American Academy of Dermatology: New Laser Treatments Get a Leg Up On Unsightly Veins; Non-Invasive Technology Offers Patients an Alternative to Surgery

SAN FRANCISCO -- With summer on the horizon, many people prepare for warmer weather by digging out their shorts and swimsuits from winter hibernation. However, for those with prominent leg veins, the arrival of shorts season may be greeted with more apprehension than anticipation as they face baring their legs for public view. Fortunately, new advancements in laser technology are giving individuals who suffer from spider and varicose leg veins the non-invasive treatment options they've been looking for.

Speaking today at the American Academy of Dermatology's 2003 Annual Meeting in San Francisco, dermatologist Arielle N.B. Kauvar, MD, clinical associate professor of dermatology at New York University School of Medicine, discussed the latest treatment options for leg veins, a common medical condition that affects more than 40 percent of women and 15 percent of men in the United States.

Spider veins are small, dilated blood vessels that appear red or blue under the skin. They may be in short, unconnected lines each about the size of a hair, or connected in a matted, "sunburst" pattern. While spider veins typically appear on the legs, they can also appear on the face or elsewhere.

Until recently, most spider leg veins were treated with sclerotherapy. This technique involves injecting a sclerosing solution directly into the vein, causing it to close up and disappear into the body within a matter of weeks. Eventually, the vein becomes barely noticeable or invisible.

While sclerotherapy is successful in the majority of patients, side effects include fear of needles, skin ulceration, matting (the formation of very fine blood vessels that appear as pink patches), brown staining of the skin, and, very rarely, blood clots or allergies to the solution.

"Since the mid-1980s, lasers have been safely and successfully used to treat facial veins and birthmarks," stated Kauvar. "Yet up until this point, leg veins have been difficult to treat with lasers because the blood vessel walls are thicker and the blood vessels are deeper. However, new advances in laser technology have allowed us to reliably use lasers to treat leg veins, with results and side effects comparable to, or better than conventional techniques."

One of the most notable advancements in laser technology has been in the use of longer laser exposure times (or pulse durations) that decrease skin bruising, improve healing times, and enable more effective removal of larger diameter leg veins. The veins are slowly heated and coagulated, causing them to close up without the explosive rupture that can occur with shorter pulse durations. This treatment, when used with specialized methods of skin "cooling" before or after the laser pulse is delivered to reduce the risk of burning, has greatly decreased the discomfort and crusting previously associated with laser procedures.

Typically, a patient will require several laser treatment sessions to effectively remove spider leg veins. A treatment session is usually 10-15 minutes long, and is performed at one-to-two month intervals to allow the damaged blood vessels to be cleared away by the body's immune system.

"While lasers are a good option for many patients, they have not been recommended for treatment of spider veins in individuals with Asian, African-American, Middle Eastern or tanned skin in the past," said Kauvar. "This is because darker skin pigments absorb laser light which can cause blistering and scarring." However, dermatologists have recently found that the laser light from one particular device, the Nd: YAG, is not readily absorbed by skin pigment, making it a safer choice for treating leg veins in individuals of color.

Varicose veins are enlarged blood vessels that appear blue and bulging under the skin. These veins occur from the backward flow of blood in the legs caused by damaged or diseased valves in the veins. Varicose veins are typically larger and cause more discomfort than spider veins. In the majority of cases, these leg markings can be unsightly and may be associated with symptoms such as swelling, cramping, aching, throbbing and fatigue of the legs and feet. Treatment, however, is usually sought for cosmetic reasons.

Until recently, treatment for varicose leg veins has included surgically tying off the damaged vein and removing it by means of an incision. This procedure requires a hospital visit under sedation or general anesthesia, and commonly includes side effects such as scars, loss of skin sensation in the legs, and prolonged recovery time.

New laser procedures are a welcome alternative to surgery for patients with varicose veins, particularly for those whose condition involves the main vein trunk in the legs (the greater saphenous vein). One treatment option uses a bare laser fiber that is inserted directly into the damaged vein like a catheter through a small quarter-inch incision in the thigh. The saphenous vein is destroyed by using laser energy to heat and seal the vein from within. Another treatment option uses radiofrequency technology to also heat the vein from within, and is similarly inserted directly into the vein to destroy it. Both options are usually performed with local anesthesia in an outpatient setting.

According to Kauvar, "Early study results with these new varicose vein treatment options show results that are comparable to the more-invasive surgical technique, without the surgical scars and prolonged recovery times."

Overall, most people enjoy a long period of remission after successful leg vein treatment, and can maintain the appearance of their legs with only occasional maintenance treatments. Yet while dermatologists can treat existing leg veins, they cannot prevent the body from forming new ones. Individuals with a tendency to develop leg veins should avoid standing for long periods, wear support hose for varicose veins and exercise regularly to tone the calf muscles, which helps propel the blood back to the heart and avoid pooling in the lower legs.

"The success of a laser treatment really depends on the skill of the physician performing it," cautioned Kauvar. "I would advise patients to be well-informed consumers and make sure that the physician they've chosen to work with is a board-certified dermatologist or other appropriately-trained surgeon with extensive experience in performing laser procedures in order to ensure the best possible results."

The American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatologic associations. With a membership of more than 14,000 dermatologists 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; supporting and enhancing patient care for a lifetime of healthier skin.

Source: American Academy of Dermatology