Stasis dermatitis
Why do I have stasis dermatitis?
Stasis dermatitis (a.k.a., venous eczema, varicose eczema, or gravitational dermatitis) is very common in older adults. It is dry, itchy, flaky skin on the shins, ankles, and tops of the feet. Our leg veins get tired from pumping blood out of our legs every day of our lives. The veins lose their strength and get leaky. This leads to leg swelling. Leg swelling stretches our skin and makes gaps in the skin allowing chemicals and irritants to get in and cause eczema. Treatment includes compression and leg elevation to get the fluid out of our legs, moisturizing to help protect and heal the skin, and topical medications to calm the redness and itchiness.
Stasis dermatitis is chronic and can flare. Dry climates, cold weather, fragrances, harsh soaps, stress, poor diet, and many chemicals and allergens (like pet dander, pollen, or dust mites) can cause flares. It also flares when you are sick.
How do I treat stasis dermatitis?
Wear compression stockings daily (or these).
Elevate your legs at night while sleeping (feet should be above the level of your heart).
Place a pillow under your fitted mattress sheet to prevent kicking the pillow off your bed in your sleep.
Exercise daily (including walking or swimming), when possible.
Use steroid (cortisone) ointments.
Nothing works better than steroids to calm down redness and irritation.
To minimize irritation, use an over-the-counter hydrocortisone ointment (instead of cream) twice daily to legs.
To make it more effective, after applying hydrocortisone, wrap the legs in plastic wrap for 30 minutes. This pushes the hydrocortisone deeper into the skin.
WARNING: Overuse of topical steroids like hydrocortisone can cause skin thinning, stretch marks, and easy bleeding or bruising.
Moisturize EVERY DAY, at least morning and night, but several times daily when needed.
Thick, greasy ointments like Vaseline or Aquaphor work best, but most people find them too greasy or heavy for daily use.
Creams are the next best option. My strong preference is either CeraVe moisturizing cream or Vanicream moisturizing cream. These do not leave a greasy or sticky feel.
What do I do if my legs have open sores or are weeping?
Start vinegar soaks daily (mix 2 tbsp white vinegar into 2 cups warm water) – dip a washcloth or paper towel into the solution and soak the legs for 10-15 minutes
Then apply Vaseline to leg sores.
How do I prevent stasis dermatitis?
Moisturize EVERY DAY, at least morning and night, but several times daily when needed.
Thick, greasy ointments like Vaseline or Aquaphor work best, but most people find them too greasy or heavy for daily use.
Creams are the next best option. My strong preference is either CeraVe cream or Vanicream cream. These do not leave a greasy or sticky feel.
Wear compression stockings daily (or these).
Elevate your legs at night while sleeping (feet should be above the level of your heart).
Place a pillow under your fitted mattress sheet to prevent kicking the pillow off your bed in your sleep.
Exercise daily (including walking or swimming), when possible.
Go fragrance-free.
Fragrance makes dry skin worse.
Use only fragrance-free washes, shampoos, and moisturizers.
Switch your household laundry detergent, fabric softener, and/or dryer sheets to fragrance-free for 1 month - if it helps, stick with it.
Additional Tips and tricks for stasis dermatitis:
These tips are not universally helpful for everyone with dry skin that leads to stasis dermatitis, but there’s a lot of trial and error to see what works best for each person.
Use a cool-mist humidifier: In dry climates or indoors when heaters are running, the humidity is low and dries out your skin. Run a cool-mist humidifier in the bedroom overnight or in your main rooms during the day.
Use an antibiotic ointment or medical-grade honey.
Apply antibiotic ointment or Manuka honey twice daily to any areas of broken skin.
NOTE: A prescription antibiotic ointment called mupirocin works better than over-the-counter options.
If a lot of red/oozy skin is present, you may need a prescription oral antibiotic.
Antihistamine treatment: I find that antihistamines sometimes help, especially at night-time, to improve sleep and help with itching/scratching:
Cetirizine (Zyrtec) in the morning and at dinnertime
Diphenhydramine (Benadryl) about 30 minutes before bedtime
Bleach baths: You are essentially turning your bath into a chlorinated swimming pool - this not only helps minimize bacterial overgrowth on the skin, but some people find bleach baths really reduce itching before bedtime. It is safe for all ages and skin types.
Avoidance measures: Avoid exposure to things that make dermatitis worse:
Rough or scratchy clothing (especially wool)
Harsh soaps or detergents
Tobacco smoke
Stress - this cannot be avoided, but be aware that when stressors happen - physical, emotional, relationship, etc. - dermatitis usually will flare.
What if my stasis dermatitis isn’t getting better?
Usually, the steps above can help most people get their stasis dermatitis better. If over-the-counter options are not working, there are stronger prescription topical medications and compression stockings. Look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.