The most common treatment method of treating spiders is by direct injection of a sclerosant agent administered using tiny (27 -30 gauge) needles. Several years ago the FDA began to address the problems associated with carcinogenic impurities found in sclerosing agents made in foreign countries and in compounding pharmacies here in the United States. In November of 2004 the FDA granted a manufacturing license to the Bioniche Company to manufacture Bioniche Sotradecol (sodium tetradecyl sulfate) and this is exclusively distributed by the AngioDynamics Company in the United States. At the same time they withdrew the “grandfather” approval of Hypertonic Saline which was much more irritating and had a higher association of ulcerations (slow healing sores). It is not illegal to use Hypertonic Saline as long as your physician discloses beforehand that this is no longer FDA approved for this purpose, though it may be their personal preference and discloses to you the reasons for not using an FDA approved agent. In March of 2010 the FDA also approved Asclera (Aethoxysklerol or Polidocanol) for the treatment of uncomplicated spider veins.
Sclerotherapy creates a therapeutic inflammation of the inner lining of the vein causing it to contract, close and be reabsorbed; typically over a 2 month period of time. These treatments take anywhere from 10 to 20 minutes and it may take 2 to 4 treatments to close a large area. The new FDA approved agents are painless when injected into the vein but will cause temporary discoloration and staining and run the risk of ulceration if the small needles penetrate through the spider veins and the solution is injected into the surrounding tissue. As with any technique driven therapy, physician judgment, experience and competence are the major determinants of success. The biggest reason for unsatisfactory results or early recurrence occurs when the treating professional fails to consider deeper underlying reasons for venous insufficiency and persists or is limited to surface injections: if the only tool you have is a hammer, then the whole world looks like a nail.