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 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.
- Painful, swollen and red skin, often with a crusty and weeping appearance.
- Swelling appears near the end of the day and decreases by the morning.
- Varicose veins with a covering of irritated, itchy or dry skin.
- Over time, these issues move 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 with 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 increased pressure in the deeper muscles in the legs or the veins located beneath the skin. The increase in pressure results from leaky valves situated in the veins. When the valves fail to function correctly, 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. This condition can also result from thrombosis or a blood clot forming deep in the veins. Since the scaliness of this skin often leads to breakage, the development of ulcers is relatively standard.
Diagnosis of Varicose Eczema
The diagnosis begins with a physical examination by a doctor. The visible symptoms and signs indicate the condition. 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 the following:
- 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 in treating this condition. Placing the legs in the highest position possible is extremely important. The typical footstool or pouffe needs to be higher. The feet must 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 regularly. Standing still for an extended period is highly discouraged. When activity occurs in the leg muscles, the blood in the veins is pushed back up the legs. This position increases the pressure placed on the veins in the legs. This is because the muscles are not squeezing the veins 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 to elevate 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 outside 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. Before 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. The physician will prescribe a class one if the medium material is uncomfortable. Wearing these stockings is extremely important because they can help prevent serious issues such as ulcers and significantly help circulation. The stockings reach 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 before 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. Individuals should be measured every time they have been replaced in case a change in size becomes necessary. The recommendation is to purchase a minimum of two pairs each time. This helps ensure a clean pair is always 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. There are applicators available at most pharmacies for individuals unable to put on the stockings.
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. Antibiotics will be prescribed if there is any infection, ulcers, erosions or cellulitis. A skin graft may be necessary in the case of a large ulcer.
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 discolouration of the skin, the individual should make an appointment with a dermatologist for assistance.
If there is extreme skin inflammation, 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 inflammation in the skin. If the skin is dehydrated, a steroid ointment will be prescribed instead of a cream. In most instances, a mid-strength steroid is enough. 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 before being rubbed in. This is different from 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 treating 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
Many individuals with varicose eczema are referred to a dermatologist to receive more specialised medical advice. If there is no improvement in the condition after treatment, the physician will most likely have additional tests like patch testing. This is when patches of different chemicals are placed on the skin to see if there is any reaction.
If no progress is made regarding the condition, there is a good chance an infection has developed. In this instance, the physician may prescribe antibiotic tablets like flucloxacillin. Depending on the severity of the condition, the physician may refer the individual to a vascular consultant.
Varicose Eczema FAQs
What is varicose eczema?
Varicose eczema is a condition that occurs when the skin on the lower legs becomes inflamed, itchy, and scaly as a result of poor circulation in the veins. It is commonly seen in individuals with varicose veins.
What causes varicose eczema?
Varicose eczema is caused by poor veins circulation, which can result from varicose veins, deep vein thrombosis, or other circulatory problems.
How is varicose eczema treated?
Treatment for varicose eczema typically includes the use of compression stockings to improve circulation, creams or ointments to reduce inflammation and itching and lifestyle changes such as weight loss, exercise and healthy diet.
Is varicose eczema contagious?
No, varicose eczema is not contagious. It is a skin condition caused by poor circulation in the veins and is not caused by an infection or infectious agent.
Will varicose eczema go away on its own?
Varicose eczema may improve with self-care measures, but it will not likely go away completely without treatment. It is essential to see a vascular specialist to determine the underlying cause of eczema and to develop an appropriate treatment plan.
- Understanding your Varicose Veins
- Key Differences Between Varicose Eczema vs. Other Eczemas
- Is Varicose Eczema Dangerous?
- What is Chronic Venous Insufficiency?
- Natural Treatments for Varicose Eczema