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Hyperpigmentation in CVI

Hyperpigmentation is darken patches than the surrounding skin or nail colour initiated by sun burn, inflammation and skin injury by increased melanin. Whereas hyperpigmentation, involving increase melanin (skin colouring agent) as well as deposition of Hemosiderin (iron-storage complex) probable cause for skin change phases due to CVI and if left untreated or progression leads to skin damage towards lipodermatosclerosis and ulceration.

Varicose veins, skin discoloration occurs during the more advanced stages of venous reflux. The initial redness is from inflammation. As blood continues to pool under the skin, the breakdown of red blood cells causes the skin damage to advance and take on a tan or reddish-brown appearance.

 

  • Causes
  • Symptoms
  • Diagnosis
  • Contemporary treatments
  • Our treatments

Causes: Though associated with number of diseases or conditions but initiation can be well understood by proper diagnosis   

Symptoms:

  • Effected site :
    • Frequent discolouration over the shins and on the feet
    • Mostly begin from ankle, shin and feet
  • Nature of discolouration
    • Usually gradual on set of reddish to reddish brown colour and skin become harder, pain full and appears like scar but some time it can also occur suddenly and without warning
    • It can range from mild dyschromia to extensive area of severe skin darkening
  • Irritated and inflamed skin
  • Itching
  • Very painful skin can occur
  • Dryness or Oozing fluid
  • Scaling / Crusting / Scabbing
  • Open sores

Diagnosis:

  • Detailed history
  • Physical examination
  • Vascular or duplex ultrasound tests

Contemporary Treatment:

  • Minor procedures or surgery :
    • Sclerotherapy:
      • Indicated in spider veins, reticular veins but it can also be done in larger veins
      • Minor procedure of injecting a solution or foam to shrink (fibrous to make it scar) to permanently close the veins.
      • It might require multiple sittings
      • Some cases bruising and swelling might appear at site of injection
    • Vein ablation:
      • Indicated for larger veins
      • Lasers or Radio waves are used to close or seal down the vein
      • Not guaranteed procedure but most of case it is beneficial
      • There is risk of localised numbing or burning sensation or little pain after procedure
    • Vein stripping and ligation: Complete removal of superficial vein and tying ( ligate) at before the joining junction to deeper veins   
    • Venous bypassing to allow blood flow though new path
  • Later stage ulcer management and skin grafting are done

Our Treatments:

As this hyperpigmentation is caused secondary to CVI, it will not be resolved until or even it takes little more time after resolving CVI hence treatments are aimed to counteract the primary cause;

  1. Short term goals to pacify symptoms like dryness, Itching, Oozing, Pain, Irritated and inflamed skin;
    1. Dhara : Process of pouring medicated liquid with specific temperature for specified duration are done either as per the requirement or sequentially
      1. ksahaya dhara; Herbal decoction
      2. Taila dhara: medicated oil
  • Ksheera dhara: medicated milk
  1. Leach therapy (Jalaukaavacharana): Nontoxic leeches are used to suck the blood from the affected area which is pain less procedure and specially indicated in people sensitive to pain like Children, Elderly, Females.

Along with removing stagnated blood it release as chemical known as Hirudin to our body. It is a powerful anticoagulant which is only found in salivary glands of leech does blood thinning, avoid or dissolve the blood clots.

 

 

  1. Long terms goals to resolve;

 

  1. Venous stasis (Anything obstructing or slowing flow of venous blood)
  2. Vein damage (Intrinsic or extrinsic)
  3. Regulating blood coagulation (Biochemical imbalance between circulating factors)

 

  1. Bloodletting therapy: To reduce venous stasis and deactivate blood coagulation

 

  1. Leach therapy (Jalaukaavacharana): Nontoxic leeches are used to suck the blood from the affected area which is pain less procedure and specially indicated in people sensitive to pain like Children, Elderly, Females
    1. Along with removing stagnated blood it release as chemical known as Hirudin to our body. It is a powerful anticoagulant which is only found in salivary glands of leech does blood thinning, avoid or dissolve the blood clots.
  2. Venipuncture (Siravyadha): About 100 to 300 ml of blood is removed at once, just like how blood is drawn during blood test or donating blood
    1. Physiological blood thinner; physiologically, sudden blood volume loss is compensated by draining body fluids into blood to avoid hypovolemic shock, which is a natural blood thinner and reduces blood viscosity being diluted by body fluids to improve circulation through maintained blood volume

 

  • Internal medication: Specially formulated Dr. Ural’s syrup and tablets are having multidimensional effects in eradicating the cause from root levels,
    • By purifier and thinning blood, helps to mobilise stagnated blood in veins towards heart as well as enhance optimal function by stimulating collateral circulation
    • By enhancing liver function it optimise quality of blood production and removal of toxins due to stasis
    • In Ayurveda blood vessels are originated from blood tissues (UpaDhatu of Rakta). Structural and functional rectification of veins are facilitated by optimized functions of blood.
    • Ayurveda concept of tissue (Dhatu) nourishment, Mamsa (Muscle tissue) is successive Dhatu nourished after Rakta, once the formation Rakta is optimum thus naturally it nourish Mamsa to regain its strength and stability in veins i.e., tunica media (muscular) layer of vein and elastic valves regain their strength enabling the function of valves and vein.
  • Oil application: Specially formulated Dr. Ural’s oil is advised to apply very gently (very less pressure) towards heart direction (upwards) for 15 mints / day and leave it for minimum 3 hours
    • Helps to improve circulation
    • Improve elasticity of veins
    • Strengthen the vein, valves of vein and skin surface
    • Reduce strain and heaviness of muscles
  • For prevention and to accelerate healing Diet, lifestyle, Yogasana and Pranayama are advised as per the individual need depending on their Prakruthi, Occupation, Age, severity of varicose vein and associated comorbidities.