A B C D E F G H I J K L M N O P R S T U V W

VARICOSE ECZEMA / ULCERS

What is Varicose Eczema ?

Varicose eczema occurs on the lower legs, in some people who suffer from varicose veins. The skin becomes dry and itchy. Brown or purple pigment develops in these parts of the skin. Scratching the skin leads to soreness. Very often, swelling of the ankles also occurs, and this can become quite severe. With time, ulcers may develop in the area of the varicose eczema. These may be triggered by some mild injury or even by scratching. The ulcer typically affects the inside of the leg, but may occur on the outside of the leg or even the foot. Added infection often follows. The bottom of the ulcer then becomes covered with an offensive smelling, yellow layer.

How does Varicose Eczema occur ?

Varicose eczema is due to increased pressure within the veins in the leg. The pressure builds up because valves in the veins fail to work. This increased pressure allows a chemical called fibrin to escape from small blood-vessels in the skin. Fibrin is then deposited around the blood-vessels, forming a barrier which prevents oxygen and other essential nutrients from penetrating through to the skin where they are needed. Lack of oxygen and other substances causes the eczema. The damage to the small blood-vessels from the high pressure in the veins causes the release of red blood cells into the skin. This causes the brown and purple pigmentation. Rubbing and scratching worsen the eczema. The incorrect use of disinfectants and certain creams may result in further aggravating the problem. Ulcers are more likely to occur in older people, where the circulation to the leg is poorer.

Why does Varicose Eczema occur ?

Varicose eczema is due to a disturbance of the veins in the legs. Although usually a result of varicose veins, sometimes a blocked vein (thrombosis) may have occurred.

Treatment Involved

Prevention is the most important part of treatment. The increased pressure in the veins can be counteracted by the use of support stockings or tights. You should use these at all times. While resting, keep the legs elevated above the waistline to prevent fluid accumulation. Varicose eczema will usually respond to steroid (cortisone-like) creams. However, these tend to dry the skin and can make the symptoms of eczema worse. Therefore they should always be used in combination with soothing applications such as emulsifying ointment or aqueous cream. A varicose ulcer is usually washed with salt solution to clean away the infected membrane. Dressings are applied to promote the formation of healing tissue within the ulcer. A large range of dressings are available for the treatment of leg ulcers. These include powders, granules, pastes and sheet dressings. They work mainly by helping to separate fluid and bacteria from the surface of the sore, which helps it heal. There is no best remedy . Each doctor tends to have his or her favourite dressing for leg ulcers. Some dressings need to be changed once or twice a day. Others can be left undisturbed for a week. However, all dressings need to be used together with compression or support bandages. In some patients, a drug called oxipentifylline may be of value. This breaks down the barrier between the blood-vessels and the skin. It allows easier transport of the oxygen and other substances into the skin. Some patients have very large varicose ulcers which have filled in but would take a long time to heal over completely. In these people, a skin graft may allow more rapid healing of the ulcer. This is a helpful way of reducing the necessary stay in hospital.

During Treatment

With treatment, varicose eczema is totally controllable. Unfortunately, the pigmentation may persist or even become worse, despite effective treatment. With varicose ulcers, there should be reasonably rapid relief of pain with treatment. If infection of the skin occurs during treatment, this will cause the surrounding skin to become inflamed and red. This will be treated with antibiotic tablets such as erythromycin.

After Treatment

Varicose eczema and ulcers will recur unless preventive measures are taken. Support stockings and elevation of the legs may well stop both the eczema and ulcers from coming back. If the skin around the ulcer becomes inflamed and sore or if the leg becomes swollen, do let your doctor know, since spreading infection or a blood clot may be responsible for this.

If Varicose Eczema is left Untreated

The scratching and soreness that occurs with untreated varicose eczema would almost certainly lead to the development of ulceration. Without proper management, varicose ulcers will persist and may spread to totally encircle your leg. Accumulation of fluid in the leg will then lead to chronic swelling. In long-standing leg ulcers, cancerous change can very rarely occur.

Effects on family of Varicose Eczema

Varicose ulcers tend to be chronic and can be very disabling. Their management requires an enormous amount of support from both family and the health services.