Stasis Dermatitis Information, Prevention, and Treatment

Total Page：16

File Type：pdf, Size：1020Kb

BATTENKILL VALLEY HEALTH CENTER STASIS DERMATITIS INFORMATION, PREVENTION, AND TREATMENT WHAT ARE THE RISK FACTORS? o Age (commonly >50 years old) o Gender: women slightly more affected o Medical History: o Varicose Veins o High Blood Pressure o Previous Blood Clot (including deep vein thrombosis) o Many pregnancies o Heart condition o Kidney failure HTTP://HEARTOFDIXIEVEINCENTER.COM/VENOUS-INSUFFICIENCY/ o Lifestyle: o Prolonged standing/sitting WHAT IS STASIS DERMATITIS? o Little/no exercise DEFINITION: o Excess body fat Stasis dermatitis is an inflammatory skin condition commonly seen in the lower legs, caused by the excess WHAT ARE THE SYMPTOMS? pooling of blood in the veins. o Heaviness or aching with prolonged standing/walking This condition typically develops in people with poor o Swelling commonly at the end of circulation. The valves in the veins of the legs have one- the day way valves that play a crucial role in circulating blood o Itchy, dry skin through the extremities and back to the heart. With age o Darker colored skin (red or violet) and/or conditions such as congestive heart failure these o Scaling skin valves can weaken and not work as effectively. The poor movement of blood from the legs up to the rest of the WHAT IS THE TREATMENT? body results in blood pooling in the lower extremities. o Compression stockings/dressings Initially this excess blood manifests as leg swelling and o Elevate legs every 2 hours what are known as varicose veins. With time, the pooled o Skin care as needed for blood causes the overlying skin to become dry, itchy, and pain/redness/swelling such as irritated, making it susceptible to complications such as corticosteroids ulcers and skin infections. 1 BATTENKILL VALLEY HEALTH CENTER WHEN SHOULD I CONTACT MY HEALTHCARE PROVIDER? Contact us with any Contact you provider if you notice any of the following: o Increased pain questions or concerns! o Increased redness Battenkill Valley Health Center o Any drainage o Open-wound or ulcer Phone: (802) 375-6566 TIPS TO MANAGE YOUR STASIS Website/Patient Portal DERMATITIS https://www.battenkillvalleyhealthc o Exercise! enter.org/ o Elevate your legs every 2 hours for 15 minutes o Take breaks while walking/standing for prolonged Address: 9 Church Street, Arlington, time periods VT, 05250 o Wear loose-fitting cotton clothing o Wear compression socks/dressings to improve circulation to your legs o Moisturize if your skin feels dry REFERENCES o The American Academy of Family Physicians: http://www.aafp.org/afp/2010/0415/p989.html o The American Academy of Dermatology: https://www.aad.org/public/diseases/eczema/sta sis-dermatitis 2 .

Copy Link

Recommended publications

Complete Healing of Venous Leg Ulcer Using a Collagen Based Dressing a Case Report
Case Report Journal of Surgical Techniques and Procedures Published: 30 Jul, 2018 Complete Healing of Venous Leg Ulcer Using a Collagen Based Dressing a Case Report Dumont Isabelle1#, Caillava Celine2#, Dupoiron Stephanie2, Guillemin Yannis2## and Gouze Jean Noel2*## 1Department of Foot and Ankle Surgery, Center of the Foot Ransart, Belgium 2Department of Research and Development, Genbiotech, France #Dumont Isabelle and Caillava Celine Contributed Equally to this Work ##Guillemin Yannis and Gouze Jean Noel are Co-senor Authors Abstract Venous Leg Ulceration (VLU) is a common pathology which affects patients at any age. Ulcers are characterized by long-term healing, pain and frequent recurrence despite adherence to standard of care resulting in time consuming and costly treatments. Here, the authors describe the case of a diabetic, 63 years old male suffering from venous insufficiency and presenting a distal leg ulcer. The ulcer was treated using GBT013 device, a new biocompatible and biodegradable tri-dimensional collagen based matrix. GBT013 seems to be well integrated to the healing tissues and well tolerated. No complication or pain was reported during treatment. Complete healing was obtained within 36 days with no recurrence to date despite a context of stasis dermatitis. Keywords: Venous leg ulcer; Collagen dressing; Tri-dimensional matrix; Wound healing Abbreviations DFU: Diabetic Foot Ulcer; VLU: Venous Leg Ulcer Introduction Venous Leg Ulcers (VLUs) are open lesions of the lower extremities caused by venous disease. OPEN ACCESS Risk factors include all factors susceptible to increase pressure within vessels (e.g., obesity, immobility, thrombosis, varicose veins, and trauma) [1-3]. They are more common in women *Correspondence: and older people and represent 60% to 80% of leg ulcers [4-7].
