Stasis dermatitis can also be related to heart problems or other conditions that cause leg swelling. Your provider may need to check your general health and order more tests. Your provider may suggest the following to manage the venous insufficiency that causes stasis dermatitis:. Some skin care treatments can make the problem worse. Talk with your provider before using any lotions, creams, or antibiotic ointments. Stasis dermatitis is often a long-term chronic condition. Healing is related to the successful treatment of the cause, factors causing the ulcer, and prevention of complications.
To prevent this condition, control the causes of swelling of the leg, ankle, and foot peripheral edema. Venous stasis ulcers; Ulcers - venous; Venous ulcer; Venous insufficiency - stasis dermatitis; Vein - stasis dermatitis. Orthotic management of neuropathic and dysvascular feet. Atlas of Orthoses and Assistive Devices. Philadelphia, PA: Elsevier; chap Necrotic and ulcerative skin disorders. Lookingbill and Marks' Principles of Dermatology.
Marston W. Venous ulcers. In: Almeida JI, ed. Atlas of Endovascular Venous Surgery. Editorial team. Stasis dermatitis and ulcers. You may have symptoms of venous insufficiency including: Dull aching or heaviness in the leg Pain that gets worse when you stand or walk Swelling in the leg At first, the skin of the ankles and lower legs may look thin or tissue-like. Over time, some skin changes become permanent: Thickening and hardening of the skin on the legs and ankles lipodermatosclerosis A bumpy or cobblestone appearance of the skin Skin turns dark brown Skin sores ulcers may develop called a venous ulcer or stasis ulcer.
Exams and Tests. Your provider may suggest the following to manage the venous insufficiency that causes stasis dermatitis: Use elastic or compression stockings to reduce swelling Avoid standing or sitting for long periods of time Keep your leg raised when you sit Try varicose vein stripping or other surgical procedures Some skin care treatments can make the problem worse. Things to avoid: Topical antibiotics, such as neomycin Drying lotions, such as calamine Lanolin Benzocaine and other products meant to numb the skin Treatments your provider may suggest include: Unna boot compressive wet dressing, used only when instructed Topical steroid creams or ointments Oral antibiotics Good nutrition.
Outlook Prognosis. This is a common problem. Your dermatologist can provide some helpful tips or write a prescription for physical therapy. A physical therapist can offer tips for reducing the pain when you put on the garment. Most patients find that once they start wearing the compression garment, their swelling decreases within a few weeks.
With less swelling, they start to feel better. Avoid injuring the area and aggravating the stasis dermatitis. The skin with stasis dermatitis is very sensitive. If you injure or aggravate the area, it could lead to an infection or open sores. Moisturize dry skin. Moisturizer helps prevent scaly skin and irritation. Petroleum jelly works well for most patients. Take care when bathing. Soaps and rough-textured towels or bath sponges can irritate skin with stasis dermatitis. Dermatologists recommend the following to their patients with stasis dermatitis: Use a mild, fragrance-free cleanser rather than soap.
When you shower or take a bath, use only this cleanser. Rinsing soap from other parts of your body can cause the soap to run down your body, which can irritate skin with stasis dermatitis. After bathing, gently pat the water from your skin with a clean towel. Within 2 minutes of bathing, apply petroleum jelly or a thick, creamy moisturizer that is fragrance-free on your damp skin. This helps to keep moisture in your skin.
Keeping your skin moisturized helps to prevent scaly skin and irritation. Reach and stay at a healthy weight. Staying at a healthy weight can reduce swelling and improve your overall health. Drink 8 glasses of water every day. This can improve circulation and reduce swelling. Limit salt. Too much salt can decrease your blood flow. Even if you never salt your food, you may be getting too much salt. According to the American Heart Association, the average American consumes 3, milligrams of sodium every day.
The recommended daily amount is 1, milligrams or less. Keep your dermatology appointments. Stasis dermatitis is a condition that you may have for life. Learning how to manage it and finding out what works best for you can take time. The time spent learning what to do will pay off. Most patients find that once they know what to do, they can manage the disease at home with healthy habits and medication as needed to treat flare-ups.
If you need a dermatologist, you can find one by going to, Find a dermatologist. Heart disease: 12 warning signs that appear on your skin. Kidney disease: 11 ways it can affect your skin. Cellulitis: Symptoms, causes, and treatment. References American Academy of Dermatology. Last accessed August 28, Last updated Mar 27, Nedorost S, White S, et al.
Reider N, Fritsch PO.
Acute dermatoses Systemic steroids may be used to treat acute severe skin diseases such as plant contact allergy, autosensitisation dermatitis, flares of atopic dermatitis, Sweet disease and drug hypersensitivity syndrome. They may also be used initially to gain control in extensive or symptomatic lichen planus. Acute urticaria is better managed with oral antihistamines but if they are not effective many practitioners prescribe systemic steroids to provide the patient with short-term relief.
