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Venous eczema

Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Updated January 2016.

What is venous eczema?

Venous eczema is a common form of eczema / dermatitis that affects one or both lower legs in association with venous insufficiency. It is also called gravitational dermatitis.

Who gets venous eczema?

Venous eczema is most often seen in middle-aged and elderly patients—it is reported to affect 20% of those over 70 years. It is associated with:

What causes venous eczema?

Venous eczema appears to be due to fluid collecting in the tissues and activation of the innate immune response.

Normally during walking the leg muscles pump blood upwards and valves in the veins prevent pooling. A clot in the deep leg veins (deep venous thrombosis or DVT) or varicose veins may damage the valves. As a result back pressure develops and fluid collects in the tissues. An inflammatory reaction occurs.

What are the clinical features of venous eczema?

Venous eczema can form discrete patches or become confluent and circumferential. Features include:

Complications of venous eczema

How is venous eczema diagnosed?

Diagnosis of venous eczema is clinical.

Patch tests may be undertaken if there is suspicion of contact allergy.

What is the treatment for venous eczema?

Reduce swelling in the leg

Treat the eczema

Treatment for varicose veins

How can venous eczema be prevented?

Venous eczema cannot be completely prevented but the number and severity of flare-ups can be reduced by the following measures.

What is the outlook for venous eczema?

Venous eczema tends to be a recurring or chronic disorder lifelong. Treat recurrence promptly with topical steroids.

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