Varicose Veins Treatment Can Prevent Dark Brown Skin Changes

Varicose Veins Treatment Can Prevent Dark Brown Skin Changes

How Ignoring Your Varicose Vein Pain Causes Complications

Varicose veins can occur anywhere in the body. They most frequently occur in the legs where gravity has the strongest effect on the venous system.

Varicose veins can cause changes on the skin including hyperpigmentation (dark brown skin changes), scarring and ulceration. Many times these skin changes are also related to a deep vein problem.

Venous ulcers can be from the superficial varicose veins and venous insufficiency alone in 23% of cases. More often, there is a combination of a deep and superficial vein problem.

If you neglect your venous problems, and ulcers develop, healing is difficult. More than half of all venous ulcers take over a year to heal. (Scott TE, Journal of Vascular surgery 1995). They are often painful.

These active or healed ulcers are seen in 1% of the population. (Fowkes FG, Angiology 2001)

Varicose veins are usually caused by blood backing up in the veins from either faulty “check valves”. That is called venous reflux that results in venous insufficiency. This is a chronic condition. Sometimes they are caused by an obstruction of the deep veins in the abdomen or pelvis.

Learn more about the consequences of ignoring your varicose veins.

How Does Venous Reflux Cause Skin Changes?

Reflux causes hypertension in the veins. This is different from high blood pressure or hypertension, as many people understand it. When you go to your primary care doctor and they measure your blood pressure, they are measuring the pressure in your arteries.

High blood pressure in your veins is entirely different. Venous hypertension results when your blood cannot return to your heart normally. The veins enlarge as a result like when you blow up a balloon.

When the blood cannot flow back to the heart normally, symptoms may occur. An accurate diagnosis of the problem is very important. Ultrasound or venous reflux Doppler testing is the first step.

This venous Doppler is not the same test that doctors order to discover whether you have a blood clot. For a proper venous reflux ultrasound to be done, you must be standing up. The technician can then determine if the blood in the veins are backing up from the force of gravity.

If the great saphenous vein is the cause, the skin changes usually begin on the inside of the ankle. If the small saphenous vein is the root of the problem, these changes usually start on the outside of the ankle. Sometimes a previous blood clot in the deep veins can destroy the valves. In these cases, the blood backing up in the deep veins is the cause of the skin changes.

The hyperpigmentation can progress up the leg and completely cover the lower leg below the level of the knee. The skin often becomes dry and cracked from metabolic changes caused by the blood sitting in the veins around the ankle.

The next stage of the problem is thickening and scarring of the skin around the ankle. This is called lipodermatosclerosis.

What Are the Changes at the Cellular Level?

The skin changes are an inflammatory condition. Many chemical mediators on the cellular level are interacting to produce the skin inflammation.

There are many theories as to what is happening at the cellular level. The first theory was that there was not enough oxygen getting to the skin because the blood was stagnant. This has been disputed.

Another theory is that the increased pressure from the veins was transmitted to the skin. The small blood vessel walls became less of a barrier. This allowed molecules called fibrinogen to surround these capillaries. The fibrinogen is converted to fibrin.

This fibrin then forms a cuff around these small capillaries. The fibrin cuff prevents oxygen from getting to the skin and its underlying tissues.

White blood cells or leukocytes then become trapped in the fibrin cuffs. They release a substance called growth factor-beta 1, which contributes to this cascade. Other substances called cytokines are released. In addition, a substance called matrix metalloproteinases may be involved in this worsening skin transformation.

What Symptoms are Associated with Venous Stasis Dermatitis?

Some symptoms that are commonly associated with this condition include:

  • Swelling of the leg
  • Heaviness of the leg
  • Aching of the leg
  • Pain in the leg
  • Leg fatigue
  • Restless legs
  • Itching
  • Cramping
  • Burning
  • Eczema

As the condition worsens, the skin will lose its elasticity. The skin texture becomes tight and hardened. The skin appears brown and leathery. This can result in scarring around the ankles called atrophie blanche.

Later the skin may crack if you scratch it. Crusting or weeping of the skin can be a result.

Venous ulcers or sores in the skin around the ankles are the last stage of this condition. These types of ulcers are very difficult to treat and often recur. They occur in 1% of the population. They result in a loss of income and cause 12.5% of people to retire early. They are often painful and require months to heal in many cases.

When Should You Seek Treatment?

Research your vein center options carefully.

Seek medical advice from a venous specialist at a vein treatment center before these skin changes occur.


Hyperpigmentation and atrophie blanche are advanced stages of venous insufficiency. Once they occur, these changes are irreversible. It’s like a brown tattoo.

There is no good treatment to make this discoloration ever go away. It is permanent but may lighten with treatment of the underlying venous condition.

Sometimes these changes occur without any visible varicose veins. In those cases, the underlying deep venous system is usually the cause. Blood in the deep veins is either backing up (reflux) or is blocked (obstruction).

Early varicose vein removal is the key to prevent these advanced skin changes.


Here’s the bottom line.

Treatment of venous stasis skin changes starts with diagnosis and treatment of the underlying vein problem.

Understanding the venous cause and the underlying changes at the cellular level are helpful in the treatment process.

If left unchecked, the condition will inevitably worsen, become more advanced, and become more difficult to treat. It will progress and worsen.

It can adversely affect your quality of life.

Health insurance does cover this condition.

Don’t put it off any longer!

If you are worried that you may suffer from chronic venous insufficiency or varicose veins, call our office for more information at 724-969-0600 or click here.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.