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Varicose eczema Content Supplied by NHS Choices
Introduction

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Varicose eczema, also known as venous eczema or gravitational eczema, is a type of eczema (chronic skin condition) that affects the legs. Like all types of eczema, the skin becomes red, flaky, scaly and itchy.

Varicose eczema usually occurs in the skin over and around varicose veins. It is caused by the faulty valves in varicose veins, which allow blood to flow in the wrong direction. Varicose eczema is usually a minor annoyance and leads to no major problems.

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) - this often runs in families and is linked to other conditions, such as asthma and hay fever
  • contact dermatitis - a type of eczema that occurs when the body comes into contact with a particular substance
  • discoid eczema - this tends to affect adults and causes circular or oval patches of eczema

Varicose veins

Varicose eczema is usually caused by varicose veins. These are swollen and enlarged veins that are usually blue or dark purple. They may also be lumpy, bulging or twisted in appearance.

Varicose veins develop when the small valves inside the veins stop working properly. In a healthy vein, blood flows towards the heart. Blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through. If the valves weaken or are damaged, the blood can flow backwards, leading to swollen and enlarged varicose veins.

The pressure inside these veins increases, and this can damage the skin, leading to varicose eczema as well as more severe skin damage.

See Varicose eczema - causes for more information about the causes of the condition.

How common is varicose eczema?

Skin problems due to venous disease (problems with your veins) become more common with age and tend to affect women more than men. Some estimates suggest that venous disease causes skin changes in 3% of adults. This rises to 20% of people above 70 years old. 

You may be more likely to develop venous skin problems if you:

  • have varicose veins
  • are overweight, as this puts extra pressure on your veins

Outlook

Treatment for varicose eczema involves treating both the dry skin and the underlying blood flow problem. Emollients, which are moisturisers applied to the skin to reduce the loss of water, are often recommended. These also help to soothe the skin. Corticosteroid ointments are often used to help manage severe symptoms.

Graduated elastic medical compression stockings, which are specially designed stockings that steadily squeeze your legs, can help to improve your circulation. You will need to wear them every day.

These treatments usually control varicose eczema. However, if they are not effective or if you have lipodermatosclerosis, a more severe form of venous skin damage, you may be referred to a vascular specialist (a doctor who specialises in veins). They can investigate and treat the underlying venous problem. Treatment of varicose veins will often cure varicose eczema, lipodermatosclerosis and venous ulcers.

See Varicose eczema - treatment for more information about the different treatment options.


Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Symptoms of varicose eczema

The first sign of varicose eczema is mild itchiness of your skin over and around a patch of varicose veins. This becomes speckled, scaly, inflamed and itchy. Your skin can turn brown.

Severe skin disease may be caused by vein problems in your leg. This usually occurs near your ankle and may extend onto your foot and as far as the mid-calf. Your skin may be brown and feels very hard to the touch. In some people, red inflammation occurs and can be painful. This problem is called 'lipodermatosclerosis'.

 

Lipodermatosclerosis

The symptoms of lipodermatosclerosis include:

  • hard, tight skin 
  • red or brown coloured skin 
  • the layer of fat and soft tissues underneath the skin (subcutaneous tissue) may become hard, causing the leg to look like an upside-down champagne bottle

Leg ulcers

Vein problems may also cause a leg ulcer. This is a damaged area where the skin has broken down into an ulcer (a chronic non-healing wound).

See the Health A-Z topic about Venous leg ulcers for more information.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Ulcers
An ulcer is a sore break in the skin, or on the inside lining of the body.
Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Causes of varicose eczema

Varicose eczema is usually caused by varicose veins. These are swollen and enlarged veins that are usually blue or dark purple. They may also be lumpy, bulging or twisted in appearance.

Varicose veins develop when the small valves inside the veins stop working properly.

Valves

Inside your veins there are one-way valves that open to let the blood through, then close to prevent it flowing backwards.

Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the valves to become weakened. If the valves do not function properly, the blood may leak backwards past the valves. If this happens, the blood collects in your veins, which become swollen and enlarged (varicose veins).

This causes the pressure inside these veins to increase, which can damage the skin and lead to varicose eczema as well as more severe skin damage.

It is not fully understood why the walls of the veins stretch and the valves weaken. Some people develop the condition for no obvious or apparent reason, although there are some risk factors, such as age or being pregnant. See Varicose veins - causes for more information.

Deep vein thrombosis

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body. A blood clot in one of the veins in your leg may block the flow of blood and damage the valves. This can increase pressure in the vein and lead to severe skin damage, such as lipodermatosclerosis.

DVT sometimes occurs for no apparent reason, but may be more likely to occur if you are immobile (unable to move) for a long period of time - for example, if you are recovering from an operation in hospital. There are a number of other possible causes and risk factors, such as heart and lung disease. See DVT - causes for more information.

Increased pressure in the leg veins

Where the blood collects in your veins, fluid can leak into the surrounding tissue. This causes swelling of the leg. Increased pressure in the leg veins can also activate cells that cause inflammation (redness and swelling), causing the other symptoms of varicose eczema and lipodermatosclerosis.

