Can worsening varicose veins cause burning and tightness of the skin?

Varicose Veins and Skin Symptoms: Burning and Tightness

Yes, worsening varicose veins can cause burning and tightness of the skin as part of their symptomatic presentation. 1

Pathophysiology and Symptoms

• Varicose veins result from valvular reflux, which involves genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure 1
• The clinical presentation of varicose veins includes localized symptoms such as:
  • Pain
  • Burning
  • Itching
  • Tingling at the site of the varicose veins 1
• Generalized symptoms include:
  • Aching
  • Heaviness
  • Cramping
  • Throbbing
  • Restlessness
  • Swelling in the legs 1
• Symptoms typically worsen at the end of the day, especially after prolonged standing 1
• Symptoms usually improve when sitting and elevating the legs 1

CEAP Classification and Skin Changes

• The CEAP classification system (Clinical, Etiologic, Anatomic, Pathophysiologic) provides a framework for characterizing venous disease 1
• The presence of symptoms is noted with a subscript "S" (e.g., C3S for symptomatic edema) 1
• Symptoms specifically include tightness and skin irritation attributable to venous dysfunction 1
• As varicose veins progress, they can lead to more severe skin changes:
  • Changes in skin pigmentation
  • Eczema
  • Lipodermatosclerosis (chronic inflammation, fibrosis, and contraction of the skin and subcutaneous tissues) 1

Risk Factors for Worsening Symptoms

• Family history of venous disease
• Female sex
• Older age
• Chronically increased intra-abdominal pressure (obesity, pregnancy, chronic constipation)
• Prolonged standing
• Deep venous thrombosis history 1, 2

Management Options

Conservative Treatments

• Compression therapy with medical grade stockings (20 mmHg or greater) for at least 3 months 3
• Elevation of the affected leg to improve symptoms 1
• Lifestyle modifications:
  • Avoiding prolonged standing and straining
  • Exercise
  • Wearing non-restrictive clothing
  • Weight loss if obese 1, 2
• Phlebotonics (e.g., horse chestnut seed extract) may provide symptomatic relief, though long-term studies are lacking 1

Interventional Treatments

• Endovenous thermal ablation (using laser or radio waves) has largely replaced surgery as the standard of care for larger vessels 1, 3
• External laser thermal ablation works best for telangiectasias (spider veins) 1
• Endovenous sclerotherapy using various agents 1
• Surgical options (less commonly used now due to better alternatives) 1, 3

When to Seek Medical Attention

• Patients experiencing burning and tightness of the skin with varicose veins should seek medical evaluation, especially if symptoms are worsening 1
• Referral for interventional treatment should not be delayed for a trial of external compression if valvular reflux is documented 1
• Venous duplex ultrasonography is recommended when venous disease is severe or interventional therapy is being considered 1

Common Pitfalls in Management

• Delaying referral for interventional treatment in favor of prolonged compression therapy when valvular reflux is documented 1
• Treating visible varicosities without investigating underlying venous reflux with duplex ultrasound 4
• Failing to recognize that symptoms like burning and tightness may indicate progression of venous disease 1
• Overlooking the potential for more serious complications such as superficial thrombophlebitis, venous ulceration, or lipodermatosclerosis 1