Venous eczema, also called stasis or varicose eczema, is an inflammatory skin condition that primarily affects the lower legs. It arises in areas of chronic venous insufficiency, where impaired return of blood from the legs causes increased pressure in leg veins and changes in local tissues. The skin reaction ranges from reddish-brown discoloration and scaling to swelling, thickening and, in advanced cases, painful ulcers. Venous eczema is a chronic condition: episodes of inflammation often recur unless the underlying venous problem is addressed.
Why Does Venous Eczema Develop?
The central cause is venous hypertension — raised pressure inside leg veins that results from valve failure, obstruction or reduced calf-muscle pump function. Persistently raised venous pressure causes leakage of fluid and blood components into the skin and subcutaneous tissues. This leakage triggers inflammation, deposition of pigmented blood products, fibrosis and skin barrier disruption. Recent work emphasizes an inflammatory cascade with immune mediators and microvascular changes that sustain the dermatitis and lead to fibrosis and ulceration if untreated. In short, the skin changes are a downstream effect of chronic circulatory disturbance rather than a primary skin disease.
How Does Venous Eczema Usually Present?
Patients typically notice itchiness and redness on the lower legs, often around the ankles. The affected skin may become dry, scaly and thin; over time it frequently darkens (hyperpigmentation) because of haemosiderin from leaked red blood cells. Repeated inflammation can cause the skin to thicken and take on a leathery texture. Swelling (oedema) is common and may fluctuate during the day. Scratching and secondary bacterial infection may lead to open sores and venous leg ulcers. Symptoms are usually worse when standing and may improve after leg elevation. Clinical variability is large — not everyone with venous reflux develops eczema, and presentations range from mild, intermittent flares to chronic inflamed skin with ulceration.
How Is Venous Eczema Diagnosed?
Diagnosis is clinical and is based on the pattern of skin changes, location on the lower legs, the presence of varicose veins or leg swelling, and a compatible medical history (for example prior deep vein thrombosis or long periods of standing). A careful skin examination seeks signs of alternative diagnoses that can mimic venous eczema, such as contact dermatitis, arterial disease, or certain inflammatory dermatoses; in atypical or treatment-resistant cases a dermatologist may perform skin biopsy or patch testing. Duplex ultrasound of the leg veins is the standard test to document venous reflux or obstruction and to guide vascular treatment decisions. Laboratories or skin swabs are used if infection is suspected.
Can Dermatoscopy Assist in Diagnosing Venous Eczema?
A dermatoscope is a handheld, non-invasive device that magnifies the skin and uses polarized or non-polarized light to visualize structures beneath the surface layer. In venous eczema, dermoscopy may reveal non-specific but supportive features, including:
•A diffuse reddish or coppery background, reflecting chronic inflammation and hemosiderin deposition
• Irregular or dotted vascular patterns, related to venous congestion and capillary dilation
• Yellowish or white scales, indicating epidermal barrier disruption
• Brownish pigmentation, consistent with chronic blood extravasation
•Occasionally, areas of white structureless zones, which may correspond to fibrosis in long-standing disease
How Is Venous Eczema Treated?
Treatment follows two parallel goals: reduce venous hypertension and control the skin inflammation.
Reducing venous hypertension is the fundamental step because it addresses the root cause. Graduated compression therapy — delivered by properly fitted compression stockings or bandages — is the mainstay of conservative treatment. High-quality reviews find that compression reduces swelling, improves symptoms and speeds healing of venous ulcers compared with no compression; higher compression is more effective but may be less well tolerated, so fitting and patient education are essential. When appropriate, interventional procedures (for example endovenous ablation or superficial vein surgery) may be considered to correct reflux; these are decided by a vascular specialist after duplex mapping.
Controlling skin inflammation is equally important for symptom relief and prevention of complications. Topical emollients restore and protect the skin barrier and should be applied regularly. For active inflammatory flares, topical corticosteroids of appropriate potency are commonly used to reduce redness and itch; they are effective when applied as directed for short courses or intermittently to control flares. If the skin is heavily inflamed, infected, or there is concern for bacterial superinfection, systemic or topical antibiotics may be prescribed following clinical assessment. Patient education on skin care and avoidance of irritants is part of standard management.
Are There Risks or Complications from Venous Eczema?
Yes. Persistent inflammation and skin breakdown increase the risk of secondary bacterial infection. Repeated or severe inflammation may evolve into skin thickening (lipodermatosclerosis) and, in some cases, full-thickness venous leg ulcers. Chronic oedema and fibrosis can reduce mobility and quality of life. Psychological effects are common because of pain, itching and visible skin change. Early recognition and combined vascular and dermatological care reduce these risks.
When Should Someone with Suspected Venous Eczema See a Clinician?
Seek medical attention if itching, redness or swelling of the lower leg is persistent, worsening, painful, or accompanied by open sores. Immediate care is needed for signs of infection (spreading redness, increasing pain, pus, fever) or when mobility is reduced. Early assessment by a clinician allows diagnosis, initiation of appropriate skin care, and referral for vascular testing when indicated; coordinated care between primary care, dermatology and vascular services improves outcomes.