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Spider veins. What can I do?

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Varicose Veins, Spider Veins Hands Indicate Where They Are on Woman's Leg

What are spider veins?

Spiders veins and telangiectasias are small veins and arteries that are visible on the skin. Telangiectasias are very small spider veins. They are common and affect more than half of women by the age of 50 years. They are unsightly but may also cause symptoms like throbbing, aching, itching, and burning. Bleeding can also occur, often from the ankles and feet. Men also get spider veins but unsightliness is often less of a concern.

For many women, spider veins may affect self-esteem, leading to increased self-consciousness with clothes and avoiding activities involving leg exposure. This affects self-confidence and may cause someone to feel older or less attractive.

The main methods of medical treatment are sclerotherapy and skin laser. Both are low risk and can achieve very good results (see below for more detail). Non-medical options include concealing creams.

Picture demonstrating sclerotherapy being performed on the right leg.
Sclerotherapy for Leg Spider Veins

What is my spider vein risk?

The risk factors are family history, varicose veins in the family, age, being female, prolonged sitting or standing, obesity, lack of activity and local trauma, including previous surgery. Sometimes the cause of spider veins is due to other medical conditions.

Having spider veins and varicose veins in the family is the main risk factor. There is also a strong connection with pregnancy, the contraceptive pill and hormone replacement therapy. Skin damage from sun exposure can also lead to telangiasias on the face. These are often called facial veins.

Facial telangiectasias are common on the cheeks.
Spider Veins Affecting the Cheek.

Facial veins are often bright red and can have a line or star-like appearance. Spider veins on the legs often have underlying varicose veins feeding them from multiple points. Star-like facial veins arise from a central feeding vessel.

Telangiectasia in a star-like pattern affecting the nose.
Typical Star-like Facial Vein.

In many people, the cause of spider veins is related to underlying varicose veins. Varicose veins cause increased pressure within the small skin veins, leading to gradual enlargement over time.

Picture of the left leg showing underlying varicose veins.
Spider Veins Caused by Underlying Varicose Veins.

Spider veins and telangiectasias also commonly occur in the absence of varicose veins. In these cases, the cause relates to other factors, such as sun damage, trauma, including previous surgery, or female hormones.

What tests will I need for spider veins?

Investigation usually involves an ultrasound scan of the leg veins to determine whether there are underlying varicose veins, as these may need treatment first.

Ultrasound of the legs being performed to look for underlying varicose veins.
An Ultrasound Scan is Needed to Detect Varicose Veins.

What are the treatments for spider veins?

Treatment involves sclerotherapy, usually followed by skin laser.  In sclerotherapy, a fine needle is introduced into the vein and a small amount of an irritant agent is injected into the spider veins, causing them to block off. Sclerotherapy is often performed with magnifying glasses and the use of ultrasound guidance (UGS).

Polidocanol and Sodium Tetradecyl Sulphate (STS) are common irritant agents. They act by damaging the wall of the vein, causing it to seal and eventually diminish over time. Both of these irritant agents are approved for use in New Zealand by Medsafe.

Following the procedure, patients need to wear compression stockings for 5-10 days, depending on the veins number and size and any other veins needing attention. The interval for skin laser is usually 6-8 weeks. For some people, skin laser may be the only treatment needed.

Skin laser is an effective treatment.
Skin Laser Treatment for Leg Spider Veins.

What about the results?

The aim of most treatments is to improve appearance, and it is important to understand the treatment will not eliminate all visible veins. Individual results also tend to vary. Sometimes people need several sessions of both sclerotherapy and skin laser to achieve an optimum result.

As with any procedure, there is always a risk of a complication or poor outcome afterwards. Allergic reactions can occur with sclerotherapy using Polidocanol and STS. Fortunately, these are very uncommon. When there is suspicion a person may be at higher risk of an allergic reaction, a test dose of the irritant agent can determine any risk.

Brownish discolouration of the skin relates to the accumulation of iron released from the blood in the treated veins. It is more likely to occur with bigger veins, lack of adequate compression after the procedure, sun exposure after the treatment and in patients with a history of discolouration. All skin types, colours and tones are susceptible. Fortunately, most cases will resolve after 3-12 months. About 1% to 2% of patients will have persistent discolouration, where it persists for more than a year. Skin creams such as Fade Cream and Dermaka can useful to hasten fading.1