Venous Stasis Ulcers

The diagnosis Punches

The distribution: the ankle

The history to increase by preceding noninflammatory (stasis)

The varicosity presence

Presentation clinic

The "stasis" of term refers itself to the chronicle presence, the edema of noninflammatory of the lower leg. The dermatitis of Stasis arrives when the to itch that accompanies often stasis takes to the scratch with consecutive excoriations, cry, crusting, and int1ammation. The color of the inflammation in the dermatitis of stasis is violaceous instead of red brilliant because of to put in common and because of blood deoxygenation streaks. In the cases of long one date back to dermatitis of stasis, postinflammatory hyperpigmentation adds a distinctive brown complexion to the color of basic violaceous. The initial changes of dermatitis of stasis inevitably almost are found to the ankles, but the extension distalment on the foot and closely on the lower leg ordinarily is seen.

A lot of types of disease of eczematous, including the dermatitis of atopic and the dermatitis of allergic contact, arrive on the ankle as a primary or superimposed disease on the dermatitis of stasis. Correct the identification of dermatitis of stasis depends on the proof that the edema of noninflammatory preceded the appearance of the eruption.

The ulcers of Stasis accompany frequently the dermatitis of stasis. They appear as in round to the lightly craters irregularly formed, 2 to 5 cm in the diameter, with the rolled borders of violaceous. The center of the ulcer consists in granulation fabric that the mayor could not be covered with purulent equipment or the adhesive crust. The quantity of present of pain is variable; often they are surprisingly asymptomatic.

The ulcers of Stasis begin following the traumatism to edematous, the skin of eczematized. This ulcerated the skin, the two because of the arterial anatomically poor blood provision to the lower leg and the amplest compromise in the sanguine flow that results from the edema, heals very slowly. When the cure arrives at last, this is to mark accompanied of. This, in the bend, compromises more the sanguine flow, allowing episodes to even minors of traumatism to establish a new cycle entire one. The bacterial infection in the ulcers or in the skin of surrounding eczematized does more complicate sometimes the process.

Flow and the Prognostic

The dermatitis of Stasis generally runs a chronic course with exacerbations and the intermittent discounts. Postinflammatory hyperpigmentation remains the present for the months after every exacerbation.

The traumatism presence (the cuts, the bruises, and excoriation) to the weakened skin in the dermatitis of stasis takes sometimes to the development of ulcers of stasis. The cure of these ulcers causes the development of solidly squeezed skin and edpaissie around the ankle (lipodermatosclerosis). This change by error sometimes is diagnosed as scleroderma. The residual edema could be above found and to the under squeezed sector. The carcinome of cell of Squamous can develop time in time in the margins edpithedliales of ulcers of stasis of long date.

Pathogenesis

The chronicity of dermatitis of stasis depends on the presence continues edema. Thus, the dermatitis of stasis ordinarily is seen when the edema is because of the incompetence of valve veineuse (the varicose veins) but arrives only rarely with the intermittent edema that accompanies the congestive cardiac insufficiency.

Only a small proportion of patients with stasis develops the dermatitis of stasis. This position is analogous to the rarity with that dyshidrosis evolves in the eczema of dyshidrotic. In the two diseases that the eczematization principally arrives because of the superimposition of the cycle of itch scratch, suggesting as well as the individuals of atopic are at the special risk.