It is not uncommon for patients to ask: Why is there hard brown skin by my ankle? It most cases this ankle discoloration is a sign of long standing vein problems. In medical terms, this is called chronic venous insufficiency. This may start with just varicose veins and swelling. However, over time the skin by the ankle become red and inflamed, especially after a long day of standing. Over time this transitions to a brown coloration, and the skin goes from being soft to hard, usually just above the ankle. This is called Lipodermatosclerosis...or LDS. This is essentially scarring of the skin and subcutaneous tissue from the long term inflammation that comes chronic high venous pressures under the varicose veins in the lower legs. This skin is often easily irritated, and can itch severely, with what some call gravitational eczema.
With time this ankle discoloration can lead to a vein ulcer. Vein ulcers are a tough problem. Most occur in patients with long standing venous insufficiency. If this area is bumped or wounded, the skin can take a long time to heal, or in some cases, does not heal at all. It is in this setting the skin can sometimes breakdown, leading to a venous ulcer. This can be called vein ulcers, venous stasis ulcers or non healing venous stasis ulcers.
The term stasis comes from the role that pooling blood at the bottom of the venous reservoir in the veins of the legs. Most veins are supposed to take blood back up to the heart. But when the valves are not working properly, the vein blood can sit in the veins by the lower leg, also known as stasis. The term ulcer comes from the breakdown of the skin, where a wound opens up. These wounds can be very painful, especially at first. They can at times become infected. Often there is a lot of wound exudate and material that benefits from debridement (or removal of the dead tissue). Besides basic wound care and treatment of any infection, the mainstay of treatment is the same as treating any varicose vein problem. We start with compression, wound care, and as quickly as we can, we determine if the patient needs a treatment like Closurefast, Venaseal or Varithena to treat the superficial venous reflux that is contributing to this problem. The data is pretty compelling. When treated properly, wounds heal faster, and have fewer incidences of recurrences in the future.
Whenever there is a question, its a good idea to see a vein specialist. They can help determine if this is in fact vein related. There are some less common dermatological causes when can be explored with a dermatologist when needed. However, when venous insufficiency is suspected as the likely cause, we generally advise getting into compression. When skin care is indicated, we can work with the patient’s primary care providers or dermatologist to suggest topical gels or creams that can help lessen the degree of itching while the treatment is carried out. However, compression can go a long way to helping the skin heal and feel better. When indicated, we can advise options such as Closurefast, Venaseal or Varithena, which can help treat the underlying cause. Especially for symptomatic patients, we often hear that the leg feels better, itches less, and swells less after these treatments.
About Inovia Vein Specialty Centers
At Inovia Vein Specialty Centers we are Oregon’s leading vein doctors who specialize in caring for patients with venous disorders such as varicose veins, deep venous thrombosis, and venous stasis ulcers. Founded in 2006, we have specialty vein clinics in NW Portland, Tigard, Happy Valley or Bend, Oregon where you can go to learn more about your treatment options.