Spider veins

Spider veins (also called telangiectasias) are clusters of blood vessels that develop close to the surface of the skin. It is formed due to abnormal dilation of the venules (smaller veins) and capillaries (smallest blood vessels of the body) that causes increased fragility of the veins.

Spider veins are so named because of the way they appear - twisting and turning in a manner similar to a spider's web or tree branch. Since the veins are close to the skin and contain blood, they appear red, purple or blue in colour. Spider veins are commonly located on the face and legs, often in association with varicose veins.

However, there are certain differences between varicose veins and spider veins, as follows:

• Spider veins are smaller and have a spider web-like appearance
• Spider veins are caused due to abnormal dilation of the venules and capillaries whereas varicose veins affect the larger veins
• The surface area of skin covered by spider veins can either be very small or large
• There are predominantly red, whereas varicose veins often appear blue
• They are comparatively close to the skin's surface as compared to varicose veins
• In the case of spider veins, the affected blood vessels are easily fragile and break

(Read more: Home remedies for varicose veins)

Spider veins are often asymptomatic, apart from the visual non-appeal. However, in large and multiple spider veins, the symptoms are similar to varicose veins though less severe. The symptoms include:

• Swelling associated with throbbing
• Aching at the site of the veins
• Itching or burning sensation on the skin
• Discolouration of the skin due to damage to the veins

The symptoms often worsen after prolonged standing or sitting and reduce upon lying down.

After developing symptoms, if large and numerous spider veins are left untreated, certain complications may develop such as:

• Recurrent bleeding, causing pain
• Permanent discolouration
• Hardening of the skin above the spider veins
• Ulceration of the skin

(Read more: Homeopathic treatment for varicose veins)

A number of predisposing factors can increase the risk of spider veins. These can include:

• Genetics: spider veins are often hereditary (almost ninety per cent of the cases)
• Age: the risk of developing spider veins increases with age
• Gender: spider veins are more common in females as compared to males
• Bodyweight: being overweight and obese are factors that predispose to spider vein development
• Prolonged periods of standing: activities or work that require standing for extended periods of time increase the risk of spider veins
• Excess pressure in the face: this is caused due to sneezing, forceful coughing or vomiting. Some women may develop spider veins on their faces while pushing during childbirth
• Pregnancy: increased blood flow, in addition to increased weight, often causes spider veins in the legs. The veins may disappear after pregnancy (Read more: Varicose veins during pregnancy)
• Hormones: contraceptive pills or hormonal treatments which contain oestrogen increase the risk of spider veins, since oestrogen is known to weaken vein valves
• Damage due to overexposure to sunlight: Ultraviolet light from the sun is known to damage skin and, hence, can cause spider veins
• History of past blood clots

Spider veins often cannot be prevented since the condition has a large association with genetics. However, using certain measures, the condition may be delayed or its progression may be slowed. These measures include:

• Wearing sunscreen: this helps protect the face from damage against the UV rays of sunlight
• Maintaining a healthy weight reduces the pressure on the veins and hence reduces the risk of dilation of the veins
• Wearing compression stockings and staying mobile: this helps prevents stasis of blood in the veins of the legs and hence reduces the risk of the development of spider veins
• Alcohol consumption: limiting alcohol consumption prevents the flushing of veins in the face and hence reduces the risk of spider veins

Despite these measures, individuals may still develop spider veins due to ageing and hormonal factors (oestrogen imbalance).

Spider veins can be diagnosed by a general surgeon. It involves taking the patient’s history and physical examination. Investigations are usually not required.

History taking: the doctor (general surgeon) will ask about the onset, location and number of spider veins. Associated factors such as occupation, pregnancy history and hormonal history may be asked.

Examination: a visual inspection and palpation of the area of concern will help confirm the diagnosis. Points of interest that are noted include:

• Areas of discolouration
• Associated swelling
• Skin changes and thickening
• Ulceration

Investigations: tests are usually not required since spider veins are a clinical diagnosis. However, ultrasonography (USG) of the legs can be done to rule out any underlying pathology, such as blood clots or incompetent valves in the underlying veins.

Diagnosis of spider veins is often simple. However, ruling out the cause of spider veins is necessary to prevent the progression of the veins.

Spider veins are often asymptomatic and do not require any sort of treatment. Individuals often ask for treatment due to the visual displeasure of the veins, especially on the face.

Treatment modalities include

• Compression stockings: wearing stockings or compression socks on the legs puts pressure on the veins of the legs. Such pressure improves the blood flow through the legs and prevents further spider veins. Adjunctly, compression stocking also helps relieve leg swelling and decrease the risk of blood clots.
• Sclerotherapy: This is a very popular treatment approach. It involves injecting an irritant substance or chemical (sclerosing agent) into the affected vein. This causes the walls of the vein to collapse and seal themselves. A similar procedure known as closure system treatment involves the same principle. The difference is that the substance is sticky and it closes the vein, causing a cut-off of the blood flow resulting in the spider vein fading or disappearing over time.
• Laser treatment: this approach is used in veins that are smaller than 3 mm and are closer to the surface of the skin. The laser shoots a strong, focused light beam that causes the blood in the spider vein to clot and dry up. The treatment is less invasive since there is no injection being administered.
• Endovenous Laser Therapy (EVLT): this is a newer procedure for the treatment of spider veins and smaller varicose veins. It involves the doctor inserting a laser fibre into the affected vein. The laser then applies heat directly to the vein causing it to collapse. It is to be noted that this technique takes a long time to show the desired results (several months to a year).

Multiple sessions may be required in interventional procedures to achieve the desired results. It is to be noted that surgery as an approach to treatment is not advised in spider veins as compared to varicose veins. This is because spider veins are smaller in size and respond better to less invasive treatments. The success rate of treatment is high but there are chances of new veins appearing in different areas of the body.

Unlike major varicose veins, spider veins rarely cause any adverse effects on an individual's health. People can live normally with the condition until it starts bothering them. The main reason for treatment is cosmetic discomfort. Rarely does an individual progress to complications. The veins may disappear over time if the underlying condition is addressed. In interventional treatment, many sittings may be required to completely get rid of this condition.

Spider veins are abnormal dilations of the smaller veins and capillaries. It is more predominant in elderly females but can occur in anyone who has a family history of spider veins. Apart from visual distress (due to the location commonly being on the face and legs), they rarely cause any adverse or distressing symptoms. Treatment becomes necessary if the condition bothers the person. Contrary to the treatment of varicose veins, spider veins require a less invasive approach to eradication. Multiple sessions may be required to achieve the desired results. However, despite treatment, new spider veins can still appear in different locations.