Can untreated varicose veins cause skin problems?
Yes, untreated varicose veins are a leading cause of progressive skin damage in the lower legs. When the valves in your veins fail, blood pools under high pressure, a condition known as venous hypertension. Over time, this pressure causes fluid, proteins, and red blood cells to leak into the surrounding skin tissue, triggering chronic inflammation. This process leads to a spectrum of conditions collectively known as chronic venous insufficiency (CVI), ranging from mild itching to permanent skin hardening and life-altering open sores.
What We will cover in this Article
- The progression from venous hypertension to skin breakdown
- Understanding venous eczema and stasis dermatitis
- The causes of permanent skin discolouration (Haemosiderin staining)
- Lipodermatosclerosis: The hardening of leg tissues
- The development and risks of venous leg ulcers
- Comparative data on the stages of venous skin disease
- Triggers that accelerate skin damage and when to seek help
The CEAP Classification: Stages of Venous Disease
Clinicians use the CEAP scale to track how varicose veins affect the skin and underlying tissue.
| Stage | Clinical Sign | Description of Skin Condition | Risk of Ulceration |
| C2 | Varicose Veins | Bulging veins without visible skin changes | Low |
| C3 | Oedema | Swelling of the ankle or leg, skin may feel tight | Moderate |
| C4a | Pigmentation/Eczema | Brown staining or red, itchy, flaky skin rashes | High |
| C4b | Lipodermatosclerosis | Hard, thickened, ‘woody’ skin; ‘inverted champagne bottle’ leg | Very High |
| C5 | Healed Ulcer | Skin is scarred where a previous sore has closed | Extremely High |
| C6 | Active Ulcer | Open, weeping sore that fails to heal naturally | Critical |
Venous Eczema and Stasis Dermatitis
One of the earliest skin problems caused by untreated varicose veins is venous eczema (also called stasis dermatitis). As fluid leaks into the skin, the immune system reacts, causing the skin to become red, extremely itchy, and flaky. Unlike standard eczema, this is not caused by an allergy but by poor circulation. If left untreated, the skin can become ‘weepy’ and develop crusts, making it highly susceptible to bacterial infections like cellulitis.
Permanent Discolouration: Haemosiderin Staining
When red blood cells leak out of high-pressure veins, they die and release iron. This iron deposits in the skin, causing a permanent brownish or rust-coloured staining known as haemosiderin staining. This usually starts around the ankle and slowly spreads upward. Once this staining occurs, it is very difficult to reverse, even if the underlying varicose veins are eventually treated. It serves as a clear warning sign that the skin is under significant stress.
Lipodermatosclerosis: Skin Hardening
As the inflammation persists for years, the fat and connective tissue under the skin become scarred and inflamed. This condition, called lipodermatosclerosis, causes the skin to feel hard, smooth, and ‘woody.’ The lower part of the leg may shrink due to scarring, while the upper calf remains swollen, giving the leg an ‘inverted champagne bottle’ appearance. At this stage, the skin is extremely fragile and can break open with even a minor bump or scratch.
The Final Stage: Venous Leg Ulcers
The most severe skin problem caused by untreated varicose veins is a venous leg ulcer. Because the skin is poorly nourished by oxygen-rich blood and is constantly inflamed, it loses its ability to heal. A small scratch can quickly turn into a large, shallow, painful open sore. These ulcers often weep fluid and can take months or even years to heal without specialist intervention and compression therapy.
Causes and Triggers of Skin Breakdown
The root cause of these skin problems is the failure of the one-way valves in the veins (venous reflux). However, certain triggers can cause the skin to deteriorate much faster.
- Inactivity: Sitting or standing still for long periods increases the pressure on the skin.
- Obesity: Added weight puts immense strain on the venous system, accelerating tissue damage.
- Injury: Even a minor ‘knock’ to a leg with chronic venous changes can trigger an ulcer.
- Heat: Warm weather causes veins to dilate, increasing fluid leakage into the skin.
Differentiation: Venous vs. Arterial Skin Issues
It is critical to differentiate between skin problems caused by veins and those caused by poor arterial supply (PAD).
| Feature | Venous Skin Problems | Arterial Skin Problems |
| Colour | Brown, dusky red, or purple | Pale, blue, or shiny/white |
| Temperature | Usually warm | Often cold to the touch |
| Pain | Aching, throbbing, heavy | Sharp, cramping (claudication) |
| Location | Usually around the inner ankle | Often on toes, heels, or bony points |
Conclusion
Untreated varicose veins are far more than a cosmetic issue; they are a direct threat to the health of your skin. From the initial stages of itching and eczema to the severe complications of lipodermatosclerosis and open ulcers, the damage is progressive. Early intervention with compression stockings or minimally invasive procedures can halt this progression and protect the integrity of your skin.
If you experience severe, sudden, or worsening symptoms, such as a sore that is rapidly enlarging, foul-smelling discharge, or high fever with leg redness, call 999 immediately.
Will treating my veins make the brown stains go away?
Usually, no. Haemosiderin staining is permanent, but treating the veins will stop the staining from getting darker or spreading further.
Is venous eczema contagious?
No. It is caused by internal pressure and fluid leakage, not by a virus or bacteria.
How can I tell if a skin change is serious?
Any areas of skin that are becoming hard, dark brown, or red and shiny are signs of advanced venous disease and require a medical review.
Can moisturiser fix venous eczema?
Moisturiser can help with the dryness and itching, but it will not fix the underlying cause. You need to address the vein pressure, usually with compression or surgery.
Why does my leg look like an inverted bottle?
This is a sign of lipodermatosclerosis, where chronic inflammation has caused the tissue above the ankle to scar and shrink.
Are venous ulcers painful?
Yes, they can be very painful, especially if they become infected or if the leg is not elevated.
Can I prevent skin problems with stockings?
Yes. Medical-grade compression stockings are highly effective at reducing the pressure that causes skin damage.
Authority Snapshot
This article provides a summary of venous-related dermatological complications based on the NICE Clinical Knowledge Summaries (CKS) and the CEAP classification system. It highlights the importance of early diagnosis to prevent the progression to Stage C6 (active ulceration). This information is intended to help patients recognize the warning signs of skin damage in the context of venous disease. Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.