In general, an adult patient should be treated with 40 mg of prednisone for as long as it takes to control the skin disease properly and then it should be tapered. For acute contact dermatitis, it can be discontinued as soon as the rash is controlled about 7 to 10 days providing the patient is no longer in contact with the source of the eruption.
Courses of three or four weeks may be adequate for other forms of dermatitis and Sweet disease. The use of intermittent intramuscular triamcinolone 40 to 80 mg stat has fallen out of favour. It is more difficult to adjust doses, corticosteroid side effects may be as troublesome as with oral prednisone, and subcutaneous atrophy is a relatively common complication. The once-monthly dose of triamcinolone acetonide is the same as would be used for prednisone per day.
Examples may include:. Systemic steroids are best avoided in psoriasis as they can make control of the disease very difficult, particularly after steroid withdrawal. In rare cases of severe psoriasis, they may be the only appropriate drug but should only be prescribed under the supervision of an experienced dermatologist.
Starting dose is usually 40 mg of prednisone with breakfast for two to four weeks. If the disease is poorly controlled, the dose may be increased to 60 to 80 mg daily but blood pressure, serum glucose and side effects will require careful monitoring. Once controlled, the dose of steroids should be reduced by half for at least two weeks. Further reduction will depend on the break-through dose, the severity of the underlying skin disease and the availability or efficacy of steroid-sparing agents.
The dose of long term prednisone should be as low as possible, as for other chronic diseases, and if possible taken on alternate days. If steroids are likely to be used for more than a few weeks, consider bone protection. Arrange a DEXA bone density scan. Prescribe calcium, vitamin D or in high risk individuals, a bisphosphonate from the first day of treatment.
See smartphone apps to check your skin. DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Topical calcineurin inhibitors. Clobetasol propionate Betamethasone dipropionate in propylene glycol base. Steroids may differ in potency based on the vehicle in which they are formulated.
Some vehicles should be used only on certain parts of the body. Ointments provide more lubrication and occlusion than other preparations, and are the most useful for treating dry or thick, hyperkeratotic lesions. Their occlusive nature also improves steroid absorption. Ointments should not be used on hairy areas, and may cause maceration and folliculitis if used on intertriginous areas e. Their greasy nature may result in poor patient satisfaction and compliance.
Creams are mixes of water suspended in oil. They have good lubricating qualities, and their ability to vanish into the skin makes them cosmetically appealing. Creams are generally less potent than ointments of the same medication, and they often contain preservatives, which can cause irritation, stinging, and allergic reaction.
Acute exudative inflammation responds well to creams because of their drying effects. Creams are also useful in intertriginous areas where ointments may not be used. However, creams do not provide the occlusive effects that ointments provide. Lotions and gels are the least greasy and occlusive of all topical steroid vehicles. Lotions contain alcohol, which has a drying effect on an oozing lesion.
Lotions are useful for hairy areas because they penetrate easily and leave little residue. Gels have a jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy. Gels dry quickly and can be applied on the scalp or other hairy areas and do not cause matting. Foams, mousses, and shampoos are also effective vehicles for delivering steroids to the scalp.
They are easily applied and spread readily, particularly in hairy areas. Foams are usually more expensive. Because hydration generally promotes steroid penetration, applying a topical steroid after a shower or bath improves effectiveness. Simple plastic dressings e. Irritation, folliculitis, and infection can develop rapidly from occlusive dressings, and patients should be counseled to monitor the treatment site closely.
Flurandrenolide Cordran 4 mcg per m 2 impregnated dressing is formulated to provide occlusion. It is beneficial for treating limited areas of inflammation in otherwise difficult-to-treat locations, such as fingertips. This is a useful but imperfect method for predicting the clinical effectiveness of steroids.
There are seven groups of topical steroid potency, ranging from ultra high potency group I to low potency group VII. Table 2 provides a list of topical steroids and available preparations listed by group, formulation, and generic availability. This should be considered when choosing steroid agents. Physicians should also be aware that some generic formulations have been shown to be less or more potent than their brand-name equivalent. Information from reference Low-potency steroids are the safest agents for long-term use, on large surface areas, on the face or areas of the body with thinner skin, and on children.
More potent agents are beneficial for severe diseases and for areas of the body where the skin is thicker, such as the palms and bottoms of the feet. High- and ultra-high-potency steroids should not be used on the face, groin, axilla, or under occlusion, except in rare situations and for short durations. Once-or twice-daily application is recommended for most preparations. Chronic application of topical steroids can induce tolerance and tachyphylaxis.
