What is Stasis Eczema
Stasis eczema is defined to be a venous eczema that occurs when there is venous insufficiency, or poor circulation in the lower legs. Venous insufficiency results when the valves in the leg veins that help push blood back to the heart begin to weaken and leak fluid.
This venous insufficiency can be caused by ageing, but can also signal serious underlying medical conditions like heart or kidney disease. In addition to the eczema, it is common to see water retention, hardening of the skin as well as ulceration.
In ancient TCM texts, names like Pouring Down Sore and Damp Toxin Sore were used to describe Stasis Eczema. This gives a very vivid imagery of how fluids are not able to circulate as well in the lower limbs due to gravity. The outcome is a festering of pathogenic substances in the calves and feet due to congestion, which ultimately affects the superficial skin.
Within this context, Chinese herbs are always used, and they are almost always combined with Precise Lymphatic Drainage to clear lymphatic congestion in the legs and ankles. This combination of approaches has worked for stasis eczema and is also successful for topical steroid withdrawal.
What does Stasis Eczema look like?
(1) Lower Limb Water Retention
Edema is an early feature of Stasis Eczema. Swelling first appears in the inner aspects of the ankle, and later spreads up to the shin, and down to the foot.
(2) Venous Hypertension
As the veins loose ability to pump blood and fluids toward the heart, varicosities begin to show around the top of the foot as well as the ankles. These are common characteristics of venous hypertension.
(3) Hyperpigmentation of the skin
Because the veins are unable to pump blood away from the lower limbs, heme starts to leave the blood vessels and present as purplish-brown discoloration on the skin
Eczema may start as an asymmetrical red patch around the ankle. This red patch may evolve into vesiculation and ultimately a weepy erosion. Over time, the area becomes scaly, and these scales are greasy and pigmented. Note that lichenification is not commonly seen in Stasis Eczema.
(5) Atrophie Blanche
This is translated as “White Atrophy” and describes small white plaques of sclerosis.
Who gets Stasis Eczema?
(1) People over 50 years old: This is why stasis eczema is associated with older folk.
(2) Women more than men: This is also thought to be due to the drop in the estrogen hormone in women after 50.
(3) As a result of an eczema flare: A version of this is possible with topical steroid withdrawal, where suddenly the lower limbs swell and skin condition worsens in the lower limbs.
Structural Causes of Stasis Eczema
(1) Absent Valves: This in an inherited condition, where the values are not damaged, but rather absent.
(2) Compromised muscle pump: Such a situation may result from neuromuscular diseases like Polio.
(3) Venous thrombosis: One known cause of this is the contraceptive pill, which causes a thrombus (blood clot) to block the deep veins, which then diverts the venous flow to the superficial vein, dilating them and causing valve insufficiency.
What is the difference between Stasis Eczema and ‘normal’ Eczema?
Stasis eczema and ‘normal’ eczema are both categorized under chronic dermatitis, involving skin inflammation to varying degrees. Common symptoms include itchy skin, redness, dryness, flaking, swelling or even blistering.
Stasis eczema is defined to be a venous eczema that occurs when there is venous insufficiency, or poor circulation in the lower legs. Venous insufficiency results when the valves in the leg veins that help push blood back to the heart begin to weaken and leak fluid. This venous insufficiency can be caused by ageing, but can also signal serious underlying medical conditions like heart or kidney disease.
Chronic venous insufficiency (CVI) is the underlying trigger for stasis eczema. The main problem causing CVI would be faulty valves. Healthy valves help maintain one-way blood flow from extremities back to the heart. When these valves are weakened or damaged, blood can flow backwards and pool in the lower legs, increasing venous pressure. Thus, the high pressure causes leakage of blood components into surrounding tissues, leading to skin inflammation.
On the other hand, ‘normal’ eczema or atopic dermatitis is defined to be the most common inflammatory skin disease worldwide, presently generalized as skin dryness, itch and rash. It can appear almost anywhere around the body.
‘Normal eczema’ starts as early as from the early stages of infancy, targeting 20% of children worldwide. All ages can be affected.
There is no single main cause for this condition, but there has been significant emerging data on how inflammation in atopic dermatitis is associated with immune-mediated abnormalities as well as a combination of genetic factors.
Additionally, the immune system plays an important role in atopic dermatitis. It is characterized by an abnormal immune response, including inflammatory response to irritants or allergens. This inflammation induced by the immune system can result in redness and itchiness, ultimately damaging the skin barrier, making it more vulnerable to external triggers.
It is often the ravaging of an imbalanced immune system by external triggers which creates the conditions for an eczema flare up. This is the case in both stasis eczema and atopic dermatitis eczema. Unfortunately, the older person suffering from stasis eczema often has a harder time recovering as the skin is already dry and compromised, which creates the very conditions that are prone to triggers and eczema flare ups!
The most obvious differences between stasis eczema and normal eczema is as follow:
- Stasis eczema affects mainly the skin of the legs (the stasis happens due to gravity being exerted on the lower limbs), while normal eczema can occur almost anywhere around the body.
- Stasis eczema usually occurs due to ageing, while normal eczema can start as early from infancy.
Treatment of Stasis Eczema vs Normal Eczema?
Treatment for stasis eczema is focused on addressing the underlying vascular issues, while the treatment for atopic dermatitis is centered on managing the immune system’s response and skin symptoms. Both conditions may require a multi-pronged approach, and treatment plans should be tailored to the individual’s specific needs and the severity of the condition.
To treat stasis dermatitis, there are a few approaches to reduce swelling in the legs, treating the eczema itself as well as treating the varicose veins. For recurring venous eczema, the most commonly used treatment is topical steroids. Topical steroids act on the skin cells and induce anti-inflammatory and immunosuppressive effects.
For oozing patches on the skin of the leg, potassium permanganate (PP) or diluted vinegar on gauze for compresses are used. Oral antibiotics can also be prescribed for secondary infections. Moisturizing cream can be used on dry, flaky areas.
Varicose veins are enlarged, swollen and often twisted veins that occur when one-way valves in the veins that become damaged or weak. When they malfunction, blood flows backwards and pool in the veins, causing them to swell and become varicose. To treat this, most patients consult vascular surgeons and undergo surgical procedures such as endovenous laser, or sclerotherapy. However, vascular disease may develop again even after the procedure since the condition is progressive.
Prevention is most definitely better than cure. To avoid the onset of stasis eczema, avoid prolonged standing or sitting down with pressure exerting on the legs to promote blood circulation.
How does TCM treat Stasis Eczema?
Chinese herbal medicine offers a holistic approach to treating skin conditions through the use of potent anti-inflammatory herbs. By addressing imbalances in the body and reducing inflammation, these herbs play a vital role in restoring harmony and promoting skin health.
For example, Forsythia or Lian Qiao is a potent anti-inflammatory herb widely used in TCM to clear heat and toxins from the body. In the context of skin conditions, Forsythia is particularly effective in addressing inflammation caused by excess heat in the epidermis. It is well suited for use in stasis eczema, especially as it relates to redness and papular skin lesions.
Another example would be Red Peony Root or Chi Shao. Red Peony Root is a versatile herb with anti-inflammatory and blood-cooling properties. It is commonly used to soothe skin conditions characterized by blood heat stuck in the interior. In older patients with stasis eczema, Red Peony Root is able to reduce the heat and bring down the inflammation and redness on the skin.
There are many other examples, but because your condition is unique, we advise that you come in for a consultation so we can see if we are able to help.