What Causes this Common Discoloration on Your Legs?

Written by WebMD Editorial Contributors

• What Is Hemosiderin Staining?
• What Causes Hemosiderin Staining?
• Treatment for Hemosiderin Staining
• Treatment for Chronic Venous Insufficiency

People experience many kinds of skin changes over time. You may notice that the skin on your lower legs becomes discolored or appears bruised as you age. The technical term for this is hemosiderin staining. It’s caused by a problem with the blood vessels in your legs called chronic venous insufficiency. You may need to make lifestyle changes to help fix the condition.  

Hemosiderin staining looks like a patch of skin that is a darker color than the surrounding skin. It can look like bruising, or it can be brownish or rust-colored. It may be harder to spot if you have a dark skin tone. Over time, the discoloration may become darker and look nearly black. 

Hemosiderin staining usually happens on the lower leg, near the ankles, or on your feet. It’s caused by blood leaking out of the tiny vessels called capillaries. The blood pools under the skin and leave a residue of hemoglobin that settles in the tissue there. Hemoglobin contains iron, which causes the rusty color of the stains. 

Hemosiderin staining is usually a symptom of a condition in the blood vessels in your legs called chronic venous insufficiency. Veins are the vessels that carry blood back to the heart from the rest of your body. The veins in your legs have one-way valves that keep the blood from flowing backward, away from the heart. Over time, these valves can weaken, and blood doesn’t flow upward the way it should. Instead, the blood pools in the vessels in your legs and feet. 

Chronic venous insufficiency isn’t serious on its own, but it can lead to other symptoms that are uncomfortable, painful, and make it harder to do daily activities. Symptoms include: 

• Pain and fatigue in the legs
• Swelling, especially after long periods of sitting or standing still
• Cramps
• Varicose veins
• Itching or flaking skin
• Sores that don’t heal

Chronic venous insufficiency is quite common, with up to 40% of Americans having the condition. It happens most often in people over 50 years old or in people who have previously had blood clots in their legs. Other risk factors of developing this include: 

• Excess weight
• Pregnancy 
• Family history of chronic venous insufficiency
• Previous injury or surgery on your legs
• High blood pressure in the leg veins due to sitting or standing for long periods
• Lack of exercise
• Smoking‌

The discoloration from hemosiderin staining can be permanent. If you recognize the underlying cause early and start managing the condition, the stains may fade somewhat over time. There are skin creams that can lighten dark spots, such as creams containing hydroquinone. Your doctor can prescribe that for you.

You can also try laser treatment or intense pulsed light (IPL) to fade the discoloration. These are treatments for reducing the appearance of dark spots on the skin. They may fade the staining on your legs. You will need to visit a dermatologist for this type of treatment.  

Since the hemosiderin staining is a symptom of chronic venous insufficiency, you will also need to address that issue. Taking care of the vein condition will help make sure the skin discoloration and related symptoms don’t get worse. 

To manage it, your doctor may suggest lifestyle changes to improve circulation in your legs. This will prevent more blood from pooling in your feet and ankles. Some tactics that can help include: 

• Avoid long periods of standing or sitting, and make sure to change positions or move your legs periodically if you must do these activities for a long time.
• Get regular exercise, even just walking.
• Lose weight if you are overweight.
• Elevate your legs when you sit or lie down.
• Wear compression stockings.

If your doctor is concerned about possible blood clots or wounds on your skin, they will suggest treatment for those issues. Medications, wound care, or vein surgery may be needed.‌

Hemosiderin staining is something to be checked out since it’s related to the blood flow in your body. Taking steps to improve your circulation will help your overall health. Reducing the effects of chronic venous insufficiency will not only help the appearance of the skin, but it will reduce the chances of other complications. Talk to your doctor if you have these symptoms. 

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Chronic Venous Insufficiency: Symptoms, Causes, Diagnosis, Treatment

Written by Teresa Dumain

• Causes
• Symptoms
• Diagnosis
• Treatment
• Lifestyle Changes
• Medications
• Medical Procedures
• Surgery
• More

The veins in your legs carry blood back to your heart. They have one-way valves that keep blood from flowing backward. If you have chronic venous insufficiency (CVI), the valves don’t work like they should and some of the blood may go back down into your legs. That causes blood to pool or collect in the veins.

Over time, CVI can cause pain, swelling, and skin changes in your legs. It may also lead to open sores called ulcers on your legs.

A blood clot in a deep vein in your leg (called deep vein thrombosis) can damage a valve. If you don’t exercise, that can cause CVI, too. So can sitting or standing for long stretches of time. That raises pressure in your veins and may weaken the valves.

Women are more likely than men to get CVI. Your chances also might be higher if you are:

• Obese
• Over age 50
• Pregnant or have been pregnant more than once
• From a family with a history of CVI
• Someone with history of blood clots
• A smoker

You may notice these in your legs:

• Swelling or heaviness, especially in the lower leg and ankle
• Pain
• Itchiness
• Varicose veins (twisted, enlarged veins close to the surface of the skin)
• Skin that looks like leather

Without treatment, the pressure and swelling will burst the tiny blood vessels in your legs called capillaries. That could turn your skin reddish-brown, especially near the ankles. This can lead to swelling and ulcers. These ulcers are tough to heal. They are also more likely to get infected, which can cause more problems.

If you have any of the symptoms of CVI, talk to your doctor. The sooner you treat it, the less likely you’ll get ulcers.

Your doctor will take your medical history. They then will check the blood flow in your legs with a test called a vascular or duplex ultrasound. Your doctor will place a small device on your skin over the vein. Using sound waves, they can see the blood vessel and check how quickly and in what direction the blood flows.

Sometimes, you may need X-rays or specific scans to check for other causes of your leg swelling.

The main goal is to stop swelling and prevent leg ulcers. Your doctor may suggest a combination of treatments based on your age, symptoms, and other things. Some options to help manage CVI include:

You can help blood flow better in your leg veins. Steps include:

Compression stockings. These elastic socks put pressure on your legs to help blood move. They come in different tightnesses, lengths, and styles. Your doctor can suggest which might work best for you.

Movement. Try not to sit or stand for a long time. If you have to sit for a while, stretch or wiggle your legs, feet, and ankles often to help your blood flow. If you stand a lot, take breaks to sit and put your feet up. This helps lower pressure in your leg veins.

Exercise. Working out helps pump your blood, too. Walking is a good, simple way to make your legs stronger and boost blood flow.

Your doctor may prescribe an antibiotic to treat infections or leg ulcers. Sometimes, they’ll give you medicine to help prevent blood clots.

If your CVI is further along, you may need a nonsurgical treatment.

Sclerotherapy. Your doctor will inject a solution into the problem vein. It scars the vein, forcing blood to flow through healthier veins. Over time, your body absorbs the scarred vein.

Endovenous thermal ablation. This newer method uses high-frequency radio waves or a laser to heat and close the problem vein.

Fewer than 1 in 10 people need surgery for CVI.

Here are your options:

Ligation. The vein is cut and tied off so blood can’t flow through. Your doctor may also remove a vein that is very damaged. You usually will go home on the same day.

Microincision/ambulatory phlebectomy. This technique uses much smaller incisions, punctures and small hooks to remove damaged veins. 

Vein repair. Your doctor fixes the vein or the valves. This can be done through an open cut on your leg or through a smaller opening by using a long, hollow catheter or tube.

Vein transplant. Your doctor replaces the problem vein with a healthy one from somewhere else in your body.