What Is Venous Stasis (Stasis Dermatitis)?

Venous stasis is a chronic inflammatory skin disease that is caused by the pooling of blood in your legs. This condition affects people who have chronic venous insufficiency, a condition where their veins in their limbs have a hard time sending blood back to the heart. Venous stasis is also commonly referred to as stasis dermatitis, gravitational dermatitis, and venous eczema.

Symptoms of venous stasis include swelling of the legs, skin discoloration, varicose veins, itching, dryness, and scaling. Treatment for venous stasis usually involves compression stockings and/or bandaging to reduce pain and manage swelling. In some cases, minor surgery might be required.

Approximately 15 to 20 million people over the age of 50 have venous stasis in the United States. 

Venous Stasis Symptoms

Venous stasis is due to the accumulation of blood in your legs due to poor blood circulation. This accumulation of blood causes increased pressure inside your leg veins, which push against your skin and cause the characteristic symptoms of venous stasis.

Venous stasis symptoms usually start gradually and worsen over time. Some of the early symptoms include:

• Itchy, dry, and discolored skin, especially around varicose veins (bulging veins)
• Skin irritation
• Skin soreness and pain
• Swelling on the inside of the ankle at the end of the day
• Swelling in your legs that goes away when you sleep but comes back during the day

If not treated early, symptoms of venous stasis can progress to:

• Deeply discolored skin (hyperpigmentation)
• Scaly skin that covers large part of the lower legs and top of feet
• Open wounds or ulcers
• Hardened skin
• Severe pain
• Shrinking of the calves
  

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What Causes Venous Stasis?

Venous stasis occurs when blood pools in your legs as a result of poor circulation, caused by weak or damaged veins in your lower extremities. This is often caused by a condition known as chronic venous insufficiency, which is characterized by poorly functioning veins in the legs.

When blood circulates through your legs, valves in your veins are responsible for keeping the blood moving toward your heart. For people with chronic venous insufficiency, these valves are weak and damaged, allowing the blood to flow backward and pool in the legs, which then causes all the symptoms of venous stasis. 

Risk factors that can contribute to developing chronic venous insufficiency include:

• Age 50 years and older
• A family history of chronic venous insufficiency
• A history of deep vein thrombosis, which is when a blood clot forms in a deep vein in your body
• Repeatedly sitting or standing for long periods of time
• Pregnancy 

However, it is important to note that chronic venous insufficiency is not the only cause of venous stasis. Venous stasis is also caused by conditions or injuries that affect the blood flow in your feet. Some factors that can put you at risk of developing venous stasis include:

• A lower leg injury that requires surgery
• Long-term high blood pressure
• Congestive heart failure
• Varicose veins or a family history of vein issues
• A previous blood clot in your leg
• Cellulitis
• Chronic kidney disease
  

Diagnosis

To diagnose venous stasis, your healthcare provider will start with a clinical examination of your skin and an evaluation of your medical history. 

During this medical history evaluation, they will ask you questions related to your heart and cardiovascular system. This would include asking if you’ve had problems with your heart, a blot clot, or a stroke and asking you questions about any medications you take to control your blood pressure. They will likely ask you if you’ve had any recent lower leg injuries or surgeries. 

In some cases, the clinical examination and medical history are enough to determine your diagnosis. In other cases, they might recommend some testing to gather more information.

This may include various imaging tests to help see the veins in your legs, such as an ultrasound, computerized tomography (CT) scan, or magnetic resonance imaging (MRI). These imaging tests can show if you have damage in your blood vessels and can help rule out if your symptoms are being caused by a blot clot rather than venous insufficiency.

Allergy tests can be used to determine if your symptoms are being caused by an allergic reaction.

Treatments for Venous Stasis

Unfortunately, venous stasis cannot be cured. However, symptoms can be managed and even improved over time. The goal of venous stasis treatment is to manage swelling and pain while also trying to improve blood flow. The type of treatment will depend on the type of symptoms you have and their severity.

Swelling

One of the first things your healthcare provider will do is provide you with treatment to address swelling in your legs. Compression therapy is the standard treatment for leg swelling caused by venous stasis. 

Compression therapy involves the use of bandages or stockings. Wearing these stockings on a day-to-day basis helps relieve pressure in your legs caused by the accumulation of blood. In some cases, your healthcare provider may also prescribe an anti-inflammatory medication called a corticosteroid, which you can apply as a cream on your legs before putting on the stockings.

