Postsclerotherapy Hyperpigmentation

The incidence of pigmentation postsclerotherapy appears to be related to multiple factors, including (1) type and concentration of sclerosing solution, (2) technique, (3) gravitational and other intravascular pressures, (4) tendency toward cutaneous pigmentation, and (5) treatment postsclerotherapy. Three histologic studies on postsclerotherapy pigmentation demonstrated this complication to be caused by hemosiderin only [2]. The incidence of hyperpigmentation following sclerotherapy has been reported to occur at a rate of 0.3–10% and up to 30% [2]. Postsclerotherapy hyperpigmentation usually occurs 6–12 weeks after treatment [2]. The general rule is slow regression of the hyperpigmentation with a 1% incidence of pigmentation persisting after 1 year [2]. Georgiev recommends a single “trial” sclerotherapy session with chromated glycerin to select patients at risk of developing postsclerotherapy hyperpigmentation [22]. Those patients who develop hyperpigmentation from intravascular chromated glycerin should be treated with a milder sclerosant, he goes on to say. Duffy and Sadick have not found the addition of 100 U/ml of heparin to sodium tetradecyl sulfate sclerosant (which has the highest incidence of hyperpigmentation) to decrease the incidence of postsclerotherapy hyperpigmentation and may, in fact, promote angiogenesis [2].Marley reported a decrease in postsclerotherapy hyperpigmentation when injecting veins proximally to distally [2].Goldman et al. report a decrease in the incidence of postsclerotherapy pigmentation from40.5% to 28.5% in patients wearing class II (30–40 mmHg) graduated compression stockings [1]. Chatard and Goldman both agree that the incidence of postsclerotherapy hyperpigmentation is not more pronounced in persons of color [2]. Treatment of postsclerotherapy pigmentation is often unsuccessful. Hydroquinone bleaching agents are ineffective in reducing this form of hemosiderin-deposited pigment. I have utilized the Q-switch Nd:YAG laser in selected patients with some improvement.