Treatment for varicose eczema involves:
- improving the condition of your skin with emollients (moisturisers) and corticosteroid medicines
- improving your circulation (blood flow) with graduated elastic medical compression stockings
- treating the underlying vein problems
There are also some self-help techniques that you can try.
If you have varicose veins (swollen and enlarged veins), graduated elastic medical compression stockings will often help to treat these as well. However, in some cases, surgery may be necessary. See the Health A-Z topic about Varicose veins - treatment for more information.
Lipodermatosclerosis (hardened, tight skin) is treated the same way as varicose eczema. See the Health A-Z topic about Leg ulcers - treatment for information about treating these.
Self-help
There are some steps that you can take to care for your varicose eczema:
- avoid injuring your skin – for example, by knocking into a chair because this could lead to an ulcer (open sore) developing
- raise your legs when you are resting – for example, by propping up your feet on some pillows, to help reduce swelling
- keep physically active, because this will improve your circulation and enable you to maintain a healthy weight
Exercise
Fluid accumulates in the lower legs if you stand or sit for too long, so it is important to keep moving. Walking will get your muscles working and help to push the blood through the veins to your heart. The National Eczema Society also recommends:
- flexing your feet regularly
- rising up onto your toes or bending down at the knees
Emollients
Emollients are substances that help to soften and smooth your skin to keep it supple and moist. They are one of the most important forms of treatment for all types of eczema. See the Health A-Z topic about Emollients for more information.
As varicose eczema can cause your skin to become dry and cracked, it is important to keep it moisturised to prevent further irritation. Emollients prevent water being lost from your outer layer of skin (epidermis), as well as adding water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.
Choice of emollient
A number of different emollients are available. Some can be bought over the counter without a prescription, but if you have varicose eczema ask your GP to recommend a suitable product.
You may need to try a number of different emollients to find one that works for you. You may also be prescribed a mix of emollients. For example:
- an ointment for very dry skin
- a cream or lotion for less dry skin
- an emollient to use instead of soap
- an emollient to add to bath water or use in the shower
The difference between lotions, creams and ointments is the amount of oil that they contain. Ointments contain the most oil so they can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least amount oil so are not greasy, but can be less effective. Creams are somewhere in between.
If you have been using a particular emollient for some time, it may eventually become less effective or it may start to irritate your skin. If this is the case, your GP will be able to prescribe another product.
How to use emollients
You should use your emollient all the time, even if you are not having symptoms. You could consider keeping separate supplies of emollients at work or at school.
To apply the emollient:
- use a large amount
- smooth the emollient into the skin in the same direction that the hair grows
- do not rub the emollient in
- for very dry skin, apply emollient every two to three hours
- after a bath or shower, gently dry the skin, then immediately apply the emollient while the skin is still moist
- do not share emollients with other people
Creams and lotions tend to be more suitable for red, inflamed (swollen) areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.
It is very important to keep using your emollients during a flare-up of varicose eczema because this is when the skin needs the most moisture. During a flare-up, apply emollients frequently and in generous amounts.
Side effects
The most common side effect of using emollients is a rash. If you have varicose eczema, your skin is very sensitive and can sometimes react to certain ingredients within an emollient. If your skin reacts to the emollient, speak to your GP, who can prescribe an alternative product.
Be aware that some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, do not use them near a naked flame.
Emollients that are added to bath water can make your bath very slippery, so take care getting in and out of the bath. As long as you are aware of these hazards, you should be able to use emollients safely.
Topical corticosteroids
If your skin is red and inflamed from a flare-up of varicose eczema, your GP may prescribe a topical corticosteroid (one that is applied directly to your skin). Corticosteroids work by quickly reducing inflammation.
Corticosteroids are any type of medication that contain steroids, a type of hormone. Hormones are groups of powerful chemicals that have a wide range of effects on the body. See the Health A-Z topic about Topical corticosteroids for more information.
You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used (illegally) by bodybuilders and athletes. When used correctly, corticosteroids are a safe and effective treatment for eczema.
