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What is Hemosiderin Staining?

Hemosiderin is a brownish pigment caused by the breakdown of blood hemoglobin, the iron content in red blood cells.  Iron and other byproducts are released from hemoglobin through leaking small blood vessels and converted into hemosiderin, and as a result stored in the tissue beneath the skin. This shows up as a brown stains or even bruise like staining on the skin and is a sign of chronic venous insufficiency.
Hemosiderin staining usually occurs as a result of venous reflux disease and venous hypertension. The stains usually appear on the bottom part of the lower leg, sometimes covering the area between the ankle and the knee. It can also darken over time causing complications.

Causes of Brown Skin Marks

The appearance of brown skin marks at the ankles is usually a sign of severe venous disease. If the underlying cause resulting from hidden varicose veins and venous reflux is not diagnosed and treated in timely manner, the skin damage will continue causing chronic inflammation in the layer of fat beneath the skin of the lower legs called venous stasis. The most common manifestation of venous stasis is the development of brown color changes in the skin at the inner aspect of the ankle. This hemosiderin staining at the ankle area usually worsen over time and eventually result in the development of open poorly-healing or non-healing wounds called venous ulcers. Although the skin lesions are commonly association with dark pigment, venous insufficiency may also clinically present as persistent redness of the lower legs and feet.
Accurate diagnosis is critical in these case, as many patients treated for cellulitis may actually have venous stasis dermatitis.
Hemosiderin staining can also occur after vein treatments like sclerotherapy or surface laser treatments. Most of the time, staining after these procedures usually clear up on its own after a few months to a year.
However, hemosiderin staining due to venous ulcers or venous stasis is unlikely to go away, although sometimes the color may lighten over time.
Venous stasis typically affects middle-aged and elderly patients, rarely occurring before the fifth decade of life. An exception would be patients with acquired venous insufficiency due to surgery, trauma, or thrombosis.

Treatment Options for Hemosiderin Staining

The best treatment for hemosiderin staining in these cases is early treatment of your venous stasis and venous ulcers . This may keep the stain from growing darker and in some cases the hemosiderin stains may lighten somewhat.
Surface laser and intense pulsed light (IPL) treatments may be efefctive in some cases, although it may only partially reduce the staining. For the best results the combination of laser technique with a topical skin care regime have been used for brown marks removal. The number of treatments needed depends on the size of the brown mark on the skin, and how dark it is.
Minimal invasive endovascular procedure for venous insufficiency with underlying condition, in which the valves in the veins are not working properly, are to be considered for definitive treatment.
Other treatment options may include:

  • Regular exercises such as brisk walking, jogging, cycling or swimming
  • Elevating the legs when at rest
  • Avoiding sitting or standing for long periods . When one must sit or stand, repetitive ankle exercises are beneficial.
  • Maintaining a healthy weight
  • Legs compression with medically graded elastic stockings properly fitted for every patient individually

Schedule Your Consultation

If you have hemosiderin staining  you should be consulted by an experienced Vein Specialist with the aid of a properly performed ultrasound examination. Schedule your consultation with Dr. Marek Sepiolo now.

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