Single or multiple telangiectasias (vascular "stars"), as well as reticular varicose veins (dilation of subcutaneous veins up to 2 mm in diameter) occur in every fourth woman aged 25-30. The reasons for the development of such a pathology have not been studied to the end. They note a hereditary predisposition, a direct connection with hormonal contraception, pregnancy and childbirth.
Numerous observations of rapid development of "vascular stars" are described. as a result of surgical trauma or as a result of soft tissue injuries.
Teleangiectasias on the lower limbs can be found in most of the adult population. The frequency is related to age:
- The pathology affects the fair half of humanity much more often than men. 80% of women (especially those who received obstetric care during childbirth) versus 20% of men.
- Yes, in women under the age of 30, telangiectasia is found in 8%, under the age of 50 – in 41%, up to 70 years – in 72%.
- For men, these indicators are equal to 1, 24 and 43%, respectively.
Vascular stars or spots can have a different shade: from violet-blue to purple. At the same time, it was noticed that the color may change over time. The size and color of telangiectasia is largely determined by its origin. An experienced specialist will be able to indicate their etiology quite accurately by the shade of the capillary pattern. For example, thin red webs that do not contour above the surface of the skin, progress from small capillaries and arterioles. And the convex blue "harnesses" are formed from venules. In some cases, over time, a small red spider web gradually transforms, acquiring large sizes and changing its shade to purple. This is explained by the fact that blood flowing through the venous section of the capillary loop partially enters the affected vessels. Most often, such changes are noted on the legs.
Until recently, there was no unequivocal answer to the question of whether to consider telangiectasia of the lower extremities as a vascular pathology or to consider this condition purely as a cosmetic defect.
For a long time, telangiectasias were the object of attention only of cosmetologists. In 1996, they were included in the I class of the international classification of chronic pathology of the veins of the lower extremities – SEAR, thereby determining their role in the development of chronic venous insufficiency, which determines the need for their correction.
However, these vascular formations are not classified as an independent disease. Therefore, there is no need to treat them. They are a cosmetic defect and do not affect health and life in general. However, on the other hand, if nothing is done with them, they can increase over time, and then ""remove"" they will be much more difficult. Therefore, the only purely medical indication for their "liquidation" there is a high probability or the presence of bleeding from these vessels, which can be quite massive. Such cases occur when the damaged vessels are very large and voluminous. As a rule, it occurs in elderly patients.
There are many classifications of telangiectasias. They are:
First of all, these are expanded capillaries and vessels of the skin, located in its various layers. As a rule, on the legs, they refer to the venous knee of the capillary bed, but sometimes common, arterio-venous telangiectasias are also noted.
- Red linear telangiectasias are often found on the face, especially on the nose and cheeks.
- Red and blue linear and tree-shaped telangiectasias most often appear on the legs.
- Arachnoid types of vessels are usually red.
- Spotted telangiectasias often occur in some skin and other diseases.
In women, telangiectasias are often located in whole families on the legs. There are two options for their location.
- In the first case, typical for the inner surface of the thigh, the dilated vessels have a linear type and are located in parallel.
- At the second – telangiectasias, more often tree-shaped, are located in a circle. This variant is usually found on the outer surface of the thigh.
In addition, due to certain features of the structure of the lower legs in women, reticular varicose veins and telangiectasias are very often found in the popliteal area. Accounting for types and variants of telangiectasia is very important for their correct treatment.
Teleangiectasias – this is an extremely common skin lesion, especially in women, many of whom perceive them primarily as a cosmetic defect.
All telangiectasias can be divided into congenital and acquired. Many factors play a role in the emergence of new and expansion of existing vessels of the dermis. Very often, telangiectasias accompany various diseases and are an external sign of damage to some organs and systems of the body. For example, they occur after injuries to the limbs, appear against the background of long-term intake of certain drugs. The most common factors leading to the development of telangiectasia are:
- Ultimately, acquired telangiectasias are formed as a result of the release or activation, for example, of hormones, histamine, etc., under the influence of many conditions, including infections, some physical factors.
- Hormonal influences in the development of telangiectasia are well known. The influence of estrogens is especially great. It has been established that a third of women first develop dilated vessels during pregnancy. Sometimes many of these vessels disappear 3-6 weeks after delivery. There is also a connection between the occurrence of telangiectasia and the use of oral contraceptives.
- On the legs, telangiectasias usually occur with varicose veins. It is very important that telangiectasias can be the first manifestation of venous disease.
The doctor's task in the presence of telangiectasias is to identify the cause and determine the need to treat these vascular formations.
Most patients with telangiectases note a decrease in tolerance to static loads, sleep disturbances and increased irritability associated with the initial manifestations of chronic venous insufficiency. Complaints and their frequency are presented as follows:
In most cases, a combination of various complaints is noted. In women, there is an increase in complaints immediately during or before menstruation. However, in most cases, such dilated vessels do not cause complaints, but disturb only their presence, spoiling the appearance.
