Spider veins
Spider veins, or telangiectasias, are small dilated veins less than 1 mm across, red or purple and very visible in the skin. They are the mildest form of venous disease and very common, especially in women.
Why do they appear?
Heredity, hormonal changes (pregnancy, the contraceptive pill), age and spending many hours standing all play a part. They are often accompanied by reticular veins, slightly larger bluish veins (1 to 3 mm) that feed them.
Are they just a cosmetic problem?
In most cases yes, although some people notice itching, burning or heaviness in the area. The important thing is that they are sometimes the visible part of deeper venous insufficiency. That is why, before treating them, a duplex ultrasound scan is advisable to rule out saphenous reflux: if it is present and not corrected, the spider veins come back sooner.
How I treat them
Micro-sclerotherapyThe reference treatment. A sclerosing drug (polidocanol) is injected with a very fine needle directly into the small vein, which closes and is reabsorbed by the body.
MicrofoamFor slightly larger reticular veins, the drug is applied as a foam, guided by transillumination.
Transdermal laserNd:YAG laser combined with pulsed light for veins too fine to inject. The 2022 European guidelines strengthened its recommendation for telangiectasias.
What to expect from treatment
- Several sessions a few weeks apart are usually needed; the number depends on the extent.
- Sessions are short, well tolerated and do not require time off work.
- After sclerotherapy it is normal to see small bruises or a temporary brown discolouration that fades over weeks or months.
- I recommend avoiding direct sun on the treated area in the following weeks.
- As with all venous disease, new spider veins may appear over time.
Possible side effects
According to the European sclerotherapy guidelines, the most common side effects are mild: temporary hyperpigmentation and the appearance of a fine network of vessels around the treated point (matting). Serious complications are exceptional. In the consultation I review each patient’s history (allergies, previous thrombosis, pregnancy) before recommending treatment.
Videos on this topic (in Spanish)
References
- Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338-354.
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267.
Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.
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Consultation with duplex ultrasound at Clínica Rotger, in the centre of Palma.
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