InflammatoryVenous insufficiencyICD-10 I83.1 / L30.4
Stasis dermatitis / venous eczema
Venous eczema · gravitational eczema · varicose eczema
Stasis dermatitis is the eczematous skin reaction to chronic venous insufficiency, typically affecting the lower legs. It is a very common DDx for cellulitis, lymphoedema flare and lipodermatosclerosis. Untreated chronic venous insufficiency progresses through hyperpigmentation (haemosiderin), atrophie blanche, lipodermatosclerosis to venous ulcers. UK NHS / NICE CG168 varicose-vein guidance and leg-ulcer pathways emphasise venous duplex assessment, compression where safe and intervention for suitable superficial venous reflux.
CurrentLast reviewed 18 May 2026
Pathogenesis
- Chronic venous hypertension → capillary leak → fibrinogen / RBC extravasation → haemosiderin pigmentation, dermal fibrosis, leucocyte trapping, lipodermatosclerosis.
- Risk factors: age, female, obesity, prior DVT, immobility, multiparity, family history.
- Strong overlap with lipodermatosclerosis and venous leg ulcer.
- Frequently mis-diagnosed as cellulitis — important because bilateral lower-leg redness is rarely cellulitis but often venous eczema flare.
Clinical features
- Bilateral medial gaiter (medial malleolus) area predominantly.
- Eczematous patches: erythema, scaling, weeping, lichenification.
- Haemosiderin hyperpigmentation; brownish discoloration; atrophie blanche.
- Concomitant features:
- Pitting oedema worse on standing.
- Varicose veins, telangiectasia, corona phlebectatica (dilated capillaries around the ankle / foot).
- Lipodermatosclerosis (acute red-tender; chronic woody fibrosis).
- Venous ulcer at gaiter / malleolar region.
- Acute exacerbations: increase erythema and tenderness; often mis-labelled as cellulitis.
- Pruritus + pain.
Differentials
- Cellulitis — unilateral; well-demarcated rapid expansion; fever; systemic features.
- Lipodermatosclerosis — chronic; "inverted champagne bottle"; tender.
- Acute lymphoedema.
- Contact dermatitis — secondary to topicals applied to legs.
- Discoid eczema — coin-shaped patches.
- Pretibial myxoedema — Graves disease.
- Stasis purpura / Schamberg.
- Carcinoma erysipeloides, cutaneous angiosarcoma — important if persistent / refractory.
Investigations
- Clinical diagnosis based on chronic bilateral pattern.
- Ankle-brachial pressure index (ABPI) before compression — ABPI 0.8-1.3 supports safe compression.
- Venous duplex Doppler ultrasound for venous reflux / obstruction; vascular surgery referral.
- FBC, CRP, U&E if unilateral / acute / unwell to differentiate cellulitis.
- Patch testing if secondary contact dermatitis suspected (frequent — to topical antibiotics, fragrances, preservatives).
- Bacterial swab if oozing / pustules suggest superinfection.
Management
- Compression therapy:
- UK Class 2-3 graduated compression stockings (≈18-35 mmHg) — first-line if ABPI 0.8-1.3.
- Multilayer bandaging for active dermatitis / ulceration.
- Pneumatic compression for refractory disease.
- Topical:
- Emollient — soft paraffin liberally.
- Mid-potency topical corticosteroid (mometasone furoate; clobetasone butyrate) 2-3 weeks.
- Avoid topical antibiotics (high sensitisation rate to neomycin / bacitracin).
- Leg elevation: above heart for 30 minutes 3-4 times daily.
- Weight management, exercise, calf-muscle pump activation.
- Vascular intervention:
- Endothermal ablation (RFA, EVLT) — first-line for confirmed truncal superficial reflux where intervention is suitable (NICE CG168).
- Foam sclerotherapy.
- Surgical ligation / stripping in selected cases.
- Concurrent venous ulcer management: hydrocolloid / foam / antimicrobial dressings; pentoxifylline as systemic adjunct.
- Counsel:
- Bilateral redness is rarely cellulitis — don't routinely give antibiotics.
- Address venous disease to prevent ulceration.
- Long-term compression often required.
References
- NICE CG168. Varicose veins: diagnosis and management. London: NICE; 2013 (reviewed 4 February 2016).
- NICE Clinical Knowledge Summary. Venous eczema and Leg ulcer - venous topics. London: NICE; accessed 18 May 2026.
- Eklöf B et al. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49:498-501.
- Bergan JJ et al. Chronic venous disease. N Engl J Med. 2006;355:488-498.
- British Lymphology Society. Standards of practice for management of lower limb compression. Sevenoaks: BLS; 2023.
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