Varicose eczema

The term "varicose eczema", although made acceptable by its use, is ambiguous and misleading. It would prompt us to believe that varicose eczema is different from common dermatological eczema. There is no such difference, and it would be more correct to speak of eczema of the varicose patient. The development of eczema in the case of a varicose patient may: --either develop in the case of a varicose patient who does not normally suffer from eczematous dermatosis; in this case static dermatitis represents a point of local reference for an eczematous crisis triggered off by a general factor and finding there a zone of reduced resistance; --or develop in the case of a known habitual eczematic. In this case, venous stasis increases and maintains the eczema. In both cases no local dermatological treatment will be able to cure the eczema, which will develop into a critical condition often provoking the development of a leg ulcer, and will necessitate the suppression of the venous counter-current. To try and understand the pathological mechanism of "varicose eczema", we have to remember the rudiments of the physiology of the cutaneous barrier, familiar to dermatologists but less so to phlebologists, and also some elements of the physiopathology of venous insufficiency, and in particular the tissular elements following the pattern explained by Comel's Italian school, by the term "histo-angiological decompensation". The circulatory unit "arteries-capillaries-veins-lymphatic-vessels-tissues" form an ensemble which has to be taken into account, as any disorders in any one of these elements reacts on all the others. These elementary rudiments lead us to understand the importance of an integral aetiopathogenic picture of varicose eczema, and the importance of the multidisciplinary collaboration between phlebologists and dermatologists in order to treat this affection, the border-line of our two specialties.