Have you noticed people sunbathing at the beach? They often try to get smooth, shiny, tanned legs. However, if your skin appears shiny, hairless, and changes color without explanation, it’s worth consulting a doctor—these could be signs of peripheral artery disease.
Peripheral artery disease (PAD) is precisely what it sounds like, a disease affecting the peripheral arteries. Arteries carry oxygenated blood from the heart all over the body, and the “peripheral arteries” are those outside of the heart and brain. The exact criteria for what causes this low blood flow isn’t always well-defined, which makes statistics a little iffy, but around 6-7% of people in America have PAD [1, 2]. This number is higher in African Americans than in other groups, and the risk increases with age [2].
Peripheral Artery Disease (PAD) most frequently damages the arteries responsible for supplying oxygen to the legs, which is why symptoms typically manifest in the legs before affecting other areas of the body.
Symptoms include:
- Intermittent claudication (claudication from the Latin word for “to limp”): calf cramping pain during exercise
- Leg pain at rest
- Weak or tired legs making it difficult to perform daily activities
- Skin changes: shiny, hairless, blue-tinged, cracked, cold, with nail changes and wounds
- Slow-to-heal wounds or ulcers on legs or feet which can be prone to infection
- An inability to exercise, which exacerbates problems by further decreasing blood flow and weakening muscles
These sound painful and aggravating, and if left untreated PAD can have serious consequences. Low blood flow to the limbs can result in the need for amputation. On top of this, PAD is indicative of bigger problems with the cardiovascular system and may present a higher risk for heart attack, stroke, and death. All these complications can make sunbathing less enjoyable.
With PAD, low blood flow typically occurs in medium or large vessels. The walls of these vessels may narrow from plaques in a process called atherosclerosis, or they may become blocked by a blood clot called thrombosis. There are a few other potential limiters of blood flow, though the strictest definition of PAD is from atherosclerosis alone. In response to low blood flow to the area, the body tries to compensate by growing new arteries and changing muscle composition, especially in the calves. When the body can’t effectively compensate, muscles are reduced, fat increases, and the small blood vessels stop working properly. This can lead to an accumulation of fats, limited waste clearance, and inflammation. Altogether, fats in the skin can leave it shiny, low blood supply can change the color, and reduced oxygen in hair follicles can cause them to function improperly or die, leaving the skin smooth and hairless [3].
- Age
- Smoking
- Diabetes
- History (or family history) of cardiovascular disease
- High hs-CRP (an inflammatory biomarker)
Conditions that may indicate risk: [4, 1]
- Kidney disease
- High cholesterol
- High blood pressure
So what can be done? The first step is diagnosis. The classical symptom of calf cramping pain (intermittent claudication) isn’t present in a majority of PAD patients [1]. Those at higher risk (such as smokers with type 2 diabetes) may want to take an ankle-brachial index (ABI), which is a quick, non-invasive test comparing the blood pressure in the upper arms to the blood pressure in the ankles. If a healthcare provider diagnoses PAD, they can offer several possible solutions. Treatments that help lower the risk of major cardiovascular problems are critical. A doctor may prescribe aspirin or other medications that lower the chance of blood clots, or statins that lower the circulating fats in the blood [5]. Smokers may be encouraged to quit or be prescribed the use of smoking cessation tools. Other medications may be prescribed to target associated conditions like high blood pressure or diabetes, further reducing risk to the cardiovascular system.
Several treatments target PAD specifically, including exercise. Supervised, structured exercise – including treadmill and resistance training, may help reduce pain and increase leg function. It may be as simple as walking on the beach instead of lying in the sunchair to get that tan. Special medications like cilostazol target arterial muscles. Advanced cases of PAD may require revascularization, where the arteries are cleared using surgery or other means. Proper footwear may also help, and clinical trials continue to search for new treatments for PAD. These may include therapies that target cells or genes and new ways to revascularize peripheral arteries without surgery. So the next time your legs look like a sunbather’s dream (but your arms don’t), consider checking with your doctor and local clinical research center to look for care options.
Staff Writer / Editor Benton Lowey-Ball, BS, BFA
References:
[1] Golledge, J. (2022). Update on the pathophysiology and medical treatment of peripheral artery disease. Nature reviews cardiology, 19(7), 456-474. https://www.nature.com/articles/s41569-021-00663-9
[2] Allison, M. A., Ho, E., Denenberg, J. O., Langer, R. D., Newman, A. B., Fabsitz, R. R., & Criqui, M. H. (2007). Ethnic-specific prevalence of peripheral arterial disease in the United States. American journal of preventive medicine, 32(4), 328-333. https://www.sciencedirect.com/science/article/pii/S0749379706005587
[3] Dean, S. M. (2018). Cutaneous manifestations of chronic vascular disease. Progress in Cardiovascular Diseases, 60(6), 567-579. https://www.sciencedirect.com/science/article/pii/S0033062018300549?via=ihub
[4] Fowkes, F. G. R., Aboyans, V., Fowkes, F. J., McDermott, M. M., Sampson, U. K., & Criqui, M. H. (2017). Peripheral artery disease: epidemiology and global perspectives. Nature Reviews Cardiology, 14(3), 156-170. https://www.nature.com/articles/nrcardio.2016.179
[5] Gerhard-Herman, M. D., Gornik, H. L., Barrett, C., Barshes, N. R., Corriere, M. A., Drachman, D. E., … & Walsh, M. E. (2017). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 135(12), e686-e725. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000470
Related Reading
Umuerri, E. M. (2019). Skin manifestations of peripheral artery disease: Prevalence and diagnostic utility. Journal of Clinical and Preventive Cardiology, 8(3), 121-125.
