In this blog we discuss five conditions related to skin (varicose eczema, haemosiderosis, telangiectasia, hyperhidrosis and hyperkeratosis,) that we often see here at City FootHealth. The management of the venous conditions 1-3 is important as they are associated with deeper vein deterioration.
Telangiectasia, sometimes called spider veins is an accumulation of dilated blood vessels near the surface of the skin. Telangiectasia rarely measure more than a few millimetres and appear as thin red, purple or blue veins that are highly visible on the leg and foot of elderly patients (as represented in the diagram below). Telangiectasia can occur between the ages of 18 –35, however, they generally tend to occur between 50 and 60 years of age.
Telangiectasia is caused by venous insufficiency and faulty valves which causes varicose veins and telangiectasia. When veins do not carry blood back to the heart correctly the blood ‘pools’ and collects near the surface of the skin.
Telangiectasia can be caused by hormones, which together with increased blood volume weaken vein walls as can be highlighted with pregnancy.
Jobs associated with prolonged standing or sitting causes blood to continually press on closed valves which causes them to fail, which in turn leads to vein distension. The condition is normally asymptomatic which means there is no pain.
Treatment / Management:
- There are several treatments available for this condition
- Small veins can be removed by laser therapy.
- Larger veins can be surgically removed.
- Wearing support stockings provided by your GP or for more attractive versions can be provided through The Footcare Centre.
- Moderate exercise to improve venous return through the calf muscle pump, limit standing for extended periods, and avoid crossing your legs.
- Whilst sitting put your legs up on a poof/foot stool
2) Varicose Eczema (stasis dermatitis)
Varicose eczema or Stasis dermatitis is a skin condition that occurs in the leg as a result of blood pooling from insufficient venous return.
It can appear with the following:
- Thinning of the skin that is brown and tissue-like with red spots, skin irritation at the ankles or legs
- Itching and/or leg pains
- Due to the thinning the skin becomes weakened and may ulcerate
Often with this condition the skin is not fully intact, this predisposes persons to cellulitis as there is a portal of entry for bacterial infection, if this occurs then antibiotic cover is needed.
Treatment consists of topical applications such as steroid based creams and emollients to help maintain the integrity of the skin. Also the use of compression stockings to assist with efficient venous return is also a very effective treatment option.
At City FootHeath the podiatrist present will be able to provide further information and aid in the use of the stockings for treatment of the condition.
Haemosiderosis is a deposition of hemosiderin in body tissues, which causes no tissue damage and reflects an increase in body iron stores.
Haemosiderosis is the medical term for iron overload, a condition that occurs when the body stores too much iron in tissues due to a lack of properly functioning red blood cells. The condition occurs due to insufficient venous return and related venous hypertension (high pressure within the veins).
Haemosiderin often forms after bleeding. When blood leaves a ruptured blood vessel, the cell dies and the haemoglobin of the red blood cells is released into the extracellular space. This results in a brown or rust discolouration of the skin.
Hyperhidrosis is a condition whereby the patient suffers from excessive sweating, which may be either localized, or affect all of the areas supplied by sweat glands. Hyperhidrosis is most common amongst young adults and athletes.
Hyperhidrotic skin loses its natural elasticity and cannot withstand tensile and shearing stresses resulting in fissures, pitting keratolysis and blisters. Patients suffering from the condition are more prone to fungal and bacterial infections.
The management may involve either control or cure. Where there is an underlying cause (infection, diabetes, thyroid over-activity), which can be treated by your GP, the hyperhidrosis can be cured. Otherwise the aim is to control the condition.
At City FootHealth the podiatrist present will offer the following treatment and advice to the patient for the condition:
Hyperhidrosis can be treated by the use of antiperspirants, which reduce sweating, or deodorants, which reduce odour because they generally contain an antibacterial agent. Frequently, both antiperspirants and deodorants may be combined in one product.
Where the condition is present between the toes and causes the skin to become soft and white the liberal application of astringents such as surgical spirit, or the use of potassium permanganate footbaths, both of which help to dry the skin out, over a period of weeks should result in a dramatic decrease in hyperhidrosis.
The podiatrist will also discuss a whole range of other tips and self-treatments with you.
Hyperkeratosis is a term used to describe thickening of the outer layer of the skin. It is commonly known as callus. It is particularly common on the heel and may become so thickened that it starts to crack and form fissures.
Callus appears as a yellowish plaque of skin. It may be symptomatic, though in most instances it is unsightly and uncomfortable. It can be confined to one particular area, or may be diffuse / widespread over a large area. It can indicate other clinical conditions e.g. anhidrosis or increased pronation.
Callus is due to excess mechanical stress and duration of loading of tissues during gait, which can be caused by:-
- Hyperkeratosis can occur as a result of excessive stresses on the foot whilst walking e.g. – Shearing, Tensile, Compressional, Torsional.
- Foot deformity
- Circulatory disorders.
- Neurovascular logical disorders where there is both reduced circulation and sensory loss such as diabetes and rheumatoid arthritis
- Occupational causes:- Standing for long periods, walking on hard surfaces
- Inappropriate footwear
- At City FootHealth the podiatrists present will offer the following treatment and treatment plans for the condition:
- Debride the callus
- Check the inside of the patient’s shoes to ensure the surfaces are even and smooth.
- Conduct biomechanical assessment and provide insoles if required.
- Palliative padding to deflect pressure away from the area of callus.
- Footwear advice e.g. avoids flip-flops and footwear without proper heel supports.
- Advise patient to moisturise the area twice daily with a high urea content emollient e.g. CCS and Flexitol cream.
- Regular use of a foot files / pumice stone when bathing.
If you have any of the above conditions then please do not hesitate to speak to one of the podiatrists here for further information and discussion. To book please call 02076283359