Materiały źródłowe

• #1 Varicose eczema: pathogenetic and clinical-pathological aspects. New treatment paradigms with the use of modern venoton…

  https://ouci.dntb.gov.ua/en/works/7BoBNKg4/

  Objective — to analyze current perspectives on the pathogenesis, clinical course characteristics, diagnosis, therapeutic methods for patients with varicose eczema (VE) and to identify further research prospects that will enhance treatment efficacy for the dermatosis in question. […] Varicose eczema manifests as a chronic relapsing condition occurring alongside chronic venous insufficiency, predominantly affecting the lower extremities and impacting up to 20 % of patients aged over 70. […] The appointment of venotonic agents to VE patients which improve venous microcirculation and lymphatic drainage, as well as slow down the processes of endothelial dysfunction, thereby increasing the effectiveness of treatment and reducing the likelihood of relapses, is pathogenetically justified. […] Further studies of the mechanisms of development and progression of VE will expand the understanding of the pathogenesis and contribute to the optimization of the therapy of this dermatosis. […] The appointment of venotonic agents is a pathogenetically justified approach to the treatment of patients with VE.

• #2 Varicose Eczema: Treatment, Stages, Symptoms, and More

  https://www.verywellhealth.com/varicose-eczema-5194491

  Varicose eczema is usually caused by increased pressure in the leg veins. […] It’s thought that varicose eczema may develop as a result of the immune system reacting to this fluid. […] Varicose eczema is more common in people with varicose veins since they are a sign that the leg veins are not working properly and circulation is poor. […] Chronic venous insufficiency, which occurs when your leg veins dont allow blood to flow back up to your heart, is one example. […] Chronic venous insufficiency and general poor circulation to the skin, particularly the legs, can lead to varicose eczema. […] When the valves weaken, some blood stays in your legs and cause venous insufficiency. […] Varicose eczema is treated by both addressing the causal factors, such as chronic venous insufficiency, and with skin-based treatments such as steroid creams.

• #3 Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9968263/

  Venous reflux that drives venous hypertension can be the result of incompetent venous valves, obstruction to venous flow, or failure of the lower extremity muscle pump and may occur in the superficial or deep venous systems. In a study of patients with chronic venous disease, primary valvular incompetence was present in 70-80% of cases; valvular incompetence was due to trauma or deep vein thrombosis in 18-25% of cases. In chronic venous insufficiency, increased venous hypertension initiates changes in the local subcutaneous tissue and skin, including activation of the endothelial cells, extravasation of red blood cells and macromolecules, diapedesis of leukocytes, and inflammatory changes that are often noted at and above the ankles. There is an accumulation of clinical evidence to support the concept that venous hypertension causes SD. One study that examined 360 lower limbs indicated a positive correlation between increased ambulatory venous pressure and severe skin damage. In another study, venous hypertension was found to be the only plausible cause of SD in patients with superficial venous insufficiency, with negative patch testing and without insufficiency of the deep veins. Interestingly, in this second study, surgical intervention targeting the venous pressure resulted in the complete and rapid resolution of SD for all patients who underwent surgery.

• #4

  https://link.springer.com/article/10.1007/s40257-022-00753-5

  Venous reflux that drives venous hypertension can be the result of incompetent venous valves, obstruction to venous flow, or failure of the lower extremity muscle pump and may occur in the superficial or deep venous systems. […] In chronic venous insufficiency, increased venous hypertension initiates changes in the local subcutaneous tissue and skin, including activation of the endothelial cells, extravasation of red blood cells and macromolecules, diapedesis of leukocytes, and inflammatory changes that are often noted at and above the ankles. […] There is an accumulation of clinical evidence to support the concept that venous hypertension causes SD. […] In terms of both the pathogenesis of SD and developing effective therapies, it is important to understand that inflammation causes the skin changes characteristic of SD.

• #5

  https://www.nhs.uk/conditions/varicose-eczema/

  Varicose eczema is usually caused by increased pressure in the leg veins. […] When small valves in the veins stop working properly, it’s difficult for blood to be pushed upwards against gravity and it can leak backwards. […] This increases the pressure in the veins, which can cause fluid to leak into the surrounding tissue. It’s thought that varicose eczema may develop as a result of the immune system reacting to this fluid. […] Varicose eczema is more common in people with varicose veins, as these are also often a sign that the leg veins are not working properly.

