Go Deeper: Skin Changes and Vein Disease

By Samuel P. Martin, MD, FACS

Skin discoloration and texture changes are common signs of more advanced vein disease. These skin changes are also often confused with other dermatological conditions and may go misdiagnosed for years due to a lack of awareness among doctors. In everyday life, anyone with skin changes such as brownish discoloration from the lower calf to the ankle, especially if they are overweight, has more advanced vein disease and will probably have ankle swelling later in the day which may be subtle.

Skin changes associated with vein disease may include:

• Color changes- pinkish to brown at the ankle and lower leg area
• Dry, even itchy, sometimes flaky or scaly skin in the lower leg and ankle
• A leathery, firm texture in the lower legs and feet
• Skin sensitivity with tendencies toward rashes
• Swollen lower legs (edema); especially later in the day- this may be very subtle
• Very noticeable vein patterns around the ankle
• Skin cracks and sores that are painful and take a prolonged time to heal; generally, in the ankle area

In addition to these skin changes, advanced vein disease can cause prominent spider patterns over your ankles and feet. When your skin is dry and brittle, these veins are vulnerable to spontaneous rupture. Ruptures can result from shaving, but most often occur after showering while drying with a towel. The veins dilate with warm water while showering or bathing. When drying with a towel, the thin, brittle skin over a vein can flake off, and projectile bleeding can occur. This can usually be controlled with gentle pressure with tissue paper balled up and taped or wrapped, and most importantly, the leg is elevated, preferably in bed. Resist removal of the tape for 24 hours and call Vascular Vein Centers.

How Does Venous Disease Cause Discoloration in the Leg?

Vein disease causes discoloration because the pressure of gravity exceeds the resistance of the vein wall in the lower leg, and inflammatory fluid passes from the vein into the tissue of the lower leg. Over time it inflames and fibroses the tissue and skin making them thick, dry, and brittle.

The fluid passing into the tissue also contains red blood cells, which contain iron. When red cells decompose, they leave the iron pigment, causing a progressive brownish discoloration, one of the many skin changes that can occur. The chronic inflammation over time, causes scar tissue to form in the skin, causing skin changes such as thickening, firmness, and dryness. The hardened tissue isn't as flexible as normal tissue and can crack, allowing the fluid that leaked into the tissue to seep out of the skin. This fluid can collect in the skin, causing scaling and inflammation, or it can erode the dry, brittle skin resulting in an ulcer.

What Can I Do If I Experience Dry and Discolored Skin Changes in My Legs?

With dry thickened skin, moisturization will help and is needed frequently, but this by itself won’t alleviate or stop the progression of the inflammation process.

The prevention of these skin changes requires compression of the lower leg and treatment of the faulty veins. In addition:

• Avoid standing or sitting for long periods
• Regular exercise like walking and water exercise is excellent to relieve the pressure on our veins
• For those who are overweight, weight loss decreases the pressure on your veins and the resistance to outflow of blood from the legs
• Elevate your legs whenever possible
• Wear compression stockings during the active part of your day
• Moisturize your dry skin two times a day: morning and night

Skin changes such as dry, discolored and/or itchiness in your lower leg and ankle, often associated with swelling, is a sign of advanced vein disease. These changes may or may not be associated with bulging veins, which can cause aching later in the day when you’ve been on your feet for long periods.

If you’re noticing skin discoloration or skin changes which may indicate vein disease, you should:

• Get a prompt evaluation by Vascular Vein Centers specialists
• Elevate your legs frequently
• Exercise regularly
• Moisturize your legs twice a day
• If deemed appropriate by your vascular specialist, wear graduated compression stockings every day. There are many fashionable styles for formal or casual wear, and even for sports activities.