Varicose eczema, or venous eczema, usually occurs just above the ankle on the inside of the leg. It is caused by either visible varicose veins or “hidden varicose veins”.
If a patient is lucky enough to see the varicose veins, they know it is varicose eczema.
If they are less lucky and have “hidden varicose veins” (medically called superficial venous reflux or chronic venous incompetence) there are no varicose veins to be seen on the surface. These patients are often misdiagnosed by doctors and nurses and are given steroid creams and/or compression stockings rather than be referred for a curative endovenous treatment.
The patient shown in the picture is a 70-year-old gentleman who came to The Whiteley Clinic with extensive varicose veins of his left leg, with some ankle swelling and eczema just above the ankle. This was typical of varicose eczema, being just on the inner aspect of the lower leg.
Following both the NICE guidelines on varicose veins and also The Whiteley Protocol, he was scanned by a clinical vascular scientist. A venous duplex ultrasound scan was performed. Although this is standard for The Whiteley Clinic, such an in-depth scan is often called an “extended venous duplex ultrasound scan”. Research has shown that when a doctor performs their own quick scan, significant venous disease is often missed. Hence this never happens at The Whiteley Clinic.
Venous duplex ultrasonography confirmed truncal vein reflux and incompetent perforators. The patient underwent local anaesthetic endovenous laser ablation, TRLOP closure of perforators and phlebectomies. Four weeks later he had no symptoms, varicose eczema had stopped itching and had almost completely gone, the swelling of the ankle had resolved and the varicose veins had disappeared.
He was given the option of continuing to improve the cosmetic look of the veins around the ankle with ultrasound guided foam sclerotherapy and micro-sclerotherapy but the patient had only been concerned to get rid of varicose eczema. He did not want the risk of deterioration to leg ulceration.
For many years, varicose veins have erroneously been thought of as cosmetic only. In fact, research has shown that between 4 – 5% of people with varicose veins deteriorate to getting swollen ankles, venous eczema, brown stains around their ankles or even leg ulceration per year. Hence it is not surprising that the National Institute for Health and Care Excellence (NICE) produced guidelines in 2013 that recommended that anyone with varicose veins and any symptoms or signs at all should undergo duplex ultrasound scanning and endovenous treatment.
Varicose eczema is classified as CEAP C4. If it is not treated, it can deteriorate to CEAP C6 which is venous ulceration.
The Whiteley Protocol is the culmination of over 20 years of research and development by Prof Mark Whiteley and his team. His continuing audits have shown that the risk of recurrent varicose veins after treatment with The Whiteley Protocol is the lowest that is humanly possible – approximately 3.3% per year. This figure is the same as the risk of someone from a family with a history of varicose veins developing varicose veins each year. As such it is impossible to get a lower recurrence rate than this.