Ask Dr. H: Red, itchy skin is vascular problem

Question:

I saw my doctor recently because of a reddened, intensely itchy area on the left inner ankle. He said that it was "stasis dermatitis," a skin condition caused by my varicose veins. He recommended a steroid cream and a visit to a vascular surgeon. Can you explain more?

Answer: Stasis dermatitis is a skin condition classically seen in the legs and feet due to chronic swelling from conditions such as varicose veins or congestive heart failure. The arteries are usually working fine, getting freshly oxygenated blood into your legs, but incompetent valves in the leg veins make it difficult to get the blood out. So they swell, becoming discolored and inflamed.

If it gets bad enough, skin breakdown and ulceration can occur. Obesity greatly increases the risk of leg swelling and stasis dermatitis.

Treating stasis dermatitis is not easy. Compression stockings and leg elevation are time-tested treatments, but my experience has been that many folks, especially men, find compression hosiery uncomfortable and fail to wear it as directed.

It is important to see a vascular specialist to make sure there is not an arterial circulation problem or leg clot that might be worsened with leg compression.

Burrow's solution can be applied with gauze to weeping areas. Steroid creams are helpful to quiet the itching, but need to be used cautiously to avoid further thinning of the skin and leg ulcers. Finally, in folks who are obese, losing as little as 10 percent of body weight will help decrease swelling and improve symptoms.

Q: My doctor says that once you wash off poison ivy sap from the skin, you can't spread it. If that's right, then why is it that whenever I get poison ivy, it seems to spread to other areas?

A: The skin rash (dermatitis) that causes poison ivy is due to the chemical urushiol in the plant's sap. All parts of the plant, from the leaves to the roots, contain urushiol. Nearly 90 percent of people who come in contact with the sap will get a poison ivy rash.

The sap containing urushiol can penetrate the skin within 10 minutes after contact. Washing your skin within 5 to 10 minutes with soap and water or even hydrogen peroxide may prevent the rash. The problem is that either we don't know we've brushed against a plant or the sap is left behind on our clothes to cause a rash days.

Urushiol is an oil, and will stick to almost anything - clothing, sports equipment, hiking gear, garden tools - even your dog's or cat's fur.

Once you've developed the rash, you can't spread it to other parts of the body or to another person. That's because once the sap is washed away, there's no more allergen around to cause a rash. Those blisters you see are your body's reaction to a foreign substance on the skin. Blister fluid does not contain any sap and therefore can't spread the rash.

Q: I've been having numbness in my pinkie finger and ring finger of my right hand for a few months. I just saw an orthopedic surgeon who diagnosed me as having cubital tunnel syndrome from talking too much on my cell phone. How is this different from carpal tunnel syndrome?

A: Cubital tunnel syndrome, sometimes referred to as "cell phone elbow," is similar to carpal tunnel syndrome in that both conditions involve compression or entrapment of a nerve in the arm.

Cubital (cubitum is Latin for elbow) tunnel syndrome occurs when the ulnar nerve, responsible for the "funny bone" sensation at the elbow, becomes irritated or compressed. Holding the phone against your ear with your elbow flexed puts the ulnar nerve under tension and stretches it. That nerve supplies sensation to the pinkie and the ring finger.

It's an overuse condition; reaching, pulling or lifting can cause it too.

Carpal tunnel syndrome occurs when the median nerve that passes through the carpal (wrist) bones becomes compressed, irritated and inflamed. It's also typically caused by overuse of the hand and wrist. Unlike cubital tunnel syndrome, the thumb, index and middle fingers are affected in carpal tunnel syndrome. In carpal tunnel syndrome, symptoms are often worse at night due to a tendency to sleep with a bent hand and wrist.

Treatment of cubital tunnel syndrome consists mainly of avoiding the aggravating factor through elbow rest, using a hands-free phone headset, switching hands when on a corded phone, splinting the elbow at night, anti-inflammatory medication, use of an elbow pad to reduce further trauma, and a steroid injection if indicated. Surgery is for situations where all other treatments have failed.