Patients with hemosiderin: reddish brown staining above the ankle

If your patient has brown staining (hemosiderin) on the lower legs above the ankles, this is likely to be caused by venous hypertension / insufficiency.

Causes of reddish brown staining / hemosiderin above the ankle in older patients

Venous hypertension / insufficiency

Venous hypertension / insufficiency happens when high pressure in the veins in the legs causes substances from the blood to leak into the tissues. Blood is pumped from the heart to the rest of the body through the arteries and returns through the veins.  The blood is propelled back to the heart by the heart pumping and actions of the leg and foot muscles during walking and ankle movement.

The veins contain one-way valves to stop the blood falling back towards the toes.  These valves can become weak or damaged.  When this happens, the  veins become so swollen (varicose veins) that blood is forced into the tissue of the skin.

The haemoglobin from red blood cells is released into the skin tissue and degrades into hemosiderin. It is this hemosiderin that causes brown patches of skin above the ankle. The stained skin is very fragile and may break down or, if knocked, fail to heal as usual.

Assessment of a patient with hemosiderin

You should give everyone who presents with a lower leg problem a comprehensive assessment that includes:

• ABC of Wound Healing, Venous and Arterial Leg Ulcers
  The BMJ (Web page)
• Doppler ultrasound to record an Ankle Brachial Pressure Index (ABPI). This test screens for clinically significant arterial impairment.
  World Wide Wounds (Web page)
  Nursing Times – Doppler assessment (Web page)

If your patient appears to have problems with their veins or arteries, you should refer them for further vascular tests.

Treatment of hemosiderin

Venous hypertension

The first line treatment for venous hypertension is compression therapy.

Wounds UK – compression hosiery  (PDF Download – Open access – registration required to download)

NICE – Compression Stockings (Web page)

People with hemosiderin staining are likely to have vulnerable or dry skin on their lower legs.  You should encourage them to use emollient based soap substitutes for washing their legs and to apply emollient creams daily to improve the strength of the skin barrier.

Publications & Evidence for hemosiderin

We’ve put together some resources to help in your everyday work.

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Patient information for hemosiderin

The patients, family and friends section has lots of useful, accessible information for your patients.

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Dowload a patient information leaflet as a pdf to print