• #6 Varicose eczema | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/varicose-eczema/

  Varicose eczema is caused by increased pressure in the leg veins. […] It is thought that varicose eczema may develop as a result of the immune system reacting to this fluid. […] This increases the pressure in your veins, which may cause fluid to leak into surrounding tissues. It is thought that varicose eczema may develop as a result of your immune system reacting to these fluids in the tissues under your skin.

• #7 Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9968263/

  In terms of both the pathogenesis of SD and developing effective therapies, it is important to understand that inflammation causes the skin changes characteristic of SD. The accumulation of leukocytes in the microcirculation of extremities with venous hypertension was reported in the 1980s, and such leukocyte trapping is now considered typical of the early stages of chronic venous insufficiency, particularly in SD. Studies demonstrated that the passively dependent blood in the feet of individuals with chronic venous diseases has low levels of leukocytes, suggesting leukocyte accumulation in regions of high venous pressure, leading to the observed inflammatory response. Here, leukocytes attach to the endothelium of vein walls and valve leaflets, causing the necrosis and/or apoptosis of the endothelium, fibroblasts, smooth muscle cells, and parenchymal cells of the venous wall. This causes weakening and destruction of the venous walls and valve leaflets, leading to the observed venous changes in SD. Increased numbers of T lymphocytes, macrophages, and mast cells were also observed in skin biopsies of the lower legs of individuals with chronic venous insufficiency, further supporting the association of inflammatory mediators with cutaneous damage. In SD, venous hypertension promotes the cellular accumulation of inflammatory cells, such as macrophages, as well as the extravasation of erythrocytes at the affected areas. Erythrocyte extravasation is followed by hemoglobin decomposition, which results in the excessive buildup of iron that is stored at the affected tissues as hemosiderin. Further macrophage accumulation is induced by the buildup of hemosiderin and hemoglobin. Such macrophages, alongside other cells, promote inflammation and induce several histological features seen in SD, including epidermal spongiotic changes and capillary proliferation.

• #8 Stasis dermatitis – Wikipedia

  https://en.wikipedia.org/wiki/Stasis_dermatitis

  Stasis dermatitis refers to the skin changes that occur in the leg as a result of „stasis” or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins. […] Insufficient venous return results in increased pressure in the capillaries with the result that both fluid and cells may „leak” out of the capillaries. This results in red cells breaking down, with iron containing hemosiderin possibly contributing to the pathology of this entity. […] Ultimately, treating the underlying venous reflux is necessary to treat Stasis dermatitis.

• #9

  https://link.springer.com/article/10.1007/s40257-022-00753-5

  In SD, venous hypertension promotes the cellular accumulation of inflammatory cells, such as macrophages, as well as the extravasation of erythrocytes at the affected areas. […] Such macrophages, alongside other cells, promote inflammation and induce several histological features seen in SD, including epidermal spongiotic changes and capillary proliferation. […] It was also demonstrated that expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 on microvascular endothelial cells, and their ligands lymphocyte function-associated antigen-1 and very late antigen-4 on leukocytes, is upregulated in the early stages of chronic venous insufficiency, including SD. […] Studies also demonstrated the role of matrix metalloproteinases (MMPs) in remodeling lesional skin in SD via degradation of extracellular matrix proteins and impairment of healing.

