Gravitational Eczema - An Overview

Introduction

Gravitational Eczema, also known as venous or stasis, is a long-term skin disease affecting the lower legs. It most commonly occurs in patients with varicose veins, such as varicose eczema, also called gravitational eczema. Treatments are available to keep this disease under control.

What Is Gravitational Eczema?

Gravitational eczema is a common skin condition like eczema or dermatitis affecting both lower legs, which is caused by venous insufficiency. It is also called venous eczema or gravitational dermatitis.

Who Gets Gravitational Eczema?

Gravitational eczema is a skin disease most often seen in middle-aged and older patients. It is reported that it affects 20 percent of people above 70 years of age. It is associated with the following conditions ;

• History of venous thrombosis on the lower leg.

• History of cellulitis on the lower leg.

• Chronic swelling increased by hot weather and prolonged standing.

• Varicose veins (twisted and enlarged veins that are superficially seen under the skin).

• Stasis ulcers (open wound around the ankle or lower leg).

What Causes Gravitational Eczema?

Gravitational eczema occurs due to fluid collecting in the tissues and also due to an innate immune response. Usually, during walking, the leg muscles pump the blood in an upward direction, and valves in the veins prevent blood pooling. A clot in the deep leg veins or varicose veins damages the valves. Fluid collecting in the tissues and back pressure is developed with inflammatory reactions since it is caused by increased pressure in the leg veins. Some factors that increase the chance of causing this skin disease include,

• Gender- Gravitational eczema is more common in women.

• Obesity - Obesity can increase pressure in the leg veins.

• Pregnancy - Pregnancy also increases pressure in the leg veins.

• Increasing Age - Generally, people find it harder to move as they get old, affecting their circulation.

What Are the Clinical Features of Gravitational Eczema?

Venous eczema can appear as discrete patches or become confluent and circumferential. These clinical features include,

• Itchy redness.

• Blisters.

• Crusted papules or dry fissured and scaly plaques on one or in both the lower legs.

• Orange-brown macular pigmentation occurs due to hemosiderin deposition.

• Atrophie blanche (irregular white scars that are surrounded by red spots).

• The champagne bottle shape of the lower leg shows narrowing at the ankles and induration.

Sometimes legs may become swollen, and veins are visible on the legs at the day's end or after standing for a longer time. Some patients may also have other symptoms, such as,

• Discoloration of the skin.

• Tender and tight skin, which becomes hardened.

• Pain.

• Eczema also affects other parts of the body.

If not treated, leg ulcers are developed. In addition, long-lasting wounds are formed where the skin has been damaged.

What Are the Complications of Gravitational Eczema?

Complications that can occur in gravitational eczema are the following:

• Impetiginization - Secondary infection caused by Staphylococcus aureus resulting in yellowish crusts.

• Cellulitis - Infection with Streptococcus pyogenes leads to cellulitis. There may be redness, swelling, pain, fever, and a red streak up the leg. Swollen nodes are seen in the groin regions.

• Secondary Eczema - Eczema that spreads to other areas of the body are called secondary eczema.

• Contact Allergy - It is seen in one or more components of the ointments or creams used by the patients.

How Is Gravitational Eczema Diagnosed?

The diagnosis of venous Eczema or gravitational eczema is made clinically. Diagnosis is based on performing the following test.

Patch Test: This test is taken when there is suspicion of contact allergy. The patch test is a type of skin test used to identify the cause of possible allergic reactions on the skin. This reaction is called allergic contact dermatitis. Contact dermatitis is one type of skin reaction to something that comes in contact with the skin. This kind of allergic reaction usually causes inflammation (redness and itching).

What Is the Treatment for Gravitational Eczema?

Reduce Swelling in the Leg:

• Avoid standing for a longer time.

• Taking regular walks is essential.

• One's feet should be elevated while sitting. If one's legs are swollen, they should be placed above the hips.

• Elevating the feet overnight in the bed.

• During the initial phases of eczema, bandaging is essential to reduce swelling.

• When eczema has settled, compression socks or stockings are used as it helps for the long term. Patients can purchase moderately fitted high-compression socks from surgical supplies companies. Travel socks are adequate and easy to wear since they only have light compression, and they can also be bought from pharmacies and travel and sports stores. More compression is obtained by wearing two pairs of socks.

• At least some patients with venous disease can benefit from horse chestnut extract.

Treat the Eczema:

• Compresses made with Condy's solution (potassium permanganate or dilute vinegar on gauze).

• Oral antibiotics such as Flucloxacillin are prescribed for patients with secondary infections.

• Applying topical steroids starts with powerful steroid creams applied accurately daily to the patches until they flatten. After a few days, change to a milder steroid cream (for example, Hydrocortisone) until the itchiness on the patches gets resolved. Please consult with one's healthcare provider who has been using steroid creams for over a few weeks. Overusing the cream can cause thinning of the skin. Short courses of stronger preparation can be used sometimes if it is mandatory to control dermatitis. Ointments such as coal tar may also be helpful.

• Using moisturizing cream frequently keeps the skin and the legs smooth and soft. Urea cream is especially effective if the skin is very scaly.

• Protecting the skin from injuries that may result in infections or ulcerations can cause difficulty in healing.

Treatment for Varicose Veins:

• Seek help from a vascular surgeon regarding varicose veins.

• Varicose veins can be treated surgically by sclerotherapy or endovenous laser.

• Since the venous disease is progressive, varicose veins may develop again after a successful operation.

How Can Gravitational Eczema Be Prevented?

One cannot wholly prevent gravitational eczema, but treatment may reduce the disease's severity by following measures.

• Avoid prolonged sitting with legs down or prolonged standing.

• Using compression socks or stockings for the legs.

• Gravitational eczema patients can apply emollients frequently and regularly to dry skin.

• Avoid using soaps. Instead, use water alone or non-soap cleansers when bathing.

Conclusion

Gravitational eczema tends to be a chronic and recurring disorder for life long. Repeatedly treating with topical steroids may be helpful. Early treatment may prevent the severity of the disease.