Varicose Veins And Spider Veins

Definition

Varicose veins are enlarged veins that can be blue, red, or flesh-colored, and visible from the skin surface. They often look like cords and appear twisted and bulging. They may be swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the legs, or inside the leg. Spider veins are like varicose veins but smaller and closer to the surface of the skin. Like varicose veins, they too are red or blue in color. They can look like tree branches or spider webs, with their short-jagged lines. They can be found on the legs and face and can cover either a very small or very large area of skin.

Severe disease can lead to more serious health problems. Sores or skin ulcers may form from chronic back-up of blood. They can be painful and hard to heal. The skin over the veins can become thin and easily injured. An injury can cause significant blood loss. Superficial thrombophlebitis is a blood clot in veins just under the skin. Deep vein thrombosis is a blood clot in a deeper vein, with pain, warmth, redness and swelling. If the blood clot travels to the lungs, it can be fatal.

Signs And Symptoms

Varicose and spider veins can usually be seen on the skin. Some other common symptoms in the legs include:
● Aching pain that gets worse after sitting or standing for long periods of time
● Throbbing or cramping
● Swelling
● Heaviness
● Rash with itching
● Darkening of the skin, especially around the ankles
● Restless legs, especially when in bed. The legs are uncomfortable and won’t stay still. 

Causes And Risk Factors

Varicose veins and spider veins can be caused by weak or damaged valves in the vein. Usually, when leg muscles contract with activity the blood is pushed back to the heart, working against gravity. Veins have valves that act as flaps, preventing blood from flowing backwards. If the valves become weak, blood can leak back from where it came from. When backed-up blood makes the veins bigger, they can become varicose. Spider veins can also be caused by hormone changes, exposure to the sun, and injuries.

A number of factors increase the risk of development of varicose and spider veins:
● Increasing age is associated with weakening valves in the veins.
● Medical and family history, being born with weak valves, and/or having family members with varicose veins increases risk.
● Hormonal changes, especially during puberty, pregnancy, and menopause; birth control pills and other medications containing estrogen and progesterone may contribute to the problem.
● Pregnancy, when there is 1.5 times the blood volume of the nonpregnant state. The growing uterus puts pressure on the veins. Improvement may occur during the first three months after delivery.
● Obesity can put extra pressure on the veins.
● Inactivity, such as sitting or standing for long periods of time forces the veins to work harder to pump blood back to the heart.
● Sun exposure may cause spider veins on the cheeks or nose of a fair-skinned person.

Diagnosis

Varicose veins can usually be diagnosed on physical examination. Sometimes tests are useful to determine the extent of disease. An ultrasound can check the structure of the veins, blood flow, and look for blood clots. Rarely, a venogram is ordered. Dye is infused into the veins for a better picture of blood flow than ultrasound can provide. Care usually starts with seeing a personal or family physician, who may refer a specialist. There are several types of doctors who care for varicose and spider veins, including:
● Phlebologist – a vein specialist.
● Vascular medicine – focuses on the blood system.
● Vascular surgeon – who can perform surgery if necessary.
● Dermatologist – specializing in skin conditions.

Treatment

 Varicose and spider veins are treated with lifestyle changes and medical procedures. The goal is to relieve symptoms, prevent complications and improve appearance. Lifestyle changes are recommended for disease with mild symptoms; for severe symptoms, several medical treatments are available, including sclerotherapy, vein stripping, and laser treatments.

Compression Stockings
Compression stockings put pressure on the veins, helping the blood flow from going backwards. There are three types: support pantyhose, over-the-counter (OTC) gradient compression hose, and prescription-strength gradient compression stockings. Support pantyhose deliver the least amount of pressure, all over, instead of where it is needed most. OTC offer slightly greater pressure than pantyhose. Prescription-strength gradient compression hose deliver the greatest pressure and can be applied by a professional.

Sclerotherapy
Sclerotherapy is the most common treatment for both spider and varicose veins. It’s very effective when done correctly. The doctor uses a needle to inject a liquid chemical into the vein. It causes the vein walls to swell, stick together, and seal shut. The vein becomes scar tissue, which stops the flow of blood. Sclerotherapy can be done in a doctor’s office and does not require anesthetic. Multiple treatments are typically required. Gradient compression stockings may be recommended to help with healing and decrease swelling. Side effects include:
● Stinging, red, raised patches of skin or bruises at the injection site. They disappear shortly after treatment.
● Spots, brown lines, or groups of fine-red blood vessels at the treatment site. They resolve right after treatment.
● Lumps of blood get trapped in the vein and cause inflammation. It isn’t dangerous, but there may be swelling, which can improve by applying heat. A doctor can drain the blood, if necessary.

There is a type of sclerotherapy in which ultrasound is used to guide the needle. It can be useful to treat veins which cannot be seen on the surface of the skin. It may be used after surgery or other treatments, if the vein returns.

