Stasis dermatitis may initially cause an aching or gnawing feeling in the legs. Itching and burning are often intense enough to lead to excoriations, secondary bacterial infection, and even an id reaction, which is dermatitis that appears at a distant site on the body, usually the hands and arms. Stasis dermatitis usually occurs in older patients when venous or lymphatic return to the legs has been compromised. With increased extravasation of blood into the tissues, darkening becomes more permanent, and soon erythema, scaling, and oozing appear (Fig. 7-1). Occasionally, the process leads to irregularly shaped ulcerations known as stasis ulcers (see Chapter 70).