Sclerotherapy in Dermatology Sacchidanand S, Nagesh TS
Note: Page numbers followed by f refer to figure and t refer to table.
Alcohol intoxication 55
Allergic reactions 86, 94
Ambulatory phlebectomy, technique of 116f
Ambulatory venous pressure 36
interpretation of 38t
Anaphylaxis 86
flare 21
joint stiffness 26
perforators 8
venous flare 19
Arterial occlusive disease, advanced peripheral 65
Arteriovenous fistula 94
Artery hypertension, pulmonary 55
Aspiration 102, 104
Asthma, bronchial 65
Atrophie blanche 19, 24
Automated foaming device turbofoam 96
Bassi's perforator 9
Bedside tests 31
validation of 34
Bicuspid valves 5
Bleomycin 47, 56
Blood coagulum, manual extraction of 95f
Blue veins 16
Body mass index 120
Brodie-Trendelenburg test 32
demonstration of 32f
interpretation of 33t
Bronchospasm 55
Cabrera's technique 75
Calf muscles 7
Calf perforators, lateral 9
Carbon dioxide 76
laser 104, 106
Cerebrovascular accidents 90
irritants 54
phlebitis post-sclerotherapy 88
Chromated glycerin 47, 54, 60
Cockett's perforators 3
after sclerotherapy, types of 43
bandage 42
application of 44
elastic 42
elastocrepe for 66
hosiery 42
therapy 41
types of 42
Compressive therapy, mechanism of action of 41
Computed tomography 34, 38
Concertina method 111
Contact dermatitis 22, 98
allergic 86
Corona phlebectatica paraplantaris 21
Cough impulse test 31
Cramps 19
Cryosurgery 102, 104
hygroma 105
lesions 100
epidermoid 100
ganglion 48
mucous 101, 102
oral mucous 100
Deep plantar arch 6
Deep vein thrombosis 64, 91
history of 65
Dermatitis 64
Detergent sclerosant 77
Diathesis, allergic 65
Disrupt vein cellular membrane 47
Distended varicose veins, persistence of 34
Dodd's and Hunterian perforators 9
Doppler ultrasonography 35, 37f, 38
Doppler ultrasound machine 36f
Dorsalis pedis 6
Duplex ultrasonography 35
Eczema 22
acute 23f
chronic 23f
Edema 20, 30, 87, 94
Embolia cutis medicamentosa 93
Embolism, pulmonary 91, 92
Endosclerosis 46
activation 17
cell 46
damage 46
Endothelium, direct caustic destruction of 47
Epinephrine 95f
Erysipelas 24
Ethanol 47, 55
deep penetration 55
Ethanolamine oleate 47, 50, 60
Excision 104
Extracellular matrix 17f
degradation 17
Fascia lata 31f
Fascial compartments of leg, superficial 1f
Fegan's technique 68, 69
Femoral vein 2
Femur, adductor tubercle of 2
Fibrin cuff theory 25
Fixed plantar flexion 27
preparation 78f
methods of 75
sclerotherapy 44, 75, 82, 86, 89, 119
advantages of 82
peroperative 75
stability 76
types of 77
perforators 8, 9
veins of 2f
Fossa ovalis 31f
Gallbladder ablation 48
Gastrointestinal bleeding, upper 48
Glycerin 58, 95f
Graduated compression stockings 43
Hemangiomas 100
Hematoma 111
Hemoglobinuria 55, 94
Hemorrhage 21
Hyperpigmentation 15, 96
post-sclerotherapy 90f, 96
Hypersensitivity reactions 86
Hyperthermia 55
Hyperthyroidism 65
saline 51, 53, 58, 71, 86
sodium chloride solution 47, 59
Hypoallergenic tape 66
Ideal compression system, properties of 41
Infection 93, 97
Ischemic attack, transient 90
Itching 19
Kaposi sarcoma 48
Keller method 111
Klippel-Trenaunay syndrome 16
Knee perforators 8
Laplace's law 77
ablation 102
treatment 119
edema 65
perforator 8
ulcers, proximity of 86
Leonardo's vein 2
Lidocaine 58, 95f
Linear bullae from tape 88f
Linton procedure 111, 115
Lipodermatosclerosis 15, 19, 23, 24f, 27, 30f
Liquid sclerotherapy 44, 86, 89
Lobular capillary hemangioma 106
Lower leg, ulceration of 26
Lower limb
deep veins of 6f
major perforator veins of 10f
perforators of 14f
pigmentation of 22f
Lymphangioma 100, 104
cavernous 105
circumscriptum 104, 105, 107f
Lymphedema 27, 87, 94
Lymphoceles 48
Magnetic resonance imaging 34, 39, 105
Matrix metalloproteinases 17
Medial calf perforators 9
Metalloproteinase, tissue inhibitor of 17f
