Stasis Dermatitis: Pathophysiology, Clinical Features, and Management

Stasis dermatitis (venous eczema) results from chronic venous insufficiency (CVI) in the lower legs.

Pathophysiology

• Venous hypertension → capillary leakage → fibrin cuffs → impaired O₂/nutrient diffusion → inflammation.
• Iron deposition from RBC extravasation → hemosiderin staining (brown discoloration).

Clinical Progression

1. Edema, aching, varicose veins
2. Erythema, scaling, pruritus, hyperpigmentation (brown)
3. Lipodermatosclerosis (indurated, “inverted champagne bottle” leg)
4. Venous ulcer (medial malleolus)

Management

• Compression therapy – 20–30 mmHg (mild), 30–40 mmHg (moderate-severe); lifelong.
• Elevation – Above heart level 30 min × 3–4×/day.
• Skin care – Emollients, topical corticosteroids for flare, avoid irritants.
• Treat underlying CVI – Ablation, sclerotherapy, vein stripping.
• Wound care – For ulcers: moisture-retentive dressings, debridement, compression.

Early intervention prevents progression to ulceration. Vascular surgery referral for symptomatic CVI.