These dilated blood vessels may be short, unconnected lines each about the size of a large hair, or connected in a matted, "sunburst" pattern. They may also look like a spider web or 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.
If spider veins are unsightly or uncomfortable, they can be treated with laser, or by injection of a solution that will cause them to disappear or become much smaller. There is about a 50-90 percent chance for a greatly improved appearance.
The cause of spider veins is not completely 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 rarely occurs as part of an internal disease.
Spider veins appear in both men and women, but more frequently in women. The female hormones 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 from hosiery held up with tight rubber bands. Spider veins may also occur in association with large varicose veins.
Spider veins can't always be prevented. Wearing support hose may minimize unwanted blood vessels from developing. Keeping one's weight at a normal level and exercising regularly may also be helpful. Eating a high-fiber diet and wearing low-heeled shoes may also help. Sun protection is important to limit the number of unwanted vessels on the face.
The injection method, 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, stick together, and the blood to thicken. Over a period of weeks, the vessel turns into scar tissue that is absorbed, eventually becoming barely noticeable or invisible.
After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual, usually over months. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.
- Stinging at the sites of injection - Some solutions for injection are relatively pain-free.
- Red, raised areas at the sites of injection - These should disappear within a day or so and are like hives.
- Brown lines or spots on the skin at the sites of treated blood vessels - Probably made up of a form of iron in the blood, these darkened areas may result when blood escapes from treated veins. These dark areas occur more often in patients who have larger veins treated. In most cases, they disappear within six months to a year, but in a small percent of patients they may last longer. Laser treatment may cause skin discoloration.
- Development of groups of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs - About a third of patients develop these; most disappear by themselves, some go away with additional injection treatment or laser therapy, a few may last.
- Small, painful ulcers at treatment sites either immediately or within a few days of injection - Although extremely rare, these occur when some of the solution escapes into the surrounding skin or enters a tiny artery at the treatment site. These can be successfully treated, but it is necessary to inform the physician of them immediately. Lasers may cause small areas of skin breakdown.
- 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.
- Allergic reactions to certain sclerosing solutions - Although such reactions can be serious, they are extremely rare and can be treated by your dermatologist. Minor reactions can be treated with antihistamines.
- Inflammation of treated blood vessels - This is very unusual but when it occurs it is treated with medications such as aspirin, compression, antibiotics, or heat.
- Lumps in injected vessels, particularly larger ones, may develop - This is coagulated blood, similar to a bruise within the vein, but is not dangerous. The dermatologist may drain the blood out of these areas a few weeks after injection.
For larger varicose veins, radiofrequency may be used instead of stripping. Great advances have been made in the use of ultrasound to guide injection of varicose veins not visible at the skin surface.
Surgically tying veins off (ligation), or pulling them out (ambulatory phlebectomy), are other procedures for treating unwanted blood vessels. These methods are usually reserved for larger varicose veins.
We will bandage the injected areas and instruct you to "compress" the treated vessels. This may help seal the treated vessels, keep the blood from collecting under the skin, and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence.