This is also called gravitational eczema, and as this name suggests, this affects the lower legs as a result from gravity's effect on the pressure of blood within the veins. This is most often seen in middle-aged to older age groups. Being overweight and female increases the risk.

Normal veins have a series of internal valves that keep the blood in the legs moving back towards the heart, and keep the pressure inside the veins at a low level. In the elderly, these valves are not functioning properly and so the pressure of blood within the veins increases considerably in the legs. The veins are distended and bulge out from under the skin, known as varicose veins.

The reduced blood flow has a knock-on effect on the nourishment of the skin; and increases the skin temperature so that more moisture is lost. These result in the eczema.

Signs

The eczema is usually located around the inner sides of each ankle, sometimes can extend to a wider area. Apart from the typical signs of eczema, namely dry cracking lines, redness, and inflammation, there may be oedema around the ankles.

The blood stasis and high pressure will force blood leaking from capillaries into the surrounding tissue. This leaked blood will be broken down and release iron, which precipitates in the skin and makes it appear as reddish-black.

Management & Treatments

Effective treatments involve helping the function of the valves, so that the pressure in the lower legs veins can be reduced. Unfortunately there is no cure, and can only be indirectly achieved by avoiding prolonged standing; leg elevation while sitting down; and compression bandaging.

The compression bandages provide a graded pressure, reducing from below upwards, and help to promote blood flow back into the heart. There are different sizes and pressure gradients, and purchasing these may require the help of the medical professionals.

Moisturisers and mild steroid creams relieve scaly and inflamed skin. Ordinary soap should be avoided because of the high alkalinity, and plenty of moisturisers should be applied after washing.

People with bad varicose veins and gravitational eczema are also at risk of developing skin ulcers around the ankle because of poor oxygen delivery by the blood stream in the affected areas. Varicose ulcers can be extremely troublesome and difficult to heal. Again, leg elevation and compression bandaging are the most helpful treatments to speed up the healing process.

For some reasons, skin affected by varicose eczema is rather sensitive and can become allergic to a range of skin medicaments, for example lanolin and some antibiotics. Lanolin is actually very moisturising and is a common ingredient for many moisturizers. If the eczema seems not to improve or even deteriorates, think of this possibility and try switching to a moisturiser free of lanolin.