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Skin: Clues to Vein Health

July 2, 2020

Skin: Clues to Vein HealthWith one system carrying blood just beneath the other, the connection between skin and veins is an intimate one. The role of veins is to carry deoxygenated blood back up to the heart, usually against gravity. In leg veins, there are valves that open to allow the blood to flow one way: up. If the valves in the veins become damaged, some blood will flow back into the legs and “pool” there, resulting in a condition sometimes referred to as venous reflux. Venous (vein) congestion can limit the amount of nutrients that fresh blood can bring to the affected area, and skin can be dramatically affected. Because skin is the end organ of venous disease, skin changes can be an indicator of venous issues.

Signs to Look for in Your Skin

Changes in the appearance or quality of the skin are common signs of venous problems. These symptoms can include the development of spider veins, the blue or purple lines that occur under the skin but are close enough to be seen on the surface, or varicose veins; large, visible veins in the leg that bulge, often pushing up against the skin. Both spider veins and varicose veins can be signs of early stage venous disease, but there are other skin changes affecting the legs or ankles that can also be an indicator of a venous issue.

A developing redness around the ankles is a common symptom, as is skin that has become harder or thicker in the lower leg. Pachydermia, for example, is an abnormal thickening of the skin, that makes the skin appear woody.

Stasis dermatitis, also known as varicose eczema, is a skin condition that happens when the venous insufficiency causes a leakage of fluid into soft tissues. Symptoms of dermatitis can include swelling; a heavy or aching feeling; or red, swollen, and painful skin, which may be weeping and crusty. These changes will usually affect the ankles first and may eventually extend to the calf. Additional symptoms may develop, such as purple or red sores, or skin that is dry, cracked, shiny, and itchy. Untreated, this condition can gradually worsen leading to areas of thick, hard skin or even cracks in the skin.

Poor skin condition makes it possible for bacterial infection to enter the skin and develop into cellulitis. Though common, cellulitis is a potentially serious bacterial infection of the skin and the tissues immediately beneath the skin. The affected skin appears swollen and red and is typically painful and warm to the touch. Antibiotics may be needed to treat the infection, and left untreated, cellulitis can spread to the lymph nodes into the bloodstream and become life-threatening.

Another skin change to pay attention to is discoloration of the lower leg, ankle or foot.
These brown or rusty-colored “patches” or “stains” are known as hemosiderin deposits. When vein valves fail, regurgitated blood forces red blood cells out of the capillaries. When the red blood cells break down, the hemoglobin releases iron and is stored as hemosiderin in tissues beneath the skin, which causes the staining. Hemosiderin staining can be signs of advanced venous disease, and should be evaluated by a physician.

Advanced Stages of Venous Disease

Because venous disease is progressive, venous reflux can often lead to additional valve failure, and as a result, the pooling of blood can affect a larger area. When blood leaks into the tissue of the skin it can cause swelling and damage to the tissue.

Open wounds or wounds that just won’t heal on the lower leg or ankle are a sign that venous disease has reached an advanced stage. At this point, the skin on the lower limbs has really begun to break down, almost from the inside out.

Ulcers may be painful or itchy and often require constant care and dressing. Because ulcers do not heal on their own, they can have a significant impact on quality of life. Often, because of a poor understanding of options for treatment, people can be plagued with ulcers for years, assuming there is no alternative. One effective way to diagnose a venous ulcer and to differentiate it from a diabetic or arterial ulcer is with a duplex Doppler ultrasound, which reveals whether or not the blood is flowing in the proper direction, or if there is any pooling occurring. With any wound, it’s important to identify the right etiology, or cause of the condition. Different types of ulcers may appear similar, but each one has a different cause and thus, very different treatments.

How Vein Treatment Impacts the Skin

If skin changes are indicators of vein disease, then it stands to reason that treating the vein disease can have a positive effect on the skin. But can treating the skin impact the veins? The short answer is that you can treat the symptom without treating the cause. For example, moisturizer or steroidal cream may help to curb itchy, dry, or scaly skin temporarily, but if the cause of the skin condition is venous in nature, then addressing the vein problem at the source is what will resolve the skin issues long-term. Even those who are experiencing late-stage conditions like venous ulcers can have excellent success with treating the problem at the source.

Cindy_Asbjornsen_HSDr. Cindy Asbjornsen is the founder of the Vein Healthcare Center in South Portland, Maine. Dr. A Diplomate of the American Board of Venous and Lymphatic Medicine, she cares for all levels of venous disease, including spider veins, varicose veins, and venous ulcers. She is the only vein specialist in Maine to be named a Fellow by the American College of Phlebology.
You can contact Dr. Asbjornsen at 207-221-7799 or