II. Pathophysiology
- See Venous Insufficiency
- Venous Stasis changes related to Venous Insufficiency
III. Epidemiology
- Prevalence: 2 to 6 million have advanced Venous Insufficiency in U.S. (500,000 with Venous Stasis Ulcers)
IV. Signs
- Venous Insufficiency changes
- Erythematous Plaque
- Fine fissures
- Scaling
- Hyperpigmentation with pinpoint brown Macules (Hemosiderin deposits)
- Stasis changes on legs and foot dorsum
- Secondary changes with scarring and skin atrophy
- Telangiectasias
- Corona Phlebectatica (abnormally dilated veins at the ankle and foot)
- Atrophie blanche (atrophic white scarring)
- Lipodermatosclerosis
- Narrowing of the distal lower leg (similar to an inverted champagne bottle)
- Results from subcutaneous fibrosis seen in Lipodermatosclerosis
V. Management
- See Venous Insufficiency
- Avoid scratching and avoid other Skin Injury
- See Pruritus Management
- Apply Skin Lubricant (e.g. Vanicream) immediately after bathing and throughout the day
- Wrap legs (changed weekly, more for weaping lesions)
- Ace bandage compression or
- Una boot (4 layers wrapped with Coban or similar)
- Weaping lesions
- Dry weaping lesions with compresses of dilute vinegar on gauze
-
Topical Corticosteroids (high potency)
- Apply to areas of closed, dry Stasis Dermatitis under wraps
VI. Complications
- Venous Stasis Ulcer
-
Cellulitis
- Recurrent Cellulitis predisposes to lymphatic insufficiency
- Eczematous Dermatitis
- Fat necrosis (sclerotic paniculitis)
- Inverted champagne bottle appearance to lower legs (bottle body) and ankles (bottle neck)
VII. References
- Abbade (2005) Int J Dermatol 44(6): 449-56 [PubMed]
- Bowers (2020) Am Fam Physician 101(3):159-66 [PubMed]
- Collins (2010) Am Fam Physician 81(8): 989-6 [PubMed]
- De Araujo (2003) Ann Intern Med 138:326-34 [PubMed]
- Etufugh (2007) Clin Dermatol 25(1): 121-30 [PubMed]
- Millan (2019) Am Fam Physician 100(5): 298-305 [PubMed]
- Nelson (2005) Am Fam Physician 71(7):1365-66 [PubMed]
- Weingarten (2001) Clin Infect Dis 32:949-54 [PubMed]