Varicose Eczema: Causes, Symptoms and Long-Term Care

What is varicose eczema?

Varicose eczema, also known as venous, gravitational or stasis eczema, is a long-term skin condition that affects the lower legs. It's common in people with varicose veins. It is a specific type of eczema triggered by poor blood flow in the leg veins, rather than an allergic reaction or an infection, resulting in itchy, dry, and swollen skin.

What varicose eczema looks and feels like

Varicose eczema causes distinct visual signs on the lower legs, usually around the ankles. You will typically notice swelling, known medically as oedema. The skin becomes very dry, flaky, and scaly.

Discolouration is a major sign. On lighter skin tones, the affected areas often look red or purple. On darker brown or black skin, the patches can appear dark brown, grey, or dark purple.

Alongside these visual changes, the skin feels intensely itchy and tender to the touch. Many people also describe a heavy, tight, or aching sensation in their lower legs, especially by the end of the day.

How symptoms can change over time

Symptoms often start mildly. You might initially notice slight swelling at the end of the day, along with small, faint specks of discolouration on your ankles.

If left untreated, these symptoms can progress. The skin becomes increasingly fragile and thin. During a flare-up, the skin can crack, weep fluid, and form crusts. Over time, severe and untreated varicose eczema can lead to lipodermatosclerosis, a condition where the skin and the fat underneath become hardened, tight, and woody.

What causes varicose eczema and who is at risk?

Varicose eczema is caused by weak valves in the leg veins that allow blood to pool, increasing pressure and triggering skin inflammation, with risk factors including older age, obesity, family history of venous insufficiency, varicose veins and immobility. How faulty veins affect the skin

To understand varicose eczema, it helps to know how your leg veins work. Inside your leg veins are tiny one-way valves that open to let blood flow up toward your heart, and close to stop it flowing backwards.

Sometimes these valves become weak and stop working properly, a problem known as venous insufficiency. When this happens, blood struggles to move upwards and begins to pool in the lower legs. This pooling increases the pressure inside the veins.

This high pressure forces fluid to leak out of the veins and into the surrounding skin tissue. Your body's immune system reacts to this fluid, triggering the inflammation, swelling, and itching that we recognise as varicose eczema.

Key risk factors

Certain factors make it more likely that the valves in your leg veins will weaken over time. Key risk factors include:

• Having visible varicose veins.
• Older age, as veins naturally lose elasticity.
• A previous deep vein thrombosis (DVT), which can damage vein valves.
• Obesity, which increases pressure on the leg veins.
• Pregnancy, due to extra weight and increased blood volume.
• Prolonged periods of standing or sitting, which makes it harder for blood to flow upwards.

Varicose eczema vs other eczema types

It is easy to confuse different skin conditions. This table highlights how varicose eczema differs from other common types of eczema.

How to create your daily varicose eczema care routine

A daily varicose eczema care routine focuses on consistently applying emollients, using topical steroids during active flare-ups, and wearing correctly fitted compression stockings.

Morning and evening care routines

Treatment may include self-help measures, emollients, topical corticosteroids and compression stockings. Building a consistent daily routine is the most effective way to protect your skin and ease your symptoms.

Morning routine:

1. Wash your legs using an emollient soap substitute instead of standard soap, which dries out the skin.
2. Gently pat your skin dry with a soft towel. Never rub.
3. Apply your emollient liberally all over your lower legs and feet.
4. Wait roughly 30 minutes for the emollient to fully absorb.
5. If you are having an active flare-up, apply your prescribed topical steroid to the red, itchy patches.
6. Put on your compression stockings.

Evening routine:

1. Carefully remove your compression stockings.
2. Re-apply your emollient to keep your skin hydrated and protected overnight.
3. Elevate your legs for at least 30 minutes while relaxing before bed.

Choosing and using emollients

Venous eczema results from impaired venous drainage and increased leg-vein pressure, with daily emollients helping maintain skin integrity. Emollients are medical moisturisers. They are the most important part of your daily treatment, creating a protective barrier that traps moisture in the skin.

You have three main options:

For the best results, use a clean spoon or spatula to scoop the emollient out of the tub to avoid contaminating it. Smooth the emollient onto your skin gently in the direction of hair growth. Apply it liberally and frequently throughout the day.

Applying topical steroids for flare-ups

Topical corticosteroids are strictly for managing flare-ups. A flare-up is when your skin becomes noticeably redder, more inflamed, and intensely itchy. Steroids reduce this inflammation, but they are not meant for everyday use on healthy skin.

To ensure you use the right amount, use the "fingertip unit" rule. One fingertip unit is the amount of cream squeezed from the tip of an adult finger to the first crease. This amount is enough to treat an area of skin twice the size of an adult hand. Always apply your emollient first, wait 30 minutes, and then apply the steroid.

Using compression stockings

Compression stockings improve blood flow and reduce swelling by gently squeezing your legs. This directly targets the root cause of varicose eczema.

When choosing compression products to manage venous leg ulcers, price variation for compression hosiery over compression bandaging is justified, provided that the hosiery is clinically appropriate and meets the needs and preferences of the person with a venous leg ulcer. The same principle applies to managing eczema to prevent ulcers. Stockings are highly effective when fitted correctly.

Always put your stockings on first thing in the morning before your legs have a chance to swell. If you find them hard to pull on, a clinician or pharmacist can recommend simple application aids. It is essential to get your legs measured by a healthcare professional so they can prescribe the correct size and compression class for you.

