Skin Deep

Dermatitis, ulcers advanced signs of vein disease.

Originally from Texas, Allison Ferguson, 42, grew up in the Houston area but relocated to Florida in June 2017. Her life is now devoted to her dual careers as the mother of an 11-year-old son and 13-year-old daughter and as a computer professional.

Photo by Jordan Pysz.

Allison Ferguson

“I work in the IT area at the corporate headquarters for Chico’s clothing stores, White House Black Market clothing stores and Sonoma stores.” Allison elaborates. “It’s also the headquarters for another brand called TellTale.”

Living in Florida, Allison likes to spend her free time at the beach with her family and friends. She loves to swim, walk and enjoys other outdoor activities, but early last year, a strange rash appeared on her leg that made her favorite pastimes less enjoyable.

“In February 2018, I noticed these red dots on the ankle of my right leg,” Allison relates. “They bothered me, but I didn’t think that much about them at first. They just came and went, and I let it go.

“My leg was extremely itchy, so it felt good to scratch it. But the more I scratched, the more red and inflamed it got, and it became a situation. At Chico’s, we have a health clinic on campus, so I went there. The nurse gave me a steroid cream to put on my leg, but the rash didn’t get better.

Then the nurse suggested I see a dermatologist.”

The dermatologist diagnosed Allison’s condition as eczema and prescribed a medicated cream, but the condition of Allison’s leg got worse instead of better. Her leg started swelling, and she broke out in hives. The redness, inflammation and itching became more intense as well.

“The itching was terrible,” Allison shares. “It was like poison ivy. It was truly consuming. And the rash was getting redder with bleeding and scabbing, so I worried about it getting infected. In May, the dermatologist tested me for skin mites and shingles, but the results came back negative.”

When nothing the dermatologist suggested helped, the doctor recommended Allison visit a rheumatologist to determine if an autoimmune disease was the cause of her symptoms. The rheumatologist couldn’t find a link, but wanted her to see a specialist at The Mayo Clinic in Jacksonville. That was a long drive from Allison’s Fort Myers home.

“Before I did that, I thought, Let me try an allergist,” Allison recalls. “I had allergies and took allergy shots in the past. But as soon as I walked in, the allergist said, This is not an allergy issue. You need to go to the University of Miami Center for Dermatology. I figured that was closer than The Mayo Clinic in Jacksonville.”

“I would definitely have the ClosureFAST endovenous ablation procedure again if I had to. And I’d definitely recommend getting that treatment from Dr. Magnant at Vein Specialists.” -Allison

Doctors in Miami ran a slew of tests and told Allison her problem was with her leg veins. That’s when she found Joseph G. Magnant, MD, of Vein Specialists in Fort Myers and Bonita Springs. Dr. Magnant, a board-certified vascular surgeon, is dedicated to the comprehensive, modern evaluation and most-advanced minimally invasive treatment of vein disorders.

Dr. Magnant explained that Allison’s problem was venous insufficiency, a disease that occurs when the valves in the leg veins that keep blood flowing toward the heart begin to fail.

As a result of the failure, blood leaks backward, or refluxes, and pools in the legs and ankles. This pooling leads to signs and symptoms such as varicose veins, swelling, heaviness, itchiness and inflammation of the skin of the legs, and venous ulceration.

“Allison was an atypical venous insufficiency patient because she simply had a rash and itching with no noticeable varicose veins,” Dr. Magnant describes. “The doctor she saw in Miami performed a biopsy that came back positive for stasis dermatitis, or inflamed skin.”

Stages of Development of Varicose VeinsStasis dermatitis is serious, but it is among the less common signs of venous insufficiency. Unfortunately, some physicians fail to attribute it to venous disease and treat it as a “skin” condition rather than consider a venous origin. That’s what happened to Allison.

“When the diagnosis of stasis dermatitis due to venous insufficiency was made, Allison was already eight months into her ordeal,” Dr. Magnant relates. “By that time, she felt like she had been bounced around, been prescribed a variety of different medications, and not found anyone who could really help her until she made it to Vein Specialists. We were able to to establish the underlying cause of her skin problem.”

That help began with an ultrasound examination to determine the presence of leaking vein valves, the exact veins affected and the severity of the valve leakiness causing Allison’s signs and symptoms. The results brought the issue into focus and led to a recommendation for a solution to the problem.

