Haemosiderin

Overview – reddish / darker skin staining above the ankle

If you have darker skin staining (haemosiderin) on the lower legs above the ankles, this is likely to be caused by venous hypertension insufficiency.

Symptoms – what is haemosiderin?

Haemosiderin staining, also known as venous staining occurs when red blood cells pass through the smallest blood vessels (capillaries). And when the red blood cells die, iron released from the haemoglobin is converted into haemosiderin and stored in the tissue beneath the skin. This shows up as a brown stain on the skin. The change you see will depend on your skin tone. Our skin naturally changes as we get older. It may lose its softness, elasticity and smoothness over time. However, you may notice more unusual changes such as darker or brown staining on your lower legs above your ankles.

Consider and observe

Does your occupation involve you having to stand for long periods, are you tall or do you have a family history of varicose veins or leg ulcers. Do you have heavy aching legs after a long day’s work or notice swelling that is increasing or skin changes which may include darker brown or reddish staining and dry itchy skin patches. Seek advice from your local pharmacy, practice nurse or GP as this could be the early signs of venous hypertension or insufficiency in the leg veins.

Causes – what causes hemosiderin?

Venous hypertension / insufficiency

Venous hypertension / insufficiency happens when high pressure in the veins in your legs causes substances from the blood to leak into your 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 your heart pumping and actions of your calf and foot muscles during walking and ankle movement.

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

The haemoglobin from red blood cells is released into your skin tissue and degrades or breaks down into hemosiderin. It is this hemosiderin that causes darker brown or reddish patches of skin above your ankle. The stained skin is very fragile and may break down or, if knocked, fail to heal as usual. What you will experience will depend on your skin tone. If you have a dark skin tone then your skin will have darker patches but may not have a reddish colour. Lighter skin tones may start with reddish patches. Regardless of your skin tone, the skin itself may be itchy or harder to the touch.

Diagnosis – getting diagnosed with hemosiderin

If your legs have reddish or brown stains on them, make an appointment at your GP practice to see a healthcare practitioner, this may be a doctor or a nurse.

Alternatively, there might be a Leg Club or specialist leg clinic in your area – you should be able to get information on this from your doctors surgery.  You can attend one of these without having to be referred by your GP.

Remember to remove any nail polish from your toenails before your appointment.

When you see the nurse or doctor, they should:

• Ask about your symptoms and how long you have had problems
• Examine your lower legs

You may be offered a simple test called a Doppler ultrasound. This test measures the blood pressure in your ankle and compares it to the pressure in your arm to see if you have problems with the arterial blood supply to your lower leg. You might have to come back to have your Doppler test on a different day or at another clinic but you should have this test within a few weeks of your first appointment.

You might also be offered further tests to check for other health problems that can affect your legs such as diabetes and anaemia.

If your GP or nurse thinks you have problems with your veins or arteries, they might refer you for further vascular tests at your local hospital or specialist clinic.

When you see the nurse or doctor ensure they take your height and weight and calculate your BMI (Body Mass Index). Being overweight can predispose you to problems in the legs such as swelling, varicose veins and skin changes. Speak to your nurse and / or doctor about ways to support your exercise and diet regime as this is an important part of keeping legs and feet healthy. You can also access support from your local pharmacy.

Treatment – what treatment will I be offered for hemosiderin?

Moisturising your skin

It is important to keep your skin clean and well moisturised. Avoid soap as this can be very drying. Instead, use a moisturising soap substitute when washing, bathing and showering.

When washing ensure the water is not too hot as this can dry the skin and cause irritation. After washing gently dry the skin avoiding excessive rubbing to reduce friction and irritation. Ensure the skin is fully dry before applying a moisturiser paying particular attention to in between the toes. Applying the moisturiser in a downward motion not against the hair growth can help prevent irritation of the hair follicle from the moisturiser.

Always moisturise your skin after washing, bathing and showering. You might want to use a bath emollient or oil as well as a moisturising lotion, cream or ointment, as these clean and hydrate the whole body. If you’re using bath oils, remember to also use a rubber mat or grip rail as the bathtub can become very slippery. 

Compression therapy

You will be offered compression therapy. Compression therapy improves blood flow through the veins by applying supportive pressure to the leg by bandaging the lower leg or by wearing supportive socks, stockings or tights. It’s very effective at reducing swelling and healing or preventing sores or ulcers; compression therapy reduces inflammation and thus wearing this will also reduce the brown or reddish skin staining and also soften the hardened areas. There are lots of different types of compression therapy so ask your nurse to find something that is right for you. Compression can be a little uncomfortable when you first start treatment but any discomfort should reduce as the swelling goes down. You might find it helpful to take pain killers when you start compression therapy.

Exercise

Try and take regular exercise, such as a brisk 30 minute walk, at least three times a week. This is because exercising your foot and calf muscles will reduce the venous hypertension and skin staining.

You could also try this gentle exercise while sitting down: move your feet around in circles, then up and down. This helps get blood back to your heart.

Where’s the harm?

• The changes you see in your skin such as discolouration and hardening are because of the underlying venous hypertension. There is no cure for this, only prevention
• Noticing the changes is important and the earlier you have compression therapy the better your life will be
• Ignoring the changes simply increase your risk of having leg ulcers
• Your GP is there to help you prevent ill health; make sure you get the compression socks you need to do this

Resources

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)

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

NICE – Compression Stockings (Web page)