Trophic venous eczema of the lower extremities - symptoms, diagnosis and treatment

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Varicose eczema is a disease that occurs as a complication of varicose veins caused by stagnation of blood in altered veins. As a result of circulatory disorders, atrophic processes occur in the skin adjacent to the causative area. This may be the result of thrombophlebitis, for which inadequate and untimely treatment was prescribed. But the most common reason is the lack of treatment for varicose veins.

According to statistics, the disease is more often observed in older people, more often in women.

Trophic venous eczema - what is it?

Trophic venous eczema is a pathological condition that occurs in the form of autoimmune dermatitis, that is, serous non-infectious inflammation of the skin (mostly the papillary layer of the dermis and epidermis), accompanied by symptoms of swelling, redness, itching and pain.

Trophic venous eczema

Venous eczema is a type and common form of eczema, which is caused by congestion in the skin due to impaired venous outflow. Venous eczema is also called varicose, congestive or gravitational. It most often has a chronic (recurrent) course. The pathology affects one or both lower extremities in combination with venous insufficiency. In the modern European, and most popular among leading experts, classification of chronic venous diseases - CEAP, this pathology is designated as C4a. This means quite severe tissue damage due to chronic venous edema.

University

Modus vivendi decided to understand the “target audience” of eczema, learn about risk factors and treatment methods. Vadim MALYUTIN, a dermatovenerologist at the medical diagnostic laboratory “SINLAB”, acted as a consultant.

UPDATED

— Eczema refers to various skin problems, so it is often considered not as a separate disease, but as a syndrome. Eczema is a fairly common phenomenon; with varying degrees of intensity, it can appear on the hands, torso, legs, and face. The syndrome can also be a companion to other diseases (for example, atopic dermatitis), and, despite the fact that it does not pose a serious health hazard, the patient’s quality of life is noticeably impaired. The resulting itching and burning interfere with usual activities during the day, disrupting the work rhythm - this is especially true for areas of activity where the patient works with irritating substances.

KINDS

— Most often in practice we register coin-shaped eczema. It is characterized by the formation of sharply demarcated lesions with rounded outlines measuring 1-3 cm. This type of disease often worsens during the cold season - due to a drop in relative air humidity, the skin is more prone to drying out.

Dyshidrotic (palm, plantar) eczema, on the contrary, can worsen in hot weather: increased sweating provokes rashes on the palms and soles. Among the varieties, varicose eczema is distinguished, affecting the legs of patients: it occurs in people with impaired venous outflow from the lower extremities.

As already noted, eczema (the same coin-shaped or palmar) can appear with atopic or allergic contact dermatitis. In such cases, it depends only on the doctor how to correctly qualify the problems that have arisen.

CAUSES

— Despite the fact that eczema has been known for a long time, the causes of its occurrence are difficult to study. There is no single theory explaining the occurrence of the disease and symptoms. According to one theory, increased sensitivity to microbes (chronic tonsillitis, caries, microbes on the skin, etc.) can lead to the manifestation of the syndrome.

We can talk about provoking factors, the main of which for various types of eczema is dry skin. Heredity plays a big role in skin diseases. Irritation can be caused by antiseptics - substances that wash away the lipid mantle (fat layer) from the epidermis. These, for example, include various fuels and lubricants. Despite the fact that eczema does not have occupation-related risk groups, doctors, hairdressers, builders (contact with cement), and bakers (contact with flour) should be especially careful.

If possible, it is advisable to exclude a stress factor that can lead to the formation of eczema and relapses. Do not forget that eczema tends to worsen due to alcohol consumption, so you should not “treat” one risk factor by consuming another.

SYMPTOMATICS

— According to complaints, the patient may be bothered by intense itching and the presence of rashes, which are the main clinical picture of the syndrome. The term “eczema” comes from the Greek word for “boiling,” which in turn reflects the appearance of the disease. Dense bubbles appear in the affected areas, which burst over time, the liquid dries out, causing crusts to form. At the same time, the skin around the lesions, often scratched (patients cannot control the itching), may be dry.

