Q: I have a problem of spider veins on my legs and thighs. Is there any cure for this?. I have heard about laser treatment but am not sure about the procedure. Is it painful, any side effects? Could you please tell me the various forms of treatment with pros and cons available for this problem.

A:The spider veins in the legs and thighs are invariably associated with reflux of the larger subsurface veins and sometimes even deep veins. It is imperative to establish this factor, as the treatment will depend on the control of the reflux. It may be that the patient has at present spider veins only and no other visible major varicose veins and will develop the full blown picture at a later date should there be incompetence and reflux. We often see patients who have no varicose veins but if they are subjected to the Duplex scan, then the incompetence of superficial veins and deep veins becomes apparent. I am not sure if the patient has had Duplex scan done, if not then that is the first thing to do. If the reflux is either excluded or treated then the spider veins can be treated and the two modalities are a) Micro-sclerotherapy and b) Laser therapy. There are advantages and disadvantages of both. Microsclerotherapy involves insertion of fine bore needles and injecting the sclerosing agent. This procedure may need to be repeated several times to control the residual veins. Laser therapy, though promoted by many clinicians, is not very successful in case of thigh spider veins as there is a subtle reflux from the other bigger veins, which may miss the scrutiny of the Duplex scan. Another factor to take in to consideration is that the laser used is IPL (Intense Pulse Light), which is given transcutaneously and is based on the light absorption ability of the blood. In pigmented people like darker skin Asians and Afro-Caribbeans, there is real danger of skin burn and this may result in scarring or hyper pigmentation or depigmentation. Also, even though the laser beam may not be a needle, it can be more painful than the very fine bore needle which is inserted after application of anaesthetic skin cream for micro-sclerotherapy.