What is the treatment for burning sensation of skin due to peripheral venous insufficiency?

Treatment of Burning Sensation of Skin Due to Peripheral Venous Insufficiency

Compression therapy is the first-line treatment for burning sensation of skin due to peripheral venous insufficiency, with graduated compression stockings (30-40 mmHg) being the most effective conservative approach to relieve symptoms. 1

Comprehensive Management Approach

First-Line Conservative Treatments

1. Compression Therapy

   • Graduated compression stockings (30-40 mmHg) to reduce venous hypertension 1
   • Double bandages (zinc paste bandages with elastic compression) for more severe cases, changed weekly 2
   • Compression therapy works by:
     • Reducing capillary hypertension
     • Improving microcirculation
     • Decreasing edema
     • Promoting venous return

2. Lifestyle Modifications

   • Regular exercise to improve calf muscle pump function 1
   • Leg elevation when at rest to reduce venous pressure 1, 2
   • Weight management (obesity worsens symptoms) 1
   • Avoiding restrictive clothing 1
   • Sodium restriction and increased consumption of fresh fruits and vegetables 1

Topical Treatments for Symptom Relief

• Hydrocolloid dressings for clean areas, changed once or twice weekly (combined with compression) 2
• Caution with topical preparations due to high risk of sensitization in patients with chronic venous insufficiency 2
• Avoid prolonged use of topical steroids - while they may provide short-term relief of inflammation and pain, they can be detrimental long-term 3

Advanced Interventional Treatments

For patients who fail conservative management, consider:

1. Endovenous Thermal Ablation

   • First-line interventional treatment for saphenous vein reflux 1
   • Options include radiofrequency or laser ablation
   • High anatomical success rate

2. Foam Sclerotherapy

   • Effective as adjunctive treatment for tributary veins and varicosities 1
   • Can be combined with thermal ablation for comprehensive treatment

3. Surgical Options

   • Reserved for cases not amenable to endovenous procedures
   • May be appropriate for selected elderly patients without contraindications 2

Monitoring and Follow-up

• Ultrasound evaluation within 1-2 weeks after interventional procedures 1
• Regular follow-up to assess treatment effectiveness 1
• After healing, continued compression therapy with stockings to prevent recurrence 2

Clinical Pearls and Pitfalls

• Important caveat: Always rule out coexisting arterial insufficiency before initiating compression therapy, especially in elderly patients 2
• Microcirculatory dysfunction in CVI leads to decreased capillary numbers, altered morphology, and reduced tissue oxygenation, which explains the burning sensation 4
• Treatment efficacy can be monitored by improvement in microcirculation parameters, including increased number of nutritive capillaries 4
• Non-healing symptoms despite appropriate compression therapy warrant investigation for:
  • Infection
  • Malignancy (ulcerated skin cancers)
  • Non-compliance with therapy 2

The effectiveness of compression therapy has been well-documented, with studies showing that clinical improvement correlates with measurable increases in the number of nutritive capillaries and reduction in capillary diameter 4. This improvement in microcirculation directly addresses the underlying cause of the burning sensation.