If you are confused by leg veins, what’s cosmetic, what’s medical, you’re in the right place. In this post, I’m going to explain when leg veins are simply cosmetic and when they are a medical issue that you probably shouldn’t ignore and I will say a little about what options you have.
I am a vein specialist based in Dorset England. I’m the director of the VeinCare centre a private specialist vein clinic and I have over 30 years of experience of treating people with a wide variety of vein problems such as phlebitis, varicose eczema and leg ulcers both in the NHS and in private practice. I have also spent many years assessing leg vein causing embarrassment and distress because of their appearance. So let’s get started and let’s cover what’s cosmetic and what’s medical.
First of all, let me say that isolated spider veins or enlarged veins on the face and forehead are cosmetic. So unless you have a rash or some other skin condition such as rosacea, these veins are not a medical problem. If you are not sure, you probably need to see your GP or a dermatologist. Most people, however, know when they just want some broken veins on their nose or cheeks treated for cosmetic reasons. I’m not going to talk any more about simple broken vein on the face – these are definitely cosmetic.
Secondly, hand and arm veins. These are common and in most people, these are not a medical problem. Unless they are present in one hand only and as long as the person who is affected is in good health with no serious medical history, enlarged hand and arm veins are cosmetic.
Other veins that are almost always cosmetic include veins on the breasts in women.
It’s important to distinguish cosmetic veins from medical veins at this time, because, during the COVID-19 pandemic, UK law allows patients to keep medical appointments and have medical treatments during lockdown. I and my team at the VeinCare Centre are part of a medical clinic which is governed by the Care Quality Commission in England. So as a medical clinic, we can remain open during lockdowns and we can provide medical treatments. However, we have decided not to treat facial veins, hand veins and chest veins during the pandemic because we want to keep everyone in our clinic safe, including staff as well as patients.
So let’s turn to leg veins.
Well, let me say straight away, problems with the leg veins range from minor to serious but they are always medical in nature. That is so important, I’m going to say it again. Problems with leg veins range from minor to serious but they are always medical in nature. Another way of saying this is in the negative. Leg veins are never cosmetic. That doesn’t mean they are all serious, but minor leg vein problems should not be considered cosmetic. This is important, because many doctors and other healthcare professionals get these 2 concepts mixed up. How many of you have been to see your GP and have been told that your spider veins or varicose veins are cosmetic? I think what is meant is that these are not serious.
- Here’s a couple of other things I would like to get straight
- Nearly all leg veins problems (which we have agreed are medical and not cosmetic) come on gradually and slowly get worse. Medical people call these chronic. Chronic leg vein problems are rarely urgent.
- There are only 2 common leg vein problems that are urgent: these are superficial vein thrombosis (frequently called phlebitis) and deep vein thrombosis (frequently called DVT). Medical people call these acute.
I’ve covered several important facts. Let me summarise so far.
- Leg veins problems are not cosmetic
- Leg vein problems can range from minor to serious
- Most leg veins problems develop gradually, they are non-urgent and they are called chronic by doctors
- Phlebitis and DVT are serious and urgent and they are called acute by doctors
- So how can you tell what sort of leg vein problem you have? Well fortunately for you, all leg vein problems are either manifested in the skin and the areas under the skin or they cause symptoms. That means you can LOOK at your leg and you can SEE the problems for yourself and even if you can’t see anything wrong, you will have symptoms and when you have finished listening to my presentation today, you will know what to look for and what symptoms to be alert to.
Here’s the 5-point check list:
- Spider Veins
- Spider Veins
These are probably the least understood manifestation of leg vein disease by both the public and by healthcare professionals, including many vascular specialists. Many regard spider veins as simply cosmetic. I’ll explain in a moment why they are not. But for the moment, let me just say that this misconception leads to 2 main problems: firstly, spider veins are not taken very seriously by doctors and secondly, they are often not treated properly. So if you have spider veins, you will not be referred for specialist advice and if you are able to get treatment, that treatment is often inadequate.
Let me show you an illustration.
In this photograph, this patient appears to have simple spider veins in the skin. However, when we look with a special device called a near infra-red imager, we can see that these spider veins are connected to a network of “invisible” veins under the skin which feed into the spider veins. If these feeder veins are not treated as well, the spider veins will not be effectively treated and they will come back. Many cosmetic clinics offer Microsclerotherapy to inject these veins, but they do not have access to the devices needed to detect these feeder veins.
The medical evidence is clear, all spider veins are connected to the entire leg vein system through a network of veins under the skin. Although spider veins are in the skin, the deeper “invisible” feeder veins must be treated as part of a medical assessment and treatment.
Now although spider veins are medical, they are not serious in 99% of cases. The one important exception is the presence of spider veins and blue veins around the ankle, a condition called “corona phlebectatica”. This is corona phlebectatica and it indicates that there is severe and advanced vein disease and that varicose eczema and leg ulceration may develop soon.
Abnormality of the leg veins causes a build-up of back pressure at a microscopic level. All the cells in our body are bathed in a fluid called lymph which carries nutrients and oxygen to the cells and which carries away breakdown products. Lymph circulates; it is flows out of the capillaries and it is carried away by the venules and microscopic vessels called lymphatics. If there is back pressure in the capillaries as a consequence of vein problems, lymph fluid builds up and the circulation of lymph is sluggish. This leads to swelling called venous oedema.
Abnormality of the leg veins leads to an efficient exchange of oxygen and nutrients from the capillaries to the skin. The skin is deprived of nutrients and oxygen and it is inflamed. This is what venous eczema looks like.
Nearly everyone knows when they have varicose veins. The apperance is very typical. However, sometimes hernias and fatty lumps can be confused with varicose veins. The simplest DIY test is to lie down and raise your legs. If the lumps “disappear”, then they are almost certainly varicose veins.
These are the symptoms:
- Restless Legs
Typically, the symptoms are worse towards the end of the day, they are aggravated by standing and relieved by leg elevation and medical compression.
This afternoon, I attempted a LIVE STREAM on YouTube. Unfortunately my broadband was not fast enough and it failed to stream properly. However, I did record it onto my computer and I uploaded it to YouTube later this evening. Here it is for you to watch.
If you would like more information about varicose eczema or indeed any other vein problem, please get in contact and one of our advisors will be happy to help you.
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