Do You Have Dermato Venous Disease?

Stasis dermatitis is a dermatologic presentation of a venous disorder.

For about a decade, Mary Anne Simpson’s lower legs were always a bit itchy. Initially, she thought the skin on her legs was just dry, so she slathered on moisturizing lotion. The lotion minimized the itching enough that she was able to live with it. Two and a half years ago, however, her legs became more itchy than ever, and she became concerned.Photos courtesy of Mary Anne Simpson.
“The itch became almost unbearable,” confides the Illinois native. “I really noticed it at night when I went to bed. Then, it got worse during the day. One day, my daughter asked me if I was okay. I said, No. I’m not okay.
“At first, I didn’t scratch. But as time went on, the itching got to the point where I couldn’t take it anymore. It was the kind of itch you get when you get bitten by a fire ant. I defy anyone to not scratch it. But not scratching didn’t help. It just got worse – to the point where it started to interfere with my life.
“I actually started to wear leggings while playing tennis because my legs were not only itchy but inflamed and unsightly. A woman on the tennis court even asked me once if I was contagious because my legs looked so bad. It was driving me out of my mind.”
During this time, Mary Anne visited several dermatologists, each of whom put her on oral steroid medications and gave her steroid creams to rub on her legs. The steroids cleared up the itching for a while, but as soon as she stopped taking them, the problem returned. Equally frustrating was the fact that each dermatologist she saw gave her a different diagnosis.
“One said I was having an allergic reaction and would probably never know what caused it,” she relates. “The next one told me I had folliculitis, which you get from scratching. It’s not an original cause. Another one told me I had something called prurigo nodularis, but with that you get big pustules on your legs, which I didn’t have.
“The last one told me I had fleas. I just about lost it when I heard that. I knew I didn’t have fleas. I know what flea bites feel like. I even saw an allergist who tested me for a hundred different foods and more than fifty chemicals and finally told me I’m not allergic to anything.”
Frustrated with the doctors’ lack of consensus, Mary Anne eventually decided to look for her answers on her own. After some extensive internet research, she theorized that her condition was either a rare fungal infection or a problem related to her leg veins called stasis dermatitis. She had no visible varicose veins, but venous insufficiency as a cause of stasis dermatitis could be easily ruled out with an ultrasound, so she consulted a vein physician.
“I went to a vein doctor and told him what I suspected,” she says. “He did the ultrasound and told me there was a vein in my left leg that was leaking badly and probably causing the problem. He treated the vein, and I felt better, but not totally better.”
Even after treatment, Mary Anne’s legs remained itchy. Before long, she had visited two more vein physicians, seeking treatment for her condition. Both doctors dismissed her without treating her.
At that point, Mary Anne was desperate. She looked for help on various stasis dermatitis forums online and was stunned when someone from a medical forum answered her. She noted that the person responding was very knowledgeable about the condition.
That individual was board-certified vascular surgeon Joseph G. Magnant, MD, of Vein Specialists, a practice which is dedicated to the comprehensive, modern evaluation and most advanced minimally invasive treatment of vein disorders.
“Dr. Magnant encouraged me to go to his website, and on it was a lot of information about my condition,” she states. “I left a message on his practice’s Facebook page on Monday night, and on Tuesday morning at eight o’clock, his office called me. I told them that I live in Illinois but would fly down to Florida to see them if they could help me.”

