Dermatologists find new application for technique used to treat spider veins

Mar 5 2009

Recent advances in skin rejuvenation can take years off one's appearance by softening or erasing fine lines and wrinkles, plumping sunken cheeks and erasing sun spots and uneven pigmentation.

While facial aging has been successfully addressed for years, addressing similar issues on the hands has been more challenging. Now, dermatologists are successfully using sclerotherapy - a longstanding treatment for spider veins - to improve the appearance of aging hands.

Speaking today at the 67th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Mary P. Lupo, MD, FAAD, clinical professor of dermatology at Tulane University Medical School in New Orleans, shared her professional experience using sclerotherapy to treat prominent veins common in aging hands, including the best candidates for the procedure and other minimally invasive techniques used to further improve signs of aging.

While the loss of dermal and subcutaneous volume that occurs with aging results in sagging of the face, it results in more pronounced blood vessels and tendons on the hands. This creates a skeletal, aged appearance that is predominantly seen in Caucasian women over age 50 due to both the natural effects of aging and the lifelong effects of ultraviolet light. Signs of aging on the hands occur less frequently in people with skin of color due to the inherent protective nature of melanin in their skin.

"As dermatologists continue to treat facial aging with much success, patients are increasingly aware of other visible areas of the body - particularly the hands, neck and the upper part of a woman's chest below the neck - that need to be addressed to avoid looking years older than their face," said Dr. Lupo. "Hands reveal one's age second only in frequency to the face and, as in facial skin aging, discoloration of the skin, fine lines and loss of volume can make the hands look older. Sclerotherapy can help minimize prominent hand veins and significantly improve appearance of the hands."

Sclerotherapy is a non-surgical procedure that permanently removes unwanted veins and is considered by dermatologists to be the gold standard for the treatment of spider veins. Dermatologists inject a special sclerosing solution with a very fine needle into the blood vessel, which irreversibly alters the vessel wall and causes it to be absorbed by the body so that it fully disappears over time. Dr. Lupo reported that studies show sclerotherapy is more effective and less costly than laser treatments, and it is a relatively inexpensive procedure that can be used in areas of the body other than the legs - including the hands, breasts and face.

Dr. Lupo advised that the procedure should be performed conservatively, such as using small injection volumes and treating a limited number of vessels, with repeat injection sessions until the desired cosmetic improvement is safely achieved. Typically, patients require only one to three sessions performed every four to six weeks. The procedure takes a mere five to 10 minutes to perform on the hands and the results are usually permanent.

Although there is no recuperation period, a pressure bandage needs to be worn 24 hours following the procedure - making delicate work with the hands difficult. Possible side effects include swelling, bruising, discoloration of the skin or, in rare cases, death of living cells or tissue as a result of a lack of blood flow to the hand.

Dr. Lupo cautioned that some patients are not good candidates for the procedure, including patients with a history of phlebitis (or inflammation of the veins) of the arm, patients who have undergone a mastectomy with lymph node removal, and those with venous or lymphatic abnormalities of the upper extremity.

"Overall, my patients are extremely pleased with their results and report an improved self-image and overall feeling of well-being that is commonly associated with cosmetic procedures," said Dr. Lupo. "For patients who want more dramatic outcomes, a multi-pronged approach using other minimally invasive therapies can complement sclerotherapy - such as using laser and light devices to fade skin discoloration or to increase collagen production."

"We also are exploring the use of injecting a dermal filler into the hands to make them appear fuller and less skeletal," said Dr. Lupo.

To help prevent or slow the progression of aging hands, Dr. Lupo recommends the daily use of a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of 15 or higher, avoiding excessive sun exposure and tanning beds, and using topical retinoids - which have been shown to improve skin cell turnover, improve dermal proteins such as collagen and work to decrease dark spots.

For more information on aging skin, go to the AgingSkinNet section of www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.