Skip to Main Content




A 40-year-old otherwise healthy school teacher presented with disfiguring spider and reticular veins on the posterior-lateral aspect of her left thigh. Her spider veins appeared in her mid-twenties and worsened with each childbirth. She was concerned about the appearance of this area since she was starting to take her young children to the swimming pool in the summer months. She described no pain but experienced occasional burning and stinging.


Physical examination showed no large varicosities. Her left lateral thigh and popliteal area was covered with a number of 2- to 3-mm reticular veins and by clusters of spider veins. Foam sclerotherapy was chosen as the treatment with good results (Figure 64-1).


Left: Pretreatment photograph of the thigh area with visible reticular and spider veins. Right: Posttreatment appearance of the thigh veins a few weeks following sclerotherapy.

Graphic Jump Location



  • An elevated venous pressure in the subdermal capillaries is blamed for spider veins. Valvular incompetence in the larger axial veins and pressure secondary to reflux of blood into the superficial cutaneous capillaries may also cause enlargement of reticular and spider veins.

  • Other etiologic factors blamed for varicose and spider veins include aging, sun exposure, hormonal shifts, smoking, alcohol intake, obesity, occupation, heredity, pregnancy, and birth control hormonal medications.

  • There is some speculation that endothelial cells and endothelin receptor density and distribution may play a role in the development of varicose veins.1




  • Spider and reticular veins are most often located on the legs and thighs in women, although they occur on the nose and face as well. Men can develop spider veins as well.

  • Although asymptomatic for the most part, some patients with large reticular and extensive spider veins complain of burning, stinging, swelling, throbbing, cramping, and leg fatigue.

  • A bluish subdermal reticular pattern of veins may be visible in patients with pale translucent skin.




  • A variety of small veins are visible on physical examination. These small vessels include telangiectasia, venulectasia, and reticular ecstasias.

  • Telangiectasias are flat red vessels, very close to the skin surface, and less than 1 mm in diameter.

  • Venulectasias are bluish in color, sometimes distended and barely above the skin surface, and less than 2 mm in diameter.

  • Reticular veins have a dark bluish or cyanotic hue and are between 2 and 4 mm in diameter.

  • Varicose veins are generally larger (>3-4 mm in diameter), protrude above the skin surface, and compress easily with slight manual pressure.




  • Dermatologic conditions with or without pigmentation can be mistaken for small varicose veins.

  • Capillary malformations associated with congenital venous malformations can also be confused with reticular and spider veins.

  • Cellulitis.

  • Stasis dermatitis.

  • Osler-Weber-Rendu syndrome or hereditary hemorrhagic ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessCardiology Full Site: One-Year Subscription

Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessCardiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.