Many varicose vein patients will have the symptoms of itchy legs, especially in the cold season, standing for a long time or blown by the cool breeze, itching on the legs at night, tossing and turning and difficult to sleep, how an itchy word! The rash after scratching, brown a large, smear some dermatitis or something not only does not work, the color is also black, the scope is getting bigger and bigger, how to do?
A. Surgery can cure dermatitis?
This is a unique medical term, called lower limb bruising dermatitis, is due to lower limb varicose veins and other diseases so that the lower limb venous circulation is impaired, chronic bruising and chronic skin inflammatory reactions, usually combined with chronic dropsy edema, hyperpigmentation, lipid scleroderma, mostly occurring in the lower 1/3 of the lower leg, for a long time easy to occur near the ankle dystrophic ulcers. If mishandled, it can easily cause generalized eczema. Patients with lower extremity seborrheic dermatitis are often the first to visit the dermatology department, and the treatment of the disease with topical medications alone is often a cure for the symptoms but not the root cause, and relapses soon after stopping the medication. Our dermatologists are very experienced in this area, and when they encounter patients with stasis dermatitis of the lower extremities, they first refer them to the vascular surgery department, where the problem of the primary veins is solved and the dermatitis can soon heal itself.
Figure 1: The comparative effect before and after surgery of stasis dermatitis of varicose veins, minimally invasive surgery, without looking closely may not even find the traces of surgery.
Second, why varicose veins are prone to dermatitis?
Let’s first understand how varicose veins are created. The venous blood flowing back to the heart in the legs goes upward against gravity. There are three forces that promote the venous blood flowing back to the heart and lungs in the legs, one is the thrust of upward squeezing produced by the contraction of the calf muscles; one is the suction force on the blood upward when a person inhales; and another is the suction force on the blood upward when the heart is stretched. These three forces will push the blood back upward, but the person in the whistle as well as the heart contraction, there is no gravitational force on the blood, so the blood will be affected by gravity back down, and there is a structure similar to a brake in the blood vessels can stop the blood backflow, this structure is the venous valve. It is like a one-way valve that is open when the blood goes up and closed when it goes down. The veins of varicose patients have become thicker, and the vein valve which was just able to close completely is now not closed tightly, or the vein valve has become less elastic and not closed tightly, so the blood will flow backwards, and the metabolic waste inside these veins and blood cannot be excreted and will accumulate on the patient’s legs, which will cause swelling and itching for a long time and form stasis dermatitis.
Third, the appearance of dermatitis represents the development of varicose veins to level 4 lesions
The bruised dermatitis is a grade 4 varicose vein lesion. It typically presents as erythema, scaling and eczema-like patches or plaques on the chronically edematous legs. When pruritus is present it can lead to mossy lesions as the patient scratches or rubs over time. By this time, the legs become progressively darker, initially brown in color, medically called hyperpigmentation, usually progressing from the neck of the foot upward, with the skin becoming darker as it progresses and the skin subsequently beginning to harden, forming an upside-down wine bottle shape over time. A very distinctive feature of stage IV lesions is that many people will experience itchy legs, and eczema will appear on the ankles or calves, with localized erythema accompanied by flaking. Many patients first go to the dermatology department, no matter how much money medicine, dermatitis repeatedly always bad, because the root of the vascular disease is not eliminated, so not the root cause. There is a special term called lower limb stasis dermatitis, which refers specifically to the dermatitis of varicose vein stage IV lesions. The progression of the disease to this stage often requires aggressive surgical treatment.
In grade 1 varicose veins, capillary dilation can be seen in the legs, but it is not very serious, somewhat like “spider legs”; in grade 2 varicose veins, the typical “earthworm legs” are seen; in grade 3 varicose veins, the patient’s legs become edematous after standing for a long time. The skin of patients with grade 4 varicose will have nutritional disorders and darkened skin; at grade 5, the patient’s skin will ulcerate; grade 6 will develop a stubborn ulcer, how to change the medicine can not cure the old rotten feet. (Simple memory for level 1 small spider, level 2 small earthworm, 3 swollen 4 black 5 broken 6 rotten.)