[Show full text]
Clinical Manifestations and Management of Livedoid Vasculopathy
Clinical Manifestations and Management of Livedoid Vasculopathy Elyse Julian, BS,* Tania Espinal, MBS,* Jacqueline Thomas, DO, FAOCD,** Nason Rouhizad, MS,* David Thomas, MD, JD, EdD*** *Medical Student, 4th year, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL **Assistant Professor, Nova Southeastern University, Department of Dermatology, Ft. Lauderdale, FL ***Professor and Chairman of Surgery, Nova Southeastern University, Ft. Lauderdale, FL Abstract Livedoid vasculopathy (LV) is an extremely rare and distinct hyalinizing vascular disease affecting only one in 100,000 individuals per year.1,2 Formerly described by Feldaker in 1955 as livedo reticularis with summer ulcerations, LV is a unique non-inflammatory condition that manifests with thrombi formation and painful ulceration of the lower extremities.3 Clinically, the disease often displays a triad of livedo racemosa, slow-healing ulcerations, and atrophie blanche scarring.4 Although still not fully understood, the primary pathogenic mechanism is related to intraluminal thrombosis of the dermal microvessels causing occlusion and tissue hypoxia.4 We review a case in which the patient had LV undiagnosed and therefore inappropriately treated for more than 20 years. To reduce the current average five-year period from presentation to diagnosis, and to improve management options, we review the typical presentation, pathogenesis, histology, and treatment of LV.4 Upon physical exam, the patient was found to have the patient finally consented to biopsy. The ACase 62-year-old Report Caucasian male presented in an a wound on the right medial malleolus measuring pathology report identified ulceration with fibrin assisted living facility setting with chronic, right- 6.4 cm x 4.0 cm x 0.7 cm with moderate serous in vessel walls associated with stasis dermatitis lower-extremity ulcers present for more than 20 exudate, approximately 30% yellow necrosis characterized by thick-walled capillaries and years.
[Show full text]
Outcome of Venous Stasis Ulceration When Complicated by Arterial Occlusive Disease
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Eur J Vasc Endovasc Surg 24, 249±254 (2002) doi:10.1053/ejvs.2002.1650, available online at http://www.idealibrary.com on Outcome of Venous Stasis Ulceration when Complicated by Arterial Occlusive Disease W. T. Bohannon, R. B. McLaffertyÃ, S. T. Chaney, M. A. Mattos, L. A. Gruneiro, D. E. Ramsey and K. J. Hodgson Division Vascular Surgery, Department of Surgery, Southern Illinois University, School of Medicine, Springfield, Illinois, U.S.A. Objective: to report the outcome of patients with venous stasis ulceration (VSU) and severe arterial occlusive disease (AOD). Design: retrospective study. Methods: using the International Classification of Diseases (ICD-9), codes for VSU and AOD were cross-matched to identify patients from 1989 to 1999 at two tertiary hospitals. Entry into the study required the presence of a VSU and an ipsilateral procedure to improve AOD or major amputation during the same hospitalisation. Results: fourteen patients (15 extremities) with a mean age of 80 years (range: 47±93) were identified as having VSU and AOD. Mean duration of VSU up to the time of revascularisation or amputation was 6.4 years (range: 4 months±21 years). The mean number of VSUs per extremity was 2.1 and mean wound area was 71 cm2. Mean ankle±brachial index was 0.46 (range: 0.10±0.78). Nine extremities (60%) had a bypass procedure, 3 (20%) had an interventional procedure, 1 (0.6%) had a lumbar sympathectomy, and 2 (13%) had an amputation.