“When Dr. Magnant gave me the results, he showed me pictures of the veins in both legs that weren’t working properly and said he could fix them with a procedure called endovenous ablation,” Allison states.

Endovenous closure is a method of sealing leaking leg veins by using heat(thermal) or medical adhesive. During endovenous thermal closure, Dr. Magnant inserts a small intravenous needle into the abnormal vein through which the heating catheter (radiofrequency or LASER) is inserted and advanced into the vein. Liquid is injected around the vein to collapse it around the catheter and to absorb the heat from the vein wall during the heating process.

There is also local anesthetic in the liquid that prevents the patient from feeling pain. The vein is then heated with either radiofrequency or LASER energy, and it shrinks into scar tissue.

“I had the ClosureFAST™ [radiofrequency] procedure done on my right leg on April 7, 2019,” Allison reports. “It was pretty effortless and painless. It was performed right in the office with a little numbing medicine, and I was able to drive home afterward. It was very convenient; it only took about an hour. Two weeks later, I had the procedure done on my left leg.”

Old Man Legs

Eighteen years ago, North Carolina native Josh Bolton, 35, was in an ATV accident that resulted in multiple injuries to his body, including injuries to his legs. Josh, now a physician assistant in the emergency department of a local hospital, continued to suffer from the consequences of that accident 18 years after it occurred.

Photo courtesy of Josh Bolton.

Josh Bolton

“The injuries led to blood clots in my legs, which then resulted in venous disease,” Josh shares. “Because of that, my legs were always swelling, and I experienced an aching and a heaviness in them. They always felt tired and painful, and they were horribly discolored. They would turn purple and blue and all different colors.

“I also had venous ulcers on the inside of my ankle on both legs. As a PA, I knew the problem was venous disease because venous ulcers are an advanced skin complication of venous insufficiency.”

Like Allison, Josh visited a number of physicians looking for answers to his uncomfortable symptoms, but none were truly able to help him.

“I saw numerous doctors back home in North Carolina, in Virginia and also here in Florida,” Josh confirms. “They ranged from dermatologists to wound care specialists and a few vascular surgeons.

“The vascular surgeons always referred me to the wound care doctors, who would debride my ulcers, apply different prescription creams and wrap my legs in compression bandages. That was my life.

“All the doctors I saw essentially treated my wounds and did everything locally, but never addressed the underlying venous disease. I always questioned that, but they just talked around the issue.”

Though slowed by the symptoms associated with his venous disease, Josh refused to let those symptoms stop him. He continued to participate in his favorite activities, including exercising, fishing and paddle boarding.

“I still did everything I love to do; I just did it in a lot of pain,” Josh describes. “It was pretty uncomfortable, especially in the Florida heat, to go out with heavy dressings on my legs and try to enjoy being outside. That was difficult.”

Josh put up with the discomfort until this past December, when he visited another dermatologist in Fort Myers. This doctor told him about Dr. Magnant. Soon thereafter, Josh’s situation began to improve.

“Literally within three days of the first treatment, my wound was starting to close up and new tissue was growing around it.” -Josh

“Josh is a weightlifter, so when I met him, he was fit as a fiddle,” Dr. Magnant remembers. “From his knees up, he looked great. But from his knees down, he looked like an old man. He came to me with chronic venous ulcers on both legs.

“On one leg, the ulcer was so deep, I could put the tip of my finger inside about halfway up to my knuckle. On the other leg, he had diffuse, spotty wounds on the leg and ankle. His legs were also swollen, heavy and purple.”

As he did with Allison, Dr. Magnant immediately ordered an ultrasound to evaluate the blood flow in Josh’s legs. The ultrasound revealed the underlying problem, which was venous insufficiency. After seeing the results, Dr. Magnant discussed a variety of treatment options with Josh.

Photo by Jordan Pysz.

Allison says her legs are “healing well” following her ClosureFAST treatment

“He ultimately recommended an endovenous radiofrequency ablation, which essentially heat seals the problem veins and doesn’t allow any more reflux of blood, which improves the ulcers on my legs,” Josh reports.

“I was able to watch Dr. Magnant perform the ablation on an ultrasound screen,” Josh recalls. “I was awake the whole time, and there was no pain associated with the procedure, so I have no complaints about the procedure at all.”

