Unwanted and unattractive blood vessels called spider veins have a red or bluish color. They appear mostly on the legs, occasionally on the face or elsewhere.

They can be short, unconnected lines each about the size of a large hair. They may be connected in a scraggly, "sunburst" pattern. They may also look like a spider web or a tree with branches. Sometimes, they occur in a small area and aren't very noticeable, or they can cover a large area of skin and be quite unattractive.

Larger unwanted blood vessels may be raised above the skin surface. They may occur along with spider veins. These large veins are called varicose veins.

Some people with unwanted blood vessels suffer from occasional pain, ranging from a dull throbbing pain to a burning sensation.

Though unwanted blood vessels carry blood, the great majority of them, especially spider veins, are not necessary. If they are unsightly or uncomfortable, they can be treated by injection of a solution that will cause them to disappear or become much smaller. There is about a 90 percent chance for a greatly improved appearance.

What Causes These Blood Vessels to Become Visible?

The cause of spider veins is not known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition can very occasionally occur as part of an internal disease.

Spider veins appear in both men and women, but more frequently in women. The hormones estrogen and progesterone may play a role in their development. Puberty, birth control pills, pregnancy or hormone replacement therapy often seem to bring them on. They may also appear after an injury or as a result of wearing tight girdles or hosiery held up with tight rubber bands. Spider veins may also occur with large varicose veins.

Spider veins on the nose or the cheeks of fair skinned persons may be related to sun exposure.

Can Spider Veins Be Prevented?

Spider veins can't always be prevented. Wearing support hose may prevent some unwanted blood vessels from developing in some people. Keeping one's weight at a normal level and exercising regularly may also be helpful. Eating a high-fiber diet and wearing low-heeled shoes can also help. Sun protection is important to limit the number of unwanted vessels on the face.

How Are Unwanted Blood Vessels on the Legs Treated?

Sclerotherapy

In the majority of cases, a procedure called sclerotherapy is used to treat unwanted blood vessels. A solution, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930s and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to clot.

Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable or invisible.

A single blood vessel may have to be injected more than once, some weeks apart, depending on its size. In any one treatment session a number of vessels can be injected.

The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. Your dermatologist will decide the solution that is best for your particular case.

Occasionally larger varicose veins are underneath the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy followed by compression or by a surgical procedure performed by a vascular surgeon. Other physicians believe that spider veins may be treated by sclerotherapy without worrying about the varicose veins unless they become troublesome.

How Successful is Sclerotherapy?

After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual. Total disappearance of spider veins is usually achieved.

Can Sclerotherapy Be Used on All Skin Types?

Yes. All skin types and skin colors respond equally well.

Will Insurance Cover the Treatment of Unwanted Blood Vessels?

Insurance coverage varies. If the treatment is solely for cosmetic reasons, it may not be covered. Sometimes a second opinion, laboratory studies or photographs are required by insurance companies before treatment is started.

Are There Side Effects to Sclerotherapy?

Even with a highly experienced physician performing the treatment, there are some possible side effects. They include:

Stinging or pain at the sites of injection, swelling of the ankles or feet or muscle cramps. Muscle cramps almost always occur when the injection takes place in the ankle area. These usually go away within 10 to 15 minutes after injection.

Red, raised areas at the sites of injection. These should disappear within a day or so.

Brown lines or spots on the skin at the sites of treated blood vessels. Probably made up of a form of iron in the blood, these darkened areas may result when blood escapes from treated veins. These dark areas occur more often in patients who have larger veins treated. In most cases, they disappear within a year, but in a small percent of patients they may last for years.

Development of groups of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs. About a third of patients develop these; most disappear by themselves, some go away with injection treatment or laser therapy, a few may last.

Small, painful ulcers at treatment sites either immediately or within a few days of injection. Sometimes these occur because some of the solution has escaped into the surrounding skin. These can be successfully treated, but it is necessary to inform the physician of them immediately.

Bruises at the site where the needle went into the skin. These will disappear in a few weeks and are probably related to the thinness of blood vessel walls.

Allergic reactions to certain sclerosing solutions. Although, on rare occasions, such reactions may be serious, they can be treated by immediate injections of epinephrine. Less serious reactions are treated with antihistamines.

Inflammation of treated blood vessels. This is very unusual but when it occurs it is treated with medications such as aspirin, compression, antibiotics or heat.

Lumps in injected vessels, particularly larger ones, may develop. This actually is coagulated blood but is not at all dangerous. The dermatologist may drain the blood out of these areas a few weeks after injection.

Will Treated Veins Recur?

Larger veins are likely to recur unless support hose are worn. Spider veins may also recur. It may seem that a previously injected vessel has recurred, when, in fact, a new spider vein has appeared in the same area.

Is a History of Blood Clots in the Lungs or Legs a Reason to Avoid Therapy?

Not necessarily, but the procedure must be done with caution to lessen the risk of blood clots.

Are There Other Treatment Methods?

New lasers may hold promise for treating blood vessels, but currently vessels in the legs do not respond uniformly to laser treatment.

Surgically tying veins off (ligation) or pulling them out (stripping) are other procedures for treating unwanted blood vessels. They are usually reserved for large varicose veins.

How Are Spider Veins on the Face Treated?

There are several ways to treat spider veins on the face. Lasers have been used successfully, alone or in combination with electric needle therapy.

What Do I Do After Treatments?

Physicians may differ in their after-treatment instructions to patients. Depending on certain factors, such as the size of the blood vessels injected, patients may be instructed to put their legs up for an hour or two and then walk. Others are asked to walk immediately. All patients are instructed to walk a good deal in the days following the procedure so that blood will be pushed through other vessels.

Some physicians bandage the injected areas and instruct patients to "compress" the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or have other characteristics.

Between treatments, many physicians recommend the use of compression or support hose. This may be particularly recommended for people who spend a lot of time on their feet.