[Show full text]
Cutaneous Manifestations of Abdominal Arteriovenous Fistulas
Cutaneous Manifestations of Abdominal Arteriovenous Fistulas Jessica Scruggs, MD; Daniel D. Bennett, MD Abdominal arteriovenous (A-V) fistulas may be edema.1-3 We report a case of abdominal aortocaval spontaneous or secondary to trauma. The clini- fistula presenting with lower extremity edema, ery- cal manifestations of abdominal A-V fistulas are thema, and cyanosis that had been previously diag- variable, but cutaneous findings are common and nosed as venous stasis dermatitis. may be suggestive of the diagnosis. Cutaneous physical examination findings consistent with Case Report abdominal A-V fistula include lower extremity A 51-year-old woman presented to the emergency edema with cyanosis, pulsatile varicose veins, department with worsening lower extremity swelling, and scrotal edema. redness, and pain. Her medical history included a We present a patient admitted to the hospital diagnosis of congestive heart failure, chronic obstruc- with lower extremity swelling, discoloration, and tive pulmonary disease, hepatitis C virus, tobacco pain, as well as renal insufficiency. During a prior abuse, and polysubstance dependence. Swelling, red- hospitalization she was diagnosed with venous ness, and pain of her legs developed several years stasis dermatitis; however, CUTISher physical examina- prior, and during a prior hospitalization she had been tion findings were not consistent with that diagno- diagnosed with chronic venous stasis dermatitis as sis. Imaging studies identified and characterized well as neurodermatitis. an abdominal aortocaval fistula. We propose that On admission, the patient had cool lower extremi- dermatologists add abdominal A-V fistula to the ties associated with discoloration and many crusted differential diagnosis of patients presenting with ulcerations. Aside from obesity, her abdominal exam- lower extremity edema with cyanosis, and we ination was unremarkable and no bruits were noted.
[Show full text]
Doxium Has Been Proven to Be the Only Oral Agent Available for Delaying the Progression of Diabetic Retinopathy. It Has Also
Doxium has been proven to be the only oral agent available for delaying the progression of diabetic retinopathy. It has also shown benefits in chronic venous insufficiency and haemorrhoids. Product Indications Pack Size DOXIUM 500 Cases of microangiopathy including diabetic retinopathy, 30’s/box capsules. chronic venous insufficiency. As an adjuvant in the treatment of blister-pack Each cap. contains superficial thrombophlebitis, post-thrombotic syndrome, 500mg calcium oedema, stasis dermatitis, circulatory disturbances of dobesilate. arteriovenous origin or due to impaired microcirculation & haemorrhoidal syndrome. ACTIVE PRINCIPLE Calcium 2, 5 dihydroxybenzenesulfonate (Ca dobesilate, INN) PROPERTIES Doxium corrects capillary hyperpermeability and increases capillary resistance. It antagonises the effect of vasoactive substances (histamine, serotonin, bradykinin, prostaglandins and PAF), acts against collagen breakdown, reduces blood hyperviscosity, increases red cell flexibility, diminishes platelet hyperaggregation and improves lymphatic drainage. CONTRA-INDICATIONS No contra-indications known up to now. TOLERABILITY Doxium is particularly well tolerated, even when administered for long-term therapy. It is not toxic; it is practically not metabolized in the body and does not impair hepatic or renal function in any way. It has no effect on arterial blood pressure, blood coagulation or glucose and lipid metabolisms. Doxium has no teratogenic effects and does not cross the placental barrier. Like most drugs, it should not be administered during the first 3 months of pregnancy. Numerous published clinical trials, totaling over 5000 cases, show that the incidence of undesirable side effects is extremely low (3.4%). These usually involve slight digestive disorders. PRESENTATIONS DOXIUM 500, capsules containing 500mg calcium dobesilate. .
