OVERVIEW: For the estimated 80 million Americans living with leg vein problems, cosmetic concerns only paint part of the picture of living with this condition. In fact, patients with varicose veins commonly experience leg pain and fatigue as well as a host of other medical problems. Varicose veins are large, dilated blood vessels that can be raised above the skin’s surface. Healthy veins have a system of valves that permit blood to flow in one direction only. In varicose veins, those valves malfunction allowing the backward flow of blood or “reflux”, which results in the discomfort associated with leg vein problems.

In the past, the only treatment available for varicose veins was a type of surgery called vein stripping, which required general anesthesia and weeks of downtime. Now, dermatologists who have received additional training are using minimally invasive procedures to treat varicose veins, allowing patients to get back to their lives more quickly and resume activities that they may have avoided beforehand.

AMERICAN ACADEMY OF DERMATOLOGY EXPERTInformation presented at the American Academy of Dermatology’s Summer Academy Meeting by Todd Cartee, MD, FAAD, a board-certified dermatologist and assistant professor of dermatology at Penn State/Hershey Medical Center in Hershey, Pa.

LEG VEIN PROBLEMS CAN BE A REAL PAINWhile varicose veins occur most commonly in adults older than 60, the condition can develop in patients as young as their 20s. In his practice, Dr. Cartee most commonly treats leg vein patients in their 40s and 50s. The reason most patients seek treatment is due to the bothersome symptoms that develop and the impact on quality of life.

In addition to the achy, tired feeling patients experience in their legs, varicose veins also can cause itching and burning, cramping in the calves, swelling, and restlessness in the legs. In more extreme cases, patients can develop skin rashes and skin darkening, blood clots, and open wounds that are painful and slow to heal. In many cases, patients’ legs will hurt so much that they are limited in performing their normal daily activities.

Spider veins are another extremely common type of leg vein problem. They are small, superficial blood vessels that can develop at any age. Spider veins can cause some local burning, itching or aching. Unlike varicose veins, they do not typically cause severe symptoms but can cause embarrassment for patients due to their unsightly appearance.

NEW TREATMENTS REPLACE SURGERYTwo minimally invasive techniques are offering patients with varicose veins alternatives to traditional surgery:

Endovenous Laser Ablation•One-hour, outpatient laser procedure performed under local anesthesia in an office setting that destroys veins from the inside•Procedure can treat an entire vein up to 30 inches through an incision a 1/4 of an inch•A infrared laser is used to deliver heat directly to the diseased vein, leaving surrounding tissue intact.•Patients can expect to return to work or daily activities the next day with almost no bruising or pain medication required.

Radiofrequency Ablation•An outpatient procedure that offers all the advantages of laser treatment but uses radiofrequency waves instead•Delivers radiofrequency energy to the vein, causing it to heat up and collapse •Bruising and pain are minimal, and patients can return to work or daily activities the next day.

Dr. Cartee added that insurance may cover these two procedures as medically necessary if veins are large and the patient has significant symptoms.

SCLEROTHERAPY RULES FOR SPIDER VEINS Sclerotherapy, in which a chemical known as a sclerosing agent is injected into clusters of spider veins with tiny needles, remains the gold standard for treating spider veins. The chemical irritates the vein wall and dissolves the veins permanently in most cases. The 30-45 minute procedure is performed in a dermatologist’s office in two to three treatment sessions. Dr. Cartee noted that sclerotherapy is more efficient and less painful for patients with typical spider veins and no additional symptoms.

MANAGING LEG VEIN PROBLEMS AT HOMEDr. Cartee explained that there are several common sense approaches to managing leg vein problems at home that can ease some of their symptoms, including:•Exercise•Weight loss or maintaining a healthy body weight•Wearing compression stockings that fit properly and are the correct strength (A dermatologist can assist in ensuring a proper fit.)

AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE:“Leg vein problems are treatable, so patients with bothersome symptoms or concerned by the appearance of their legs should see a board-certified dermatologist to discuss their treatment options and how to best manage their condition,” said Dr. Cartee.

Celebrating 75 years of promoting skin, hair and nail healthHeadquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology) or Twitter (@AADskin).