Stasis Dermatitis
What is This Rash on My Legs?
Stasis dermatitis is a common rash seen on the lower legs of patients with swelling in their legs. It can be on both legs, or if a patient has more swelling in one leg compared to the other, it can be worse on one leg.
Sometimes, even before we detect varicose veins, spider veins, or extensive swelling in the legs, the legs are swelling off and on every day. I admit that I often have to loosen my tennis shoelaces at the end of the workday if I am not wearing support hose. I am 43, relatively healthy, and exercise regularly. Most people’s legs swell sometimes, so let’s agree on that premise. Everyone tries to tell me that their legs NEVER swell. Legs swell because the blood is not flowing back to the heart correctly, which is very common.
When blood doesn’t flow back correctly, the blood leaks slightly out of the blood vessels and into the surrounding skin; when the blood enters the skin, it often irritates the skin causing the legs to itch and sometimes be red. This itchy rash on the lower legs is called STASIS DERMATITIS. Even after the rash fades, the skin may have a tan bronze discoloration. This discoloration is an iron stain in the skin from the blood that is leaking into the skin. Even after the rash is improved, it can take months and months for the tan bronze discoloration to fade. Some patients never have itching, but if you look closely at the photos, you can see the pinpoint dots of blood in the skin.
Treatment for stasis dermatitis, involves prevention and treatment.
- When sitting around, we need to ELEVATE OUR LEGS ABOVE THE LEVEL OF THE HEART. Sit in a recliner kicked back, prop legs up on the end of the couch, or on pillows.
- Use a topical steroid on an active red rash on the legs. Twice a day when rough AND red. Once a day, when rough OR red. Stop when roughness and redness clears. Use as needed with the above guidance. This is a chronic problem and will need long term treatment.
- Wear support stockings as much as possible.
Secondary problems with stasis dermatitis may also need treatment. These include fungal infection and thickening of the skin.
SUPPORT STOCKINGS
When people have venous disease, they need to wear support stockings to encourage blood to flow back to the heart from the legs naturally. The support stockings come in various strengths, known as mmHg, which stands for millimeters of mercury, which measures how much pressure will be exerted on the legs to encourage blood flow back to the heart. The higher the strength, the more effective they are. However, in people with arterial disease, we can’t have it too strong, or it will cut off healthy blood flow.
IF HOSE ARE OBTAINED WITHOUT A PRESCRIPTION, THEY GENERALLY ARE NOT MEDICALLY EFFECTIVE.
Steps to get your stockings….
- Take your prescription to one of the above locations. Call ahead and make sure they will have someone available to measure you. YOU MAY NEED AN APPOINTMENT!
- Go and have your legs measured in the MORNING when your legs are their smallest.
- They will order your hose. It may take a FEW WEEKS to get them.
- Many insurance companies will not pay for your hose. However, Dr Rosenberger would be happy to fill out whatever forms needed, if you have a medical problem requiring stockings.
When I say support stockings, most people sigh. However, they are not nearly as bad as they used to be. First of all, there are many more cosmetically acceptable options, including ones that look like dress socks for men and ones that look like pantyhose for women. Plus, they have super cute fluorescent ones for exercise that are quite stylish for athletes. The next complaint is that they are hard to get on. There are several devices to aid in applying these.
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