What is varicose eczema?
So you would have heard about varicose veins, but varicose eczema? It’s a skin condition caused by increased pressure in the veins of the legs. Usually affecting seniors and obese persons among others, it often takes a long time to heal.
It is also the term used for skin changes that occur with the increased venous pressure. You may also hear it referred to as gravitational eczema, stasis eczema, or most commonly, venous eczema.
The affected skin typically becomes red. The redness can sometimes come on quickly and be mistaken for infection (cellulitis). Most people with varicose veins have few or no symptoms, other than the veins looking unsightly. Some, however, have more severe symptoms, which can include swollen and uncomfortable feet and ankles, which can become painful. Legs may ache, feel heavy and can produce a throbbing or burning sensation. Muscle cramps, especially at night, could also be experienced.
Although varicose veins can occur in other parts of the body, those in the legs are much more common, and much more likely to produce the symptoms described above. Another symptom which can arise from varicose veins is the formation of varicose eczema. This condition usually begins with a mild itching sensation on the skin over or around the veins.
While this condition rarely causes major problems, the itching can develop into large patches of red, inflamed and intensely itchy skin. The skin can become very dry, and even turn brown; it may harden and tighten as well.
People most at risk are those who already have varicose veins, who have had varicose vein surgery, or who have had a thrombosis in a deep leg vein (DVT — deep vein thrombosis).
What causes varicose eczema?
Varicose eczema is caused when pressure increases in the veins running under the skin and in the deep muscles of the legs. This build-up in pressure results from the valves in the veins becoming weakened. This makes it difficult for the blood to flow back up the legs against gravity. This restriction to blood flow is what causes increased pressure in the veins in the legs. This can cause pigment to leak into the skin, inflammation, eczema, scarring and ulceration.
Varicose eczema can also occur after a thrombosis (blood clot) forms in the deep veins.
A general practitioner (GP) will usually be able to diagnose varicose eczema simply by looking at the affected area and through a patient’s medical history. The GP may ask questions to try to determine whether the patient has high blood pressure in their veins, as this would support a diagnosis of varicose eczema. If there is any doubt, further tests may be requested and the GP may make a referral to a vascular specialist.
• Try to avoid injuring the skin (for example, against furniture).
• Put your legs up on a pouffe or footstool when sitting.
• Keep active and go for regular walks.
• Use moisturising creams to ensure that the skin does not become too dry.
If the skin becomes very inflamed, your doctor may prescribe a topical steroid (steroid creams or ointments applied to the skin). Topical steroids work by reducing inflammation in the skin. The steroid is applied as an ointment rather than a cream if the skin is very dry. A moderate-strength steroid is usually prescribed unless the skin is very inflamed, in which case a very strong ointment may be needed.
This is also known as compression hosiery. It works by applying pressure from outside the veins, preventing leakage of blood into the surrounding tissues. You will need to have a test first to check that the circulation through the arteries of your legs is normal. Compression stockings come in light, medium or strong material, although many people find these difficult to wear for any length of time.
What if your treatment
If your condition does not seem to be responding to treatment, your doctor may consider patch testing to check if you have developed contact dermatitis (sensitivity to any of the creams, ointments or dressings you have applied to the skin). This involves putting various chemicals in patches on to the skin, to see whether a reaction develops. This is usually done by a dermatologist (skin specialist).
Lack of progress sometimes means that infection has set in; antibiotic tablets may then be needed.
You may require surgery if:
• Your varicose eczema will only get better if underlying varicose veins are treated.
• You have a leg ulcer which is not responding to medical treatment.
• You have a blockage in the arterial circulation of the leg.
Can it be prevented?
There are no hard and fast methods. But lifestyle modifications can be tried first to control the eczema regardless of its severity.
It is critical to always moisturise; limit contact with anything that irritates the skin; along with avoiding sweating, overheating, and sudden changes in temperature and humidity. Reducing stress levels is helpful too.
Your feet mirror your general health . . . cherish them!
Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited The Holistic Clinic. E-mail firstname.lastname@example.org or visit the
website at www.almawiclinic.com