Surface Laser Treatments

 Laser treatments can be effective on spider veins and small varicose veins. The technique sends strong bursts of light into the vein, which causes the vein to fade and disappear. It is safe for only certain skin types, particularly for lighter skin. The heat from the laser can be painful. Cooling can reduce the pain. Treatments take 15 to 20 minutes; usually two to five treatments are needed. It is not effective for varicose veins larger than 3.0 millimeters (about a tenth of an inch.) It allows usual activity immediately. Side effects include:
● Redness or swelling, which quickly disappears.
● Discolored skin, which disappears in 1 to 2 months.
● Burns and scars from poorly performed laser surgery (rare).
Endovenous techniques (radiofrequency and laser), and surgical procedures are reserved for severe disease.

Prevention/Lifestyle Management

Not all spider and varicose veins are preventable, but there are some steps to take to prevent or minimize the appearance of new varicose or spider veins, and to care for your skin and health in general. Some of these measures can also help ease discomfort:
● Wear natural sunscreen (without parabens or petrochemicals) to protect your face and minimize spider veins on the face.
● Exercise regularly, focusing on exercising the legs. Running and walking are good exercises.
● Control weight to avoid too much pressure on the legs.
● Don’t cross your legs for long periods of time while sitting. It can injure the legs. A minor injury increases risk of varicose veins.
● Elevate legs while resting.
● Don’t sit or stand for long periods of time. If spending considerable time standing is required, shift weight from one leg to the other every few minutes. With prolonged sitting, stand up and move around or take a brief walk every 30 minutes.
● Wear elastic support stockings.
● Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone the calf muscles for good blood flow.
● Eat a low-salt, high-fiber diet to help the swelling and avoid constipation.
Take proper care of your skin – it is your body’s largest organ. Avoid potentially harmful skincare ingredients, and instead use clean, simple ingredients to moisturize, nourish and tone your skin. This will help it to maintain a youthful, healthy glow. 

Your Questions Answered

1. How common are abnormal veins?
   More than half of people have varicose veins at age 50 and older.
2. Are spider veins dangerous?
   It’s extremely rare for spider veins to lead to serious health problems.
3. Should I see a doctor about spider and varicose veins?
   If the vein becomes red, tender, or warm to the touch, bleeds, causes a rash or discolored skin, or if the veins are interfering with daily activities, a physician should evaluate the condition.
4. Is there medicine I can take to get rid of spider veins?
   No. Here are 14 natural skin alternatives you may want to try.
5. What is the most important thing to do to prevent or limit the disease?
   Wear gradient-compression support stockings as much as possible.
6. Can spider veins return after treatment?
   New spider veins and varicose veins can develop because there is no cure for weak valves.

Article Written By Sheila M. Krishna M.D., FAAD

Dr. Krishna is a board certified dermatologist. She received her undergraduate degree at the Massachusetts Institute of Technology where she double majored in biology and foreign languages and graduated with Phi Beta Kappa honors. She is fluent in both English and Spanish. Dr. Krishna received her medical degree at the David Geffen School of Medicine at the University of California, Los Angeles, where she was a member of the Alpha Omega Alpha Medical Honor Society. She completed her dermatology residency at the Virginia Commonwealth University in Richmond, Virginia, and she served as Chief Resident in the Department of Dermatology. She completed an additional research year at UCLA with Dr. Lloyd Miller, where she gained expertise in research methods and protocol design and execution. Dr. Krishna is a Fellow of both the American Academy of Dermatology (AAD) and the American Society for Mohs Surgery (ASMS). Dr. Krishna practices in San Diego, California where she treats adults and children for skin conditions. Dr. Krishna was selected as a Top Doctor by her peers in San Diego in 2017. Website - https://www.sheilakrishnamd.com/

Article Reviewed By Natalia Kerr, Licensed Esthetician/Facial Specialist

Natalia Kerr is a licensed esthetician/facial specialist. She graduated from Orange Technical College in 2019 with her diploma in Facial Specialty. She is passionate about skincare and skin health, and has continued her education since graduation by attending various seminars, trainings, and trade shows. She struggled with acne for many years throughout her middle and high school years, and knows the damage to self-confidence that comes with it. This inspired her journey into the world of skincare, and she currently owns and practices at Skin by Natalia in Orlando, Florida. Website - https://skin-by-natalia.square.site/

More Information For The Public

American Academy of Dermatology
Phone: 847-240-1280; Toll-Free: 866-503- SKIN (7546)
https://www.aad.org
 
American Society for Dermatologic Surgery
Phone: 847-956-0900
https://www.asds.net

References

1. U.S. Department of Health and Human Services, Office on Women’s Health: https://womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.html
2. American Society of Plastic Surgeons: https://www.plasticsurgery.org/cosmetic-procedures/spider-veins.html
3. National Library of Medicine: https://www.nlm.nih.gov/medlineplus/varicoseveins.html
4. Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/varicose-veins/basics/definition/con-2004347