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Leg ulcer - venous - Management
How do I manage a venous leg ulcer with associated dermatitis?
- Exclude cellulitis if there is worsening venous eczema and signs suggestive of active infection.
- Use an emollient and a mild to moderate potency topical corticosteroid ointment. If compression bandaging is being used, consider replacing bandages more frequently than once weekly to apply topical treatment. For more information see the CKS topic on Eczema - atopic.
- If there is no improvement with an emollient and a moderately potent topical corticosteroid, or there are concerns about allergic contact dermatitis (worsening rash with topical treatment at any stage), refer the person to Dermatology for consideration of patch testing, and advise them to avoid any allergens subsequently identified.
Clarification / Additional information
- Contact dermatitis caused by bandages is well demarcated (i.e. stops where the bandage stops).
- Common sensitizers include wool alcohols (lanolin), topical antibiotics, topical corticosteroids, cetyl stearyl alcohols, parabens, and rubber mixes. For more information see Issues to consider before prescribing.
Table 1. Features of venous eczema and cellulitis.
Features | Venous eczema | Cellulitis |
|---|
History | Chronic (usually) | Insidious (24–72 hours) |
Appearance | Red, painful to touch, haemosiderin pigmentation | Red, warm, tender to touch |
Rash margin | Diffuse (poorly demarcated) | Well demarcated |
Symptoms | Itchy | Not itchy, person is systemically unwell, pyrexia |
Scaling | Yes | No |
|
Basis for recommendation
- These recommendations are based on the clinical guidelines: The nursing management of patients with venous leg ulcers published by the Royal College of Nursing [RCN, 2006], Management of chronic venous leg ulcers published by the Scottish Intercollegiate Guidelines Network (SIGN) [SIGN, 2010], together with the best available trial evidence, informed expert opinion, and current good clinical practice.
- People can become sensitized to components of their topical treatment at any time. One randomized controlled trial (RCT) suggested that more than 20% of people previously patch tested had developed at least one new allergy at retesting 2–8 years later [RCN, 2006].
- As there are no RCTs evaluating the impact of patch testing and avoidance policies on ulcer healing, the recommendations are based on expert opinion [RCN, 2006].
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