Spider veins

are dilated threadlike venous capillaries filled with an excessive volume of blood, making them visible and unwanted. It affects mainly women and is a reoccurring condition. Even today the treatment of choice remains the injection treatment called sclerotherapy . ("Sclera" in Greek means hard and scar tissue is a hard tissue, hence the term "sclerotherapy " . )

It basically implies injection of a chemical (sclerosing agent) into the vein in order to produce a minimal local injury to the inner lining of the minute blood vessel. The produced scar tissue-the end result of any healing process-acting as a "glue", will close and seal off the spider veins. The closed vein disappears from sight and blood is shunted toward normal capillaries. The available agents used in this country are saline solution, a very concentrated and thus painful table salt solution, prone to cause local injury and Sotradecol , a detergent (soap) type chemical. The best solution, however, is a European solution Ethoxysclerol or Sclerovein soon to be approved by the FDA. Regardless of the sclerosing agent used, several injection sessions 1-3 weeks apart may be needed to obtain at least 70-80% improvement. Occasionally, a few days of local compression in the form of a gradient elastic surgical stocking may be required following the sessions.

Please note that LASER treatments have not replaced sclerotherapy for spider veins on the leg in the hands of ethical and moral practitioners. Lasers are exceptionally good for facial spider veins. Laser sessions are very expensive and the results are not good enough. Many times injections must be used as a supplement to achieve the desired results. An ethical practitioner will suggest LASER treatment only for small spiders localized on the skin of the face. Please do not fall for newspaper claims from manufacturers or practitioners advertising this form of treatment. Financial gains rather than hard scientific facts are the real reasons for this type of misleading advertisement. Please remember that a variety of specialists have acquired these expensive (six figures) laser machines. For them, in this era of HMO's and PPO's, laser means: Last Attempt for Salavage Economical Return. A special caution for the use of Photoderm as it can cause severe skin injury and pigmentation. See also: FAQ

Lasers

One and a half years have passed since the above was written. Even today, almost 2 years later, the general assumption of moral practitioners is that the lasers have basically failed us in the treatment of spider veins of the leg. (For the facial spiders they are good and they should be used as the first line of treatment.) Personally, I think that the industry and several physicians who have had and may still have financial incentives in promoting these expensive machines have all but misled us, the public and physicians alike, all because of greed.

A well known practitioner who has clear financial interests in the PHOTODERM machine mentioned above, while demonstrating the greatness of this machine at a major venous meeting in 1996 has caused severe skin injuries on 2-3 provided volunteers.

Personally, when I will pay off my laser machine, the LASERSCOPE, I will have shelled out over 100.000 dollars and in ten life times I will not be able to recover my "investment". Now, after several years of industry’s praise of these "magnificent" forms of treatment, we hear that the wavelength of these machines should have been not in the range of 532-600 nm ( as most were) but double the range, namely 1064 nm. I am convinced that in several years we will hear departure from this new "standards" as well!

I was present at a recent meeting organized by the LASERSCOPE Company when this new wave length machine was introduced. When I criticized their statements regarding the "successes" of the previous laser machines in treating leg spider veins, one of the officials of the company , who shall remain nameless, almost attacked me physically after I had enough of the nonsense and decided to leave the conference.

The reader should also know of dirty tricks employed by another well-known practitioner in order to block the publishing of at least one medical report critical of the results of the Photoderm. Only after the firm stance of the author, who wrote to the chief editor of the medical journal, was his critical report printed on the pages of the journal, the Dermatologic Surgery.

Personally, I can testify that the results of the LASER are inconsistent, the treatment is long, requiring many sessions, is expensive, and is also painful. In many cases and after 1-3 sessions the disillusioned patients demand to revert back to the injection treatment. Sclerotherapy remains, therefore, even today the main form of treatment for spider veins of the leg. Lasers should be used sporadically on leg veins and only on cases of small areas of red spiders that do not respond to injection treatment. Also, if after 2 maximum 3 sessions no results are seen, the treatment should be stopped. Personally I take a photo of one small area and do a test dose possibly repeated one additional time. I do not charge for these test doses. Only if positive response is clearly visible while comparing the before and after photographs would I suggest targeting larger areas.