Treatment of long-standing varicose eczema

Venous eczema is a common complication in patients with chronic venous insufficiency and is frequently associated with long-standing leg ulcers. Inflammation of the periwound skin can occur as a result of venous hypertension, prolonged exposure to wound exudate, contact irritation from dressings or underlying dermatological sensitivity. When left untreated, eczema can increase discomfort, exacerbate itching and pain, and contribute to delayed wound healing. This case study describes the management of a 74-year-old woman with chronic venous insufficiency, obesity and limited mobility, with two non-healing leg ulcers for 2 years. The ulcers were accompanied by significant periwound varicose eczema characterised by erythema, itching, dry inflamed skin and moderate exudate. A comprehensive clinical assessment, including ankle brachial pressure index, confirmed suitability for compression therapy. Management included the use of a potent topical corticosteroid, applied intermittently over 3 weeks, to treat the eczema, combined with regular emollient therapy to restore skin barrier function. Compression therapy was introduced to address the underlying venous hypertension. The patient received treatment within a Leg Club setting, where specialist wound care assessment and education were provided. The eczema resolved within 2 weeks, with significant reduction in itching and pain, and the ulcers progressed to healing over the following 6 weeks. This case highlights the importance of holistic assessment, appropriate dermatological management of periwound skin, and the use of compression therapy in treating venous leg ulcers complicated by eczema. It also demonstrates the value of specialist-led community services, such as the Leg Clubs, in improving healing outcomes and patients’ quality of life.