Venous stasis dermatitis, or varicose eczema, involves swollen and itchy discolored skin on the lower legs. It usually occurs when venous insufficiency leads to varicose veins. It can lead to ulcerations or open sores.

Other names for the condition are gravitational dermatitis and venous eczema. It is a chronic condition that slowly develops and worsens over time.

Varicose veins occur when veins of the legs become twisted, swollen, and more visible. They develop due to a weakening of the valves and walls of the veins. This weakening causes blood to collect in the vessels, which can result in varicose veins and swelling that develops into stasis dermatitis.

This article gives an overview of the possible causes of venous stasis dermatitis and the treatment options.

Collage of a female rubbing ointment on her leg and a close-up of varicose veins.Share on Pinterest
Photography courtesy of Prof. Dr. med. Gerd Hoffmann/Wikimedia, James Heilman, MD/Wikimedia, & Guido Mieth/Getty Images

Estimates suggest that 6–7 million people in the United States have poor circulation in the legs, known as venous insufficiency. Every year, about 150,000 people receive a new diagnosis of the condition.

According to the National Eczema Association, varicose eczema is more common in females than in males and tends to affect people over the age of 50 years. It appears to be less common in non-Western countries.

A 2020 study looked at the incidence of chronic venous insufficiency, which can lead to varicose eczema. In this study, which involved 66,621 people, mild chronic venous insufficiency affected up to 55% of white people and 28% of Hispanic people. More severe symptoms occurred in up to 61% of white people and 21% of African American people.

In a 2016 study involving more than 20,000 people with advanced chronic venous insufficiency, 85% of the participants were white, and 15% were African American. The African American participants presented with more severe symptoms. As a result, they had to undergo more treatment than the white participants and incurred more hospital charges.

The veins in the legs have valves that help push blood back toward the heart. With age, these valves can weaken. Weakened valves can cause fluid and blood to leak out and pool into the lower leg, leading to a condition known as venous insufficiency.

Over time, if a person does not receive treatment, venous insufficiency can develop into venous stasis dermatitis. In this condition, the skin becomes irritated and starts to break down due to the fluid that collects under the skin.

Risk factors include:

  • being female
  • being pregnant
  • obesity
  • older age
  • history of deep vein thrombosis (DVT)
  • lack of movement
  • congestive heart failure
  • history of surgery to a vein in the leg or a deep injury to the leg
  • kidney disease
  • chronic unmanaged high blood pressure, which can weaken the valves and result in stasis dermatitis

Venous stasis dermatitis can affect one or both ankles or lower legs. The skin may become extremely sensitive and painful to the touch.

The symptoms, which may be more noticeable throughout the course of the day, include:

  • ankle swelling
  • orange-brown speckles of discoloration
  • discolored areas of skin, which may appear red on light skin and brown, purple, gray, or ashen on dark skin
  • heavy legs when standing for a prolonged period
  • itchy and dry skin
  • painful skin

Without treatment, venous stasis dermatitis can progress and worsen, causing:

  • calf swelling
  • hardened skin
  • skin that weeps or leaks fluid
  • painful open wounds or ulcers

Early recognition of the symptoms of venous stasis dermatitis may help a doctor diagnose a possibly life threatening condition, such as heart or kidney failure.

The doctor will ask a person about their symptoms and medical history. People with a history of high blood pressure, heart disease, blood clots, or previous leg injuries should make the doctor aware of this information.

The doctor will also perform a physical examination and check the skin on the lower legs, looking for signs of venous stasis dermatitis. In many cases, they will easily tell that a person has stasis dermatitis due to the symptoms, particularly the appearance of the affected skin and its location.

Another indication is the presence of certain chronic conditions, such as congestive heart failure or kidney failure, which can predispose a person to varicose eczema.

In some cases, stasis dermatitis may look similar to a skin allergy, so a doctor may do a patch test to rule this out.

Once the doctor has confirmed the diagnosis, they will likely refer the person to a specialist or another doctor, who will carry out several tests to determine the cause.

