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Q: During the winter months, my lower legs, ankles and feet get very dry and extremely itchy. I have tried just about every over-the-counter remedy, but nothing seems to work very well or very long. Do you have a suggestion of something I can use to alleviate this problem?

-- G.C., Greensburg, Pa.

A: The winter months are the time when everyone's skin tends to dry out. That's because the humidity of the air is lower, and it is made worse by heating systems that dry out the air inside a house even more.

But poor circulation is also a reason for skin to dry out and become itchy. And the feet and legs area a common place for poor circulation to develop. This is particularly true for people with diabetes or atherosclerosis of the leg arteries.

When an artery is occluded (partially or completely blocked), the part of the body served by the artery beyond the point of blockage may not receive enough blood. This results in a decrease of oxygen, water and other nutrients being delivered to the affected tissue.

Occlusion of cardiac arteries is associated with heart attacks. Occlusion of carotid arteries and their branches is associated with transient ischemic attacks (TIAs, also called mini-strokes) and strokes. Peripheral vascular disease, also called peripheral arterial occlusive disease, affects the aorta, its major branches, and arteries of the legs.

Most people with peripheral arterial occlusive disease have atherosclerosis. Atherosclerosis occurs when a large amount of fatty material develops in and on the walls of an artery. This accumulation of fatty material is called a plaque or atheroma.

The buildup of fatty material reduces the elasticity of the artery and reduces blood flow beyond the area of accumulation. A piece of this material, or a clot formed on the plaque, can break off and travel in the blood stream. It finally becomes lodged in a smaller artery, blocking it completely.

Atherosclerotic plaque buildup can occur in all arteries -- coronary arteries and carotid arteries, as well as aortic and peripheral arteries. So someone with peripheral arterial occlusive disease is at a higher risk for heart attack and stroke as well.

When an artery in the leg is narrowed by atherosclerosis, a person will begin to feel tingling, pain, and an aching, crampy or a tired feeling in the muscles of the legs during physical activity. This feeling is known as intermittent claudication. In the early stage of this disease you may not experience this, however, but only notice your skin being colder and drier than normal.

Treatment of atherosclerosis begins with prevention by limiting controllable risk factors. This means lowering LDL and total cholesterol, raising the HDL cholesterol, lowering blood pressure, quitting smoking, losing weight, and beginning an exercise program. Not much can be done about one uncontrollable risk factor, age.

Changing to a healthier lifestyle may only have a slight effect on the amount of blockage already present, but it will help prevent additional accumulation. Exercising will also increase the circulation to your legs both during and after exercise.

Medications, such as aspirin, that decrease clotting may be of some value in reducing blockage by decreasing the clots that form on the plaques. Clopidogrel (brand name Plavix) is similar to aspirin in that inhibits the action of platelets in forming clots.

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