• #10 Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9968263/

  It was also demonstrated that expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 on microvascular endothelial cells, and their ligands lymphocyte function-associated antigen-1 and very late antigen-4 on leukocytes, is upregulated in the early stages of chronic venous insufficiency, including SD. This process remains upregulated as SD progresses. This would facilitate the transmigration of leukocytes into nearby tissues. Epidermal basal keratinocytes were also found to express elevated levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in SD, potentially promoting skin tissue damage through a perpetuated and upregulated influx of activated leukocytes and eventually leading to skin ulcerations. […] Studies also demonstrated the role of matrix metalloproteinases (MMPs) in remodeling lesional skin in SD via degradation of extracellular matrix proteins and impairment of healing. In a study that examined skin samples from 19 patients with SD, elevated levels of MMP-1, MMP-2, and MMP-13 were found, with diminished levels of tissue inhibitor of metalloproteinases (TIMP)-1 and TIMP-2, compared to healthy control samples. Such overexpression and production of MMP-1, MMP-2, and MMP-13, without the inhibitory effects of TIMP-1 and TIMP-2, may be the result of cytokine-mediated induction. Increased expression of MMPs and other proteinases by the vessel wall promotes further degradation of the vascular extracellular matrix, resulting in abnormal vascular permeability as well as edema. Moreover, the release of ferritin and ferric ion from extravasated erythrocytes may result in oxidative stress and additional MMP activation, promoting skin tissue damage, ulcer formation, and delaying healing. MMPs as well as other forms of inflammation may also cause skin hyperpigmentation in SD.

• #11

  https://link.springer.com/article/10.1007/s40257-022-00753-5

  Increased expression of MMPs and other proteinases by the vessel wall promotes further degradation of the vascular extracellular matrix, resulting in abnormal vascular permeability as well as edema. […] Moreover, the release of ferritin and ferric ion from extravasated erythrocytes may result in oxidative stress and additional MMP activation, promoting skin tissue damage, ulcer formation, and delaying healing. […] Very little is known regarding the pathophysiological mechanisms of SD-linked pruritus.

• #12 Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management | springermedizin.de

  https://www.springermedizin.de/stasis-dermatitis-an-overview-of-its-clinical-presentation-patho/24039742

  Increased expression of MMPs and other proteinases by the vessel wall promotes further degradation of the vascular extracellular matrix, resulting in abnormal vascular permeability as well as edema. […] Moreover, the release of ferritin and ferric ion from extravasated erythrocytes may result in oxidative stress and additional MMP activation, promoting skin tissue damage, ulcer formation, and delaying healing. […] MMPs as well as other forms of inflammation may also cause skin hyperpigmentation in SD. […] Very little is known regarding the pathophysiological mechanisms of SD-linked pruritus. […] SD-related pruritus is likely nonhistaminergic because antihistamines do not improve SD-associated pruritus.

• #13 Stasis Dermatitis: A Review of Differential Diagnosis, Pathogenesis, and Current Treatment Options | Published in Journal of Integrative Dermatology

  https://www.jintegrativederm.org/article/129790-stasis-dermatitis-a-review-of-differential-diagnosis-pathogenesis-and-current-treatment-options

  Stasis dermatitis (SD) is a cutaneous manifestation of chronic venous insufficiency (CVI), secondary to venous hypertension. […] Understanding the pathogenesis of SD and targeting the underlying causes of the disease are vital in ensuring appropriate treatment and management. […] If left untreated or inadequately managed, venous hypertension and its subsequent inflammatory processes result in further damage to the vessels and endothelium, leading to a cycle of worsening symptoms and complications which may require further treatment. […] The pathogenesis of SD is poorly characterized, despite its impact on patient quality of life (QoL). […] Initially it was thought that the presence of a fibrin cuff surrounding dermal capillaries decreased the permeability of oxygen and nutrients, leading to the development of SD.

• #14 Stasis Dermatitis: A Review of Differential Diagnosis, Pathogenesis, and Current Treatment Options | Published in Journal of Integrative Dermatology

  https://www.jintegrativederm.org/article/129790-stasis-dermatitis-a-review-of-differential-diagnosis-pathogenesis-and-current-treatment-options

  As an extension of the fibrin cuff theory, the trap theory was developed. This theory suggests that various growth factors and inflammatory cells may become trapped in the fibrin cuff, leading to uncontrolled inflammation and the prevention of proper wound healing. […] Later, the fibrin cuff theory was disproven by studies which showed that fibrin cuffs can be found in other chronic ulcerative diseases in which venous oxygen tension was higher than that observed in patients with CVI. […] The most probable cause of SD-related skin changes is the chronic inflammatory processes associated with venous hypertension, including the local accumulation of inflammatory cells, macrophages, and leukocytes, which result in further structural changes to venous walls and valves. […] One of the key processes leading to the progression of uncontrolled inflammation involves the extravasation of leukocytes across the vascular endothelium secondary to increased venous pressure.

