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Varicose eczema Content Supplied by NHS Choices
Introduction

Varicose eczema, also known as venous, gravitational or stasis eczema, is a long-term skin condition that affects the lower legs. It's common in people with varicose veins.

Varicose eczema tends to be a long-term problem. However, treatments are available to help keep it under control.

This topic covers:

Symptoms

When to seek medical advice

Causes

Treatment

Other types of eczema

Symptoms of varicose eczema

Like all types of eczema, the affected skin becomes:

  • itchy
  • red and swollen
  • dry and flaky
  • scaly or crusty

There may be periods when these symptoms improve and periods when they become more severe.

Your legs may become swollen, especially towards the end of the day or after long periods of standing. Varicose veins (swollen and enlarged veins) are often visible on the legs.

Some people also have other symptoms, such as:

  • brown discolouration of the skin
  • red, tender and tight skin that can eventually become hardened (lipodermatosclerosis)
  • small, white scars (atrophie blanche)
  • pain
  • eczema affecting other parts of the body

Left untreated, leg ulcers can develop. These are long-lasting wounds that form where the skin has become damaged.

When to seek medical advice

See your GP if you have symptoms of varicose eczema. They'll often be able to make a diagnosis simply by looking at the skin.

Your GP will also ask you questions to determine whether you have a problem with the flow of blood in your leg veins, as this is the main cause of varicose eczema.

To help make a diagnosis, your GP may want to know if you have a history of:

  • varicose veins - swollen and enlarged veins
  • deep vein thrombosis (DVT) - a blood clot in one of the deep veins of your legs
  • leg ulcers - areas of damaged skin that take several weeks to heal
  • cellulitis - an infection of the deeper layers of the skin and underlying tissue
  • surgery or injury to your legs

Your GP may also check the pulse in your feet and may carry out an ankle brachial pressure index (ABPI) test to see if compression stockings are suitable for you. See the section on treating varicose eczema for more information about these.

The ABPI test involves comparing blood pressure readings taken from your ankles and upper arms. A significant difference in the readings suggests a problem with the flow of blood in your arteries - in which case, compression stockings may not be safe to use.

Referral to a specialist

You may be referred to a specialist in a local hospital for further tests. This might be a vascular specialist (a doctor or surgeon specialising in conditions affecting the blood vessels) or a dermatologist (a specialist in skin conditions) if:

  • you have varicose veins and changes to your skin, such as varicose eczema, lipodermatosclerosis (hard, tightened skin) or a history of leg ulcers
  • you have very poor blood flow in the blood vessels in your legs
  • your symptoms don't get better, despite treatment
  • it's possible you have contact dermatitis

Causes of varicose eczema

Varicose eczema is usually caused by increased pressure in the leg veins.

When the small valves in the veins stop working properly, it's difficult for blood to be pushed upwards against gravity and it can leak backwards.

This increases the pressure in the veins, which can cause fluid to leak into the surrounding tissue. It's thought that varicose eczema may develop as a result of the immune system reacting to this fluid.

Varicose eczema is more common in people with varicose veins, as these are also often a sign that the leg veins aren't working properly.

Some people develop the condition for no obvious reason, although there are certain factors that increase the chances of this happening, including:

  • gender - varicose eczema is more common in women
  • obesity - this can increase the pressure in your leg veins
  • pregnancy - this can also increase the pressure in your leg veins
  • not being able to move for a long period of time - this can affect the circulation in your leg veins
  • having previously had deep vein thrombosis (DVT) - blood clots that develop in leg veins, which can damage the valves in your veins
  • increasing age - people generally find it harder to move about as they get older, which can affect their circulation

Treating varicose eczema

For most people, treatment involves a combination of:

  • self-help measures - including ways to improve your circulation, such as keeping active and frequently raising your legs
  • emollients - moisturisers applied to the skin to stop it becoming dry
  • topical corticosteroids - ointments and creams applied to the skin to help treat the eczema and relieve symptoms
  • compression stockings - specially designed stockings, usually worn every day, that squeeze your legs tightly at the foot and ankle and become looser further up your leg, helping to improve your circulation

If these treatments don't help, your GP may refer you to a dermatologist (skin specialist) in case there's another cause for your symptoms or if they're concerned you may also have contact dermatitis.

If you have varicose veins, you may be referred to a vascular specialist (a doctor or surgeon specialising in conditions affecting the blood vessels) who can talk to you about the treatment options for varicose veins.

Read about treating varicose eczema.

Other types of eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:

  • atopic eczema (also called atopic dermatitis) - the most common type of eczema
  • contact dermatitis - a type of eczema that occurs when the body comes into contact with a particular substance
  • discoid eczema - a type of eczema that occurs in circular or oval patches on the skin
Treatment

Treatment for varicose eczema aims to improve the condition of your skin, treat your symptoms and help improve your circulation (blood flow).

For many people, this involves long-term treatment with a combination of:

Lipodermatosclerosis (hardened, tight skin) is treated in a similar way to varicose eczema. If you have a venous leg ulcer, you can also read about treating venous leg ulcers.

If you also have varicose veins, your GP may also refer you to a vascular surgeon, who can plan any necessary treatment. Read about treating varicose veins.

Self-help tips

The following steps may help reduce the symptoms of varicose eczema and help prevent further problems:

  • try to avoid injuring your skin - injuries to your skin could lead to an ulcer developing
  • raise your legs when you are resting - for example, by propping up your feet on some pillows (ideally so that they're above the level of your heart), as this can help reduce swelling
  • keep physically active - this will improve your circulation and help you maintain a healthy weight

Fluid can build up in the lower legs if you sit or stand for too long, so it's important to keep moving. Walking will get your muscles working and help to push the blood through the veins to your heart.

