Varicose eczema

Varicose eczema, also known as venous, gravitational or stasis eczema, is a long-term skin condition that affects the lower legs. It's common in people with varicose veins.

Varicose eczema tends to be a long-term problem. However, treatments are available to help keep it under control.

Symptoms of varicose eczema

Like all types of eczema, the affected skin becomes:

• itchy
• red and swollen
• dry and flaky 
• scaly or crusty

There may be periods when these symptoms improve 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 are long-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'll often be able to make a diagnosis simply by looking at the skin.

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 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 be a vascular specialist (a doctor or surgeon specialising 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 of leg ulcers
• you have very poor blood flow in the blood vessels in your legs 
• your symptoms don't get better, despite treatment 
• it's possible you have contact dermatitis

Causes of varicose eczema

Varicose eczema is usually caused by increased pressure in the leg veins.

When the small valves in the veins stop working properly, it's difficult for blood to be pushed upwards against gravity and it can leak backwards.

This increases the pressure in the veins, which can cause fluid to leak into the surrounding tissue. It's 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 aren't working properly.

Some people develop the condition for no obvious reason, although there are certain factors 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 also increase the pressure in your leg veins
• not being able to move for a long period of time – this can affect the circulation in your leg veins
• having previously had deep vein thrombosis (DVT) – blood clots that develop in leg veins, which can damage the valves in your veins
• increasing age – people generally find it harder to move about as they get older, which can affect their circulation

Treating varicose eczema

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 squeeze your legs tightly at the foot and ankle and become looser further up your leg, helping to improve your circulation

If these treatments don't help, your GP may refer you to a dermatologist (skin specialist) in case there's another cause for your symptoms or if they're concerned you may also have contact dermatitis.

If you 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.

Read about treating varicose eczema.

Other types of eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:

• atopic eczema (also called atopic dermatitis) – the most common type of eczema
• contact dermatitis – a type of eczema that occurs when the body comes into contact with a particular substance
• discoid eczema – a type of eczema that occurs in circular or oval patches on the skin