• #15 Stasis Dermatitis: A Review of Differential Diagnosis, Pathogenesis, and Current Treatment Options | Published in Journal of Integrative Dermatology

  https://www.jintegrativederm.org/article/129790-stasis-dermatitis-a-review-of-differential-diagnosis-pathogenesis-and-current-treatment-options

  Intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and their ligands are upregulated during the early stages of CVI (including SD), which drives the transmigration of leukocytes into nearby tissue, leading to skin damage and ulceration. […] This could lead to further deterioration of venous wall structures and valve leaflets, causing a continued cycle of venous hypertension and subsequent inflammation. […] Several non-specific histological changes are associated with SD, including hyperkeratosis, spongiosis, and acanthosis. […] Prolonged venous hypertension leads to extravasation and migration of macromolecules (fibrinogen and 2-macroglobulin, 2 plasma proteins which cause accumulation of collagen and subsequent thickening of the skin), leukocytes, and erythrocytes into the dermis.

• #16 Stasis Dermatitis: A Review of Differential Diagnosis, Pathogenesis, and Current Treatment Options | Published in Journal of Integrative Dermatology

  https://www.jintegrativederm.org/article/129790-stasis-dermatitis-a-review-of-differential-diagnosis-pathogenesis-and-current-treatment-options

  Increased ferritin and ferric ion levels extravasated through hyperpermeable capillaries activate MMPs and perpetuate tissue damage. […] Studies have shown that increased venous hypertension is associated with overexpression of MMP-1, -2, and -13 without the inhibitory effects of tissue inhibitor metalloproteinases TIMP-1 and TIMP-2, which may result in hyperpigmentation, skin tissue damage, ulcer formation, and delayed healing. […] SD-associated pruritus is likely nonhistaminergic because the use of antihistamines does not necessarily provide relief. […] Nonhistaminergic pruritus involves several itch mediators, including cytokines/chemokines, proteases and their receptor amines, neuropeptides and their receptors, ion channels, and immune cells.

• #17 Is Varicose Eczema Serious? | The VeinCare Centre

  https://www.theveincarecentre.co.uk/blog/is-varicose-eczema-serious/

  Varicose eczema is an inflamed area of skin on the leg caused by a fault in the function of the veins under the skin called superficial venous reflux or by a problem in the deep veins following a deep vein thrombosis. Yes, it is a serious condition because it is a warning sign that you are at risk of a leg ulcer. […] Varicose eczema is caused by a malfunction of the veins of the legs. Blood doesn’t flow normally and the skin does not receive the nutrients and oxygen that it needs to remain healthy. The skin is damaged and responds by becoming inflamed. Inflammation is the body’s normal response to injury. The skin becomes red, itchy and thickened. Importantly, the underlying problem with varicose eczema is not in the skin, but in the veins. […] Varicose eczema should be taken seriously. It is a warning sign that the skin is being damaged by inflammation and if neglected and not treated, varicose eczema will progress to a leg ulcer.

• #18 Varicose Eczema (Symptoms and Treatment) | Doctor

  https://patient.info/doctor/varicose-eczema-pro

  The exact pathophysiology behind the skin changes is unclear. Leakage of blood constituents into the surrounding tissues and activation of inflammatory cells and fibroblasts are broadly responsible for the changes observed. These skin changes progress through the following changes: […] The chronic nature of varicose eczema and the requirement for regular treatment mean that it can carry significant morbidity and have major socio-economic implications.

