Skin necrosis, telangiectatic matting and post-inflammatory hyperpigmentation (PIH) are side effects which may occur in susceptible patients following sclerotherapy. Their appearance may be preventable in some patients using careful injection techniques. Patients should be warned of these potential complications, which vary between practitioners, when deciding on whether to undergo treatment.
PHILIP COLERIDGE-SMITH Telangiectatic matting is the occurrence of new vessels less than 0.1 mm diameter following sclerotherapy. This is also seen in the region of treatment when using surgery or thermal ablation techniques. It may arise near vessels containing coagulum or those affected by thrombophlebitis. This process reflects the response of skin to injury in those people who are predisposed to the development of telangiectasias. Mitchel P Goldman, in a review in 1995, has suggested that this problem may arise when sclerotherapy is given with too high an injection pressure using an excessively strong sclerosant in genetically susceptible subjects. He suggests using fine needles, a low sclerosant concentration and a low injection pressure when treating reticular veins.
Once formed, telangiectatic matting will usually resolve without intervention over a few months. Further treatment in the same region may give rise to more matting so a careful search for ‘feeding veins’ should be made as part of the treatment. A diligent search for incompetent saphenous trunks, tributaries and perforating veins using ultrasound imaging, should be made in all cases of matting. Smaller veins can be demonstrated under skin trans-illumination or by direct vision under bright lighting conditions. Cautious sclerotherapy of all feeding veins by sclerotherapy should be undertaken using the minimum volume of sclerosant which is effective. Direct injection of the matting may also be required once the feeding veins have been treated.