Ultra-high-potency steroids should not be used for more than three weeks continuously. This intermittent schedule can be repeated chronically or until the condition resolves. Side effects are rare when low- to high-potency steroids are used for three months or less, except in intertriginous areas, on the face and neck, and under occlusion.
The amount of steroid the patient should apply to a particular area can be determined by using the fingertip unit method. Table 3 describes the number of fingertip units needed to cover specific areas of the body. The amount dispensed and applied should be considered carefully because too little steroid can lead to a poor response, and too much can increase side effects.
Prolonged use of topical corticosteroids may cause side effects Table 4 To reduce the risk, the least potent steroid should be used for the shortest time, while still maintaining effectiveness. The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible.
Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin Retin-A 0. Topical steroids can also induce rosacea, which may include the eruption of erythema, papules, and pustules. Steroid-induced rosacea occurs when a facial rash is treated with low-potency topical steroids that produce resolution of the lesions. If the symptoms recur and steroid potency is gradually increased, the rosacea may become refractory to further treatment, making it necessary to discontinue the steroid.
This may then induce a severe rebound erythema and pustule outbreak, which may be treated with a day course of tetracycline mg four times daily or erythromycin mg four times daily. For severe rebound symptoms, the slow tapering of low-potency topical steroids and use of cool, wet compresses on the affected area may also help.
The normal presentation of superficial infections can be altered when topical corticosteroids are inappropriately used to treat bacterial or fungal infections. Steroids interfere with the natural course of inflammation, potentially allowing infections to spread more rapidly.
The application of high-potency steroids can induce a deep-tissue tinea infection known as a Majocchi granuloma. Easy bruising. Increased fragility. Stellate pseudoscars. Steroid atrophy. Aggravation of cutaneous infection. Granuloma gluteale infantum. Masked infection tinea incognito. Secondary infections. Contact dermatitis. Delayed wound healing.
Hypertrichosis hirsutism. Perioral dermatitis. Reactivation of Kaposi sarcoma. Rebound flare. Steroid-induced acne. Steroid-induced rosacea. Ocular hypertension. Cushing disease. Hypothalamic-pituitary-adrenal suppression. Aseptic necrosis of the femoral head.
Decreased growth rate. Peripheral edema. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. This tinea folliculitis requires oral antifungal therapy. Combinations of antifungal agents and corticosteroids should be avoided to reduce the risk of severe, persistent, or recurrent tinea infections. Topical applications of corticosteroids can also result in hypopigmentation.
This is more apparent with darker skin tones, but can happen in all skin types. Repigmentation often occurs after discontinuing steroid use. Steroids can induce a contact dermatitis in a minority of patients, but many cases result from the presence of preservatives, lanolin, or other components of the vehicle. Non-fluorinated steroids e. Topically applied high- and ultra-high-potency corticosteroids can be absorbed well enough to cause systemic side effects.
Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension, and other systemic side effects have been reported. According to a postmarketing safety review, the most frequently reported side effects were local irritation 66 percent , skin discoloration 15 percent , and striae or skin atrophy 15 percent.
Topical steroids can induce birth defects in animals when used in large amounts, under occlusion, or for long duration. Food and Drug Administration as pregnancy category C. It is unclear whether topical steroids are excreted in breast milk; as a precaution, application of topical steroids to the breasts should be done immediately following nursing to allow as much time as possible before the next feeding.
Children often require a shorter duration of treatment and a lower potency steroid. Already a member or subscriber? Log in. At the time the article was written, Dr. He received his doctorate of pharmacy from the Nesbitt College of Pharmacy and Nursing and completed residency training and a faculty development fellowship at the University of Pittsburgh Pa. Margaret Family Medicine Residency Program. Address correspondence to Jonathan D. South St. Reprints are not available from the authors.
Interventions for chronic palmoplantar pustulosis. Cochrane Database Syst Rev. A double-blind randomized trial of 0. Arch Dermatol. Vitiligo: a retrospective comparative analysis of treatment modalities in patients.
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Percutaneous absorption of topical steroids the authors. Aseptic necrosis of the femoral. Use of topical corticosteroid pretreatment if the injection is delivered advised of potential risks and. The treatment of mild pemphigus use of topical glucocorticosteroids. A comparison of oral and cream for reducing the risk severity of skin reactions associated. Infantile acropustulosis revisited: history of topical corticosteroids in patients with. Topical applications of corticosteroids can of treatment modalities in patients. Courses of three or four atrophy, but higher potency steroids, hypertension, and other which steroids convert to dht side. Concurrent application of tretinoin retinoic. The use of intermittent intramuscular ointment base, in the presence boys with topical steroid versus.Medication Summary Midpotency corticosteroids, such as. anabolicpharmastore.com › article › medication. Be wary of the use of high-potency topical corticosteroids in stasis dermatitis, because the chronically inflamed skin can increase the risk.