Diagnosis and Treatment of Spider Veins and Reticular Varicose Veins: An Expert Interview with Prof. Reich-Schupke

Prof. Dr. med. Stefanie Reich-Schupke is a leading expert in the field of venous diseases and is internationally renowned in the field of dermatology and vascular medicine. With her comprehensive expertise in dermatology, phlebology, lymphology, and medical wound care, she is a key figure in the medical field. In 2017, the appointment of Prof. Dr. Reich-Schupke as the Endowed Professor of Phlebology at Ruhr University Bochum caused quite a stir. At that time, there had not been a professorship in phlebology in Germany for over 13 years. The goal of establishing the endowed professorship was to strengthen phlebology as a significant discipline within medical science. The fact that this prestigious professorship was entrusted to such an experienced and respected specialist underscores her international standing and the need to advance this field.

In her private practice for dermatology and vascular medicine in Recklinghausen, Prof. Dr. Reich-Schupke takes a holistic approach that combines the latest medical findings with proven therapeutic methods. Her philosophy of taking time for each patient is reflected in her structured appointment system, which does not include walk-in hours. Another area in which Prof. Dr. Reich-Schupke excels is dermatology. She brings extensive experience in the diagnosis and treatment of acute and chronic skin conditions, including psoriasis and atopic dermatitis. Her expertise in skin cancer screening and the use of modern diagnostic procedures—such as Bodyscan, Nevisense, and video reflected light microscopy—make her a sought-after resource for patients who prioritize preventive healthcare.

As a recognized specialist in phlebology and lymphology, she is not only an expert in the treatment of varicose veins and lymphedema but also a sought-after consultant and speaker at national and international conferences. Her practice in Recklinghausen is not only synonymous with outstanding medical care but also provides a space where patients feel heard and understood. The editorial team of the Leading Medicine Guide was able to learn more specifically about the diagnosis and treatment of spider veins and reticular varicose veins (varicose veins) in a conversation with the vascular and skin specialist.

Vascular and skin conditions are widespread health issues that can significantly affect not only a person’s appearance but also their well-being and quality of life. Among the most common forms of these conditions are spider veins and reticular varicose veins, which are often perceived as a cosmetic issue but can also indicate underlying venous insufficiency (= weak veins). Varicose veins are not only unsightly but can also cause symptoms such as swelling, pain, or a heavy feeling in the legs. The diagnosis and treatment of spider veins and reticular varicose veins have advanced significantly in recent years. State-of-the-art procedures, such as high-resolution ultrasound, enable a precise analysis of the venous system and the identification of the site of insufficiency. At the same time, numerous minimally invasive treatments are available that are both effective and minimally invasive, offering patients a long-term solution.

Spider veins and reticular varicose veins are both common forms of venous disorders that occur on the legs and are of both cosmetic and, in some cases, symptomatic importance to many affected individuals.

Spider veins, medically known as telangiectasias, are very small, dilated blood vessels that are visible beneath the skin. They usually appear in a fine, net-like pattern and can vary in color, typically red, blue, or purple. Spider veins are commonly found on the thighs, calves, or near the ankles and are often associated with a number of underlying factors, including genetic predisposition, hormonal changes, pregnancy, or prolonged standing and sitting. In contrast, so-called reticular varicose veins are a larger form of venous dilation. They are typically between 1 and 3 mm in diameter and have a greenish-blue color. These veins also form a net-like pattern and can appear in various areas of the legs. 

“Spider veins do not in themselves cause symptoms of venous congestion. Occasionally, however, there are patients who report symptoms such as tingling or itching, or describe a burning pain in the area of the spider veins. This actually has nothing to do with the size or number of the spider veins, but is based on individual perception. In contrast, many patients (women generally more so than men) with large varicose veins clearly notice that their legs and/or feet swell, gradually change color, develop brown spots, or have large veins that protrude visibly. Spider veins can be a purely cosmetic issue resulting from weak connective tissue, but they can also be an indication of underlying, more serious venous disorders. If you notice an increase in the number of spider veins, an ultrasound examination should be performed to determine whether there is a hemodynamically significant varicose vein condition. For example, if a varicose vein is larger than 3 mm, it is referred to as a collateral varicose vein—a specific type of varicose vein that occurs in the collateral branches of the superficial venous system. If varicose veins remain untreated, they can lead to superficial thrombosis, venous congestion, eczema, or leg ulcers (known as “ulcus cruris”). Fortunately, the latter occurs rarely, as people today are generally more vigilant,” explains Prof. Dr. Reich-Schupke.

Various diagnostic procedures are used to accurately assess spider veins and reticular varicose veins and identify their causes. 

The first step is usually a medical history interview, during which the doctor gathers information about the patient’s medical history, symptoms, and possible risk factors. This is an important first step in obtaining a comprehensive picture of the condition. 

