Venous Skin Ulcers: Causes, Symptoms, Treatment, and Prevention

Alan Lucks | MD

Medically reviewed by Alan Lucks | MD, Alan Lucks MDPC Private Practice - New York on January 2nd, 2024.

Key Takeaways

  • These chronic wounds develop when damaged one-way valves in leg veins allow blood to pool backward, creating pressure that eventually breaks down skin tissue around the ankles and lower legs.
  • Characteristic brown or rust-colored skin staining (hemosiderin deposits) appears months before ulcers form, serving as an early warning sign alongside persistent swelling and skin hardening.
  • Compression therapy using 30-40 mmHg graduated stockings can heal 70-85% of ulcers within 12-24 weeks when combined with proper wound care and leg elevation above heart level.
  • Recurrence rates reach 70% within 5 years without preventive measures, making lifelong compression wear and weight management critical for long-term success.
  • Women over 65 face the highest risk, particularly those with a history of deep vein thrombosis, multiple pregnancies, or jobs requiring prolonged standing for over 4 hours daily.

Venous skin ulcers, also known as venous leg ulcers, are slow-healing sores that develop on the leg, usually around the ankle. These ulcers occur when there is a break in the skin, and the veins in the leg are not effectively sending blood back to the heart. If left untreated, venous skin ulcers can lead to more serious problems, but with proper care and prevention methods, you can manage and avoid them.

Causes of Venous Skin Ulcers

The primary cause of venous skin ulcers is weak blood circulation in the leg. This can happen when the valves in the veins, which prevent blood from flowing backward, are not functioning properly. As a result, blood pools in the lower leg, increasing pressure and weakening the skin, making it harder for cuts or scrapes to heal.

Who Is at Risk?

Approximately 1% of Americans develop venous skin ulcers, with older people, particularly women, being more susceptible. Other risk factors include:

  • Previous leg injuries

  • Varicose veins

  • Smoking

  • Obesity

  • Diabetics

  • History of circulation problems, such as blood clots or phlebitis

Symptoms of Venous Skin Ulcers

Venous skin ulcers often cause itching or burning sensations, and the leg around the ulcer may be swollen. Other signs and symptoms may include:

  • Rash or dry skin

  • Brownish discoloration

  • Foul-smelling fluid oozing from the sore

If the ulcer becomes infected, you may experience:

  • Redness or swelling of the surrounding skin

  • Worsening pain

  • Fever

  • Pus

Venous Skin Ulcers: Causes, Symptoms, Treatment, and Prevention

Diagnosing Venous Skin Ulcers

If you have a wound that is not healing or you suspect is infected, consult your doctor. In most cases, a simple examination of the sore and the surrounding skin is enough to diagnose a venous skin ulcer. Your doctor may ask about your history of chronic conditions, such as diabetes or hardening of the arteries. In some cases, additional tests, such as an X-ray or CT scan, may be ordered to examine your veins and the area around the ulcer more closely.

Treating Venous Skin Ulcers

The most common treatment for venous skin ulcers is compression therapy, which involves wearing compression bandages or stockings. The pressure helps improve blood circulation in the leg, enhancing the body's ability to heal the sore. Elevating the affected leg for 30 minutes, 3 to 4 times a day, can also promote better circulation.

If the ulcer is infected, antibiotics may be prescribed to clear the infection. A moist dressing can be applied to the ulcer to accelerate healing. In some cases, surgery may be recommended to improve leg circulation, which can help heal the ulcer and prevent future occurrences.

Preventing Venous Skin Ulcers

There are several ways to prevent venous skin ulcers through lifestyle changes, diet, and medication. These include:

  • Quitting smoking

  • Losing weight

  • Controlling chronic conditions, such as high blood pressure or diabetes

  • Taking aspirin to prevent blood clots

  • Reducing salt intake

  • Exercising regularly

  • Wearing compression stockings

  • Keeping legs elevated when possible

By understanding the causes, symptoms, treatment options, and prevention methods for venous skin ulcers, you can take proactive steps to maintain healthy legs and avoid these slow-healing sores. If you suspect you have a venous skin ulcer, consult your healthcare provider for proper diagnosis and treatment.

The Bottom Line

Early recognition of brown skin discoloration and persistent leg swelling allows for preventive treatment before painful ulcers develop. Consistent compression therapy remains the most effective treatment, but requires months of commitment and lifestyle changes to prevent recurrence. If you're noticing persistent leg swelling or skin changes, Doctronic can help you get quick answers about your symptoms.

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