This type of eczema developping on the lower extremities is initially triggered by chronic venous insufficiency. Over time, superimposed allergic contact dermatitis, mostly to ingredients of topical therapies, can constitute an additional etiological factor. Irritant contact dermatitis due to exsudation from venous ulcers is yet another etiological factor. Stasis dermatitis can lead to disseminated eczema.
Clinical picture: Diffuse, severly itching erythema and scaling, with multiple ill-defined patches at the periphery may develop into oozing and erosive lesions when intense irritation occurs. Other signs of venous insuffiency such as chronic oedema, hyperpigmentation, atrophie blanche, varicosities, venous ulcers and lipodermatosclerosis are often present.
Distribution: Lesions may affect the inner maleoli and extend to involve the distal lower extremities.
Diagnosis: The diagnosis is based on the clinical picture. Patch testing is recommended to exclude underlying contact allergies.
Differential diagnoses: Irritant and allergic contact dermatitis, nummular eczema, psoriasis and cutaneous T-cell lymphoma are possible differential diagnoses.