Stasis Dermatitis Flashcards
What is the most common underlying cause of stasis dermatitis?
What is a common dermatological association with stasis dermatitis?
Chronic venous hypertension
Most common cause for secondary dissemination of dermatitis (Id reaction)
What are the mechanisms that lead to back flow into the superficial venous system, leading to varicose veins?
- Elevated hydrostatic pressure (damages capillary permeability barrier)
- Incompetent valves
What are the mechansims that lead to stasis dermatitis?
- Increased hydrostatic pressure damages capillary permeability barrier
- RBC extravasate = stasis purpura, hemosiderin deposits
- fluid/plasma proteins into tissue = edema
- Contact sensitization
- Irritant dermatitis due to wound secretions
List 4 clinical features of stasis dermatitis
- Pitting edema around/proximal to ankle
- Lipodermatosclerosis
- Acute = resembles cellulitis
- Chronic = inverted wine bottle, fibrotic skin
- Erythema, scaling and lichenification
- Intensely pruritic
- Episodes of vesiculation
- Contact sensitization (markedly symmetrical)
What are the mainstays of treatment for statis dermatitis?
- Control venous hypertension
- Compression
- Lifestyle changes (elevating feet, walk as much as possible)
- Exercise of calf muscles
- Surgical strategies (varicose vein treatment)
- Topical treatments
- Topical corticosteroids
- Emollients
- Avoid prolonged seating/standing
What are the 3 major types of leg ulcers?
- Venous
- Arterial
- Neuropathic/diabetic
For venous ulcers…
What is their typical location?
List 5 clinical features
Medial malleolus
- Shallow
- Irregular borders
- Yellow, fibrinous base
- Surrounding skin has hemosiderin deposits (yellow-brown discolouration)
- Stasis purpura (pinpoint petechiae)
- Lipodermatosclerosis
- Varicosities
- Leg/ankle edema
- Stasis dermatitis
For arterial ulcers…
What is their typical location?
List 5 clinical features
Pressure sites, distal points (toes)
- Dry, necrotic base
- Well-demarcated (“punched out”)
- Shiny, atrophic skin
- Hair loss
- Weak/absent peripheral pulses
- Cool feet
- Prolonged CRT (>3-4 seconds)
- Pallor with leg elevation (45˚ for 1 min)
- Dependent rubor
For neuropathic ulcers…
What is their typical location?
List 3 clinical features
Pressure sites
- Well demarcated “punched out”
- Thick callus
- peripheral neuropathy with decreased sensation
- Foot deformities
What is this dermatological finding?
Corona phlebectasia
List 4 risk factors for chronic venous disease
- Family history
- Age
- Female gender
- Obesity
- Pregnancy
- Prolonged standing
- Height
What is this dermatological finding?
Chronic lipodermatosclerosis
What is this dermatological finding?
What is another name for the white areas?
What should you assess for?
Livedoid vasculopathy
Atrophiae blanche
Thrombophilia
Why is maintenance of moisture important to wound healing?
- simulates collagen synthesis
- promotes angiogenesis by creating a hypoxic environment
- encourages reepithelialization
- decreases pain
How is colonization of a wound defined?
Explain critical colonization
Presence of replicating bacteria in a wound without evidence of tissue damage
Bacterial burden in a chronic wound not causing signs/symptoms of an infection but delaying healing
How does compression therapy help with venous insufficiency?
What is the typical pressure used for moderate venous insufficiency?
- Improves venous return
- Reduces edema
- Stimulates healthier granulation tissue within ulcers
- Improves quality of life
- Decreases leg fatigue
30-40mmHg (class II)
How are ischemic foot ulcers typically precipitated?
What are the 2 most common risk factors for peripheral artery disease?
Trauma
Diabetes and smoking
How is an ABI (ankle-brachial index) calculated?
What are the possible results?
Highest of systolic pressures from dorsalis pedis or posterior tibialis
higher of the brachial artery systolic pressures
- >1.3 = imcompressible tibial arteries due to medial calcification (DM, chronic renal insufficiency, older age)
- 0.91-1.3 = Normal
- <0.9 = peripheral artery disease
- 0.71-0.9 = mild
- 0.41-0.7 = moderate
- 0-0.4 = severe
What is a characteristic of Buerger disease?
What is the most common association?
Distal thrombosis in the upper and lower extremities
Smoking
What diagnosis should you consider with a posterolateral ulcer above the lateral malleolus?
What is the common association with this type of ulcer?
What is a clinical feature of this type of ulcer?
Martorell ulcer
Hypertension causing ischemia
Excruciating pain
What are the 2 exceptions for treating arterial ulcers
- Avoid sharp debridement to prevent further necrosis and ulcer enlargement
- Avoid VAC therapy
What is a mainstay of treatment of diabetic ulcers?
Off-loading (avoid repetitive trauma by alleviating mechanical loading)
What are the 4 factors identified as playing an important role in the development of pressure ulcers
How high does interstitial pressure have to be to compromise oxygenation and microcirculation?
What type of tissues are most susceptible?
- External pressures
- Shearing forces
- Friction
- Moisture (increases risk 5 fold)
>32 mmHg
Subcutaneous tissues
What are the 4 stages of pressure ulcers?
Stage 1 - non-blanchable erythema, induration, warmth
Stage 2 - epidermal or dermal ulceration
Stage 3 - Deep ulceration into subcutaneous tissues, not including underlying fascia
Stage 4 - Deep ulceration into muscle, bone
