Spider Veins (Telangiectasias)

What spider veins are

Spider veins are telangiectasias: tiny veins, capillaries or venules, usually less than 1 mm wide, that have become permanently widened. On the legs they often fan out from a central point like a spider's body and legs, or form branching lines. On the face they appear as fine red lines, most often on the nose and cheeks.

Larger bluish-green veins of 1 to 3 mm, called reticular veins, often feed leg spider veins and need treating too for the best results.

Spider veins vs varicose veins

Spider veins and varicose veins often occur together. Spider veins concentrated around the inner ankle (corona phlebectatica) can be an early sign of venous insufficiency.

What causes spider veins

On the legs

• Family history: the strongest risk factor
• Female sex and hormones: puberty, pregnancy, birth control pills, hormone therapy and menopause
• Pregnancy: increased blood volume, hormones and pressure from the uterus. Many fade within months after delivery.
• Standing or sitting for long periods, such as in nursing, teaching, retail or office work
• Age: vein walls and valves weaken
• Overweight and obesity
• Injury to the skin

On the face

• Sun damage: ultraviolet light weakens vessel walls
• Rosacea: persistent redness with visible vessels on the cheeks and nose
• Alcohol and frequent flushing
• Skin aging and fair skin
• Long-term use of steroid creams on the face
• Pregnancy and hormonal changes

Spider veins as a sign of other conditions

• Spider angiomas (a red central dot with radiating legs that blanch when pressed): a few are normal, especially in children and pregnancy. Many on the upper body can be a sign of liver disease such as cirrhosis.
• Hereditary hemorrhagic telangiectasia: small red spots on the lips, tongue and fingertips with frequent nosebleeds.
• Connective tissue diseases such as limited scleroderma.
• Radiation damage to the skin.

How spider veins are diagnosed

Spider veins are diagnosed by appearance. A doctor will ask about symptoms and look for varicose veins, swelling and skin changes. A duplex ultrasound of the leg veins is recommended if there are symptoms of venous disease or before treatment when larger feeding veins are suspected. Treating underlying valve problems first reduces recurrence.

Treatment

Treatment is usually for appearance and is generally not covered by insurance unless there are symptoms of venous disease.

Sclerotherapy (legs)

The first-choice treatment for leg spider veins. A very fine needle injects a solution (such as polidocanol or sodium tetradecyl sulfate) that irritates the vein lining, so the vein collapses and fades over weeks.

• Most people need 2 to 4 sessions, spaced 4 to 6 weeks apart.
• Results appear over 3 to 6 weeks for spider veins, longer for larger veins.
• Compression stockings are usually worn for a few days to weeks afterward.
• Side effects: bruising, temporary brown staining (hyperpigmentation), new tiny red vessels near the site (matting), and rarely skin ulcers or clots.

Laser and intense pulsed light (face and fine leg veins)

• Face: pulsed dye laser, KTP laser and intense pulsed light work well for facial spider veins and rosacea redness, usually in 1 to 3 sessions.
• Legs: surface lasers are used for very fine vessels or in people who cannot have injections, though sclerotherapy is usually more effective on legs.
• Side effects: temporary redness, swelling, bruising, and pigment changes, especially on darker skin.

Treating underlying varicose veins

If ultrasound shows venous reflux, treatments such as endovenous ablation of the faulty vein may be done first.

Self-care and prevention

• Compression stockings ease aching and swelling and may slow new veins forming, though they do not remove existing ones.
• Move regularly: take walking breaks, flex your calves when sitting, and avoid crossing your legs for long periods.
• Elevate your legs for 15 minutes a few times a day.
• Exercise to strengthen calf muscles.
• Maintain a healthy weight.
• Use sunscreen daily on the face, and manage rosacea triggers.
• Cover spider veins with makeup or self-tanner if desired.

Creams, supplements and essential oils marketed for spider veins have no reliable evidence of removing them.

Outlook

Spider veins are harmless for most people. Treatments remove most existing veins, but new ones often appear over the years because the tendency remains, so occasional touch-up sessions are common.

Frequently asked questions

What causes spider veins on the legs?

Leg spider veins are mainly caused by genetics, female hormones (puberty, pregnancy, birth control, menopause), aging, standing or sitting for long periods, and excess weight. Sometimes they come with underlying vein valve problems, especially when there are aching, swelling or varicose veins.

Are spider veins dangerous?

Usually not. Most spider veins are a cosmetic issue only. They can be a sign of underlying venous insufficiency if you also have leg aching, swelling, skin changes or varicose veins. Many spider-like spots on the upper body can point to liver disease and should be checked.

How do I get rid of spider veins?

Sclerotherapy injections are the most effective treatment for leg spider veins, usually over 2 to 4 sessions. Laser or intense pulsed light treat facial spider veins well. Compression, exercise and leg elevation help symptoms and may slow new veins, but do not remove existing ones.

What is the difference between spider veins and varicose veins?

Spider veins are tiny, flat red or purple lines under 1 mm wide that usually cause no symptoms. Varicose veins are larger (3 mm or more), raised and twisted, often caused by faulty vein valves, and can cause aching, swelling and skin changes.

Do spider veins come back after treatment?

Treated veins usually do not return, but new spider veins can develop over time because the underlying tendency remains. Many people have touch-up sessions every few years. Treating underlying vein problems, staying active and wearing compression can reduce new veins.