Cutaneous Necrosis, Telangiectatic Matting, and Hyperpigmentation following Sclerotherapy Etiology, Prevention, and Treatment

Abstract

After studying the following article, participant should be able to: 1. Understand the definition and potential causes of cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. 2. Advise patients prior to treatment on the common risks involved in sclerotherapy and to advise them on the relative incidence. 3. Understand the concept of minimal sclerosant concentration and how it can help the physician to choose sclerosing solution concentrations to minimize risks.

Safety Concerns for Sclerotherapy of Telangiectases, Reticular and Varicose Veins

“…Technique-related measures to prevent this complication include using the minimum sclerosant concentration, small volumes and low pressure when treating a vein. Telangiectic matting usually is transient and resolves 3-12 months posttreatment [5,12] . Nevertheless, matting can be also permanent [12] .…”

“…The cause of matting remains unclear. It has been suggested that this represents either dilatation of pre-existing subclinical vessels or angiogenesis due to inflammatory processes and vascular obstruction [12] . It appears as a patchy pigmentation with onset 4-6 weeks posttreatment.…”

“…Although hyperpigmentation may persist for months, spontaneous resolution occurs in 70% of patients in 6 months with 99% resolution occurring in 1 year. Permanent pigmentation, that is, staining after 1 year affects 1-2% of patients [12] . Hyperpigmentation is caused by the migration of melanin pigment to the skin and by the deposition of hemosidirin in the dermis.…”

“…This local AE occurs in approximately 15-20% of patients treated with sclerotherapy. Matting consists of an unpredictable individual reaction of the patient that appears after the surgical removal of the vein [12,19] . The cause of matting remains unclear.…”

0.5% polidocanol for treatment of varicose veins

“…The larger the varicosities are, the more likely it is that the side effects will occur. 24,25 Occasionally, localized thrombi become painful and require stab-wound transcutaneous evacuation with manual compression of the vein. This is done with local anesthetic infiltration of the skin under sterile conditions.…”