Following sclerotherapy treatment of surface leg veins it is usual to develop some superficial bruising in the area of treatment. This bruising typically changes in colour from an initial purple discoloration to a brown colour before disappearing over one to two weeks in the same way a bruise from a knock to the leg might resolve. Show In a small percentage of patients however, darker brown marks can develop on the skin after sclerotherapy and can persist for a number of months. These brown marks are termed ‘staining’ or ‘post sclerotherapy hyperpigmentation’ and it is estimated that brown marks that last more than 12 months after sclerotherapy can occur in about 1-2 % of patients. The pattern of brown staining is commonly in the line of the treated vein (linear staining) but circular coin shaped discolouration can also occur (nummular staining). Biopsy studies have shown that the brown skin discolouration in staining is due to Haemosiderin, which is the iron residue from red blood cells. In staining the Haemosiderin is predominantly found deposited in the superficial dermis of the skin but can sometimes be found deeper. It is thought that when leg veins are injected red blood cells leak from inside the vein into the surrounding skin (extravasation) and then the Haemoglobin in the blood cells is broken down into Haemosiderin. As Haemosiderin is a brown pigment deposits appear as a brown discolouration on the skin with the more Haemosiderin the darker brown the colour. Various factors have been identified that are associated with an increased risk of staining and include
In patients identified as at higher risk of staining the appropriate use of compression stockings after sclerotherapy treatment is very important to reduce the risk of staining. Compression can help reduce the leakage of blood cells into the surrounding skin and hence lessen the risk of staining. The use of compression stockings is particularly necessary if a decision has been made to treat surface veins in the presence of underlying deeper vein reflux. In the vast majority of patients who develop staining after sclerotherapy no specific treatment is required apart from encouraging daily massage to the area to help dissipate the unwanted pigment and with time and massage the brown discolouration slowly disappears. In a small number of patients if they are concerned about the appearance of the staining or it proves very persistent then treatment is possible. Bleaching agents such as Hydroquinone, Kojic acid and Azealic acid target melanocytes and as such are not effective on Haemosiderin pigment. Exfoliants such as chemical peels can sometimes help but carry a risk of causing inflammation and further inflammatory pigment. The most effective treatment option for removing post sclerotherapy staining is with the use of medical grade lasers. Various lasers have been tried and it has been found that lasers which deliver their laser beam in much shorter pulses are more effective in shattering pigment than lasers that produce longer pulses. The shortest laser pulses are produced by Q Switch nanosecond or picosecond lasers. It has also been determined that light in the 660-680 nanometre wavelength range is particularly attracted to Haemosiderin pigment and lasers that produce laser light in or near this range are the most effective in targeting Haemosiderin. Hence the laser that is preferred for removing post sclerotherapy staining is either the Q Switch 650nm (REVLITE) or Q Switch 694nm laser (RUBY). The new 755nm picosecond laser (PICOSURE) also seems very effective and is preferred for darker skin types with post sclerotherapy staining as it is less likely to effect normal pigment cells.. At the Melbourne Leg Vein Centre we have all 3 of these lasers available. Although in our clinic the incidence of post sclerotherapy staining that requires laser treatment is very rare, we are often asked to treat patients who have developed staining after sclerotherapy treatments elsewhere. Is it normal to have bruising after sclerotherapy?It is normal for the area to look red, slightly inflamed, and itchy after sclerotherapy. This resolves in a few hours. Bruising can occur and lasts a few days to a few weeks. The plant extract arnica can be used to help speed up the absorption of bruising.
How long does discoloration last after sclerotherapy?Within 6-12 months, most of this hyperpigmentation will heal up. Less than 5% continue beyond 12-months.
Why do my veins look worse after sclerotherapy?You will likely look worse after the treatment because the medicine leaves small welts similar to mosquito bites. Don't' be discouraged! Proper spider vein treatment is a process and it is after the subsequent treatments that you really begin to see the effects.
How long does it take for legs to look better after sclerotherapy?Results. If you were treated for small varicose veins or spider veins, you can usually expect to see definitive results in three to six weeks. Larger veins may require three to four months. However, multiple treatments may be needed to achieve the results you want.
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