Stasis dermatitis
Also called venous stasis dermatitis, gravitational eczema, venous eczema
Chronic venous hypertension wearing an eczema mask: itchy, red-brown, scaly lower legs with hemosiderin staining, edema, and, at the end of the road, medial malleolar ulcers. Most famous for being misdiagnosed as bilateral cellulitis.
How it looks
Bilateral erythematous, scaly, hemosiderin-stained patches over the gaiter area of the lower legs with pitting edema and varicosities.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
In deeply pigmented skin the erythema of a flare hides while hemosiderin and post-inflammatory pigment dominate, so the legs read 'dark' rather than 'red'; warmth, tenderness, scale, and edema then carry the assessment.
Don't miss
Bilateral 'cellulitis' of the legs is stasis dermatitis until proven otherwise; treating it with repeated antibiotic courses misses the venous disease and teaches the wrong lesson twice.
Forms & variants
Stasis ulcer (venous ulcer)
The end-stage: a shallow, exudative, irregularly bordered ulcer over the medial malleolus in skin already carrying stasis pigment and induration; compression is the treatment the ulcer is waiting for.
Symptoms & course
- Itch, heaviness, and ache worse by evening
- Chronic swelling that pits
- Weeping flares that mimic infection
Diagnostic approach
- Clinical diagnosis on a venous background
- ABPI before compression
- Swab only when infection genuinely suspected, colonization is universal
Differential, and how to separate them
- Cellulitis
Favours it: A hot, tender, spreading red leg
Against it: Cellulitis is almost never bilateral, arrives in days not years, and brings fever; stasis is chronic, itchy, and mirrored
- Contact dermatitis
Favours it: Weeping eczematous flare after a new cream or dressing
Against it: Stasis legs sensitize easily, so the two coexist; patch testing separates them when treatment fails
- Nummular eczema
Favours it: Coin-shaped plaques on the legs
Against it: Nummular lesions are discrete circles without the venous backdrop of edema and hemosiderin
Management principles
- Compression is the disease-modifying treatment; everything else is adjunct
- Emollients and moderate topical corticosteroids for flares
- Elevation and calf-pump activity, and avoid common sensitizers in leg products
Clinical pearl: An ulcer over the medial malleolus in a stained, indurated leg is venous until the ABPI says otherwise; the arterial ulcer is punched-out, distal, and pale.
Keep going
Try the case: Both legs, for the third timeBack to the Atlas