Diagnosis

Diagnosis of stasis dermatitis is based on the history and physical examination. Other disorders to consider include allergic contact dermatitis (especially to topical preparations used to treat underlying stasis changes), lichen simplex chronicus, and xerotic dermatitis. Especially in association with acute exacerbation, secondary infection with Staphylococcus aureus should be excluded with a bacterial culture.

Stasis ulcers are also diagnosed on the basis of a history and physical examination. Bacterial cultures should be obtained if secondary bacterial infection is suspected. The differential diagnosis of leg ulcers is quite long and broad ( T.a.b.l.,e 239-.,1,). If the ulcer does not have the clinical findings mentioned above, other diagnoses should be considered, and appropriate history sought and tests performed. This is particularly important for certain disorders, such as arterial ulcerations, pyoderma gangrenosum, and polyarteritis nodosa, that require immediate attention. For instance, if peripheral pulses are absent and the patient has a history of claudication, vascular blood flow studies should be performed to rule out arterial ulcers. If the patient reports a rapidly developing ulcer that began as a pustule or erythematous nodule and has violaceous overhanging borders, pyoderma gangrenosum should be suspected. If the diagnosis is in question, consultation with a dermatologist is indicated.

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