If you’re over 50, you may have noticed discolored patches of brownish or purplish skin on your lower legs.  These areas may be flaky dry and itch often.   Although they’re common in older people, you don’t want to ignore them.  They could be the first sign of an underlying health condition that requires attention.  This common skin condition is called stasis dermatitis and you’ll want to know what to do about it…

Stasis Dermatitis:  What Those Discolored Patches May Mean

If you’ve ever banged your shins, either doing house or lawn work, or maybe from a fall, you may have noticed discolored skin patches in those areas.  That’s a reaction to damaging the tiny blood vessels, the capillaries, in the top layer of your skin.  The blood in these capillaries leak into the surrounding skin and a buildup of clotting blood, fibrin, forms a deposit.  This deposit then appears on the skin surface as a kind of permanent bruise.

In addition, inflammation can develop around these areas and often create a permanent reddish, brownish, or purplish patch.  Hitting the front of your legs this way is one of the common ways in which you might get stasis dermatitis.

Another cause of stasis dermatitis is something called venous insufficiency.  That’s when blood flow to the veins and capillaries of your legs is not enough to nourish the skin and tissues of your lower legs.  This can occur from blockages in vessels further up that results in diminished blood flow to your legs.  The characteristic dry, itchy, flaky discolored patches then start to form.   When you scratch them, they may start to ooze a clearish fluid.  The scratched areas may be slow to heal as well.

With age, the valves of the blood vessels in your legs become weaker.  They may no longer be strong enough to completely pump blood back up to your heart.  So, some of this blood pools in your lower legs, ankles and feet.  This is a condition commonly called venous stasis – where your blood literally stays in the veins.  As a result, you’ll likely notice more swollen ankles at the end of the day. Your feet may also have a lot of visible “spider veins” that result from a network of broken capillaries.

You can also develop stasis dermatitis if you’ve had surgery on varicose veins or by a blood clot higher up in your vascular system.

Stasis dermatitis commonly occurs in women over the age of 50 but also affects men.  By the time a woman is in her 70’s, about 20% have this condition.  Stasis dermatitis may be associated with, or progress to, more serious, underlying health issues like the following:

a. Bacterial skin infections.  Scratching at these areas can directly deposit all the bacteria under your nails directly into the skin.

b. Chronic leg ulcers.  Chronically diminished blood flow can result in problems healing.

c. Bone inflammation/infection.  Untreated, chronic infections in the skin can eventually travel down into the underlying tissues and even bones.

In addition to the typical discolored patches of skin, you may have these other more serious signs associated with stasis dermatitis:

1.  Leg and/or ankle swelling at the end of the day.

2.  Tender calves.

3.  Dull, aching calves, worse on standing.

4.  Open ulcers – or spots that don’t seem to heal well.

5.  Oozing of clear fluid especially after scratching.

These are signs that you should visit your doctor to have this condition evaluated.  You can start with your dermatologist, but they will likely refer you to your regular medical doctor.  They’ll want to do an ultrasound of your lower legs to determine your blood flow.  If the blood flow is only mildly decreased, then you can usually just watch the condition to make sure it doesn’t get worse.

You can help prevent this condition from worsening by doing the following:

a.  Avoid long periods of sitting.  For each hour you’re sitting, get up and move around for 5-10 minutes to get your circulation moving.

b. Use compression stockings.  These can be a big help to prevent swelling from pooling blood in your lower legs and ankles.

c. Elevate your legs.  If you do have to sit for a while, elevate your legs.  You can also do a little leg lifting, or foot flexing exercise, to get the blood moving.

d. Lose weight/Exercise.  For each extra pound of weight, you have additional blood supply that your veins are required to pump blood to.  This puts a lot of strain on your vascular system.  Maintaining a normal weight can significantly help decrease swelling in the legs. Regular aerobic exercise will also keep the muscles of your legs strong.  In turn, toned muscles help return blood in your legs back to your heart.

e. Watch salt intake. As you get older, your body doesn’t clear salt from your body as well as it once did.  As a result, you hold onto a lot of fluid that puts a big strain on your vascular system as well.

f. Drink more water.  Dehydration can result in decreased volume of your blood which can make circulation harder.  Thicker blood is also more prone to clot.  Drink enough water for your weight every day, at least 0.5 ounce per pound of body weight.

Even though stasis dermatitis is fairly common, and usually just reflects past bumps and bangs to the shins, you shouldn’t just ignore it. That’s why I always check my patients’ lower leg skin to evaluate the degree of stasis they may have.  You, too, should do regular skin checks of your lower legs to watch for signs of skin breakdown.  Be sure to use a good moisturizer on this skin to alleviate dryness and itching that can lead to bacterial infections.

Stay Well,
Jay Brachfeld, M.D.

Stasis Dermatitis, http://www.healthline.com/health/stasis-dermatitis-and-ulcers#