DIAGNOSTICS

— Diagnosis in dermatology is usually made based on two components: a survey of the patient and the clinical picture. If the patient has not been examined before, he may be recommended to consult an ENT doctor or dentist to look for foci of chronic infection - tonsils, caries, etc.

Laboratory tests are needed only if the dermatovenerologist needs to exclude other diseases. In such cases, a skin biopsy is taken for histological examination. But this is the exception rather than the rule. Usually, it is enough to consult an experienced doctor who is well versed in eczema, allergic and contact dermatitis and will be able to make the correct diagnosis and select individual treatment for the patient.

TREATMENT AND PREVENTION

— Treatment should be prescribed by a dermatovenerologist. You should not self-medicate. The main approach is to eliminate the triggers discussed above. Try to avoid stress, give up alcohol, and avoid contact with irritating substances. If varicose eczema appears as a result of venous insufficiency, you need to contact a surgeon who can advise on the possibilities of correcting the function of the veins.

External treatment is aimed at restoring the skin barrier. Despite the fact that the lesions get wet, the skin itself is dry, so it is necessary to regularly use moisturizers.

Especially when it comes to eczema on the hands, which is caused by irritating substances: while washing your hands, soap degreases the skin, so you need to constantly moisturize it.

You can use hormonal ointments in short courses (no more than two weeks). There are other, longer-term regimens for their use, but such a course must be completed under the supervision of a dermatovenerologist. In severe forms of eczema, systemic hormones are used for a short course - they are needed to relieve the acute reaction, then external therapy is prescribed.

Ultraviolet light helps patients with atopic dermatitis and eczema. During the cold season, you can attend special procedures or go on vacation to warm countries. However, when relaxing at sea, you need to take into account the fact that salt water can dry out the skin. In this case, it is better to refrain from swimming. You also need to remember about the carcinogenic effect of ultraviolet radiation. The risk of getting skin cancer later is greater in people who have had sunburn in the past, so try not to get sunburned in the southern sun.

To reduce itching, the doctor may prescribe antihistamines: they do not have a therapeutic effect, but will help relieve symptoms and improve night sleep. Do not forget that a wet surface is a breeding ground for microbes, which can cause pustular complications. In such situations, wet lesions are treated with aniline dyes (brilliant green solution, etc.).

It should be remembered that eczema is a chronic disease that cannot be cured, but can be successfully controlled. Avoid provoking factors, follow doctors' recommendations, and your quality of life will not suffer.

Help Modus vivendi. Vadim Malyutin in 2008 Graduated from BSMU with a degree in general medicine. Assistant at the Department of Skin and Venereal Diseases of the Belarusian State Medical University, dermatovenerologist at the medical diagnostic laboratory "SINLAB". Author: Evgeny Vladimirov BelGazeta , March 21, 2016

Why does trophic venous eczema occur?

Venous eczema is most often observed in middle-aged and elderly patients - according to leading European dermatologists, it affects up to 20% of patients over 70 years of age. This is due to the following reasons:

Phlebeurysm.
Previous deep vein thrombosis of the affected limb.
The presence of venous trophic ulcers.
Previous cellulitis on the affected limb.
Chronic swelling of the lower leg, aggravated by hot weather and prolonged static position (standing).

The main cause of the pathology is varicose veins, which is why you can sometimes come across the term “Varicose eczema”.

Venous eczema of atypical localization

Quite often, signs of eczema can be found in young patients with a long history of varicose veins. There is no doctor, both in public and private clinics, who would not observe venous eczema in patients under 40 years of age.

Symptoms of the disease

The sooner treatment is started, the higher the chances of getting rid of the disease. Therefore, it is important to know what symptoms it begins with. Main signs in the initial stages:

change in skin tone in the leg area: first, areas of the skin turn pale, then become dark red, with a purple tint;
cramps of the calf muscles;
small rashes on the skin;
itching that accompanies the rash.

