The aetiology and treatment of varicose pigmentation

The skin pigmentation of chronic venous insufficiency is associated both with increased melanin production and also with deposition of haemosiderin. Following treatment by compression sclerotherapy this pigmentation usually decreases. Seven patients with varicose pigmentation were assessed prior to treatment by colour photographs and skin biopsies. About one year after sclerotherapy further photographs and biopsies were taken. Six of the patients showed a definite decrease of pigmentation on the photographs. In all seven the amount of melanin had decreased. The results for haemosiderin were less uniform and showed a variable rise or fall. It therefore seems likely that the discoloured legs of chronic venous insufficiency result from stimulation of melanocytes perhaps similar to a sunburn response or to the mechanism in haemosiderosis. In the same way this may be reversible when the stimulus of venous hypertension or ultraviolet radiation is removed. The haemosiderin discolouration may also result from extravasation of red cells through capillaries if blood leaks out of the tissues during injections without adequate pressure bandaging.