Dermatologists offer several treatments options. The most widely used is sclerotherapy and laser treatments. Before selecting the treatment option best for each patient, a dermatologist considers many factors including the vein type, location of the vein or veins, and the patient’s medical history.

   It is important for your dermatologist to know if you have a history of blood clots in your lungs or legs or a clotting disorder. This does not necessarily means that treatment must be avoided, but it may affect the treatment. For the best results, more than one treatment option may be used.

Spider veins are blood vessels that lie near the surface of the skin and range in color from red to blue to purple. Commonly occurring on the legs, spider veins also develop on the face and other areas of the body. Some spider veins look like short, unconnected lines about the size of a hair or a strait pin. Others form a “starburst” pattern that may resemble a spider web or branches on a tree. Spider veins can occur in a small area and maybe barely noticeable, or they can cover a large area of skin. Occasionally, spider veins can cause some burning and discomfort.

These are veins that have become enlarged or swollen. Varicose veins commonly develop in the legs and feet, but can occur on any part of the body. Often varicose veins rise above the surface of the skin and have a telltale knotted appearance. Some varicose veins are flesh-colored. Others are blue, green, or dark purple. Sometimes varicose veins appear together with spider veins.

Varicose veins can be painful. Smaller varicose veins can cause pain that ranges from dull and throbbing to a burning sensation. The larger varicose veins are, the more likely they are to cause discomfort.

To understand why varicose veins and spider veins develop, it helps to know what veins do. Arteries carry oxygen-rich blood from the heart to the entire body. Veins return the oxygen-poor blood to the heart. Veins have valves that prevent the blood from flowing backward. When a valve weakens, blood may lead backward. If enough blood flows backward, it can cause the vein to swell. When this happens, the vein becomes a varicose vein. Some people inherit predisposition for weak valves, which gives them an increase risk for developing varicose veins.

Spider veins also can result from this backflow of blood. Other factors that many cause spider veins are the hormonal changes that occur during puberty, pregnancy and menopause. Birth control pills and hormone replacement therapy also may play a role. This seems to explain why spider veins occur more frequently in women than in men. An injury or tight garments held fast by elastic also seem to cause spider veins. In fair-skinned people, sun exposure may lead to spider veins on the cheeks, and nose.

While spider and varicose veins cannot always be prevented, some lifestyle choices seem to reduce the likelihood of developing these veins. Exercising regularly, maintaining a normal body weight and eating a high-fiber diet can help. Protecting the face from sun exposure can help prevent spider veins on the face. Elevating the legs when resting and not crossing the legs when sitting also may help. What a person wears can make a difference, too. Elastic support hose, loose-fitting clothing and low-heeled shoes can reduce the appearance of leg veins.  

Sclerotherapy is the most popular treatment option for veins on the legs. It is used to treat spider and varicose veins on the legs and spider veins on the face.

Sclerotherapy involves injecting small doses of a solution directly into the unwanted vein with a very fine needle. The solution irritates the vein, causing it to swell, stick together and the blood to clot. This essentially seals off the treated vein from other veins. Over a period of weeks, the treated vein turns into scar tissue that is absorbed by the body. Eventually, the scar tissue becomes barely noticeable or invisible. This procedure can be performed in a dermatologist’s office and does not require anesthesia. 

A treatment session generally lasts 15 to 20 minutes. A number of veins can be treated during one treatment session and a single vein may be injected several times. Some veins require more than one treatment session. Sessions may be spaced weeks or months apart, depending on the vein.

To treat larger varicose veins, a dermatologist may use ultrasound-guided sclerotherapy. The ultrasound gives the doctor a live view of the veins, which allows the solution to be injected exactly where it will be most effective.

After treatment, most patients can expect to see an 80-90% improvement. This may require several treatments. Fading is gradual and occurs over a period of time.

While sclerotherapy can be safely used on all skin types, there are potential side effects. Most side effects are mild and temporary.

