Treatment

It is most important to determine and then manage the underlying venous insufficiency.

Postural drainage may be used to counteract the high venous pressure. The patient should be encouraged to lie on the bed for an hour in the afternoon with the legs drained; similarly, they should be encouraged to sleep with the foot of the bed raised. Standing should be discouraged; exercise, encouraged.

Chronic use of topical steroids is not advised since they will accelerate the development of atrophy. Scratching and trauma may be prevented by the use of ichthyol or tar-impregnated bandages.

Mild eczema is treated with moderately potent corticosteroid for 3-4 weeks and emollients. Severe eczema may require higher potency corticosteroid treatment with emollients. Infected eczema may be treated with potent corticosteroids, antiseptic and astringent agent such as potassium permanganate (1:10000) and oral antibiotics (2).

Reference:

• (1) Grey JE et al. ABC of wound healing: Venous and arterial leg ulcers. BMJ. 2006; 332(7537): 347-350