Varicose Eczema Ulcers

1
Varicose Eczema/ Ulcers

• Aetiology inflammation due to toxin release
  from hypertensive veins in lower leg, in turn due
  to gradual superficial/ deep venous valve
  incompetence.
• Prevalence
• v v (gt40yrs) 15(?) 27.5(?)
• Ulcers 0.3- 2 (by age 80)

2
Varicose Eczema/ Ulcers

• Contributing factors age, 2 pregnancies,
  obesity (female only), DVT, obstructed venous
  return, ?also smoking, prolonged standing and
  sitting.
• Symptoms itching, burning, aching especially at
  night-time, (odour with ulcers !).Pain should
  alert to arterial cause

• Examination erythema and excoriation medial
  calf above medial malleolus (LSV),
  post-inflammatory melanoderma. Oedema. Not
  usually painful even when shallow ulceration

3
Varicose Eczema/ Ulcers

• Assessment. Examine lying and standing.
  Varicosities
• Assess arterial supply (Doppler?) (anomalies in
  results due to oedema or arterial calcification)

4
Varicose Eczema/ Ulcers

• Ulceration team approach is vital.
• Swab occasionally helpful if pseudomonas
  suspected (bright green exudate)

5
Varicose Eczema/ Ulcers

• Beware of large ulcers and possible development
  of osteomyelitis

6
Varicose Eczema/ Ulcers

• Rx. Compression easily most important
  provided arterial supply adequate
• (class 1-3, open/closed toe, knee or thigh
  length)
• Emollients(?)
• Systemic antibiotics for secondary infection
  (?)(Fluclox. /- pen V/ amox. or erythromycin)

7
Varicose Eczema/ Ulcers

• Ulcers
• recent published meta-analysis
• The type of dressing applied beneath compression
  was not shown to affect ulcer healingapplying
  hydrocolloid dressings beneath compression
  produced no benefit in terms of ulcer healing
  compared with applying simple low adherent
  dressings. No conclusive recommendations can be
  made as to which type of dressing is most cost
  effective. Decisions on which dressing to apply
  should be based on the local costs of dressings
  and the preferences of the practitioner or
  patient. (BMJ  2007335244)
• Compression for all whose arterial supply is
  adequate (gt0.7)
• 4 layer bandaging

8
Varicose Eczema/ Ulcers

• Can be difficult to apply compression hosiery
  (especially Classes 2 and 3)

• Acti-glide can help

9
Varicose Eczema/ Ulcers

• Elevation
• Antibiotics if infected (rim of erythema and
  granulation at base with some exudate are normal
  )
• Be patient
• Referral if enlarging or deepening