Fourth, if you do not want to operate for the time being, you can choose the bruising dermatitis treatment
The management of bruxism eczema includes treatment of the underlying chronic venous insufficiency, symptomatic treatment of dry skin, pruritus and inflammation, and prevention of ulcer formation.
(i) Treatment of underlying chronic venous insufficiency – Treatment of underlying venous hypertension is the primary treatment for brucellosis dermatitis and may include.
1. general methods of reducing edema and venous hypertension (e.g., leg elevation, daily walking, exercise, and weight reduction)
2. wearing medical compression stockings or bandages. Medical compression stockings are used reasonably in patients with varicose veins in the lower extremities. The quality of elastic stockings is very important, poor quality elastic stockings not only do not work, but very easily cause leg allergy, rash and itching.
3.Systemic treatment, including venoactive or venous tone regulating drugs such as M, Mizarin, calcium hydroxybenzoate, flavonoids such as Diosmin tablets.
4. Skin care – Gentle cleansing of the skin and frequent use of mild emollients are required as symptomatic treatment for the dryness and itching associated with brucellosis dermatitis. Patients should gently cleanse the legs daily with a mild, non-soap (synthetic) cleanser (e.g., magnolia oil, Aveeno) to remove scales, bacteria, and crusts.
Emollients control dryness and itching by forming a film of oil to moisturize the skin. Products containing a petroleum jelly base are superior to emollients containing lanolin or fragrances in reducing the risk of contact sensitization. Emollients work best when the skin is moist (e.g., immediately after showering or bathing) or can be used after wet compresses to moisturize.
(ii) Patients with acute bruising dermatitis
1. Topical corticosteroids – For patients with brucellosis dermatitis with erythema, itching, blistering and oozing, topical corticosteroids can be used. Corticosteroid ointments such as Pirenzone can be used on the affected skin once or twice a day for 1-2 weeks. Prolonged use of highly potent corticosteroids should be avoided as they may induce skin atrophy and increase the risk of ulcer formation. Corticosteroid preparations containing emulsifiers and additives should be avoided to minimize the risk of sensitization; Vaseline is the preferred excipient since it does not contain any additives.
2. Wet compresses – For patients with exudative eczema, wet compresses may facilitate the removal of scabs and exudate and may reduce itching. Wet compresses can be applied with saline or diluted potassium permanganate, which has anti-infective properties. Moistened soft cotton or oiled gauze is applied directly to the affected area and then covered with dry, light and breathable gauze. The wet compresses are held for 2-3 hours at a time and may be applied 2-3 times daily or continuously in more severe cases or in patients with active disease. Emollients may be applied after removal of the wet dressing to add moisture and achieve moisturization. Wet compresses may be used in combination with topical corticosteroids. Supplementing the use of topical corticosteroids with wet skin compresses can increase the penetration and absorption of corticosteroids.
3.Oral medication
Patients with intractable brucellosis dermatitis – Patients whose inflammatory symptoms are not adequately relieved by topical corticosteroids may be treated with a short course of oral systemic corticosteroids (e.g., prednisone, 20-30 mg/d for 5-7 days). Another approach is a single dose of intramuscular trenbolone (40 mg).
Summary
Lower extremity bruxism dermatitis is caused by varicose veins in the lower extremities that cause impaired circulation in the veins of the lower extremities, and metabolic wastes are not excreted and accumulate on the legs, which can cause itching over time. Stasis dermatitis is a grade 4 varicose vein lesion. Progression of the disease to this stage often requires aggressive surgical treatment, and minimally invasive surgery can eradicate varicose veins and dermatitis. Conservative treatment options include leg elevation, daily walking, exercise and weight reduction, wearing medical compression stockings or bandages, and oral vein-activating medications. For skin care emollients control dryness and itching by forming a film of oil to moisturize the skin. Emollients work best when the skin is moist (e.g., immediately after showering or bathing), and can also be used after wet compresses to moisturize. Topical corticosteroids, saline or diluted potassium permanganate with anti-infective properties are used as wet compresses. Oral medication prednisone, 20-30 mg/d for 5-7 days, if necessary.