How to Avoid Brown Marks and Staining After Sclerotherapy | A Guide for Healthcare Professionals
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- Опубліковано 30 чер 2024
- 4 Reasons Why Brown Marks and Staining Happen After Sclerotherapy and What You can do to prevent it.
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Time Stamp:
00:00 How to Avoid Brown Marks and Staining After Sclerotherapy | A Guide for Healthcare Professionals
00:34 Incidence of Brown Marks and Staining After Sclerotherapy
01:07 Melanin and Post-Inflammatory Pigmentation after Sclerotherapy; Haemosiderin deposits after Sclerotherapy
02:12 Excessively Strong Sclerosant as a cause of Hyperpigmentation after Sclerotherapy
03:02 Persistent Reflux in Reticular Veins as a cause of Hyperpigmentation after Sclerotherapy
03:54 Superficial Venous Reflux in Saphenous Vein as a cause of Hyperpigmentation after Sclerotherapy
04:30 Excessive Thrombus and Clot formation as a cause of Hyperpigmentation after Sclerotherapy
05:24 Thrombectomy of Clot
06:00 How to Avoid Complaints in patients with Hyperpigmentation
The reported short-term incidence of pigmentation ranges from 10% to 30%. Post-sclerotherapy pigmentation is usually due to a combination of both melanin and haemosiderin pigment deposits. Melanin is formed as part of the natural healing process after Microsclerotherapy. It’s part of the post inflammatory pigmentation. And hemosiderin is derived from extravasated red blood cells. Red cells that have left the blood vessel, entered the interstitium and deposited iron into the tissues. In my opinion, the reported incidence is more lower than it actually occurs. I think some degree of pigmentation after sclerotherapy occurs in all cases if you look closely enough, so what we are REALLY talking about here is excessive hyperpigmentation. The sort that goes on for 12 months that causes your patients distress. So what can you do about this?
I'm going to cover the 4 major reasons why excessive hyperpigmentation develops after Microsclerotherapy and what you can do about it. And please stay until the end where I will share with you my top tip for dealing with established brown marks - Marks that persist beyond 12 months - so that you can avoid complaints from your patients.
The first reason is that the sclerosant used was too strong. For leg spider veins and blue reticular veins, I advise liquid Polidocanol (Aethoxysklerol) at 0.5% or liquid STD (Fibrovein) at 0.2% Avoid the use of foam sclerotherapy. If hyperpigmentation continues to be a problem in your practice, consider diluting down to 0.25% Polidocanol or 0.1% STD.
The second reason is the presence of persistent reflux in associated reticular veins, a small perforator vein or even in adjacent varicose veins. Re-examine the area under the brown marks and staining with a transillumination device such as Veinlite and check for varicose veins in the standing position. Check for persistent reflux in and around the brown marks with high frequency ultrasound. Finding small perforator veins can be difficult, even with high frequency ultrasound, so consider referral to a more experienced colleague if you think this is appropriate.
The third reason is that there is reflux in a major truncal vein such as the saphenous vein. This can be an issue particularly if spider veins are clustered around the ankle, even in the absence of varicose veins. The conditon is called Corona Phlebectatica. You should consider examining or re-examining the patient by a complete venous duplex ultrasound.
The fourth reason is that there has been excessive thrombus formation after the Microsclerotherapy injection session. In some cases this can be reduced by applying compression by bandaging immediately afterwards and by the wearing of compression stockings. In addition, many specialists will review their patients 2 weeks after Microsclerotherapy and release the thrombus by pricking the area with a needle. - Розваги
These videos are quite thought-provoking. It's important then, to inform these patients that venous disease treatment is damage control (besides the telangiectasia being treated for cosmetic purposes). Patients often ask if the veins wil return. I'm sad to tell them that it doesn't prevent varicose veins from returning, but keeping to the treatment plan (including follow up), keeps them away since what they have is an on-going chronic disease of the veins. And, I often keep hoping that they aren't disenchanted about treatment
Thank you @small-timegarden. That is a very, very good point to make and I agree. Venous disease is a chronic condition which needs to be managed rather than cured. You are right in pointing out that a treatment plan and follow up are crucial to success. I think patients value honesty. BTW are you a healthcare professional? The reason I ask is that your comment is very insightful!
@@VeinCareAcademy I just emailed you 😁. I'm on Vein Experts
Ah, I got your email! Welcome!!!
Nice information, doctor 👍
Thanks for liking
Mine are fantastic you can’t even see the incision no marks at all.
Great to know
Excelente análisis de las causas y manejo de la híper pigmentación. Muchas gracias desde Colombia. Cordial saludo.
Thank you @sabrinaracelly for your comment and appreciation. Cordial greetings to you from England.
May I ask you @sabrinaracelly "Do you advise your patients to avoid sun exposure after sclerotherapy?"
@@VeinCareAcademy Sí. En nuestro país son muy comunes los fototipos 3, 4 y 5. Evitar el sol por lo menos las primeras dos semanasPor lo menos creo que reduce, la hiperpigmentación postinflamatoria
El sol parece aumentar la actividad de la tirosinasa. Sin embargo no parece influir en la pigmentación hemosiderínica.
I totally agree, thank you.
Have you not heard of the Q switched laser for this hyperpigmentation? If this laser is used for tattoo removal and hyperpigmentation due to sun/aging, why would this not be a viable option for hyperpigmentation due to sclera-therapy?
Thank you for that suggestion. I will do some research. Do you have experience of using this treatment?
Location doc. I heard Whiteley clinic they r also expert n vien surgery
Yes, the Whiteley Clinic does provide expert vein treatments
Do you still do consultations of any kind?
No. I now provide training and coaching for health professionals. Where do you live?