Thread veins, also called telangiectasia or spider veins, are small clusters of blue or red broken veins that 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 areas such as the face and legs.
Sclerotherapy was developed in the 1920s for the treatment of varicose veins. This was refined for the treatment for thread veins, which 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 2mm in diameter.
Depending on where the thread veins are situated, different treatment options are available. These range from micro sclerotherapy which is mostly used for legs and other parts of the body, to microwave, laser or IPL treatments and electro-cautery for the face.
Sclerotherapy is a simple procedure performed by skilled medical practitioners which involves injecting a solution into the veins on the body using a micro-needle, thereby causing the vein to collapse and fade from view. The treatment, which has been shown to be the most successful way to eliminate these tiny blood vessels, is almost painless and causes little discomfort.
Most patients are pleased with the difference that sclerotherapy makes, usually seeing an overall improvement of 80% following a course of treatments 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 appear.
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.
How successful is sclerotherapy?
The injections are almost painless, and all the thread veins can usually be treated in one 30 to 60-minute 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. Improvement continues for a year. For this reason, it is a good idea to plan treatment some time before a holiday or important event. The treatment will last for several years, but other thread veins will often develop over time. An improvement of around 80% can usually be expected.
How many treatment sessions are needed?
The number of treatments varies and is dependent upon the patient and the extent of the veins, but each session must have a four to six-week interval. This and other aspects of the treatment will be discussed in more detail at the pre-treatment consultation.
Are there any complications or side-effects?
No treatment is risk free, but sclerotherapy is very safe. Most patients experience no complications, but 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 irritants and treated areas will resemble a nettle rash for a few hours afterwards and may be itchy, which is entirely normal.
Complications that may occur include in rare cases are:
- Hyperpigmentation, which is usually transient and is less common in small vessels than in large ones. Compression garments decrease the incidence of hyperpigmentation.
- Allergic reactions including mild skin conditions such as urticaria and possible anaphylaxis, although this is incredibly rare.
- Telangiectatic matting (the appearance of new small vessels) 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. Telangiectatic matting usually responds to gentle sclerotherapy and treatment of hidden feeding veins (reticular veins, perforators, saphenous veins).
- Superficial thrombophlebitis, which usually occurs in large vessels that are rarely treated with micro sclerotherapy.
- Tissue necrosis, which presents as an ulcer, is a rare complication of sclerotherapy and 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 most normal activity can be undertaken immediately afterwards. The site may feel itchy or prickly for a short while, which can be relieved with antihistamines, and you will usually be advised to wear compression hosiery for one week while recovering.
For the first 12 hours after treatment, you will be advised to avoid standing for long periods or sitting with your feet down. For 10 days following treatment you will be advised to avoid high impact exercise, extremes of heat or cold, exposing your skin to the sun or shaving/hair removal in the treated area.
Is micro-sclerotherapy painful?
Patients who have had microsclerotherapy have reported little discomfort. Some experience a slight to moderate burning sensation immediately after the injection but this disappears within a few seconds. The level of pain varies with the type of sclerosant used.