Skin Care

Chronic Venous Insufficiency (CVI) is a general term that includes the different skin changes that occur in the lower leg, above the ankle area and around the ankle area. Valvular insufficiency of deep, superficial and/or perforating veins can result in venous hypertension. This increased pressure over a period of years can lead to swelling and eventually to chronic inflammatory changes in the tissues of the lower leg.

Common complaints are aching, swelling, muscle cramps, itching around veins or in dry skin, color changes of the skin and later firm tissue in the ankle area. These changes can eventually lead to ulceration.

EXACERBATED BY:

• Prolonged sitting or standing, or travel, especially in cramped spaces
• Warm and humid weather
• Prior to menstrual period
• Obesity

Edema is a classic symptom of CVI that can range from mild to extreme. Edema, or swelling, is due to the abnormal accumulation of fluid in the extra vascular space of the ankle and of the calf. Edema is usually pronounced later in the day after prolonged standing or sitting.

Chronic high pressure pushing against the vein walls eventually can stretch the walls and allow fluid to pass out into the tissue (edema). Blood and fluid can now seep and ooze through the vein out into the tissue.

If this continues over time, inflammatory changes occur because red cells, white cells and caustic proteins contained in the fluid irritate the surrounding tissue. Hemoglobin, the pigment in red cells, is broken down to first cause a pink color and then later a brownish staining of the skin.

Stasis dermatitis is characterized by reddening and tension of the skin at the inner or outer side of the lower leg and ankle. It develops frequently after prolonged standing. This is an inflammation but is frequently mistaken for cellulitis and infection. It is itchy as well as painful to the touch. Without treatment, the inflamed skin develops a woody texture over time. Atrophie blanche or white atrophy refers to an area of skin lacking normal pigmentation. The skin is porcelain in color, is thin and vulnerable to ulceration.

Venous ulcers are the most common type of leg ulcers and typically take a prolonged time to heal. Active wound management consisting of compression dressing or stockings and periodic elevation can help heal venous ulcers. Patient compliance is essential. Unfortunately, jobs which entail prolonged standing make the healing process more difficult and lengthy.

Long term healing generally will not occur if the source of the high pressure is not corrected. It has been shown that laser ablation in conjunction with chemical ablation of diseased veins is effective. A thorough physical examination and ultrasound evaluation of the venous system should be completed to determine the best treatment for the patient.

This page discusses some very specific vein ailments that affect the skin, but on another section of our website you can get a general introduction to vein disease that can possibly help you understand your symptoms.