Spider veins treatment

Vitamin K is the most common active ingredient in spider vein creams. Sadly, it appears to be completely ineffective. First, there are no studies demonstrating that it reduces spider veins. Second, even on purely theoretical grounds, there is no obvious rationale why it would help. Vitamin K is a blood clotting cofactor. Since it facilitates blood clotting, it may help in such conditions as bruising, post-surgical recovery and the like, i.e. whenever there is bleeding to be stopped. However, spider veins are dilated not ruptured. There is no bleeding to be stopped

Vessel strengthening agents (topical or oral)

It stands to reason that strengthening veins and capillaries could improve spider veins or at least prevent their progression. Indeed, week vessel walls appear to be a factor in the development of this condition. Unfortunately, vessel-strengthening agents have not been systematically studied as a treatment for spider veins. However, a number of plant-derived substances were shown in clinical trials to improve a related condition also related to weak vessel walls -- venous insufficiency.

One such agent is escin, a substance found in horse chestnut. Escin strengthens veins and capillaries by blocking enzyme called hyaluronidase. Blocking hyaluronidase prevents the breakdown of proteoglycans, which are important structural component of venous and capillary walls. Other plant-derived agents shown in clinical studies to improve venous insufficiency and associated edema of extremities include Butcher's broom rhizome extract and grape seed extract.

Unfortunately, until proper studies are conducted, we won't know for sure whether these agent are indeed useful in treating or preventing spider veins, whether they are best used orally or topically, and what dosage or strength is optimal. Some of these agents, particularly grape seed extract, appear to have other skin and health benefits and a good safety record. Depending on your philosophy, this may be a sufficient reason to give it a try before hard evidence is in.

Lasers and intense pulsed light

Hemoglobin, the oxygen carrying pigment in red blood cells, is known to selectively absorb light in a particular range of wavelengths (500 - 600 nm). When a high-energy beam of such green-to-yellow light is directed at the skin with spider veins, it is absorbed more by the blood than by the rest of the tissue. As a result, dilated vessels heat up, close and are eventually absorbed into the body. This leads to fading and sometimes complete disappearance of spider veins.

The good part of this approach is that it is scientifically sound and often works well. It does not require injections or incisions. But there are also drawbacks and limitations. Some people do not respond. Others respond only after several repeated treatments. In some people, results are permanent or at least long-term, while in others, spider veins will recur. There may be discomfort and bruising for a few days after the procedure.

As a rule, laser/light treatments work best for small isolated facial spider veins / broken capillaries. Small spider veins in the legs also respond but not as well as facial ones. Laser/light are the least effective for larger, wide spread, branched spider veins in the legs, which, due to size, blood pressure and retrograde blood flow, often do not close or quickly reappear. (For those, sclerotherpay tends to be a better choice.)

The equipment used to treat spider veins includes lasers emitting in the 500-600 nm range and intense pulsed light devices with filters allowing to isolate the desired green-to-yellow range. (See Noninvasive Treatments for information on specific devices.)

Sclerotherapy

Sclerotherapy involves injecting a chemical agent (sclerosant) into a vein in order to induce local damage and scarring, which causes the vein to close. Sclerotherapy is used to treat varicose veins as well as medium-to-large spider veins. Injecting small spider veins with sclerosant is too difficult and laborious to be practical. When used appropriately, sclerotherpay is effective in over 80% of patients. For extensive, branched leg spider veins, the long-term success of sclerotherpay partly depends on whether the feeder veins (larger viens feeding into the spider veins) are closed as well. Otherwise, such spider viens have greater chance of recurrence.

Serious side effects of sclerotherapy, such as allergic reaction to sclerosant, ulceration or necrosis, are possible but rare. Minor side effects, such as bruising or itching are common but transient. A relatively prolonged (6-12 mo) discoloration of the skin along the vein may occur in some people.