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What’s this rash on my legs?

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Stasis dermatitis is a common rash seen on the lower legs of patients who have swelling in their legs.  It can be seen on both legs, or if a patient has more swelling in one leg compared to the other, can be worse on one leg.

Notice the rash sharply stops where the patient's socks prevented swelling. This is NOT a tan line.
Notice the rash sharply stops where the patient’s socks prevented swelling. This is NOT a tan line.

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 shoe laces at the end of the workday if I am not wearing support hose.  I am 45, relatively healthy and exercise on a regular basis.  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.  This 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 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.  It can take months and months for the tan bronze discoloration to fade.

Some patients never have itching, but if you look closely in the photo below you can see the pinpoint dots of blood in the skin.

Pinpoint red dots from red blood cells extravasating in the skin.
Pinpoint red dots from red blood cells extravasating 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 or prop legs up on the end of the couch or on pillows.
  • Use topical steroid on 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 seen with stasis dermatitis may also need to be treated.  These include fungal infection and thickening of the skin.

Next post will focus on the benefits of support stockings and a cute picture of me wearing mine.

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