Micro-marsupialization technique 102
Microsclerotherapy 71
Micro-stab avulsion phlebectomy 116
Microvascular valves 10
Migraine 65, 90
Minimal invasive methods 118
Minocycline 89
Montreux technique 76, 77
Mucocele 102f, 103f
Multi-layer bandaging systems 42
Muscle cramps 30
Necrosis 92, 97
Neovascularization 89f
Nerve-3 impairment 55
injury 90
Nonsteroidal anti-inflammatory drugs 96
Ok 432 47, 56
Oliguria, transient 94
Oral lesions, percutaneous ablation of 48
Oral ranulas, treatment of 102
Orbach's air block 77
Osmotic solutions 51
Pain 30, 27, 64
Paresthesia 19
Patent foramen ovale 90
origin, varicose veins of 86
vascular lesion 39f
Percussion test 31
Perforating veins, incompetent 64, 86
ligation 115, 115f
nomenclature 8t
old and new terminologies of 14t
paratibial 9
thigh 8, 9
Periostitis 27
Peripheral arterial occlusive disease 65
Peripheral calf muscle pump 7f
Perthes test 33, 34
demonstration of 33f
interpretation of 34t
modified 33
Phlebectomy 116
ambulatory 116
Phlebitis, superficial 19
Pigmentation 22, 89, 94
post-sclerotherapy 89
Plethysmography 38
Polidocanol 47, 49, 58, 59, 68, 75, 85, 87f, 88f, 101
Polyethylene-oxide chain 49
Polyiodinated iodine 47, 55, 60
Pressure erythema 22
Protein theft denaturation 47
Pruritus 30
Pubic tubercle 31f, 113f
Pyogenic granuloma 100, 106, 108f
Q-switched laser 96
ablation 120
thermal energy 120
Ranula 101, 102, 103f
Restless legs 19
Reticular veins 15, 16, 21f, 58, 69
Rindfleisch-Friedel procedure 111
Salivary gland 101
Saphenofemoral junction 2, 3, 4f, 93, 111
incompetence 65, 114f
Saphenofemoral ligation 112
Saphenopopliteal junction 4, 5f, 93, 114
ligation 114
Saphenous nerve 10
Saphenous stripping
lesser 114
long 112
Saphenous vein
greater 2, 3f, 13, 31, 31f, 64, 111
incompetent 64, 86
inversion stripping of 114f
lesser 31, 64
short 13
small 2, 4, 5f, 91, 114
superficial 87
Scarring 15
Sclerosant 46, 65
concentration of 67, 68t
Sclerosing agents 47t, 58, 58t-60t, 78
Sclerosing solutions 46, 65, 66
Sclerotherapy 41, 43, 63-65, 69, 71, 71f, 73, 80, 85, 100, 102, 104, 105f, 106, 107, 108f, 119
complications of 85
contraindications of 86t
indications of 64, 86t
mechanism of 63
objectives of 63
over surgical procedures 108
procedure 100
purpose of 46
techniques 68
tray 67f
Sebaceous cyst 100, 101f
Sigg's technique 68, 69
irritation 30, 87, 97
necrosis 55, 93f
pigmentation 30
Smooth muscle
apoptosis dysregulation 17
cell 17, 17f
chloride solution with dextrose 47, 58, 60
morrhuate 47, 50, 59
sotradecol solution 119
tetradecyl sulfate 47, 48, 58, 59, 68, 69, 85, 101, 103f
Spider veins 16, 86
Standard varicose vein surgery, complications of 118
Static stiffness index 42
Steatocystoma multiplex 104, 104f
Stroke 90
Subdermic venous system, lateral 13
compartment of venous system of leg, anatomy of 13f
fascia, layer of 113f
vein thrombosis, acute 64
Sural nerve 10
Swelling 19
Systemic disease, severe 65
Tap test 31
Telangiectasia 15, 16, 20, 58, 71, 86, 95f
microsclerotherapy of 71
Tessari method 75, 76f
Thrombophilia 65
Thrombophlebitis, superficial 21, 87
Thrombosis, superficial 91
Thrombus formation 92f
Tissue plasminogen activator 25
Topical nitroglycerine ointment 66
Total endothelial destruction 47
Transilluminated powered phlebectomy 116, 117
Trendelenburg test 34
modified 32
Tumors, hemorrhagic 48
Ulcer 15, 24, 27, 30
healing 30f
varicose 23f, 27f
Ultrasound guided sclerotherapy 72, 72f, 85
techniques of 72
Urticaria 86
post-injection 87f
Valsalva maneuvers 98
Valves 5
dysfunction 16
Variceal bleeding 48
Varices 16
Varicoceles 48
Varicose veins 15-17, 19, 20f, 30f, 34, 39f, 41, 57, 63, 64, 86
ablation of 64
complications of 64
emptying of 34
evaluation of 29
formation 17f
large 58
pathophysiology of 13
