Perceived Impact of Cutaneous Hyperpigmentation After Venous Procedures on Patient Self-Esteem: An Observational, Retrospective, Descriptive, Single-Center Case Series.

BACKGROUND AND

OBJECTIVE

Cutaneous hyperpigmentation following venous procedures is commonly regarded as an aesthetic complication of limited clinical relevance. Its effect on patients' self-esteem and aesthetic perception, however, remains underexplored in the medical literature. This study aimed to describe the perceived impact of hyperpigmentation on self-esteem among patients who developed cutaneous hyperpigmentation after venous procedures.

MATERIALS AND

METHODS

This was a retrospective, descriptive, single-center case series including a total of 91 consecutive patients with cutaneous hyperpigmentation following venous procedures who were treated between 2019 and 2025 at a specialized private vascular clinic. Data were extracted from a structured, non-validated questionnaire routinely applied in clinical practice, covering sociodemographic and clinical variables, aesthetic perception, and a self-reported rating of the perceived impact of hyperpigmentation on self-esteem (none, mild, moderate, or high). Variables were summarized using absolute and relative frequencies.

RESULTS

Of the 91 patients included in the study, most were female (n=85, 93.4%), aged 30-49 years (n=49, 53.8%), had completed higher or postgraduate education (n=71, 78.0%), and had Fitzpatrick skin phototype III or IV (n=81, 89.0%). All lesions were located on the lower limbs, most frequently on the lateral (n=29, 31.9%) and medial (n=18, 19.8%) thigh. Hyperpigmentation had been present for up to six months in 89 patients (97.8%) and most commonly followed foam sclerotherapy (n=44, 48.4%). Every participant reported some degree of impact on self-esteem, rated as moderate in 35 (38.5%) and high in 46 (50.5%). Clothing was intentionally used to conceal the affected area at least occasionally by 86 patients (94.5%) and frequently or always by 56 (61.5%). Among the 89 patients whose hyperpigmentation followed varicose vein treatment, 72 (80.9%) considered the hyperpigmentation aesthetically worse than the varicose veins themselves. Most patients (n=79, 86.8%) expected at least 75% lightening of the lesions with the current treatment.

CONCLUSIONS

In this case series, impaired self-esteem, concealment behaviors, a greater aesthetic burden attributed to hyperpigmentation than to the underlying venous disease, and high treatment expectations were consistently reported. Taken together, these findings highlight the relevance of residual hyperpigmentation to the patient's subjective experience and support the systematic use of patient-reported outcomes in the planning and evaluation of the outcomes of venous procedures. The findings should be interpreted in light of the retrospective design, single private-center setting, the characteristics of the sample, and the use of a questionnaire without psychometric validation.