35389 Polidocanol: A review of clinical uses

Abstract

Polidocanol is a nonionic detergent sclerosant that disrupts the intimal lining of blood vessels by inducing a negative charge on endothelial surfaces. Ultimately, thrombotic occlusion at the site of endothelial damage gives rise to endovascular fibrosis and effective obliteration of the target vessel. Polidocanol is FDA-approved for the treatment of uncomplicated spider veins and reticular veins in the lower extremity. Despite its limited indication, there are numerous reports of polidocanol’s use for a variety of off-label conditions. The purpose of our study was to describe the dermatologic clinical uses of polidocanol and to characterize efficacy and adverse effects associated with its various applications. In a review of literature searchable on PubMed from 2004 to 2020, polidocanol has shown efficacy in the treatment of varicose veins, hemangioma, mucocele of the minor salivary gland, pyogenic granuloma, lymphangioma circumscriptum, digital mucus cyst, mixed skin ulcer, cutaneous focal mucinosis, seroma, glomovenous malformation, acne cyst, and lymphocele. Commonly reported complications of polidocanol therapy include pain, edema, ecchymosis, ulceration, tissue necrosis, and thrombosis of the treated vein. Although not always first-line therapy, polidocanol may be chosen as a treatment method for off-label conditions due to its low cost, ease of use, and adaptability to difficult anatomic locations.