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

Question

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?

Raffy Karamanoukian, MD, FACS · Answer

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.

Afshin Farzadmehr, MD · Answer

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.

David Singh, MD · Answer

Thank you for your question.
We routinely use both Asclera and STS in treatment of spider and varicose veins.  If a severe allergic reaction is reported to one, we do not use the other. While I prefer Asclera over STS (for less pigmentation changes), I would not recommend  its use if you had an anaphylactic reaction to STS. 
I would consider hypertonic saline or if your veins a small and isolated, laser treatment. 
I hope this helps.

Best,
David Singh, MD

Albert Malvehy, MD · Answer

Both of these medications are in the same family. I would suggest you ask your physician about using glycerin or even an older hypertonic saline solution. The risk of anaphylaxis (which can be delayed up to 24 hours), is too great.

Michael Nguyen, MD · Answer

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. 
Best,

Susan Fox, DO, RPVI · Answer

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

Joel Gotvald, MD, FACS · Answer

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.

Hratch Karamanoukian, MD, FACS · Answer

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.

Robert Strimling, MD · Answer

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.

James E. White, MD · Answer

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.

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

Answers (19)

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