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Venous eczema and lipodermatosclerosis - Management
How do I assess a person with venous skin changes?

  • Determine whether the person is likely to have venous hypertension, as this supports a diagnosis of venous skin problems. Indicators of possible venous hypertension include varicose veins (although severe venous hypertension can occur in the absence of visible varicose veins) or a history of varicose vein surgery, deep vein thrombosis, or leg ulcers.
  • Document the location and severity of any varicose veins.
  • Document the nature and severity of skin changes:
    • Venous eczema — red, scaly or flaky skin, which may have blisters and crusts on the surface.
    • Lipodermatosclerosis — hardened, tight, red or brown skin, typically affecting the inner aspect of the calf. The subcutaneous tissues may become hard and depressed, eventually resulting in an 'inverted champagne bottle' leg if the damage is circumferential around the ankle. It can present acutely and may be wrongly diagnosed as cellulitis or phlebitis.
    • Atrophie blanche — star-shaped, ivory white, depressed, atrophic scars with surrounding pigmentation, often found in areas where an ulcer has healed.
  • Document the presence or absence of foot pulses.
  • If use of compression stockings is being considered, measure the ankle-brachial pressure index using a Doppler machine (some experts suggest that this is unnecessary if foot pulses are easily palpable, the person has no symptoms of arterial disease, and strong compression is not being applied). For further information see the CKS topic on Compression stockings.
  • If venous ulcers are present, see the CKS topic on Leg ulcer - venous.

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