Prolonged venous hypertension results in venous dilatation and passage of red blood cells through the endothelium into the interstitium with subsequent breakdown and conversion of hemoglobin to hemosiderin. Iron oxide remains as a brown pigment stain on the skin typically located on the lower medial third of the lower leg. The fact is that hemosiderin can be deposited anywhere there is significant venous hypertension. This is a photo of the left hand and arm of a man who developed a subclavian vein thrombosis with subsequent venous insufficiency of the left arm and a stasis ulcer of the fingers. It’s a good reminder that the issue is the venous hypertension—it’s not unique to the leg.
Caroline Fife, MD
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