You’ve heard the one about the woman with the road map on her legs? I can’t remember the specific joke but I do know that it is not funny. Varicose veins, which affect millions of women and men, are not only unsightly, they can itch, make your legs feel tired and they can be painful. But one need not suffer with varicose veins. spoke with dermatologist Dr. Michael A. Tomeo about varicose veins and the various treatment options for them.

EverBeautiful: What are varicose veins?

Dr. Michael A. Tomeo: Varicose veins, also known as varicosities, are veins that are dilated and cosmetically unsightly. Varicosities are a result of an incompetent venous system. Those who develop varicosities have veins that have a combination of insufficient tone and valves that do not work properly. As such, venous blood backs-up and causes those affected veins to expand and grow abnormally. There are all sizes of varicose veins ranging from the smallest “spider veins” to the larger cord-like and sinuous veins.

Varicose Veins
Varicose Veins


EB: Do varicose veins cause pain or any other health issues?

MT: Yes, in some cases, varicose veins, particularly the larger ones, become tender or painful especially after prolonged standing. Additionally those veins can become clotted resulting in superficial thrombophlebitis.

Varicose Veins
Spider Veins

EB: Do varicose veins differ from spider veins?

MT: Spider veins are a type of varicosity. The two types of veins that I treat with sclerotherapy are spider veins and reticular veins. The very tiny red veins are spider veins. The slightly larger veins that are blue in appearance are reticular veins. However the larger, cordlike varicosities are not only more cosmetically inelegant but they can be painful and more challenging to treat with standard sclerotherapy and may require surgical stripping.


EB: Who gets varicose veins?

MT: Men and women both get varicose veins, however women seem to have a higher prevalence due to hormonal factors and heredity.


EB: What causes them?

MT: Heredity is the main cause. However, certain lifestyle factors may contribute to the worsening of varicosities, in particular standing for long periods of time, wearing high heels and pregnancy. Insufficient walking, underfloor heating and obesity are other contributing factors.


EB: Where do varicose veins occur?

MT: Usually from the knee down.


EB: How do you treat them?

MT: We use sclerotherapy to treat varicose and spider veins. Sclerotherapy consists of introducing a substance into those abnormal-appearing veins to cause an inflammatory response that results in scarring of those veins from the inside out. The body then naturally clears those degenerating veins. We use three categories of sclerosants: osmotic, detergent and irritant. The osmotic agents change the permeability of the blood vessels. Hypertonic saline is the best example. Detergents or soaps disrupt vein cellular membranes. These agents are the safest and most commonly used. Lastly, irritants are chemicals that are directly caustic to the veins. They are rarely used today.


EB: How do you decide which agent to use to treat the varicosity?

MT: I prefer to use the detergent agents, namely Sotradecol® or Aetoxisclerol® because they are FDA approved substances and are the most effective, least irritating and have the lowest side effects.

Varicose Veins
Varicose Veins Being Treated with Sclerotherapy

EB: Is treatment painful?

MT: The treatment is slightly painful because you’re introducing a very fine needle just under the skin. The substance itself doesn’t burn very much. People may feel a little bit of discomfort but that’s mostly from the needle. However, if you use hypertonic saline, that’s the one agent that does tend to burn more.


EB: Is treatment permanent?

MT: Yes it is, however, new veins can erupt over time. Sometimes the treatment isn’t perfect. It is not uncommon to need a re-treatment which can be done as soon as six weeks after the first treatment. It may require up to three treatments to get the desired results.


EB: Are there any side effects from treatment?

MT: There can be. If the fluid leaks into the surrounding tissue it can cause a reaction such as immediate pain, bruising, tissue damage or discoloration. These side effects are typically not permanent. If the physician dilutes the sclerosant and is careful in how it’s administered, then side effects are typically minimized.

Varicose Veins
Compression Stockings Should Be Worn After Treating Varicose Veins

EB: Are there any special recommendations after treatment?

MT:  It’s critical that patients who have had sclerotherapy wear compression stockings such as Jobst® or Futuro® for at least 72 hours (up to 3 weeks) for optimal results. The typical amount of compression recommended ranges from 22-32 millimeters of mercury (mmHg). Post treatment , it is probably prudent to not exercise strenuously after the first few days, however , it is imperative to resume your normal activity thereafter. Vitamin K topical preparations have been shown to reduce post therapy bruising. Additionally, horse chestnut and arnica may also be helpful.


EB: How can you prevent varicose veins?

MT: You probably can’t because the most significant factor is heredity. However you should probably minimize standing in place for long periods of time, and minimize the time you’re in heels.


EB: How does one prepare for treatment?

MT: The one thing that is critical to have a successful outcome is to make sure you’re not on any blood thinning agents and keep in mind that a lot of naturopathic agents can be problematic. For instance, Vitamin E, Vitamin D, fish oil and garlic can interfere with clotting. Clearly, you don’t want to be on any aspirin-containing medications. Aspirin inhibits platelet production causing one to bleed more easily. And by the way, Ibuprofen and other non-steroidal anti-inflammatory drugs also affect your blood’s ability to clot.


EB: What type of physician is the best one to perform sclerotherapy?

MT: You want to seek a physician who has a vast amount of experience with sclerotherapy. Typically those individuals are dermatologists, however there are other physicians who specialize in sclerotherapy.


EB: Are there other methods to treat varicose veins?

MT: Although sclerotherapy is still the gold standard, there are cases in which the laser may be helpful. In particular, the KTP laser and PDL (pulsed dye laser) laser are alternative therapies for those very small red spider veins. For the slightly larger blue veins, the YAG laser appears to be the most effective.

Varicose Veins

EB: What if you don’t want to undergo treatment? Are there ways to camouflage varicose veins?

MT: Yes, you can wear tinted stockings or, in the summer time, you can use concealer makeup such as Dermablend.

Ed. note: You can purchase Dermablend below:

About Dr. Michael A. Tomeo

Dr. Michael A. Tomeo

Michael A. Tomeo, MD is a Fellow of the American Academy of Dermatology (FAAD). He is the former Chief of Dermatology at Holy Redeemer Hospital in Meadowbrook, PA and is a Clinical Instructor at Hahnemann University Hospital in Philadelphia.  His practice, Advanced Dermatology Center215-938-8771, is located in the Holy Redeemer Medical Office Building located in suburban Philadelphia. Dr. Tomeo’s website address is

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