The cosmetic treatment of spiders vein by injection (sclerotherapy) dates back for over fifty years. The traditional sclerotherapy agents include hypertonic saline and sodium tetradecyl sulfate. (STS) While effective, they are associated with pain on extravasation, tissue necrosis with extravasation, and a moderate risk of hyperpigmentation. A ‘new’ sclerotherapy agent, Asclera (polidocanol), was approved in 2010 that offers some advantages over the effects of saline and STS. Asclera was FDA-approved for spider veins of less than 1mm and reticular veins from 1mm to 3mm. Interestingly, Asclera has been available for more than forty years around the world but historically not in the U.S. Its effects have been well known but not was available for use until more recently.
Compared to saline and STS, what are the advantages of Asclera sclerotherapy solution? It specifically has two. First, it is much less painful to inject. Many patients would say that it is painless during injection. Secondly, it is not associated with or has much less tissue necrosis potential with extravasation. It may have less potency than STS but clinical studies show equal efficacy in spider veins of similar size. It is available in 0.5% and 1% concentrations in 2ml ampoules.
Asclera offers a new sclerotherapy solution to U.S. physicians that is an effective aesthetic leg treatment for bothersome spider veins. For small vessels 1mm or less I use the 0.5% concentration. For larger vessels the 1% concentration is more effective.