What to Know About Hemosiderin Staining

This reddish residue settles in your tissues to form the hemosiderin stain. Over time, this hemosiderin stain can change from a brown to black color. It depends on your skin tone, but:

• Darker skin may have darker patches.
• Lighter skin may have reddish patches.

No matter your skin color, the stain may be itchy and feel hard or like wood when touched.

How hemosiderin staining can look different from other types of stains

Who's at risk?

Chronic venous insufficiency happens most often if you are over 50 years old or have a history of blood clots in your legs, also called deep vein thrombosis (DVT). You may also have a higher chance of chronic venous insufficiency if you have:

• Varicose veins or a family history of them
• Obesity
• 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 or using tobacco
• Sleeping in a recliner chair
• May-Thurner syndrome (a blood vessel going into your right leg, called an artery, presses on the vein in your leg)

Chronic Venous Insufficiency Symptoms

If untreated, chronic venous insufficiency can lead to uncomfortable, painful, and even life-threatening complications. That's because it affects your veins or blood vessels, and that can sometimes mean blood clots.

It's typically harder for the blood to return to your heart from your feet. So you may notice chronic venous insufficiency symptoms in your legs first, which can 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

How hemosiderin staining is diagnosed

Your doctor can help you diagnose the underlying cause of hemosiderin staining. They'll also prescribe treatment earlier to prevent complications. To diagnose the problem in your leg, they may:

• Review your medical history
• Ask you about your symptoms
• Order an ultrasound to check the blood pressure in your legs

Hemosiderin staining is related to the blood flow in your body, so always get it checked out. In fact, one of the most common reasons for chronic venous insufficiency is DVT.

When to call the doctor

DVT and pulmonary embolism (PE) can both cause chronic venous insufficiency, which can be life-threatening if untreated. So, get emergency medical care right away if you have:

• Pain in your chest (worsens when you move or take a deep breath)
• Pain in your side or belly
• Dizziness or cough (may have blood)
• Fast heartbeat
• Fast breathing or shortness of breath
• Clammy, bluish skin, or fainting
• Severe headache
• Red or discolored skin
• Swollen, painful, warm area in your leg

Treatment for Chronic Venous Insufficiency

Since hemosiderin staining is a symptom of chronic venous insufficiency, your doctor will first treat the damaged blood vessel. Taking care of the condition will help make sure that:

• Your skin discoloration doesn't get worse
• Your symptoms don't worsen

Lifestyle tips for mild chronic venous insufficiency

Your doctor may suggest lifestyle changes to boost circulation in your legs. This can help you prevent more blood from pooling in your feet and ankles. Here are some other tips that can help: 

• Avoid long periods of standing or sitting.
• Make sure to change positions or move your legs periodically if you must stand or sit.
• Get regular exercise, even just walking.
• Lose weight if you are not at your target weight.
• Keep your legs raised when you sit or lie down.
• Wear compression stockings to provide support and boost blood flow.

Treatment options for chronic venous insufficiency

With chronic venous insufficiency, you may also have problems with blood clots or wounds on your skin. If this happens, your doctor may suggest:

• Antibiotics to treat skin infections, ulcers, or other problems
• Blood thinners (anticoagulants) to prevent blood clots
• Wound care such as a medicated wrap (Unna boot), which combines compression with a zinc oxide wound cover
• Ablation, which involves injecting foam, chemical liquid, or a medical glue into the damaged vein to collapse it
• Sclerotherapy, which injects an irritant (a chemical or foam) into the damaged vein, causing it to close before it is naturally absorbed by the body
• Thermal ablation, which uses heat (a laser or high-frequency radio waves) to close up the damaged vein to stop the bleeding

Are there specific medical procedures that treat the underlying vein leakage?

It's called vein surgery and you'll probably see a special doctor who operates on veins, called a vascular surgeon. You and your doctor will discuss the best treatment plan for your hemosiderin staining. If other treatments aren't working, they may suggest:

Vein ligation and stripping. Your doctor ties off the damaged part of the vein and uses a "stripping" method (small cuts) to take out any larger veins that are injured.

Phlebectomy. It uses small cuts or a needle to place a tiny hook into your skin to remove the damaged vein, but you likely won't need stitches.

Subfascial endoscopic perforator surgery (SEPS). This treatment uses a small clip to shut off the injured vein. This can stop the blood from pooling in your leg and allow the ulcer to heal.

Vein bypass. Your doctor takes part of a healthy vein (from another part of your body) and uses it to repair the damaged one in your leg. This is usually done when other treatments aren't working.

Taking steps to improve your circulation can help your overall health. Lowering the effects of chronic venous insufficiency can help you lower your risk of circulation problems.

Treatment for Hemosiderin Staining

The discoloration from hemosiderin staining can be permanent but may fade over time. If it's mild, your doctor may suggest:

• Compression therapy
• Dressing, a wrap to cover the wound if needed
• Leg elevation, putting your leg up for 30 minutes, three to four times a day
• Taking blood thinners, if you're at risk for blood clots

Stains caused by blood vessel damage usually go away after the injury heals. But if you have chronic venous insufficiency, you may need to visit a specialist, such as a vascular surgeon or a dermatologist.

They can suggest treatment to help fade dark spots on your skin, such as:

• Skin creams that contain hydroquinone to lighten dark spots
• Laser treatment or intense pulsed light (IPL) to fade the discoloration

Takeaways

Hemosiderin staining happens when blood leaks out of a damaged blood vessel or vein in your leg. The discoloration can be permanent, but it may fade over time. Your doctor can diagnose the underlying cause and prescribe creams or laser therapy to help fade your stain. A leg injury commonly leads to hemosiderin staining. But if you have chronic venous insufficiency, get emergency care right away to prevent life-threatening problems if you have signs of a blood clot, including a fast heart rate, shortness of breath, bluish skin, red or discolored skin, warm swelling in your leg, or pain in your chest, leg, or belly that gets worse when you move.

FAQs About Hemosiderin Staining

Does sun exposure make hemosiderin staining worse? 

It's often the creams used to lighten hemosiderin staining that can make your skin sensitive to sunlight. These skin treatments can make you more likely to get sunburn. Ask your doctor about combining topical cream and compression therapy if your:

• Blood pressure is under control
• Staining is mild

Can hemosiderin staining cause skin breakdown or ulcers?

The staining itself doesn't cause skin breakdown or ulcers; it's actually the underlying condition that causes the vein damage. So, it's important to see your doctor about hemosiderin staining. They can help you diagnose what's causing your skin to turn red or brown.

One of the most common causes of hemosiderin staining is chronic venous insufficiency, which can cause:

• Damage to your vein and blood vessel leakage
• This can cause varicose veins, which get enlarged
• If untreated, the skin can breakdown and develop venous ulcers

Why do my legs feel hard or wood-like where the staining is located? 

If your hemosiderin staining is caused by chronic venous insufficiency, your legs can feel heavy and hard. Chronic venous insufficiency can cause scar tissue to form and trap fluid in your calf. The extra fluid can push on your skin and tissues, causing it to feel:

• Larger than normal
• Swollen
• Hard like wood

But your skin may also harden if you have another inflammatory condition called lipodermatosclerosis. Sometimes the swelling can be severe and point to a blood clot in your leg or lungs, so get medical care right away if you have:

• Fast heartbeat
• Shortness of breath
• Red or discolored skin
• Swelling with warmth in the area
• Pain in your leg, chest, or belly that gets worse when you move