[Show full text]
Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD)
Evidence-based Practice Center Systematic Review Protocol Project Title: Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD) Project ID: DVTT0515 Initial publication date if applicable: March 7, 2016 Amendment Date(s) if applicable: May 6th, 2016 (Amendments Details–see Section VII) I. Background for the Systematic Review Lower extremity chronic venous disease (LECVD) is a heterogeneous term that encompasses a variety of conditions that are typically classified based on the CEAP classification, which defines LECVD based on Clinical, Etiologic, Anatomic, and Pathophysiologic parameters. This review will focus on treatment strategies for patients with LECVD, which will be defined as patients who have had signs or symptoms of LE venous disease for at least 3 months. Patients with LECVD can be asymptomatic or symptomatic, and they can exhibit a myriad of signs including varicose veins, telangiectasias, LE edema, skin changes, and/or ulceration. The etiology of chronic venous disease includes venous dilation, venous reflux, (venous) valvular incompetence, mechanical compression (e.g., May-Thurner syndrome), and post-thrombotic syndrome. Because severity of disease and treatment are influenced by anatomic segment, LECVD is also categorized by anatomy (iliofemoral vs. infrainguinal veins) and type of veins (superficial veins, perforating veins, and deep veins). Finally, the pathophysiology of LECVD is designated typically as due to the presence of venous reflux, thrombosis, and/or obstruction. LECVD is common
[Show full text]
Stasis Dermatitis
STASIS DERMATITIS http://www.aocd.org Stasis dermatitis is a disease of the veins in the extremities that may present after the valves inside the vessels become incompetent, or unable to fully complete their job of bringing blood back to the heart. This causes the pressure in the veins to increase due to gravity such that blood leaks out of small capillaries and into surrounding tissue, giving rise to this condition. The skin typically appears pigmented in a reddish, yellowish, or brown tone, especially on the lower legs around or above the ankles. At times, this skin condition could have a scaly and/or weeping appearance overlying the dermatitis. Varicose veins and loss of hair may also accompany stasis dermatitis. Those predisposed to this condition are those who are obese, pregnant, or those who are generally inactive. Anemia and zinc deficiency could exacerbate the condition. At times, ulcers may form over the affected skin. This usually occurs in progressive stasis dermatitis where leg swelling (edema) and fibrosis predominate. These ulcers tend to be painful and yellow in appearance. The healing process is typically lengthy due to their location on the lower extremity. Additionally, any time there are breaks in the skin, bacteria have the propensity to enter and infect which slows down healing as well. To treat this condition, efforts focus on increasing the return of blood back to the heart. The use of support stockings may be effective as well as elevation of the extremities. Standing still for long periods should be avoided, but walking is encouraged as this acts as a "pump” to return blood to the heart.
[Show full text]
Stasis Dermatitis
FOR EDUCATIONAL PURPOSES ONLY PRIMARY CARE DIAGNOSTIC INSTITUTE Stasis Dermatitis EPIDEMIOLOGY: Approximately 6-7% in patients older than 50 years ETIOLOGY: Chronic venous insufficiency with venous hypertension PATHOGENESIS: Swelling is caused when plasma (the fluid portion of blood) leaks out of the blood vessels and into the tissues CLINICAL: Reddish-brown skin discoloration HISTOLOGY: Hyperkeratosis, acanthosis, basal pigmentation, and perivascular lymphoid infiltration Stasis Dermatitis is a skin condition caused by fluid building up under the skin, due to poor circulation in the veins (venous insufficiency). The poor circulation will eventually lead to ulcers in the skin. Patients typically pres- ent with an insidious onset of pruritus affecting one or both lower extremities. Reddish-brown skin discoloration is an early sign of stasis dermatitis and may precede the onset of symptoms. Treatment options available are: Elevating the ankle while resting: Compression therapy (generally accomplished by means of specialized stockings that deliver a controlled gradient of pressure) which must be maintained on a lifelong basis. Compression that is more aggressive can be performed by using elastic wraps or compression boots. Topical therapy: Using wet-to-damp gauze dressings soaked with water or with a drying agent, such as aluminum acetate. Topical corticosteroids are frequently used for reducing inflammation and itching in acute flares. BIBLIOGRAPHY 1. “Stasis Dermatitis” (Online) November 2005. http://www.merck.com/mmpe/sec10/ch114/ch114i.html html (visited: March 15, 2008) 2. “Stasis Dermatitis” (Online). February 2007. http://www.emedicine.com/derm/TOPIC403.HTM (visited: March 15, 2008) www.DermpathDiagnostics.com.
