Causes of Stasis Dermatitis
The root cause of stasis dermatitis is poor venous return in the lower legs, which leads to blood accumulating in the dermis layer. The reasons for poor venous return can largely be divided into the following:
Congenital Factors
Some people are born with poorly functioning venous valves or smaller, flatter veins, which impairs normal blood circulation and return, causing blood to more easily pool in the dermis of the lower legs. This is an inherited, constitutional factor.
Acquired Factors
1. Occupations that require prolonged standing or sitting, obstructing venous return 2. Leg injuries, burns or surgical lymph node removal preventing proper lymph drainage 3. Obesity or pregnancy increasing load on the legs and venous pressure 4. Diabetes or cardiovascular disease causing microvascular damage 5. Hormonal medications like birth control affecting venous function All of these factors can impair smooth venous return, leading to localized microcirculatory problems.
Pathological Development
When venous return is poor, blood pools in the dermis, hemoglobin leaks out, and fibrin deposits form. These deposits stimulate an inflammatory response, causing fibrosis in the dermis that hardens the skin and deprives it of oxygen. The lack of oxygen causes pigment deposition, giving the skin a dusky red or brown appearance. Severe cases can lead to non-healing ulcers. Edema also worsens locally, and subcutaneous tissues fibrose and swell, producing a “bottle-leg” appearance.
Common Sites and Symptoms
Stasis dermatitis most often affects the lower legs, starting with edema, itching, and dusky red patches. Severe cases develop oozing ulcers, induration, and hyperpigmentation. It can also involve the dorsal foot and ankle skin. Symptoms tend to be recurrent and difficult to fully resolve.
High Risk Groups
Those at higher risk include people with occupations requiring prolonged standing, obesity, long-term hormonal medication use, diabetes or heart disease, and prolonged bedrest.
Treatment Principles
1. Control inflammation: Topical or oral steroids 2. Improve circulation: Compression stockings, leg elevation 3. Prevent ulcer deterioration: Oral antibiotics, artificial skin grafts 4. Curative treatment: Laser or surgery to remove varicose veins In addition to active treatment, patients need to control weight, avoid prolonged standing, use compression stockings, and regularly elevate their legs to improve venous return. Stasis dermatitis requires long-term management, otherwise it is prone to recurrence.
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