Pigmentation Following Sclerotherapy

I had sclerotherapy done a year ago to remove a blue vein. This caused hyperpigmentation. The doctor used tromboject. How do I know whether my pigmentation is due to hemosiderin or melanin?

When I pinch the skin above the pigmented area, the pigmentation disappears. When I let go, it shows up again. Almost as if something underneath the skin is causing it to look brown. What can I do to get rid of the pigmentation faster and is there a different solution I should use next time?

Doctor Answers 8

Pigmentation after sclerotherapy

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It is forst important for patients to ONLY receive FDA-approved solutions. Thromboject is NOT FDA approved. The FDA approved solutions to treat leg veins are Sotradecol and Asclera.

Pigmenation can occur from any sclerosing solution and in my practice goes away in 99% of patients within a fewe months.

The way to prevent or minimize pigmentation is to treat the feeding reticular blue veins BEFORE treating the smaller veins. In addition, I recommend that ALL patients wear medical graduated 30-40mmHg compression stockings 24 hours a day for 7 days after the procedure and then only during the day for another 2 weeks. Stockings must be worn for the first 7 days even in the shower.

If poigmentatiojn does occur, it can be drained or treated with a q-switched ruby laser. Pigmentation is usually due to hemosiderin or iron from blood that has leaked out of the vein.

San Diego Dermatologic Surgeon
4.9 out of 5 stars 25 reviews

How do you treat hyperpigmentation after sclerotherapy? Sclerovase

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It has been shown by many clinical researchers that every type of sclerosant solution can cause hyperpigmenation. 

I have always followed the principle that feeding veins, refluxing veins should be treated before the spider veins and varicose veins in order to reduce hyperpigmentation. 

We use topical products in our practice to reduce hyperpigmentation following sclerotherapy. You can get more information about these products on the link below. They are called Scleroquin plus and Sclerovase. Sclerovase is applied during daytime and Scleroquin plus in the evening. 

I hope this helps. 

Pigmentation should improve.

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Pigmentation following sclerotherapy can occur and is more common with hypertonic saline and sodium tetredecyl sulfate versus policocanol and glycerine. Pigmentation is usually due to hemosiderin deposits from blood leakage during the sclerotherapy treatment. Usually pigmentation will resolve spontaneously over about one year. If not a q switched laser may help. What you are describing with the "pinch test" appears to indicate that the pigmentation is due to blood rather then hemosiderin. Your doctor should look for feeding vessels to this area which, if treated, should improve the discoloration.

John Landi, MD
Naples General Surgeon

Sclerotherapy darkening after leg vein injections

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If you're pinching the skin and the pigment disappears then either there is something in the subcutaneous tissues that is causing the color, or blood flow/vessels as both hemosiderin and melanin would be located in the superficial dermis (and epidermis for melanin) and not disappear with pinching.  You need an in-person consultation for an examination. You might need more treatment for reticular veins that are deeper.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Hyperpigmentation after Sclerotherapy, what to do?

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This is a very common occurrence after Sclerotherapy.  It is hard to know exactly the cause in your situation without at least a photograph but it sounds like the vein itself is thrombosed from the treatment and has dark blood inside of it.  This will eventually be absorbed by the body, but a simple procedure called a thrombectomy can help this heal faster.  See your treating physician and if they have enough experience he/she should be able to tell you what is going on.



Craig Crippen, MD
Kelowna Physician

Pigmentation does not disappear with pinching the skin.

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Sounds like you still have blood vessels there. Only blood vessels will disappear with pinching the skin. Pigmentation will not disappear. More blood vessel treatment is probably needed, be it with sclerotherapy or lasers or both. Revisit your doctor to discuss your options.

Harlow Hollis, MD
Victoria Plastic Surgeon

Pigmentation from Sclerotherapy

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Pigmentation in the skin will not disappear with pinching. Your "pinch test" is most likely squeezing the blood from a collection of new, functioning blood vessels in the previously treated area. You should return to your treating physician to discuss further options such as repeating sclerotherapy treatments which usually works to fix this problem. If the vessels are too small to inject, lasers are the next best choice.


Pigmentation following sclerotherapy

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Neither melanin nor hemosiderin would disappear with pinching.  You may have developed "matting", which is an accumulation of tiny vessels in an area treated with sclerotherapy.  Matting can be treated with more sclerotherapy or a vascular laser.  I would recommend highly that you visit the physician who treated you for treatment options.

Hope that helps.

Madeline Krauss, M.D.

Madeline Krauss, MD
Boston Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.