The severe skin damage caused by lipodermatosclerosis makes the skin very fragile. Eventually, it can break down to form an ulcer (chronic non-healing wound). See the Health A-Z topic about Venous leg ulcers - causes for more information.

Risk factors

A number of risk factors can increase your likelihood of developing varicose eczema and lipodermatosclerosis, including:

  • your age - as you get older, your veins start to lose their elasticity and the valves inside them stop working as well
  • your gender - varicose eczema is more common among women
  • your weight - being severely overweight puts extra pressure on your veins, which means that they have to work harder; it also increases the pressure on the valves, making them more prone to leaking

You can use the healthy weight calculator to find out whether you are overweight.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Ulcers
An ulcer is a sore break in the skin, or on the inside lining of the body.
Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Diagnosing varicose eczema

See your GP if you are having symptoms of varicose eczema. They can usually make a diagnosis by simply looking at the affected areas.

Your GP will ask you some questions to find out whether you have increased blood pressure in your veins. This causes varicose eczema, so it will support your diagnosis. Signs of increased venous blood pressure include having a history of:

  • varicose veins (swollen and enlarged veins) 
  • deep vein thrombosis (DVT) - a blood clot in one of the deep veins in your body
  • leg ulcers - damaged skin below the knee on your leg or foot that takes longer than six weeks to heal

If your GP is in doubt, or if you need to have further tests, you may be referred to a vascular specialist (a doctor who specialises in veins).

Varicose veins

If you have varicose veins, your GP will also need to examine them. If they feel that it is necessary to investigate your varicose veins further, they may refer you to a vascular specialist.

See the Health A-Z topic about Varicose veins - diagnosis for more information.

Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Treating varicose eczema

Treatment for varicose eczema involves:

  • improving the condition of your skin with emollients (moisturisers) and corticosteroid medicines 
  • improving your circulation (blood flow) with graduated elastic medical compression stockings
  • treating the underlying vein problems

There are also some self-help techniques that you can try.

If you have varicose veins (swollen and enlarged veins), graduated elastic medical compression stockings will often help to treat these as well. However, in some cases, surgery may be necessary. See the Health A-Z topic about Varicose veins - treatment for more information.

Lipodermatosclerosis (hardened, tight skin) is treated the same way as varicose eczema. See the Health A-Z topic about Leg ulcers - treatment for information about treating these.

Self-help

There are some steps that you can take to care for your varicose eczema:

  • avoid injuring your skin - for example, by knocking into a chair because this could lead to an ulcer (open sore) developing
  • raise your legs when you are resting - for example, by propping up your feet on some pillows, to help reduce swelling 
  • keep physically active, because this will improve your circulation and enable you to maintain a healthy weight

Exercise

Fluid accumulates in the lower legs if you stand or sit for too long, so it is important to keep moving. Walking will get your muscles working and help to push the blood through the veins to your heart. The National Eczema Society also recommends:

  • flexing your feet regularly
  • rising up onto your toes or bending down at the knees

Emollients

Emollients are substances that help to soften and smooth your skin to keep it supple and moist. They are one of the most important forms of treatment for all types of eczema. See the Health A-Z topic about Emollients for more information.

As varicose eczema can cause your skin to become dry and cracked, it is important to keep it moisturised to prevent further irritation. Emollients prevent water being lost from your outer layer of skin (epidermis), as well as adding water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.

Choice of emollient

A number of different emollients are available. Some can be bought over the counter without a prescription, but if you have varicose eczema ask your GP to recommend a suitable product.

You may need to try a number of different emollients to find one that works for you. You may also be prescribed a mix of emollients. For example:

  • an ointment for very dry skin 
  • a cream or lotion for less dry skin
  • an emollient to use instead of soap 
  • an emollient to add to bath water or use in the shower

The difference between lotions, creams and ointments is the amount of oil that they contain. Ointments contain the most oil so they can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least amount oil so are not greasy, but can be less effective. Creams are somewhere in between.   

If you have been using a particular emollient for some time, it may eventually become less effective or it may start to irritate your skin. If this is the case, your GP will be able to prescribe another product.  

How to use emollients

You should use your emollient all the time, even if you are not having symptoms. You could consider keeping separate supplies of emollients at work or at school.

To apply the emollient:

  • use a large amount 
  • smooth the emollient into the skin in the same direction that the hair grows 
  • do not rub the emollient in
  • for very dry skin, apply emollient every two to three hours 
  • after a bath or shower, gently dry the skin, then immediately apply the emollient while the skin is still moist 
  • do not share emollients with other people

Creams and lotions tend to be more suitable for red, inflamed (swollen) areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed. 

It is very important to keep using your emollients during a flare-up of varicose eczema because this is when the skin needs the most moisture. During a flare-up, apply emollients frequently and in generous amounts.

Side effects

The most common side effect of using emollients is a rash. If you have varicose eczema, your skin is very sensitive and can sometimes react to certain ingredients within an emollient. If your skin reacts to the emollient, speak to your GP, who can prescribe an alternative product. 

Be aware that some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, do not use them near a naked flame.

