ECZEMA VARICOSUM

A variety of eczema is named usually from the
primary or consecutive type of lesion that predom-
inates, e.g., erythematous, papular, vesicular, pustu-
lar, squamous, crusted, or fissured, eczema; or from
some prominent clinical symptom, e.g., eczema
rubrum, eczema madidans. Occasionally an ecze-
matous lesion takes its name from its most impor-
tant etiological factor, e.g., eczema intertrigo,
eczema varicosum. The legs are a common site
for eczema in patients past middle life and although
varicose veins may be present for years before the
development of an eczma it is undoubtedly true that
the varices, when present, exert a strong influence
upon the character and course of the malady, and
that the disturbance of circulation predisposes to
and frequently determines the outbreak of eczema
cruris. The disease appears almost invariably, and
is always more prominent, on the lower half of the
leg. It may start as any of the primary varieties,
but although the erythematous and papular forms
are common, the vesicular is uncommon and the
pustular is quite rare. They all evolve rapidly, as
a rule, into one of the secondary types, eczema
squamosum, rubrum or madidans, but some of the
elementary lesions often persist at the border or in
the neighborhood of the secondary patch. The
course is nearly always protracted and in any long-
standing case the infiltration and induration of the
skin are apt to become very pronounced, sometimes
sufficiently to justify the appellation eczema sclero-
sum. Exceptionally the thickening and the associ-
ated edema are so considerable as to suggest ele-
phantiasis. The natural furrows of the skin are ac-
centuated. Occasionally petechiae or larger pur-
puric spots are found scattered about the patch.
Papules and dry patches are apt to be dusky red or

even violaceous and thus resemble in color the le-
sions of lichen planus. After some time the skin
becomes more or less darkly pigmented and the
brownish stain is usually permanent. The nutrition
of the skin is frequently so impaired in old cases
that there results a complete disorganization in
places with the formation of shallow, shelving, slug-
gish ulcers, ulcera varicosa. The leg is the only
region in which eczema leaves permanent traces
either as scars or pigmentation. DIAGNOSIS:
The localization, the associated varices, the protean
and often multiform character of the early lesions,
the brawny induration, pigmentation and tendency
to ulceration in the later stages, together with the
other characteristics of the various forms of eczema,
elsewhere described, tend to make the diagnosis
usually very easy. TREATMENT: The treatment
is substantially that of the corresponding lesional
or secondary types in other regions, combined with
the treatment of the varices. (See E. erythema-
tosum, E. rubrum, E. squamosum.) The essential
thing is relief of the blood stagnation. That alone
may effect the cure of a mild case, and without it
all other measures are sometimes of no avail. The
best method is to put the leg at rest horizontally.
When that is unfeasible the leg should be wrapped
from the toes to the knee or higher with a two-inch
wide, cotton elastic webbing bandage. To protect
the bandage from the salves, lotions or the eczema-
tous discharge it is best to cover the leg smoothly
with layers of gauze, and a sheet of oiled silk if nec-
essary, supported by a stocking, and then apply
the bandage evenly over all. The pressure should
be moderate and uniform, and cause no discomfort.
The dressing should be renewed once a day or
oftener,

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