If you have, or think that you might have, Venous Eczema you need to be assessed by a venous expert such as the experts at The Whiteley Clinic. You should probably go to your GP first, but you should not allow yourself to be side-tracked into ineffective or temporary treatments such as steroid creams or support stockings (see below).
Everybody who either has Venous Eczema, or who might have Venous Eczema, needs to have a specialised venous duplex ultrasound performed by an experienced vascular scientist. Many people perform venous duplex ultrasound examinations, but only a few do these regularly most days of every week. It is essential to have a venous duplex ultrasound performed not only by someone who is trained, but who spends the majority of their time scanning veins. At The Whiteley Clinic we ensure that all of our Vascular Scientists are trained to the level required by The Whiteley Protocol® and have regular venous work keeping their skills honed.
It is acceptable to have support stockings or steroid creams in the short term provided they are only used to relieve the symptoms whilst the referral to a venous specialist and a venous duplex ultrasound is arranged.
The principle of treatment is easy. As Venous Eczema is caused by blood refluxing the wrong way down the veins that don’t have valves working in them, then stopping this venous reflux cures the condition.
In the past, surgeons used to stop the blood falling down these veins by tying the veins and stripping them away under a general anaesthetic. However, this has shown to be a bad idea as it is painful, destructive and the veins only grow back again in the majority of patients.
Since Mark Whiteley brought keyhole surgery for varicose veins into the UK in March 1999, the optimal treatments for venous reflux are combinations of keyhole methods.
It is both the wide choice of techniques that are now available and the fact that different veins are optimally treated by different combinations of these techniques that makes the treatment choice more difficult.
Fortunately, Mark Whiteley from The Whiteley Clinic developed The Whiteley Protocol® which directs the experts at The Whiteley Clinic to use the optimal combination of treatment options for the venous reflux pattern that is found in patients.
Therefore, the exact treatment each patient needs is tailored individually for them, using The Whiteley Protocol® – making sure that when treatment is finished, there is no blood refluxing down any veins in the pelvis or leg, stopping any inflammation and therefore letting the Venous Eczema heal.
Traditionally Venous Eczema has been treated by a variety of creams (usually steroid), anti- histamines and / or support stockings (or more correctly ‘Graduated Pressure Stockings’).
The steroid creams and anti-histamines are used to try to calm the inflammation in the skin. However, as the inflammation in the skin is caused by the inflammation coming from more deeply – which is caused by venous reflux and the impact of the blood falling down veins in which the valves have failed) – calming the inflammation in the skin alone is illogical.
It may help the skin to feel better in the short term, but the underlying reflux and inflammation will continue to worsen, leading to a worsening of the condition despite the skin feeling better. As this worsening can result in clots in the veins (phlebitis), bleeding or leg ulceration, then hiding the eczema away by steroid creams or anti-histamines is not a good idea.
Of course these can be used, provided that they are only prescribed for symptomatic relief whilst the patient is referred for specialist investigation and treatment.
In the case of support stockings, the pressure of the stocking on the skin is transmitted into the veins deep within the leg. This raises the pressure in the lower leg, reducing the flow of blood refluxing (or ‘falling’) back down the veins with non-working valves.
As the venous reflux is reduced, the inflammation is reduced and so the Venous Eczema either improves a little or is held stable.
Of course, as nothing has been done to the underlying veins themselves, as soon as the support stockings are removed the problem continues as if nothing has happened.