Venous eczema and chronic venous disease
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-074602 (Published 17 August 2023) Cite this as: BMJ 2023;382:e074602
- Michael Tran, lecturer and general practitioner1 2,
- Vivienne Lea, anatomical pathologist3,
- Cathy Zhao, clinical lecturer in dermatology4,
- Sean Kristoffersen, general practitioner5
- 1Department of General Practice, The University of New South Wales, School of Population Health, NSW, Australia
- 2Erskineville Doctors, Newtown, NSW
- 3Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW
- 4The University of Sydney, NSW
- 5Church Street Medical Practice, Newtown, NSW
- Correspondence to: M Tran Michael.m.tran{at}unsw.edu.au
What you need to know
Comprehensive assessment of venous eczema includes asking about triggers, time course of symptoms, discomfort or pain, complications, and quality of life
Effective management is multifaceted, and requires patient engagement and concurrent treatment of contributing lifestyle factors
Frameworks such as the revised venous clinical severity score can help categorise and monitor the burden of disease and guide management
A man in his 70s with hypertension, a body mass index of 30, and reduced mobility presents with a six month history of erythematous, scaling patches over his lower limbs, which are persistently oedematous. The rash is itchy and weeping. Moisturising has not improved his symptoms, and he is concerned about infection.
This article will help you to understand the signs and symptoms of chronic venous disease, with a focus on the complication of venous eczema. It offers guidance and a framework on how to manage the condition in a community setting.
What you should cover
History
Venous eczema is a common inflammatory dermatosis of the lower extremities, occurring in patients with chronic venous disease.1 It occurs secondary to chronic inflammation, which arises from venous hypertension and a failure of the venous pump, obstructed venous flow, and dysfunctional venous valves, with reflux of blood from deep into now high pressure superficial venous systems (fig 1).1 Symptoms of venous eczema vary according to chronicity. Initial presentation can be highly variable and overlap with symptoms of chronic venous disease, including lower extremity heaviness, aching, swelling, itching, and discomfort.2 Exclude differential diagnoses (box 1).
Pathophysiology of chronic venous disease and venous hypertension
Differential diagnoses of venous eczema
Common
Cellulitis
Irritant or allergic contact dermatitis
Asteatotic eczema (eczema craquele)
Lichen simplex chronicus
Psoriasis
Dermatophyte infection (tinea corporis)
Actinically damaged skin (sun damage)
Autosensitisation dermatitis (secondary dermatitis that has developed at a location distant from the primary inflammatory focus)
Less common
Skin cancer
Consider the following …
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