Last updated: 11/24/2009

Conservative treatments

Patients who are experiencing some discomfort from spider veins may be helped by any or several of the following approaches:

• Exercise. Walking or other forms of exercise that activate the muscles in...
  
  the lower legs can relieve aching and cramping because these muscles keep the blood moving through the leg veins. One exercise that is often recommended is repeated flexing of the ankle joint. By flexing the ankles five to 10 times every few minutes and walking around for one to two minutes every half hour throughout the day, the patient can prevent the venous congestion that results from sitting or standing in one position for hours at a time.
• Avoiding high-heeled shoes. Shoes with high heels do not allow the ankle to flex fully when the patient is walking. This limitation of the range of motion of the ankle joint makes it more difficult for the leg muscles to contract and force venous blood upwards toward the heart.
• Elevating the legs for 15–30 minutes once or twice a day. This change of position is frequently recommended for reducing edema of the feet and ankles.
• Wearing compression hosiery. Compression benefits the leg veins by reducing inflammation as well as improving venous outflow. Most manufacturers of medical compression stockings now offer some relatively sheer hosiery that is both attractive and that offers support.
• Medications. Drugs that have been used to treat the discomfort associated with spider veins include nonsteroidal anti-inflammatory drugs (NSAIDs) and preparations of vitamins C and E. One prescription medication that is sometimes given to treat circulatory problems in the legs and feet is pentoxifylline, which improves blood flow in the smaller capillaries. Pentoxifylline is sold under the brand name Trendar.

If appearance is the patient's primary concern, spider veins on the legs can often be covered with specially formulated cosmetics that come in a wide variety of skin tones. Some of these preparations are available in waterproof formulations for use during swimming and other athletic activities.

Electrodesiccation, laser therapy, and pulsed light therapy

Electrodesiccation is a treatment modality whereby the doctor seals off the small blood vessels that cause spider veins by passing a weak electric current through a fine needle to the walls of the veins. Electrodesiccation seems to be more effective in treating spider veins in the face than in treating those in the legs; it tends to leave pitted white scars when used to treat spider veins in the legs or feet.

Laser therapy, like electrodesiccation, works better in treating facial spider veins. The sharply focused beam of intense light emitted by the laser heats the blood vessel, causing the blood in it to coagulate and close the vein. Various lasers have been used to treat spider veins, including argon, KTP 532nm, and alexandrite lasers. The choice of light wavelength and pulse duration are based on the size of the vein to be treated. Argon lasers, however, have been found to increase the patient's risk of developing hemosiderin discoloration when used on the legs. The KTP 532nm laser gives better results in treating leg spider veins, but is still not as effective as sclerotherapy.

Intense pulsed light (IPL) systems differ from lasers because the light emitted is noncoherent and not monochromatic. The IPL systems enable doctors to use a wider range of light wavelengths and pulse frequencies when treating spider veins and such other skin problems, as pigmented birthmarks. This flexibility, however, requires considerable skill and experience on the part of the doctor to remove spider veins without damaging the surrounding skin.

Complementary and alternative (CAM) treatments

According to Dr. Kenneth Pelletier, the former director of the program in complementary and alternative treatments at Stanford University School of Medicine, California, horse chestnut extract is as safe and effective as compression stockings when used as a conservative treatment for spider veins. Horse chestnut (Aesculus hippocastanum) has been used in Europe for some years to treat circulatory problems in the legs; most recent research has been conducted in Great Britain and Germany. The usual dosage is 75 mg twice a day, at meals. The most common side effect of oral preparations of horse chestnut is occasional indigestion in some patients.