Venous Eczema

Venous eczema (also known as venous stasis dermatitis, venous dermatitis, or varicose eczema) is where the skin surrounding the varicose vein becomes scaly, red, and itchy. This can be mild and limited to the localised areas, or it can cover the whole lower leg, where the skin is very inflamed.

Symptoms of venous eczema

Near leg veins and ankles: dry scaly skin, itching, pain, open sores that ooze or crust due to scratching, thickened or rough skin.

What causes venous eczema?

When incompetent veins fail at returning blood to the heart, blood pools, and pressure build up inside the vein. This is known as venous hypertension (an increase in localised blood pressure). This additional pressure pushes blood into the capillaries, the tiny veins near the surface of the skin. Venous hypertension is the main cause of venous stasis dermatitis and inflammation in progressive venous disease.

With the increased pressure in the capillaries and blood vessels, red blood cells leak out close to the skin surface. The immune system sends inflammatory cells to the leaked red blood cells to start the healing process via a reaction in the skin. However, as the red blood cells continue to leak thanks to venous insufficiency, the inflammation becomes chronic venous eczema. The skin feels irritated, itchy, and the skin can break down and become rough, scaly, with sores forming because of the scratching. These open sores (leg ulcer) can be difficult to heal until the underlying problem of the varicose vein is dealt with. Until then, they can cause infections and be painful.

Hyperpigmentation – Discolouration of the skin

Hyperpigmentation is a typical sign of advancing venous disease. This is the development of skin discolouration above the ankle, often localised to a varicose vein. If blood flow leaks out of the damaged blood vessel, the haemoglobin breaks down and disperses in the tissue, this causes discolouration, known as hyperpigmentation.

Symptoms of hyperpigmentation

Brown staining of the skin surface near the ankle.

What causes hyperpigmentation?

When varicosities leak blood (including red blood cells and haemoglobin) into the capillaries and tissues near the surface of the skin, they are broken down into iron which stains the skin. This can become quite dark. When the underlying varicose veins are treated, the colour usually lightens somewhat, however, the staining may not completely disappear.

Hyperpigmentation can also occur after sclerotherapy treatment, read more about it here.

Oedema – Swelling of the leg

Oedema is a complication of chronic venous disease where the ankle, foot, and/or lower leg swells. Swelling can sometimes occur in patients with less advanced varicose veins, but is often present in advanced cases of severe venous disease.

Venous Ulcer – Open sores

Localised or extensive breakdown of the skin barrier, particularly around the ankle region. If left untreated, severe venous disease leads to worsening symptoms in the lower legs, which will ultimately culminate in the development of a venous ulcer. The ulcer may be small or large. Ulcer treatment can be complex and must be managed correctly, with a combination of conservative and medical interventions by a phlebologist.

Lipodermatosclerosis – Thickening of the skin of the lower leg or ankle

One of the stages of skin change prior to ulceration is referred to as lipodermatosclerosis or chronic panniculitis. The is a thickening of the skin and soft tissue in the lower leg and ankle primarily in association with chronic venous disease and varicose veins.

Phlebitis and Cellulitis

Severe bacterial infection of the vein and the surrounding tissues below the skin.

Thrombophlebitis

Thrombophlebitis is the inflammation and blood clotting of a vein. Blood clotting is a normal function that stops bleeding after an injury. When it happens within a vein and hinders blood flow, it can lead to serious health problems.

Symptoms of thrombophlebitis

Swelling, tenderness and the skin feels warm to the touch. However, many patients show no symptoms (asymptomatic).

The signs can be difficult to identify because of other conditions with similar symptoms, such as skin irritations, ruptured cysts, muscle strain, phlebitis, and cellulitis.

What causes thrombophlebitis?

Thrombophlebitis (inflammation and blood clot) occurs when the body mistakes the pooling of the blood in a varicose vein for blood loss. The body sends inflammatory cells and white blood cells to stop the ‘bleeding’. This clots the blood. As the clot occurs inside the vein, it can obstruct the free flow of blood.

The danger to health can depend on the location of the clot. If it forms in a vein close to the skin (superficial vein thrombosis), it can cause inflammation of nearby tissues, development of red lumps, and the whole limb can become swollen. If the clot occurs in a deeper vein (deep vein thrombosis), the clot can break off and travel to the heart and lungs, leading to a pulmonary embolism. This could be life-threatening.