Thread veins or "spider veins" are very small veins in the skin itself. They look like thin bluish red lines in the skin. (varicose veins are bluish lumpy veins underneath the skin but the skin itself is normal).
Thread veins do not cause any symptoms but because they are so visible, people often dislike their appearance and feel unattractive because of them. They can be associated with varicose veins but can occur even when there are no varicose veins.
Thread veins are extremely common. Most people have some (although they may not want to tell you). There is often an inherited component, for example, identical twins often have the same type of thread veins in the same areas of the body. So if your parents have had thread veins you can blame them. Hormonal factors can contribute, so that thread veins often appear in pregnancy (usually they go away again afterwards).
Women who have had several pregnancies are more likely to develop thread veins than those who have never been pregnant. Thread veins can be associated with varicose veins (see below). Lots of other things can sometimes cause thread including injuries and cuts, exposure to sunlight (usually on the face) exposure to radiation, for example radiotherapy treatment of cancers can sometimes cause thread veins in the skin.
Thread veins are not dangerous and do not cause symptoms so the first question to consider is whether they are enough of a problem to bother with. If only a very small area is affected then camouflage creams may hide them. If you do dislike their appearance and want to improve it then the first question is whether there are associated varicose veins. If there are varicose veins associated then the results of treatment are better if these are dealt with first (see varicose veins). Once any associated varicose veins are dealt with they can be treated with microslerotherapy or lasers.
Microsclerotherapy requires injections using a very fine needle into the thread veins themselves. This causes the lining of the veins to swell so that no blood can flow through them. It is actually the blood in the veins that is visible in the skin rather than the veins themselves so that if blood is prevented from flowing through the veins they disappear.
It is important to wear a support stocking after the procedure as this helps the veins to seal off and prevents blood flowing back into them. Occasionally, a small area of brownish pigmentation can occur at the site of the injection, very rarely a small area of skin may react to the injection causing a little ulcer. If this happens it normally recovers over time but sometimes the effects can be longer lasting.
Many people consider laser treatment to be less effective than microslerotherapy. In a recent medical review in the Drugs and Therapeutics Bulletin (the Medical equivalent of Which), it was concluded that microsclerotherapy was more effective than lasers and that it should be used in preference for most people.
Lasers also have the disadvantage that people have to avoid sun exposure before and after treatment and occasionally produce permanent areas of whiteness in the skin. Whatever method is used, treatment takes some time to achieve the maximum effect and for everything to settle down. It is not realistic to decide to get your thread veins treated a week before your summer holiday.
The benefits of treating thread veins take some time to develop. It usually takes several goes to get a worthwhile benefit and it is worth waiting at least six weeks before the effectiveness of treatment in a particular area can be assessed. If there are several areas to be treated, they can be treated sequentially, for example one leg one week, the other leg a week later.
Treating thread veins is in some respects like weeding the garden. If you put some work into it the garden will look much better but you do not expect that the weeds will never grow again. Treating thread veins is not a cure and does not stop you making new thread veins. It is normally possible to get rid of a large proportion of the veins and most people feel that their legs look much better and that the effort has been worthwhile. However, it is important that your expectations are realistic.
While treatment of thread veins can normally produce a substantial improvement, treatment will not get rid of every single thread vein nor result in perfect legs.