What Is It?

A client recently came to the clinic with this condition, but was not sure what the problem was. However, the level of frustration being experienced, was causing a high level of stress, especially due to the appearance of the legs. A long-term skin condition that affects the lower legs, it is common in people with varicose veins, which was the case of the patient in question. It is also known as venous eczema, gravitational eczema, and stasis eczema. The word eczema (or dermatitis), refers to a common inflammatory skin condition. It is more widespread as people get older, and occurs more often in women than in men.

Signs and Symptoms

Like all types of eczema, the affected skin becomes: 

• – itchy
• – red and swollen
• – dry and flaky
• – scaly or crusty.

There may be periods when these symptoms improve, and periods when they flare. Your legs may become swollen, especially towards the end of the day, or after long periods of standing. Varicose veins (swollen and enlarged veins), are often visible on the legs.

Some people also have other symptoms, such as: 

• – brown discolouration of the skin
• – red, tender and tight skin, that can eventually become hardened (lipodermatosclerosis)
• – small, white scars (atrophie blanche)
• – pain
• – eczema affecting other parts of the body.

Left untreated, leg ulcers can develop. These are long-lasting wounds that form where the skin has become damaged. Sometimes, varicose eczema can trigger eczema elsewhere on the body; this is known as secondary eczema.

What Causes It?

When the small valves in the veins stop working properly, it’s difficult for blood to be pushed against gravity, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins, which can cause fluid to leak into the surrounding tissue. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to leakage of blood, and blood products into the surrounding tissue. This then triggers inflammation in the skin. It is thought that varicose eczema may develop as a result of the immune system reacting to this fluid.

Being overweight can make the problem worse, because of increased pressure on the leg veins. Immobility, leg swelling, varicose veins, previous clots in the leg (venous thrombosis), and previous cellulitis, are other possible contributory factors.

How is It Diagnosed?

It is usually a clinical diagnosis, based on its typical appearance, and associated features. There are some other causes of a rash on the lower leg, such as allergic contact dermatitis (when a person develops an allergy to substances or treatments on the skin); and irritant contact dermatitis (when the skin becomes irritated by secretions, bacteria or certain treatments). In general, doctors who regularly look after patients with varicose eczema, are able to identify which of these rashes is the most likely problem; but on some occasions, it may be necessary to carry out further investigations to help make the diagnosis.

When to Seek Medical Advice?

See your GP if you have symptoms of varicose eczema. They will often be able to make a diagnosis simply by looking at the skin.

Can It Be Cured?

Unfortunately, the problem of the valves in the veins not working properly means that varicose eczema does not clear up completely, so people with this problem tend to have it for life.

How is Varicose Eczema Treated?

Though it tends to be a long-term problem, treatments are available to help keep it under control. Simple measures are very important in helping to reduce venous pressures, and the risk of further complications. These include losing weight and keeping active. The condition can be made worse by standing or sitting with the legs down for long periods, for example sleeping in a chair. When at rest, raise your legs as high as possible, for at least part of the day; ideally, above the level of your heart by lying down.

Care also needs to be taken to avoid damaging the skin on the leg; for example, it is important to avoid knocking, or hitting the leg on hard objects (such as supermarket shelves, trolleys, doors of kitchen cupboards, etc.).

For most people, treatment involves a combination of:

• – self-help measures – including ways to improve your circulation, such as keeping active and frequently raising your legs.
• – emollients – moisturisers applied to the skin to stop it becoming dry
• – topical corticosteroids – ointments and creams applied to the skin to help treat the eczema and relieve symptoms. Steroids however, contribute to the skin becoming thinner.
• – compression stockings – specially designed stockings, usually worn every day, that steadily squeeze your legs and         help to improve your circulation. These stockings should not be used in patients with arterial disease in the legs. Your dermatologist or doctor can advise you about this, and a simple test measuring your leg circulation is often performed, before using compression stockings.

If these treatments don’t help, your GP may refer you to a dermatologist, in case there is another cause for your symptoms, or if they are concerned you may also have contact dermatitis.

If you also have varicose veins, you may be referred to a vascular specialist, who can talk to you about the treatment options for same.

Other Types of Eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:

• – atopic eczema  (also called atopic dermatitis) – it’s the most common type.
• – contact dermatitis – which occurs when the body comes into contact with a particular substance.
• – discoid  eczema – it presents as circular or oval patches on the skin.

Your feet mirror your general health . . . cherish them!