Why Do My Legs Have Dark Patches?

You’ve recently noticed that a few small areas of skin on your lower legs are covered in dark patches that feel dry, rough, or a bit leathery. A quick internet search has you wondering if these “hyperpigmented” patches are a result of sun damage or if you might be dealing with a chronic skin condition like eczema or psoriasis. 

One of the most common causes of such lower extremity skin changes — especially among middle-aged and older adults — is stasis dermatitis, which is itself a warning sign of a deeper underlying condition: chronic venous insufficiency (CVI). 

Here, our board-certified specialists at Vascular Vein Centers take a closer look at CVI, the skin changes it can cause, how we evaluate the problem, and what you can do about it. 

Chronic venous insufficiency basics 

Chronic venous insufficiency (CVI) is a long-term circulatory problem that develops gradually, often over the course of decades. An estimated one in 20 adults, most of whom are 50 or older, live with the effects of this widespread condition.

Commonly known as poor circulation, CVI typically occurs when gravity-strained valves in your leg vein weaken with age. When these one-way valves stop working properly, they no longer facilitate efficient blood flow from your lower extremities back to your heart. 

CVI may be defined as sluggish lower extremity blood flow, but the damaging, cascade-like effects of poor circulation can extend all the way to the surface of your skin. Here’s how:

1. Blood routinely pools behind weakened vein valves 
2. As circulation slows, intravascular pressure increases
3. Increased pressure sets the stage for vein damage 
4. Visible varicose veins or spider veins may start to appear
5. As tiny capillaries begin to leak fluids, leg tissues swell
6. Leg swelling deprives overlying skin tissues of oxygen 

Certain risk factors make CVI more likely, including family history (genetics), frequent sitting, lack of exercise, excess weight, having multiple pregnancies, and smoking. 

Here’s how CVI shows up on your skin 

When slow circulation and lower extremity swelling rob your skin of oxygen, it starts to wither and change. The resulting condition has several names, including venous stasis dermatitis, varicose eczema, and gravitational dermatitis. Let’s break it down:

• Venous refers to the specific vessels involved (veins)
• Stasis refers to the pooling of blood that occurs with CVI
• Dermatitis and eczema are associated with inflammation of the skin 
• Gravitational highlights the effect of gravity on leg veins

CVI-related skin changes commonly appear around varicose veins, but can also affect areas of skin with no visible vein issues. Skin inflammation — which may be masked by leg swelling — is usually the first sign of stasis dermatitis.    

As it persists, the inflammation associated with stasis dermatitis gives rise to skin tone and textural changes — along with irritation and itchiness. You may experience:

• Red or purplish discoloration (on lighter skin)
• Brown or ashen discoloration (on darker skin)
• Dry, flaky, or scaly skin patches that are itchy
• Thickened skin areas that are tight and shiny
• Distinctly enlarged or inflamed varicose veins 

Stasis dermatitis can also cause orange-brown speckles called “cayenne pepper spots.” These little discolored spots occur when CVI-related pressure and swelling cause the tiny capillaries just beneath the skin to burst.

Diagnosing CVI and stasis dermatitis 

A visual skin examination is usually all it takes to diagnose venous stasis dermatitis, largely because its specific set of skin changes are easy for our team to spot. Visible vein damage (varicose veins or spider veins) is common with stasis dermatitis; in more advanced cases, slow-healing sores may also be present. 

Next, we ask about other CVI symptoms you may be experiencing, like persistent leg pain, nighttime leg cramping, or legs that often feel achy, heavy or tired. Finally, we use vascular ultrasound testing to take a closer look at the blood flow in your leg veins.   

Using high-frequency sound waves to capture real-time moving images of your vascular structures and blood flow, this noninvasive imaging test gives us a way to detect and assess poorly functioning vein valves as well as areas of vascular narrowing or blockage.

A comprehensive treatment approach 

CVI-related skin changes require a comprehensive care approach that aims to ease stasis dermatitis symptoms, slow vascular disease progression, and prevent complications like venous ulcers (open wounds that heal slowly or not at all). Your plan may include:

• Dry, itchy skin relief (i.e., medicated lotion)
• Leg swelling relief (i.e., compression therapy)
• Circulation-improving strategies (i.e., exercise)
• Helpful lifestyle changes (i.e., weight control)

Do you have worrisome skin changes? We can help. Schedule your visit at the nearest Vascular Vein Centers office in College Park of Orlando, Kissimmee, Waterford Lakes of East Orlando, Lake Mary, Davenport/Haines City, or The Villages, Florida, today.