Why do skin changes occur?

In the lower limb, if the valves in the veins of the lower limb are damaged or not working correctly, blood will flow back down into the veins leading to an increase in blood volume and pressure.

Valves may not work because of traumatic damage, e.g. surgery or fracture, or may not work properly, e.g. they may be unable to close because the vein is swollen due to congestion.

This situation can be made worse if the foot and calf muscles are not working well, as these also help to move blood back towards the heart.

Limited movement

If the muscle is weak or has limited movement, such as in immobile or elderly people, it will not squeeze the veins sufficiently to push the blood upwards.

With the backflow of blood, the walls of the vein stretch, leading to them becoming varicose, and the pores in the capillary wall enlarge, allowing fluid, red cells and protein to leak out into the tissues.

It is this process that results in skin changes.

What do skin changes look like?

Early Stages

In the early stages skin changes will be mild and may go unnoticed at first. They include aching, heavy limbs , spider veins ankle flare, hyperpigmentation and mild swelling. At this stage, swelling and aching usually resolves on elevation of the legs.

Blood Pressure

The persistently increased volume of blood begins to put extra pressure on the perforating and superficial veins of the legs. As these veins stretch, their valves do not close properly so they can no longer prevent a backflow of blood.

The volume of blood within the veins increases further, raising blood pressure in the vein, causing it to stretch and causing more fluid to leak out into the tissues.

Lipodermatosclerosis

Prolonged leakage can then trigger inflammatory processes in the tissues, which results in skin changes such as induration varicose eczema and lipodermatosclerosis It is this process that results in skin changes.

Venous Hypertension

Initially, a healthy lymphatic system can compensate, but with time, it becomes unable to cope with the extra volume of fluid, leading to chronic high blood pressure in the vein (venous hypertension).This process is the main underlying cause of venous leg ulceration and lymphovenous oedema.

Lymphorrhoea

Severe skin changes such as leg ulceration, deformed, swollen limbs and wet leaky legs (lymphorrhoea) can have a huge negative impact upon the patient’s quality of life (QoL), and can lead to social isolation and depression (Lymphoedema Framework, 2006; Upton, 2013).

Cellulitis

They also put the patient at risk of infection (cellulitis) and the skin and tissues, if not broken, are at a high risk of ulceration (Anderson, 2006; 2008).

With the breakdown in the skin’s integrity as a result of oedema and/or leg ulceration, the risk of infection increases. Poor lymph drainage and the accumulation of protein-rich fluid provides the ideal medium for bacteria to flourish, thus increasing the risk of acute inflammatory episodes.

Management of skin changes

Severe signs and symptoms of venous and/or lymphatic disease generally do not occur out of the blue, but begin as mild skin changes that become worse with time if the underlying failure of the venous and lymphatic systems is left unchecked.

If you recognize any skin changes on your limb, speak to your health-care professional about them, so that a can be made to prevent or delay the worsening of the underlying condition(s).

The care plan usually involves the use of skin cleansing and moisturising to maintain skin health, wound management if a leg ulcer is present, and compression therapy to address the underlying lymphatic and venous congestion.

Regardless of the skin changes present, whether mild or very severe, a good care plan can help to alleviate signs and symptoms.