Emollients that are added to bath water can make your bath very slippery, so take care getting in and out of the bath. As long as you are aware of these hazards, you should be able to use emollients safely. 

Topical corticosteroids

If your skin is red and inflamed from a flare-up of varicose eczema, your GP may prescribe a topical corticosteroid (one that is applied directly to your skin). Corticosteroids work by quickly reducing inflammation.

Corticosteroids are any type of medication that contain steroids, a type of hormone. Hormones are groups of powerful chemicals that have a wide range of effects on the body. See the Health A-Z topic about Topical corticosteroids for more information.

You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used (illegally) by bodybuilders and athletes. When used correctly, corticosteroids are a safe and effective treatment for eczema.

Choice of topical corticosteroid

Different strength topical corticosteroids can be prescribed depending on the severity of your varicose eczema. If you have flare-ups of lipodermatosclerosis, you may need a very strong topical corticosteroid. Therefore you may be prescribed a cream or an ointment.

If your varicose eczema is moderate to severe, you may need to apply topical corticosteroids between flare-ups and during them.

If you need to use corticosteroids frequently, visit your GP regularly so they can check that the treatment is working. 

How to use topical corticosteroids

When using corticosteroids, apply the treatment sparingly to the affected areas. Always follow the directions on the patient information leaflet that comes with the corticosteroid, as it provides details about how much to apply. 

During a flare-up of varicose eczema, do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day. When applying the topical corticosteroid, you should:

  • apply your emollient first and wait several minutes before applying the topical corticosteroid (until the emollient has soaked into your skin)
  • apply a small amount of the topical corticosteroid to the affected area (see the box above for a guide on the amount you should use)
  • use the topical corticosteroid for 7 to 14 days
  • continue to apply the treatment for 48 hours after the flare-up has cleared up

If you are using corticosteroids on a long-term basis, you may be able to apply them less frequently. Your GP will advise you about how often you should be applying them.

Also speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved.

Side effects

Topical corticosteroids may cause a mild burning or stinging sensation as you apply them. In some areas, they may also cause:

  • thinning of the skin, particularly in the crease of your knee joint
  • telangiectasia (visible blood vessels) - particularly on the cheeks  
  • acne (spots) 
  • increased hair growth

Generally, using a stronger topical corticosteroid or using a large amount of topical corticosteroid will increase your risk of getting side effects. For this reason, you should use the weakest and smallest amount possible to control your symptoms.

Graduated elastic medical compression stockings

Medical compression stockings are specially designed to steadily squeeze your legs to help improve your circulation. They are often tightest at the ankle and get gradually looser as they go further up your leg. This encourages your blood to flow upwards towards your heart.

Medical compression stockings are used to treat varicose eczema and lipodermatosclerosis. This is because it is thought that they improve the condition of the skin by reducing the high blood pressure in the veins in the leg. They are an important part of your treatment.

Compression stockings are available in a variety of different sizes and pressures. Most people with varicose eczema will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking. They are also available in:

  • different colours
  • different lengths - some come up to your knee and some also cover your thigh; you should only need knee-high stockings for varicose eczema 
  • different foot styles - some cover your whole foot and some stop before your toes

Compression tights are also available, but not on the NHS. They can be bought from pharmacies or directly from the manufacturers.

Wearing compression stockings

You will usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Wearing compression stockings can be uncomfortable, particularly during hot weather, but it is important to wear them correctly to get the most benefit from them.

Pull them all the way up so that the correct level of compression is applied to each part of your leg. Do not let the stocking roll down or it may dig into your skin in a tight band around your leg. Speak to your GP if the stockings are uncomfortable or if they do not seem to fit. It may be possible to get custom-made stockings that will fit you exactly.

If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure that your stockings will be the correct size. If your legs are often swollen, they should be measured in the morning when any swelling is likely to be minimal.

Take care when taking your compression stockings on and off because this can damage fragile skin. If you have a leg ulcer, it ideally needs to heal before you start wearing compression stockings.  

Caring for compression stockings

Compression stockings usually have to be replaced every three to six months. Speak to your GP if your stockings become damaged, as they may no longer be effective. 
 
You should also be prescribed two stockings (or two sets of stockings if you are wearing one on each leg) so that one stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat.

Treatment of varicose veins

The combination of skin care and compression stockings will help many people with varicose eczema. However, in some cases the eczema persists. In people with severe skin damage due to venous disease, such as lipodermatosclerosis or a venous ulcer, investigation and treatment of the underlying venous disease will cure the problem in the long-term.

The most common venous disease that causes skin damage is varicose veins. Your doctor should suggest referral to a vascular surgeon who can arrange for colour duplex ultrasound imaging of the leg to find the faulty blood vessels. Treatment of the varicose veins can then be planned.

Several modern methods are available that will cure varicose veins and resolve associated varicose eczema, lipodermatosclerosis and venous ulcers. These are usually performed in the day surgery department of a hospital.

For more information about all the possible treatments, see Varicose veins - treatment options.


Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Ulcers
An ulcer is a sore break in the skin, or on the inside lining of the body.
Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
 
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