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.

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.

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.