I Believe I Have Hemosiderin Staining After Sclerotherapy. How Can I Tell and What Should I Do?

Hemosiderin following sclerotherapy may last months or years.  It is likely that the amount of hemosiderin that you have will fade away within a few months.  If the hemosiderin persists, I have had good results treating the hemosiderin with low dose q-switched alexandrite lasers using multiple treatments spaced a month apart.

Generally coagulum that is a result of sclerotherapy is removed within a two week period following treatment. However, what you are seeing should resolve over time, about 6months - 1year. If you still see staining after a year treatment with a laser may be helpful. 

We use a regimen of two topical cremes called Sclerovase and Scleroquin plus to help reduce the hyperpigmentation that can result with sclerotherapy. We also use an oral supplement called Scler-X, aka PIH Relief Complex. Sometimes we use a YAG laser if there is residual pigmentation after 6 months. 

Following sclerotherapy, the treated veins can clot or blood can escape from the treated veins and form around these veins. Both of these can lead to the hemosiderin deposits. The majority of these will dissolve spontaneously over time and could take up to one year. Local care to the area with warm compresses will help. Also, you should return to your treating physician who can evacuate the clotted blood under local anesthesia with a small needle. This releases the trapped blood to lighten the area. If all of this should fail, then there are topical lasers which may help. From your picture, your problem should resolve with local care and evacuations.

Hemosiderin deposition after sclerotherapy usually occurs because either the blood from the treated varicose vein leaks out into your tissue, staining them, or blood clotting within the treated vein, and keeping the area inflammed and "hard."

Here's how you take care of it. Apply heating pad several times a day to the area. Rub/massage the area several times a day, or whenever you get a chance. Call bellagiomedspa.com at 480-788-5621, for a free consultation, ad I will formulate a treatment with Yag laser. Yag is the laser of choice for these sclerotherapy complications because we are ultmately dealing with hemoglobin and iron, which absorb 1064nm lasers the best. In addition, Yag laser penetrate deeper allowing complete resolution of the hemosiderin stainings. 

Your images are consistent with hemosiderin deposition after sclerotherapy. The pigment inside the destroyed blood vessels, hemoglobin, becomes hemosiderin and looks brownish red. Most commonly, it will go away on its own, although this may take several months in some patients. If after 6 months it is still present, I advise you to consult your doctor regarding laser treatment to remove the pigment.

The picture seems to indicate that you do have some hemosiderin depostion although it may be some trapped blood which is the lumpiness you have described.  Distinguishing between the two is a matter of splitting hairs. Both of these reactions can occur after sclerotherapy. Trapped blood can occur when larger vessels are injected during sclerotherapy.  I would see your treating physician as some do prefer to drain them to hasten their resolution.  Others feel differently and some prefer to let them resolve spontaneously.

After a sclerotherapy procedure, bruises around the treated areas usually disappear within the first week. A tan or brownish pigment may persist from several weeks to several months, especially when larger veins are involved. This is typically caused by the clotted blood which is being slowly reabsorbed. Although Lasers can speed up the resolution of this darker color, the best course is simply waiting as they typically will completely resolve over several months. If there is trapped blood in any of the veins it is usually easily removed through a small nick in the overlying skin. You should return to your injecting physician to see if this treatment is appropriate.