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Varicose Ulcers and Eczema

1940; BMJ; Volume: 1; Issue: 4138 Linguagem: Inglês

10.1136/bmj.1.4138.699

0959-8138

A. D. Wright,

Systemic Sclerosis and Related Diseases

Varicose veins, though sometimes practically symptom- less, often produce very definite symptoms such as real pain in the veins themselves, accentuated by either strenuous exercise or long standing.Itching, tiredness, and fullness in the legs towards the end of the day are complained of, as well as severe muscular cramps on exercise, especially when swimming ; these cramps may be very severe at night after a strenuous day, and muscular soreness persists for forty-eight hours.So frequent are muscular cramps that in Germany varicose veins are known as "Krampfader."Apart from the relief of these symptoms patients come for treatment of the varicose veins when complications develop.In this connexion it is most essential to note that these complications are not new diseases but further manifestations of the disordered circulation in the leg that produces a loss of balance between arterial inflow and venous outflow.This loss of equilibrium leads to loading of the tissues with oedema and katabolites, and as a result the normal mechanism of resistance to trauma and infection breaks down.Circulatory equilibrium must therefore be restored by treatment of the varicose veins, and by supportive treatment if the deep veins are also at fault.Once the circulation is put right and the leg remains free from oedema the ulcers and eczema will heal without the help of cod-liver oil, insulin dressings, healing rays, and a hundred and one other much-recom- mended local applications which consume time and money.The main complications of varicose veins are thrombo- phlebitis, eczema, and ulceration, but in long-standing cases all the tissues of the leg suffer from the disordered circulation: the bones show periostitis and osteoporosis, the joints hypertrophic osteo-arthritis ; the fascia and septa may ossify or calcify, and the muscles develop a peculiar hypertrophy comparable probably to the unhealthy cardiac hypertrophy in myocarditis.Pes planus arises in many cases, and with the development of painful ulcers the foot may become deformed from reflex muscular contractions.