Eczema types: Stasis dermatitis diagnosis and treatment

A dermatologist is often the doctor who diagnoses and treats stasis dermatitis

This disease can look like other diseases that tend to develop on the lower leg, and accurate diagnosis is key to getting proper treatment.

How do dermatologists diagnose stasis dermatitis?

Your dermatologist will examine the affected skin carefully and ask questions. Before your appointment, it can be helpful to take some time to prepare so that you can tell your dermatologist:

• All medications that you take, including the names of medications you take to control blood pressure and heart disease

• All your medical conditions, including problems with your heart, a previous blood clot, or stroke

• If you’ve ever injured the area with the skin problem

• Surgeries you’ve had, including ones that involved a lower leg

• The symptoms you’ve had, such as itch or pain

After examining the area and considering your answers to the questions, your dermatologist may give you the diagnosis.

Sometimes, a dermatologist recommends testing to see how your blood is flowing in the affected area. To do this, your dermatologist may order an ultrasound of your legs. A Doppler ultrasound study can rule out a blood clot and show any damage to your blood vessels. These tests are called non-invasive because they use devices that allow a doctor to see what’s happening inside your body without making an incision.

Some patients need an allergy test called a patch test, which can tell if an allergic reaction is affecting the skin. Many dermatologists perform patch testing in their offices.

Your dermatologist may also order another type of test, such as a blood test.

Your dermatologist will consider all this information before giving you a diagnosis. Stasis dermatitis can resemble another condition like cellulitis or contact dermatitis.

Once you have an accurate diagnosis, your dermatologist can create a treatment plan tailored to your individual needs.

How do dermatologists treat stasis dermatitis?

Your treatment plan will be based on your signs and symptoms — and how severe they are. The following explains how dermatologists treat these.

Swelling: To reduce the swelling, your dermatologist may prescribe a medication called a corticosteroid that you apply for a few weeks and a compression stocking or wrap that you wear all day.

While you’re awake, you may also need to elevate your legs above your heart for 15 minutes once every two hours. Your treatment plan may also require you to elevate your legs above your heart while you sleep. If this is necessary, you’ll get instructions to help you do this.

For some patients, massage can help reduce swelling. Always check with your dermatologist before starting massage therapy. If you have a blood clot or another medical condition, a massage could cause serious side effects.

Patient’s leg before beginning (A) and after using (B) compression therapy

While wearing compression wraps or compression stockings can feel uncomfortable at first, sticking with it can help reduce your swelling and discomfort.

Poor blood flow: Elevating your legs and wearing a compression stocking or wrap can also help improve your blood flow. Physical activity also helps. To help you get started, your dermatologist may write a prescription for physical therapy.

If you have wounds that need treatment, your dermatologist may prescribe an Unna boot. It’s not actually a boot. It’s a bandage that contains calamine and other wound-healing ingredients. An Unna boot goes on wet and dries hard. When you walk, the dried dressing restricts your calf muscles in order to improve your blood flow.

For some patients, massage can help improve circulation. Always check with your dermatologist before starting massage therapy.

Wearing a compression stocking is often part of a treatment plan for stasis dermatitis

Before you wear one, make sure that your dermatologist knows about all your other medical conditions.

Itch: If you’re bothered by itch, your dermatologist may prescribe an antihistamine (pill form), a corticosteroid that you apply to the area, or both.

Pain: Medication you apply to the skin can help ease pain.

Wounds, including open sores: Wound care may involve cleaning the area with saline, along with applying bandages and medication. It’s important to keep wounds moist, as this helps them heal.

Some wounds can be difficult to treat. It’s important that you follow your dermatologist’s instructions, which may change. Once wounds heal, you need to continue wearing your compression stocking. This helps prevent new wounds from developing.

Infection: An antibiotic that you take or apply to the infected area may be prescribed.

Dry, cracked skin: Moisturizer, along with a skin care plan that can prevent open sores.

Discolored skin: This can be difficult to treat. Even when the disease is under control, you may still see some discolored skin. Your dermatologist can recommend a camouflaging makeup to hide the discoloration.

Another option may be to treat the discolored skin with intense pulsed light (IPL). Some patients have seen their discoloration disappear completely after IPL. Getting IPL typically involves three to four treatment sessions.

Choosing a doctor who has experience treating skin discoloration with IPL is the key to getting a good outcome. Many board-certified dermatologists perform laser and light treatments. Some even specialize in this type of treatment.

Vein surgery may be an option

Researchers are studying whether this may be an effective treatment for stasis dermatitis. In one small study, 10 patients who had poor blood flow in a certain vein underwent a surgical procedure called flush ligation and saphenectomy. Between eight and 10 weeks after this surgery, all 10 patients saw the stasis dermatitis go away. One year after surgery, none of the patients had signs of stasis dermatitis.

While the results from this study are encouraging, more research is needed to know how effective and safe this surgery is for stasis dermatitis.

Your dermatologist may refer you to another doctor

While your dermatologist can treat the stasis dermatitis, some patients have a related health condition, such as vein disease or a heart condition. Your dermatologist will partner with that doctor to help ensure that you get the care you need.

To get the best results from treatment, you will also need some self-care. Here’s what dermatologists recommend, Stasis dermatitis: Self-care.

Images
Images 1 and 4: Getty Images

Images 2 and 3: American Academy of Dermatology. “Stasis dermatitis and leg ulcers.” Basic Dermatology Curriculum. Last accessed August 28, 2020.

References
American Academy of Dermatology. “Stasis dermatitis and leg ulcers.” Basic Dermatology Curriculum. Last accessed August 28, 2020.

Flugman SL, Clark RA. [editor: Elston DM] “Stasis dermatitis.” Medscape. Last updated Mar 27, 2020.

Nedorost S, White S, et al. “Development and implementation of an order set to improve value of care for patients with severe stasis dermatitis.” J Am Acad Dermatol. 2019 Mar;80(3):815-7.

Reider N, Fritsch PO. “Other eczematous eruptions.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018:235-6.

Sundaresan S, Migden MR, et al. “Stasis dermatitis: Pathophysiology, evaluation, and management. Am J Clin Dermatol. 2017;18(3):383-90.