[Show full text]
Varicose Veins and Superficial Thrombophlebitis
ENTITLEMENT ELIGIBILITY GUIDELINES VARICOSE VEINS AND SUPERFICIAL THROMBOPHLEBITIS 1. VARICOSE VEINS MPC 00727 ICD-9 454 DEFINITION Varicose Veins of the lower extremities are a dilatation, lengthening and tortuosity of a subcutaneous superficial vein or veins of the lower extremity such as the saphenous veins and perforating veins. A diagnosis of varicose veins is sometimes made in error when the veins are prominent but neither varicose or abnormal. This guideline excludes Deep Vein Thrombosis, and telangiectasis. DIAGNOSTIC STANDARD Diagnosis by a qualified medical practitioner is required. ANATOMY AND PHYSIOLOGY The venous system of the lower extremities consists of: 1. The deep system of veins. 2. The superficial veins’ system. 3. The communicating (or perforating) veins which connect the first two systems. There are primary and secondary causes of varicose veins. Primary causes are congenital and/or may develop from inherited conditions. Secondary causes generally result from factors other than congenital factors. VETERANS AFFAIRS CANADA FEBRUARY 2005 Entitlement Eligibility Guidelines - VARICOSE VEINS/SUPERFICIAL THROMBOPHLEBITIS Page 2 CLINICAL FEATURES Clinical onset usually takes place when varicosities in the affected leg or legs appear. Varicosities typically present as a bluish discolouration and may have a raised appearance. The affected limb may also demonstrate the following: • Aching • Discolouration • Inflammation • Swelling • Heaviness • Cramps Varicose Veins may be large and apparent or quite small and barely discernible. Aggravation for the purposes of Varicose Veins may be represented by the veins permanently becoming larger or more extensive, or a need for operative intervention, or the development of Superficial Thrombophlebitis. PENSION CONSIDERATIONS A. CAUSES AND/OR AGGRAVATION THE TIMELINES CITED BELOW ARE NOT BINDING.
[Show full text]
Review Skin Changes Are One of the Earliest Signs of Venous a R T I C L E Hypertension
pp 11 - 19 ABSTRACT Review Skin changes are one of the earliest signs of venous A R T I C L E hypertension. Some of these changes such as venous eczema are common and easily identified whereas DERMATOLOGICAL other changes such as acroangiodermatitis are less common and more difficult to diagnose. Other vein MANIFESTATIONS OF VENOUS related and vascular disorders can also present with specific skin signs. Correct identification of these DISEASE: PART I skin changes can aid in making the right diagnosis and an appropriate plan of management. Given KUROSH PARSI, MBBS, MSc(Med), FACD, FACP the significant overlap between phlebology and Departments of Dermatology, St. Vincent’s Hospital and dermatology, it is essential for phlebologists to be Sydney Children’s Hospital familiar with skin manifestations of venous disease. Sydney Skin & Vein Clinic, This paper is the first installment in a series of 3 Bondi Junction, NSW, Australia and discusses the dermatological manifestations of venous insufficiency as well as other forms of vascular ectasias that may present in a similar Introduction fashion to venous incompetence. atients with venous disease often exhibit dermatological Pchanges. Sometimes these skin changes are the only clue to an appropriate list of differential diagnoses. Venous ulceration. Less common manifestations include pigmented insufficiency is the most common venous disease which purpuric dermatoses, and acroangiodermatitis. Superficial presents with a range of skin changes. Most people are thrombophlebitis (STP) can also occur in association with familiar with venous eczema, lipodermatosclerosis and venous incompetence but will be discussed in the second venous ulcers as manifestations of long-term venous instalment of this paper (Figure 2).