Unseen Symptom

Allison and Josh are young, healthy, active adults, but both suffered with chronic venous insufficiency. Their cases make it clear that venous insufficiency is not a disease that only affects older adults.

Though it is more common among older adults, venous insufficiency is a common disorder that affects more than 50 million Americans and is five times as prevalent as peripheral arterial disease (PAD) and twice as prevalent as coronary artery disease.

Neither Allison nor Josh had the most obvious signs of venous insufficiency, which are varicose veins. They did, however, have the more subtle, yet more advanced skin-related signs of stasis dermatitis and ulcers.

“Patients can have stasis dermatitis that doesn’t show through the skin,” Dr. Magnant stresses. “In those cases, the patient’s legs may get very itchy as their day wears on. The itch occurs primarily in the lower half of the calves. Patients expect to see something there when they look down, such as red spots or a red area, but those signs may not be present.

“Even in the absence of that physical sign of inflammation, the patient may still have stasis dermatitis because that’s how it starts. Allison’s stasis dermatitis essentially began with intense itching on her leg that became a full-blown rash after she scratched it.”

Dr. Magnant notes that venous ulcers are not uncommon in young people like Josh. In fact, most leg ulcers in the younger population are related to vein causes. When an ulcer is identified, the initial step is to investigate the patient’s vascular supply to ensure there’s adequate arterial blood flow and venous return in the area.

“That’s why my advice to patients with leg wounds is to have an early vascular evaluation at an accredited vein center,” Dr. Magnant asserts. “This evaluation can rule out any underlying venous or arterial pathology.

“Patients will really benefit from a thorough vascular evaluation, including a pulse check and a special Doppler ultrasound, because that evaluation will often disclose the underlying problem.

“In Josh’s case, it was great saphenous vein insufficiency. He then had the endovenous ablation, and his wounds started closing almost immediately.”

Closed and Cleared

The endovenous radiofrequency ablation on Josh’s left leg was done in March, and the procedure on his right leg was performed in April. Josh is amazed by the success of the procedures.

“Literally within three days of the first treatment, my wound was starting to close up and new tissue was growing around it,” Josh recalls. “Now, the ulcer on my left leg is completely closed.

“There’s no ulceration there at all anymore. There’s tissue growing, and the skin is healing very well. I’m getting a normal skin color back to my ankle, which I haven’t seen in years. The ulcer on my right leg is closing up as well, and the color is starting to return.

“My swelling has decreased tremendously. Before, when I worked in the ER, my feet would be swollen within two hours. Now, even after ten to twelve hours, my feet are barely swollen. It’s like I only worked for an hour. And I don’t feel any pain at all. It’s great.”

Allison is also quite pleased with the outcome of her ClosureFAST procedures.

“The dermatitis is not one hundred percent cleared yet, but it’s probably eighty percent cleared, so it’s healing well,” she states. “Dr. Magnant says it takes time for the blood that is stored in my legs to work its way out and for the skin to heal, but the treatment is definitely working.

“My skin hardly itches anymore, so I would definitely have the ClosureFAST endovenous ablation procedure again if I had to. And I’d definitely recommend getting that treatment from Dr. Magnant at Vein Specialists. In fact, I’ve already recommended them.

“A colleague at work told me her mom has the same issue as me and has been to a dermatologist, but they couldn’t find out what’s wrong. I told her about my procedure and said she should go to Dr. Magnant. I absolutely recommend him.”

So does Josh, who dealt with the ulcers on his legs for 18 years before he saw Dr. Magnant and found some relief.

“I recommend Dr. Magnant because he’s a great guy and because the results of his treatment far exceeded my expectations,” Josh says. “I’ve shown my legs to multiple doctors and PAs who saw my legs before, and they’re all astonished by how great they look now.

“My case proves how important it is to pay attention to the underlying problems behind the ulcers. That way, people can actually start being comfortable again and stop being in pain like I was.”

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    • Vein Specialists

      Vein Specialists is 100 percent dedicated to identifying and treating vein disorders. Led by Dr. Joseph G. Magnant, they understand that the venous system varies between patients and consists of both deep and superficial venous systems and a net... Read More

    • Joseph G. Magnant, MD, FACS, RPVI

      Joseph G. Magnant, MD, FACS, RPVI, is a Fellow of the American College of Surgeons and is board certified by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a g... Read More