Dermatologic & Cosmetic Surgery

Dermatologic Treatments

Sclerotherapy

Spider veins are dilated small blood vessels that have a red or bluish color. They appear mostly on the legs, occasionally on the face or elsewhere, and may often be unwanted.

They can be short, unconnected lines each about the size of a large hair or connected in a scraggly, "sunburst" pattern. They many also look like a spider wed or have a tree with branches. Sometimes, they occur in a small area and aren't very noticeable, or they can cover a large area of skin and be quite unattractive.

Larger dilated blood vessels called varicose veins may be raised above the skin surface. They may occur along with spider veins.

Some people with unwanted blood vessels can have pain, ranging from a dull throbbing pain to a burning sensation. The larger vessels are more likely to cause discomfort.

Although unwanted blood vessels carry blood, the great majority of them, especially spider veins, are not necessary. If they are unsightly or uncomfortable, they can be treated by injection of a solution that will cause them to disappear or become much smaller. There is about a 50-90% chance for a greatly improved appearance.

BENEFITS
Decrease number of unwanted spider veins.

WHAT CAUSES SPIDER VEINS?
The cause of spider veins is not known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition can very occasionally occur as part of an internal disease.

Spider veins appear in both men and women, but more frequently in women. The hormones estrogen and progesterone may play a role in their development. Puberty, birth control pills, pregnancy or hormone replacement therapy often seem to bring them out. They may also appear after an injury or as a result of wearing tight girdles or hosiery held up with tight rubber bands. Spider veins may also occur with large varicose veins.

Spider veins on the nose or the cheeks of fair skinned persons may be related to sun exposure.

HOW CAN THEY BE TREATED? WHAT IS SCLEROTHERAPY?
In the majority of cases, a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930's and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to clot.

Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable or invisible.

A single blood vessel may have to be injected more than once, some weeks apart, depending on its size. In any one treatment session a number of vessels can be injected.

The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. Dr. Lawrence will decide the solution that is best for your particular case.

Occasionally larger varicose veins are underneath the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy followed by compression or by a surgical procedure performed by a vascular surgeon. Other physicians believe that spider veins may be treated by sclerotherapy without worrying about the varicose veins unless they become troublesome.

HOW SUCCESSFUL IS SCLEROTHERAPY?
After several treatments, most patients can expect a 50 to 90% improvement. However, fading is gradual. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

HOW SOON WILL THE VESSELS DISAPPEAR?
Each vessel usually requires one to three treatments. The vessels disappear over a period of 2 weeks to 3 months. Recurrences may rarely occur over a period of 1 to 5 years. This treatment dies not prevent new telangiectasias from developing.

HOW OFTEN CAN I BE TREATED?
The same area should not be injected for 3 to 4 weeks to allow for complete healing.

HOW MANY TIMES DOES IT HAVE TO BE DONE?
This varies with the number of areas that have to be injected, as well as the response to each injection. It usually takes one to three injections to obliterate any vessel, and 10 to 40 vessels may be treated in any one session.

ARE THERE CERTAIN KINDS OF SPIDER VEINS THAT CAN NOT BE TREATED?
Certain types of large varicose veins may not respond readily to sclerotherapy alone. These vessels may require a minor surgical procedure followed later with sclerotherapy. You may be referred to a vascular surgeon for complete or partial treatment of these specific types of large varicose veins. Some of the extremely small vessels (less than 1/1000 of a millimeter) may require treatment with a pulsed dye laser.

CAN SCLEROTHERAPY BE USED ON ALL SKIN TYPES?
Yes. All skin types and skin colors respond equally well.

CAN SPIDER VEINS BE PREVENTED?
Spider veins can't always be prevented. Wearing support hose may prevent some unwanted blood vessels from developing. Keeping ones weight at a normal level and exercising regularly may also be helpful. Eating a high fiber diet and wearing low-heeled shoes can also help. Sun protection is important to limit the number of unwanted vessels on the face.

WILL TREATED VEINS RECUR?
Larger veins are likely to recur unless support hose are worn. Spider veins may also recur. It may seem that a previously injected vessel has recurred, when, in fact, a new spider vein has appeared in the same area.

ARE THERE OTHER TREATMENT METHODS?
New lasers may hold promise for treating blood vessels, but currently vessels in the legs do not respond uniformly to laser treatment.

Surgically tying veins off (ligation) or pulling them out (stripping) are other procedures for treating unwanted blood vessels. They are usually reserved for large varicose veins.

DOES IT HURT?
A very small needle is used. The procedure is very tolerable to most people.

WHAT ARE THE SIDE EFFECTS?
Slight blistering may occur around the injection vessels and resolves in a day or so. Raised red areas. Up to 30% of patients develop a small freckle-like tan to brown spot around the injection vessel. This usually resolves in 80% of these patients within 3 to 6 months. A few patients will have a persistent freckle for up to a year. Slight stinging or burning may occur with injection of certain types and concentrations of solutions in certain areas.

Sometimes a clot develops at the injection site (especially if the recommended pressure stockings are not worn for the proper amount of time). This clot will not commonly cause internal problems, but its removal within 2 weeks of the injection will speed the healing process and decrease the incidence of "freckling".

Swelling over the injection site may rarely occur. It is particularly common when patients have jobs in which the stand for long periods of time or when vessels in the ankles are injected. The swelling is never dangerous but occasionally must be treated with elevation and compression dressings.

A small superficial ulceration of the skin overlying the injected vessel may occur. This does not usually leave a scar but needs to be seen as soon as possible by your doctor. Superficial thrombophlebitis, an irritation of the injected vessel, occurs unless than 1 per 1000 patients. It may have to be treated with anti-inflammatory agents and compression stockings.

Bruises at the site where the needle went into the skin. These will disappear in a few weeks and are probably related to the thinness of blood vessel walls.

RECOVERY TIME
No down time from work needed. Stocking should be worn as directed. No vigorous exercises for 48 hours.

To make an appointment with a Cooper University Hospital physician at an office near you, call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.