Hyperpigmentation after sclerotherapy: modern possibilities for prevention and treatment

Abstract

Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area.