It is very important to quickly distinguish between varicose eczema and cellulitis and to start the correct treatment. Varicose Eczema is a vascular condition that can lead to ulceration and cellulitis is an infection that can lead to sepsis.
People with varicose eczema need a duplex ultrasound scan and people with cellulitis need antibiotics.
So why is there confusion?
Varicose Eczema can take 2 forms.
- It frequently looks like a skin rash around the ankle and it is sometimes mistakenly considered to be primarily a skin condition. Therefore it is sometimes managed with creams such as hydrocortisone or similar steroid creams for long periods of time. This is the chronic form of varicose eczema that can be present for years before it may eventually cause a leg ulcer. The eczema in its early stages, may come and go, and the symptoms of itch and discomfort are relieved quickly by hydrocortisone. The problem with chronic varicose eczema is that many people receive the incorrect treatment: they are given creams when really these people should be referred to a vascular specialist for a venous duplex ultrasound scan and subsequently, the vein problem should be treated to prevent leg ulceration. At the very least, people with varicose eczema should be given advice about compression socks.
- The other form is acute varicose eczema (also known as acute lipodermatosclerosis). This condition can develop very quickly and it causes severe pain and swelling.
Acute varicose eczema (also known as Lipodermatosclerosis) is often misdiagnosed as cellulitis.
It is the acute form of varicose eczema that causes confusion. Many people with acute varicose eczema are diagnosed as having an injury or an infection.
Few doctors in primary care will have seen acute varicose eczema and it is frequently misdiagnosed as cellulitis. Antibiotics are often given to people with acute varicose eczema inappropriately. Antibiotics are the wrong treatment. Acute varicose eczema needs to be investigated by a venous duplex ultrasound scan.
Summary
- Varicose Eczema is a vascular condition
- The Acute Form of Varicose Eczema is very painful and can mimic cellulitis
- The Chronic Form is sometimes treated for long periods with creams and ointments
- A venous Duplex Ultrasound Scan should be considered in cases where the diagnosis is in doubt
- The abnormal veins which cause varicose eczema should be treated as soon as possible to prevent progression to leg ulceration