Long-term lifestyle changes to manage your condition

Managing varicose eczema long-term involves maintaining a healthy weight, staying physically active to pump blood upwards, and regularly elevating your legs to improve circulation.

Exercises to boost leg circulation

Varicose eczema is linked to increased pressure in leg veins and may be supported by exercise, leg elevation, weight management and regular emollient use. Keeping active is vital. Movement activates your calf muscles, which act like a pump to push blood back up your legs toward your heart.

Gentle, regular walking is excellent for circulation. If you are sitting at a desk or in a chair for long periods, practice simple leg exercises. Try ankle pumps by pointing your toes down and pulling them up toward your knees. You can also trace circles in the air with your toes.

How to elevate your legs

Management focuses on chronic venous insufficiency through compression, emollient-based skin care, leg elevation and mobilisation. Elevating your legs uses gravity to help drain pooled blood and fluid out of your lower legs, reducing swelling quickly.

To elevate your legs properly, you need to raise your feet above the level of your heart. Resting your feet on a low footstool is not enough. Lie on a sofa and prop your legs up on several firm pillows. Aim to do this for 15 to 30 minutes, three to four times a day, particularly after you have been standing or sitting for a long time.

Diet and weight management

Maintaining a healthy weight takes unnecessary pressure off the veins in your lower legs. This makes it easier for your body to pump blood efficiently. Eating a balanced diet rich in vitamins and staying well hydrated by drinking plenty of water also supports your overall skin health, helping it to remain supple and resilient.

Understanding and preventing complications

Complications of varicose eczema include painful venous leg ulcers and lipodermatosclerosis, both of which can be prevented by strictly adhering to a daily skincare and compression routine.

Varicose eczema and leg ulcers

When you have varicose eczema, your skin is inflamed and fragile. This fragile skin is much more vulnerable to minor injuries, such as a scratch, a bump against a chair, or a small cut.

Because the blood flow in the area is already poor, these minor injuries struggle to heal. The skin can break down completely, forming an open sore known as a venous leg ulcer. This is why strict daily skin care and wearing your compression stockings are so important. They keep the skin strong and reduce the swelling that causes skin breakdown.

Skin infections vs normal flare-ups

It is very common to worry about infections. Knowing the difference between a normal flare-up and a bacterial infection helps you get the right care at the right time.

A normal flare-up involves an increase in your usual symptoms. The skin will feel itchier, drier, and look redder or darker in the areas where you normally get eczema.

An infection looks and feels different. The redness will start to spread rapidly. The skin will feel unusually hot and painful to touch, not just itchy. You might see yellow crusts or pus weeping from the skin, and you might feel generally unwell, potentially with a fever or shivers.

Understanding lipodermatosclerosis

Lipodermatosclerosis is an advanced complication of long-term, severe venous insufficiency. Over many years, the chronic inflammation causes the skin and the fat beneath it to become hard, tight, and woody. The lower leg can sometimes take on the shape of an inverted champagne bottle, where the ankle is very narrow and tight, and the calf above it bulges out. Consistent daily management from the early stages of varicose eczema helps to prevent this condition from developing.

When to see a doctor for varicose eczema

You should see a doctor for varicose eczema if you notice new skin changes on your lower legs, suspect a rapidly spreading bacterial infection, or see signs of an open sore developing.

Your first GP appointment

If you notice skin changes on your lower legs, you should seek medical advice. Our online GPs frequently consult with patients about skin concerns and can carry out an initial assessment via a video appointment.

During an appointment, the clinician will ask about your symptoms, how long you have had them, and your medical history. They will examine the appearance of your legs. To check your circulation before prescribing strong compression stockings, you will likely need an Ankle Brachial Pressure Index (ABPI) test, which is a painless procedure that compares the blood pressure in your ankle with the blood pressure in your arm.

Urgent red flag symptoms

Most symptoms can be managed with routine care, but some signs require immediate medical attention.

When to get urgent help

• Call 999 or go to A&E if: you develop symptoms of a severe infection like sepsis, which include a fast heartbeat, extreme shivering or muscle pain, confusion, or severe breathlessness.

• Call NHS 111 if: your skin becomes suddenly hot, painful, and rapidly red or swollen, or if you develop pus and a high temperature, as this could be cellulitis (a serious bacterial skin infection).

• See a GP urgently if: you notice an open sore or ulcer developing on your leg, or if you experience a painful, hot, and swollen calf, which could indicate a deep vein thrombosis (DVT).
  

Getting help for varicose eczema

Getting help for varicose eczema starts with consulting a healthcare professional to confirm a diagnosis, assess your leg circulation, and prescribe the correct compression treatments.

Summary of key takeaways:

1. Varicose eczema is a direct result of poor circulation and high pressure in the leg veins.
2. A strict daily routine of using emollients and wearing fitted compression stockings is the foundation of your care.
3. Simple lifestyle habits, such as regular walking and elevating your legs above your heart, will significantly reduce swelling and improve symptoms.
4. Always monitor your legs for signs of infection or skin breakdown and seek prompt medical advice if things change.

The best step you can take today is to establish your daily moisturising routine. If you have not yet had a formal diagnosis, or if your symptoms are getting worse despite self-care, it is time to speak to a clinician. They can confirm the diagnosis, arrange a circulation check, and prescribe the appropriate compression stockings and creams.

If you are worried about the skin on your lower legs, book an online GP appointment with Doctor Care Anywhere today. Our virtual GPs can assess your symptoms, discuss your treatment options, and help you build a care plan to get your legs feeling comfortable again.