presentation 19t
recurrent 120
residual and recurrent 64, 86
reticular 64, 86
sclerotherapy, principles of 67
surgical treatment of 111
fibrosis 64
malformation 48, 58
obliteration 64
diameter 80
examination of 36f
length 80
perforating 7, 8, 13
refluxing 86
superficial 1, 2, 5, 111
thread 16
X-ray of 35f
Venogram 35f
Venography 34, 35
anatomy 1
dilatation 16
diseases 13
chronic 64
of lower limb 1
eczema 19
hypertension 13
insufficiency 19
chronic 15, 16, 29, 38, 63
primary 15
symptoms suggestive of 29, 30
ligation, conservative 117
malformations 86
pathophysiology 15
physiology 15f
pressure 14, 42
reflux, superficial 114f
sinuses 7
of lower limbs 13, 14
superficial 72
varicosities, lateral 64
telangiectasia 19
thrombosis, superficial 24, 92
ulceration, mechanism of 25
ulcers 19, 22, 26, 63, 64
Venule 58
Venulectasia 16
Visual disturbances 90
White blood cell 25
White cell trapping theory 25
X-ray of veins 35f
Chapter Notes

Save Clear

Sclerotherapy in Dermatology
Sclerotherapy in Dermatology
Editors Sacchidanand S DVD MD FRCP (Glasgow) Dean/Director Bangalore Medical College and Research Institute Director of Medical Education Government of Karnataka Bengaluru, Karnataka, India Nagesh TS MD DNB Professor and Head Sapthagiri Institute of Medical Sciences and Research Center Bengaluru, Karnataka, India Foreword Dinker Belle Rai MD FACS FRCS(c)
Jaypee Brothers Medical Publishers (P) Ltd
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Jaypee-Highlights Medical Publishers Inc
City of Knowledge, Bld. 235, 2nd Floor, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Mobile: +08801912003485
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone +977-9741283608
© 2018, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at:
Sclerotherapy in Dermatology
First Edition: 2018
Printed at
  • Akhilesh A MD
  • Assistant Professor
  • Department of Dermatology
  • Sapthagiri Institute of
  • Medical Sciences and Research Center
  • Bengaluru, Karnataka, India
  • Savitha AS MD DNB FRGUHS (Dermatosurgery)
  • Assistant Professor
  • Department of Dermatology
  • Sapthagiri Institute of
  • Medical Sciences and Research Center
  • Bengaluru, Karnataka, India
  • Nirmal B MD FRGUHS (Dermatosurgery)
  • Assistant Professor and Consultant
  • Department of Dermatology
  • Velammal Medical College Hospital and Research Institute
  • Madurai, Tamil Nadu, India
  • Shashikumar BM MD
  • Associate Professor
  • Mandya Institute of Medical Sciences
  • Mandya, Karnataka, India
  • Shruthi C MD
  • Consultant Dermatologist
  • Bengaluru, Karnataka, India
  • Lakshmi DV DVD
  • Senior Resident
  • Bangalore Medical College and
  • Research Center
  • Bengaluru, Karnataka, India
  • Teresita S Ferrariz MD FPDS FPSCS FPADSFI
  • Board of Directors, ISDS
  • Immediate Past President, PADSFI
  • Head on Accreditations
  • Dermatology Department
  • Centuria Medical Makati
  • Kalayaan Ave, Makati City, Philippines
  • Divya Gorur K MD FRGUHS (Dermatosurgery)
  • Senior Resident
  • Bangalore Medical College and
  • Research Center
  • Bengaluru, Karnataka, India
  • Shilpa K MD FRGUHS (Dermatosurgery)
  • Assistant Professor
  • Bangalore Medical College and
  • Research Center
  • Bengaluru, Karnataka, India
  • Dinker Belle Rai MD FACS FRCS(c)
  • Chairman
  • Department of Surgery
  • Interfaith Medical Center
  • Brooklyn, New York, USA
  • Visiting Associate Clinical Professor of Surgery
  • SUNY Downstate Medical Center Brooklyn
  • Visiting Professor of Surgery
  • Rajiv Gandhi University
  • Bengaluru, Karnataka, India
  • Late GR Ratnavel MD
  • Former Professor
  • Stanley Medical College
  • Chennai, Tamil Nadu, India
  • Sacchidanand S DVD MD FRCP (Glasgow)