The most common, mild side effects include:

• Stinging or pain at the injection site and muscle cramps. Sometimes an injection is painful. Occasionally, swelling of the ankles or feet and muscle cramps occur.
• Red, raised areas at the injection sites. Hive-like reactions and itching can occur and usually fade within 10-15 minutes of the injection. Sometimes, it can take a day or so for the red, raised areas to disappear.
• Brown lines or spots on the skin at the treated sites. Darkened areas may appear and tend to be more common in patients who undergo treatment for a large or delicate vein and patients who tan easily. In most cases, the discoloration disappears within a year, but it can last longer.
• Clusters of fine, red blood vessels develop near the injection sites (matting). When larger veins are treated, about one-third of patients develop these clusters. Especially common on the thigh, many clusters disappear with time. Some respond to additional sclerotherapy or laser therapy. A few may last.
• Temporary bruises. Patients who tend to bruise easily may have temporary bruising. This usually disappears in a few weeks.

Although rare, more severe side effects are discussed below:

Small, painful ulcers at treatment sites. Appearing immediately or within a few days of treatment, these develop when some of the solution escapes into the surrounding skin or enters a small artery. This can be successfully treated, but it is necessary to inform the dermatologist immediately, especially if increasing pain or scabbing is noticed.

Allergic reaction. Some patients have an allergic reaction to the injected solution. Wheezing, difficulty swallowing, and severe swelling are usually signs of a severe allergic reaction. Most commonly this happens during treatment or shortly afterwards. Inform the dermatologist immediately if these symptoms occur so that appropriate medical treatment can be given.

Inflammation of treated blood vessels (phlebitis). More common in patients who have a family history of clotting disorders, phlebitis can be effectively treated with aspirin, compression, antibiotics, or heat.

Lumps (thrombi) in injected vessels. Most common following treatment of larger varicose veins or very large spider veins, this can be successfully treated by draining the coagulated blood from the areas.

 

Lasers are used to treat spider and varicose veins on the legs, and spider veins of the face.

Lasers send wavelengths of light directly into the vein. This causes the vein to heat up internally and turn into scar tissue. The scar tissue gradually fades or disappears. Technological advances make laser treatment safer and more effective than ever. Like sclerotherapy, laser treatment can be performed in a dermatologist’s office and does not require anesthesia.

Many types of lasers are used to treat veins. Your dermatologist will recommend the best type of laser, based on the size and location of the veins to be treated. For best results, laser therapy may be combined with sclerotherapy.

Different lasers are used for different skin types. To prevent permanent skin discoloration, people of color may require lasers that emit specific wavelengths of light.

• Redness or swelling. Occurring after treatment, this usually disappears in one or two days.
• The treated vein remains despite treatment.
• Discoloration of the skin. Treated skin may become lighter or darker than the surrounding skin. Often this disappears within a month or two, but it can be permanent.
• Skin wounds. These heal, but may cause scarring.
• Temporary bruising may occur.
• Side effects vary with the type of laser selected. Your dermatologist can explain the potential side effects for a specific laser.

For spider veins on the face, other treatment options include electrodessication and intense pulsed light. Large varicose veins on the legs may require vein ligation and stripping, an outpatient surgical procedure used to remove a damaged vein. Ambulatory phlebectomy is another option for varicose veins. Developed by dermatologist, this procedure involves making small punctures in the skin in order to remove the damaged vein. Radiofrequency can be used to destroy large veins in the legs.

After treatment, the area tends to look worse. This is normal. Improvement occurs gradually. Post-care instructions will depend on the treatment given and a number of considerations.

Following treatment for a leg vein, exercise is often limited for a few days or longer. Patients receiving sclerotherapy are usually instructed to walk for a certain amount of time each day and to avoid intense physical exercise. It may be necessary to avoid prolonged sitting and standing.

While generally spider veins completely disappear, new spider veins can appear in the same general area. It is possible for large veins to recur. Sometimes spider veins also recur. For another look at therapies available see Kristen Richardson's blog (http://www.pinebeltderm.com/blog/say-goodbye-to-spider-veins)