Veins have the vital job of returning deoxygenated blood to the heart. They usually fight gravity to do so, which includes the valves in leg veins which allow blood to flow upward. However, if damage occurs to those valves, venous reflux can happen due to blood accumulation in the legs.
Skin can be negatively impacted if fewer nutrients of fresh blood reach the damaged area, and this can be a result of venous congestion. Skin changes can be a sign of venous problems, since skin is the end organ of venous insufficiency.
Typical signs of venous issues include changes in the look or quality of the skin, such as spider veins or varicose veins. Both happen under the skin, with spider veins typically being smaller (but still visible) blue/purple streaks, while varicose veins tend to be larger and more obvious, pressing against the skin.
Venous issues fall on a spectrum, and as they worsen, the impact on skin becomes more dangerous. Spider veins and varicose veins are often early symptoms of disease, and there are other indicators that occur in the legs or ankles.
Two of those frequent precursors are redness that develops around the ankles, or lower leg skin that hardens or thickens. One example is pachydermia, an unusual thickening of the skin that leads to it having a wood-like appearance.
One skin issue caused by venous reflex (resulting from too much fluid in soft tissues) is stasis dermatitis, also referred to varicose eczema. Dermatitis frequently affects first the ankles and then works its way up to the calves. It may involve aching, heaviness and swelling, along with painful red skin that might also be oozing or crusty. Along with that, purple or red sores may develop, as well as dry, itchy, cracked skin.
This can become worse over time if not treated, resulting in skin that thickens, hardens and even cracks. In addition, this type of condition can lead to cellulitis, which can occur if a deficient skin condition allows bacterial infection to invade.
Cellulitis is a bacterial infection of the skin and the tissues right beneath it, and while common can be extremely serious. The skin usually feels hot and painful, with swelling and redness. The infection may require antibiotics, because if untreated, cellulitis can reach the lymph nodes and bloodstream and potentially become fatal.
Any discoloration of the foot, ankle or lower leg is important to note, because hemosiderin staining is a warning sign. Hemosiderin deposits are a result of red blood cells being forced out of capillaries, due to vein valves failing. When that happens, the hemoglobin releases its iron and ends up as hemosiderin underneath the skin. This is what causes the staining, and it should be assessed by a physician since it can be an indication of advanced venous disease.
Venous disease escalates over time, so venous reflux frequently results in more valves failing, and the accumulation of blood means a greater area can be affected. Blood leakage into skin tissue can cause damage from the swelling.
Another signal that venous disease has advanced is open or non-healing wounds. This means the affected skin is starting to break down from within.
Ulcers caused by venous disease often need ongoing care including dressing changes, since in addition to the pain and itchiness, they are often wet and frequently drain. They also do not improve without treatment, so they can have a major impact on a patient’s quality of life. Sadly, people will in some cases live with these ulcers for years – simply due to not realizing they have medical alternatives and options.
Venous ulcers comprise about 80% of chronic leg ulcers, and make up the majority of the three largest classes of ulcers; diabetic and arterial are the other two. They typically appear below the knee, and are red with uneven borders. The hemosiderin staining discussed earlier may result in the tissue being darkened. On the other hand, an arterial ulcer’s wound bed usually has a smooth border that is yellow, grey or black.
A duplex Doppler ultrasound is the preferred method for diagnosing a venous ulcer, because it shows if there is any blood pooling in addition to directional flow. Identifying the cause of the condition (etiology) is vital with any wound. While ulcers have similarities, they each have a unique cause and therefore require a unique treatment plan.
A reasonable question is whether treating the skin can impact the veins – if skin changes are indeed precursors to vein disease, it does seem that treating the disease will help the skin.
Ultimately, you can treat the symptoms without treating the cause. One example: various creams or moisturizers might improve skin conditions on the surface, but if those conditions are caused by venous issues, the most effective course of action is to resolve the source of the problem. Vein treatment has been used with great success even with patients who are dealing with venous ulcers.
The skin is often used as a guide by phlebologists, or vein specialists, when it comes to detection and care. Their established classification has standardized the discussion of vein issues and is called the C.E.A.P. system: Clinical, Etiology, Anatomy and Pathophysiology. “Clinical” is the most important in doctors’ discussions, as it refers to the severity rating of someone’s veins. The classification of the C.E.A.P. system includes pigmentation, ulceration, and other related skin conditions.
The medical specialties of phlebologists and dermatologists frequently intersect, with the former mostly concentrating on legs while the latter focuses on the entire body. Many dermatologists have helped advance the field of phlebology, as teachers, pioneers and initiators.
Vein specialists and dermatologists often refer patients to each other, once they review symptoms and determine whether the issues seem to be venous. The most effective patient care results from the C.E.A.P. classification system, along with clear communication between physicians.
If you have additional questions, please do not hesitate to contact the clinic.