Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Should I Worry About Skin Discoloration?

Thursday, 01 July 2010 09:08 AM

Question: I've never seen the condition "stasis dermatitis " addressed. Do you have experience ridding the ankle and shin of the reddish-brown discoloration?

Dr. Hibberd's Answer:

The reddish-brown pigmentation changes seen with stasis dermatitis are actually a late finding and reflect advanced disease of your venous system. Correction of this condition involves rectifying the venous disease.

Once your circulatory condition is corrected, the pigment changes will gradually fade over time, but unfortunately will be unlikely to disappear. Blanching agents are available from your dermatologist, but these need to be used under close supervision if at all.

Laser treatment may actually cause further harm to these already fragile tissues and is not the optimal treatment.

The safest approach to disguise these pigmented areas is to use makeup, as long as you have no open areas. Be sure any infection is treated. Sometimes this is difficult to recognize with pigment changes. Ask your doctor for some topical therapy for the accompanying dermatitis. Most dermatologists and wound care centers have samples and ready packaged product or they can arrange for the pharmacist to blend a custom compound for you if necessary.

Lately there are a number of minimally invasive procedures that can be performed in the office or outpatient surgery center designed to help minimize stasis dermatitis progression as well as help heal any stasis ulcerations.

Most procedures available target relieving the excessive pressure in the superficial veins. The venous system in the legs conduits blood from the tissue capillary network back to the heart using bicuspid unidirectional valves within your veins to prevent backflow, and situates the deep veins between leg and thigh muscles serving as pumps to propel blood through the veins back toward the heart. The veins on the surface are part of the superficial network of the venous system.
The deep veins and superficial veins communicate by perforator veins which form a communication network with flow normally directed from superficial to deep with the assistance of unidirectional valves.

Superficial venous system procedures are also commonly employed. You should however be aware that sclerotherapy applied to varicosities and spider veins are cosmetic and temporary. The unidirectional valves hold the secret to the success of our venous system.

How these valves work can be seen if you place your right hand on your knee while sitting in an upright chair. Clench your fist and release several times. Then gently clench your right fist, and with the index of your left hand, gently apply direct pressure to the vein visible on the back part of your right hand near your wrist. Then slide your index down toward your third or middle finger. You will see the blood held in check by one of these valves within the vein of your right hand.
Now, imagine veins like this passing from the surface to your deeper structures, and you will understand how damage to the perforator veins does overload the superficial system since the deep system is propelled by virtue of skeletal ( i.e., leg) muscle contraction.

In fact, many newer endoscopic techniques (using a vascular scope to either remove or destroy the incompetent perforator veins ) are very successful and popular at present. These procedures combined with weight loss, smoking cessation, judicious exercise and disease management (diabetes, infection, inflammation etc.) can delay skin changes and ulcerations if intervention is accomplished early enough.

These procedures will actually allow venous ulcerations to heal where they otherwise may never have totally healed. The previous days of wearing compression hose and medicated boots appear to be limited thanks to modern imaging and technology.

No treatment available is a permanent cure.

The lesson here is in prevention. All patients with stasis dermatitis have chronic venous insufficiency. The presence of chronic venous insufficiency changes need to be addressed early. Be proactive in modifying risk factors for this condition especially if you see family members affected. Stop smoking, optimize exercise and nutrition, optimize lipids and circulation, modify weight to reasonable goals, and discuss other preventive strategies with your health-care professional.

© HealthDay

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