A variety of factors... Spider and thread veins of the legs are permanently dilated superficial skin veins that often appear in the early 30’s and 40’s, more commonly affecting women.

They are often caused by hormonal changes especially during pregnancy and due to hormonal changes associated with low levels of progesterone. Localised trauma/bumps to the legs can also cause damage to the superficial veins leading to thread veins

Low levels of tissue oxygen levels reaching the tissues is another factor. This may happen if the skin is compressed by tight clothing such as skinny jeans or there has been poor tissue circulation from varicose veins or prolonged standing.

Usually, thread veins are asymptomatic but sometimes can be associated with aching of the legs and itching.

Sometimes they can be hereditory.

The veins in the legs have to return blood from the feet back up towards the heart against gravity. There are two main systems of veins in the legs. The deep system lies within the muscles in the legs and carries the majority of the blood.

As the muscles contract the veins are squeezed and blood moves up the veins. Valves attached to the walls of the vessels prevent backward flow and as the blood moves up it is drawn into the deep system from the superficial system in the skin.

In healthy veins the valves close, and blood only moves in one direction.

Approximately 50% of the population will at some point develop a problem with their veins.

Varicose veins occur when the valves in the veins do not close properly and blood leaks back against the flow, this is called reflux. Reflux causes back pressure in the superficial veins which are not supported by muscle and can dilate. As they stretch their valves do not close properly, and so the problem develops, leading to varicose veins and thread veins.

Though varicose veins can be very unsightly and uncomfortable only 2% of sufferers will go on to develop skin problems such as swelling, pigmentation, and leg ulcers caused by poor circulation. For this reason, the NHS does not usually offer treatment for varicose veins which are considered largely a cosmetic problem.

The affected area is sanitised, then using a very fine needle, a tiny amount of a sclerosing agent - Aethoxysklerol 0.5% Solution is injected into the visible dilated thread veins that are being treated. When injected, the sclerosant liquid damages the lining of the vein walls, causing swelling, which immediately diverts the blood into unaffected veins, causing immediate blanching or whitening of the treated veins.

The treated veins will become inflamed and blocked from the sclerosant, which then closes the veins shut to stop them from opening up with blood. The closed-up veins then fade away and are harmlessly reabsorbed into the body.

Because this treatment targets individual veins, it may take more than one treatment to eliminate them all.

Unfortunately, if you have this tendency there is very little that can be done to stop them appearing.

There is no clinical evidence that any homoeopathic remedies will either remove or stop them from appearing.

Varicose veins and thread veins may be symptoms of an underlying problem. Whilst these symptoms can be treated there is no cure to prevent them from occurring again in the future.

Some things can help...

Maintain a healthy weight. Avoid standing or sitting for long periods, as the veins need the squeeze of active muscles to move the blood.

Wearing compression hosiery will improve the circulation in the legs and manage any symptoms of poor circulation such as aches or swelling.

Give up smoking, which constricts the capillaries.

Treatment time will vary depending on how large an area you want treated and how many veins are visible but normally a treatment session can range from 10 to 30 mins. You may be required to elevate your legs for 10 minutes after the procedure, you will be able to go home after your treatment.

New regulations state that certain medications must be prescribed with a face-to-face consultation.

Before booking sclerotherapy, you will require a face-to-face consultation with my prescriber who is based in a local practice, this is because Aethoxysklerol 0.5% Solution is a POM (prescription only meducation).

These prescribing clinics are usually held on Wednesdays 5-6 pm or Thursdays 1-2pm, and are situated at Sisu’amour salon which is just 5 minutes away.

To make this appointment please contact Sisu’amour direct:

Tel: 0117 3251315 or 07494 423938

Appointment required: Prescribing clinic appointment with Sharon

Address: Sisu’amor, 4-6 Charlton Rd, Keynsham, Bristol BS31 2JA

ONCE YOU HAVE HAD THE CONSULTATION, YOUR SCLEROTHERAPY APPOINTMENT WILL BE AT WESTFIELD CLINIC.

Please allow at least 2 weeks between having this consultation and the actual treatment with me, to allow me time to order the prescribed product.

You will have also have a consultation with me, just before you have the sclerotherapy treatment, so that I can answer any questions that you may have on the day.

Treatment cannot go ahead without the prescription.

