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BACKGROUND
Sun, gravity and other environmental exposures subject the hands to
unique combinations of physiologic and environmental stress. With
the passage of time, the hands lose volume as a result of muscle atrophy,
bone demineralization, and loss of normal fatty tissue. Elasticity
is lost and skin texture of the hands dramatically changes.
This process is accelerated by sun-induced damage, which results in
wrinkled, discolored skin, and prominent superficial veins of the
hand. These veins get larger and more noticeable over time. In this
setting, dorsal hand veins (on the back of the hands) represent the
equivalent of varicose veins of the lower extremities. These unsightly
veins can be easily removed in one or two sessions with painless sclerotherapy.
Sclerotherapy of the hands is just as effective as treatment of spider
veins on the legs. However, as for sclerotherapy at any site, patients
should be excluded if they have a history of circulatory disease.
THE PROCEDURE
Sclerotherapy of the hands is done in two sessions. At the first,
one half of the dorsal hand is treated and then the patient returns
two to four weeks later to complete treatment on the other half.
STS is the FDA approved sclerosing agent of choice and is used at
increasing strength concentration from 0.2 to 1%, with volumes of
1 mL to 4 mL. STS is a detergent sclerosant that acts by damaging
the vein wall lining through protein disruption. This leads not only
to congestion of the injected vein lumen, but also destruction of
the wall. A higher concentration is used in the hands compared with
the spider veins of the legs because the hand veins we treated of
large caliber and so higher doses of sclerosant are needed to obtain
good results.
After the treatment, a pad is placed over the treated area and the
hand wrapped with an elastic bandage for overnight. However, patients
are instructed to release the bandage earlier if they note any change
in color, sensation, or ability to move the digits.
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