• #19

  https://eczemacompany.com/blogs/blog/how-to-treat-varicose-eczema?srsltid=AfmBOoqlOEYs3ZpthMKkct2vawGojuAIX6qxpShtWE7yHosU1uRdLF1R

  Varicose eczema is a common type of eczema for people with varicose veins. It is most common in seniors, affecting about 70% of people over the age of 70. It usually affects just the lower legs, which become swollen from poor circulation. Eczema then forms on the skin where varicose veins are present. […] Varicose eczema is caused by poor circulation which can lead to a build up of pressure as the blood attempts to flow upward through the body and heart. This pressure causes the fluid to leak out of the vein and into the skin. The skin can then become dry, itchy, and swollen. […] Not only is varicose eczema uncomfortable, but it can quickly lead to a much bigger problem: varicose ulcers. Skin affected by varicose eczema is thin and unhealthy and can easily break down. If left untreated, a small hole can appear and become deeper and wider over time. This can lead to a buildup of bacteria, making your eczema even worse and leading to serious infection.

• #20 Varicose Eczema | Eczema Foundation

  https://www.pierrefabreeczemafoundation.org/en/varicose-eczema

  Varicose eczema is eczema of the legs due to venous insufficiency. […] Its main cause is venous insufficiency. The veins in the legs are no longer able to pump blood back to the heart. Their walls dilate, forming varicose veins where blood accumulates and stagnates. This is venous stasis. This causes ankle edema and skin disorders such as ocher dermatitis or skin sclerosis, as well as chronic inflammation such as eczema. […] In cases of venous insufficiency, the skin on the legs is more reactive and at risk of contact allergy. Thus, varicose eczema can be complicated by contact eczema due to a product applied to the skin or a leg ulcer dressing.

• #21 Contact sensitization in venous eczema: Preliminary results of patch testing with Indian standard series and topical medicaments – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/contact-sensitization-in-venous-eczema-preliminary-results-of-patch-testing-with-indian-standard-series-and-topical-medicaments/

  Contact sensitization to active drugs or to their constituents is a continuously operating factor and is one of the factors responsible for the chronicity and deterioration in stasis dermatitis. Patch test should be used to identify the topical agents that may be responsible for perpetuation or aggravation of eczema, especially in patients who do not improve despite adequate treatment of other underlying cause(s). Additionally, it is imperative to consider unprescribed medications causing sudden exacerbation of existing dermatitis. The significance of patch testing with these need to be emphasized, especially in patients such as the one who developed exacerbation of venous eczema following accidental application of topical diclofenac.

• #22 Venous eczema – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/venous-eczema/

  Venous eczema occurs when valves in the leg veins do not work properly, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins. This congestion then causes damage to the overlying skin. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to the increase in pressure pushing blood and blood products from the veins into the surrounding tissue. This then triggers inflammation in the skin. […] Unfortunately, the problem of the valves in the veins not working properly cannot be cured; this means that venous eczema does not clear up completely if left untreated. However, simple measures to improve the function of the valves and treatments for the active eczema can greatly improve the skin and associated symptoms, keep the eczema under control and help to prevent complications such as leg swelling, infection and lipodermatosclerosis.

• #23 Varicose Eczema: Symptoms, Diagnosis and Treatment

  https://www.drsumitkapadia.com/blog/varicose-eczema-symptoms-diagnosis-treatment/

  This increased venous pressure damages the small blood vessels in the skin, causing inflammation and, eventually, varicose eczema. While varicose veins are the most common trigger, other factors such as obesity, pregnancy, deep vein thrombosis (DVT), or a sedentary lifestyle can also increase the risk of developing this condition. […] Treating varicose eczema involves managing the underlying venous insufficiency and alleviating the skin symptoms. In mild cases, treatment may include topical corticosteroids to reduce inflammation and moisturizers to combat dry, flaky skin. […] For moderate to severe cases, its essential to address the venous issue directly. Compression therapy, such as wearing compression stockings, is a mainstay of treatment as it improves circulation and reduces swelling.

• #24 Is Varicose Eczema Serious? | The VeinCare Centre

  https://www.theveincarecentre.co.uk/blog/is-varicose-eczema-serious/

  The majority of people with varicose eczema have a problem with the leg veins that can be cured by non-invasive procedures under local anaesthetic on a walk-in walk out basis — procedures such as laser, radiofrequency, foam sclerotherapy or superglue. […] Varicose Eczema is a complication of leg vein problems. Varicose Eczema indicates that the skin is being damaged and that the area is at risk of ulcers.

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