II. Pathophysiology

III. Epidemiology

  1. Prevalence: 2 to 6 million have advanced Venous Insufficiency in U.S. (500,000 with Venous Stasis Ulcers)

IV. Signs

  1. Venous Insufficiency changes
  2. Erythematous Plaque
  3. Fine fissures
  4. Scaling
  5. Hyperpigmentation with pinpoint brown Macules (Hemosiderin deposits)
  6. Stasis changes on legs and foot dorsum
  7. Secondary changes with scarring and skin atrophy
  8. Telangiectasias
  9. Corona Phlebectatica (abnormally dilated veins at the ankle and foot)
  10. Atrophie blanche (atrophic white scarring)
  11. Lipodermatosclerosis
  12. Narrowing of the distal lower leg (similar to an inverted champagne bottle)
    1. Results from subcutaneous fibrosis seen in Lipodermatosclerosis

V. Management

  1. See Venous Insufficiency
  2. Avoid scratching and avoid other Skin Injury
    1. See Pruritus Management
    2. Apply Skin Lubricant (e.g. Vanicream) immediately after bathing and throughout the day
  3. Wrap legs (changed weekly, more for weaping lesions)
    1. Ace bandage compression or
    2. Una boot (4 layers wrapped with Coban or similar)
  4. Weaping lesions
    1. Dry weaping lesions with compresses of dilute vinegar on gauze
  5. Topical Corticosteroids (high potency)
    1. Apply to areas of closed, dry Stasis Dermatitis under wraps

VI. Complications

  1. Venous Stasis Ulcer
  2. Cellulitis
    1. Recurrent Cellulitis predisposes to lymphatic insufficiency
  3. Eczematous Dermatitis
  4. Fat necrosis (sclerotic paniculitis)
    1. Inverted champagne bottle appearance to lower legs (bottle body) and ankles (bottle neck)

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