title: Stasis Dermatitis: Pathophysiology, Evaluation, and Management.
abstract: Stasis dermatitis commonly occurs in older age. It is caused by venous hypertension resulting from retrograde flow due to incompetent venous valves, valve destruction, or obstruction of the venous system. Further tissue changes arise from an inflammatory process mediated by metalloproteinases, which are up-regulated by ferric ion from extravasated red blood cells. Stasis dermatitis presents initially as poorly demarcated erythematous plaques of the lower legs bilaterally, classically involving the medial malleolus. It is one of the spectrum of cutaneous findings that may result from chronic venous insufficiency. Its mimics include cellulitis, contact dermatitis, and pigmented purpuric dermatoses. Duplex ultrasound is useful in demonstrating venous reflux when the clinical diagnosis of stasis dermatitis is inadequate. Conservative treatment involves the use of compression therapy directed at improving ambulatory venous pressure. Interventional therapy currently includes minimally invasive techniques such as endovenous thermal ablation and ultrasound-guided foam sclerotherapy, which have supplanted the use of open surgical techniques.
authors.affiliation: University of Texas McGovern Medical School at Houston, Houston, TX, USA.
authors.forename: Swaminathan
authors.initials: S
authors.lastname: Sundaresan
authors.affiliation: Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Migden
authors.affiliation: Department of Dermatology, University of Texas McGovern Medical School at Houston, 6655 Travis St, Ste 980, Houston, TX, 77030, USA. Sirunya.Silapunt@uth.tmc.edu.
authors.forename: Sirunya
authors.identifier: http://orcid.org/0000-0003-3794-6302
authors.initials: S
authors.lastname: Silapunt
mesh_terms: D000367:Age Factors; D003872:Dermatitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000209:etiology; D035002:Lower Extremity; D015911:Sclerotherapy / Q000379:methods; D018084:Ultrasonography, Interventional; D014689:Venous Insufficiency / Q000150:complications*; D014690:Venous Pressure