Chronic Venous Insufficiency in Left Leg of 70-Year-Old Man

Tortuous, dilated varicosities; multiple smaller caliberabnormal perforating vessels; and chronic brawnyedema of chronic venous insufficiency (CVI) were seenon a 70-year-old man's left leg (A). He reported that theedema and discoloration had worsened over the last15 years. The brawny edema stopped just above theankle, indicating that compression by the patient's sockcontrolled the signs and symptoms of CVI.Stellate dermal sclerotic changes that developedfrom old healed stasis ulcers were noted on the medial aspectof the foot (B). These hypopigmented changes,known as atrophie blanche, are typical of chronic CVI butmay be seen in other conditions as well. The starlikeporcelain-white scars also demonstrate peripheral telangiectasiaand hyperpigmentation.Venous stasis arises from incompetent venous valvefunction, which impedes venous flow to the heart. Predisposingfactors for CVI are female sex, family historyof the disease, pregnancy, and minor leg injury. A host ofskin manifestations may be associated with CVI, includingvaricose veins, dependent edema, pigmentary changesthat are secondary to hemosiderin staining from extravasatedred blood cells and from postinflammatory hyperpigmentation,stasis dermatitis, atrophie blanche, ulceration,and lipodermatosclerosis(woody indurationof the lowerthird of theaffected leg inadvanced CVI).The mainstaysof treatmentare compression with stockings or a soft cast andleg elevation, especially when seated; surgical interventionmay become necessary. A topical mid-potency corticosteroidointment can be used to treat the acute dermatitisand emollients can be helpful for prevention.In addition to compression stockings and leg elevation,this patient used triamcinolone ointment, 0.1%, forCVI-associated dermatitis. He was lost to follow-up.