Choice of topical corticosteroid
Different strength topical corticosteroids can be prescribed depending on the severity of your varicose eczema. If you have flare-ups of lipodermatosclerosis, you may need a very strong topical corticosteroid. Therefore you may be prescribed a cream or an ointment.
If your varicose eczema is moderate to severe, you may need to apply topical corticosteroids between flare-ups and during them.
If you need to use corticosteroids frequently, visit your GP regularly so they can check that the treatment is working.
How to use topical corticosteroids
When using corticosteroids, apply the treatment sparingly to the affected areas. Always follow the directions on the patient information leaflet that comes with the corticosteroid, as it provides details about how much to apply.
During a flare-up of varicose eczema, do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day. When applying the topical corticosteroid, you should:
- apply your emollient first and wait several minutes before applying the topical corticosteroid (until the emollient has soaked into your skin)
- apply a small amount of the topical corticosteroid to the affected area (see the box above for a guide on the amount you should use)
- use the topical corticosteroid for 7 to 14 days
- continue to apply the treatment for 48 hours after the flare-up has cleared up
If you are using corticosteroids on a long-term basis, you may be able to apply them less frequently. Your GP will advise you about how often you should be applying them.
Also speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved.
Side effects
Topical corticosteroids may cause a mild burning or stinging sensation as you apply them. In some areas, they may also cause:
- thinning of the skin, particularly in the crease of your knee joint
- telangiectasia (visible blood vessels) – particularly on the cheeks
- acne (spots)
- increased hair growth
Generally, using a stronger topical corticosteroid or using a large amount of topical corticosteroid will increase your risk of getting side effects. For this reason, you should use the weakest and smallest amount possible to control your symptoms.
Graduated elastic medical compression stockings
Medical compression stockings are specially designed to steadily squeeze your legs to help improve your circulation. They are often tightest at the ankle and get gradually looser as they go further up your leg. This encourages your blood to flow upwards towards your heart.
Medical compression stockings are used to treat varicose eczema and lipodermatosclerosis. This is because it is thought that they improve the condition of the skin by reducing the high blood pressure in the veins in the leg. They are an important part of your treatment.
Compression stockings are available in a variety of different sizes and pressures. Most people with varicose eczema will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking. They are also available in:
- different colours
- different lengths – some come up to your knee and some also cover your thigh; you should only need knee-high stockings for varicose eczema
- different foot styles – some cover your whole foot and some stop before your toes
Compression tights are also available, but not on the NHS. They can be bought from pharmacies or directly from the manufacturers.
Wearing compression stockings
You will usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Wearing compression stockings can be uncomfortable, particularly during hot weather, but it is important to wear them correctly to get the most benefit from them.
Pull them all the way up so that the correct level of compression is applied to each part of your leg. Do not let the stocking roll down or it may dig into your skin in a tight band around your leg. Speak to your GP if the stockings are uncomfortable or if they do not seem to fit. It may be possible to get custom-made stockings that will fit you exactly.
If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure that your stockings will be the correct size. If your legs are often swollen, they should be measured in the morning when any swelling is likely to be minimal.
Take care when taking your compression stockings on and off because this can damage fragile skin. If you have a leg ulcer, it ideally needs to heal before you start wearing compression stockings.
Caring for compression stockings
Compression stockings usually have to be replaced every three to six months. Speak to your GP if your stockings become damaged, as they may no longer be effective.
You should also be prescribed two stockings (or two sets of stockings if you are wearing one on each leg) so that one stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat.
Treatment of varicose veins
The combination of skin care and compression stockings will help many people with varicose eczema. However, in some cases the eczema persists. In people with severe skin damage due to venous disease, such as lipodermatosclerosis or a venous ulcer, investigation and treatment of the underlying venous disease will cure the problem in the long-term.
The most common venous disease that causes skin damage is varicose veins. Your doctor should suggest referral to a vascular surgeon who can arrange for colour duplex ultrasound imaging of the leg to find the faulty blood vessels. Treatment of the varicose veins can then be planned.
Several modern methods are available that will cure varicose veins and resolve associated varicose eczema, lipodermatosclerosis and venous ulcers. These are usually performed in the day surgery department of a hospital.
For more information about all the possible treatments, see Varicose veins - treatment options.
