Lymphology Association of North America (LANA) Practice Exam

In patients with advanced venous insufficiency, what skin condition is likely to develop?

1. Hemosiderin staining

2. Thickened toenails

3. Acrocyanosis

4. Rubor

The correct answer is: Hemosiderin staining

Hemosiderin staining is a common condition that arises in the context of advanced venous insufficiency. This occurs due to chronic venous hypertension, which leads to the leakage of red blood cells from the capillaries into the surrounding tissue. When these red blood cells break down, they release hemoglobin, which is further metabolized to hemosiderin, a brownish pigment. This accumulation of hemosiderin in the skin is what creates the characteristic discoloration, often seen as a brownish or reddish discoloration on the lower legs, particularly around the ankles. In contrast, thickened toenails can result from various factors, including fungal infections or injury, but are not specifically linked to venous insufficiency. Acrocyanosis is related to peripheral circulation issues that generally manifest as a bluish discoloration of the extremities, often not associated with the specific chronic venous changes found in advanced venous insufficiency. Rubor, or redness of the skin, can occur in several conditions, including inflammation or infection, but it does not specifically indicate hemosiderin deposition or the chronic changes associated with advanced venous insufficiency. Thus, hemosiderin staining is the most relevant skin condition associated with this particular issue, reflecting the underlying pathology