Cutaneous Necrosis, Telangiectatic Matting, and Hyperpigmentation following Sclerotherapy Etiology, Prevention, and Treatment
- 1 January 1995
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Dermatologic Surgery
- Vol. 21 (1), 19-29
- https://doi.org/10.1111/j.1524-4725.1995.tb00107.x
Abstract
Telangiectatic matting and hyperpigmentation are some of the most commonly observed side effects of sclerotherapy. Cutaneous necrosis is relatively rare and often of limited sequelae but most commonly related to extravasation of sclerosant. Physicians treating varicosities and telangiectasia by sclerotherapy must be familiar with causes and means for minimization of all three side effects. This review article discusses the proposed etiology, risk factors, approach for minimizing, and suggested treatment for the three side effects of cutaneous necrosis, telangiectatic matting, and hyperpigmentation. Cutaneous necrosis may occur with the injection of any sclerosing agent even under ideal circumstances and does not necessarily represent physician error. When sclerosant extravasation occurs, dilution must occur immediately. Telangiectatic matting is a recognized complication occurring in approximately 15-20% of patients treated by sclerotherapy. Although the exact mechanism of the phenomena remains unknown, reactive inflammatory and/or angiogenic mechanisms are felt to play a role. Patients are advised that telangiectatic matting is usually not permanent and usually resolves spontaneously in 3-12 months. Postsclerosis pigmentation is defined as the appearance of persistent, increased pigmentation running the course of an ectatic blood vessel treated by sclerotherapy. The general incidence of hyperpigmentation ranges from 10 to 30%. Although hyperpigmentation may persist for months, its presence rarely deters patients from continuing treatment. Spontaneous resolution occurs in 70% at 6 months with 99% resolution occurring within 1 year. With understanding the etiology, risk factors, and ways to minimize these side effects our goal is to reduce their incidence. Attempting prevention may ultimately be the most effective means of treatment. Dermatol Surg 1995;21:19-29. After studying the following article, participant should be able to: 1. Understand the definition and potential causes of cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. 2. Advise patients prior to treatment on the common risks involved in sclerotherapy and to advise them on the relative incidence. 3. Understand the concept of minimal sclerosant concentration and how it can help the physician to choose sclerosing solution concentrations to minimize risks.Keywords
This publication has 56 references indexed in Scilit:
- Mechanisms of Angiogenesis in Normal and Diseased SkinInternational Journal of Dermatology, 1991
- Minocycline hydrochloride hyperpigmentation complicating treatment of venous ectasia of the extremitiesJournal of the American Academy of Dermatology, 1991
- Treatment of essential telangiectasia: Effects of increasing concentrations of polidocanolJournal of the American Academy of Dermatology, 1989
- Angiogenesis and the skinJournal of the American Academy of Dermatology, 1987
- Infarct Size Reduction: A Review of the Clinical TrialsThe Journal of Clinical Pharmacology, 1986
- Angiogenesis is stimulated by a tumor‐derived endothelial cell growth factorJournal of Cellular Biochemistry, 1985
- The effects of posture, exercise, and bandage pressure on the clearance of 24na from the subcutaneous tissues of the footBritish Journal of Surgery, 1972
- Microspectrophotometry of Hæmosiderin GranulesNature, 1962
- THE NATURE OF STORAGE IRON IN IDIOPATHIC HEMOCHROMATOSIS AND IN HEMOSIDEROSISThe Journal of Experimental Medicine, 1960
- Hyaluronidase: A review of its therapeutic use in pediatricsThe Journal of Pediatrics, 1951