Phlebitis Migrans: Causes, Symptoms & Treatment

Phlebitis migrans is a special form of thrombophlebitis. Thrombophlebitis is an acute thrombosis of the veins near the skin that occurs together with inflammation. On the other hand, thrombosis in the deep veins is called phlebothrombosis. Phlebitis migrans is a thrombophlebitis that occurs in alternate sites on the body.

What is phlebitis migrans?

Numerous synonyms exist for the term phlebitis migrans, for example, phlebitis saltans, thrombophlebitis migrans, or thrombophlebitis saltans. A characteristic feature of phlebitis migrans is that the vein does not appear as a varicose vein. The disease occurs in temporal succession and occurs at changing locations. Basically, therefore, it is a thrombophlebitis that changes its localization. In this particular case, thrombophlebitis has the characteristics of appearing superficial, migratory and, above all, unexpected. At the same time, it is sometimes considered an early symptom of a so-called visceral occult tumor. For this reason, the condition is also called facultative paraneoplastic syndrome. In phlebitis migrans, as a ‘migratory’ inflammation of the veins, the inflammation originates from already diseased areas of the veins. The inflammation can spread both in the direction of blood flow or in the opposite direction. The disease always affects the superficial veins near the skin. In this case, the inflammation is localized on the wall of the vein. As a result, a blood clot or thrombus may form, but this does not occur in every case.

Causes

In principle, phlebitis migrans can be an indication of serious underlying diseases. For example, it may occur as part of a paraneoplastic syndrome, such as pancreatic carcinoma, bronchial carcinoma, or leukemia. In addition, phlebitis migrans can occur as an accompanying symptom in connection with bacterial and viral infections. In many cases, however, it is not possible to determine the exact cause of phlebitis migrans. Most often, phlebitis migrans occurs in combination with thrombangiitis obliterans. Observations indicate that up to 62 percent of affected individuals also suffer from phlebitis migrans. Sometimes phlebitis migrans also occurs in vasculitides, such as lupus erythematosus, Wegener’s granulomatosis or giant cell arteritis in the presence of polymyalgia rheumatica. The reason for the development is probably a thrombotic, allergic-hyperergic reaction of the vessels. Such reactions can be triggered, for example, by chronic, bacterial focal infections. However, Behçet’s disease, carcinomas of the lung, pancreas and prostate, as well as leukoses and malignant lymphogranulomatoses can also be the triggers. Tumors are capable of releasing cysteine proteinases. This sets in motion a mechanism, not yet fully understood, that increases production of the substance thrombin.

Symptoms, complaints, and signs

Phlebitis migrans causes various typical symptoms and complaints in affected individuals. In many cases, the affected areas are found on the outer sides of the legs. Far less frequently, phlebitis migrans occurs on the trunk or arm. Characteristic of the disease are redness on the skin, which occupies a small area and hurts. At the same time, in some cases, small edemas appear. This type of phlebitis usually heals unexpectedly, so usually no treatment measures are required. In the majority of cases, men are affected by phlebitis migrans. The disease usually progresses in episodes and extends over different sections of the veins. In this case, an acute and painful, strand-like and easily palpable thrombophlebitis appears. The symptoms usually subside after two to three weeks, usually leaving a faint hyperpigmentation. Giant cells and histiocytes enter the vein during this process. Phlebitis migrans may also indicate the presence of other diseases. For example, the disease is frequently associated with malignant tumors, Bürger’s syndrome, various autoimmune diseases or tuberculosis. For this reason, clarification of other underlying diseases is urgently required.

Diagnosis and course of the disease

In any case, the diagnosis of phlebitis migrans must be performed by a specialist.First, the physician discusses the patient’s medical history with the patient, including the exact symptoms. To confirm the suspicion of phlebitis migrans, imaging procedures are used in most cases. With their help, the vessels of the extremities are analyzed. In addition, a sample biopsy should be considered. As part of the differential diagnosis, the presence of panniculitis, for example, must be investigated.

Complications

The symptoms of phlebitis migrans can vary widely, so that a general course of the disease cannot usually be predicted. However, in most cases, the symptoms themselves occur on the legs, so there is marked redness on the skin in these regions of the body. The skin itself may also become taut and painful. In most cases, the disease further also leads to hyperpigmentation, which negatively affects the appearance of the affected person. If phlebitis migrans is caused by a tumor, the affected person also suffers from permanent fatigue and exhaustion. Weight loss and severe pain may also occur. In many cases, however, self-healing takes place in phlebitis, so that no additional treatment is necessary. However, further treatment is carried out depending on the underlying disease, if it is necessary. As a rule, medications are used in this process. Smokers should give up the habit, as a healthy lifestyle has a very positive effect on phlebitis migrans. Other complications do not occur. However, hyperpigmentation may remain even after successful treatment.

