Varicose Eczema

[Sarah Buchan]

Dear Caroline,
Many thanks for posting your question; I hope my advice will provide you with some relief from your symptoms.

Varicose eczema, as I’m sure you are aware, develops when the small valves in the veins of the legs stop working properly making it difficult for blood to push against the gravity. This increased pressure in the veins then causes fluid to leak into the surrounding tissues which in turn causes the immune system to react to the fluid. It is most commonly seen in patients who also experience varicose veins. As a result, the skin can become itchy, red, swollen, dry and scaly. Legs may become swollen at the end of the day, especially after long periods of standing.

It is important that patients seek medical advice and comply with treatment for varicose eczema as leg ulcers may develop if left untreated.

Treatment for varicose eczema aims to improve the condition of your skin, treat symptoms and help improve circulation and usually involves a combination of self-care and topical agents.
1) Self-Care
To improve circulation in the legs, raise your legs when resting for example by propping them up on pillows raised above your heart - this will help to reduce swelling.
Keeping physically active is important in maintaining good circulation and maintaining a healthy weight, so do try even a short walk every day to boost your circulation.

2) Emollients
Emollients moisturise the skin to stop it becoming dry. They should be used twice a day even if you do not have any symptoms. There are a number of emollients available and you may need to use a combination to obtain the best results. For example;
- An ointment for very dry skin (ointments contain the most oil and are most effective at keeping moisture in the skin)
- A cream or lotion for less dry skin (lotions contain the least oil)
- Emollient to use instead of soap
- Emollient to add to the bath / use in the shower

You should apply a large amount of emollient, enough to cover all of the skin on the lower leg not just the affected area. Smooth the emollient into the skin in the same direction that hair grows. Apply every 2-3 hours for very dry skin.
After a bath / shower, gently dry the skin then immediately apply the emollient while the skin is still moist. Emollients added to bath water can make the bath slippery, so take care getting in and out of the bath when using.

It is important to keep using emollients during a flare up of varicose eczema as this is when the skin requires most moisture.

3) Topical Corticosteroids
If the skin is inflamed from a flare up, your GP may also prescribe a topical corticosteroid to reduce inflammation.
Corticosteroids should only be applied to the affected area. Depending on which product they chose, the GP will advise how much and how often to apply.
The emollient should be applied first and left for 30mins to be absorbed by the skin before applying the corticosteroid. The corticosteroid should then be used for 7-14 days and continued for 48 hours after the skin has cleared.

4) Compression stockings
These are specially designed stockings worn daily which steadily squeeze legs to improve circulation. Compression stockings are available in a choice of sizes, styles and pressures depending on your requirements. Patients are advised to put them on in the morning and remove before going to bed.

Caroline I have outlined a number of potential treatments for your varicose eczema but I would advise you make an appointment to discuss these with your GP and together decide on the most appropriate treatment plan for your symptoms.
If you have already tried a number of these options, it may be that your GP will refer you to a dermatologist (skin specialist) or, if you also have varicose veins, a vascular specialist, to discuss further options for you.

If you have any additional questions, please do not hesitate to get in touch again.

I wish you the very best,

Sarah