Stasis Dermatitis (Venous Eczema)


Venous dermatitis is a common type of eczema/dermatitis that involves one or both lower legs in association with venous insufficiency. It is also known as gravitational dermatitis.


Venous eczema primarily occurs in middle-aged and elderly individuals, with a prevalence of 20% in those over 70 years old. It is related with:

  • Stasis ulcers.
  • History of deep venous thrombosis in an affected limb
  • History of cellulitis 
  • Chronic edema in the lower leg, exacerbated by high temperatures and long periods of standing
  • Varicose veins


Venous dermatitis is caused by fluid accumulation in the tissues and triggering of the innate immune response.

Typically, during walking, the leg muscles facilitate the upward flow of blood and valves in the veins prevent blood from accumulating. Deep venous thrombosis (DVT) or varicose veins may compromise the valves in the deep leg veins. Back pressure causes fluid accumulation in the tissues. An inflammatory reaction occurs.

Clinical manifestation:

The condition usually manifests as red, scaly, and eczematous patches or plaques on chronically edematous leg. The medial ankle is most commonly and severely affected, with skin changes possibly extending to the knee and foot. Pruritus can lead to lichenification due to continuous scratching or rubbing.

Chronic forms are characterized by scaling and hyperpigmentation from cutaneous hemosiderin accumulation. Additional signs of chronic venous insufficiency and associated comorbidities are frequently observed, such as:

  • Atrophie blanche —refers to stellate, porcelain-white scarring patches caused by microthromboses. 
  • The lower leg shaped like “Champagne bottle” — narrowing at the ankles and induration (lipodermatosclerosis)
  • Ulceration


  • Impetiginisation — is a secondary infection caused by Staphylococcus aureus that leads to the formation of yellowish crusts.
  • Cellulitis — an infection caused by Streptococcus pyogenes, characterized by redness, swelling, pain, fever, a red streak up the leg, and swollen lymph nodes in the groin.
  • Secondary eczema — spread of eczema to other parts of the body.
  • allergic reaction to one or more ingredients in the lotions or ointments used


Stasis dermatitis is usually diagnosed clinically on the basis of:

  • Skin lesions’ clinical presentation 
  • Venous insufficiency history
  • Other chronic venous insufficiency manifestations (e.g., varicose veins, pitting edema, hyperpigmentation) 

A skin biopsy is usually unnecessary to diagnose stasis dermatitis. If the diagnosis is unclear or if the patient presents with unusual characteristics (such as a single lesion or no ankle involvement), performing a biopsy and histopathologic examination can help confirm the diagnosis and rule out other skin conditions like allergic contact dermatitis, asteatotic eczema, or cutaneous malignancies. 


General measures:

  • Lifestyle modification— Patients with chronic venous disease and stasis dermatitis should make lifestyle adjustments to lower venous hypertension, decrease edema, and prevent venous ulcers. These consist of weight loss, regular walks, avoiding extended standing, exercising, and elevating your legs whenever possible. 
  • Skin care — To treat skin dryness and itching in mild or chronic stasis dermatitis, it is recommended to use mild, fragrance-free liquid cleansers for gentle skin washing and apply bland emollients regularly. White petroleum jelly is effective, affordable, and non-irritating. Emollients can be administered frequently throughout the day.

Compression therapy: 

Compression therapy using either compression bandaging systems or compression stockings, is the primary conservative treatment for stasis dermatitis and the associated chronic venous disease.



Written by:

Mashael Alanazi, Medical Student.

Revised by:

Maee Barakeh, Medical Student.