If measures are not taken, ulcers form, and then scarring changes in the skin, and this is an irreversible process. As the disease progresses, sclerotic changes in the epidermis form and folds appear.

Secondary ulcers appear when a bacterial infection occurs.

Trophic venous eczema is very bad

Varicose eczema has a chronic, relapsing course and a tendency to progress. Quite often you can encounter a situation, especially in public hospitals, when only dermatologists treat venous eczema. Considering the main etiological component of the pathology, impaired venous outflow, treatment of such patients takes years.

Chronic recurrent eczema on the right lower limb

The disease slowly recedes, but invariably appears again. Moreover, trophic changes in the lower extremities progress, lipodermatosclerosis occurs, and then an ulcer appears.

Why does trophic venous eczema almost always appear on the lower extremities?

The answer to this question lies in the pathogenesis of varicose veins, the dominant cause of venous eczema. Varicose veins affect exclusively the lower extremities, where, according to the gravity gradient, it is in their distal parts that trophic disorders occur. One of which is venous eczema.

Trophic eczema of the lower extremities

Pathological eczematous changes in the skin of the lower extremities are most often caused by varicose veins, since they are the cause of impaired venous outflow (up to 90% according to leading experts in the region).

Prevention

For prevention, two types of care products are used.

Moisturizing products with powerful emollients, such as urea and glycerin, soften and prevent the body from drying out due to the fact that, distributed in the outer layers of the epidermis, they attract moisture. They are applied throughout the day as needed.
Natural oils, waxes and silicones create a protective barrier on the surface of the skin, preventing moisture evaporation. They are best used after a shower and applied to a damp area of the body.

Trophic venous eczema - diagnosis

Diagnosis of venous eczema in public and private urban medical institutions often begins in a dermatologist’s office, where a specialist evaluates local changes in the skin. It is very important here that the patient is referred to a good phlebologist in a timely manner. If eczematous changes are associated with venous pathology, then treatment of skin manifestations only is likely to be ineffective. Even a visual examination by a phlebologist using all kinds of functional tests often does not reveal the true cause of the pathology. At this stage, the best solution would be a good ultrasound examination of the veins of the lower extremities.

Ultrasound diagnosis of trophic venous eczema

Only competent modern diagnostics of the venous system will help determine the correct treatment tactics.

Non-hormonal ointments

The formula of non-hormonal anti-eczema pharmaceutical products includes various compounds that mitigate the symptoms of the disease. In some cases, using one of the non-hormonal ointments is sufficient to achieve remission. Combination medications are aimed at several components of the disease at once. They work well and have no systemic complications. Local adverse events vary depending on the formulation.

Akrustal

The active ingredient of this brand is solid oil. It helps with flaking, itching, and inflammation, although the exact mechanism by which it works is unclear. Solidol causes contact dermatitis, so upon first use it is necessary to test the reaction on a small area of the body surface. With prolonged use, oil acne appears due to the fact that solid oil clogs the ducts of the sebaceous glands. If such a reaction occurs, it is recommended to apply Akrustal every other day.

Boron-zinc-naphthalan ointment

This is a combination drug that is used for inflammatory diseases of the epithelium. Boric acid in its composition is an antiseptic. Zinc oxide dries and has an astringent effect, which is useful for weeping. Naftalan oil has a strong anti-inflammatory effect, relieves redness and itching, and cleanses the skin.

Heparin

Contains heparin, which resolves blood clots in the veins and improves blood flow. Thanks to auxiliary additives that dilate blood vessels in the dermis and increase tissue permeability, heparin is more easily distributed under the skin in the area of application. In addition, the composition includes a local anesthetic, which reduces itching, pain and the feeling of fullness. This ointment is useful against venous eczema, but is not effective against atopic eczema on the arms, face and torso.

Dermasan

This is a liquid with a very simple composition, which is used for dry skin, irritation and cracks. Glycerin softens and soothes, and ethyl alcohol destroys germs.

