Skin disorders of the lower leg

0


What is it about ?

The causes are very diverse, but they are often poor blood circulation, an allergy, an infection due to a fungus (yeast infection) or a bacteria or a skin disease such as psoriasis. It is rarer for a disease affecting the whole body (systemic disease) to be the cause.

How to recognize it?

The two main symptoms of dermatitis on the lower leg are rash and itching.

The most common types are:

  • the stasis dermatitis caused by varicose veins: blood does not flow sufficiently back to the upper part of the body and a fluid retention in the legs (edema) and brown discoloration of the skin. Sometimes sores (ulcers) appear.
  • the’cracked eczema occurs mainly in older people and is the result of excessive washing and rubbing of the skin, which dries it out. It usually gets worse in winter and gets better in summer, when exposed to the sun.
  • THE’atopic eczema causes a rash accompanied by itching (pruritus) It mainly affects skin folds, face, neck and eyelids. It can also develop on the legs. Over time, the skin can also become thicker and rougher. Atopic eczema is often associated withasthma, to hay fever and food allergies. Atopic eczema often begins in childhood. Usually, the disease affects several family members.
  • THE’nummular eczema is a common and chronic variant of eczema. It often begins with a single blister or spot around which several new, similar lesions appear. These cluster together to form well-defined patches, round or oval, often red, scaly, sometimes moist and itchy. This type of eczema usually gets worse in winter.
  • the psoriasis is a skin disease that most commonly occurs in the knees and elbows. Often there are lesions in other parts of the body as well. Psoriasis most often presents as red, hard, thick, delineated patches (plaque psoriasis) covered with a layer of white skin flakes (scales). They can appear mainly in the navel, armpits, knees, elbows, nails, scalp and between the buttocks.
  • the ringworm (tinea) is a skin disease caused by a fungus. It can occur almost anywhere on the body, including the legs. It presents as red, round lesions with a scaly outline. The skin of the feet is also often affected (tinea pedis).
  • THE’allergic contact eczema is an acute rash that is red in color, accompanied by itching. There are also often small bumps, blisters, scabs and / or peeling skin (scales, skin dandruff). The rash occurs in reaction to certain chemicals in contact with the legs (soaps, creams, textile dye in the stockings, …). It appears at and around the contact site.
  • The neurodermatitis (chronic lichen simplex) is a skin condition that is itchy (itchy) and is fed by rubbing and scratching. It is often a complication of another skin condition. The skin becomes thicker and darker. The condition usually affects the top of the foot, ankle or lower leg.
  • the lumpy prurigo is a very extensive form of neurodermatitis. Scratching creates small, red, raised, crusted bumps (nodules) on the skin, ranging in diameter from 0.5 to 1 cm. The trunk is often affected, too.
  • the lichen planus is a condition whose cause is not well known. Small, shiny, flat, red-purple bumps (papules) form, often with itching. They appear on the body, usually on the inside of the wrists, lower back and ankles, with whitish lines visible on their surface. Papules are usually arranged in groups, lines, or rings. On the legs, the lesions are usually thicker. If the skin is damaged (for example after scratching), new lesions can appear in these places. Painful lesions can also occur on the mucous membranes of the mouth and genitals.
  • the’erysipelas and the cellulite are bacterial infections of the skin. They are usually accompanied by fever and a feeling of general ill-being. Both conditions affect only one side of the body; a hot red patch quickly appears. The contour of the plate is slightly raised; you can feel it when you touch it with your finger. After a few days, blisters may appear and may tear spontaneously. Nearby lymph nodes (for example, lymph nodes in the groin in the case of erysipelas on the leg) may swell and become painful.
  • the pigmentary purpuric dermatoses are harmless conditions, but which pose an aesthetic problem. They come in different forms: spotted bleeding under the skin, the size of a pinhead or larger, or brownish to purplish patches.

There are also other, rarer skin disorders that can occur on the legs:erythema nodosum, erythema migrans (the Lyme disease), various forms of skin cancer, inflammation of the blood vessels (periarteritis nodosa, nodular vasculitis), …

How is the diagnosis made?

The doctor makes the diagnosis based on your story and the appearance of your legs.

If he suspects a yeast infection, he takes a few skin scales that he sends to the laboratory to confirm the diagnosis.

In case of suspected allergy to certain products, skin tests can identify the responsible allergens.

If the diagnosis is not certain, a biopsy (taking a piece of tissue from the lesion) may show the problem.

What can your doctor do?

The basis of treatment is often the application of a cortisone cream. If needed, you will also be given an itchy medicine (antihistamine) temporarily.

Elastic stockings or bandages help reduce water retention in stasis dermatitis due to varicose veins. Surgical intervention is indicated in some cases.

If you suffer from cracked eczema, you will be advised to apply a moisturizer and avoid triggering factors (soap, sauna).

Ringworm is treated with an anti-fungal cream, while erysipelas and cellulitis require an antibiotic.

Want to know more?

Source

Foreign clinical practice guide ‘Dermatoses of the legs’ (2000), updated on 30.05.2017 and adapted to the Belgian context on 04.07.2019 – ebpracticenet