What caused blisters after sclerotherapy?

Question

I have some long thin blisters at the injection site as well as large bean shaped blisters. They are painful. The doctor tried to tell me they came from tape, I find this hard to believe. I think he missed the veins and instead injected the solution into my skin. What caused this reaction, and should I expect that the veins will still be there when the bruising and blisters heal?

Stephen Prendiville, MD · Answer

Extravasation issues aside, the blisters seen in the picture look like a "tape reaction" or contact dermatitis. The blisters or bullae are epidermal. This should have no effect on the results of your sclerotherapy.

Otto Joseph Placik, MD · Answer

It is difficult if not impossible to predict what caused the blisters in this situation. It could be due to the shear or stress of the dressing or to inadvertent extravasation of the sclerosant in to the skin. With gentle wound care these should heal uneventfully. It is not unusual to require several sessions to achieve successful therapy of varicose or spider veins.

Hratch Karamanoukian, MD, FACS · Answer

The blisters that you show in this picture is most likely an allergic reaction to tape used over gauze that was used to cover the area of sclerotherapy or from the ace bandage that was used to achieve compression following sclerotherapy.

John Landi, MD · Answer

The most common cause of what you are describing is irritation from the tape or bandage.  I have seen this occur if an ace bandage slides/rubs over an area and also from tape irritating the skin.  It would be very unlikely that the sclerosing solution caused this problem.  A topical cream or ointment such as silvadene or bactracin would help.  If the veins were injected, then they should resolve over time.

Margaret Mann, MD · Answer

As a vein specialist who does a lot of sclerotherapy in my office, I have unfortunately seen this type of reaction before.  Fortunately it rarely occurs and tends to happen in my patients who are very active after sclerotherapy treatments.  It results from friction of the skin against the tape and compression wrapping.  Much like wearing a misfitted pair of shoes that causes blisters, friction from the compression rubs against the skin to cause blisters after sclerotherapy, especially if you do a lot of movement on the legs.  It is usually not a true allergy to the tape or adhesive (that usually appears as a rectangular mark exactly the shape of the tape).  And it is unlikely due to the actual injections themselves.  

	The good news is that this should resolve without leaving any marks, but be sure to take good care of the blisters (keep it moist with vaseline).  And if the veins were properly treated, they should go away as well!

	Best,

	Dr. Mann

Craig Crippen, MD · Answer

This looks like a reaction to something on your skin rather than injection into the veins under the skin.  How many days is this after the injection?

	An irritant or allergic dermatitis would be the most likely situation.

	Try keeping the area clean and apply no bandages to the area.  Use some benadryl oral pills to help it settle down.

	Good luck.

Peter A. Aldea, MD · Answer

I understand that you are frustrated and angry with your outcome but this is NOT the time to round up "the usual suspects". There will be plenty of time to do that later IF your suspicionsare right. 
Instead, I would advise you to cooperate with your doctor and solve the predicament you are in.
Blisters indicate tissue damage (as may be seen in some 2nd degree burns). This CAN be caused by harming the tissues with extravasation of the vein irritant but may also be caused by tape which was stretchedas it was applied to the skin. The parallel blisters are not consistent with tape UNLESS the tape was applied in this fashion.
If your doctor is NOT a Plasticsurgeon or Dermatologist who is familiar with burns, I would suggest you may want to be seen by one. Your injured skin should be treated aggressively to prevent full thickness skin losses and permanent scarring.

Good Luck.

Dr. Peter Aldea

Victoria Karlinsky-Bellini, MD · Answer

Most likely your doctor is correct and the blisters come from the tape which was placed on the skin with too much tension. I do not think that your therapy is compromisezed in any way because of the blisters. You may want to ask that your doctor use a paper tape next time or try to avoid tape all together. For now treat the blisters as if they were burns. Keep them klean and under a non-sticky dressing.

Samir Shureih, MD · Answer

The blisters you show are not a typical reaction to the sclerosing agents usually used in the U.S.

	What was the material injected?

	Blisters like this could come from reaction to tape adhesive or tape put with a stretch on the tale. so it creates a friction on the skin and causes blisters.

	Sclerotherapy for spider veins may require more than one session to get rid of them.

Arnold R. Oppenheim, MD (retired) · Answer

The large bullae and much of what is seen is due to an allergic contact dermatitis to the adhesive and not extravasation of the sclerosing agent. The same would hold for the red streaks unless you tell me adhesive was not used in this direction. 

	  I would recommend follow up with a dermatologist ( if a dermatologist was not the injector)  to elucidate your allergy, probably through patch tests. These are discs or strips impregnated with various chemicals to ascertain to what you may be allergic.

	 The dermatologist would also be able to guide you on best treatment of the reaction also.

	  I am not as sure about the red lines, but those are probably the same. It would be hard to believe someone what have that poor an injection technique to cause them. If the tape was put in that direction, your reaction would be due to the tape.

What caused blisters after sclerotherapy?

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