Stasis Dermatitis: Differentiation from Other Common Causes of Lower Leg Inflammation and Management Strategies

Rzepecki, Alexandra K.; Blasiak, Rachel

doi:10.1007/s13670-018-0257-x

Cited by 8 publications

(112 citation statements)

References 23 publications

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“…Estimates for the prevalence of chronic venous insufficiency vary widely, highlighting a knowledge gap in the extant epidemiological data, with the observed numbers often depending on the clinical characteristics and lifestyles of the populations examined. Geographically, the highest reported prevalence of chronic venous insufficiency is across Western countries, ranging from < 1 to 40% in women and from < 1 to 17% in men [ 1 , 6 ]. A Saudi Arabian study estimated the overall prevalence of chronic venous insufficiency as about 45.6% [ 7 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…SD, as a cutaneous manifestation of chronic venous insufficiency caused by retrograde venous blood flow, is classified as C4 (changes in skin and subcutaneous tissue secondary to chronic venous disease) on the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification of venous disorders [ 1 , 16 ]. This is an internationally accepted standard for describing patients with chronic venous disorders based on the clinical manifestations, the current understanding of disease etiology, the involved anatomy, and the underlying venous pathology [ 16 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…This is an internationally accepted standard for describing patients with chronic venous disorders based on the clinical manifestations, the current understanding of disease etiology, the involved anatomy, and the underlying venous pathology [ 16 ]. The typical clinical presentation involves poorly demarcated erythematous and eczematous patches and plaques of the lower extremities, with the medial malleolus region being the most frequently and severely involved [ 1 , 2 ]. The eczematous nature of SD is represented by scaling, erythema, and xerosis of the skin.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…These skin changes may extend to the foot as well as to the knee. Characteristic symptoms include pruritus (itch) on the medial ankle (which can extend to the shin), pain, lesional inflammation, scaling, and skin color changes and thickening [ 1 , 3 ]. Itch is the most troublesome symptom, impacting patient quality of life (QOL) and leading to scratching that can aggravate wounds and increase risk of skin infection.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Statis dermatitis (SD), also known as venous eczema, stasis eczema, venous SD, or gravitational dermatitis, is a chronic inflammatory skin disease driven by underlying chronic venous insufficiency that typically affects the lower extremities of older individuals [ 1 , 2 ]. In SD, alterations in the function of the deep venous plexus at the lower extremities cause blood to backflow to the superficial venous system, leading to venous hypertension, cutaneous inflammation, and a range of potential complications, including venous ulcers [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

et al. 2023

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Stasis dermatitis is a chronic inflammatory skin disease of the lower extremities. It typically occurs in older individuals and is the cutaneous manifestation of venous hypertension caused by venous reflux. Such retrograde venous blood flow is the result of incompetent venous valves, valve destruction, or venous obstruction. Stasis dermatitis is eczematous. The associated impairment of venous valves may cause swelling of the legs, leading to serious conditions including venous ulcerations. Diagnosis can be challenging because of its clinical resemblance to other skin conditions and poor clinical recognition by physicians. The cornerstones of stasis dermatitis treatment are compression therapy to ameliorate pain and swelling, topical treatments to alleviate secondary skin changes, and interventional treatment options to correct the underlying causes of venous reflux. Given the central role of inflammation of the lower extremities in driving the cutaneous changes characteristic of stasis dermatitis, new therapeutic approaches that target the inflammation are under clinical evaluation in patients with stasis dermatitis.

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Section: Epidemiologymentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

et al. 2023

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Stasis dermatitis: A challenging patient journey

Lebwohl,

Kirsner,

Margolis

et al. 2023

JEADV Clinical Practice

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Stasis dermatitis (SD) is a chronic inflammatory dermatosis that typically presents with nonspecific signs and symptoms such as pruritic and xerotic skin, aching legs, and areas of dyspigmentation (red or brown in lighter skin tones and brown, purple, gray, or ashen in darker skin tones). These signs and symptoms are often misdiagnosed as other conditions, such as cellulitis. Moreover, within healthcare systems, SD is often overlooked due to a lack of understanding of the magnitude and impact of the condition, as well as incomplete recognition of the various presenting clinical manifestations. Inadequate or inappropriate management may lead to disease progression, including worsening edema, pain, and itch as well as complications such as venous leg ulcers. When patients do seek medical attention (often upon worsening of the condition), a diagnosis of SD is often challenging because of physician lack of expertise and the plethora of disorders that may manifest similarly to SD. Furthermore, upon diagnosis, evidence‐based treatment options are limited, and adherence to SD treatment regimens is often low. SD significantly impacts patient and caregiver quality of life (QoL), with far‐reaching psychosocial and socioeconomic effects. In this review, we describe the patient journey associated with SD and the challenges associated with diagnosis, the burden of disease and impact on patient QoL, and the unmet needs that remain with current therapeutic options.

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Narrative Review of the Pathogenesis of Stasis Dermatitis: An Inflammatory Skin Manifestation of Venous Hypertension

Silverberg

Jackson

Kirsner

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Stasis dermatitis (SD), also known as venous dermatitis, is a form of inflammatory dermatitis of the lower extremities that typically occurs in older individuals and represents a cutaneous manifestation of venous hypertension. Venous hypertension (also known as sustained ambulatory venous pressure) is most often due to retrograde blood flow, which occurs due to calf muscle pump failure. This failure is most commonly secondary to incompetent venous valves, valve destruction, or obstruction of the venous system. Many of the common symptoms associated with SD are caused by inflammatory processes. Methods This review summarizes the pathogenesis and key role of inflammation in SD by reviewing inflammatory biomarkers associated with SD. The literature was selected though a high-level PubMed search focusing on keywords relating to inflammation associated with SD. Results Venous reflux at the lower extremities causes venous hypertension, which leads to chronic venous insufficiency. High venous pressure due to venous hypertension promotes the local accumulation and extravasation of inflammatory cells across the vascular endothelium. Leukocyte trapping in the microcirculation and perivascular space is associated with trophic skin changes. Cell adhesion molecules are linked with the perpetuated influx of activated leukocytes into inflammatory sites. Here, inflammatory cells may influence the remodeling of the extracellular matrix by inducing the secretion of proteinases such as matrix metalloproteinases (MMPs). The increased expression of MMPs is associated with the formation of venous leg ulcers and lesions. Phosphodiesterase 4 activity has also been shown to be elevated in individuals with inflammatory dermatoses compared to healthy individuals. Discussion Because inflammation is a key driver of the signs and symptoms of SD, several of the highlighted biomarkers of inflammation represent potential opportunities to target and interrupt molecular pathways of cutaneous inflammation and, therefore, remediate the signs and symptoms of SD. Conclusion Understanding the pathogenesis of SD may help clinicians identify drivers of inflammation to use as potential targets for the development of new treatment options.

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Stasis Dermatitis: Differentiation from Other Common Causes of Lower Leg Inflammation and Management Strategies

Cited by 8 publications

References 23 publications

Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

Stasis dermatitis: A challenging patient journey

Narrative Review of the Pathogenesis of Stasis Dermatitis: An Inflammatory Skin Manifestation of Venous Hypertension

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