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Clinical Summary

Stasis dermatitis results from venous insufficiency, is characteristically distributed on the distal tibia above the medial malleolus, and appears early with erythematous patches. These can progress to scaling as well as eczematous and weeping plaques. Patients will often have light brown pigmentation distributed on the lower third of the extremity due to microvasculature blood extravasation (hemosiderin deposition secondary to increased superficial capillary pressure). Varicose veins are usually present, although they are often difficult to visualize in obese patients. Patients with heart failure, cirrhosis, nephrotic syndrome, or lower extremity trauma are at increased risk due to a chronic edematous state.

Management and Disposition

Referral to a primary care physician should be initiated to address the underlying etiology (eg, venous valvular insufficiency, thromboembolic disease, chronic edematous state), and dermatology referral should be made to ensure other diagnoses are not playing a role. Daily elevation and compression hose use should be encouraged. Emollients and mid-potency topical steroids help decrease the pruritus and promote healing.

FIGURE 13.121

Stasis Dermatitis. Erythematous patches and mild scaling in a patient with chronic venous insufficiency. Note location above the ankles. (Photo contributor: Lawrence B. Stack, MD.)

Pearls

  1. Differentiation of stasis dermatitis and early cellulitis can be difficult. Clinical history and deviation from previous presentations may be helpful. Close follow-up for reevaluation should be obtained.

  2. Due to the chronic and repetitive nature of stasis dermatitis, patients use many over-the-counter topical products. These may contribute to allergic and irritant contact dermatitis.

  3. An associated contact dermatitis may initiate an “autosensitization” rash, erythematous patches on the legs and arms. Stop nonessential topical medications or other products.

FIGURE 13.122

Stasis Dermatitis. An example showing erythematous, scaly, and oozing patches over the lower leg. Several stasis ulcers are also present. (Used with permission from Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Principles of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008: 315.)

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