What are Varicose Vein and Venous Leg Ulcers?

What are the signs and symptoms of varicose veins and venous ulcers?

In the beginning, you may have swollen, heavy, tired, and aching legs. Over time, however, you may develop blue to purple bulky and twisted veins in your legs which can be painful. You may have wounds on your mid-calf area to the ankles which are hard to heal. People who develop stasis dermatitis experience dry and itchy skin with a scaly and dry rash.

Risk factors for Varicose veins & venous ulcers

• Prolonged sitting or standing
• If your biological sex is female
• Multiple pregnancies
• Obesity
• Previous blood clots in legs
• Previous traumatic damage to valves has weakened their ability to move blood back to the heart.

How will your doctor diagnose varicose veins and venous leg ulcers?

If you have blue or prominent veins in your legs or minor wounds in your leg, start by making an appointment with your primary care physician.  Your doctor will then conduct a thorough physical exam of the skin and veins of the legs.  You will need to talk about your symptoms, family history, activity levels, and lifestyle to determine your risk factors for developing varicose veins.

An ultrasound machine can be used to take pictures of your veins to determine whether your veins are functioning properly or not. Sometimes your doctor may order another test like a Computed Tomography Scan (CT) of the legs to further assess detailed pictures of your veins. If you have a non-healing wound, your doctor can take a small skin sample from your wound (called a skin biopsy) if they suspect an infection.

Depending on your veins’ condition, your primary care physician may also refer you to a vascular surgeon, a dermatologist, or a radiologist.

Treatment of Varicose veins and venous leg ulcers

Treating varicose veins and venous ulcers involves identifying the cause of the venous disease and taking active steps to reduce high pressure in these leg veins. Here are some steps that help reduce swelling and discomfort in your legs as much as possible;

• Elevate your leg often. One way to do this is to lie down with your feet propped up on pillows.
• Raise and rest your legs 3 to 4 times daily for 30 minutes.
• Point and flex your feet 10 to 15 times.
• Take a walk or exercise every day. Being active helps improve blood flow to and from the heart. Walk around and try not to sit or stand in one place for an extended period of time.
• Wear compression stockings or bandages as instructed. They help prevent blood from pooling, reduce swelling, help with healing, and reduce pain.

Many patients prefer surgical procedures for varicose treatment for cosmetic reasons. If you develop venous ulcers that do not heal well, your provider may recommend specific surgical procedures to improve blood flow through your veins. The surgical procedures might involve;

• Heat or laser application to close off a varicose vein
• Surgical removal
• Stripping of  prominent varicose veins

Tips on how to take care of a venous ulcer or wound care

• Always keep the wound clean.
• You will need to bandage the wound to prevent infection.
• Work with your doctor to determine how often you need to change your dressing.
• Keep the dressing and the surrounding skin dry. Try not to get healthy tissue around the wound too wet. This can soften the healthy tissue, causing the wound to get bigger.
• Wear compression stockings or a bandage over the dressing. This helps to drain blood away from the legs, reduce swelling, and heal the ulcer.
• Protect the skin around the wound by keeping it clean and moisturized.
• Use gentle, fragrance-free cleansers for the skin and moisturize with creams or ointments such as petrolatum.
• Ask your doctor about suitable creams or ointments to apply to avoid a rash or irritation.
• Your doctor may prescribe medicated steroid creams or ointments to help reduce skin inflammation or itchiness.
• Avoid using topical antibiotics containing neomycin or bacitracin, as you may develop a skin allergy that may worsen your rash. Avoid using topical ointments and creams without consulting your doctor first.
• You might need a wound care nurse to take care of your wound if your wounds are large and non-healing.
• Seek immediate medical care if it is too painful, your legs have reddened, and you have symptoms like fever and chills. This could be a sign of an infection of the skin’s deeper layers caused by bacteria, which could require treatment with antibiotics.
• Your doctor may also prescribe painkillers for your pain, blood thinning medications for those with a blood clot disorder, and some oral pills and ointment to heal your wound faster.

How do we prevent varicose veins and venous leg ulcers?

• Minimize your standing or sitting time.
• Elevate your legs while lying down.
• Weight loss: If you are overweight, aiming for a healthy weight could improve blood flow and pressure in your veins.
• Eat a healthy diet and exercise regularly. Physical activity helps to move blood through your veins. Strenuous or vigorous exercise might make varicose veins worse, however. Ask your doctor about what level of physical activity is right for you.
• Keep control of health conditions such as heart disease, diabetes, and peripheral arterial disease.
• Check the skin on your legs frequently. Moisturize any dry or scaly areas. Everyone with venous insufficiency will not develop stasis dermatitis, but poor blood flow will increase the risk of getting it.

Questions for your doctor

• What is the cause of my varicose veins and ulcers?
• Why is it not healing on its own?
• What lifestyle modifications do I need to make?
• What should I do if my varicose ulcers keep coming back? Do I need surgery?
• How do I care for my leg ulcer?
• Do I need to wear compression stockings all day and night?
• Which cream should I apply and which ones should I avoid?

References

Venous Ulcers | Dermatology | JAMA Dermatology | JAMA Network

Venous Leg Ulcers – Annals In the Clinic Patient Information (acpjournals.org)

Stasis Dermatitis | Dermatology | JAMA Dermatology | JAMA Network

Varicose Veins – Varicose Veins | NHLBI, NIH

Venous ulcers – self-care: MedlinePlus Medical Encyclopedia

Eczema types: Stasis dermatitis overview (aad.org)