Management of Venous Dermatitis / Leg Ulcers

See Figure 1 for image of venous dermatitis / leg ulcers.

Bilateral leg redness is rarely cellulitis. Refer to the Lower Limb Inflammatory Pathway (formerly known as Red Legs Pathway) produced by the British Lymphology Society.

Venous dermatitis

Venous (also known as varicose or stasis) dermatitis is a common cause of bilateral red legs. It is common in older patients and those with stasis risk factors (high BMI, immobility, leg swelling, varicose veins, previous venous thrombosis and previous cellulitis). It is usually a clinical diagnosis.

Management of venous dermatitis:

• Maintain normal BMI.
• Elevate legs.
• Regular emollient application e.g. Zerobase^® cream or Cetraben^® cream twice daily to affected areas. Consider prescribing a soap substitute if necessary. In most cases, regular emollient preparations are suitable for use as bath additives and soap substitutes; bath and shower preparations should be reserved for situations where the use of regular emollient preparations is not sufficient.
• Consider need for maintenance topical steroids e.g. betamethasone valerate 0.1% ointment twice weekly.
• Consider Class 1 British Standard compression hosiery worn long-term (can be used safely without need for ankle brachial pressure index (ABPI) and in patients with pre-existing peripheral arterial disease).
• Screen and treat coexisting fungal skin infection (toes, folds, creases).

Venous leg ulcers

A venous leg ulcer is a chronic, open wound that occurs in the lower leg caused by venous insufficiency and high venous pressure. They can occur within an area of untreated venous dermatitis, typically in the gaiter area (between ankle and mid-calf) on the medial aspect, and may be painful.

Management of venous leg ulcers:

• Consider early referral to the Tissue Viability Service for advice on dressings and wound management.
• Compression bandaging therapy, where appropriate.
• Screen and treat associated comorbidities and complications (e.g. diabetes mellitus, renal impairment, thyroid disease, peripheral vascular disease).

Guideline updated: February 2026

Page updated: November 2026