Levomekol

A combined drug that has a wound-healing effect and also fights bacteria that cause infection.

Losterine

A series of combined agents that have a good therapeutic effect for atopic dermatitis. A unique component of the Losterin series is naftalan oil, a powerful anti-inflammatory agent that soothes irritation, reduces swelling, itching and redness, and promotes healing. In addition, among the active ingredients are urea, which is a good emollient, salicylic acid (softens and exfoliates), D-panthenol and almond oil.

Methyluracil

Methyluracil enhances metabolism in epithelial cells, stimulates their division and promotes regeneration.

Radevit

The working components of Radevit are vitamins A, E and D. Vitamin A promotes the renewal of epithelial cells. Vitamin E is an excellent antioxidant. Vitamin D fights inflammation and improves cell nutrition.

Salicylic

Salicylic acid softens scales and helps cleanse the skin in case of eczematous lesions. It also regulates the functioning of the sebaceous and sweat glands, which is useful for seborrheic dermatitis. Thanks to its antiseptic properties, it prevents infection of epidermal lesions. Contraindicated for children.

Skin Cap

Skin Cap cream and shampoo contain the therapeutic component zinc pyrithione. The main direction of Skin Cap's work is anti-inflammatory. It softens the epithelium, eliminates itching and flaking. Active against fungi that support inflammation and flaking in seborrheic dermatitis. Zinc pyrithione also fights bacteria that complicate eczema.

Solipsor

Solipsor products contain medical grease and birch tar, which fight inflammatory manifestations, and natural herbal extracts soothe, eliminate itching, and destroy microorganisms. Solidol sometimes provokes contact dermatitis, so for the first time Solipsor should be tried on a small area.

Thymogen

Thymogen regulates cell renewal, stimulates tissue regeneration and healing.

Zinc paste

Having drying and astringent activity, zinc paste makes it easier to get wet.

Elidel

A highly effective medicine, comparable in strength to hormones. Elidel, penetrating into the dermis, inhibits the division of immune cells responsible for the formation of inflammation and blocks the release of allergy mediators. Elidel does not cause atrophy, does not affect general immunity (even when taken orally, in the form of tablets), and does not reduce resistance to infections. Approved for children from 3 months of age, but not yet sufficiently studied during pregnancy. Adverse reactions such as infection at the site of application are rare with very long-term use.

Emolium

This is a line with significant moisturizing activity. Emulsion Emolium contains natural oils, urea, paraffin oil and other emollients, that is, substances that help the body retain moisture as much as possible.

Eplan

Contains a solution of lanthanes in glycerin - the active Glycolan complex, which promotes skin regeneration and rapid healing of damage, and also prevents infection.

Trophic eczema, treatment in Moscow

Good treatment of venous eczema in Moscow can be divided into local (topical effect on skin inflammation) and treatment of the venous system. In the first, a dermatologist is often actively involved. Local treatment includes:

Ointments and creams, steroid drugs, both as part of the latter and as part of systemic treatment.
The use of antibiotics and antiseptics when an infection occurs.

Often, in the conditions of public medicine, patient care ends at the stage of the above topical treatment. This is not the best solution, since the disease is based on completely different reasons and a relapse of the disease will not take long to occur. Namely, venous stasis, which requires a slightly different approach. It is very important that a patient in Moscow has a timely appointment and diagnosis with a good phlebologist who can determine the correct tactics for managing the patient. The treatment of venous eczema is based on eliminating stasis and improving venous blood flow. Correction of the latter most often involves removing pathologically altered varicose veins. The presence of innovative technologies in modern Moscow centers makes it possible to effectively treat even complicated forms of varicose veins, moreover, on an outpatient basis.

Treatment of trophic eczema in our phlebology center

Leading medical centers in Moscow for the treatment of venous pathology use thermoobliteration techniques for these purposes. In a good city medical phlebology center you can count on safe, effective treatment. Modern vein removal procedures are performed under local anesthesia through skin punctures with minimal surgical trauma.

Bibliography

Dakhovsky, A. Skin diseases / A. Dakhovsky, N. Stogova. - M.: Book on Demand, 2011. - 761 p.
Gadzhimuradov, M. N. Clinical features of Kirle’s disease [Text] / M. N. Gadzhimuradov // Clinical dermatology and venereology. - 2022. - No. 1. - P. 16-19.
Zudin B.I. Skin and venereal diseases. Textbook. Ed. 2nd, revised and additional - M.: Medicine, 1996, 256 p.
Sokolova, T. V. Strategy for choosing external therapy for microbial eczema [Text] / T. V. Sokolova, A. P. Malyarchuk, L. A. Safonova // Clinical dermatology and venereology. - 2022. - No. 3. - P. 46-63.
Therapy of chronic dermatoses [Text]: [conversation with Ph.D. Assoc. department Dermatovenerology of the First Moscow Moscow. honey. University named after I. M. Sechenova T. A. Belousova / interviewed by N. Marchenko] // Medical Council. - 2017. - No. 11. - P. 80-82. 88.
UVB 311 NM phototherapy for immune-dependent dermatoses [Text]: educational method. allowance / E. S. Ponich [etc.] // Physiotherapist. - 2017. - No. 2. - P. 57-64.

Trophic varicose eczema - treatment without surgery

The main factor in the development of congestive eczema is the pathology of the venous system. Therefore, there is no need to talk about any effective treatment without radical intervention. The best solution would be to stop the inflammation and carry out a procedure to remove varicose veins. But is surgery really that scary?

Trophic eczema - laser treatment in our center

Modern European technologies for vein removal are not inferior to advanced manipulations in dentistry in terms of minimal surgical trauma and possible side effects. But today it would not even occur to anyone to refuse caries treatment due to fear of intervention.

Trophic venous eczema - laser treatment (EVLO, EVLT), radiofrequency treatment (RFA, RFO)

Considering that radical treatment of varicose eczema is the treatment of venous pathology, it is modern methods of removing varicose veins that will be the main way to combat eczema itself. Today, the undisputed leaders at the forefront of innovative treatment of varicose veins are thermal obliteration techniques, laser and radiofrequency. If we compare both technologies, there are simply no fundamental differences for the patient.

Treatment of trophic eczema with radiofrequency

What are the advantages of thermoobliteration technologies:

Radicality and effectiveness (when used by experienced specialists, the result is practically 100%).
Low invasiveness, the procedure is carried out through skin punctures.
Highest cosmetic value.
Full outpatient, no need for anesthesia or hospitalization.
Safety and comfort of the procedure for the patient.

The result of laser treatment of trophic eczema after 1 month

After endovascular treatment, the symptoms of eczema quickly resolve on their own.

Using a laser

Laser radiation has proven to be very effective in eliminating the root cause of varicose eczema. In this case, the laser’s task is to restore blood flow. The procedure is very effective, painless and completely safe, but only when it is used by an experienced doctor.

The essence of the procedure is that a special catheter is inserted into the lumen of the vein through a small puncture, at the end of which a light guide is placed. By pulling the light guide along the catheter, the lumen of the vein is treated with laser radiation. The procedure is performed very carefully, at intervals; one advance of the light guide takes no more than five centimeters of the damaged vein.

This technique is good, among other things, because it does not leave scars or scars, since it does not involve stitches. Upon completion of the procedure, the puncture site is covered with a sterile bandage. After some time, the previously affected vein begins to become overgrown with connective tissue, and subsequently resolves. During the recovery process, it is important to properly monitor the condition of the skin, use restorative creams, wear compression garments, and avoid contact with direct sunlight.

Results of treatment of trophic venous eczema. Photos before and after treatment

The result of treatment of trophic eczema using endovenous laser coagulation (EVLC) using German Biolitec technology in our center

Photos before and after treatment of trophic eczema on the left lower limb

The result of treatment of trophic venous eczema using radiofrequency ablation (RFA) in our patient

Photos before and after treatment of trophic venous eczema on the left lower limb

Questions and answers

Are there differences in the causes of eczema on the hands and eczema on the feet?

