Synopsis
Recognise lower-leg eczema caused by chronic venous hypertension, exclude arterial and acute vascular disease, treat skin inflammation, and coordinate safe compression and venous referral.
- Venous eczema affects the lower gaiter region with itch, scale, oedema, haemosiderin colour, varicosities and sometimes lipodermatosclerosis or ulceration.
- Bilateral chronic itch and scale favour venous inflammation; acute unilateral pain, fever or rapid spread requires assessment for cellulitis or thrombosis.
- Check arterial symptoms and pulses and obtain the locally required vascular assessment before compression; do not prescribe compression blindly.
Key red flags
Sudden unilateral swelling, chest symptoms, rest pain, cold foot, absent pulses, fever, rapidly increasing erythema, severe ulcer pain or uncontrolled bleeding requires urgent vascular or medical assessment.
Sudden one-sided swelling, calf pain, cold foot, rest pain, absent pulse or chest symptoms needs urgent assessment.
Investigation priorities
Identify arterial compromise or acute vascular threat before compression.
Management branches
Chronic gaiter eczema and oedema occur without acute arterial, thrombotic or infectious red flags.
- Use leave-on emollient daily as cleanser and moisturiser and a defined course of topical corticosteroid only on actively inflamed patches.
- Encourage walking, calf activation and periods of leg elevation while reducing prolonged dependent sitting or standing where feasible.
Key medicines
Betamethasone valerate 0.1% creamApply thinly to active intact lower-leg eczema once or twice daily for up to four weeks, then reduce or stop when inflammation is controlled.