Itchy Legs — Venous Eczema and Varicose Veins

What Causes Itchy Legs?

Itchy skin on the lower leg, particularly around the ankle and inner calf, is a frequently overlooked symptom of chronic venous insufficiency. When venous pressure rises due to faulty vein valves, proteins and red blood cells leak into the skin. This triggers an inflammatory response — venous eczema (also called stasis dermatitis or gravitational dermatitis) — characterized by:

• Persistent itching, often worse in warm weather or after prolonged standing
• Redness, scaling, or flaking of the skin around the ankle
• Brownish discoloration (hemosiderin staining) from iron deposits in the skin
• Dry, thickened, or weeping skin patches

The Difference Between Venous Eczema and Other Skin Conditions

Venous eczema is often misdiagnosed as atopic eczema or contact dermatitis and treated with topical steroids alone — without addressing the underlying vein problem. The key distinguishing feature is location: venous eczema occurs in the lower third of the leg (gaiter area) and is associated with varicose veins, ankle swelling, or leg heaviness.

Why Treating Only the Skin Is Not Enough

Topical corticosteroids reduce inflammation temporarily, but without correcting the underlying high venous pressure, venous eczema recurs — and can progress to venous ulceration, an open wound on the lower leg that is difficult to heal.

Treating the diseased vein — using EVLA, RFA, or VenaSeal — eliminates the source of high pressure and typically resolves venous eczema and prevents ulceration.

Diagnosis and Treatment

A venous duplex ultrasound identifies the underlying reflux and guides treatment planning. Dr. Aronhime performs the duplex at the first consultation.

• EVLA via tofes 17 — at Shamir Medical Center; eligible patients pay little or nothing
• RFA — at a private hospital; covered by supplemental private insurance
• VenaSeal — medical adhesive; no tumescent anesthesia; ₪15,000
• Sclerotherapy — for smaller surface veins