Elderly Skin Conditions series – Stasis Dermatitis (Varicose Eczema)

 

This is another 4-part series, focusing on elderly. For those of you who have been following this blog, you know I’ve been passionately persevering in bringing you information for eczema children. This month, however, I’m inspired to focus on elderly because (i) I see a desire among elderly ladies in the eczema support group meeting to care for their skin and (ii) I am ashamed that I can’t convince my own elderly parents of the right skincare. Hopefully, with this series, elderly who surf the internet and found this blog will find the series useful and adult kids (yes, you and me included!) will be empowered to help their aged parents with the correct skincare. So here we go!

Last week, we talked about the elderly skin differences and the loss of skin functions. This week is on stasis dermatitis, very likely if you start noticing, you’d see many elderly with this skin condition.

Stasis dermatitis is a common inflammatory skin condition that occurs on the lower extremities (our body from the hip to the toes, including also the knee, ankle joints, the thigh, leg and foot). Stasis dermatitis is also known by various names, such as varicose eczema, venous eczema, venous dermatitis and gravitational dermatitis.

Its prevalence is about 7% in elderly persons above the age of 50 and can be up to 20% for those above age 70. The main cause of stasis dermatitis is venous insufficiency, which has been reported to affect more than 50% of elderly above age 50 internationally (thus, making stasis dermatitis a common skin condition for elderly).

What Causes Stasis Dermatitis?

Venous insufficiency is the main cause – a term that you’d see being commonly mentioned.

Venous insufficiency refers to the poor blood circulation, commonly due to weakening of the valvular function with age. The malfunction allowed a backflow of the blood from deep venous system into the superficial venous system, creating venous hypertension.

It is hypothesized that this increased pressure leads to the dermal capillaries being more permeable. This results in the leaking out of macromolecules (fibrinogen) that eventually polymerized and form a cuff (fibrin cuff) that reduces oxygen to the skin cells. White blood cells that help the body to fight inflammation becomes activated and trapped in the fibrin cuff resulting in a hyper state of inflammation.

Who gets Stasis Dermatitis?

Typically middle-aged and elderly patients, from age 50s onward

Patients with venous insufficiency due to surgery, trauma or thrombosis (blood clot)

Women, due to increased stress on the lower extremity venous system from pregnancy

Patients with health conditions such as high blood pressure (hypertension with diastolic dysfunction) and congestive heart failure

Patients taking medications such as antihypertensive medication, e.g. amlodipine

Sedentary lifestyle and Obesity

Symptoms of Stasis Dermatitis

Symptoms may show at area at the lower leg and around the ankle, such as

• Itch
• Hyperpigmentation/discoloration, usually reddish-brown skin
• Atrophic skin patches (small/white scarred skin that is decreasing/thinning)
• Edema (swelling from excess fluids, e.g. blood pooling from faulty varicose veins)
• Dilated superficial veins
• Infection with honey-colored crust over infected area
• Pain
• Slow healing of open sores
• Lichenification (thickening of skin from repeated scratching)

 Complications of Stasis Dermatitis

Chronic stasis dermatitis where the skin is inflamed severely for prolonged period can lead to weeping patches, plaques (solid, raised lesion), on-healing venous ulcers and higher likelihood of contact dermatitis. It can also aggravate into other conditions such as:

Cellulitis – Streptococcus or staphylococcus bacteria entering through a break in the skin, causing infection that can spread quickly from a reddened skin to lymph nodes/blood stream

Lipodermatosclerosis – Underlying fat necrosis (degeneration of fat cells), with appearance of “inverted champagne bottle” on the inner leg

Prevention of Stasis Dermatitis

To prevent stasis dermatitis, measures can be taken to reduce venous insufficiency. This can be prompt treatment of varicose veins, treatment of health conditions, management of venous insufficiency and preventing deep vein thrombosis.

1. Leg elevation – above the heart when lying down to improve blood circulation and reduce swelling
2. Compression socks – also improve circulation
3. Not standing for long periods
4. Taking regular walks
5. Moisturizing (avoiding harsh soaps and perfumed products)
6. Protecting from further injury (e.g. knocks or falls)

Treatment of Stasis Dermatitis

Treating the cause of the venous insufficiency is one part of treating the skin condition. Avoid scratching and follow the nurse’s instruction for wound care. Antibiotics may be prescribed, either topically or orally, if there is infection. Topical steroid may be prescribed but since the skin is already thin, talk to the doctor about alternative non-steroid options or be careful to apply only the low potency for limited time.

As I look through the pictures of stasis dermatitis, I really feel very sad. It’s an age-related problem and the thought that our parents who bore the hard work to raise us have to bear this pain is very heart-breaking. The irony is that they don’t quite believe in skincare or compression stocking – encourage one another to stay positive in helping our parents!