Is Asclera (polidoconal) a Safer Sclerosant Than Sodium Tetradecyl Sulfate?

I had an anaphylactic reaction to scerosing agent sodium tetradecyl and now need more treatment. I possibly reacted to the preservative benzyl alcohol. Is polidoconal safer?

Doctor Answers 16

Spider vein injections with Asclera and Polidocanol - Comparison with STS

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There is evidence that the risk profile of Asclera is less than that of STS, but both solutions are safely used to eliminate unwanted spider veins.  Choosing the appropriate sized veins to treat, and patient selection are important in reducing complications and improving results. 

Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Polidocanol is safer than sodium tetradechyl

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Although it is generally safer and less allergenic, the fact that you had a life-threatening reaction suggests that you should not have either agent - ever.

A good choice for you might be laser treatment of the feeding reticular veins - more painful and more treatments than with Polidocanol - or hyper tonic salt solution injected directly into the visible and offending spider veins. This will back fill the reticular vein feeders. I did this alone for years before I got and then abandoned a laser.

Hypertonic saline has very small amounts of hydrochloric acid and small amounts of sodium hydroxide - neither of which causes allergic reactions. There is also a miniscule amount of aluminum that should not cause a problem.

I now do a combination of Polidocanol for the feeding reticular veins and 23.4% salt solution for the spiders. The concentration of salt in the blood is only about 0.9%. The osmotic load with this concentration of hyper tonic saline is enormous and will usually destroy the reticular vein feeders - if they are not too big. Before I started using polidocanol, I used to get to them by filling the spiders and back filling the reticulars.

Hypertonic saline is very safe to use, but by knocking out the feeders with polidochanol, the spiders will gradually fade away. This is my first choice because it has the least problems.

Think twice before you let anyone inject anything that could kill you. Better yet, don't do it.

Robert Swanson, MD - RETIRED
Bay Area General Surgeon

Treatment options

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Asclera contraindication include patients with known allergy (anaphylaxis) to polidocanol and also patients with acute thromboembolic diseases. Your vein specialist can advise you in detail about treatment. I encourage you to visit your vein specialist to decide on best plan option for your treatment. 


Sclerosant allergy

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STS has a sulfur moiety in it.  It is more allergenic than asclera but both are both in the same class of sclerosants. If you are allergic to one, I would not use the other.  A safer choice would be hypertonic saline diluted down to the appropriate strength for the veins being treated 

Susan Fox, DO
Hollywood Phlebologist
5.0 out of 5 stars 8 reviews

Asclera (Polidocanol) Sclerotherapy Drug Reaction Allergy, Which Medication is Safe?

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If you had a true anaphylactic allergic reaction to Sodium Tetradecyl (Sotradecol), I would suggest that you avoid Asclera as well . . . although they are different drugs they work through a similar mechanism.  Since your body has demonstrated that it does not like this type of medication in your system, I would consider you to be at too much of a risk to try the Asclera.  Asclera is typically very safe, with an estimated 1 in 10,000 chance of an anaphylactic reaction.  But since you have proven to be a high risk patient, I would avoid any of the "detergent" type sclerosants.  My advise for you is to either have a different treatment altogether (such as  laser or  thermocoagulation if you are a candidate) or else consider one of the older methods to sclerotherapy, such as the use of hypertonic saline (salt water)


I hope this information was helpful to you.

Allergic reaction to STS or Asclera

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vein specialists (phlebologists) use both STS and Asclera and if you had a life threatening reaction to one, avoid the other. Find a vein specialist or dermatlogist (an old timer) who has experience using 21% saline and have him/her use that. There are potential risks of skin necrosis if the injector is inexperienced using this formula but saline (sodium chloride) is part of our system  physiologicaly and you will not have an allergic reaction to sodium chloride.

Anaphylaxis possible with Polidocanol

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I would recommend against either agent for you.  Hypertonic saline slolution (sterile salt water) is the only sclerosant not associated with anaphylaxis to my knowledge.  Although this is an off-label use, it is well known to be very efective.  I would still recommend a small test dose.

Lasers are generally less effective, cost more, hurt more and are generally not preferred over sclerotherapy.

Robert Strimling, MD
Las Vegas Dermatologist
4.3 out of 5 stars 9 reviews

Polidocanol is safest and best

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I have been using polidocanol for more than eight years.  I have not had not even one case of adverse reaction in over a 1000 of patients that I have treated.  This product is safe and effective.  The average cost is aout $400 to treat the spider veins.

Afshin Farzadmehr, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 58 reviews

Safe use of sclerotherapy agents, Polidocanol and Sodium Tetradecyl Sulfate

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Polidocanol and sodium tetradecyl sulfate are in the same class of sclerosing agents. While there is a good chance that Polidocanol would pose no problem for you, there is some risk of a similar allergic reaction. Therefore, a small test dose should be administered first, wait a week, and then proceed with treatment if no problem arises.  Polidocanol (Asclera--BioForm Medical, USA; Aethoxysclerol--Europe)  has been used with great success and excellent safety profile for many years in other countries.  Not sure that any studies show that Polidocanol is a safer sclerosant than sodium tetradecyl sulfate.   Both have side effects (bruising, hemosidering staining, post-inflammatory hyperpigmentation, and occasional blister, ulceration, and/or scar)--as seen with ALL sclerosants (FDA-approved or not).  Key to safety is a foundation with a good history and physical examination, skilled injector techniques, appropriate testing and access to emergency rescue medications.  Using this approach, sclerotherapy is a very safe procedure.

James E. White, MD
Chattanooga General Surgeon

Polidocanol potentially safer but approach with some caution

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Polidocanol (Asclera) and sodium tetradecyl sulfate (Sotradecol) are similar in structure so there is a potential for a similar reaction, although the chance may be small.  It will be important to inform the treating physician of your history of anaphylaxis, and you may consider trying a test dose first, at a low concentration.  Foaming the agent also always a lower concentration of the agent to be used while at the same time increasing the efficacy of treatment.  If you do choose to undergo treatment, ensure the physician is ACLS-certified and rescue agents are close by, and that you are monitored for at least 30-60 minutes in the office following your test dose.

Melanie D. Palm, MD - Account Suspended
San Diego 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.