What Causes Skin Discoloration On Legs & Ankles?

If you are noticing any changes in the pigmentation or texture of your skin on your ankles and legs, you may have an underlying vein disease causing a condition known as stasis dermatitis. 

Vein disease is caused by poor circulation, which affects millions of Americans. In fact, each year approximately 150,000 people in the United States are diagnosed with chronic venous insufficiency.

What Are The Symptoms of Skin Discoloration?

Early symptoms of skin discoloration may include:

• Reddish-brown patches of skin on ankles, calves or feet
• Skin may also appear irritated, as if there is a rash
• Swelling and a feeling of heaviness, aching and fatigue after long periods of standing or sitting

As stasis dermatitis progresses, the symptoms become more severe and can impact your quality of life:

• Shiny, swollen, tight skin
• Swelling begins to extend upward into the calf
• Reddish or purple ulcers may develop and ooze fluid
• Dry, itchy, cracked skin

When stasis dermatitis is left untreated, individuals are more prone to infection and may experience their calves shrinking. Also, skin that is affected by venous stasis dermatitis is at increased risk and more vulnerable to injuries.  Small cuts or sores can develop into larger, infected wounds known as venous stasis ulcers.  

While the initial symptoms may be unsightly, it is important to know that there are steps you can take to help minimize the condition and prevent it from getting worse.

What Causes Skin Discoloration?

Skin discoloration results from the blood pooling and settling in the veins of the legs and feet. Over time, the skin takes on a tan, brown, or reddish-brown tone. Typically, discoloration begins on the skin inside the ankle, but may also appear on the shin and the feet.

The areas of darkening are called Hemosiderin deposits.  Hemosiderin is a dark brownish pigmentation that is created when hemoglobin (iron found in red blood cells) breaks down in the blood.

If blood has been pooling for more extended periods, the skin becomes inflamed and prone to irritation. Additional symptoms include itching, dryness, eczema, redness, scaling. In severe cases, open sores may develop from persistent scratching, which are known as venous stasis ulcers.    

In some cases, individuals may have patches of red, shiny skin that is hard, almost scar-like. 

Venous Stasis Dermatitis?

Venous Stasis Dermatitis, also known as stasis dermatitis, venous eczema, varicose eczema, or gravitational dermatitis, occurs more frequently in people over 50 and is more common in women than men. https://www.medicalnewstoday.com/articles/322896.php#causes

Stasis Dermatitis causes inflammation, itchy skin, and ulcers on the lower legs. 

People who tend to develop this condition will typically have an underlying venous disorder, such as:

• chronic venous insufficiency
• deep vein thrombosis (dvt)
• varicose veins and spider veins 
• congestive heart failure

Additional conditions that may affect blood flow to the legs include:

• Surgery affecting the lower leg veins
• Injury or trauma to the lower leg

Chronic Venous Insufficiency (CVI)

Chronic venous disease is a venous disorder that affects the leg veins. Leg veins are responsible for carrying blood back up to the heart. Healthy veins utilize one-way valves that open and close tightly to push blood upwards toward the heart. 

When vein disease sets in, the veins and valves are damaged or weakened and can no longer work properly, allowing blood to flow backward in the vein and pool in the lower legs. 

Pooled blood increases pressure inside the veins, known as venous hypertension, which can lead to several conditions, such as skin discoloration and skin changes.  If you begin to notice areas of discoloration on your legs, ankles, or feet, contact a vein specialist for a consultation. 

What Are Common Symptoms of Chronic Venous Insufficiency?

The most common symptoms of chronic venous insufficiency include:

• Spider veins
• Varicose veins
• Leg cramping and aching
• A sensation of heaviness and fatigue in the legs
• Swelling
• Itching

Over time, if Chronic Venous Insufficiency is not addressed, symptoms intensity and may progress.  If you are experiencing Venous Stasis Dermatitis, this may be a sign that an underlying vein disease is progressing.

Risk Factors of Skin Discoloration

Several risk factors are known to increase one’s risk of developing stasis dermatitis:

• Obesity
• Over the age of 50
• You are a woman
• High blood pressure
• Kidney disease
• Standing or sitting for long periods
• Low levels of activity
• Giving birth

While it is more common for women to develop chronic venous insufficiency, it is more common in both genders over the age of 50.  

How to Diagnose Stasis Dermatitis

Your doctor will be able to provide a diagnosis by examining the lower legs for visual signs of the condition, taking a full medical history, and discussing your symptoms.

You must notify your healthcare provider of any current or previous conditions:

• Injury or trauma to the lower legs
• Prior surgeries
• Blood clots (deep vein thrombosis)
• Heart or circulation condition

Also, your doctor may decide to order imaging tests such as:

• Ultrasound
• Venogram
• Duplex Sonogram

The above imaging tests are quick, efficient, minimally invasive, and provide information on blood flow, the overall health of the veins and blood vessels, as well as the presence of blood clots.

What Treatment is Available for Skin Discoloration

Several conservative therapies target stasis dermatitis and are designed to boost circulation, slow progression, and minimize your symptoms.

• Use of compression stockings
• Elevating legs when possible
• Sleeping with legs elevated
• Use of medications to minimize swelling (corticosteroids or topical calcineurin inhibitors)
• Use of antibiotics to treat infected ulcers
• Use of emollients and moisturizers to protect dry skin
• Maintain a healthy weight and diet

Endovenous Ablation Treatment Options

If conservative treatments are not effective, a vein specialist may want to discuss further interventions, such as Endovenous Ablation.

Thermal Ablation

Endovenous ablation uses ultrasound technology to help guide a tiny catheter into the diseased vein.   Once inserted, radio-frequency or laser energy will be directed into the unhealthy vein, causing it to shrink and collapse.   Once the vein has been closed off, blood flow is naturally redirected to nearby healthy veins.  

Non-thermal Ablation

Non-thermal ablation treatments utilize liquid, foam or glue sclerotherapy.  You doctor will inject a small amount of a specialized chemical or glue into the diseased vein.  The material will cause the vein to collapse on itself, similar to thermal ablasion treatment.

Surgical Options

In more severe cases, a vein specialist may recommend vein ligation or stripping, which requires the surgical removal of the problematic vein. 

When Stasis Dermatitis Is Left Untreated

Untreated, stasis dermatitis, will likely progress and may lead to health complications, such as:

• Chronic leg ulcers that will not heal
• Development of cellulitis (bacterial infection in the deeper layers of the skin)
• Osteomyelitis (infection of the bone)

Can I Prevent Stasis Dermatitis?

While not always preventable, there are several lifestyle changes you can employ to help reduce your risk or slow the progression:

• Regular exercise
• Maintaining a healthy weight and diet
• Limit sodium intake
• Elevate legs above the heart frequently

Effective Treatments Are Available 

We are lucky to live in a time where significant medical advances allow for minimally invasive, non-surgical treatments. Current treatments for vein disease are often performed in your doctor’s office and take on average 15 to 30 minutes, often allowing you to return to your normal activities in just a day or two.

While seeking care from your primary care doctor or dermatologist is a great place to start, consulting with a skilled, experienced vein specialist will be able to target your symptoms related to Venous Stasis Dermatitis.

A trained vein specialist will have the experience and tools needed to help you restore your health and improve the appearance of your legs!