Gold standard for spider veins and reticular varicose veins:
New guidelines recommend sclerotherapy in preference to laser therapy
Sclerotherapy and laser therapy offer two minimally invasive procedures for the treatment of spider veins and reticular varicose veins. The latest guidelines from the European Society for Laser Dermatology (ESLD) demonstrate once again why sclerotherapy is still considered the treatment of choice for C1 varicose veins and what the limitations of laser therapy are.2
Attractive legs are becoming more important
In our society, having a good body image and feeling attractive gains more and more importance. This development goes hand-in-hand with a generally increasing desire amongst the population to have conspicuous blemishes treated, such as spider veins and reticular veins on the legs. More than half of the adults in Germany have aesthetically unpleasing veins that can be categorised as C1 according to the CEAP classification – and most of those affected are still in their prime and living busy, active lives.2,3 So there is a high level of interest in treatment methods that deliver satisfactory cosmetic results without inconveniencing the patient.
Well-established treatments for spider veins
Thanks to advanced treatment methods, varicose veins of all sizes can now be removed gently. Apart from sclerotherapy, transdermal laser treatment is also widely used for spider veins. According to the laser experts, the use of laser therapy for dilated veins in the legs has never had the same success as when used for veins on the face. Variations in size and blood flow and, in particular, the fact that they lie deeper in the skin make it much more difficult to treat leg veins successfully with transdermal lasers. The European Society for Laser Dermatology therefore still considers sclerotherapy to be the treatment of choice for spider veins and reticular varicose veins. Laser therapy could be considered for patients with needle phobia and for those who are unable to tolerate sclerotherapy or it can be tried for smaller superficial C1 veins. The choice of a suitable laser is extremely important to ensure that the beam penetrates deeply enough to reach the target vein.1
Lasers carry a risk of thermal damage
Experience shows that patients tend to think of lasers as the “wonder weapon” of high-tech medicine. Studies have demonstrated, however, that their high expectations are not always matched by reality, especially when it comes to the treatment of spider and reticular veins. With incorrect use, laser therapy carries a considerable risk of skin damage from heat.4 Adequate cooling during laser treatment is therefore essential to minimise the risk of thermal injury to the skin and other tissues – the epidermis of the legs, in particular, reacts very sensitively.1 Every laser pulse is followed by some degree of pain and burning sensation that are perceived by patients as more or less unpleasant. However, as pain is an important indicator of possible adverse effects, anaesthetics should generally be avoided.
Sclerotherapy is safe, effective and almost painless
In the guidelines, sclerotherapy is recommended as the gold standard and treatment of choice for spider veins and reticular varicose veins.1,5 Studies have comprehensively confirmed the clear advantages of the method in its efficacy and tolerability.6,7 Moreover, with sclerotherapy the spider and reticular veins can be occluded that are too deep for lasers to reach – including the deeper-lying feeder veins that supply most of the spider veins. If these feeder veins are not treated, they prevent the successful treatment of spider veins by maintaining the blood flow.
The few scientific studies that have directly compared sclerotherapy with laser therapy have shown that the more rapidly visible cosmetic results and the less painful procedure give sclerotherapy the advantage.8,9,10,11
Its low cost provides another plausible argument for sclerotherapy, as patients usually have to pay the costs for treatment of cosmetically unattractive C1 veins out of pocket.
For most patients, there is no alternative
Without doubt, lasers enrich the possibilities of cosmetic dermatology and are particularly successful for facial venous lesions. They can be considered as a possible treatment option for superficial, small-calibre spider veins in the legs, that are not supplied by deeper-lying feeder veins.8,10,11,12 For most patients, however, sclerotherapy is the better choice of treatment, as the well-established procedure is almost painless, well tolerated and gives good results.
Patients and affected persons can find in-depth information on spider and varicose veins and on appropriate methods of treatment for vein disease on the new dedicated website www.healthy-veins.com.
sup>2 Rabe E et al. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie. Epidemiologische Untersuchung zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen Wohnbevölkerung. Phlebologie. 2003;32:1-14.
3 Robert Koch-Institut (Hrsg.): Venenerkrankungen der Beine. Gesundheitsbericht-erstattung des Bundes, Heft 44, Mai 2009.
4 Alam M et al. Complications of lasers and light treatments. Dermatol Ther. 2011 Nov-Dec;24(6):571-80.
5 Rabe E et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014 Jul;29(6):338-54.
6 Zhang J et al. Efficacy and safety of Aethoxysklerol® (polidocanol) 0.5%, 1% and 3% in comparison with placebo solution for the treatment of varicose veins of the lower extremities in Chinese patients (ESA-China Study). Phlebology 2012;27 (4):184–90.
7 Peterson JD et al. Treatment of reticular and telangiectatic leg veins: double-blind, prospective comparative trial of polidocanol and hypertonic saline. Dermatol Surg 2012;38:1322-30.
8 Lupton JR et al. Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectases. Dermatol Surg. 2002 Aug;28(8):694-7.
9 Munia MA et al. Comparison of laser versus sclerotherapy in the treatment of lower extremity telangiectases: a prospective study. Dermatol Surg. 2012 Apr;38(4):635-9.
10 Meesters AA et al. Transcutaneous laser treatment of leg veins. Lasers Med Sci. 2014 Mar;29(2):481-92.
11 Parlar B et al. Treatment of lower extremity telangiectasias in women by foam sclerotherapy vs. Nd:YAG laser: a prospective, comparative, randomized, open-label trial. J Eur Acad Dermatol Venereol. 2015 Mar;29(3):549-54.