June 21, 2018
Venous skin damage is a sign of varicose veins deteriorating towards leg ulcers. Venous skin damage can be venous eczema, red stains or more commonly brown stains. It almost always happens on the inside of the lower leg just above the ankle.
Patients with venous skin damage need to have their varicose veins treated to stop progression to leg ulcers. Many people can have venous skin damage and not to see varicose veins on the surface. These people have “hidden varicose veins”.
This patient is a man who has very severe varicose veins. In the last year, he has started to feel itching of his lower legs. He had not noticed that the skin had also started to change to a brown colour. This is because the varicose veins are so big, when he looked down he could not see the brown area because of shadow from the veins. However, when he came for consultation at The Whiteley Clinic, the brown stains were obvious when he lay flat. Lying flat the varicose veins shrink away temporarily exposing the venous skin damage.
Constant inflammation caused by either varicose veins or hidden varicose veins causes inflammation in the skin around the ankle. This inflammation is due to blood falling down the affected veins and hitting the ankle from the inside. In normal people, who do not have venous disease, little valves inside the veins stop this from happening. However, people who have varicose veins or people with hidden varicose veins have lost these valves. The constant inflammation from blood falling down the veins on standing results in symptoms or signs of venous disease. One of the more severe of these is venous skin damage.
Traditionally people have been taught by their doctors and nurses that “varicose veins are just cosmetic”. Research has shown that this is incorrect.
Every year, 4.6% of patients who have varicose veins or hidden varicose veins deteriorate to the next level of venous disease. These levels are called the CEAP clinical classes of vein disease. These are:
Many patients are concerned that they might have varicose veins or hidden varicose veins, but are not sure if they need treatment because they do not have pain. However varicose veins rarely if ever cause pain. The symptoms of varicose veins or hidden varicose veins are usually:
And all of these get better when the patient sits down and elevates the legs. Support stockings can also help the symptoms, although they are not a cure. As soon as the support stockings are taken off, the problem resumes.
The NICE clinical guidelines say that anyone with varicose veins and any of the symptoms or signs above should have a venous duplex ultrasound scan and treatment using the techniques championed at The Whiteley Clinic.