Stained, sore spot a year after sclerotherapy.

Question

A year ago I received sclerotherapy on my ankle. The results were bad: an ulcer that lasted 3 months and brown spots. An inch from the injection site I developed a small area that looks and feels like a permanent bruise - light brown color and always tender to the touch. I have been to two doctors and neither know what this is. I am worried this is a blood clot or venous stasis caused by the injections. The attached photo shows 1: the ulcer scar, 2: the painful permanently bruised spot.

Jason Emer, MD · Answer

It looks like it could be Hemosiderin staining. This type of "staining " is caused after bruising and is not uncommon with sclerotherapy. It can be treated with fraxel lasers and lightening creams. I suggest a formal consultation with an expert. Best, Dr. Emer

John Landi, MD · Answer

The scar from the ulcer may lighten with time.  The other are looks like staining.  It would be wise to do a venous ultrasound to look for any signs of venous reflux which, if present and treated, may improve the discoloration.  Also topical treatment with Dermaka cream may help as well as licorice extract.

Hratch Karamanoukian, MD, FACS · Answer

The area with a rim of hyperpigmenttaion and inner core of hypopigmenttion is worrisome as it implies that you may have developed skin necrosis after sclerotherapy. For the hyperpigmentation, consider this:Make sure you use the following topicals to reduce likelihood of hyperpigmentation of the overlying skin. 
You need to use some adjunctive measures after sclerotherapy to reduce post inflammatory hyperpigmentation. it is those that don't follow such instructions immediately following sclerotherapy, starting on day1 (next day) that seem to get retained hyperpigmentation. I recommend 2 creams: Scleroquin plus and Sclerovase and also Scler-X supplement to reduce post inflammatory hyperpigmentation (see link below) as well as compression stockings for at least 2 weeks.
H Karamanoukian MD FCS
certified vein specialist from ABVLM and double board certified surgeon

Georgios Ziakas, MD, FACS · Answer

Scarring, chronic pain and hyperpigmentation are well known risks of sclerotherapy treatment but they occur infrequently. Scarring may improve over time and silicone gel sheathing may help for hypertrophic scars. Hyperpigmentation can be addressed with local hydroquinone (bleaching agent) or laser (both these approaches have their risks and benefits). Rarely a superficial localized clot may occur which may need drainage if it does not dissolve over time. Recommend follow up with your doctor that administered the initial treatment for further evaluation and treatment.

Stained, sore spot a year after sclerotherapy.

Answers (4)