  • Dean/Director
  • Bangalore Medical College and Research Institute
  • Director of Medical Education
  • Government of Karnataka
  • Bengaluru, Karnataka, India
  • Sujala S MD, FRGUHS (Dermatosurgery)
  • Consultant Dermatologist
  • Sujala Polyclinic
  • Bengaluru, Karnataka, India
  • Durganna T MS
  • Professor
  • Department of Surgery
  • Rajarajeswari Medical College and
  • Research Center
  • Bengaluru, Karnataka, India
  • Agnes E Thaebtharm MD
  • Fellow, Philippine Academy of Dermatologic Surgery Foundation
  • Inc. Consultant at the Department of Dermatology
  • Jose R Reyes Memorial Medical Center
  • Manila, Philippines
  • Nagesh TS MD DNB
  • Professor and Head
  • Sapthagiri Institute of
  • Medical Sciences and
  • Research Center
  • Bengaluru, Karnataka, India
  • Aniketh Venkataram MS MCH (Plastic Surgery)
  • Consultant Plastic Surgeron
  • The Venkat Center for
  • Cosmetic and Plastic Surgery
  • Bengaluru, Karnataka, India
At the outset, I am rejoicing a sense of accomplishment in writing this foreword on a book written on the system of the human body which happens to be the cause of the most common ailment in India and the rest of the world but hitherto is also the least attended area by the medical fraternity, i.e. diseases of the venous system. A field I passionately fell in love immediately after I finished my Vascular Surgery fellowship in 1979. No sooner I came in contact with a few like-minded physicians across the nation (USA) and we formed the first ever society for Venous diseases in US named the Phlebology Society of America. We began interchanging and propagating the new explorations. Venous field was in its primordial state in USA till then. This new movement soon kindled the interest of other physicians mainly from Surgery and Dermatology to establish new venous societies.
As a surgeon, my interest was not just cosmetic sclerotherapy, but the understanding of Chronic Venous Insufficiency Disease (CVID) in its entirety. CVID presents itself in its initial manifestation as spider veins, telangiectasia, reticular veins and superficial varicosity. In full blown form, presents large varicose veins, severe skin changes, swelling, intractable ulcers and inability of ambulation with pain on weight bearing. In the process of treatment, we revisited the old art of sclerotherapy. It was practiced by few physicians in 1920s in the US and eventually fell out of use because there was no scientific follow-up and interchange of the knowledge or meeting of the minds. No well organized written techniques of application. We re-explored and soon found that it is applicable both for cosmetic and therapeutic treatment of all kinds of superficial manifestation of CVID if done methodically. Found the possibility of replacing the age old surgery of ligating and stripping of the saphenous system for all kinds of CVID. This brought out a paradigm shift in understanding the underlying etiology of the disease, thereby changing the diagnostic modalities. Resulted in newer methods of nonsurgical treatment. It could be managed as outpatient office practice, affordable to common people and cost effective. At the same time more effectively, time saving for the patient and cosmetics to young ladies. Soon, we started giving workshops all over the world and became a new specialty by itself attracting mainly the attention of Dermatologists. Today, after practicing it for more than 35 years, I am pretty well convinced that sclerotherapy alone with minimal invasive procedure known as stab phlebectomy in selected patients can manage 95% of venous diseases on outpatient basis. Except 5%, which belong to deep venous system, may need surgical procedures.
