Varicose veins are swollen, twisted veins, most commonly appearing in the legs, that result from faulty valves allowing blood to pool instead of returning efficiently to the heart. While they are a vascular problem, the answer to whether a dermatologist can treat them is yes, with an important qualification. Dermatologists frequently manage varicose veins, but their expertise typically focuses on the smaller, more superficial vessels, which often present as a cosmetic concern. This means that for many patients, a dermatologist may be the first and most appropriate specialist to consult for treatment.
The Specific Role of Dermatologists in Superficial Vein Treatment
Dermatologists specialize in conditions affecting the skin, which includes the superficial veins lying just beneath its surface. Their training in procedural skin treatments makes them well-suited to address the cosmetic presentation of venous disease, such as spider veins and smaller, less complicated varicose veins. These vessels are part of the superficial venous system, which is distinct from the deeper veins responsible for the majority of blood return.
The scope of dermatological practice centers on minimally invasive techniques that remove or collapse the visible veins. Dermatologists often acquire additional training in phlebology, which is the study and treatment of vein disorders, qualifying them to perform these procedures. They are proficient in managing veins where the primary concern is the rope-like appearance on the leg surface, but their focus remains on the visible manifestation, not necessarily the deeper, underlying vascular health.
Minimally Invasive Procedures Used for Varicose Veins
Sclerotherapy
One of the most common treatments performed by dermatologists for small varicose and spider veins is sclerotherapy, a procedure that involves injecting a specialized chemical solution directly into the diseased vein. This solution, known as a sclerosant, irritates the inner lining of the blood vessel, causing it to swell, seal shut, and eventually collapse. The collapsed vein is then gradually absorbed by the body over several weeks or months.
The procedure is performed in the office, typically requires no anesthesia, and takes about 30 to 45 minutes to complete. Following the injection, patients are usually instructed to wear compression stockings for a period, often between one week to a month, to maintain pressure and encourage the vein to close permanently. Spider veins may disappear within three to six weeks, while slightly larger varicose veins can take three to four months to fully fade from view.
Endovenous Laser Treatment (EVLT)
For larger, more pronounced varicose veins, a dermatologist may offer Endovenous Laser Treatment (EVLT), also known as Endovenous Laser Ablation (EVLA). This technique uses a thin laser fiber inserted into the faulty vein under ultrasound guidance, often near the knee. The laser delivers controlled heat energy directly to the vein wall, causing it to contract and seal itself shut through a process called thermoablation.
EVLT is a minimally invasive outpatient procedure performed using a local anesthetic to numb the area. Recovery is swift, with most patients able to resume their normal daily activities, including walking, within one to two days. Separately, surface laser treatments are also employed for the smallest spider veins, using focused light energy applied through the skin to destroy the vein without requiring an injection.
Distinguishing Dermatological Care from Vascular Specialists
While dermatologists handle many superficial vein issues, their care has specific limits, particularly when the venous disease is advanced. A vascular surgeon or phlebologist (a physician specializing in vein disorders) should be consulted when the problem involves the deep venous system or chronic venous insufficiency. These specialists possess the training to perform a comprehensive diagnostic ultrasound to map the entire vascular structure of the leg.
Referral is necessary if a patient presents with a large vein diameter, significant underlying reflux in the deep veins, or signs of severe venous insufficiency like skin ulceration or marked swelling. Dermatologists may not be equipped to perform complex deep vein procedures or major interventions like traditional vein stripping, which may be required in rare, severe cases. For a complete medical assessment of the root cause, particularly if symptoms extend beyond cosmetic annoyance, a vein specialist is the most appropriate next step.