Describe the pathogenesis of stasis dermatitis.
Venous insufficiency→venous HTN and extravasation of fluid and RBCs out of vessels into interstitium→edema, hemosiderin deposition, and inflammation in the skin
What is contact sensitization with relation to stasis dermatitis?
- irritants or allergens applied to the stasis derm that can worsen the rash (from topical products or medications like triple antibiotic ointments that the patient may be allergic to)
Describe clinical picture of stasis dermatitis
Clinical presentation of acute stasis derm:
- bright red, warm, tender patches or plaques that may have vesicles or serous weeping fluid
What is a common cause of stasis dermatitis flare?
- standing for long periods of time
Clinical presentation of subacute stasis derm:
Subacute eczema w/ erythematous slight scaly patches and plaques on the lower legs, especially the medial side of the lower leg
- Associated pitting edema
- Typically bilateral
Why is chronic stasis derm darker in color?
- due to hemosiderin deposition
If you have a patient with stasis derm who develops an eczematous or papulovesicular lesion at a site other than the legs, you should think of ______ (whats the pathogenesis of this condition?)
- Id reaction
- immune mediated
Physical exam pearls for suspected stasis dermatitis patient:
- Unilateral vs bilateral:
o Unilateral suggests cellulitis but stasis dermatitis can
also be unilateral
- Look for an entry for skin infections:
o Tinea pedis or skin maceration between toes - Look for scale on rash itself (takes time to develop!)
o Argues against cellulitis, suggests stasis dermatitis - Palpate the affected skin
o Exquisite pain or crepitus, think necrotizing fasciitis
o Unilateral pitting edema + Homans, think DVT - Elevate the leg for 30 seconds , if Erythema improves, think stasis dermatitis
- If thinking cellulitis, outline erythema on legs
o Helps to monitor for improvement w/ antibiotic regimen
Important DDx for stasis dermatitis that you cant miss!
- Cellulitis (unilateral vs bilateral in stasis, painful, fevers, entry points for infection like maceratied toes or wounds, risk factors for infections like diabetes, immunesuppression or recent hospitilization), will be hot, tender, swollen
- DVT: recent immobilization, flights, surgeries, hypercoagulable states, etc.
Histology of stasis dermatitis:
Spongiosis correlating w/ dermatitis seen clinically, increase proliferation of capillaries below DEJ (reactive to the relative anoxia), extravasated RBCs w/ hemosiderin deposits, and possibly dermal fibrosis at later stages
Treatment of stasis dermatitis?
- Compression and Elevation!!
- can use emollients or TCS for the actual dermatitis
Prognosis of stasis derm:
- there is no cure, only control! Make sure they compress and elevate!
