The chronic venous insufficiency that leads to stasis dermatitis exhibits irregular venous flow patterns. Normally, valves of the deep veins in the calves block the retrograde flow of venous blood. Previous deep vein thrombosis can lead to post-thrombotic syndrome and incompetent valves of the deep veins of the lower extremities. Communicating veins that unite the superficial calf veins with the deep veins are also damaged in the setting of chronic venous insufficiency. In this case blood will demonstrate retrograde venous flow from the deep calf veins to the superficial venous plexuses. These irregular flow patterns contribute to the pathogenesis of stasis dermatitis.

Fibrin deposited in the face of this vascular damage also contributes to the disease process. Fibrin is laid down in the extravascular space causing sclerosis. The microvasculature and lymphatic channels become destroyed and nutrition of the epidermis is compromised. Eventually the epidermis breaks down and venous stasis ulcers arise [1, 2].

Patients with stasis dermatitis often present with classic clinical signs of chronic venous insufficiency. As with our patient, they will often complain of aches, pains, and heaviness of the legs. These symptoms are provoked by periods of standing still and are relieved by walking. The use of leg musculature helps pump the blood through these compromised vasculature structures. Edema of the legs is also associated with standing and is worst at the end of the day. Patients’ shoes fit tightly by the end of the day as a result of the edema and they often experience night cramps. The edema often resolves or improves to some degree in the morning after the patient has experienced an extended period of time in a horizontal position while sleeping. This position takes the pressure off of the veins with nonfunctional valves [1, 2].

Crusted and scaly erosions are often seen around the ankles. Inflammatory papules may be present. Dermal sclerosis may also be present and can be painful and limit movement of the ankle. Varying degrees of pigmentation is also noticeable due to hemosiderin deposits from old and new hemorrhages. Pruritus associated with stasis dermatitis may lead to excoriations from chronic scratching. Irritant dermatitis may also be simultaneously present as a result of secretions from venous stasis ulcers and bacterial colonization [1, 2].