Not a skin disease
Black discoloration of leg skin is a common problem. People in India, out of ignorance, think this is due to some skin disease and therefore go to a skin specialist for treatment. In reality, these black spots are caused by disease of veins called Chronic Venous Insufficiency (C.V.I.). Previously, ladies especially during pregnancy or after delivery would suffer from black spots on legs. But these days young males and females who spend long hours sitting in front of computers, or standing for long hours due to job compulsions, are falling victim to this disease at an alarming rate.
Lack of regular daily walk, leg exercise, and a sedentary lifestyle greatly contribute to the development of Chronic Venous Insufficiency. If the lower portion of your leg has black spots or discoloration, or if the colours of the skin of your ankle and leg is darker than the rest of your body skin, or if you develop swelling in the leg after walking, or if after a short walk you feel your legs are stretched-out and profoundly fatigued, then all these point not towards skin disease, as usually believed, but towards disease of the veins, or C.V.I.
Why do black spots appear on leg?
The majority of women above 30 years of age suffer from C.V.I. This disease in most of the ladies starts developing just after either pregnancy or delivery of the child. Physical exercises and regular daily walk have become non-existent in our modern day-to-day living. Young males and females working in call centers, at reception counters, stock exchange and offices of government and multinational companies are falling victim to this debilitating venous disease, as they are required to sit every day with legs hanging down in front of computers or stand continuously for a long period during their working hours.
The supply of oxygen to legs and feet is made possible by pure blood that flows through arteries. After giving away oxygen to the legs, the remaining deoxygenated impure blood has to go back to lungs through heart for purification or replenishment with oxygen. The channels that carry back impure oxygen-deficient blood from legs to lung are called veins. This explains that veins of legs form the drainage system of the leg. If the functioning of veins is upset by any reason, the drainage system of leg and foot becomes faulty. Because of this malfunctioning, the impure blood instead of going upwards towards the lung starts accumulating in the lower portion of the legs. This ultimately heralds the beginning of swelling and discoloration of leg skin. If timely intervention is not initiated under the guidance of a Cardiovascular or a Vascular Surgeon, the black patches which are small in size in the initial stage will enlarge and deepen and eventually will convert into a non-healing ulcer of leg.
One of the main reasons of development of C.V.I. is deep vein thrombosis in which blood flowing in the leg veins get clotted and thereby blocks the return flow of impure blood. These blood clots may or may not dissolve completely even after treatment. Even if blood clots dissolve completely, they may have already destroyed valves which are situated inside the veins. These venous valves control and maintain the unidirectional flow of blood. The destruction of valves of vein deranges the process of upward return of impure blood through veins. The muscular pump of the leg which helps in pushing the impure blood upwards also becomes weak due to lack of regular daily walk and leg exercise. In some patients, venous valves are either congenitally absent or under developed since birth. In such patients, the symptoms of C.V.I. appear from a very early age.
What do patients generally complain of?
The early complaints in a patient of C.V.I. are the appearance of swelling in the leg and feet by the evening, and disappearance of swelling in the morning when the patient gets up. As the disease progresses, patients of C.V.I. start complaining of mild pain, stretching and early fatigue in the legs. Later on appear black spots on the skin of legs and feet, which slowly keep on increasing in size and depth. As the days advance, the same very black spots give rise to eczema and ulcer.
Where to go if you have black spots on your leg?
Go to a hospital where a Vascular or Cardiovascular surgeon is there. It is essential to know the cause of these black spots on leg. For this, we need the help of investigations like Venous Doppler study, M.R. Venogram and sometimes angiography. Some special blood tests too are required to know whether mechanism of blood clotting is defective or not. Always make sure before entering a hospital where these modern investigatory facilities are available or not. A few years back in majority of the cases, medicines and special exercises were required to control the disease. But in modern era, specialized latest operations like Venous Valvuloplasty, Axillary Vein Transfer or Venous Bypasses are done to control the disease.
What to do if you have black spots on leg?
1. Avoid tight belt and clothing around your waist. Avoid tight panties.
2. Avoid high-heeled sandals. Low-heeled sandals keep muscular pump of your leg active and dynamic.
3. Avoid jogging, skipping & exercises which give constant jerks to your knees. Do normal stretching exercises.
4. Avoid postures which require prolonged standing or prolonged sitting with legs hanging. Have a break after one hour of continuous sitting or standing.
5. Avoid oily & cholesterol-rich food. Prefer foods having plenty of fibers with low calorie content, which will be helpful for veins.
6. Females should avoid contraceptives or other estrogen preparations because these medicines dilate the veins that will result into more accumulation of blood into the legs.
7. Do regular and daily morning walk for at least 5-6 km.
8. Always wear on your legs specialized graduated compression stockings. These specialized stockings increase the blood flow and decrease the swelling. They decrease the backpressure of blood in the leg caused by gravity. This halts the progression of C.V.I.
9. Any yogic exercise which gets your legs elevated for a few minutes will be helpful in controlling this disease.
10. While in bed during sleep, keep your legs elevated 10-12 inches above the chest level. This accelerates the returns of impure blood towards the heart.
—The writer is Senior Consultant Cardiothoracic & Vascular Surgeon, Indraprastha Apollo Hospitals, New Delhi. firstname.lastname@example.org