Additionally, light physical activity such as walking can help reduce swelling by encouraging blood flow. You may also be instructed to elevate your legs over your heart for 15 minutes every two hours so blood can drain from your legs toward your heart.

Blood Flow

Blood flow in the legs can be treated by some of the treatments that address swelling. Wearing compression stockings or bandages, walking, and elevating your legs can all help improve blood flow in the legs.

Blood flow can also be improved by an Unna boot. An Unna boot is a compressive bandage that is applied as a wet gauze on your leg and hardens over time. When hardened, the Unna boot restricts your calf muscles in place, thus improving blood flow. Additionally, the gauze of an Unna boot is infused with medications like calamine and zinc oxide, which can help heal wounds caused by venous stasis.  

Medications

Your healthcare provider might prescribe various medications to help manage leg pain, itchiness, and dryness. Some medications include:

• Blood thinners (anticoagulants): These are medications that help improve blood flow and reduce your risk of blood clotting.
• Antihistamines: These medications can help reduce itchiness by blocking your body from creating histamine, the chemical that causes allergy symptoms.
• Moisturizers: These can help reduce itchiness and dryness as well as promote wound healing.
• Topical corticosteroids: Corticosteroid creams can reduce pain, inflammation, and itchiness.
• Tylenol (acetaminophen): Tylenol is an analgesic (painkiller) that can help temporarily reduce pain and swelling.

Intense Pulsed Light 

Intense pulsed light is a treatment that involves the use of laser light to treat deeply discolored skin caused by venous stasis. During this therapy, your healthcare provider will expose your skin to laser light of varying wavelengths and durations. 

Usually, this treatment takes three to six sessions to see its full effects. In some cases, people with venous stasis have seen their discoloration fully disappear after intense pulsed light therapy.

Surgery and Procedures

There are a few minor surgeries and procedures that can be used to treat venous stasis. Some of these are used to treat chronic venous insufficiency, therefore improving symptoms of venous stasis. These include:

• Phlebectomy: This involves the removal of damaged veins through small cuts in the skin.
• Sclerotherapy: This involves an injection of a chemical solution that causes your vein to swell closed, causing your body to absorb the vein.
• Lysis therapy (thrombolytic therapy): This procedure is used to remove clots from veins in the legs. A catheter is inserted into the vein of your leg and medications are injected to help break up the clot.
• Stents: A tiny balloon is inserted into your vein and inflated to help widen the vein. Then a stent is inserted to help the vein remain open.
• Endovenous thermal ablation: This uses laser or radio waves to create heat, closing enlarged veins without causing much bleeding or bruising.
• Subfascial endoscopic perforator surgery (SEPS): This is a simple procedure that targets varicose veins above your ankle. It uses a clip to block damaged veins, helping ulcers (open wounds) heal and preventing them from returning.
  

Prevention

Preventing venous stasis includes trying to manage chronic venous insufficiency, the condition that causes venous stasis. Some preventative measures include:

• Avoiding standing or sitting for very long periods of time
• Quitting smoking to avoid putting undue stress in your blood vessels
• Exercising and staying active as much as possible
• Weight management to avoid extra stress on lower extremities
• Moisturizing legs and feet regularly
• Managing blood pressure, blood sugar levels and cholesterol 
  

Complications

Many conditions are related to venous stasis. As discussed previously, venous stasis is associated with heart and blood-related conditions like blood clots, high blood pressure, and heart failure.

Additionally, having venous stasis can oftentimes lead to other health complications. Some people who have venous stasis can develop contact allergies. Contact allergy (contact dermatitis) is an allergic reaction that is caused by an irritating substance having extended contact with your skin. Approximately half of people with venous stasis have contact dermatitis as well.

"Superinfections" are also a common complication of venous stasis. Open wounds and ulcers caused by venous stasis make it easier for you to contract harmful bacteria or fungi. Additionally, stretching or itchy legs while having venous stasis can cause minor breaks in the skin, making it easier for bacteria to enter your skin and cause an infection.

Living With Venous Stasis

If left untreated, venous stasis is a condition that can get progressively worse over time. However, with early diagnosis and treatment, symptoms can be reduced and, in some cases, improved. 

Staying physically active and exercising can help manage symptoms and improve your quality of life. Your healthcare provider can refer you to physical therapy to help you develop a regimented exercise plan.

It can be helpful to eat a heart-healthy diet that is low in sodium. Many fruits and vegetables contain necessary nutrients and have anti-inflammatory properties that can help with blood flow.