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What Doctors Don't Tell You

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September 2020 (Vol. 5 Issue 6)

Spider veins

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Spider veins image

Q) Since having children, I've been plagued with unsightly spider veins on my legs

Q) Since having children, I've been plagued with unsightly spider veins on my legs. I've heard that sclerotherapy can be effective at getting rid of them. Is it safe? Are there any alternative solutions for spider veins?-S.S., via e-mail

A) Spider veins-also known as 'telangiectasias' or 'sunburst varicosities'-are small clusters of red or purple veins that are visible just under the skin. Heredity, pregnancy and increasing age are the most common causes (Am Fam Physician, 1992; 46: 827-37).

Unlike varicose veins, spider veins are harmless and generally cause no pain or discomfort. They can, how-ever, still cause great distress.

Sclerotherapy involves injecting a chemical agent (a 'sclerosant') into the affected veins, causing them to fade from view. It's effective against spider veins (Dermatol Surg, 2002; 28: 11-5; Dermatol Surg, 2005; 31: 631-5), particularly if compression stockings are worn for a few weeks afterwards (J Vasc Surg, 2007; 45: 1212-6).

However, the procedure does have side-effects, including oedema, pain, localized itching, blisters and, most commonly, hyperpigmentation (dark-ening of the skin along the course of the treated vein) (Am Fam Physician, 1992; 46: 827-37). Hyperpigmentation is reported in up to 30 per cent of patients treated for spider/varicose veins, regardless of the sclerosant used. However, in most cases, it dis-appears within six to 24 months. For some, though, the problem may persist for five or so years (J Dermatol Surg Oncol, 1987; 13: 547-50).

Other-albeit rare-complica-tions are more serious, including systemic allergic reactions, deep vein thrombosis, thrombophlebitis (vein inflammation) and skin tissue death (Am Fam Physician, 1992; 46: 827-37).

Another treatment for spider veins is laser therapy, which uses bursts of near-infrared light to burn and seal off the veins, resulting in clearance. A variety of laser systems is effective (Semin Cutan Med Surg, 2000; 19: 245-52), though it's not as good as sclero-therapy, and can cause blisters, crusts and long-term atrophic scars (Dermatol Surg, 2002; 28: 694-7; J Cutan Laser Ther, 1999; 1: 179-80).

Other alternatives

Vitamin K cream is claimed to be an effective natural treatment. Topical vitamin K was effective at reducing laser-induced bruising and purpura (red or purple patches caused by bleeding under the skin) (J Am Acad Dermatol, 2002; 47: 241-4; Dermatol Surg, 1999; 25: 942-4). However, WDDTY could find no published studies showing that vitamin K can reduce or eliminate spider veins.

Nevertheless, an unpublished study reported in WDDTY's sister publication PROOF! (vol 4 no 3) tested the efficacy of a 5-per-cent pharmaceutical-grade vitamin K product (Dermal-K) on 50 women. Of these women, three had a significant reduction or complete healing of their spider veins within eight to 14 days, 17 had a significant reduction or complete healing in 15-30 days, 26 had a significant reduction within 31-46 days, two had a significant reduction within 47-120 days and two showed no effects at all, after six months. There was no improvement among 50 women who used an aloe vera skin cream for comparison.

So, vitamin K cream may be worth a try, but proceed with caution as the long-term safety of this treatment has not been established.

Other ingredients found in creams for spider veins are extracts of horse chestnut, red vine leaf and butcher's broom. Although these haven't been studied for spider veins specifically, they were effective-taken orally-for venous insufficiency, a related condition in which the veins don't send enough blood from the legs back to the heart (Arch Dermatol, 1998; 134: 1356-60; Arzneim Forsch, 2000; 50: 109-17; Arzneim Forsch, 2002; 52: 243-50). These herbs appear to strengthen vessel walls, but whether they will have any effect on spider veins is not known for certain.

Finally, spider veins can be covered up. There are long-lasting (and some waterproof) body makeups specially formulated to camouflage spider veins and other blemishes. In the UK, the British Red Cross runs a free treatment service at centres across the country, used by patients with birthmarks, burns, scars and spider veins (see ).

Tips for prevention

- Exercise regularly to aid your circulation

- Reduce strain on your legs by avoiding prolonged standing and excessive heavy lifting

- Maintain an ideal body weight, as obesity is known to contribute to the development of spider veins (J Dermatol Surg Oncol, 1992; 18: 883-6)

- Don't cross your legs when sitting, as doing so can slow the upward flow of blood back to the heart and increase the pressure on the leg veins

- Try massage and other therapies that increase circulation

- Consider supplements as, in addition to horse chestnut, red vine leaf and butcher's broom, there are other vessel-strengthening agents that may help to prevent spider veins, including gotu kola, oxerutins (synthetic bioflavonoids derived from rutin) and OPCs (oligomeric proanthocyanidin complexes, extracted from pine bark and grape seeds).

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