Varicose/venous eczema: symptoms and treatments

A patch of red, rough skin appears on the lower legusually above ankle (not on thighs or knees). This plate tends to peel. Crusts form and, above all, « the person feels the instantaneous need to scratch », explains Dr. Nicolas Néaume, vascular doctor and general secretary of the French Society of Phlebology.

“It’s not an eczema like any other. It has nothing to do with atopic dermatitis or an allergy,” he specifies. The problem is, in fact,venous origin.

In this particular case, the eczema is linked to venous insufficiency. The lower limb veins are no longer tonic enough to bring blood back to the heart. By stagnating in the legs, the blood exerts excessive pressure on the wall of the vein. This expands and, over time, a varicose vein forms.

In fact, the disease evolves gradually and in several phases. Varicose eczema manifests at stage C4, according to a classification used by vascular doctors:

• stage C0: the person complains of heaviness in the legs.
• stage C1: small vessels become visible on the surface of the skin.
• stage C2: a varicose vein is diagnosed on ultrasound.
• stage C3: a edema forms : the leg swells.
• stage C4: the skin changes appearance. It is at this stage that varicose eczema appears, but also other trophic disorders, that is to say related tovenous insufficiencyas the ocher dermatitis. We also talk about stasis dermatitis.
• stage C5: a sore, called an ulcer, forms. At this point, she manages to heal.
• stage C6: thevaricose ulcer can no longer heal, the wound becomes chronic.

Some people with venous insufficiency will only suffer from heaviness in the legs. But others will evolve, more or less quickly, towards varicose veins or even varicose eczema, in the absence of treatment. “The problem is that we don’t know which patients will progress to this advanced stage. Most likely, these are genetically predisposed people. Overweight, physical inactivity and the exercise of a profession requiring standing for more than six hours a day, such as hairdressers, pharmacists or air hostesses, are aggravating factors.observes Dr Néaume.

A vascular doctor (or angiologist) will place the varicose vein diagnosisafter performing a Doppler echo. This examination makes it possible to measure the blood flow in the leg, thanks to an ultrasound probe. Sometimes, a dermatologist, noting eczema in the leg, refers his patient to a vascular doctor to confirm the venous origin of the problem.

A cream topical corticosteroid, prescribed by a doctor, will help calm the inflammation. It is applied daily directly to the skin. Thanks to its action, redness and itching will gradually fade. « The eczema will regress in a few months, the time that the skin cells regenerate », explains the vascular doctor. However, the problem will not really be solved.

Indeed, the basic treatment of varicose eczema consists in removing the varicose vein. Intervention is needed because “a varicose vein never regresses on its own. It is better to treat it, especially if the patient is at the stage of trophic disorders”, insists Dr. Néaume.

the stripping, a surgical intervention consisting in pulling out the vein, is gradually being abandoned. To destroy the diseased vein, the vascular doctor now has two techniques: laser or radiofrequency. In both cases, the procedure takes place on an outpatient basis (no hospitalization) and under local anesthesia: “There is no longer any need for an incision. The probe is introduced into the vein using a needle. The patient returns home the same day and on his own two feet, without the need for a work stoppage. »

Venous insufficiency remains, however, a chronic disease. Varicose veins can recur on the same leg or on the other. Monitoring is therefore necessary, generally at the rate of an echo-doppler every year.

Varicose eczema that is left untreated will not heal on its own. On the contrary, it risks evolving unfavorably towards other pathologies:

• Ocher dermatitis is part of the trophic disorders (stage C4) that can affect the skin in a person suffering from venous insufficiency. “Typically, the skin on the calf turns brown forming a kind of sock. The skin is, in reality, tattooed by the iron of the blood which stagnates in the leg. This stain will not go away, even if the varicose vein is removed. We have no treatment to make it disappear,” emphasizes Dr. Néaume.
• Varicose ulcer is another possible complication. Damaged skin can become infected. This wound does not heal easily and requires special care. It happens that a contact eczema is added to the ulcer. In this case, the reaction is due to an allergy to the dressing applied to the wound or to the glue that holds it together.

For prevent the return of varicose veins, therefore limiting the risk of varicose eczema, you should consult in the slightest doubt. This is the only way to intervene as early as possible. « You must consult if the feeling of heavy legs returns, or in the event of cramps, edema and itching », advises Dr Néaume.

In prevention, physical activity is essential, combined with good hydration. “Human beings are made to walk. Remaining still, standing or sitting, does not allow the blood to have a sufficiently dynamic flow to rise correctly towards the heart. Walking at least 30 minutes a day will facilitate venous return,” reminds the vascular doctor. This regular exercise also helps to lose weight, another important point to relieve your legs.

For people who are forced to stand without moving for several hours a day, wearing socks or compression stockings will again facilitate the venous return and relieve the feeling of heavy leg.