Varicose Eczema
Varicose eczema is an inflamed area of skin on the leg caused by a fault in the function of the veins under the skin called superficial venous reflux or by a problem in the deep veins following a deep vein thrombosis.
Varicose Eczema is also known as Venous Eczema, Gravitational Eczema or Stasis Eczema.
Is Varicose Eczema Serious?
Yes, it is a serious condition because it is a warning sign that you are at risk of a leg ulcer.
What does varicose eczema look like?
The skin becomes itchy and swollen, dry and flaky or scaly. On lighter skin it looks red or brown and on darker skin it tends to look dark brown or grey. In addition to leg, the eczema may spread to other parts of the body.
This is the common chronic form of varicose eczema. It tends to develop gradually and in the early stages, it may come and go.
An acute form of varicose eczema called lipodermatosclerosis can mimic cellulitis. It comes on very quickly, it is painful and there is a lot of swelling.
Varicose Eczema is the Skin's Response to Underlying Vein Problems
The term varicose eczema is in fact a misnomer and it is very misleading. This condition is neither an eczema – a skin problem – nor is it caused by varicose veins. The term arose before we fully understood the true nature of the problem. So varicose eczema can develop in the absence of visible varicose veins and unlike skin problems it should not be managed solely by dermatologists. Other misleading synonyms are gravitational eczema and stasis eczema suggesting that gravity somehow preferentially adversely affects some people — clearly ridiculous — or that blood is stagnant in some people — equally ridiculous. Varicose eczema is what we see when the skin is being damaged.
Abnormal leg veins prevent the exchange of nutrients and oxygen in the skin micro-circulation which in turn leads to the skin changes we can see and the symptoms.
What causes varicose eczema?
The true nature of varicose eczema is a malfunction of the veins of the legs which causes inflammation and scarring of the skin and underlying fat layer. These changes are seen when biopsies of varicose eczema are looked at under the microscope. A better medical term is lipodermatosclerosis
What is the treatment for varicose eczema?
The underlying vein problem should be diagnosed by Duplex Ultrasound and it should be rectified if possible.
Can varicose eczema be cured?
Over half of all cases of varicose eczema are caused by a malfunction in the superficial veins of the leg- veins which lie deep to the skin but superficial to the leg muscles. These problems in the superficial veins can nearly always be cured by non-invasive procedures under local anaesthetic on a walk-in walk out basis — procedures such as laser, radiofrequency, foam sclerotherapy or superglue.
Will varicose eczema come back after vein treatment?
Varicose eczema is a condition in which the skin is damaged and there may be permanent scarring and changes only visible under the microscope. The area is vulnerable and although the vein condition can be cured, the skin may not completely return to normal.
What about creams for varicose eczema?
Often the skin becomes dry and itchy. Moisturising creams can help. Varicose eczema should not be treated with steroid creams except for very brief periods when itch and pain are very troublesome. Longer term use of steroid creams will help the relieve symptoms and the area will look and feel better, but the use of steroids will thin the skin over time making it more vulnerable to further damage.
What about medical stockings for varicose eczema?
Medical stockings or socks help normalise the function of the leg veins and therefore wearing them will go a long way to improving the varicose eczema. Ideally, they should be put on first thing in the morning before getting out of bed and they should be taken off last thing at night. They are not a long-term solution and most people do not like wearing them.
What happens if I ignore varicose eczema?
Varicose eczema should be taken seriously. It is a warning sign that the skin is being damaged by inflammation and if neglected and not treated, varicose eczema may progress to a leg ulcer. Once an area of eczema has ulcerated, it may be difficult treat and heal. Avoiding deterioration to a leg ulcer is therefore very important.
Are there any Self-Help Remedies for Varicose Eczema?
Varicose Eczema is a progressive inflammatory condition of the leg veins and the skin around the ankle. That means it will get worse and it may permanently damage the microcirculation of the skin.
I always recommend that people with varicose eczema see a vein specialist. If a Duplex Ultrasound Scan shows that there is a problem in the leg veins that can be remedied, then treatment is advisable. This is also the advice of the National Institute for Health and Care Excellence.
Although varicose eczema is important and should be taken seriously, it is not usually an urgent problem (except when the eczema weeps – see below). So while you are waiting for treatment, there are 9 things you might wish to consider in addition to seeing a specialist.
- Moisturise the skin of the legs
- Elevate your legs
- Watch your weight
- Eat a healthy diet
- Wear Compression Socks
- Keep Active
- Consider occasional use of steroid cream to the skin
- Stop smoking
- Avoid injuries
When is Varicose Eczema Dangerous or Urgent?
