Aug. 2, 2004 -- New treatments are helping the millions of people with varicose or spider veins on their legs to shed their cover-ups this summer, say experts speaking at the annual summer meeting of the American Academy of Dermatology in New York City last week.
"These veins cause heaviness of the legs, aches, pains, night cramps, and ankle swelling," says Mitchel P. Goldman, MD, an associate clinical professor of dermatology at the University of California at San Diego. "They are a huge national problem -- far and beyond just a cosmetic problem."
The good news is that new, effective, and minimally invasive procedures exist that can vanish these unsightly veins quickly and painlessly.
Spider veins are small, red, blue, or purple veins under the skin that look almost like road maps, while varicose veins are larger and deeper. Such unsightly veins occur in 30% of people by age 20 and in 80% of people by age 80. They occur when the walls of the veins or the valves are weak. Blood is supposed to flow through the veins and to the heart, but when a valve in a vein becomes damaged, blood pools, flows backward, and puts pressure on vein walls -- causing bulging, painful varicose veins
With sclerotherapy -- the procedure used to treat these conditions -- a doctor injects a scarring or sclerosing solution into the veins. The solution causes the inside lining of the vein to become inflamed and 'sticky,' causing it to then close.
Today, "foam sclerotherapy is less painful and less dangerous and a better bang for the buck" than older treatments, he says.
They are a "major advance and there is no pain whatsoever with these new detergent foam treatments," he says.
But all good things take time, he explains.
It takes about six weeks for the veins to disappear. "You don't walk into the office before you go on a cruise to have your veins done because it takes six weeks for veins to go away."
But "not only do we get rid of veins, we get rid of all the symptoms," he says.
Avoid Compounding Pharmacies
"Doctors especially nondermatologists are trying to buy inexpensive sclerotherapy solutions from compound pharmacies and they don't know what they are getting," he warns.
These pharmacies are largely unregulated and can create solutions that may contain a potentially fatal cancer causing compound called carbitol. In a study conducted by Goldman, some solutions mixed by compounding pharmacies had dangerously high levels of carbitol. This research will be published later this year.
"This is an incredible problem," he says.
"You need to know what type of solution your doctor is using," Goldman says. "It needs to come from a pharmaceutical lab -- a real lab not from some guy buying detergent and mixing it in his own lab," he says, adding that it should be an FDA-approved, FDA-licensed, and FDA-sanctioned product.
"Go to a dermatologist or dermatological surgeon to get leg veins treated -- not an obstetrician or other specialist," he says. "I don't know any dermatologist or dermatologic surgeon who buys solutions from compounding pharmacies, but it is such a popular procedure and so many doctors on the planet are injecting solutions into patients' legs," he says.
Zapping Varicose Veins Away
A new laser treatment -- the Endo Laser Vein System -- destroys varicose veins from the inside out. It allows doctors to insert a laser into the vein and pull it out as it is fired. Whereas, older lasers shot the laser through the skin, this procedure requires only local anesthesia, a small incision, and no stitches, Goldman explains. Unlike previous treatments for varicose vein stripping which required general anesthesia.
"You insert a laser into the vein and destroy the vein from the inside out," while protecting the skin, he says.
It's also quick, Goldman says. "From the time I walk into the operation room until I walk out, it's about 12-14 minutes and for the patient, it's about 35 minutes."
"It's a very simple out-patient treatment and you are back to work that day," he says.
One study, slated to be published in the November 2004 issue of Dermatologic Surgery, showed that after 18 months, all 24 people who underwent the Endo laser intravascular procedure had been completely cured.
"In fact, the treated vein was not identifiable six months after treatment, and there was no recurrence of any varicose veins at any time during our follow-up," Goldman explains.
He also says there were no reports of postoperative pain.
"There is no pain and it costs less than the older procedure because it does not require hospitalization and there is no time off from work [needed]," he says.
"This laser is a remarkable treatment that has been shown to work and be incredibly effective for large veins," says Ariel Ostad, MD, a dermatologic surgeon and assistant clinical professor at the New York University School of Medicine in New York City.
The foam sclerotherapy is something that Europeans use which is a great treatment for spider veins," Ostad says.
The treatment of varicose veins "is revolutionized without a doubt," he tells WebMD. "Thirty years ago, it involved vein stripping which left tremendously large deformed scars all over the legs and you wouldn't even be able to wears skirts after the procedure," he says. "And all the veins came back, so you would have scars and veins," he says.
Today's treatments involve no skin scars and much fewer risks than the older procedures, he says.