Treatment

Attempts should be made to determine and correct the underlying cause of dependent edema. Venous hypertension should be reduced by leg elevation and the use of support stockings. Weeping eruptions should be treated with an astringent compress like Domeboro's solution. A low- to midpotency topical steroid such as fluocinolone acetonide (Synalar) 0.025% cream or hydrocortisone 2.5% cream should be used twice a day. The patient should be told the medication is used to treat the erythema, scale, and pruritus. Hyperpigmentation will not respond to treatment; therefore, the medication should be discontinued when erythema, scale, and pruritus resolve. Oral antihistamines, such as Benadryl or Atarax, should be used for pruritus and for nighttime sedation. Secondary bacterial infection should be treated with cephalexin, dicloxacillin, or ciprofloxacin for 7 to 10 days. Evidence of cellulitis or lymphangitis may require hospitalization for intravenous antibiotics. Topical neomycin, antihistamine creams, and anesthetic creams should be avoided as they may cause allergic contact dermatitis when used in this setting.

Because venous leg ulcers are chronic and slow to heal, emergency department treatment should focus on treating underlying causes of edema, stasis dermatitis, secondarily infected ulcers, cellulitis, or lymphangitis. Follow-up should be arranged with a dermatologist, with a vascular surgeon, or at a leg ulcer clinic for further treatment.

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