Skin iron deposition characterises lipodermatosclerosis and leg ulcer

Area of Science:

• Vascular Medicine
• Dermatology
• Iron Metabolism

Background:

• Chronic venous disease (CVD) is associated with increased skin iron content, stored as haemosiderin.
• The role of haemosiderin in venous ulceration is gaining interest, but systematic evaluation in CVD limbs is lacking.

Purpose of the Study:

• To assess skin haemosiderin deposition in relation to the presence and severity of skin changes in CVD legs.
• Classification of CVD severity was based on the clinical, etiologic, anatomic, and pathophysiologic (CEAP) system.

Main Methods:

• 85 skin biopsies were obtained from 49 limbs with CVD (CEAP stages C2, C3, C4, C6).
• Ferric ion content was quantified using Perl's Prussian Blue (PPB) staining.

Main Results:

• Haemosiderin was absent in normal skin (C2-C4A) and less severe pigmentation.
• Haemosiderin was consistently found in lipodermatosclerotic skin and ulcers.
• Perilesional skin in C4b and C6 stages, and regenerating dermis of healing ulcers, showed variable haemosiderin presence.

Conclusions:

• Iron overload (haemosiderin) is not evident in early CVD skin damage but is consistently present in lipodermatosclerosis and ulcers.
• Severe skin changes in CVD correlate with iron overload, suggesting a potential genetic predisposition.
• Further investigation into disordered iron metabolism in CVD patients is warranted.