Pathophysiology Venous insufficiency has effects on both the dermal and epidermal components of the skin. Dermal effects are a direct vascular problem. A decrease in venous return results in venous hypertension. In response to this, surrounding vessels dilate and become more permeable, leading to the lymphatics being overwhelmed. The consequence is oedema which impairs the normal nutritional exchange between capillaries and cells.
Epidermal effects see oedema accumulate and cells become swollen and separate.
Repair processes result in irregular thickening of the epidermis, with the stratum corneum ill formed. This leads to the characteristic scaling of the condition. Differential Diagnoses and Complications - Contact Dermatitis. Remove oedema - through leg elevation, increased exercise and gentle diuretic treatment. Maintain skin integrity - use of non abrasive emollients and creams.