged. This position increases the pressure placed on the veins in the legs. This is because the veins are not being squeezed by the muscles like they are when the individual is walking. The skin must be prevented from becoming too dry. This can be accomplished with the regular use of moisturising creams.
The focus of the treatment is providing the individual with relief from their symptoms. According to the (AAD) American Academy of Dermatology, raising the legs is important. The recommendation is elevating the legs every two hours for fifteen minutes. While sleeping, the legs should be placed on one or two pillows.
Compression stockings are also referred to as compression hosiery. The stockings are effective because the pressure is applied from the outside of the veins. The squeezing caused by the stockings pushes the blood back up the legs. This helps decrease the pressure within the veins. The blood can then be prevented from leaking into the surrounding tissues. Prior to purchasing compression stockings, a test must be given to ensure the circulation through the arteries of the legs is normal. This test is generally performed by a nurse using a Doppler machine to measure the pressure in the arteries.
Compression stockings are available in different materials. Class one is a light material, class two medium and class three heavy. The average individual can tolerate the medium material. If the medium material is uncomfortable, the physician will prescribe a class one. Wearing these stockings is extremely important because they can help prevent serious issues such as ulcers and can significantly help circulation. The stockings reach to just below the knee. Compression stockings are available in a variety of different colours. The colour should suit the individual who will be wearing them. The correct colour helps ensure the individual will wear the stockings.
The stockings need to be taken off when the individual goes to bed and put back on when they wake up in the morning. The stockings must be on prior to the beginning of any swelling in the morning. The options are closed or open toes. The open toe stockings are recommended for individuals with:
- A preference for open toes
- Painful toes caused by an infection or arthritis
- Wanting to wear socks in addition to support stockings
- Large feet
The stockings need to be replaced every three to six months. The individual should be measured every time they are replaced in case a change in size becomes necessary. The recommendation is purchasing a minimum of two pairs each time. This helps ensure there is always a clean pair available for wear while the others are being washed and dried. Support stockings should never be tumbled dry because this can cause damage to the elastic. If the standard sizes do not fit, they can be custom made. A prescription will be required. For individuals unable to put on the stockings, there are applicators available at most pharmacies.
Additional Treatments for Varicose Eczema
Emollients and moisturisers can help decrease dry skin. The general recommendations are a thick, fragrance-free cream or petroleum jelly. The individual can speak with their physician, pharmacist or dermatologist regarding the best options available. The physician may prescribe medications including a (TCI) topic calcineurin inhibitor or corticosteroid to decrease pain, redness, swelling and inflammation. If there is any kind of infection, ulcers, erosions or cellulitis present, antibiotics will be prescribed. In the case of a large ulcer, a skin graft may be necessary.
Itching can be decreased with antihistamine medication. Painful varicose veins, sores and discomfort can be eliminated with surgery. Special dressings may be required for weeping lesions or ulcers. In this instance, the dressing is initially changed every two or three days. When enough time has passed, this can be decreased to once or twice per week. If there is a discoloration of the skin, the individual should make an appointment with a dermatologist for assistance.
If there is extreme inflammation of the skin, a topical steroid may be prescribed by the physician. Both steroid ointments and creams are applied directly to the skin. The purpose of a topical steroid is to decrease the amount of inflammation in the skin. If the skin is extremely dry, a steroid ointment will be prescribed as opposed to a cream. In most instances, a mid-strength steroid is enough. If there is heavy inflammation, a much strong ointment may be necessary. Topical steroids are generally used once or twice each day. The physician will tell the individual how often to use the topical steroid.
The steroid is applied evenly and thinly on the inflamed area of the skin prior to being rubbed in. This is different than the generous application necessary with an emollient. The best way to determine how much to use for each application is to squeeze a little ointment onto the end of a finger directly from the tube. The steroid should begin at the fingertip and end at the first crease. This is referred to as a fingertip unit. One of these units is sufficient for the treatment of an area twice as big as the flat of the hand when the fingers are held together. The ointment or cream should be rubbed gently into the skin until it is completely gone. The individual should then wash their hands.
When the Treatment is Ineffective
If there is no improvement in the condition after treatment, the physician will most likely have additional tests run. This is often to determine if the individual has developed contact dermatitis. This is a sensitivity to all or any of the dressings, ointments or creams that have been used on the skin. A dermatologist or skin specialist will probably conduct patch testing. This is when patches of different chemicals are placed on the skin to see if there is any reaction. Many individuals with varicose eczema are referred to a dermatologist to receive more specialised advice regarding their condition.
If there is no progress being made regarding the condition, there is a good chance an infection has developed. In the instance, the physician may prescribe antibiotic tablets like flucloxacillin. Depending on the severity of the condition, the physician may refer the individual to a surgeon with a speciality in veins and arteries called a vascular surgeon. If certain issues are present, surgery may be required. This includes:
- There is a blockage located in the artery of the leg
- Treatment of underlying varicose veins is necessary for the varicose eczema
- A leg ulcer is not responding to any of the medical treatments provided
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