Varicose eczema

Varicose eczema - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Varicose eczema Varicose eczema About varicose eczema Causes of varicose eczema Diagnosing varicose eczema Treating varicose eczema About varicose eczema Varicose eczema is a long-term skin condition that affects the lower legs and is common in people with varicose veins . Itisalso known as venous eczema, gravitational eczema andstasis eczema. Signs and symptoms Like all types of eczema,the affected skin becomes: itchy red andswollen dry andflaky scaly or crusty There may be periodswhen these symptomsimprove and periods when they become more severe. Your legs may become swollen, especially towards the end of the day or after long periods of standing. Varicose veins (swollen and enlarged veins) are often visible on the legs. Some people also have other symptoms, such as: brown discolouration of the skin red, tender and tight skin that can eventually become hardened (lipodermatosclerosis) small, white scars (atrophie blanche) pain eczema affecting other parts of the body Left untreated, leg ulcers can develop. These arelong-lasting wounds that form where the skin has become damaged. When to seek medical advice See your GP if you have symptoms of varicose eczema. They willoften be able to make a diagnosis simply by looking at the skin. Read more about diagnosing varicose eczema . What causes varicose eczema? Varicose eczema is caused by increased pressure in the leg veins. When the small valves in the veins stop working properly, its difficult for blood to be pushed against gravity and itcan leakbackwards. This increases thepressure in the veins, which can cause fluid to leak into the surrounding tissue. It is thought that varicose eczema may develop as a result of the immune system reacting to this fluid. Varicose eczema is more common in people with varicose veins, as these are also often a sign that the leg veins arent working properly. Read more about the causes of varicose eczema . How varicose eczema is treated Varicose eczema tends to be a long-termproblem. However, treatments are available to help keepit under control. For most people, treatment involves a combination of: self-help measures  including ways to improve your circulation, such as keeping active and frequently raising your legs emollients  moisturisers applied to the skin to stop it becoming dry) topical corticosteroids  ointments and creams applied to the skin to help treat the eczema and relieve symptoms compression stockings  specially designed stockings, usually worn every day, that steadily squeeze your legs and help to improve your circulation If these treatments dont help, your GP may refer you to a dermatologist (skin specialist) in case there is another cause for your symptoms or if they are concerned you may also have a type of eczema called contact dermatitis. If you also have varicose veins, you may be referred to a vascular specialist (a doctor or surgeon specialising in conditions affecting the blood vessels) who can talk to you about the treatment options for varicose veins . Readmore about treating varicose eczema . Causes of varicose eczema Varicose eczema is usually caused by increased pressure in your leg veins. Inside your veins there arevalves that let the blood through in one direction and prevent it flowing backwards. Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the valves to become weakened. If the valves do not function properly,blood may leak backwards. Thisincreases the pressure in your veins, which may cause fluid to leak into surrounding tissues. It is thought that varicose eczema may develop as a result of your immune system reacting to these fluids in the tissues under your skin. This increase in pressure can also cause blood to collect in your veins, which become swollen and enlarged ( varicose veins ). Whosmost at risk? It is not fully understood why the walls of the veins stretch and the valves weaken.Somepeople develop the conditionfor no obvious reason, although there are certainfactors that increase the chances of this happening, including: gender  varicose eczema is more common in women obesity  this can increase the pressure in your leg veins pregnancy this can alsoincrease the pressure in yourleg veins not being able to move for a long period of time  this can affect the circulation inyour leg veins having previously had deep vein thrombosis (DVT) blood clots that develop inleg veins, which can damage thevalves in your veins increasing age  people generally find it harder to move about as they get older, which can affect their circulation Diagnosing varicose eczema See your GP if you have symptoms of varicose eczema. They can usually make a diagnosis by simply looking at the affected areas. Your GP will also ask you questions to determine whether you have a problem with the flow of blood in your leg veins, as this is the main cause of varicose eczema. To help make a diagnosis, your GP may want to know if you have a history of: varicose veins  swollen and enlarged veins deep vein thrombosis (DVT) a blood clot in one of the deep veins of your legs leg ulcers areas of damaged skin that take several weeks to heal cellulitis  an infection of the deeper layers of the skin and underlying tissue surgery or injury to your legs Your GP may also check the pulse in your feet and they may carry out an ankle brachial pressure index (ABPI) test to see if compression stockings are suitable for you. See the section on treating varicose eczema for more information about these. The ABPI test involves comparing blood pressure readings taken from your ankles and upper arms. A significant difference in the readings suggests a problem with the flow of blood in your arteries in which case, compression stockings may not be safe to use. Referral to a specialist You may be referred to a specialist in a local hospital for further tests. This might bea vascular specialist (a doctor or surgeonspecialising in conditions affecting the blood vessels) or a dermatologist (a specialist in skin conditions) if: you have varicose veins and changes to your skin, such as varicose eczema, lipodermatosclerosis (hard, tightened skin) or a history ofleg ulcers you have very poor blood flow in the blood vessels in your legs your symptoms dont get better, despite treatment it is possible that you may havecontact dermatitis Treating varicose eczema Treatment for varicose eczema aims to improve the condition of your skin, treat your symptoms and help improve your circulation (blood flow). For many people, this will involve long-term treatment with a combination of: emollients (moisturisers) topical corticosteroids compression stockings There are also some self-help techniques that you can try. These treatment options are described in more detail below. Lipodermatosclerosis (hardened,tight skin) is treated in a similar way to varicose eczema. If you have a venous leg ulcer , you can alsoread about treating venous leg ulcers . Self-help There are some steps you can take to reduce the symptoms of varicose eczema and help prevent further problems, such as: try to avoid injuring your skin injuries to your skin could lead to an ulcerdeveloping raise your legs when you are resting for example, by propping up your feet on some pillows(ideally so that they are above the level of your heart), as this can help reduce swelling keep physically active this will improve your circulation andhelp you maintain a healthy weight Fluidcan build upin the lower legs if you sit or stand for too long, so it is important to keep moving. Walking will get your muscles working and help to push the blood through the veins to your heart. The National Eczema Society also recommends regularly flexing your feet and rising up onto your toes or bending down at the knees. Emollients Emollients aremoisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film.They are often used to help manage dry or scaly skin conditions such as eczema. Choice of emollient Anumber of different emollients are available. Some can be bought over the counter without a prescription, but if you have varicose eczema it may be helpful to ask your GPto recommend a suitable product. You may need to try several different emollients to find one that works for you. You may also be prescribed a mixture of emollients, for example: an ointment for very dry skin a cream or lotion for less dry skin an emollient to use instead of soap an emollient to add to bath water or use in the shower The difference between lotions, creams and ointments is the amount of oil thatthey contain. Ointments contain the most oil, so they can be quite greasy, butare the most effective at keeping moisture in the skin. Lotions contain the least amount ofoil, so are not greasy, but can be less effective. Creams are somewhere in between. How to use emollients If you have varicose eczema, you should usean emollient at least twice a day, even if you do not have any symptoms. To apply the emollient: use a large amount you should aim to cover all of the skin on your lower leg, not just the obviously affected areas dont rub it ininstead, smooth it into the skin in the same direction that the hair grows applyevery 2to 3hours for very dry skin after a bath or shower, gently dry the skin, then immediately apply the emollient while the skin is still moist do not share emollients with other people It is very important to keep using emollients during a flare-up of varicose eczema, because this is when the skin needs the most moisture.Apply emollients frequently and in generous amounts during a flare-up. Side effects Its unusual for emollients to cause side effects, but they can occasionally cause a rash, and greasy emollients may sometimes cause folliculitis (inflammation of the hair follicles). If you experience any side effects from your emollient, speak to your GP, who can prescribe an alternative product. Emollients added to bath water can make your bath very slippery, so take care getting in and out of the bath. Topical corticosteroids If your skin is inflamed from a flare-up of varicose eczema, your GP may prescribe a topical corticosteroid (corticosteroid medication that is applied directly to your skin in the form of a cream or ointment) to quickly reduce the inflammation. They