This is not a painful procedure. The injections are made superficially with a tiny needle. Most individuals tolerate the procedure and do not require any type of anaesthesia. You may experience a slight burning or stinging sensation as the solution is applied, but nothing severe. This will vary from person to person.

After treatment, the treated areas may experience itching and mild discomfort which usually passes within 1-2 days.

It is quite common for there to be some immediate itching and redness at the site of the treatment.

You may also experience localised swelling and irritation. Your legs may look bruised.

The veins may also look worse before they look better. Sometimes a darker colour appears under the skin, but by days 10 to 14 you will start to see an improvement.

Within 4 to 6 weeks the veins will look much better, sometimes full benefit can be seen at approximately 12 weeks.

Everyone is different. These guides do not define success or failure.

Most people require between 2-4 treatments, but you may require more or less depending on how severe the veins are and your response to treatment.

The results after one treatment vary considerably from one client to another. Some veins may disappear completely whilst others may only fade and some remain unchanged.

On completion of a successful treatment you can expect an improvement in the overall appearance of 60-80%.

After 4-6 weeks a review is booked and/or possible further treatment if required. You should leave a 4-6 week gap in between having further treatments on the same area.

If you have lots of veins you want to be treated, you may visit again after 2 weeks as long as it's a different vein to be treated.

This treatment is suitable for the legs only.

The foot and ankle (malleolar area) are considered high-risk zones for sclerotherapy because major arteries and nerves are located very close to the skin surface. We recommend having treatment using ultrasound in this area to precisely locate the veins and ensure the needle does not enter an artery

In any one session, a limited amount of Aethoxysklerol may be used; this is for your safety. However, you can return 2 weeks later to treat a different vein/area.

The results of treatment are permanent on the veins that are treated.

With future pregnancies, venous disease, trauma to the skin, underlying or un-treated varicose veins, may mean new thread-veins are more likely to recur.

Some people come back for a top-up session in 2/3 years time. for any new thread veins which may have developed.

Sclerotherapy is a treatment for the symptoms rather than a cure for the cause.

Absolutely nothing. Thread veins are almost entirely a cosmetic problem. They do not form blood clots and they do not cause swollen feet. A few people find that their veins cause some aching which is relieved by sclerotherapy.

Thread veins have no function and removing does no harm. The only reason they are removed is because of their unsightly appearance.

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It is expected most patients will experience some minor bruising, localised swelling, and there may be noticeable discolouration of the treated veins which will slowly resolve over the next 2-3 months after treatment. This can be a normal and expected part of the treatment process.

Occasionally hyperpigmentation may occur, which is discoloration of the skin, usually a brownish colour or shadowy in appearance. It occurs in 9-30% of patients. Post-sclerotherapy hyperpigmentation is usually temporary, fading within six months. More severe cases can last up to a year, and in a minimal number of patients, about 1%, hyperpigmentation can be permanent. These effects can be reduced by wearing appropriate compression garments after treatment and avoiding excessive sun exposure to the legs.

If you take Hormone Replacement Therapy or Birth Control Pills, beware that they can be angiogenic and increase chances of hyperpigmentation (brown staining of skin).

A few people may develop intense itching at the site of injection.

More serious side effects are rare but can include allergic reactions and skin blistering and necrosis.

In extremely rare cases, patients have suffered deep vein thrombosis but the risk of this is one patient in 10,000.

To reduce the risk of bruising and bleeding, if appropriate, you should avoid anti-inflammatory painkillers (aspirin, ibuprofen, Nurofen, etc), as well as St John's Wort, Vitamin E, Fish oil, Gingko, Ginseng, or Garlic supplements 2 days pre-treatment.

If possible, avoid taking iron supplements (including multi-vitamins containing iron) for 1 week before, as this will help decrease the chance of hyperpigmentation.

Avoid alcohol and smoking for 2 days before and 2 days after treatment.

Compression garments may be suggested to be worn continuously for up to 72hrs immediately post-treatment; therefore, you may like to wash/shower prior to your appointment, but do not use bath oils, lotions or creams on your leg(s) for 24 hours before your treatment.

Make sure that you have had something to eat and drink on the day of your treatment.

Please dress in loose clean clothing (jogging bottoms or a skirt).

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Between 10-45 minutes depending on how many veins we're treating in a session. Also allow 15 minutes for consultation.

Avoid anti-inflammatory painkillers (aspirin, ibuprofen, Nurofen, etc), as well as St John's Wort, Vitamin E, Fish oil, Gingko, Ginseng, or Garlic supplements at least 2 days post-treatment. Avoid iorn 7 days post-treatment.

