Stasis Dermatitis: Pathophysiology, Evaluation, and Management

• Published in: American journal of clinical dermatology Vol. 18; no. 3; pp. 383 - 390
• Main Authors: Sundaresan, Swaminathan, Migden, Michael R., Silapunt, Sirunya
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2017; Springer Nature B.V
• Subjects: Ablation; Age; Age Factors; Blood; Clinical trials; Compression therapy; Cost analysis; Dermatitis; Dermatitis - diagnosis; Dermatitis - etiology; Dermatitis - therapy; Dermatology; Endovascular Procedures - methods; Gene expression; Humans; Hypertension; Hypertension - complications; Hypertension - etiology; Inflammation; Lasers; Legs; Lower Extremity; Medicine; Medicine & Public Health; Muscle contraction; Musculoskeletal system; Pharmacology/Toxicology; Pharmacotherapy; Review Article; Sclerotherapy - methods; Surgery; Systematic review; Ultrasonic imaging; Ultrasonography, Interventional; Varicose veins; Venous Insufficiency - complications; Venous Pressure; Chronic Venous Insufficiency; Compression Therapy; Venous Insufficiency; Compression Stocking
• ISSN: 1175-0561; 1179-1888
• DOI: 10.1007/s40257-016-0250-0

Stasis dermatitis commonly occurs in older age. It is caused by venous hypertension resulting from retrograde flow due to incompetent venous valves, valve destruction, or obstruction of the venous system. Further tissue changes arise from an inflammatory process mediated by metalloproteinases, which are up-regulated by ferric ion from extravasated red blood cells. Stasis dermatitis presents initially as poorly demarcated erythematous plaques of the lower legs bilaterally, classically involving the medial malleolus. It is one of the spectrum of cutaneous findings that may result from chronic venous insufficiency. Its mimics include cellulitis, contact dermatitis, and pigmented purpuric dermatoses. Duplex ultrasound is useful in demonstrating venous reflux when the clinical diagnosis of stasis dermatitis is inadequate. Conservative treatment involves the use of compression therapy directed at improving ambulatory venous pressure. Interventional therapy currently includes minimally invasive techniques such as endovenous thermal ablation and ultrasound-guided foam sclerotherapy, which have supplanted the use of open surgical techniques.