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Causes of Venous Eczema


Who gets Venous Eczema?

Venous Eczema occurs only after many years of inflammation due to venous reflux.

Research performed by Mark Whiteley, in Reading in the 1990s, showed that 1 in 20 schoolchildren aged 9 had venous reflux already, and 1 in 9 of schoolchildren aged 18 had venous reflux – although virtually none of them had any varicose veins visible on the surface.

Therefore the underlying venous problem that can cause Venous Eczema starts very early in life – and so it is possible that Venous Eczema can also appear fairly early in life. However, due to the time it takes to develop, it is rarely seen in the under 20s but it is more common the older the person becomes.

Hidden Varicose Veins

In the adult population, about 1 in 4 people have varicose veins. As there are many people who have venous reflux without visible varicose veins (‘hidden varicose veins’) the number of people at risk from Venous Eczema is even higher.

As Venous Eczema is curable and preventable, no one should actually have it at all. If people insisted on seeing venous experts and having treatments such as those provided by The Whiteley Protocol®, then anyone with Venous Eczema could be cured and virtually anyone coming with any venous problems before the Venous Eczema developed could have the Venous Eczema prevented.

Therefore in any population where it is common, it shows that there is a lack of people having proper diagnosis, investigation and treatment.

Unfortunately there is a general lack of understanding about varicose veins and venous reflux disease. Most people (and many doctors and nurses) only diagnose varicose veins if they can see bulging veins on the surface – and if they do see them, they usually dismiss them as “only cosmetic”. Both of these responses are usually wrong.

To understand varicose veins and venous reflux fully is difficult – hence the huge amount of research that has gone into the development of The Whiteley Protocol® for treating venous problems. However, the underlying principles can be made simpler.

Blood gets pumped from the heart into the legs to keep the tissues oxygenated and supplied with nutrients. Once the blood has got to the feet and lower legs, it has to be pumped back up the legs to the heart. When lying down, this isn’t a problem. However, when we are standing up or sitting down, the feet and ankles are below the heart. Therefore, to get the blood back to the heart it needs to be pumped up the veins against gravity.

The pumping of the blood is achieved by contraction of the leg muscles which push on the veins, forcing the blood up the veins. When the muscles relax, the blood could fall back with gravity if it wasn’t for the valves inside the veins. When the blood starts to flow back down the veins, valves flap open from the vein wall, holding the blood where it is. On the next muscle contraction, more blood is forced up the vein, opening the valve and carrying the blood further upwards on its way to the heart.

In people with varicose veins or venous reflux (hidden varicose veins) valves in some of the veins stop working. In these people, the muscle contraction and pumping is normal. However, when the muscles relax, the blood falls down the vein that has lost the valves, hitting the small veins and capillaries at the bottom of the vein and causing inflammation.

In some people, the body reacts to try to stop the inflammation by dilating side veins. In these patients, the blood falling down the main vein gets side-tracked into the dilated side veins which act as ‘shock absorbers’ reducing the impact of the blood on the small veins at the lower leg and therefore reducing the inflammation. These dilated side veins can sometimes be seen bulging under the skin – these are ‘varicose veins’.

However, in other people, the body doesn’t open up side branches. In these people the blood falls down the vein without anything to stop it, causing inflammation at the bottom of the vein. In these people there are no visible varicose veins on the surface and so patients, doctors and nurses often say that the patient doesn’t have ‘varicose veins’! However the underlying problem of the valves not working and the inflammation that is caused by the blood ‘refluxing’ down the vein the wrong way is the same! This is why we call this problem ‘venous reflux’ or ‘hidden varicose veins’.

The inflammation that is caused by the venous reflux – both in people who have visible varicose veins as well in those who have ‘hidden’ varicose veins – affects the small veins at the point where the falling blood hits them. This is usually at the bottom of the leg, around the ankle. At first the inflammation is deep inside and so it is not noticed. With time, if the veins aren’t treated, the inflammation continues and so starts to spread outwards, towards the skin surface.

At this stage people will often notice some swelling of the ankles or aching of the leg, both caused by the deep but spreading inflammation. Unfortunately, if varicose veins aren’t visible on the surface, these signs are often ignored or mis-diagnosed and the opportunity to cure the problem is missed.

As the inflammation spreads outwards through the deep tissues of the lower leg, it causes some irritation of the deep layer of the skin. This makes the person with the problem start to rub and scratch the leg – often without noticing that they are doing so. Over time, repeated scratching and rubbing damages the skin surface causing an inflammation of the skin itself. This is called Eczema

The fact that the underlying cause of the eczema is the venous reflux is the reason it is called ‘Venous Eczema’.

If you have followed the above sequence and have understood it, then the treatments become clear and obvious – as do the things that you should avoid.


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