In What Cases is There a Risk of Scarring from Sclerotherapy?

Following the acute setting where a patient can have an allergic reaction (rare), bruising (common) which will resorb and fade, phlebitis and deep vein thrombosis (are rare), the likelihood of hyperpigmentation is real and warrants the use of compression stockings for a period of 2 weeks to 3 months. 

Sclerotherapy,in general, has very few side effects and associated risks.  Both of these decrease as the experience of the injector increases.  The more common side effects include itching, redness, bruising, discoloration of the injected veins and hematoma formation.  Although "more common" they are not frequent.  The less common side effects would be staining, allergy and the possibility of DVT.   Even less common is the risk of stroke which can occur with the foamed solutions. Having stated all of this, it has been my experience over 20 years of injecting veins that the risks and complications are very few and far between and sclerotherapy is an extremely safe procedure when done by experienced hands.

Scarring can occur if the sclerosant is injected into the skin surrounding the vessel. If blood becomes trapped in areas treated darkening of the skin can occur.

The potential adverse side effects from sclerotherapy treatment to lower extremity veins include, but are not limited to, discoloration, ulceration and/or scarring at the site of the injections. That being said, these adverse side effects are quite rare. It is possible to develop redness and mild bruising at the treated sites, both of which typically resolve within a few weeks. Sclerotherapy is still considered first line treatment for most lower extremity veins. 

Sclerotherapy is a Safe Procedure with Minimal Risk of Scarring. However, if the sclerosant solution is mistakenly injected outside the intended blood vessel, there may be a blister and crust formation, which may result in a scar. This is not a common occurrence and may be avoided with proper technique. Patients with connective tissue disease (lupus and antiphospholipid antibody syndrome) may be at greater risk of ulceration and scarring if extravasation occurs.

The risk of scarring from Sclerotherapy is small.  The risks include infection, ulceration (with scar formation), bruising, discoloration of the skin, and depending upon the sclerosant used there is a risk of allergic reaction.  Fortunately, most of these are rare except for the discoloration of the skin which happens in a fair percentage of cases.  The good news is that it is temporary and will eventually resolve spontaneously.

Risks of sclerotherapy include ulceration of the skin and scarring, blood clot, allergic reaction, and hyperpigmentation.  Most side effects can be avoided with good technique, choosing the appropriate sclerosant (medicine), and appropriate screening of patients.  In experienced hands, sclerotherapy works well with a low side effect profile.  Ulceration and scarring is often due to use of hypertonic saline as the sclerosant.  In most cases, there are better and safer sclerosants to choose from, such as polidocanol. 

The complications of sclerotherapy

1: scarring, due to extravasation of the medicine into the tissue.

2; hemosidrin stain

3: No response, or minimal response

4: Discomfort while injecting the medicine

5: Very rarely deep venous thrombosis

The potential adverse effects from sclerotherapy include, but are not limited to, infection, permanent increased or decreased pigmentation, ulcerations and scarring. This is the case whenever a needle is inserted into the skin for any reason. Fortunately most side effects are quite rare. Most bruises are small and usually resolve within a few weeks. A tan or brownish pigment may persist from several weeks to several months, especially when larger veins are involved.