Anyone can suffer with thread (red, spider or broken) veins, and they can appear on any part of the body. Although harmless, they can cause distress as the sufferer often feels self-conscious, particularly if the veins are on an areas such as the face and legs.
Sclerotherapy treatment was developed in the 1920s for the treatment of varicose veins. This was refined for the treatment for thread veins, and this is what we now call microsclerotherapy.
Thread veins are smaller than varicose veins. They are usually very near the surface of the skin, red, blue, or purple in colour, and less than 1 to 2 mm in diameter.
Depending on where the thread veins are situated, different treatment options are available. These range from microsclerotherapy which is mostly used for leg and other thread veins on the body (but rarely the face) to microwave treatment and laser or IPL treatments and electro-cautery.
Sclerotherapy is a simple procedure performed by skilled medical practitioners, which involves injecting a solution into the vein using a micro-needle, thereby causing the vein to collapse and fade from view. It is a virtually painless treatment which has been shown to be the most successful treatment available today for these tiny blood vessels.
Most patients are pleased with the difference that sclerotherapy makes, usually seeing an overall improvement of 80% following treatment. It is important to realise however that this treatment does not prevent new veins from emerging in the future and as time passes by, it may be necessary for touch-up treatments when new veins surface.
Sclerosants include the following:
- Detergents – Disrupt vein cellular membrane
- Sodium tetradecyl sulfate (Fibrovein)
- Polidocanol (Sclerovein)
- Ethanolamine Oleate (Neosclerol)
- Osmotic agents – Damage the cell by shifting the water balance through cellular gradient (osmotic) dehydration and cell membrane denaturation
- Hypertonic sodium chloride solution
- Sodium chloride solution with dextrose (Sclerodex)
- Chemical irritants – Damage the cell wall by direct caustic destruction of endothelium
- Chromated glycerin (Scleremo).
The most commonly used agents are hypertonic saline, sodium tetradecyl sulfate, polidocanol, and chromated glycerin.
How does the treatment work?
A dilute irritant solution is injected into the vein using a very fine needle. This damages the vessel lining causing it to close off. The body treats this as damaged tissue which is slowly absorbed over about three months. Sometimes all the thread veins disappear.
How successful is Sclerotherapy?
The injections are almost painless and all the thread veins can usually be treated in one half hour session. They look worse to begin with and large vessels may go black. Fading starts after three weeks and it will be three months before the main benefit is seen and improvement continues for a year. For this reason it is a good idea to plan treatment some time before your holiday. The treatment will last for several years, but other thread veins will often develop over time. An improvement of 80% is more usual.
How many treatment sessions are needed?
The number of treatments varies and is dependent upon the patient and the extent of the condition but each session must have a 4-6 week interval. This and other aspects of the treatment will be discussed in more detail at the pre-treatment consultation.
Are there any complications?
Bruising is transient and clears with time.
Hyperpigmentation is usually transient and is less common in small vessels than in large ones. Compression garments decrease the incidence of hyperpigmentation.
Allergic reactions include urticaria and possible anaphylaxis. The incidence is 0.3%, and these reactions may occur with the use of any sclerosant.
Telangiectatic matting is due to injections that are administered too rapidly or in which the sclerosant concentration is too high. It usually resolves spontaneously over several months but may be permanent. It usually responds to gentle sclerotherapy and treatment of hidden feeding veins (reticular veins, perforators, saphenous veins).
Superficial thrombophlebitis usually occurs in large vessels which are rarely treated in conjunction with microsclerotherapy. Tissue necrosis is a rare complication of sclerotherapy; this complication is more common with hypertonic saline.
What should I do before treatment?
Avoid aspirin, vitamin E and Aloe Vera preparations for at least 10 days. If you also suffer from varicose veins you will need these treated before you undertake sclerotherapy.
How long does the treatment take?
In most cases, treatment takes 30-60 minutes and no recovery time is needed so normal activity can be undertaken immediately afterwards.
Is micro-sclerotherapy painful?
Patients who have had micro-sclerotherapy have reported little discomfort. Some experience a slight to moderate burning sensation immediately after the injection but this disappears within a few seconds.
Are there any side-effects following treatment?
Most patients experience no complications; however, some minor side-effects have been reported. These include slight blistering which occurs when small amounts of the solution seep into the surrounding skin areas. These blisters tend to heal rapidly. Occasionally, a small, dark area of pigmentation resembling a freckle may remain. These spots, however, do tend to disappear over time or respond to further treatment with bleaching creams. Bruising around the treated area, which eventually disappears, can result if the veins are unusually weak. Sclerotherapy solutions are irritant and treated ares will resemble a nettle rash for a few hours afterwards. There will also be itching and this is entirely normal.