When should you see a doctor?

As a rule, phlebitis migrans should always be examined by a physician. Because the condition does not improve without treatment and often intensifies, early diagnosis is important. The doctor should be consulted in case of phlebitis migrans if there is redness or severe spots on the skin. These rednesses do not disappear by themselves and occur without any particular reason. Pain does not always occur with phlebitis migrans, but it can significantly reduce the patient’s quality of life. If these spots appear in different parts of the body, a doctor should be consulted. Likewise, hyperpigmentation may indicate phlebitis migrans and should be investigated. Since those affected by phlebitis migrans also suffer from a significantly increased risk of skin cancer, regular examinations by a dermatologist are very useful in this case. As a rule, phlebitis migrans is diagnosed and treated by a dermatologist. Whether this results in a reduced life expectancy for the patient cannot generally be predicted.

Treatment and therapy

Treatment of phlebitis migrans depends primarily on the causes, although these are not clearly identifiable in every case. Smokers are encouraged to give up the habit. In addition, the search for tumors is intensified. As an external therapy method of phlebitis migrans, heparin ointments and compression bandages are often used. Anti-inflammatories or even corticosteroids are usually used as part of internal therapy. After the episodes have healed, hyperpigmentation usually remains.

Outlook and prognosis

The further course of phlebitis migrans cannot generally be predicted, as it is very much dependent on the manifestation of this disease. Therefore, a physician should be consulted at the first signs and symptoms of the disease and treatment should also be initiated to avoid complications or other complaints in the further course. As a rule, phlebitis migrans cannot heal on its own, so that the affected person is always dependent on a visit to a doctor. If there is no treatment, the symptoms can spread to other regions of the body and cause discomfort there as well. Smokers are particularly affected and should therefore give up or reduce smoking completely. A healthy lifestyle with a healthy diet can also have a positive effect on the further course of phlebitis migrans. The symptoms can also be alleviated by treatment with various ointments or creams.However, in this disease, the treatment of the underlying disease is very important and should therefore be the main focus. Possibly, the life expectancy of the affected person is also reduced in the process.

Prevention

Concrete measures for the prevention of phlebitis migrans do not exist according to the current state of research. A healthy lifestyle and, in particular, refraining from smoking possibly reduce the likelihood of developing phlebitis migrans.

Follow-up

In most cases, those affected by phlebitis migrans have only a few or limited measures of direct aftercare available to them. In this disease, early diagnosis with subsequent treatment is very important, as this is the only way to prevent further complications and discomfort. Self-healing is not possible with phlebitis migrans, so that those affected should ideally see a doctor at the first symptoms and signs. In order to positively influence recovery, smokers should give up this habit completely. In general, a healthy lifestyle with a balanced diet also has a positive effect on the further course of the disease. Regular checks and examinations by a doctor are also very important in order to detect further tumors at an early stage and then remove them. It is also not uncommon for various medications to be taken in order to alleviate the symptoms. Patients should always ensure that they take their medication regularly and in the correct dosage. In the event of side effects or if anything is unclear, a doctor should be consulted first. Despite treatment, the life expectancy of the affected person is significantly limited by phlebitis migrans in many cases.

What you can do yourself

When phlebitis migrans occurs, the most important action is to go to the nearest hospital or call an emergency physician. In any case, the thrombosis requires immediate treatment, because otherwise it can lead to further discomfort and complications, even death of the patient. After the initial treatment, the causes of the thrombophlebitis must be determined and eliminated. If the condition is based on excess weight, this must be reduced through exercise and a healthy and balanced diet. In addition, a comprehensive examination should take place, as there may be other health conditions that could cause further problems in the future. Smokers also need to take measures to prevent recurrence of phlebitis migrans. First, smoking should be stopped, supported by dietary changes and the introduction of positive habits. In general, a healthy lifestyle with a suitable diet and adequate exercise can significantly reduce the risk of developing phlebitis migrans. Affected individuals should speak with a dietitian and work with the dietitian and primary care physician to take appropriate steps to ensure vascular health.