Underlying Condition

Hoping for a miracle, Mary Anne left her home in the Chicago area and traveled to Florida to see Dr. Magnant on March 14. An ultrasound performed that day revealed that Mary Anne was suffering from significant venous reflux disease in both legs, as well as left iliac vein compression (May-Thurner syndrome).
Upon learning of the diagnosis, Mary Anne met with Dr. Magnant and made plans to proceed with further investigation with intravascular ultrasound (IVUS) and had a stent placed first to reopen the iliac vein and relieve her pelvic venous congestion. This was successful, and within four to six weeks she noted marked improvement in her symptoms.
“My legs are a million times better. And they look so much better, it’s unbelievable.” – Mary AnneMary Ann returned to Dr. Magnant’s Fort Myers office for treatment of her venous insufficiency in April. Before she left for Chicago, however, Dr. Magnant explained vein disease to her in detail.
“Veins are the blood vessels that take blood from the legs back up to the heart,” describes Dr. Magnant. “To help keep blood flowing in the right direction, there are a series of one-way valves in leg veins.
“When these valves fail, the flow of blood going toward the heart is impeded. That’s a condition called venous insufficiency or venous reflux disease. As a result of this condition, blood leaks out of the veins and pools in the legs, causing various signs and symptoms.”
Some of the visible signs of venous insufficiency include varicose veins and swelling. Other symptoms include achiness, heaviness and nighttime cramping. As it progresses, venous insufficiency can also lead to thickening, discoloration and itching of the skin, or stasis dermatitis, which Dr. Magnant says is not uncommon.

Skin Manifestation

Stasis means pooling or still, not moving,” informs Dr. Magnant. “The blood is static because damage to the valves causes high pressure in the veins around the ankle and lower leg. Derma means the skin, and itis is the suffix in Latin for inflammation. Stasis dermatitis, then, is inflamed skin secondary to pooling blood from damaged or leaky valves, or venous insufficiency.”
Stasis dermatitis is a progressive condition that starts with
swelling when high pressure causes blood, which is mostly water, to seep through the thin-walled veins and to settle into the leg tissues. In addition to water, other components of the blood, such as red and white blood cells, also leak into the tissues, causing pigmentation and damage to the skin.
“The red blood cells essentially rupture when they leak into the tissue outside of the circulatory system,” observes Dr. Magnant. “When they rupture, their cell walls open and release their pigment, called hemosiderin, and that’s what causes the brownish discoloration in the legs.
“Over time, the white blood cells also leak out and release their contents. These contents are enzymes and are basically like Clorox 2®. When they’re released nonspecifically into the skin and fatty tissue, they cause scarring and inflammation of the skin. They also cause the itching that Mary Anne experienced.”
Many people who have stasis dermatitis are seen by dermatologists, who might treat them with steroid cream, which simply treats the external signs of the disease. Instead, those patients should consider further venous investigation to determine what’s going on inside the veins leading to the skin changes.
“Because it’s a skin disorder, stasis dermatitis is often not investigated as a vein problem,” points out Dr. Magnant. “Many health care providers look for varicose veins to determine a vein problem rather than look and think about something underneath the skin.
“My recommendation for patients with any sort of change around the skin in the lower legs, including discoloration or itchiness, is to seek a venous evaluation by a qualified vein specialist.”

No Comparison

Mary Anne finally found just such a specialist in Dr. Magnant, who
recommended treating her through a procedure called endovenous ablation.
“During endovenous ablation, we guide a very thin catheter through a tiny needle placed in the vein via a small puncture in the leg,” Dr. Magnant explains. “Using either radiofrequency or laser energy, we
gently collapse the diseased veins, which are eventually absorbed
by the body.”

Photos courtesy of Mary Anne Simpson.

Mary Anne found the treatment she needed in endovenous ablation.

Dr. Magnant performed the endovenous ablation procedure on Mary Anne’s right leg when she returned for treatment in April. She has yet to have the procedure performed on her left leg but says the procedure on the right leg alone has made a difference.
“My legs are a million times better,” she marvels. “And they look so much better, it’s unbelievable. I still have some itching in my left leg because it hasn’t been treated yet, but I only have itching in that leg maybe once every two weeks. Once I get my left leg treated, the itching will subside even more.
“There’s absolutely no comparison of how my legs felt before to how they feel now. I wake up sometimes and think, This is what it feels like to feel normal. I hadn’t felt normal for two and half years. I’m thrilled.”

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    • Vein Specialists

      Vein Specialists is 100 percent dedicated to identifying and treating vein disorders. Led by Dr. Joseph G. Magnant, they understand that the venous system varies between patients and consists of both deep and superficial venous systems and a net... Read More

    • Joseph G. Magnant, MD, FACS, RPVI

      Joseph G. Magnant, MD, FACS, RPVI, is a Fellow of the American College of Surgeons and is board certified by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a g... Read More