They may be ugly, but varicose veins and spider veins usually are only a cosmetic issue. However, sometimes, these bulging veins on the skin surface can signal a deeper problem.
“Varicose veins and spider veins are a plumbing issue,” says dermatologist Jennifer Lucas, MD. “They’re almost like leaky valves that are not capable of pushing blood back up to the heart.”
Varicose and spider veins are very common. About half of all women and nearly as many men in the U.S. suffer from abnormal veins in the legs, where varicose and spider veins most often appear. You’re more prone to vein problems if your job keeps you on your feet all day.
Genetics, pregnancy and crossing your legs when seated also make vein problems more likely.
How varicose veins happen
Gravity causes blood to pool in your legs, leading to an increase in pressure that, over time, stretches out and weakens the vein walls. Once they are enlarged or weakened, the tiny valves within the veins that keep blood from flowing backward can no longer close. Blood builds up and enlarges the veins close to the surface of your skin and varicose and spider veins appear.
“Varicose and spider veins are on a spectrum,” says Dr. Lucas. “Spider veins are more of a cosmetic nuisance, but large, distended varicose veins can often indicate a more serious problem.”
Varicose veins are a symptom of venous insufficiency, which causes poor circulation in the feet and legs. If your feet don’t get enough oxygenated blood, skin and tissues start to break down.
If your legs are swollen, tired, achy or uncomfortable, or if you have pain along the area where your vein bulges, see a doctor.
Cosmetic issues vs. bigger problems
“A lot of people come to see me about how their legs look,” Dr. Lucas says. “If they have symptoms, or if I’m worried about whether there’s a deeper problem, I send them for an ultrasound to evaluate the blood flow and determine if there is reflux.”
If there is reflux, treatments such as endovenous thermal ablation or laser therapy can be used to heat the inside of the vein, closing it off and rerouting the blood through healthier veins.
If the problem is only cosmetic, Dr. Lucas’ first choice for treatment is sclerotherapy. For smaller blood vessels, she uses laser ablation.
“If I can get a needle into the blood vessel, I use sclerotherapy – it works,” she says. “We inject a medication that’s essentially a detergent into the veins. It causes damage, and scar tissue forms to keep blood from flowing through, so you can’t see the blood vessels from the surface.”
The biggest downside to treatment is that people have to wear compression hose for a week. People may also have bruising or discoloration of the skin. Rarely, an ulceration may form.
Varicose veins that show up during pregnancy might get better on their own, but most don’t.
“Anytime you can wear compression hose, it will be better,” Dr. Lucas says. “But once the vessels are dilated, it’s hard to get them to go back down.”