Scaly, Itchy Legs? Is it Stasis Dermatitis?

Venous insufficiency doesn’t always present with varicose veins.

Developed by the Department of Defense to measure prospective enlistees’ knowledge and skills, the Armed Services Vocational Aptitude Battery (ASVAB) helps identify an individual’s potential for training and success in the military.

Dennis Arnold

As a teen, Dennis Arnold scored extremely high on the exam and was told he could have his pick of duty assignments. Unfortunately, his first choice wasn’t unavailable.

“Originally, I considered going into the Navy, but they couldn’t guarantee me a job working in the nuclear power plants on their submarines,” shares Dennis, 64. “The Air Force, however, guaranteed me the job I wanted, so I enlisted with them instead.

“I knew back in high school that electronics were going to be the next big thing. The Air Force offered me the job with the most electronics training, and for almost 10½ years, I took care of the launch delivery systems for the nuclear weapons aboard our aircraft.”

After retiring from the military in 1999, Dennis worked for several companies in Fort Myers maintaining and programming fire alarm systems. He later did the same kind of work for the Lee County School Board before retiring for good.

Not long after, he began to struggle with his health.

“At first, I had problems with my left ankle,” he relates. “It became inflamed, and I couldn’t walk very well. I also experienced a lot of swelling in both legs. The skin had darkish brown spots and looked terrible. It looked like I had some kind of disease.”

Dennis’ condition grew steadily worse, so in 2020 he visited a walk-in emergency clinic. The staff there told him he had methicillin-resistant Staphylococcus aureus, or MRSA, an infection caused by a bacterium that’s resistant to several antibiotics.

“The doctors gave me medication to put on my ankle and pills to take, and the problem went away,” Dennis remembers. “But it came back. This time, not only did my legs swell up again, but they also itched like crazy.

“After going to my primary care doctor three times and getting no answers, I visited my dermatologist. She said, I’m going to send you to Vein Specialists and have them do an ultrasound. They’ll find out what’s going on with your legs.

Vein Specialists is the practice of Joseph Magnant, MD, a board-certified vascular surgeon dedicated to the modern and comprehensive evaluation of leg vein disorders. Dr. Magnant uses the most advanced minimally invasive techniques to diagnose and treat patients.

“Dennis presented with swelling in both legs, most notably his left leg,” Dr. Magnant recalls. “The skin on both legs was inflamed and thick, dark and itchy, which is a presentation of advanced venous insufficiency called stasis dermatitis.”

Endovenous Ablation

Venous insufficiency is a condition that occurs when leg veins are damaged and don’t allow blood to flow back toward the heart.

“Varicose veins are the most commonly recognized presentation of venous insufficiency,” Dr. Magnant observes. “However, there are less recognized symptoms that can be present in addition to or in the absence of varicose veins. They include leg swelling, cramping, and itchy and discolored skin, or stasis dermatitis.

“Many times, patients with stasis dermatitis visit a dermatologist for treatment, which typically includes a hydrocortisone cream. Sometimes, dermatologists perform a biopsy in an effort to diagnose the condition. Unfortunately, the injury caused by the biopsy can lead to a nonhealing ulcer in patients with underlying venous insufficiency.”

Dr. Magnant stresses that a biopsy is not required to make a diagnosis of stasis dermatitis. Vein specialists can generally make the diagnosis by examining the skin.

“Vascular surgeons are used to seeing patients with this presentation of venous insufficiency,” he contends, “so the diagnosis is usually obvious by looking at the legs. Untrained physicians often see inflamed skin and confuse it with an infection. Dennis, for example, was previously diagnosed with MRSA and prescribed antibiotics, which didn’t resolve his symptoms.

Before Treatment

“When Dennis came to us, we performed an ultrasound and identified his problem as venous insufficiency of the great saphenous vein in both legs. Several smaller veins were affected as well. To correct the problem, we sealed his great saphenous veins using endovenous ablation, which is performed in our office using local anesthesia and ultrasound guidance.”

During an endovenous ablation, a vascular surgeon accesses the compromised veins through tiny punctures in the skin. The leaking veins are then sealed using heat from a laser or radiofrequency energy, and the blood flow is rerouted to healthy veins.

“In sealing Dennis’ saphenous veins, we used an endovenous ablation technique called ClosureFAST, which is a heating treatment that uses radiofrequency energy,” Dr. Magnant reports. “Whether we use radiofrequency energy or laser is based primarily on the patient’s anatomy and whether the patient is taking blood-thinning medication.

“We cannot use endovenous ablation to treat veins below the knee because those veins are very close to the nerves, and the nerves can be damaged by the radiofrequency or laser heat. For those veins, we typically use a technique called Varithena®.”

Varithena is a sclerosing foam injected into the compromised veins. It displaces the blood and irritates the vein walls, causing them to collapse and eventually close completely.

“Like Night and Day”

“Dr. Magnant treated my left leg first,” Dennis recounts. “As soon as he was done, I couldn’t believe the difference. I started losing all kinds of fluid out of my leg. The swelling went down instantly that same day. Within two weeks, I could move my leg like I hadn’t been able to for years. The same thing happened with my right leg.

“Before long, the dark spots on my legs started disappearing. Now, all the discoloring and itching are gone, and I’ve never had another outbreak. The strength is back in my legs, and I’m able to go to the gym and work in my garden. I’ve never recovered from anything so quickly; it was like night and day. It was a miraculous thing to have happen to me.

“I’ve never recovered from anything so quickly; it was like night and day.” – Dennis

“I’m really happy because I thought I was going to end up in a wheelchair. After treatment, I realized that I’m not that old after all. I just had a problem with my leg veins.”

Dennis is just as happy with the vascular surgeon who treated his venous insufficiency and stasis dermatitis.

“Dr. Magnant is very knowledgeable and explained everything that was going to happen to me,” Dennis raves. “While he was performing my procedures, he talked to me and told me what he was doing, but I didn’t feel a thing. He’s got gifted hands when it comes to this type of work.

“I recommend Dr. Magnant to everybody. People who see me now ask, How are you getting around so much better? I tell them the whole story and say, Dr. Magnant is the guy to see! I don’t know anybody who can treat vein problems like he can.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. Before image courtesy of Vein Specialists. mkb
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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