In 2006, the prominent Dermatologists of Bengaluru, Dr Sacchidanand S, Dr SDN Gupta and Dr Venkatram Mysore invited me to give a Hands-on Workshop in Sclerotherapy, for the treatment of Varicose veins. This was done for Indian Association of Dermatologists, Venereologists and Leprologists during their conference held in Bengaluru. This opened a new door for the Indian dermatologists to take over the treatment of venous disease from the surgeons. Sclerotherapy was applied by them both as a cosmetic and therapeutic tool in as a single stroke.
I congratulate Dr Sacchidanand S and Dr Nagesh TS carrying the mantle and spreading this art of treatment across the nation to help millions of Indians suffering from venous problems. Especially, it is more important today as a large population of India suffering from venous ailments are left out of treatment and are helpless. Office sclerotherapy makes it very affordable, cost effective, simplified outpatient management. So, I am proud to be part of this movement as an Alumni of Bangalore Medical College. It gives me an incredible sense of fulfillment that I am a part of this great medical contribution to India.
I consider this a special honor for me to write the foreword to this book titled Sclerotherapy in Dermatology of which the chief editors are Dr Sachidanand S and Dr Nagesh TS. I admire their dedication and commitment. Let this be a useful manual guiding all beginners and as well as the rest of the practitioners who may be from other specialties and interested in this field including the surgeons.
“The secret of change is to focus all of your energy not on fighting the old, but on building the new”—Socrates.
Dinker Belle Rai MD FACS FRCS(c) Chairman
Department of Surgery
Interfaith Medical Center
Brooklyn, New York, USA
Visiting Associate Clinical Professor of Surgery
SUNY Downstate Medical Center
Visiting Professor of surgery
Rajiv Gandhi University
Bengaluru, Karnataka, India
Dermatology is a branch of medicine which relies heavily on outpatient treatment and also managing several incapacitating diseases as inpatients. Dermatosurgery is evolving as a sub-specialty in itself and various newer surgical modalities of treatment have been added to the dermatosurgeons’ armamentarium. Management of venous diseases from the dermatologist's point of view always involved treating the venous eczema and pigmentation. However, sclerotherapy has been widely being practiced by dermatologists in the west in the treatment of varicose veins and its manifestations.
Varicose veins and its skin manifestations is a very common problem presenting to the dermatology outpatient departments. Sclerotherapy done in the early stages is a very useful tool in the management of varicose veins and also to prevent the complications of varicose veins. However, not many books are available on this subject and also dermatologists are not practicing this procedure regularly.
Our book Sclerotherapy in Dermatology is an attempt to provide a simple and comprehensive guide to the practitioners about sclerotherapy. It includes the basics of venous anatomy and also the techniques of sclerotherapy. We would like more and more dermatologists to take up this simple and effective therapeutic procedure for the treatment of venous diseases. In this book, we also have given the extended indications of sclerotherapy in the management of cystic lesions and pyogenic granuloma. The target readers are postgraduate students, dermatologists, and surgeons. We hope to arouse interest in sclerotherapy among the dermatologists.
We hope that this book will provide the knowledge and confidence to clinicians and postgraduates to take up sclerotherapy in their practice.
Sacchidanand S
Nagesh TS
We would like to acknowledge the great help and support of Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra (Associate Director-Content Strategy), Ms Payal Bharti (Senior Manager) of M/s Jaypee Brothers Medical Publishers, New Delhi, India.