Post - Sclerotherapy Hyperpigmentation

Introduction Postsclerotherapy hyperpigmentation following the treatment of either varicose veins and/or visible blood vessles (telangiectasias) in the lower limbs has always been a major problem for the phlebologist. In literature there are conflicting data on the true incidence of this complication. In some studies the incidence is estimated in 30% of patients treated with sodium tetradecyl sulphate and from 10.7% to 30% with polidocanol (lauromacrogol, 400). According to Avramovic (1989) the remaining hyperpigmentation that remains after treatment is by far the most common complication (3.5% of 7200 patients treated), while "the Australian Polidocanol Study" reports an incidence of 0.31% in 8177 lower limbs one year after sclerotherapy with polidocanol (or lauromacrogol, 400). The varying data found in the studies probably depends on the fact that inhomogeneous “end points”such as vessel diameter, the observation times, the sclerosing agents and the technique used, have been considered. The incidence is closely related to operator-dependent causes, such as the choice of concentration and dose of the drug and the injection technique. It is however also related to non-operator dependent factors such as skin type and ferrokinetics (Table 1). The relationship between the risk of hyperpigmentation and sclerotherapy agents have been reported in numerous studies which show a higher frequency of complications with the use of sodium tetradecyl sulphate compared to chrome glycerin. The frequency is also higher after sclerosis of the small vessels, since the more superficial layers of the skin are less vascularized than the dermis.