Hemosiderin staining refers to discoloration of the skin due to the buildup of hemosiderin beneath the skin. Hemosiderin is a protein compound that helps the body store iron.

When trauma or medical issues affect capillaries, blood cells break down and iron is released from hemoglobin in the blood forming hemosiderin. A rusty brown-yellow color (resulting from the presence of iron) becomes evident beneath the skin. This causes a bruise-like "stain" on the skin. Hemosiderin staining is most common in the lower legs, but it can develop anywhere.

Doctor talking to patient in doctor's office — FatCamera / Getty Images

Symptoms

The primary sign of hemosiderin staining is the change in skin pigmentation. The spots are most likely to be a golden-yellow-brown color. However, the skin may also appear brown or purple, depending on your skin tone.

Other symptoms that may occur with the discoloration include:

Itchiness
Swelling
Heaviness in the legs
Fragile skin that may split or fail to heal if damaged

The lower legs from the ankles to the knees is the most common area affected by hemosiderin staining. However, the discoloration can develop anywhere, including the face.

The staining itself often comes without pain. However, the causes of hemosiderin discoloration are often severe health disorders that can present with their own symptoms, complications, and issues.

Causes

Hemosiderin is often associated with blood vessel conditions that lead to an excessive breakdown of iron-containing cells. The most notable condition that causes hemosiderin staining is chronic venous insufficiency (CVI). CVI develops when blood flow is compromised due to ineffective blood valves in the legs.

The blood that is supposed to go up towards the heart flows backward into the veins in the legs, causing blood to pool. This leads to excessive blood cell breakdown and iron accumulation. The hemoglobin in the blood breaks down to form hemosiderin. This results in discolored patches of skin above your ankle.

Other Causes of Hemosiderin Staining

Other factors that may cause hemosiderin staining include connective tissue disease, high blood pressure, and other issues that interfere with vein health or put excess pressure on the leg veins.

Additional causes include:

Trauma: Injuries can damage the capillaries in some people.
Leg treatments: Procedures such as sclerotherapy and others that reduce the appearance of spider and varicose veins can cause hemosiderin buildup.
Diabetes: Poor circulation due to diabetes complications can lead to hemosiderin staining.
Superficial siderosis: A degenerative disorder, superficial siderosis affects the nervous system and stems from bleeding in the subarachnoid space in the brain.
Medications: Research has found that people undergoing iron infusion therapy to address deficiencies may also develop hemosiderin staining. The side-effect is rare and most notably affects people with severe iron deficiency anemia. Staining because of iron infusions typically occurs where the iron is injected into the bloodstream instead of on the bottom of the legs.

Can Iron Supplements Cause Hemosiderin?

There is no evidence to support hemosiderin discoloration caused by iron supplements, such as powder or capsules. However, if a person takes too much iron and has a condition that can cause blood pooling, they may be at risk of hemosiderin staining.

Treatment

Treatments for hemosiderin discoloration may first focus on the condition causing it. Since CVI can be severe, medical providers will likely address it before the stained patches. That said, there is treatment available for hemosiderin staining.

Research has shown that Q-Switched laser therapy is the best option for people with hemosiderin staining. It works by directing light energy straight into the skin. The light energy breaks down the pigmentation so the lymphatic system can filter it out of the body.

Hemosiderin staining caused by an injury will usually go away on its own as the tissue heals. Recovery can take weeks, months, or over a year depending on your health and the severity of the injury. The discoloration can be permanent in some instances.

Diagnosis

Medical providers will examine the area and take a medical history to diagnose hemosiderin straining. Symptom collection is also vital to determine a possible cause of the staining.

Since CVI is often associated with hyperpigmentation, tests to diagnose that condition will likely be done. The way medical providers diagnose the cause of the stain will heavily rely on how you feel otherwise in accompaniment to the stain. The test most used for CVI is known as a Duplex ultrasound. It measures the blood flow in the legs and can aid in diagnosing a cause of hemosiderin staining.

A Sign of the Need for Better Disease Management

In some people with hemosiderin discoloration, the presence of the patches may indicate that they need further testing for an existing health condition. The hyperpigmentation could be a sign that you need to find better ways to manage the disease or indicate that it could be worsening. In that case, tests will be specific to the health condition instead of hemosiderin staining.

When to See a Healthcare Provider

If you notice any skin discoloration changes and do not know why they are there, it’s essential to see your healthcare provider. While not all skin discoloration is dangerous, it can be associated with severe health disorders that require prompt treatment.

Summary

Hemosiderin staining can develop in brown or golden-brown-yellow patches on the skin. It is typically caused by disorders that affect blood flow, such as CVI. In some cases, it may develop in other areas of the body.

Trauma and treatment for varicose or spider veins can also induce pigment changes caused by a buildup of iron beneath the skin. If you notice hemosiderin staining, you should contact your medical provider. They will investigate the cause and enact proper treatment.

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Hamilton HK, Dover JS, Arndt KA. Successful treatment of disfiguring hemosiderin-containing hyperpigmentation with the Q-switched 650-nm wavelength laser. JAMA Dermatol. 2014 Nov;150(11):1221-2. doi:10.1001/jamadermatol.2014.1838
National Library of Medicine: MedlinePlus. Venous insufficiency.
Nickles M, Tsoukas M, Braniecki M, Altman I. Cutaneous hemosiderosis in chronic venous insufficiency: A review. Osteopathic Family Physician. 2022 May;14(3):22-26. doi:10.33181/13072
Johns Hopkins Medicine. Chronic venous insufficiency.
Center for Advanced Cardiac and Vascular Interventions. Treatment for Hemosiderin Staining.
UCLA Health. Hemosiderin staining product of trauma or venous insufficiency.
Hauzer W, Gnus J, Rosińczuk J. Endovenous laser therapy with echosclerotherapy as a hybrid method for chronic venous insufficiency: experience in 200 patients and literature review. Eur Rev Med Pharmacol Sci. 2021 Dec;25(24):7777-7786. doi:10.26355/eurrev_202112_27624
American Family Physician. Chronic Wounds: Evaluation and Management.
National Organization for Rare Diseases. Superficial siderosis.
Crowley CM, McMahon G, Desmond J, Imcha M. Skin staining following intravenous iron infusion. BMJ Case Rep. 2019 Jun 6;12(6):e229113. doi:10.1136/bcr-2018-229113
Gan SD, Orringer JS. Hemosiderin hyperpigmentation: Successful treatment with Q-switched 755-nm laser therapy. Dermatol Surg. 2015 Dec;41(12):1443-4. doi:10.1097/DSS.0000000000000513

By Angelica Bottaro
Bottaro has a Bachelor of Science in Psychology and an Advanced Diploma in Journalism. She is based in Canada.

See Our Editorial Process

Meet Our Medical Expert Board

Was this page helpful?

Thanks for your feedback!

What is your feedback?

Causes of Hemosiderin Staining: Hyperpigmentation of the Skin