The internet is full of information and is the number one place many of us to go find information about our health. But so much of what can be found is not medically sound. We want to be an educational resource for you, to empower you to get the professional medical attention you need to be at your best health. That is why we have prepared this Q & A series with your vein specialist, Dr. Vincent Gardner. This time we will explore the question: What causes color (or pigment) skin changes in the lower legs and ankles? How does vein disease cause pigment changes in the skin?

Q: Is pigment the same thing as melanin? What are they?

A: Melanin is what gives your skin, hair and eyes color, or pigment. The terms melanin and pigment may be used interchangeably. Melanin is produced by your body in skin cells called melanocytes.

Q: What are some signs and symptoms of venous insufficiency?

A: Varicose veins are only one sign that you may have venous insufficiency. Other signs and symptoms of venous insufficiency may include:

  • Enlarged veins that are visible beneath the surface of the skin
  • Edema or swelling of the lower leg or feet
  • Legs that feel achy, itchy, tired, heavy, or even painful
  • Discolored pigmentation and unusually darkened melanin of the skin
  • Leg cramps, particularly at night
  • Restlessness or feeling that you must move your legs, particularly at night
  • Thickened or hardened skin
  • Open sores or venous ulcerations
  • Tight skin with or without weeping of clear fluid
  • Blood clots or phlebitis

Q: Are pigment changes over veins a cause for serious concern?

A: Although many vein issues are not cause for serious concern, catching them before they develop further is crucial to preserving your health and preventing serious concern from developing. Mild symptoms of venous disease can include changes in skin color. But venous stasis dermatitis is when the skin pigmentation changes towards an uncharacteristic darker bronze or red pigmentation and is a symptom associated with severe venous disease. Most people don’t know this but the end organ that becomes damaged in vein disease is the skin.  So seeing skin changes is a sign of advancing disease. Severe venous disease can also lead to skin ulcers, DVT, or pulmonary embolisms, which is when a blood clot travels to your lung. It is always best to get professional medical attention if you notice any of these symptoms.

Q: What causes venous stasis dermatitis?

color or pigment skin changes caused by vein disease

A: Severe venous insufficiency means the veins are not properly circulating the blood. Venous stasis dermatitis is caused when red blood cells leak out from damaged veins into the surrounding skin and soft tissue. It is there that the body breaks the red blood cells down.  The red cells contain iron which stains the tissues, causing a dark red/brown discoloration to appear on the skin and surrounding tissues in the lower legs and ankles. Not only does this cause visible discoloration, but it can also lead to itchiness, which can sometimes be very intense.

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[Source: “EPublications.” Varicose Veins and Spider Veins Fact Sheet. Ed. Robert J. Min. Women’s Health, US Department of Health and Human Services, 16 July 2012. Web. 18 June 2015.]


  1. Melissa S Medina-Reply
    August 15, 2020 at 8:48 AM

    This was extremely helpful information!

  2. Suzanne van der Merwe-Reply
    October 31, 2020 at 10:57 AM

    Thank you, this information was very helpful. Appreciate you!

  3. Deb rathburn-Reply
    December 22, 2020 at 1:59 AM

    I have had discoloration for over 10 year my legs they itch very painful wakes me up a warm towel behind my legs help my legs they will even jerk whil I’m lying in bed I guess from pain that when it does it I’ve had two ulcers the 2 Nd came back where the other was what am I looking at in the furture the pain is unbelievable had feet surgery I’m giving my shot shots in belly to help prevent clot blood thinner my surgeron order a pump I haven’t reiceved it yet an I finally found a pair stocking I can wear the panty hose like doesn’t work for me I use cloth one

    • Vincent Gardner-Reply
      February 11, 2021 at 12:10 PM

      I’m so sorry to hear that you are having so much trouble but thankful that you have a doctor helping you.

  4. February 2, 2021 at 5:50 PM

    I am interested in a consultation. After seeing my dermatologist, today, I learned that I have vein disease. I would like to know what treatment would help me, whether my medical insurance would cover treatment, and what, if any, my out-of-pocket costs would be. Thank you!

    • Vincent Gardner-Reply
      February 11, 2021 at 12:05 PM

      Thank you for reaching out. If you are in the Greater Chattanooga, TN or Calhoun, GA areas, we would love to see you for a consultation. Please call the office at 423-551-8346 to schedule your appointment.

  5. Lance Barnhart-Reply
    October 24, 2021 at 1:21 PM

    How do I solve the problem of discoloration in my legs and angles and top of feet???

    • Vincent Gardner-Reply
      November 9, 2021 at 4:44 PM

      Great question…..Skin discoloration can happen for different reasons. The discoloration may be related to vein issues. If it is then it is usually referred to as hemosiderin staining. Basically, iron pigment from ruptured red blood cells can stain the skin much like a tattoo. And like a tattoo it is usually permanent. If it is caused by venous disease then we usually recommend correcting the underlying venous issue. Once the veins have been treated then we sometimes see improvement or fading of the discoloration over time. If it persists then it sometimes responds to IPL/laser treatments. You need to have an evaluation to see if the source of the pigment can be determined and then we make recommendations from there.

  6. tejay-Reply
    December 29, 2021 at 2:28 AM

    This actually helped I’m young and overweight so it was nice to know what is going on. I am working out and getting my veins fixed

  7. Kathleen heeley-Reply
    April 11, 2022 at 3:40 PM

    I have these awful brown marks on my lower legs docs tried putting blood pressure cuffs on both of them to see if it’s to do with my heart but it was to painful so I’m waiting to see wats next I do hope it goes soon I’ve had it a long time now

  8. Jean-Reply
    April 15, 2022 at 4:57 PM

    Cannot be one leg that has the issue or does it usually involve both?

  9. Jean-Reply
    April 15, 2022 at 4:58 PM

    (What I meant to ask …) Can it be just one leg, or does it usually involve both?

    • Vincent Gardner-Reply
      May 3, 2022 at 10:44 AM

      It depends on the individual. Pigmentation issues are usually an indication that a patient has advanced chronic venous insufficiency or vein disease. So if a patient has vein disease in both legs then they can develop pigmentation issues in both legs. If they have vein disease in only one leg then that leg can develop pigmentation issues as the disease process becomes progresses.

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