By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
Endovenous ablation and sclerotherapy often result in some hyperpigmentation or brown discoloration of the skin for several weeks after the procedure. In rare cases, discoloration may be permanent but in most cases it does resolve although sometimes it can take up to a year to completely fade. Hyperpigmentation is more likely after sclerotherapy than the endovenous ablations because the amount of blood left in the vessel is greater in sclerotherapy than in the ablations. It is impossible to predict who will get discoloration and who will not but there are a few things we recommend to prevent the discoloration from becoming permanent or speed up the resolution. The information in this article are more focused on post-sclerotherapy recommendations since it occurs more often with this type of procedure.
After your procedure, we recommend graduated compression stockings, 20 to 30 mmHg be worn 24 hours a day for the first three days minimally only removing to shower. Research has shown that wearing them 24 hours a day for three weeks resulted in the least amount of discoloration. The compression stockings help to keep the vein collapsed after the procedure reducing the amount of trapped blood in the vein. The discoloration results from something called hemosiderin, which an iron storage complex or pigment produced by the destruction of red blood cells that is left behind in the tissues. The body has a very difficult time breaking down hemosiderin and reabsorbing it, so it often remains left behind in the tissues. By reducing the amount of blood left in the vein, there is less blood for the body to breakdown and reabsorb which reduces the amount of discoloration that results from the hemosiderin being left behind.
Another preventative measure we recommend is to stop any additional iron supplementation during procedures and for at least one month afterward. Research has supported that patients with higher levels of iron stored in the body increased the tendency to have post-procedure discoloration. The amount of iron in a regular multi-vitamin is usually not enough to cause a difference, it is usually only when a higher dose iron supplement is used.
There is some proof that anti-histamine medications may help prevent discoloration. Histamines assist in the contraction of the vessel after the procedures helping to reduce the amount of blood that is left behind. This is part of the normal, expected reaction the body has to the procedures. This has not been completely proven by research, so it is not a general recommendation even though it may help.
Minocycline is a medication that changes the pigmentation of the hemosiderin causing a blue-gray discoloration instead of a brown discoloration and is more likely to result in permanent discoloration. If you are taking minocycline, it is important to tell the provider so you can discuss your options.
Some other measures that we recommend are to avoid direct sun exposure which has been proven to cause skin damage altering the normal healing process and is a risk factor for the development of spider veins. We also recommend to avoid self-tanning products or tinted moisturizers which may be abnormally absorbed by the cells during the healing process.
We do apply arnica gel to the treated areas after sclerotherapy and give a small sample to take home and use for several days after the procedure. Arnica is a plant based gel that has been used since the 1500’s to help resolve muscle aches and reduce inflammation. It is generally safe when used topically for short periods of time. Long term use may cause rashes or blistering. It should not be used on any open areas like ulcers. There are no known drug interactions so anyone can use it for a short period of time. Most providers who do sclerotherapy do recommend its use after procedures.
It is important to remember that the risk of permanent discoloration is not predictable and if you are not willing to take risk of discoloration, you should not have the sclerotherapy done. No sclerotherapy procedure done for cosmetic purposes is absolutely necessary. If you have concerns regarding discoloration, it is important to talk to the provider before undergoing the procedure.
For more information, feel free to contact us for further evaluation at (814) 515-9919.