Avoid periods of prolonged immobility.

• Wear class 1 or 2 compression garments either lower leg or full leg depending on the areas of treatment post-procedure for 24-72hrs continuously. During this time you will not be able to take a bath or shower then 12 hours per day for the next 1-2 weeks following treatment. Wearing a compression garment can reduce the risk of side effects and improve the effectiveness of the treatment.

• Expect your legs to appear worse on removal of the stocking or bandage, at this stage this is normal. They may look worse for up to 2 weeks post-treatment.

• Do not disturb, lift or pick any scabs that form on the skin. Scabs are an important part of the skin healing process and if removed too soon could scar the skin.

• Avoid extremes of temperature for up to 2 weeks ie. very hot baths, and saunas. It is advised that you shower rather than take a bath during this time. Avoid scrubbing the skin over the treated area.

• Do not apply body lotion or creams to the treated area for one week.

• Avoid sun exposure for 4 weeks, pigmentation may take longer to fade.

• Avoid strenuous/high-impact exercise for up to 2 weeks.

• Elevate your legs as much as possible for the next 2 weeks.

• Avoid waxing or shaving the treated area for two weeks.

• Consider delaying long-haul traveling for up to 6 weeks post-treatment.

• You will require a review appointment 4-6 weeks later, where if required a follow-up treatment can take place.

• If you have multiple veins that could not all be treated at your appointment, you may come back 2 weeks later if treating a different area.

You will be given full aftercare information at your appointment.

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Yes, maintaining proper compression is critical because it minimises the blood re-entering the injected area, improves venous blood flow, decreasing the incidence of post-sclerotherapy hyperpigmentation and telangiectatic matting. We advise wearing compression garments either lower leg or full leg depending on the areas of treatment post-procedure for 72hrs continuously then 12 hrs per day for the next 1-2 weeks following treatment. Wearing a compression garment can reduce the risk of side effects. We can provide you with advice about getting appropriate compression garments prior to your treatment.

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Class 1 stockings (light compression) exert a pressure of 14–17 mmHg. Flight socks will suffice for lower leg veins.

Class 2 stockings (medium compression) exert a pressure of 18–24 mmHg.

Class 3 stockings (high compression) exert a pressure of 25–35 mmHg (NOT required for thread veins).

Injection micro-sclerotherapy is suitable for many patients. However not always suitable if you have any of the following:

If you have a history of DVT (Deep Vein Thrombosis) or (PE) Pulmonary Embolism.

Taking 75mg + of Asprin daily

Patients taking corticosteroids.

Unable to walk for any reason.

Currently pregnant or breastfeeding.

Very overweight (obese).

Experiencing acute inflammation with/or without blood clot formation (phlebitis/superficial thrombophlebitis) in the vein to be treated.

An allergy to the sclerosant solution Aethoxysklerol (polidocanol, also known as lauromacrogol).

An infection in the skin on the area to be treated.

An infection throughout the body (systemic infection), such as a virus or a cold.

Diabetes that is not well controlled.

Significant heart disease.

Significant peripheral arterial disease.

Significant kidney disease.

Varicose veins which require surgical/endovenous intervention.

Varicose veins caused by pelvic/abdominal tumours.

Currently on medication to thin the blood (e.g. Warfarin).

Anticoagulant therapy

Varicose Veins which are related to more serious venous disease need to be treated before micro-sclerotherapy is undertaken otherwise the treatment is often less successful.

The first session costs £170.

Any subsequent sessions cost £150 (provided the prescription is still within 6 months of your consultation).

Clinical evidence

Some of the Aethoxysklerol clinical evidence highlights are detailed below:

• Aethoxysklerol microsclerotherapy treating spider and reticular veins with the 0.5% and 1.0% strengths resulted in 95% highly effective clearance and 84% patient satisfaction (measures taken 26 weeks after treatment cessation).

• An extensive study conducted by 98 experienced phlebologists over a two year period, assessed Aethoxysklerol (0.5%, 1.0% and 3.0%) in treating spider veins, smaller venules and varicose veins. Participants were asked to compare it to their prior experience with Fibrovein 0.2% (STS). Aethoxysklerol was considered more effective by 85% and to have a lower frequency of complications by 90%

Aethoxysklerol 0.5% solution (not foam)

Patient leaflet: