Varicose veins

Also called Venous insufficiency, Venous eczema

Not just cosmetic. Untreated venous disease is the commonest cause of leg ulcers in the UK.

What it is

Varicose veins affect around a third of adults. Valves in the leg veins fail, blood pools, and pressure builds in the skin.

They are routinely dismissed as cosmetic, and for many people they are. But chronic venous insufficiency, the pressure that follows, is the commonest cause of leg ulceration in this country, and those ulcers take months to heal and recur for years.

The progression is predictable: veins, then swelling, then skin changes, then ulceration. Treating it earlier in that sequence prevents the end of it.

NICE recommends referral for assessment where there are symptoms, skin changes, or a healed or active ulcer. Being told it is cosmetic when the skin has already changed is not consistent with the guidance.

Signs you might notice

Visible bulging veins, aching, heaviness, and swelling worse at the end of the day.

Itching over a vein. Cramps at night.

Skin changes: brown staining around the ankle, hardened tissue, and venous eczema, which is dry, itchy and often mistaken for cellulitis because both legs look red.

An ulcer, typically just above the ankle bone on the inner side.

Bleeding from a varicose vein, which can be surprisingly heavy and needs pressure and elevation immediately.

How it can affect day-to-day life

The commonest error in leg ulcer management is compression not being used, because nobody has done the ankle brachial pressure index to check the arteries are adequate. See wound care.

Venous eczema gets treated with repeated antibiotics as if it were infection. Both legs red is very rarely cellulitis; it is usually venous.

Ulcers, once established, dominate a life: dressings twice a week, leakage, smell, and reduced mobility.

Supporting someone well

Take skin changes seriously as a signal to seek treatment, not as an inevitability.

Wear the compression stockings, correctly fitted and put on before getting up.

Move the ankle. Calf muscle pumping is what drives blood back, so walking and ankle exercises are treatment.

Elevate legs above hip level when resting.

Moisturise daily; venous eczema responds to emollient and, when inflamed, to a short course of topical steroid, not to antibiotics.

Ask for referral for vein treatment where there are symptoms or skin changes. Modern treatments are done under local anaesthetic as day cases.

For bleeding, lie down, elevate the leg high, and press firmly. It stops with pressure and gravity.

Where to get help

A GP can assess and refer to a vascular service.

Legs Matter campaign on exactly this and their material is useful to take to an appointment.

An ulcer that has not healed in two weeks needs proper assessment including an ABPI.