Skin care for venous dermatitis
Skin care of the lower limb is essential to maintain skin integrity and minimise the risk of further ulceration.
Dermatitis on the legs is common in patients with ulcers, especially venous leg ulcers. Contributing factors include dryness and irritants (eg soap, antiseptics). Allergic contact dermatitis from dressings and topical medications may also occur (see Previous reactions to ulcer and wound dressings). Common allergens include preservatives in creams, rubber accelerants in elastic dressings and topical antibiotics. Specific allergen identification is facilitated by patch testing, which is undertaken by a dermatologist (see Contact dermatitis).
Dermatitis varies in severity. Milder forms may have a dry, scaly appearance with superficial cracking of the skin; more severe forms have a moist, intensely erythematous, appearance with oozing, weeping and crusting. Contact dermatitis often presents with a well-demarcated, sharply cut-off rash on the area in contact with the allergen or irritant.
Treating venous dermatitis around a wound may reduce the risk of infection (including cellulitis) and promote ulcer healing. Encourage skin care (see Skin care for intact skin around an ulcer).
- cleanse with a pH-appropriate skin cleanser (avoid soap)
- use products without fragrance or preservatives
- avoid frequently changing skin products
- to protect skin in the shower, apply an emollient (see Emollient types and properties) to skin before showering (it will wash off)
- shower in potable water or wash the leg using a dedicated bowl of potable water
- wipe the leg with a moist cloth
- gently pat the leg dry (avoid rubbing) with a clean towel
- apply moisturiser (in the direction of hair growth) after showering to maintain healthy skin
Treat venous dermatitis with a simple emollient (eg a paraffin-containing ointment), applied at least daily. Continue even after the ulcer is healed. A moderately potent topical corticosteroid in an ointment base (eg betamethasone dipropionate 0.05% ointment) should be applied liberally to all areas of dermatitis at each dressing change until the skin is completely clear. Emollients can be applied on top of the corticosteroid. For milder presentations, a weaker topical corticosteroid such as triamcinolone acetonide 0.02% ointment could be used—hydrocortisone 1% ointment is inadequate. Topical corticosteroids can be applied safely over cracked or broken skin, and should be applied up to (and including) the edge of an ulcer. Also consider using zinc paste bandages.
Excessive ulcer exudate can lead to skin irritation, maceration and delayed healing—choose dressings that appropriately manage ulcer exudate (see Ulcer and wound dressings).
For advice on cleansing the wound, see Cleansing and debridement.