Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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Microsclerotherapy Complications An Aesthetic Complications Expert Group Consensus Paper JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2017 • Volume 10 • Number 4 E 3 The ingestion of tetracycline drugs, such as oxytetracycline and minocycline, is associated with a higher risk of marking so caution is advised if patients are taking these medications. Topical application of anti-inflammatory gels may also help to r educe skin marking. Remember allergy and make sure the gel is fresh as these gels can quickly lose their potency once opened. Skin marking may also be safely treated with intense pulsed light with a variable success rate. Pain If a patient experiences pain on needle insertion, assume you have touched a cutaneous nerve and withdraw the needle immediately. If you continue to inject, it will be very uncomfortable and probably tender post- treatment. It is important to be aware that certain areas of the leg can be hypersensitive, such as medial to the knee, behind the knee, the shin, and medial to the ankle. Injection discomfort can be significantly reduced by stretching the skin and passing the needle slowly through the skin. This is different to a subcutaneous or intramuscular injection where the needle is entered more rapidly. Topical anesthetic should not be required with careful injection technique, but if used, it does take over 30 minutes to achieve anesthesia and caution must be advised on the dosages used as large volumes may be required for the legs and there is a risk of toxicity. Treatment Failure/Expectation Management 6,7 A small number of patients can be resistant to treatment no matter what sclerosant is used. The author believes that some patients can develop a resistance to a sclerosant after repeated treatments over many years and uses chromated glycerine (Scleremo) for these patients. This substance appears very safe, but is very viscous and difficult to inject. Warming the vial in hot water significantly reduces the viscosity and makes injection easier. It is best to spend a lot of time with the patient both before and during treatment explaining that you can maintain their legs. The more relaxed your patients are, the less discomfort they will feel. R emember additional veins and flares can occur in the future and you want your patients to return. Deep Vein Thrombosis Although this is a complication feared by many practitioners, deep vein thrombosis is not an outcome that occurs with microsclerotherapy when using the correct technique, the correct concentration of sclerosant, and in the correct patient. References 1. The electronic Medicines Compendium (eMC). https://www.medicines.org.uk/emc/medicine/28116. 2. Frullini A, Felice F, Burchielli S, Di Stefano R. High production of endothelin after foam sclerotherapy: a new pathogenetic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011;26(5):203–208. 3. Parsi K, Hannaford P. Intra-arterial injection of sclerosants: report of three cases treated with systemic steroids. Phlebology. 2015 Apr 2. [Epub ahead of print]. 4. Jones L, Parsi K. Arteries masquerading as varicose veins: a trap for phlebologists. Phlebology. 2014 Jul 25. [Epub ahead of print]. 5. Schuller-Petrovic S, Pavlovic MD, Neuhold N, Brunner F, Wolkart G. Subcutaneous injection of liquid and foamed polidocanol: extravasation is not responsible for skin necrosis during reticular and spider vein sclerotherapy. J Eur Acad Dermatol Venereol. 2011 Aug;25(8):983–986. 6. Dickhoff C, Cremers JE, Legemate DA, Koelemay MJ. Medical liability insurance claims after treatment of varicose veins. Phlebology. 2014;29(5):293–297. 7. Noppeney T, Noppeney J, Scheidt A, Kurth I. Indications and technique for sclerotherapy of varicose veins [Article in German]. Zentralbl Chir. 2001;126(7):546–550. Microsclerotherapy Complications Expert Group: Martyn King, MD (Chair); Emma Davies, RN, NIP (Deputy Chair); Stephen Bassett, MD; Sharon King, RN, NIP Microsclerotherapy Complications Consensus Group: Elizabeth Bardolph, RN, NIP; Helena Collier, RN, NIP; Ben Coyle, MD; Sam Robson, MD; Askari Townshend, MD; Frances Turner-Traill, RN, NIP; Patrick Treacy, MD

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