are also commonly known as topical steroids. Different strength topical corticosteroids can be prescribed, depending on the severity of your varicose eczema. If you have flare-ups of lipodermatosclerosis, you may need a very strong topical corticosteroid. How to use topical corticosteroids When using corticosteroids, only apply the treatment to the affected areas. Your doctor can advise youon how much to apply and how often. You can also check the advice in the patient information leaflet that comes with your medication. Most people only have to apply a topical corticosteroid once a day. When applying the medication, you should: apply your emollient first and wait around 30 minutes before applying the topical corticosteroid (until the emollient has soaked into your skin) apply it only to the affected area use the topical corticosteroid for7 to 14 days and continue to apply the treatment for 48 hours after the flare-up has cleared If your varicose eczema is moderate to severe, you may need to apply topical corticosteroids both between flare-ups and during them. If you need to use topical corticosteroids on a long-term basis, you should apply them less frequently. Your GP will advise youon how often you should be applying them. You should also speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved. Side effects Topical corticosteroids may cause a mild and short-lived burning or stinging sensation as you apply them, particularly if using a cream. Generally, using a strong topical corticosteroid for prolonged periods will increase your risk of getting more serious side effects, such as thinning of the skin. Your doctor will advise you as to the strength of the medication you require and when you should use it. Compression stockings Medical compression stockings are specially designed to steadily squeeze your legs to help improve your circulation. They are tightest at the ankle and get gradually looser as they go further up your leg. This encourages blood to flow upwards towards your heart. Medical compression stockings are used to treat varicose eczema and lipodermatosclerosis by improving the flow of blood through your leg veins and reducing the pressure in the veins. Choice of compression stockings Compression stockings are available in a variety of different sizes and pressures. They are also available in: different colours different lengths  some come up to the knee and others also cover the thigh (you should only need knee-high stockings for varicose eczema) different foot styles  some cover the whole foot and some stop before the toes Support stockings or tights that lightly compress the legs can be bought from pharmacies. Compression stockings that compress the legs more are available on prescription and will require you to be measured by a nurse first. In some cases, if you find it difficult to put on your stockings, you may be advised to use a tubular bandage instead. Wearing compression stockings You will usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Wearing compression stockings can be uncomfortable, particularly during hot weather, but it is important to wear them correctly to get the most benefit from them. Pull them all the way up so that the correct level of compression is applied to each part of your leg. Do not let the stocking roll down, or it may dig into your skin in a tight band around your leg. Speak to your GP if the stockings are uncomfortable, they do not seem to fit, or you have difficulty putting them on. It may be possible to get custom-made stockings that will fit you exactly. Take care whenputting compression stockings on and taking them off,as thiscan damage fragile skin. If you have a leg ulcer, it ideally needs to heal before you start wearing compression stockings. Caring for compression stockings Compression stockings usually have to be replaced every 3to 6months. Speak to your GP if your stockings become damaged, as they may no longer be effective. You should be prescribed 2stockings (or 2sets of stockings if you are wearing 1on each leg) so that 1stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat. Treating varicose veins If you have varicose veins ,as well asvaricose eczema, treating these may sometimes be helpful. If your GP thinks treatment may be beneficial, they can refer you to a vascular surgeon, who can arrange for an ultrasound scan of your leg to find the faulty blood vessels. Treatment of your varicose veins can then be planned. There are a number of treatments available that can improve the symptoms and appearance of varicose veins, including: endothermal ablation where energy from either high-frequency radio waves or lasers is usedto seal the affected veins sclerotherapy  where aspecial foam is injectedinto your veins to seal them ligation and stripping  where affected veins are tied off and surgically removed These procedures are usually performed in the day surgery department of a hospital. Read more about treating varicose veins . Source: NHS 24 - Opens in new browser window Last updated: 07 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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