The National Eczema Society also recommends regularly flexing your feet and rising up onto your toes or bending down at the knees.

Emollients

Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. They're often used to help manage dry or scaly skin conditions such as eczema.

Choice of emollient

A number of different emollients are available. Some can be bought over the counter without a prescription, but if you have varicose eczema it may be helpful to ask your GP to recommend a suitable product.

You may need to try several different emollients to find one that works for you. You may also be prescribed a mixture of emollients, for example:

  • an ointment for very dry skin
  • a cream or lotion for less dry skin
  • an emollient to use instead of soap
  • an emollient to add to bath water or use in the shower

The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil, so they can be quite greasy, but are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil, so aren't greasy, but can be less effective. Creams are somewhere in between.

How to use emollients

If you have varicose eczema, you should use an emollient at least twice a day, even if you don't have any symptoms.

To apply the emollient:

  • use a large amount - you should aim to cover all of the skin on your lower leg, not just the obviously affected areas
  • don't rub it in - instead, smooth it into the skin in the same direction that the hair grows
  • apply every two to three hours for very dry skin
  • after a bath or shower, gently dry the skin, then immediately apply the emollient while the skin is still moist
  • don't share emollients with other people

It's very important to keep using emollients during a flare-up of varicose eczema, because this is when the skin needs the most moisture. Apply emollients frequently and in generous amounts during a flare-up.

Side effects

It's unusual for emollients to cause side effects, but they can occasionally cause a rash, and greasy emollients may sometimes cause folliculitis (inflammation of the hair follicles).

If you experience any side effects from your emollient, speak to your GP, who can prescribe an alternative product.

Emollients added to bath water can make your bath very slippery, so take care getting in and out of the bath.

Topical corticosteroids

If your skin is inflamed from a flare-up of varicose eczema, your GP may prescribe a topical corticosteroid (applied directly to your skin) to quickly reduce the inflammation.

Different strength topical corticosteroids can be prescribed, depending on the severity of your varicose eczema. If you have flare-ups of lipodermatosclerosis, you may need a very strong topical corticosteroid.

How to use topical corticosteroids

When using corticosteroids, only apply the treatment to the affected areas. Your doctor can advise you on how much to apply and how often. You can also check the advice in the patient information leaflet that comes with your medication.

Most people only have to apply a topical corticosteroid once a day. When applying the medication, you should:

  • apply your emollient first and wait around 30 minutes before applying the topical corticosteroid (until the emollient has soaked into your skin)
  • apply it only to the affected area
  • use the topical corticosteroid for 7 to 14 days and continue to apply the treatment for 48 hours after the flare-up has cleared

If your varicose eczema is moderate to severe, you may need to apply topical corticosteroids both between flare-ups and during them.

If you need to use topical corticosteroids on a long-term basis, you should apply them less frequently. Your GP will advise you on how often you should be applying them.

You should also speak to your GP if you've been using a topical corticosteroid and your symptoms haven't improved.

Side effects

Topical corticosteroids may cause a mild and short-lived burning or stinging sensation as you apply them, particularly if using a cream.

Generally, using a strong topical corticosteroid for prolonged periods will increase your risk of getting more serious side effects, such as thinning of the skin. Your doctor will advise you as to the strength of the medication you require and when you should use it.

Compression stockings

Medical compression stockings are specially designed to steadily squeeze your legs to help improve your circulation. They're tightest at the ankle and get gradually looser as they go further up your leg. This encourages blood to flow upwards towards your heart.

Medical compression stockings are used to treat varicose eczema and lipodermatosclerosis by improving the flow of blood through your leg veins and reducing the pressure in the veins.

Choice of compression stockings

Compression stockings are available in a variety of different sizes and pressures. They're also available in:

  • different colours
  • different lengths - some come up to the knee and others also cover the thigh (you should only need knee-high stockings for varicose eczema)
  • different foot styles - some cover the whole foot and some stop before the toes

Support stockings or tights that lightly compress the legs can be bought from pharmacies. Compression stockings that compress the legs more are available on prescription and require you to be measured by a nurse first.

In some cases, if you find it difficult to put on your stockings, you may be advised to use an tubular bandage instead.

Wearing compression stockings

You'll usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed.

Wearing compression stockings can be uncomfortable, particularly during hot weather, but it's important to wear them correctly to get the most benefit.

Pull them all the way up so the correct level of compression is applied to each part of your leg. Don't let the stocking roll down, or it may dig into your skin in a tight band around your leg.

Speak to your GP if the stockings are uncomfortable, they don't seem to fit, or you have difficulty putting them on. It may be possible to get custom-made stockings that will fit you exactly.

Take care when putting compression stockings on and taking them off, as this can damage fragile skin. If you have a leg ulcer, it ideally needs to heal before you start wearing compression stockings.

Caring for compression stockings

Compression stockings usually have to be replaced every three to six months. Speak to your GP if your stockings become damaged, as they may no longer be effective.

You should be prescribed two stockings (or two sets of stockings if you are wearing one on each leg) so that one stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat.

Complementary therapies

Some people try complementary therapies such as food supplements or herbal remedies to treat varicose eczema, but there is often a lack of evidence that shows they are effective in treating the condition.

If you're thinking about using a complementary therapy, speak to your GP first to ensure the therapy is safe for you to use. You should continue with any other treatments prescribed by your GP.

 
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