By: Dr. Pierre Ghassibi – 4-23
Yes, heart failure, renal failure, cirrhosis … but the commonest causes are not these.
By far, the commonest cause is obesity in a person who sits the whole day: the compression at the level of the posterior thighs prevents venous return, but also the muscles are not moving to milk the venous blood up. With time, the tissues of the legs lose their elasticity and lose their recoil property and the skin gets spongy and prone to breakdown and chronic ulceration…
Some medications can also dilate the vessels and along with the above cause make things worse. These include Amlodipine, Nifedipine, Pioglitazone , anti-inflammatory meds, Gabapentin, oral Steroids and to a certain extent narcotics. Some anticonvulsants do this too.
Management consists of changing or lowering the dose of the culprit medication , compression, elevation when possible, and avoiding sitting all the time.
A DVT (deep venous thrombosis = blood clot ), even with treatment, may end up affecting the function of the valve of the vein involved and cause permanent edema.
A one sided edema should raise the possibility of an acute blood clot and if this is ruled out, a search for a mass higher up blocking the venous return would be in order. I had a patient with a tumor in the pelvis that caused unilateral edema. A CT scan showed the tumor.
Venous ulcers are best treated with elevation, compression, exercise, local hygiene with soap and water and surgical dressings. Topical antibiotics are effective for very superficial ulcers and very often cause dermatitis if used for more than a week. Bad infection may respond to systemic antimicrobials. For prevention, on intact unbroken skin, I use topical 2.5 % to 5 % Benzoyl Peroxide gel if infections are a frequent occurrence. It removes and kills infective organisms, and it does not lead to resistance.
After 10 days, the skin is sanitized and I continue with only soap and water. Bactericidal soaps have led to resistant bacteria; simple soap is better.
Marked leg compression stockings half way up may hinder venous return and increase the risk of blood stagnation and clot formation. ◊