Most often, telangiectasias are localized on the outer and back surfaces of the thighs, in the area of the ankle joints, on the feet, and in the popliteal area. Thus, "vascular asterisks" cause not only purely aesthetic but also physical suffering, reducing the patient's quality of life. This fact allows us to consider these changes in the subcutaneous veins as a pathological condition that requires special treatment.
The low effectiveness of the first method of treatment of telangiectasia of the lower extremities is noted by most specialists. A large percentage of unsuccessful results and rapid relapses after laser therapy are associated with high hydrostatic pressure in the subcutaneous veins of the lower extremities.
Despite their small size, these capillaries have a very high pressure, the same as in the large vessels of the abdominal cavity. Therefore, for "burning" vessels on the legs, transdermal laser is often ineffective. He "doesn't cope" with such pathology of blood vessels, therefore cannot completely ""burn"" them. The vessels do not disappear, and the laser leaves traces of burns and pigment spots on the skin. In any other place – on the face, hands, chest – laser helps to get rid of this cosmetic defect amazingly. Phlebologists use such a laser in cases where only very small capillaries need to be removed. Therefore, as the main method of treatment of telangiectases and reticular varicose veins, microsclerotherapy is considered, and laser coagulation is used for localization of telangiectases in other parts of the body.
When used correctly, both sclerotherapy and laser coagulation – effective methods of eliminating telangiectasias, of their various types and at different localizations. The combination of sclerotherapy and laser photocoagulation of blood vessels should be considered optimal in the treatment of telangiectasias of the lower extremities. Indications for laser photocoagulation are only capillary telangiectasias and allergy to sclerosants.
And indeed, many laser devices have a weak effect on the skin vessels of the legs. This is due to the fact that, compared to telangiectasias of the face, the vessels on the legs are coarser and located deeper. For an effective effect on these vessels, a high energy density in the pulse, a millisecond duration, a large diameter of the light spot and active cooling of the epidermis are necessary. Today, only some models of laser devices have similar characteristics.
The limiting factor for laser photocoagulation is the amount of melanin in the skin (simply speaking – skin color): constitutional or acquired (tanning). Among the side effects of laser photocoagulation, temporary hypopigmentation is the most common.
- As a rule, this is a course of several sessions. The number of sessions depends solely on the number of vessels that need to be removed and on the amount of the drug that is needed for this.
- Such manipulation is carried out on an outpatient basis, that is, the patient can lead a normal lifestyle without restrictions in terms of physical activity, work and rest. In terms of time, the session lasts from 30 to 60 minutes.
- The performance of microsclerotherapy is almost painless, as very thin needles with a diameter of a human hair are used. The sensation during the injection can be described as a mosquito bite.
The drugs used for such treatment are absolutely safe and act only locally, that is, they affect the wall of the vein at the injection site and are not absorbed anywhere else, not affecting anything else. Allergic reactions to sclerosants are so rare that they can be ignored. Moreover, an allergy test for the drug is always performed before the procedure. After the introduction of a sclerosing drug into the lumen of the "vascular asterisk" a specific reaction occurs, very similar to an allergic one, which is manifested by redness of the skin around the vessels and its swelling. Such a reaction is natural and indicates the correctness of the procedure.
Microsclerotherapy (sclerotherapy of microvessels & capillaries) – it is an effective, safe and painless method of treating vascular ""asterisks"". As a rule, microsclerotherapy effectively eliminates venous telangiectasias. The possible ineffectiveness of sclerotherapy of venous telangiectasias is primarily related to insufficient concentration of the solution or insufficient volume for the thickness and area of the vascular wall, as well as inadequate contact time between the sclerosant and the intravascular surface.
The following side effects and complications are possible with microsclerotherapy: bruising, hyperpigmentation, skin ulcers, allergic reactions.
In our clinic, we use drugs that are recognized as the best in the world, with proven effectiveness and maximum safety, as well as an original technique with the use of special accessories that increase the effectiveness of the procedure. Treatment with these drugs is usually well tolerated. When the drug is administered, a short-term light burning sensation at the injection site may be noted.
In case of violation of the doctor's recommendations and untimely removal of elastic bandages, the development of hyperpigmentation of the skin is possible, which goes away on its own within 4-6 months.
In any case, a specialist evaluates contraindications individually, since a number of them are relative in nature.
After microsclerotherapy for 2-3 months, it is not recommended to do epilation, sunbathe, visit saunas and baths, take oral contraceptives and hormonal drugs. In the first 3 days, you should not engage in aerobics, gymnastics and exercise bikes.
In conclusion, it should be emphasized that for more effective treatment of telangiectasias of the lower extremities, the doctor must have extensive knowledge to assess the state of the vascular system of the lower extremities as a whole, and also have both sclerotherapy and laser photocoagulation in his arsenal.
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