Stasis dermatitis is inflammation of the lower leg skin caused by chronic venous insufficiency, where poor vein valves let blood and fluid pool in the legs. It is usually on both legs, itches more than it hurts, and can lead to venous ulcers.
Key symptoms
- Itchy, scaly, red or brown skin above the ankles
- Leg swelling that is worse at the end of the day
- Heaviness or aching in the legs, better with elevation
- Weeping, crusting or open sores near the ankle
What you find on exam
- Red-brown discoloration and scale on the lower legs, often both sides
- Pitting edema and varicose veins
- Hardened, tight skin above the ankle (lipodermatosclerosis)
- Shallow ulcers over the inner ankle
- Pulses, warmth and tenderness to rule out arterial disease, cellulitis or DVT
Tests
- Diagnosis is clinical
- Ankle-brachial index before compression to check arterial flow
- Venous duplex ultrasound for reflux or a blood clot
- Patch testing if contact dermatitis from creams is suspected
Treatment basics
- Leg elevation, walking and calf muscle exercise
- Compression stockings once arterial flow is confirmed
- Emollients and a mid-potency topical corticosteroid such as triamcinolone for flares
- Avoid topical antibiotics and fragranced products that cause allergy
- Wound care for ulcers and vascular referral for vein treatment
Red flags
- One leg suddenly hot, painful and swollen with fever (cellulitis or DVT)
- Weak or absent foot pulses before compression
- Ulcer that grows or does not heal despite treatment
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.