[Show full text]
Practical Approach to Lower Extremity Edema
Practical Approach to Lower Extremity Edema BRETT C. STOLL, MD, FACC, FCCP FEB 22, 2014 Not Everything that Swells is Heart Failure BRETT C. STOLL, MD, FACC, FCCP FEB 22, 2014 Overview A common challenge for primary care physicians and cardiologists alike Goal is to determine the cause and find an effective treatment for leg edema Despite the prevalence, no formal existing practice guidelines at present Definition Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Edema, other than localized edema, does not become clinically apparent until the interstitial volume has increased by 2.5 to 3 liters. Etiology of Edema Increase in intravascular pressure Increase in capillary vessel wall permeability Decrease in the intravascular osmotic pressure Excess bodily fluids Lymphatic obstruction Local injury Infection Medication effect Anatomy and Pathophysiology Anatomy and Pathophysiology Starling's Law of Capillaries Anatomy and Pathophysiology Introduction The most likely cause of leg edema in patients over age 50 is venous insufficiency Venous insufficiency affects up to 30% of the population Heart failure affects only approximately 1% Introduction The most likely cause of leg edema in women under age 50 is idiopathic edema (formerly known as cyclic edema). Introduction Most patients can be assumed to have one of these diseases unless another cause is suspected after a history and physical examination. However, there are at least 2 exceptions to this rule: pulmonary hypertension early heart failure Both conditions can both cause leg edema before they become clinically obvious in other ways. Classification There are two types of leg edema: Venous edema consists of excess low-viscosity, protein-poor interstitial fluid resulting from increased capillary filtration that cannot be accommodated by a normal lymphatic system.
[Show full text]
Lower Extremity Ulcers: Venous, Arterial, Or Diabetic?
Lower Extremity Ulcers: Venous, Arterial, or Diabetic? Determining the answer to this question is crucial to avoid administering treatment that only makes a serious condition worse. After pointing out where to look for the keys in the history and physical, the authors review how the etiology of an ulcer should influence the therapeutic approach. By Ani Aydin, MD, Srikala Shenbagamurthi, MD, and Harold Brem, MD hen a patient presents to the duration, progression, prior treatments, and clinical emergency department with a course of the ulcer can suggest its etiology. Pos- lower extremity cutaneous ul- sible considerations to rule out include diabetes; cer, many etiologies must be hypertension; hyperlipidemia; coronary artery dis- Wconsidered. These include venous and arterial dis- ease; alcohol and tobacco use; thyroid, pulmonary, ease, diabetes mellitus, connective tissue disorders, renal, neurologic and rheumatic diseases; peripheral rheumatoid arthritis, vasculitis, and malignancies. vascular disease; deep vein thrombosis; and specifi- One goal of the initial assessment is to determine cally cutaneous factors including cellulitis, trauma, whether the ulcer is chronic (defined as taking a and recent surgery. The patient should be asked significant amount of time to heal, failing to heal, about lower extremity pain, paresthesia, anesthesia, or recurring), as such ulcers are associated with sig- and claudication. nificant morbidity.1,2 Physical examination, too, may suggest the etiol- Most prominent in the differential diagno- ogy of an ulcer. Wound characteristics that should sis should be venous reflux, arterial insufficiency, be noted include size, location, margins, presence of pressure ulcer, and ulcer granulation tissue, necrosis, weeping, odor, and pain. >>FAST TRACK<< secondary to diabetic neu- Pulses must be palpated in the distal extremities.
[Show full text]