What are Common Spider Vein Treatment Side Effects?

Can you pls explain the possible side effects from vein treatment

Doctor Answers 21

Sclerotherapy can cause hyperpigmentation

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You asked about side effects and most importantly one should remember that any of the sclerosant solutions can cause hyperpigmentation which in rare cases, can last as long as a year or more.

To prevent hyperpigmentation, meticulous technique should be used as well as avoiding excessive pressure during the injection process to avoid extravasation of blood. As well, treating venous reflux disease will also reduce the likelihood of hyperpigmentation.

Another important problem can be clot formation in injected reticular veins which should be evacuated with a micro puncture blade to minimize dermal pigmentation - i.e. hyperpigmentation.

Hratch L Karamanoukian, MD

Complications of spider vein treatment

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The most common complication of spider vein treatment is that the legs look worse before they look better. There can be bruising, scabs, and discoloration. All of these go away in a relatively short period of time.

The next complication of spider vein treatment is that the treatment may not work. the usual cause of failure of therapy is that the doctor does not treat the underlying problem. Spider veins are dilated veins in the skin. In the legs they are caused by abnormal pressure relationships - usually malfunctioning venous valves in the larger veins up stream from the visible spiders. The next level of veins are called reticular veins. If they are not treated, there will almost certainly be either a recurrence or the development of another complication called telangectatic matting - a diffuse red discoloration caused be vessels too small to inject. With proper visualization these feeding reticular veins can be satisfactorily obliterated, thus preventing recurrence and matting.

The worst complication is post treatment hyperpigmentation. This can be caused by blood that is trapped in the skin and leaves a pigment behind as it decomposes or by a darkening of the skin cause by minor injury to the skin in a process called post inflammatory hyperpigmentation. The first can occur in anyone and may or may not go away - it usually does. The second is more common in people with darker skin.

There is always the possibility of temporary bruising, and depending on the agent used in sclerotherapy or the laser used there is the chance of skin necrosis - death of a small patch of skin. Since I stopped using lasers and started using polidochanol for reticular veins I have not seen skin necrosis.

In the last 20 + years I have seen only 3 infections that required antibiotics.

That's the list of complications. With careful attention to technique these can be kept to a minimum and the treatments can be very effective.

Robert Swanson, MD - RETIRED
Bay Area General Surgeon

Rare but possible spider vein treatment side-effects

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Side effects of the procedure are rare. However they may include but are not limited to the following:

  • Itching: usually mild and lasting 2-3 days
  • Hyperpigmentation: brown discoloration which may be permanent in 1% of patients after one year.
  • Matting: an area of very fine veins that appear similar to a bruise
  • Pain: usually minimal discomfort is experienced
  • Ulcers: Rarely an ulcer or open sore may develop at the injection site, which will resolve in 4-6 weeks with local treatment but will leave a faint scar.
  • Allergic Reaction: 0.3% risk of reaction to injectant and usually occurs within 30 minutes.
  • DVT/ Pulmonary Embolism: A blood clot in the deep vein of the leg or a blood clot in the lung is a very rare occurrence.

Vein Treatment Side Effects

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The most common side effects of injection treatment of leg veins or sclerotherapy are:

  • Temporary blush called matting
  • Temporary pigmentation called hemosiderin (iron)
  • Only partial response

These side effects are best managed and treated by an experienced physician.

Robert A. Weiss, MD
Baltimore Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Risks of sclerotherapy of spider veins

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Sclerotherapy is a safe treatment if done by an experienced surgeon.  The American Board of Phlebology is the governing board for vein specialists.  There are many risks with any procedure.  However, the most common with sclerotherapy are pigmentation, recurrence of the spider vein, and tissue extravasation.  By far, recurrence of development of more spider veins is the most common outcome. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Sclero complications

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One of the most common side effects after sclerotherapy treatment is hyperpigmentation. This occurs because hemosiderin, a breakdown product of red blood cells, have extravasated from the blood cells. This takes about 6 months to 1 year to completely go away. If it persist beyond this time a laser may help with treatment.  

Another common complication is superficial thrombophlebitis in which the treated vein becomes tender and swollen. Compression stockings do help to prevent the occurrence. 

Telangiectatic matting can appear after sclerotherapy treatment. This generally occurs because there is a reticular vein below that is still continuing to feed the treated area. 

Less common side effects include neurological complications, cutaneous necrosis, deep vein thrombosis, and allergic reactions. 

Common side effects of Spider Vein Treatments

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During sclerotherapy, you may experience mild discomfort and cramping for a minute or two when the solution is injected into the veins. There might be some itching and bruising as well. With lasers, there might be some swelling that will disappear within a few days. With both, you might experience some discolored skin in the areas that have been treated, but this fades in 10-14 days. It’s extremely important that you see a highly trained dermatologist—to have these procedures done. In inexperienced hands, lasers, in particular, can cause burns and scars on the skin.

Dennis Gross, MD
New York Dermatologist
4.7 out of 5 stars 11 reviews

Usually minor side effects.

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Sclerotherapy is associated with several side effects- all of which occur infrequently and it is not uncommon for the incidence of side effects to be directly related to the experience of the injector. Side effects include staining(skin discoloration), matting(increased fine vessel vein formation), temporary itching or swelling, darkening of the injected veins, clotting of the injected veins and failure of the veins to resolve.  Even rarer side effects include superficial phlebitis, DVT and ulcer formation.

John Landi, MD
Naples General Surgeon

Potential Side Effects of Spider Vein Treatment & Sclerotherapy

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The risk of side effects after spider vein treatment is relatively low in the hands of an experienced vein specialist.  Always research the physician doing the procedure & make sure that they are appropriately qualified to be doing vein treatments and that they are board certified in treatment of vein diseases.  Board Certification in Vascular (blood vessel) conditions is preferred.

Risk including 1) allergic reaction to the medication injected, 2) abnormal skin discoloration known as hyperpigmentation or hemosiderin staining which results from pigment depositing in the skin as a result of red blood cell destruction and skin inflammation, 3) matting, which is the development of a cluster of capillaries or small spider veins around the injected area that often looks like a bruise, 4) development of skin ulcerations or wounds (a rare side effect), thrombophlebitis (inflammation and small clots occurring inside leg veins), or recurrence of the veins with failure of the veins to resolve.

Luckily most patients get good results with sclerotherapy and are very satisfied with the results and rarely get these side effects, with an approximate 10-15% skin side effect rate.  Over 90% of patients who develop skin side effects will have resolution of the side effects with time, but it can often take many months for the abnormal skin reactions to resolve completely.


I hope that this information was helpful.


Side Effects of Sclerotherapy (Vein Treatment)

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The most common side effects of sclerotherapy (injection treatment of leg veins) are temporary bruising or redness, temporary pigmentation (discoloration), and rarely ulceration (break in the skin). It is best to be treated by a board-certified physician specializing in the treatment of leg veins (typically a dermatologist or vascular surgeon).



Channing R. Barnett, MD
Boca Raton Dermatologist
4.1 out of 5 stars 8 reviews

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.