Compression therapy is believed to reduce fibroproliferative scarring by increasing collagenolysis and reducing tissue metabolism. Examples include:
- standard size or custom-fit pressure garments
- elastic bandages
- graduated lower limb compression stockings
- appendigeal, tailored compression devices eg button compression or clip-on earrings for ear lobule keloids
Compression therapy can be used in isolation or with adjunctive procedures such as silicone sheeting or intralesional corticosteroid injection. The majority of patients who use compression garments have some symptomatic improvement. However, there are potential problems in that compliance can be poor due to the theoretical necessity to wear the garments for prolonged periods. Some sources suggest that pressure garments should be worn continuously for up to a year during the period of scar maturation. Under the garments on hot days, the skin can become macerated and pruritic. Also, some areas of the body do not permit the easy application of pressure eg the neck and face.
It is possible to acquire latex-free compression garments in those with an allergy.
General advice (1):
Do not routinely include ’made to measure’ on the prescription. ‘Made to measure’ should only be selected if the patient has had their leg measurements checked in the past six months and none of the standard sizes are appropriate. If in doubt discuss with the community pharmacist or community nurse.
- to avoid confusion hosiery can be prescribed as generic e.g. ‘compression hosiery class 1 below knee
- compression hosiery is palliative not curative and treatment should continue for as long as there is evidence of venous disease – in most cases this is life-long (exc. pregnancy)
- compression hosiery should not be applied if there is a history or presentation of symptomatic peripheral arterial disease (PAD) (see assessment criteria)
- in the absence of any of the risk factors in the assessment criteria it is safe to start with compression hosiery up to 20mmHg, which is defined as mild graduated compression
- the Ankle Brachial Pressure Index (ABPI) test should be used as guide to assess the presence of significant PAD but should only be an adjunct to clinical assessment
- for patients requiring higher than 20mmHg compression hosiery e.g. to treat moderate/severe oedema, ABPI is required. Consider the use of a milder compression whilst waiting for the Doppler assessment to avoid deterioration of condition if appropriate and dependant on the results of a thorough assessment. An ABPI is also recommended if starting with Class 3 support stockings
- all patients with chronic venous leg ulcers should have a lower limb assessment performed prior to treatment
- arterial insufficiency should be investigated further by the vascular team to ensure adequate circulation if clinically appropriate
- the recommended degree of compression depends on the condition being treated. If the person cannot tolerate the preferred compression for their condition, try the next level down
- ideally, lower limb assessments should be repeated every 6–12 months or earlier if clinically indicated
- patients treated with compression hosiery should be reviewed every 6 months (with repeat lower limb assessment if appropriate) to reassess the condition for disease deterioration and to ensure the person is continuing to wear the stocking correctly and successfully
- compression hosiery for the sole prevention of deep vein thrombosis (DVT) for travellers is not available on NHS prescription and patients should be advised to purchase class 1 below knee stockings or proprietary “flight socks”.
Assessment (1):
Compression hosiery should not be applied if there is a history or presentation of symptomatic peripheral arterial disease (PAD). Before prescribing, the patient should be assessed for the following:
- acute infection of the leg/foot (increasing unilateral redness, swelling, pain, heat)
- symptoms of sepsis
- acute or chronic limb threatening ischaemia
- suspected acute DVT
- suspected skin cancer
- painful cramping in calf muscles during activity e.g.walking or climbing stairs (intermittent claudication)
- leg numbness or weakness
- cold leg and/or foot, especially when compared with the other side
- absent or difficult to feel foot pulse
- poor capillary refill (should be less than 2 seconds)
- drop in pulse oximetry on leg elevation
- if any one or more of these is present, arterial insufficiency should be excluded by measuring the ABPI using a Doppler machine, performed by a suitably trained and competent healthcare professional
- all patients with chronic venous leg ulcers should have a lower limb assessment performed prior to treatment which may include an ABPI using a Doppler ultrasound
Reference:
- 1. Derbyshire Joint Area Prescribing Committee. Guidelines for the use of compression hosiery (accessed 14th July 2024).