Q. I am being treated as a follow-up case of stasis dermatitis and there is no satisfactory improvement. The symptoms are hyperpigmentation on the lower part of both legs (feet); swelling occurs on prolonged standing. It started 8 years back with red pigmentation marks on my feet. Later, the red marks persisted and there were wounds after 2 years. I went to a dermatologist who then prescribed medicine that successfully healed the wounds. With no remarkable improvement, I went for ayurvedic treatment for almost 6 months. No improvement still then I went to another dermatologist who diagnosed it as some problem related to the veins that cannot be cured. Then, my parents decided to go to the hospital last year and till now I have visited the hospital 8 times. Tests done: (i) Skin biopsy – negative; (ii) ANA/C-ANCA – negative; (iii) Blood and urine tests normal. I feel comfortable while walking but not standing, and I am unable to go for an excursion. Please help.
A. Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities in patients with chronic venous insufficiency. The excess fluid in the tissues interferes with the blood’s ability to feed the tissue cells and dispose of cellular waste products. The tissue becomes poorly nourished and fragile, resulting in stasis dermatitis. The disorder is common on the ankles because there is less supportive tissue in this area. You could undergo venous Doppler studies as yet another test to confirm the diagnosis, which may reveal deep venous thrombosis or severe valve damage due to past thrombosis. The tests mentioned above are more than enough. Treatment options available are: elevating the ankle while resting and compression therapy (generally with the help of specialized stockings that deliver a controlled gradient of pressure). More aggressive compression can be performed by using elastic wraps; compression (Unna) boots. You must know that compression therapy must be maintained on a lifelong basis. Topical therapy: Using wet-to-damp gauze dressings soaked in water or with a drying agent such as aluminium acetate. Topical corticosteroids are frequently used for reducing the inflammation and itching in acute flares. You did not mention if you also have ulcers but if they are present then ulcers are best treated with compresses and bland dressings (e.g. zinc oxide paste) and various other dressings (e.g. DuoDerm). Oral antibiotics are useful when there is cellulitis (inflammation and redness); topical antibiotics are useless and often cause contact dermatitis (eczema). When the swelling subsides, split-thickness skin grafts (a kind of plastic surgery) may be useful. Be wary of infection in stasis dermatitis; this becomes more problematic when using topical corticosteroids, which can make the patient more prone to infection. So my advice to you is to either consult a vascular surgeon or a dermatologist so that suitable treatment can be formulated for you.