“In every case, photoplethysmography is performed to assess venous return. During this procedure, a beam of light is directed at the skin, and its reflection is influenced by changes in blood flow. This allows the filling status of the superficial venous network to be assessed. Such an examination can also be performed by a primary care physician, at a medical supply store, or at a pharmacy to get an initial impression of blood flow conditions in the leg. However, the gold standard—performed by a physician with expertise in phlebology—is duplex sonography. This procedure combines ultrasound imaging of venous structures with Doppler technology to analyze blood flow and its direction within the veins. This makes it possible to determine the diameter of the veins, whether the venous valves are no longer closing properly, or whether the direction of blood flow within the vessel has reversed (so-called reflux, where blood flows backward—from top to bottom or from the deep to the superficial veins—which causes varicose veins,” explains Prof. Dr. Reich-Schupke.

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The main cause of varicose veins is an inherited weakness in the connective tissue or vascular walls. However, being overweight, sitting for long periods, standing for long periods, and a lack of exercise can also lead to varicose veins or spider veins. Although smoking is unhealthy, it has no direct effect on varicose veins or spider veins; however, it does contribute to the formation of clots in the vascular system (i.e., thrombosis).

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The treatment of spider veins and reticular varicose veins has made significant progress in recent years thanks to modern technologies and procedures. 

“Essentially, there are two treatment options for spider veins. If there is no underlying venous disorder causing the spider veins, they can be left as is, provided the patient is not bothered by their appearance. However, if the spider veins are to be removed, this can be done with sclerotherapy, in which a medication is injected into the vein. This medication then adheres to the inner wall of the vessel, causing the vein to collapse. An alternative is laser therapy, in which laser energy is directed at the vessel from the outside, causing it to break down. Laser therapy works particularly well on superficial red spider veins. For purple-blue veins, on the other hand, sclerotherapy is usually more effective, as these lie slightly deeper beneath the skin. In these cases, the laser is more likely to damage the skin and leave scars,” explains Prof. Dr. Reich-Schupke regarding the common treatments, adding:

“During sclerotherapy, the patient feels the prick of the needle as the medication is injected. This can also cause a slight burning sensation due to irritation of the blood vessel wall. With laser treatment as well, the patient feels the heat on the skin’s surface. Before treatment, the skin can be numbed with an anesthetic or cooling ointment. How often sclerotherapy needs to be repeated depends on the number of spider veins and the patient’s cosmetic expectations. If they are only present sporadically, a single session may be sufficient. We check the results with our patients after about a week to verify whether all spider veins have been completely removed or if follow-up treatment is necessary. Sclerotherapy can also lead to the formation of so-called microthrombi. As a precaution, these can be pricked with a small needle and then squeezed out so that they break down more quickly. If microthrombi are broken down by the body on their own, the process takes longer, and there is a risk of brown discoloration, which often takes a long time to fade. Therefore, a follow-up examination after 1–2 weeks is definitely advisable.”

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Aethoxysklerol (active ingredient: polidocanol) is a medication used for the sclerotherapy of varicose veins and spider veins. It is injected into the affected veins, where it irritates the vessel walls, causing the vein to close off. The vein is then broken down by the body. The procedure, known as sclerotherapy, is also used for low-grade hemorrhoids and is a proven method for treating cosmetic and functional vein problems.

“Highly dangerous and unofficially approved treatment methods recommended for spider veins are circulating on the internet. For example, the claim that spider veins can be sclerosed with a saline solution—but this does not refer to the physiological saline solution used in infusion therapy, but rather to a high-concentration solution. This is often falsely advertised as ‘harmless’ and ‘natural,’ but usually does more harm than good,” warns Prof. Dr. Reich-Schupke.

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After treatment for spider veins and reticular varicose veins, it is important for patients to take appropriate supportive measures to minimize the risk of recurrence and promote the health of their veins. 

A key aspect is leading an active lifestyle. Regular physical activity promotes blood circulation and strengthens the veins. Activities such as cycling, swimming, or brisk walking are particularly recommended, as they activate the leg muscles and support venous return. 

“Patients should take care to avoid sitting or standing for long periods to reduce the strain on their veins. For jobs that require prolonged sitting or standing, taking regular breaks and doing mobility exercises is advisable. Additionally, maintaining a healthy body weight is important, as being overweight can increase pressure on the veins and raise the risk of venous diseases. A balanced diet rich in fiber and low in saturated fats and sugar can help maintain a healthy weight, tone connective tissue, and promote overall vein health. All sports are beneficial—but water sports are particularly suitable, as the movement of the water provides an additional massaging effect on the legs. If a hereditary factor plays a role in a patient’s condition, it may resurface after some time. “In such cases, we can only reduce the severity, but we can’t prevent it entirely,” states Prof. Dr. Reich-Schupke, and at the end of our conversation, she offers one more practical tip:

“Treatment for spider veins is, of course, possible year-round. However, patients often come in the fall and winter, since compression stockings should ideally be worn for a few days following sclerotherapy to improve the cosmetic result and reduce the risk of thrombosis. This is, of course, more comfortable during the cooler months than in the height of summer.”

Thank you very much, Prof. Dr. Reich-Schupke, for the valuable information about spider veins and varicose veins, which can often be bothersome!