Broken blood vessels they may look like and broken blood vessels they may be called, but they aren't actually broken at all! Telangiectasias are the web-like proliferation of the tiniest superficial veins that make their appearance on the skin for a variety of reasons. Lacy red to purple thread-like lines may be few and wispy or numerous and tangled. Some have such large feeder veins beneath the skin that a central "body" within the telangiectasias gives a suggestion of a spider, hence the term spider vein. How to prevent them and eradicate those already present can help keep your skin looking creamy smooth.

The obvious question is why are they there in the first place? There are a number of causes, although the most likely is simply due to the blend of genetics and the natural aging process of the skin. The more sun damage one has had throughout their lifetime, the more likely they are that telangiectasias will form. Here's a list of the most common causes:

• Genetics
• Sun Damage
• Steroid atrophy (topical or systemic use)
• Rosacea
• CREST (a form of scleroderma)
• Lupus

Does This Mean I Have Rosacea?

How do you know if you have spider veins or actually have rosacea? I am frequently asked by patients who present with blood vessel growths on the face if they have rosacea. Anyone who has had sun damage, is getting older, has very fair skin or has a family history of facial telangiectasias is fair game for forming spider veins. This has nothing to do with having rosacea. You can have telangiectasias without having rosacea and you can also have rosacea without having spider veins. However, if a patient only has spider veins and nothing else to go on, I will refrain from any other diagnosis until such time that other symptoms develop.

Red With Embarrassment

Whenever a blood vessel dilates, it releases more blood to the surface of the skin, and automatically produces redness of the skin. Here is a partial list of factors that can lead to temporary increased facial redness:

• Sun/wind/cold weather exposure
• Physical exertion or becoming overheated
• Stress
• Hot foods and beverages
• Spicy foods and beverages
• Alcohol
• Foods: Liver, citrus fruits, tomatoes, soy sauce, vinegars, some cheeses

Veinity?

After finding yourself unflatteringly flushed after catching a glimpse at a party you may suddenly find motivation to eradicate this tangled web. Not only is it appropriate, it's become very popular! In order to get rid of the redness, you can accomplish this by physically destroying the blood vessels as well as dealing with general redness. Those blood vessels aren't really "broken"; they are blood vessels called telangiectasias. These blood vessels can form due to a variety of causes and this is what leads to the over diagnosis of rosacea. Anyone with considerable accumulated sun damage, or has been overusing topical or oral steroids are going to be far more prone to developing them. And it naturally goes hand in hand that someone with a fair complexion or whose family are all fair complected will likely be more prone to getting sunburned throughout their lifetime and go on to form spider veins.

Epilation

Epilation destroys telangiectasis by zapping them with low voltage electricity. It is simple, highly effective and very economical. Injected anesthesia is not performed in order to keep the blood vessels from blanching and losing visibility. Certainly a topical anesthetic could be used by the patient at home such as LMX 4% Topical Anesthetic Cream - 30gm 2 hours before their appointment time. I have a concoction I have mixed by the pharmacist known as betacaine plus that does a wonderful job when applied in the office just 15 minutes before treatment. Topical anesthetics don't entirely deaden the area but they do dramatically raise one's threshold of pain tolerance.

A very tiny needle attached to the machine literally zaps along the length of the surface blood vessel and destroys it. There may be some swelling and redness of the treated area for a day or 2. The longest I ever saw a patient take to heal was 2 weeks on an elderly patient. Depending upon the number of blood vessels present, 1 or 2 treatments are typically adequate. The session probably will last between 15-30 minutes. You can expect to pay approximately $200.00. Remember, just like other "age-related" growths, if you're prone to growing telangiectasias, you'll probably continue to find new ones arising periodically. Prepare for maintenance treatments every now and then.

Intense Pulsed Light

For anyone who is resistant to epilation or has such an overwhelming number of blood vessels that epilation seems ridiculous, IPL, or FotoFacial is another option. IPL is not a true laser but a pulsed light therapy that helps destroy unwanted superficial blood vessels as well as brown skin discoloration. IPL requires 5 30 minute treatments performed every 3-4 weeks in order to help reduce facial redness and help eliminate telangiectasias. Costs can range up around $2500.00. Plan on maintenance treatments every 3-12 months.

Vitamin K

Vitamin K has become very popular in dermatology to help improve the appearance of a number of conditions including bruising, dark circles, ruddy skin tone and spider veins. Vitamin K, also known as phytonadione, is used medically to stop bleeding. The topical use of Vitamin K has been surprising in how well it does manage to reduce the appearance of facial redness, bruising, dark circles, ruddy skin tone and of course spider veins. If you have large telangiectasias or incredibly numerous ones, you may find the intensity of the redness diminishes but require a procedure to reach your intended goal. Topicals generally range in strength from 2-5%. Auriderm Clearing Gel is useful when applied twice daily and tends to be well tolerated when applied simultaneously with most other skin care products.

Red Plus Green Equals...

There's nothing wrong if you simply want to hide the redness and the veins. You may not feel like wearing a layer of make-up compatible to spackle, so consider your color wheel when you try to hide it. Green counteracts red. Dust with a green powder and you will find the intensity of the redness is automatically countered. T. LeClerc Loose Facial Powder (Tilleul) is an easy way to help normalize the ruddiness. You can always apply a cream form FusionBeauty Prime Results on the larger veins and then apply a flesh toned concealer or liquid foundation on top if necessary.

Rejuvenate

Anyone with spider veins looking to their skin rejuvenation options have a few issues to consider. The first is that tretinoin (the active ingredient in Retin A and other rx Vitamin A derivatives) and therefore retinols (guilt by association) may act to stimulate the formation of spider veins. This includes Retin A, Tazorac, Afirm, Avita, Differin, RoC, etc. Don't worry about miniscule sprinkles of a retinyl palmitate for instance in your skin care products, particularly if they are listed way down on the ingredient list. You have to draw the line of concern somewhere! Remember that anyone with spider veins is likely going to continually form new telangiectasias. So it could be a hard call on determining whether it's the drug or the skin at fault. Purists will simply avoid the use of these Vitamin A ingredients; others may decide to stick it out unless they witness a rapid onset of spider veins. You aren't wrong either way, but this is important to be aware of.

The second relates to the tendency towards increased skin sensitivity particularly when numerous spider veins are present. Those blood vessels are going to open up and your skin will redden with the use of any acidic topicals. Look to GHK Copper Peptides such as Neova, white tea extract and superoxide dismutase in DERMAdoctor Calm Cool & Corrected Anti-Redness Tranquility Cream or N-6 furfuryladenine that can be found in Kinerase as rejuvenation options that shouldn't exacerbate your condition. And don't forget to wear your sunscreen! it will help prevent further photodamage that can contribute to spider vein formation.

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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