These tests may include:

The treatment will focus on relieving the symptoms. The options may include:

  • Compression stockings or dressings: These can help reduce swelling and boost circulation.
  • Raising the legs: The American Academy of Dermatology Association (AAD) recommends that people elevate their legs above the heart level for 15 minutes every 2 hours during waking hours. In some cases, it may also be necessary to raise the legs during sleep.
  • Medications: These may include corticosteroids, which a doctor may prescribe to reduce inflammation in the legs. Another option is an antihistamine, which can reduce itching.
  • Ulcers or weeping: In people with these symptoms, the skin may need special dressings that require replacing regularly.
  • Antibiotics: These will be necessary in the case of cellulitis, ulcers, and other types of infection. A large ulcer may need a skin graft.
  • Moisturizers and emollients: These can help reduce dry skin. The AAD recommends using petroleum jelly or a thick cream that the manufacturers have clearly marked as “fragrance-free.”
  • Surgery: A surgical procedure can remove varicose veins that lead to pain, discomfort, and sores.
  • Cleansers and moisturizers: People should use gentle, fragrance-free products to clean and hydrate the affected area while avoiding topical antibiotics, which can cause contact dermatitis and worsen the symptoms.

People with venous stasis dermatitis will usually have it for the rest of their life.

The following lifestyle adjustments may help prevent this condition:

  • exercising regularly
  • eating a nutritious, low sodium diet
  • maintaining a moderate body mass index (BMI)
  • wearing loose-fitting cotton clothing
  • taking breaks from long periods of sitting or standing
  • avoiding injuries to the legs
  • avoiding products that may irritate the skin
  • moisturizing the skin

Typically, itchy legs do not indicate a serious problem. They may be a sign of an allergic reaction or chemical irritation. Other possible causes include dry skin, rashes, insect bites, folliculitis, irritation from shaving, or stress.

However, if a person has other symptoms or there is no improvement over time, they should talk with a doctor to rule out underlying medical conditions.

Venous stasis dermatitis is a chronic condition that affects the skin. The cause is poor circulation in the lower legs which leads to varicose veins. The veins eventually leak fluid and blood into the legs.

The initial symptoms are usually mild and include itchiness and irritation. Without treatment, the skin may become painful, swollen, and discolored. In more severe cases, the skin may become scaly and develop sores that weep and crust.

There is no cure for venous stasis dermatitis, but lifestyle changes may help improve the symptoms and prevent further complications.

If a person thinks that they may have venous stasis dermatitis, they should consult a doctor as soon as possible for a diagnosis and treatment.

Below, we answer some common questions about varicose eczema.

How can I treat varicose eczema at home?

Prevention is the best cure. Things that can help improve and prevent symptoms include wearing compression stockings, keeping the legs elevated, and getting regular exercise.

In addition, some natural remedies that some people use to treat venous insufficiency are:

  • gotu kola
  • grape seed extract
  • lavender
  • butcher’s broom
  • horse chestnut

A person should discuss these natural remedies with a doctor before using them.

People with symptoms of stasis dermatitis should consult a doctor for a diagnosis and seek their advice on the best alternative treatment options.

What exercises can help varicose eczema?

Walking is the best exercise for venous stasis dermatitis, as it helps increase blood flow to the lower legs. Other forms of low impact exercise, such as biking, swimming, and calf stretches, are also good.

Is varicose eczema dangerous?

Although this condition can be uncomfortable, it is not usually dangerous. It may, however, indicate an underlying medical condition. A person should discuss any concerns with a doctor.

Is venous stasis dermatitis curable?

There is no cure for venous stasis dermatitis. However, treatment can relieve the symptoms.

What is the difference between venous stasis dermatitis and cellulitis?

Cellulitis is a bacterial skin infection that can cause similar symptoms to venous stasis dermatitis.

Cellulitis can lead to serious complications and usually requires treatment with IV antibiotics.

What causes venous stasis dermatitis to flare up?

Prolonged sitting or standing, lack of exercise, a poor diet, stress, or tight-fitting clothing may cause venous stasis dermatitis to flare up.