Ulcerated Scars and Hyperpigmentation After Sclerotherapy

I had multiple clusters of spider veins on my legs. Doctor performed sclerotherapy. All he used to find my veins was a regular light. Ended up going though the veins and injected solution into soft tissue. Now I have ulcerated scars on both of my legs (he made the same mistake twice!). The skin surrounding the scar is now hyperpigmented.

He said all we could do would be waiting for them to completely heal. Then he would cut the original scar out and give me a new (smaller) scar.

I spent 9 months after procedure putting silver sulfadine cream on the lesions and covering with bandages. It has now been one year. Not only do I have the scars/lesions, but the bruising from the other veins that were treated haven't diminished.

Should he have used something else to find the veins? Is this the most appropriate way to treat the scarring? Could I sue for a botched job?

Doctor Answers 3

Auriderm and Tazarac

This most likely is due to hemosiderin deposition. Usually the body will absorb this over time, but obviously this has not been the case in your situation.

I would recommend a combination of Auriderm and Tazarac cream. Please be aware Tazarac is a Category X and should not be used if there is a chance you might become pregnant.

Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

Ulceration after sclerotherapy is unlikely and rare with new FDA approved sclerosants

Ulceration was more likely in the past where high concentration sclerosant solutions were used, such as 21% hypertonic saline. Remember that physiologic saline solution that is given intravenously while you are hospitalized is 0.9% whereas hypertonic saline is 23 times more concentrated. 

When this solution is extravasated into the skin outside of the vein, it causes skin necrosis.

I no longer use hypertonic saline for sclerotherapy. I use FDA approved sclerosants which have a very very low likelihood of causing skin necrosis. 

Having said that, every sclerosant solution has associated risks when used for sclerotherapy - infection, hyperpigmentation, thrombophlebitis, DVT ... 

Discuss further with the vein specialist before sclerotherapy is planned. 

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

This is not uncommon...

sometimes too much of a sclerosant is injected or too much pressure used or too strong a concentration can cause these "ulcers" to form.

every physician who treats veins has had this happen, and it really depends on the patient being treated.  some are just more prone to this occurring.  it can be minimized by using small injection doses, weaker solutions, and low injection pressures.

Craig Crippen, MD
Kelowna Physician

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.