There are a lot of home remedies and quick fixes in the news and the internet for patients with varicose veins and one of them is a varicose vein cream. It’s accessible, easy to buy online, and promises great results, from improving the appearance of these dark-colored veins to relieving their symptoms. But..
Do these creams really work?
Is it worth it to pay hundreds of dollars for these miracle creams?
The short answer is NO.
These creams and all other home remedies for varicose veins sadly do not work the way they are marketed.
Varicose veins are tortuous and widened veins seen in the subcutaneous or shallow part of the tissues of the leg. They are very visible when you have them and are not only bothersome because of how they look, but also have other symptoms that cause significant distress to patients who have them.
About one-third of adults have varicose veins (1) and have significantly caused patients distress because of the discomfort, pain, and embarrassment that comes with the disease.
What is the Problem with Varicose Veins?
Cosmetic concern is one of the biggest reasons patients spend hours researching on how to cure varicose veins. Most patients do not get any other symptoms from varicose veins but because they often occur in the lower part of the leg, women specifically have a hard time wearing outfits that show these veins.
Pain and Discomfort
Patients with varicose veins may complain of leg discomfort. These may be described as itching, aching, heaviness, or numbness of the lower extremities. Patients often complain that symptoms worsen after a day of walking or prolonged standing.
Leg swelling is not a common symptom of varicose veins but it may occur in patients with large varicosities.
Thrombophlebitis is defined as an inflammatory process that happens in the veins that causes a blood clot to form. The affected vein is often found near the surface of the skin or deep within a muscle. (2)
Having superficial thrombophlebitis can complicate your varicose veins. If phlebitis extends above the knee there might be a risk for a deep vein thrombosis (although rare). (3)
When you have thrombophlebitis, seeing your doctor as soon as possible is a must because sadly, even the most expensive cream cannot solve it.
Bleeding of varicose veins is unusual (4) but may be a signal that treatment should be done immediately. Bleeding of varicose veins may be because of a high venous pressure in a standing position coming from a prominent vein with an unhealthy skin overlying it. Scratching or accidentally nicking a prominent vein may be causes of bleeding from a varicosity.
Hyperpigmentation where the skin becomes brownish in color, eczema, and lipodermatosclerosis is also seen in varicose veins. Lipodermatosclerosis is an inflammation of the fatty layer of the skin that may lead to ulceration when neglected.
Leg ulcers may be present in patients who have varicose veins. Groups who are at a higher risk of developing them are those from an older age group, female sex, history of trauma in the lower extremities, immobility, history of deep vein thrombosis, phlebitis, and obese patients. (5) Leg ulcers secondary to varicose veins and lipodermatosclerosis are bothersome and may become chronic when it persists for more than 6 weeks. Because of the decrease circulation from the venous insufficiency, these ulcers heal slowly and may become infected easily and can cause recurrent hospital admissions and even sepsis when left untreated.
Who is at Risk for Varicose Veins?
Women are at more risk to varicose veins is related to the hormonal and hydrostatic effects of pregnancy. The occurrence of at least 28% of new varicosities occurs in pregnancy. (6)
As mentioned, pregnancy is a risk factor for varicose veins because during pregnancy because the extra volume of blood and fluids are produced for your baby, this extra volume means extra pressure on the blood vessels especially that in the lower extremity. Blood vessels would need to work against gravity to push back the blood back to the heart, if your valves are already faulty this puts you at risk for varicosities.
Patients who have parents or siblings with varicose veins are more likely to also get them. Studies show that heredity plays an important role in the cause of varicose veins but the exact genetic basis is still poorly understood. (7)
The older you are, the higher the risk for varicose veins because valves that help propel the blood back to the heart get weaker and even the walls become more dilated. People aged 40 and above are at a higher risk for varicose veins.
The extra weight puts more pressure on the lower extremities and makes it harder for the valves to return the blood back up. Patients who are obese are advised to lose weight to help relieve the signs and symptoms of varicose veins.
Prolonged standing or walking
The leg carries the body when we walk or stand and prolonged walking or standing can cause increase pressure in the lower extremities and also increases your risk for varicose veins
Why are Leg Creams not Effective?
Leg creams, oils, or lotions for the matter do not help treat the underlying problem of varicose veins which is the pooling or stasis of blood on the veins because of weak valves of the veins or stretched veins that cause valves to weaken.
Doctor prescribed creams may help with itching, skin irritation, or swelling but they do not resolve the main cause of varicose veins.
There are many creams available with different targeted use like decreasing swelling, removing hyperpigmentation, decreasing leg discomfort, lightening the varicosities, and so on but these creams are not effective and may cause more harm than good.
Varicose creams may sound like a miracle that can help solve your leg problems easily but unfortunately, it is too good to be true. No cream has been found to heal the deep-rooted problems of varicose veins and buying one will only cost you more in the long run.
The danger in using these creams is that a lot of them have not been clinically tested nor dermatologically proven. The chemicals used may cause harm or may even be contraindicated if you have other conditions like dermatitis or eczema.
Better to treat the real cause of the problem rather than getting a temporary fix that is not proven.
What are the Alternatives to a Varicose Cream?
Compression therapy is the gold standard for the treatment of varicose veins. It is a non-invasive treatment readily available if you do not want surgery. It has been proven to be effective in decreasing venous stasis (staying of venous blood and not moving in the vessels) and inflammation.
It works by exerting an external pressure in the lower extremities. This pressure prevents the reflux of blood downwards. Compression stockings are effective because unlike our arteries, veins are very compressible.
