Spider Vein / Varicose Vein Therapy

Board-certified dermatologists offer several treatments to improve the appearance of varicose and spider veins. The most widely used treatments are sclerotherapy and laser therapy.

Your dermatologist will recommend the best treatment option for you after considering several factors, including the type and location of the vein, as well as your medical history.

It is important to tell your dermatologist if you have a clotting disorder or a history of blood clots in the lungs or legs, as this may affect your treatment options.

Treatment of spider veins is usually considered to be a cosmetic procedure, so it likely will not be covered by medical insurance. Treatment of varicose veins can be covered if there is an underlying issue that needs to be fixed. Before deciding on a treatment option, be sure to discuss the cost with your dermatologist.

WHAT ARE SPIDER VEINS?

Spider veins are blood vessels that lie near the surface of the skin. They can range in color from red to blue to purple. Some look like short, unconnected lines about the size of a hair, while others form a “sunburst” pattern that may resemble a spider web or the branches on a tree.

Spider veins

Spider veins commonly occur on the legs, but they may also develop on other areas of the body. They can be small and barely noticeable, or they can cover a large area of the skin. Occasionally, spider veins can cause some discomfort.

WHAT ARE VARICOSE VEINS?

Varicose veins are veins that have become enlarged or swollen. They often rise above the surface of the skin and have a knotted appearance. Some are flesh-colored, while others may range in color from green to blue to dark purple.

Varicose veins commonly develop in the legs and feet, but they can occur on any part of the body.

Varicose veins can cause pain that ranges from a dull, throbbing feeling to a burning sensation. The larger the veins are, the more likely they are to cause discomfort.

WHAT CAUSES SPIDER AND VARICOSE VEINS?

Veins have valves that keep blood moving in one direction. If these valves weaken, blood may flow backwards and accumulate in the vein, causing it to swell and become a varicose or spider vein.

Some people inherit a predisposition for weak valves, which puts them at an increased risk for developing varicose and spider veins. Those who sit or stand for long periods also may be prone to enlarged veins. Other risk factors for spider veins include hormonal changes and injury.

HOW CAN I PREVENT SPIDER AND VARICOSE VEINS?

Dermatologists recommend the following tips for preventing varicose and spider veins:

• Exercise regularly and maintain a healthy body weight.
• Elevate your legs when resting.
• Take breaks from prolonged periods of sitting or standing.
• Don’t cross your legs while sitting.

Spider veins

If you already have varicose or spider veins, your dermatologist may recommend that you wear compression stockings to help your circulation, prevent blood clotting and improve the appearance of existing veins, while preventing new ones from forming.

WHAT IS SCLEROTHERAPY?

The most common treatment for leg veins, sclerotherapy involves injecting a solution directly into the vein, causing its destruction.

A board-certified dermatologist can perform this procedure in his or her office. It does not require anesthesia. A treatment session generally lasts 15 to 20 minutes. A number of veins can be treated during one treatment session, or a single vein may be injected several times.

Sclerotherapy is typically used to treat spider veins or small varicose veins. To treat larger varicose veins, a dermatologist may use ultrasound-guided sclerotherapy. The ultrasound gives the doctor a live view of the vein, which allows him or her to inject the solution where it will be most effective.

Spider veins typically disappear within three to six weeks after treatment, while varicose veins may take three to four months to disappear. Some veins may require more than one treatment session. Sessions may be spaced weeks or months apart, depending on the vein.

While sclerotherapy can be safely performed on all skin types, there are potential side effects, most of which are mild and temporary. You may notice the following at the injection site:

• Short-lived stinging, pain or muscle cramps.
• A red, raised area.
• Brown lines or spots on the skin.
• Clusters of fine, red blood vessels.
• Small, painful ulcers.

Other side effects may include an allergic reaction, inflammation of treated blood vessels (phlebitis) or lumps (thrombi) in the treated veins. If you experience any side effects after sclerotherapy, talk to your dermatologist.

WHAT IS LASER THERAPY?

Used to treat spider veins and small varicose veins, laser therapy involves sending wavelengths of light directly into the vein, causing it to heat up and turn into scar tissue, which gradually fades or disappears. Small spider veins can disappear almost immediately after treatment, while larger spider veins and varicose veins will get darker before fading over the course of one to three months.

Like sclerotherapy, laser therapy can be performed in a board-certified dermatologist’s office and does not require anesthesia. Laser therapy may be combined with sclerotherapy to achieve the best results.

Many types of lasers can be used to treat veins. Your dermatologist will recommend the best type of laser based on the size and location of the veins that are getting treated, as well as your skin type.

Potential side effects from laser therapy may include redness or swelling, skin discoloration, bruising, or other wounds. Side effects will vary based on the type of laser used. Your dermatologist can explain potential side effects.

WHAT ARE SOME OTHER METHODS OF VEIN TREATMENT?

• Vein ligation and stripping is an outpatient surgical procedure that can remove a damaged vein. This may be necessary for large varicose veins.

Spider veins

• Ambulatory phlebectomy, which was developed by dermatologists, involves making small punctures in the skin to remove a damaged vein. This is another option for varicose veins and is done under local anesthesia.
• Endovenous laser therapy and radiofrequency ablation are newer treatments that work to destroy the damaged vein from the inside. EVLT is used to treat varicose veins; however, if the vein is twisted, then EVLT is not an option. RFA is used to treat large varicose veins.
• Tissue glue vein closure uses a catheter to introduce an adhesive that closes off varicose veins.
• Mechanical endovenous vein removal uses a thin video camera to visualize and close varicose veins, and then remove them through small incisions. This is used for advanced cases if other treatments have failed.

WHAT CAN I EXPECT AFTER VEIN TREATMENT?

Improvement occurs gradually after treatment. It is normal for the area to look worse before it looks better.

Your dermatologist will provide you with post-treatment instructions to help you achieve the best results.

While you can return to work and most activities the day after your treatment, you may need to avoid intense physical exercise. You also may need to wear compression stockings after leg vein treatment.

After sclerotherapy, you may be instructed to take daily walks. After laser therapy, you will need to protect your skin from the sun.

It is possible for varicose and spider veins to recur after treatment, or for new veins to appear in the same area. If this occurs, your dermatologist can provide further treatment.

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about spider and varicose veins or to find a board-certified dermatologist in your area, visit aad.org/veins or call toll-free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.

Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

American Academy of Dermatology

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