Sclerotherapy options: How they stack up

Recent advances in the materials and procedures used have shown great promise in the treatment of venulectasia and varicose veins. Robert Weiss, M.D., associate professor, and Girish Munavalli, M.D., M.H.S., clinical instructor of dermatology at Johns Hopkins University School of Medicine, have specifically evaluated the role of nondetergent sclerosants for minimizing side effects after sclerotherapy.

Eliminate high pressure

"Detergent-based sclerosants, such as sodium tetradecyl sulfate (STS), have the ability to be foamed to increase contact with the endothelium. Osmotically corrosive agents such as glycerin, on the other hand, are more site specific, immediate acting, destroy the entire endothelial cell and are less inflammatory, but cannot be foamed. Glycerin is also used in Europe and the United States for fine telangiectasias and has a high viscosity, which means it stays exactly where you put it," Dr. Munavalli tells Dermatology Times.

Efficacy study

Dr. Munavalli, in collaboration with dermatologic surgeons Margaret Weiss, M.D., and Dr. Robert Weiss, performed a study comparing the efficacy of low concentration foamed detergent (0.1 percent foamed STS) and mildly corrosive 72 percent glycerine solution.

Results showed that immediately post-treatment, the 0.1 percent foamed STS treated veins had edema and erythema, whereas the glycerine treated veins demonstrated only a mild erythema and mainly vessel contraction. There was no difference in patient perception of mild discomfort.

Interestingly, thigh telangiectatic groups improved after treatment with both sclerosants, but their efficacy after one treatment was judged at 90 percent for STS and only 60 percent for glycerin (from photographic evaluation by a blinded physician).

"Glycerin should be used for veins smaller than 0.4 mm to 0.6 mm and in patients who are prone to matting and/or hyperpigmentation, or those with post-treatment hyperpigmentation or matting. Conversely, 0.1 percent foamed STS is better for vessels larger than 0.4 mm to 0.6 mm, and should be considered as the first choice in sclerotherapy treatment in those patients with no history of adverse effects from previous treatments," Dr. Munavalli says.

Hand veins

Dr. Munavalli says that a slightly stronger concentration of foamed STS (0.2 percent to 0.5 percent or 0.5 percent to 1 percent) can also be used for cosmetically unappealing dorsal hand veins, with strikingly positive aesthetic results.

Two to three treatments are usually necessary for complete resolution of the vessels. He says that pre-treatment considerations are important and include a history of hand trauma (e.g. weakness), carpal tunnel syndrome, a need for frequent intravenous medications and a foreseeable need to canalize hand veins (e.g. chemotherapy).