There are different compression stockings available in the market and the fitting and the proper compression stockings will depend on your condition. Graduated compression stockings are made to squeeze the legs. They may be knee or thigh-high and can either be elastic or non- elastic and have specific types of compression.
Compression stockings relieve pain, decreases swelling, and minimizes the appearance of varicose veins and is a better solution than varicose cream if you want a non- invasive approach.
Radiofrequency ablation (RFA) is a safe and minimally invasive procedure for varicose veins. It involves a scope that will emit thermal energy that will ablate the varicosities. It has lesser complications and decreases the risk of recurrence. The procedure is done on an outpatient basis and is preferred when dealing with large varicose veins.
Sclerotherapy is often done for small and mid-size veins. The doctor instills a sclerosing solution to the veins involved using an ultrasound. Patients undergoing sclerotherapy are advised to wear compression stocking afterward.
Vein Ligation and Stripping
It involves the stripping and ligation of the vein. Two cuts are made— one on the top of the leg just below the groin and the other behind the knee or ankle. The vein is first tied off on the upper incision (this is called vein ligation) then a long wire is inserted on the lower incision and pushed up through the same vein. Then the lower end of the wire will help pull the entire vein throughout the incision near the groin.
This procedure involves having small cuts on the affected vein. A small hook is then used to pull the vein out of the cuts. It is usually cut and removed in several pieces and is helpful when dealing with smaller veins.
Smaller cuts are done to minimize scarring that can occur when larger cuts are made.
Which Treatment Should You Get?
The best treatment will depend on what is suitable for you. Patients with large varicosities or those who are obese may more likely to benefit from radiofrequency ablation or vein stripping and ligation. If your varicose veins are not bothering you but you are concerned with the cosmetic side, then a compression stocking or undergoing sclerotherapy may be best for you.
Advice on what treatment you should get should be a decision between you and your health care provider.
When are Varicose Veins Dangerous?
The National Institute for Health and Clinical Excellence (NICE) (8) made a referral guide for patients with varicose veins to determine when you should see a doctor:
A bleeding varicosity that has eroded the skin. This means that you may need to go to the nearest hospital or doctor as soon as possible to get treatment for your varicose veins. A bleeding varicosity will need to be treated immediately.
Varicosities that have bled and are at risk of bleeding again. These may mean that your varicose vein has been bleeding but stopped but may bleed again if pressure is placed or when you exert effort on it. This warrants that you should get a consult or a referral to your doctor.
This involves an ulcer that is progressive and painful despite treatment. Ulcers of the lower extremities are dangerous and may cause infection. They are frequently non- healing because the legs do not get enough blood flow. A consult with your doctor may be needed if you have this kind of ulceration.
Patients with active or healed ulcers, progressive skin changes like lipodermatosclerosis may need routine consults with their health care providers. Recurrent superficial thrombophlebitis is also one concern that may need a follow-up.
Varicose veins are insidious in nature. They start as harmless visible veins but further along the line becomes more troublesome. Home remedies, creams, and lotions may sound like easy solutions that you are most likely to try to avoid a visit to the doctor but always be careful of what you read or what you see on the internet.
Remember that with diseases of the vein, it is always best to see your doctor, get a professional opinion, and manage the problem before it gets worse. Do not fall into the trap of getting advice when things have worsened. Varicose veins may be a symptom of chronic venous insufficiency and you may need to get a full workup to see if you have other underlying problems and rule out other vessel diseases like peripheral arterial disease (which is altogether a different disease).
In Elite Vein Clinic, we offer consultations and we make sure that you get the best care for your veins.
With the proper treatment, you can be assured that your veins and health are in good hands!
If you want to scroll to a specific topic in this article, here is a quick link:
- What is the Problem with Varicose Veins?
- Who is at Risk for Varicose Veins?
- Why are Leg Creams not Effective?
- What are the Alternatives to a Varicose Cream?
- Which Treatment Should You Get?
- When are Varicose Veins Dangerous?
- Campbell B. (2006). Varicose veins and their management. BMJ (Clinical research ed.), 333(7562), 287–292. https://doi.org/10.1136/bmj.333.7562.287
- Thrombophlebitis. (2020, March 03). Retrieved from https://www.mayoclinic.org/diseases-conditions/thrombophlebitis/symptoms-causes/
- Chengelis, D. L., Bendick, P. J., Glover, J. L., Brown, O. W., & Ranval, T. J. (1996). Progression of superficial venous thrombosis to deep vein thrombosis. Journal of vascular surgery, 24(5), 745–749. https://doi.org/10.1016/s0741-5214(96)70007-1
- McCarthy, W. J., Dann, C., Pearce, W. H., & Yao, J. S. (1993). Management of sudden profuse bleeding from varicose veins. Surgery, 113(2), 178–183.
- Vasudevan B. (2014). Venous leg ulcers: Pathophysiology and Classification. Indian dermatology online journal, 5(3), 366–370. https://doi.org/10.4103/2229-5178.137819
- Stansby G. (2000). Women, pregnancy, and varicose veins. Lancet (London, England), 355(9210), 1117–1118. https://doi.org/10.1016/S0140-6736(00)02057-2
- Shadrina, A. S., Sharapov, S. Z., Shashkova, T. I., & Tsepilov, Y. A. (2019). Varicose veins of lower extremities: Insights from the first large-scale genetic study. PLoS genetics, 15(4), e1008110. https://doi.org/10.1371/journal.pgen.1008110
- Surveillance report 2016 – Varicose veins in the legs (2013) NICE guideline CG168 [Internet]. London: National Institute for Health and Care Excellence (UK); 2016 Feb 4. Available from: https://www.ncbi.nlm.nih.gov/books/NBK552076/
Dr. Nima Azarbehi
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