If the skin is cracked and weeping, then infection can develop. The infection can spread up the leg and become cellulitis or the infection can spread to the blood stream leading to sepsis.
Any weeping or discharge is urgent and if you develop a fever or feel generally unwell, the condition serious and urgent.
Why does Varicose Eczema Weep?
"Weeping is potentially serious because it means that the skin has small cracks in it. These cracks allow fluid out but they also may allow infection in sometimes leading to sepsis. Weeping also means that the skin is very vulnerable and that even a small knock or injury can start a leg ulcer."
This photograph shows an example of varicose eczema which has been present for over 10 years. Over that time, the condition became progressively worse with intense itch and swelling.
You can see the severity of the swelling by the presence of a line or “dent” which has been made by the top of the sock. Indents and marks made by socks indicate that there is a build up of fluid in the leg – a condition called Venous Oedema.
Small cracks in the skin allow the fluid to leak out onto the surface. When this fluid dries it may leave a “crust”. When fluid leaks out, the eczema becomes wet and weeps.
Weeping is potentially serious because it means that the skin has small cracks in it. These cracks allow fluid out but they also may allow infection in sometimes leading to sepsis. Weeping also means that the skin is very vulnerable and that even a small knock or injury can start a leg ulcer.
A leg ulcer in unhealthy skin affected by varicose eczema is very difficult to get healed. Even once healed, a leg ulcer often comes back. For these reasons, it is always best to act when varicose eczema develops and weeping is a particularly important sign that treatment is urgent.
It is very unfortunate that this lady had not been advised to have treatment years before she came to The VeinCare Centre.
Despite suffering from varicose eczema for over 10 years, the result of treatment by Endovenous Laser Ablation is dramatic.
Only 6 weeks after treatment, the pain, itch and weeping have all gone.
Furthermore, the skin has healed and has nearly returned to normal.
A Duplex Ultrasound Scan performed at her 6 week check up showed that she no longer had Superficial Vein Reflux.
This lady is no longer at risk of ulcers and she can get on with her life without worrying about her leg.
Her coment as received the good news was “I wish I had known about this treatment years ago! I was told there was nothing that could be done for it. I did my own research and found the The Veincare Centre.
Can I get varicose eczema on my arms?
Strictly, the answer is no. But if you have varicose eczema on your leg, it can “spread” to other parts of the body. The medical term is autoeczematisation. Once the leg vein problem is treated, the eczema elsewhere gets better.
So, if your legs are healthy with no eczema, you cannot get varicose eczema on your arms.
Acute Varicose Eczema
Acute varicose eczema (also known as acute lipodermatosclerosis) is a condition can develop very quickly and it causes severe pain and swelling.
Acute varicose eczema (also known as Lipodermatosclerosis) is often misdiagnosed as cellulitis.
If the acute form of varicose eczema is allowed to develop over a long period of time, the area becomes scarred.
If acute varicose eczema is allowed to enter a chronic phase, the skin contracts and becomes very tight.
Chronic Lipodermatosclerosis refers to changes in the skin of the lower legs. It is a form of panniculitis (inflammation of the layer of fat under the skin). Signs and symptoms include pain, hardening of skin, change in skin colour (redness), swelling, and a tapering of the legs above the ankles.
Over time, the area becomes very vulnerable to injury and even a very minor knock may cause a leg ulcer.
This advanced form may not be completely reversible.
This photograph demonstrates the results of treating acute varicose eczema.
This lady had severe pain, swelling and a rash around her ankle. Her GP initially thought she might have had an injury or that perhaps she had twisted her ankle. In the absence of any history of injury, he diagnosed cellulitis and started her on antibiotics.
She came to see me when the swelling and pain continued to get worse. She was concerned that she might have a Deep Vein Thrombosis (DVT).
I performed a duplex ultrasound and I confirmed that in fact she had superficial venous reflux and that she was suffering from acute varicose eczema. I treated her by Endovenous Laser Ablation.
As you can see, 6 weeks later, the swelling has subsided and her ankle is a now a normal size. The pain has gone and she can walk normally.
Summary
- A duplex ultrasound scan is essential in all cases of varicose eczema. It will detect the exact vein abnormality and the results of the scan will form the basis of the plan for curative treatment.
- Varicose Eczema is a complication of leg vein problems.
- Varicose Eczema indicates that the skin is being damaged and that the area is at risk of ulcers.
- Moisturising creams are helpful.
- Steroid creams provide temporary relief but if used frequently, the skin becomes more vulnerable to injury and ulceration.
- The acute form of varicose eczema (lipodermatosclerosis) can mimic cellulitis