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Can ulcers happen due to stasis dermatitis in leg?

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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Dermatologist
Practicing since : 2002
Answered : 4167 Questions
Question
My father has stasis dermatitis on his leg which appears to be spreading almost up to the knee and is looking very nasty. We are worried about the possibility of ulcers developing. Is it likely that this could happen? If so is there anything he can do to reduce the likelyhood of this happening please?
Posted Fri, 28 Feb 2014 in Skin Hair and Nails
 
 
Answered by Dr. Sanjay Kumar Kanodia 48 minutes later
Brief Answer: Kindly send details with high resolution pictures Detailed Answer: Hi, I can understand your concern for the stasis dermatitis in your father. The history provided by you is insufficient to guide you best, so I request you to kindly elaborate the concern: 1. Since exactly how many years your father has stasis dermatitis. 2. Is this present on both the legs. 3. Are there any red areas on the affected portion. 4. Any previous history of ulceration or infection. 5. Any previous treatment taken for the stasis dermatitis. It would be best to send few good resolution pictures of the affected area so that it can be analyzed best. You have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries better. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). "Wish you good health" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)
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Follow-up: Can ulcers happen due to stasis dermatitis in leg? 9 days later
In answer to your questions:- Question 1: My father has had this condition for about 12 months now. Question 2: Yes it is present on both legs, moreso on 1. Question 3: As you can see from the attached photos, the affected areas are very red and angry looking. Question 4: My father has no previous history of infection or ulceration to the affected areas. Question 5: The only previous treatment my father has tried is some topical applications recommended by the treating doctor which have done little more than keep the area moist and free from cracking. Sorbolene moisturiser. I have some photos which clearly show the condition of my father's legs. Can you please advise how I can attach these and send them to you. Also my father has had 2 biopsies so far on the affected area. One was several months ago and came back positive for stasis dermatitis. Also a couple of weeks ago he had a second biopsy done which came back positive for psoriasis. The doctor has since prescribed prednisolone tablets which he has been on for one week which appear to be reducing the soreness slightly and the skin appears to be less flaky.
 
 
Answered by Dr. Sanjay Kumar Kanodia 15 hours later
Brief Answer: Send the pictures by attachment Detailed Answer: Hi, I was waiting for the pictures to get uploaded so that I can guide you best regarding your father's condition. I had already guided you the process in the previous mail. You have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries better. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). Hope to hear soon form your side. "With good health wishes" Dr Sanjay Kumar Kanodia MD- Dermatology
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Follow-up: Can ulcers happen due to stasis dermatitis in leg? 47 hours later
As instructed here are the photos of my father's legs. We're a bit confused now about what the problem actually is due to having had two biopsies show up positive 1. for stasis dermatitis and one for psoriasis. We would appreciate any thoughts that you have in relation to the two different answers? Thanks for your help.
 
 
Answered by Dr. Sanjay Kumar Kanodia 5 hours later
Brief Answer: psoriasis; methotrexate after blood investigations Detailed Answer: Hi, Thanks a lot for uploading the good resolution pictures. After thoroughly analyzing the pictures I can make a diagnosis of psoriasis in your father’s condition. The hallmark of psoriasis is the deep redness at the affected site. Then the second most important point in the diagnosis is the scaling part. You can see both the things are quite obvious. So I will go with the latest biopsy report which confirms the condition as psoriasis. An important differentiating feature of psoriasis with stasis dermatitis is that – in stasis dermatitis there is pigmentation of brownish to dark brown color rather than redness. There is minimal of scaling and that too fine scaling which is not very perceptible and lastly it remains confined to the lower legs at the ankle region and barley go above middle legs . You can see all these features of stasis dermatitis are in contrast with your father’s condition. If I were your father’s dermatologist then I would have kept the mainstay of the treatment in psoriasis by tablet Methotrexate by mouth given in weekly doses after through investigation of complete blood profile and liver function tests. I would not have preferred for oral steroids but rather topical steroids would be my choice such as clobetasol or halobetasol (high potency)in initial few weeks and then shifted to mometasone (medium potency) in next few weeks and then shifted to reducing potency after proper relief. Plenty of moisturization is very beneficial in the condition. For itching round the clock antihistamine such as loratadine is quite beneficial to alleviate the itching. I hope these information will help in your father’s condition. I will be glad to help if you have any further queries. "With good health wishes" Dr Sanjay Kumar Kanodia MD- Dermatology
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Follow-up: Can ulcers happen due to stasis dermatitis in leg? 30 hours later
Dear Dr. XXXXXXX XXXXXXX Kanodia, Yes I did like your answer. It was very helpful. I have one last question if I could please? Is there any risk of the psoriasis completely disappearing with the treatment that you have recommended? Is there an increase risk of developing ulcers as a result of the psoriasis? Thanks again. XXXXXXX XXXXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 10 hours later
Brief Answer: Psoriasis is a very simple disease Detailed Answer: Hi XXXXXXX Let you understand few more important dermatological/ medical facts: - Psoriasis is a very simple disease where there is over proliferation of skin is present. In simple words- the skin which renews in 28 days gets renewed in 4-5 days. - It is not at all life threatening or disabling disease. It does not require daily treatment. - The only problem with psoriasis is that we have not been able to cure it completely but that is again not a serious issue. As the treatment is required till the complete healing of skin or during recurrence of the problem. - It is a not an infectious disease & the person surrounding can never get it. AS I have seen stigma for red patches in both patients as well as surrounding people. - It never cases any type of ulcers which you can see in your father too that rather than ulcer it is the deep red skin which is actually the main problem. - It can be treated with simple measure of proper topical and oral medicine s which I had already suggested you in previous mail. SO getting to all these points- If I were your father’s dermatologist then would have first gone for the blood investigations including complete blood profile and liver function tests. If the tests come normal then would have gone for Methotrexate in the dose of 15 mg per week under controlled monitoring. If the blood test comes abnormal then would have preferred for topical applications only as the mainstay. You can apprise your dermatologist with my suggestions and my main aim is that your father gets better as early as possible. My all best wishes for his earliest recovery. In future you can reach me directly on: Bit.ly/drsanjaykanodia I hope these information will help in your father’s condition. I will be glad to help if you have any further queries. "With good health wishes" Dr Sanjay Kumar Kanodia MD- Dermatology
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