Eczema (varicose) - Treatment 

Treating varicose eczema 

Complementary therapies

Some people use complementary therapies such as food supplements or herbal remedies to treat varicose eczema. There is often a lack of evidence that shows they are effective in treating conditions such as eczema.

If you are thinking about using a complementary therapy, speak to your GP first to ensure the therapy is safe for you to use. You should continue with any other treatments prescribed by your GP.

Treatment for varicose eczema aims to improve the condition of your skin and help your circulation (blood flow). If you have any underlying vein problems, they will also need to be treated.

Treatment options may include:

There are also some self-help techniques that you can try. These treatment options are described in more detail below.

If you have varicose veins, graduated elastic medical compression stockings will often help to treat these as well. However, in some cases surgery may be necessary.

Lipodermatosclerosis (hardened, tight skin) is treated the same way as varicose eczema. If you have a venous leg ulcer, you can also read information about treating venous leg ulcers.

Self-help

There are some steps you can take to care for your varicose eczema:

  • avoid injuring your skin – for example, by knocking into a chair, as 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 – this will improve your circulation and help you maintain a healthy weight

Exercise

Fluid builds up in the lower legs if you sit or stand 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.

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 the outer layer of skin (epidermis), as well as adding water to the skin. They act as a protective barrier to keep moisture in and 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 several different emollients to find one that works for you. You may also be prescribed a mixture 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 are the most effective at keeping moisture in the skin. Lotions contain the least amount of 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 may start to irritate your skin. If this is the case, your GP will be able to prescribe another product.  

How to use emollients

If you have varicose eczema, you should use an emollient all the time, even if you do not have any symptoms.

To apply the emollient:

  • use a large amount 
  • smooth it into the skin in the same direction that the hair grows 
  • do not rub it in
  • apply every two to three hours for very dry skin 
  • 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 emollients during a flare-up of varicose eczema, because this is when the skin needs the most moisture. Apply emollients frequently and in generous amounts during a flare-up.

Side effects

The most common side effect of using emollients is a rash. If you have varicose eczema, your skin is sensitive and can sometimes react to certain ingredients in an emollient. If this happens, speak to your GP, who can prescribe an alternative product. 

Be aware 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 added to bath water can make your bath very slippery, so take care getting in and out of the bath.  

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.

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 both 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 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
  • use the topical corticosteroid for seven to 14 days
  • continue to apply the treatment for 48 hours after the flare-up has cleared

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.

How much topical corticosteroid to use

  • topical corticosteroids are measured in a standard unit called the fingertip unit (FTU)
  • one FTU is the amount of topical steroid squeezed along an adult's fingertip
  • one FTU is enough to treat an area of skin twice the size of an adult's hand

Read more information about fingertip units and dosage of topical corticosteroids.

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 blood to flow upwards towards your heart.

Medical compression stockings are used to treat varicose eczema and lipodermatosclerosis. They improve the condition of the skin by reducing the high blood pressure in the veins in the leg.

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 the knee and others also cover the thigh (you should only need knee-high stockings for varicose eczema)
  • different foot styles – some cover the whole foot and some stop before the 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 putting compression stockings on and taking them off, as 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.

Treating 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, treating 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 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.

Read more information about how varicose veins are treated.


Page last reviewed: 15/10/2012

Next review due: 15/10/2014

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

cecileannemarie said on 28 March 2012

Having had varicose excema diagnosed am worried that this may cause problems when travelling by air, especial;ly re insurance cover - advice please.

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