Online Vein Self-Assessment


C4: Venous Insufficiency

C4a,b – includes pigmentation (darkening) of the skin, eczema (redness, itching), lipodermatosclerosis (hardening of the soft tissues), and atrophie blanche (a whitish skin area)

C4 includes pigmentation (darkening) of the skin, eczema (redness, itching), lipodermatosclerosis (hardening of the soft tissues), and atrophie blanche (a whitish skin area; skin changes without ulceration

C4a:  eczema:  Erythematous dermatitis, which may progress to blistering, weeping, or scaling eruption of the skin of leg.  Most often located near varicose veins, but may be located anywhere in the leg.

C4a:  pigmentation:   brownish darkening of the skin, resulting from extravasated blood.  Usually occurs in ankle region but may extend to leg and foot

C4b:  atrophie blanche (white atrophy) Localized, often circular whitish and atrophic skin areas surrounded by dilated capillaries and sometimes hyperpigmentation.

C4b:  lipodermatosclerosis:  Localized chronic inflammation and fibrosis of skin and subcutaneous tissues of lower leg 

Most people recognize varicose veins or spider veins, but do not associate advancing vein conditions with those depicted in these photos.

Skin changes are an external sign of an underlying vein problem known as venous insufficiency, or impaired venous circulation.  Venous insufficiency is more likely to be present in patients who have vein-related symptoms such as chronic pain and discomfort, leg heaviness, leg swelling, or leg cramping.

  • As veins begin the process of becoming abnormal, the vein walls begin to weaken and stretch out.
  • What causes this vein wall weakening to occur?  Recent research shows that it is a complicated process involving inflammation in the body that results in damage to the vein wall.   At this point, we don’t understand what triggers the inflammation, or how to prevent it.
  • As the vein stretches and becomes wider, the vein walls pull apart the one-way valves, allowing gravity to take over and pull extra blood down toward our feet (reflux).
  • Once they’ve become stretched, these veins hold more blood and do not drain effectively.  The venous circulation is overloaded and creates pressure.   The venous pressure in turn can allow blood to seep into the soft tissues, such as these examples.
  • At times, particularly if the area of the leg with a varicose vein is hit by something, or after a long car or plane ride or a period of bed rest, a clot can develop in an abnormal skin vein.  This is called superficial thrombophlebitis. The vein can become hard, red, and tender.
  • Superficial thrombophlebitis can be a serious and potentially life-threatening condition, if your varicose vein becomes red, warm and tender, you should seek medical attention.

Finding the Right Doctor

A crucial step in obtaining the best treatment and results is finding the right doctor. The American College of Phlebology (ACP) is the premier association for vein care specialists in the United States. With more than 2,000 physicians and allied health care professionals in the network, finding a doctor in your area has never been easier. Click the link below to visit the ACP’s find a physician page and locate a doctor near you.

Find a Physician

More Information:

Symptoms Detection Treatment  Risk Factors


Symptoms commonly described by patients suffering from venous disease include:

  • visual abnormalities
  • leg discomfort
  • pain
  • aching
  • throbbing

  • burning
  • heaviness
  • fatigue
  • swelling
  • intense itching

If you experience leg symptoms, seeking professional advice is suggested.


Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive diagnostic “duplex” ultrasound is often used.  Duplex ultrasound can accurate detect venous blood clots and abnormal blood flow.


  • Individuals with skin changes may benefit from resolution of the cause.  A comprehensive consultation begins with a vein specialist.
  • Symptoms are often eliminated or greatly improved with treatment.
  • Conservative treatment such as wearing compression stockings may alleviate or reduce symptoms.
  • Regular exercise, such as walking or swimming, is recommended.
  • Scientific studies have shown that plant-based bioflavenoid supplements have anti-inflammatory properties and can have beneficial effects on vein disorders as well.
  • Natural supplements can be an important addition to your vein treatment.  Some supplements have been found effective to reduce aching, heaviness, and swelling in the legs.
  • When patients seek medical attention, a diagnostic test might be useful in determining the exact cause of the problem.
  • Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem.
  • In addition to a physical examination, non-invasive diagnostic “duplex” ultrasound is often used.  Duplex ultrasound can accurately detect venous blood clots and abnormal blood flow and can often discover the root cause
  • Ultrasound often finds that the root cause of the skin changes which actually lies deeper in the leg and is not visible by looking at the leg.
  • Elimination of the cause of skin changes may include a combination of treatment options, depending on the diagnosis.
  • Patients often require diagnostic ultrasound examinations of the leg.

Risk Factors

There are a number of reasons why vein disease occurs.  Physicians refer to these causes as risk factors.   As people age, vein issues become more common. Small problems that started earlier often progress into larger ones

Other risk factors include:

Family History  Trauma  Medications  Pregnancy  Occupation  Other

Family History

  • If you have immediate family members who have varicose veins, chances are that you may develop them as well.  Vein disorders are hereditary.
  • Inherited factors related to blood clots or clotting disorders are also important, as you could also have inherited the same clotting disorder.

Trauma or Injury

  • Soft tissue injuries can often result in the onset of swelling due to damage of the venous or lymphatic drainage.
  • This can happen as a result of an impact injury, such as getting hit with a ball or another hard object.   Trauma can subsequently lead to thrombosis.  Varicose veins in that area of your leg may appear.
  • The damaged veins may not be evident for some time.
  • Post-surgical patients carry risks for blood clots, often due to inactivity or immobility.
  • Skin changes may be due to chronic fluid or swelling in the damaged area.


  • Female hormones such as estrogen and progesterone can cause spider veins to form.
  • The most common medications to do this include oral contraceptives (birth control pills), hormone replacement therapy, and infertility drugs.


  • Progesterone levels remain very high during pregnancy.
  • Progesterone relaxes the muscle in the vein walls, allowing them to stretch.
  • Many women notice large numbers of new veins during their pregnancy for this reason.
  • The physiologic changes that a woman undergoes during pregnancy place her at risk for the development of spider and varicose veins


  • If you have skin changes, you may notice that they worsen while standing.
  • Sitting for long periods of time will increase venous pressure, and thus leg changes will be more apparent.
  • Teachers, nurses, flight attendants, hairstylists, sales clerks, etc., are very prone to developing vein problems.
  • An underlying venous problem likely is present when chronic skin changes are evident.

Other Medical History

  • The presence of skin changes, such as the changes depicted in photos above, suggests a severe form of venous problems.   Other concomitant diseases, including heart disease, kidney disease, venous obstruction, or other medical problems may be associated with lower extremity skin changes.
  • People often assume that weight is a risk factor in venous disease. While many patients find that they feel better when they maintain a healthy weight, the actual influence of weight on the development of varicose veins is not clearly known.
  • A risk factor likely exists in patients who are grossly overweight.
  • Gait:  how we walk is critical to movement of the blood.  It is important to have the blood pumped through the veins by activating our calf muscles.  This can be facilitated by fully flexing the ankle, known as dorsiflexion.
  • Blood clots:   often familial but a very important risk factor for venous disease.