How Dermatologists Treat Leg Veins

Visible veins on the legs raise two questions at once: what are they, and what can be done about them?

The American Academy of Dermatology answers both by describing who tends to get leg veins, what the first exam involves, which self-care steps help, and the procedures dermatologists use, from injections to lasers to treatments inside the vein. Use those answers to prepare questions. The choice of treatment belongs to your dermatologist.

Who tends to get leg veins

The American Academy of Dermatology describes varicose veins as enlarged veins that often twist and can bulge above the surface of the skin, and spider veins as veins that often look like webs. It says having spider or varicose veins can affect more than your appearance, because these veins can cause serious discomfort, and some varicose veins put you at risk for a complication like a blood clot or open sores on your legs. The academy adds that minimally invasive treatment can get rid of or fade leg veins, and can diminish symptoms like pain and fatigue and prevent complications.

Some people are more likely to develop them. The American Academy of Dermatology says that if blood relatives have these veins, you have a higher risk, and that many people get them because they sit or stand for long periods most days of the week. It says the veins also become more common with age and during pregnancy, and that spider veins can also be caused by sunlight, hormonal changes, or an injury.

None of these risk factors can be read off a calendar, so the useful question for a first visit is which of them apply to you. If your work keeps you at a desk or on your feet most of the week, say so at the start, because the academy lists it as a risk factor.

What the first exam is for

The American Academy of Dermatology says a physical exam helps your dermatologist decide if leg vein treatment is safe for you. During the exam, your dermatologist will look closely at your leg veins and ask about your medical history, and non-invasive tests that look at the veins in your legs may also be necessary. The academy names two: a Doppler ultrasound, which shows the blood flow in your leg veins, and plethysmography, which uses a blood pressure cuff to measure changes in blood volume and can help find problems like abnormal blood flow.

This is the step where the dermatologist decides whether treatment is safe for you, so come with your medical history written down. A general overview of vein treatments from a dermatologic surgery society is a useful companion if you want to build a list of questions before that visit.

Self-care and compression

The American Academy of Dermatology says your dermatologist can give you tips to improve your circulation, including exercise, elevating your legs, getting up and walking around every 30 minutes if you sit for long periods, taking a break every 30 minutes if you stand for long periods, and avoiding soaking in hot baths for long periods of time. It says self-care tips can help prevent new varicose and spider veins but cannot get rid of existing ones.

Compression stockings are the other everyday tool. The American Academy of Dermatology says these stockings apply steady pressure to help move the blood back to your heart, lessen swelling in your lower legs, and reduce the risk of getting a blood clot. You will still have visible leg veins, though, so stockings and self-care manage the problem rather than remove it.

Sclerotherapy, an injection into the vein

In sclerotherapy, the American Academy of Dermatology says, your dermatologist injects a chemical into the spider or varicose vein, which irritates the wall of the vein. Different areas of the vein are injected, your dermatologist may massage the area, and a compression stocking is then placed on each leg before you are observed for a time and able to go home.

The American Academy of Dermatology says sclerotherapy causes the walls of the vein to stick together, so the blood cannot flow through it anymore, which improves circulation in the treated leg and reduces swelling. It says spider veins usually disappear in 3 to 6 weeks, varicose veins take 3 to 4 months, and to get the best results you may need 2 or 3 treatments. The dermatologic surgery society explains the approach on its page about sclerotherapy for varicose veins.

Those timelines are worth holding against your own calendar. Weeks to months is a long stretch, so ask how many visits to plan for and when you are likely to see change.

Laser treatment for small veins

The American Academy of Dermatology says dermatologists use lasers to treat spider veins and small varicose veins. Your dermatologist directs the laser light at the vein, and the light can destroy the vein without damaging your skin. Small spider veins may disappear immediately after treatment, while larger spider veins and varicose veins will darken and you will likely see them for 1 to 3 months before they disappear. To get complete clearing, the academy says you may need 3 or more treatments.

The darkening phase is the detail most worth knowing in advance. A vein that looks worse for a month or two after laser treatment is, on the academy's account, part of the expected path for larger veins, which is a reason to ask your dermatologist what you should see and when.

Treating the vein from the inside

The American Academy of Dermatology describes endovenous laser therapy (EVLT) and radiofrequency ablation (RFA) as newer treatments that often replace the need to surgically remove a vein. Both work inside the vein to destroy it. Dermatologists use EVLT to treat spider veins and small varicose veins, and RFA is used to treat large varicose veins.

The American Academy of Dermatology says it takes about 1 year for the treated vein to disappear with both EVLT and RFA, and that you may need more than one treatment for best results. That is a much longer horizon than the injection or laser timelines above, so it belongs in any conversation about when to start.

Another procedure name you may hear is ambulatory phlebectomy, which the dermatologic surgery society describes on its own page. Ask your dermatologist whether it applies to your veins.

The academy's complete list of treatments

The American Academy of Dermatology's article Leg veins: Why they appear and how dermatologists treat them sets out every treatment in the academy's own words, and it is worth reading in full before the exam.

Choosing with your dermatologist

Start with the exam, since it settles whether treatment is safe and which of the methods above fit the veins you actually have. Then ask about timing: how many visits, how long until the vein disappears, and how the season you start in fits around healing and compression stockings. Self-care can reduce the chance of new veins, but only treatment addresses the ones already there. A licensed clinician decides what suits your legs.

The figures above are general information, not medical advice.