Treatment Options for Telangiectasias, Reticular Veins

A review published in the Cochrane Database of Systematic Reviews appraised existing treatment options for telangiectasias and reticular veins. Although sclerosing agents outperformed sham treatment, they were associated with higher odds of hyperpigmentation, matting, and pain. Sclerosing treatment combined with laser may offer greater improvement over sclerosants alone.

Existing treatments include sclerotherapy, laser, intense pulsed light, microphlebectomy, and thermoablation, although the relative efficacies of these options are unknown. To better establish treatment guidelines, investigators conducted a systematic review of studies published before March 2021 regarding the management of telangiectasis or reticular veins. Eligible studies were randomized controlled trials (RCTs) that compared treatment methods with placebo or with one another. In all, 3 review authors independently performed study selection and data extraction. Risk for bias and evidence strength were evaluated using GRADE criteria. The primary outcome was resolution or improvement of telangiectasis or reticular veins. Patient-reported quality of life, time to resolution, recurrence, pain, and adverse events were also captured.

A total of 35 RCTs were included in the review, comprising a pooled cohort of 3632 patients. Studies compared laser treatments, compression, and sclerosing agents; no studies investigated intensive pulsed light, thermocoagulation, or microphlebectomy. There were 10 RCTs conducted in the United States; 5 in Switzerland; 4 in Germany; 3 in Brazil; 3 in Spain; 2 in France; and 1 each in China, Turkey, Australia, Canada, Denmark, Romania, Vietnam, and Mexico. Publication year ranged from 1987 to 2021. The majority of studies,(71%), evaluated only women. Participant ages ranged from 17 to 80 years. Data were of low to moderate quality.

Sclerosing agents showed more resolution or improvement of telangiectasias compared with placebo, per data from 4 studies with a pooled cohort of 613 patients (standard mean difference [SMD], 3.08; 95% confidence interval [CI], 2.68-3.48). However, sclerosing agents were associated with more frequent adverse events, including hyperpigmentation and matting. Pain may also be more common with sclerosing agents, although just 1 study with low-quality evidence identified this association. There was no apparent advantage with one sclerosing agent compared with another. Treatment outcomes were similar between sclerosing agents and polidocanol, although polidocanol may result in less pain (SMD, -0.26; 95% CI, -0.44 to -0.85; n=5 studies with 480 patients). Sodium tetradecyl sulphate offered comparable improvement odds with sclerosing agents, but was associated with greater likelihood of hyperpigmentation and pain. Foam treatment was associated with more matting compared with sclerosing agents. Laser alone appeared to reduce odds of hyperpigmentation compared with sclerosing agents. Laser treatment combined with sclerotherapy appeared to increase the odds of resolution compared to sclerotherapy only (SMD, 5.68; 95% CI, 5.14-6.23; 2 studies with 710 patients). However, combined treatment was associated with more pain than sclerosing agents alone.

The results demonstrated that sclerosing agents outperform placebo for the resolution or improvement of telangiectasias, but are associated with adverse events and pain. No significant evidence supported the use of one sclerosant compared to another or compared to laser. Combined treatment with sclerosing agents and laser may improve overall treatment outcomes, but is more painful. Risk for bias was moderate to high with many studies, limiting the reliability of these results.

“Further well-designed studies are needed to improve our confidence in the comparisons identified in this review, for other treatments available, and for other important outcomes, such as recurrence, time to resolution and long-term side effects,” study authors wrote.

Reference

Nakano LC, Cacione DG, Baptista-Silva JC, Flumignan RL. Treatment for telangiectasias and reticular veins. Cochrane Database Syst Rev. 2021;10(10):CD012723. doi: 10.1002/14651858.CD012723.pub2