The appearance of foci of inflammation on the extremities is in most cases associated with traumatic factors or exposure to aggressive chemicals. The formation of vesicles or weeping on the body is often the result of allergic reactions and systemic pathologies identified in patients.

What are the main clinical recommendations for diagnosed eczema?

A patient with a confirmed diagnosis of eczema should discuss with a dermatologist the advisability of consultations with other doctors: endocrinologist, allergist, gastroenterologist. Their use can reduce the frequency of exacerbations of the disease and reduce the intensity of reactions to factors that provoke the inflammatory process.

Do patients with chronic eczema need to take any medications regularly?

Drug and hardware treatment along with courses of physiotherapy are prescribed during periods of exacerbations. After relief of acute symptoms of the disease, the patient does not need to systematically take medications. A significant role during this period is played by the child or adult’s compliance with the recommendations of the attending physician and preventive measures.

Frequently asked questions from patients on the Internet about trophic venous eczema

How to treat venous eczema of the legs in Moscow?

For good treatment of venous eczema of the lower extremities in Moscow, you need to contact a competent specialist, a phlebologist. The doctor will conduct a detailed diagnosis, including an ultrasound examination. Only after this can we talk about modern treatment. The best solution would be to find a good city phlebological center, where the ultrasound will be performed by the phlebologist himself.

What is the modern treatment for venous eczema of the legs in Moscow?

In Moscow, good modern treatment of venous eczema that meets European standards includes innovative technologies for both diagnosis and treatment. Leading city phlebological centers, including our Moscow Innovative Phlebological Center, successfully treat venous eczema. First, a detailed duplex angioscanning of the venous system of the lower extremities is performed. Only then is treatment prescribed, including the fight against local inflammation and modern treatment of the true cause of eczema, varicose veins.

How to treat venous eczema with folk remedies?

Specialists of the Moscow City Phlebological Center have good experience in working with various trophic disorders in venous diseases, including venous eczema. Leading phlebologists at our center do not recommend treating venous eczema with folk remedies. The disease responds well to treatment using modern technologies, but we often encountered serious complications after treatment with folk remedies.

My mother has venous eczema on her legs, which doctor is best to see?

If you suspect that your mother has venous eczema, it is better to first contact a good phlebologist, a doctor specializing in the diagnosis and treatment of venous pathology. First you need to understand the cause of inflammation in the lower extremities. You may need the help of a dermatologist. If eczema is of venous origin, then now there are modern European technologies with the help of which curing your mother will not present any special problems.

Causes of varicose veins

Blood circulates continuously in the human body; the heart, veins and arteries take a direct and constant part in this movement. Through arteries, blood moves from top to bottom, through veins, on the contrary, from bottom to top, to the heart. The blood moves upward in spurts, fixing itself in the places where the valves are located, and the valves, in turn, prevent the blood from returning back down. Thus, blood moves freely from one valve to another.

This movement of blood occurs with proper and complete functioning of the muscles of the lower extremities. But if the valve does not contract enough, then some of the blood returns down, which leads to an increase in venous pressure and subsequent dilation of the veins. The result is stagnation of blood in the veins.

What could cause valve malfunction?

The reasons may be both external factors and genetic disposition. The veins contract with the help of the muscles located around them. If a person has a sedentary lifestyle or a job that requires constant sitting, such as driving a car or office work, then the muscles become inactive and weak, which leads to poor circulation and, accordingly, to venous diseases.

External factors and causes of varicose veins can be:

- excess weight

- pregnancy

- taking hormonal medications

- menopause

- loads on the lower limbs

- sedentary lifestyle

- work that requires constant sitting (driving a car, office work)

- work that requires constant standing without the possibility of rest or change of body position (surgeons, teachers, salespeople)

- frequent wearing of high-heeled shoes

- wearing tight underwear

- Frequent carrying of heavy bags