Stasis dermatitis is the dark discoloration of the skin, usually a brown pigmentation, due to poor venous drainage in the legs. It is also known as venous eczema. This is usually as a result of poor circulation caused by venous insufficiency, the inability or incompetence of the leg veins to assist with returning circulating blood back to the heart.

How does stasis dermatitis occur?

Causes of Stasis Dermatitis

Properly circulating blood is important for the health of all the body tissues including the skin. When this circulation is impaired, a number of pathologies can arise, like stasis dermatitis. Many circulatory problems of the leg occur as a result of a dysfunction of the veins. Arteries carry oxygenated blood to all parts of the body and the veins return the deoxygenated blood back to the heart and lungs.

Stasis Dermatitis from the Medical Library of Utah

Stasis Dermatitis Picture from the Medical Library of Utah

However, in vein related disorders of the leg (venous insufficiency) blood cannot easily return back to the heart. A common cause of venous insufficiency is when the valves in the leg veins, which prevents back flow of the blood, does not function adequately. Blood pools in the lower limbs thereby hampering healthy circulation. This results in many of the conditions associated with circulatory problems of the leg, like venous ulcers and venous stasis dermatitis.

Other causes of venous insufficiency may not involve the valves of the veins but other disorders affecting the veins. These include deposition of fibrin, an essential component of healing, around the blood vessels. This fibrin may hamper oxygen and carbon dioxide exchange between blood and the tissue of the leg.

Another condition that may cause stasis dermatitis is abnormal reflexes of the smaller blood vessels of the leg. These blood vessels may constrict over long periods of time hampering the blood flow of the leg. Stasis dermatitis may complicate if the areas is injured and can lead to venous stasis ulcers. Other factors such as a bacterial or fungal infection of the skin at the affected area may further affect healing.

What does stasis dermatitis look like?

Signs & Symptoms of Stasis Dermatitis

Also known as venous stasis dermatitis or bad circulation rash, stasis dermatitis may initially present as red rash of the skin (erythema) of the lower leg and ankle. It is itchy and the skin may be dry and rough. The first skin discoloration may be a red to purple hue which progresses to a brown and black discoloration. Over a period of time, this changes to brown and dark brown discoloration of the skin of the leg. There may be mild scaling or peeling of the skin and swelling at the affected area (edema) increases over time as the condition gets worse. Varicose veins of the leg may also be visible although stasis dermatitis is usually isolated to the ankle. Eventually there may be thickening and hardening of the skin known as lipodermatosclerosis.

How do you treat or manage stasis dermatitis?

Treatment & Management of Stasis Dermatitis

Conservative measures to reduce the incidence of stasis dermatitis include elevating the legs to increase the return of venous blood to the heart and reduce leg swelling. Support hose (elastic compression stockings) helps increase support of the veins of the legs and reduces swelling and pooling of the blood in the legs.

Topical treatment of hydrocortisone and zinc oxide cream may be required for long term stasis dermatitis. An antifungal cream may be necessary for a skin fungus affecting the lesions. In cases of secondary bacterial infection of the dermatitis, an antimicrobial cream and appropriate wound dressing should be utilized, especially if a venous stasis ulcer is present. Oral antibiotics may required in cases of cellulitis.