2017-01-16
Therapy of hyaluronic acid mesotherapic injections and sclerotherapy for treatment of lower leg telangiectasia
Background. Telangiectasia is the dilation of dermal capillaries mainly due to hypertension and vein insufficiency. Treatments of choice for this condition are sclerotherapy with foam liquid or intradermal fiber optic laser energy delivery. Aim. The aim of this study was to assess the efficacy of a new therapeutic approach consisting in the use of polymerized hyaluronic acid mesotherapicinjections following sclerotherapy in the areas of the skin affected by telangiectasia in patients without major vein insufficiency.
Materials and Methods. A total of 20 women, aged between 19 and 64 years, affected by recurrent lower leg telangiectasia, were included in this study. Patients were preliminarily submitted to echo color Doppler sonography to rule out severe saphenofemoral valve and lower limb major vein insufficiency. All patients underwent 3 sessions a month of polidocanol 1% capillary injections for 2 months. This was followed by 0.1 ml cross-linked hyaluronic acid introduction in the polidocanol 1% needle track. A total of 50 mesotherapic injections (0.05 ml each) were performed on the skin surface where an ice pack was previously applied for 4 to 5 minutes. A follow-up visit was performed at 3 months. The results, based on photographic examination, were rated as follows: poor improvement (0%-50%), good improvement (51%-75%), and very good improvement (76%-100%). The side effects of the clinical procedure, in terms of pain, itching, paresthesia, ecchymosis, and relapse of telangiectasia over the treated skin surface, as well as a persisting pigmentation in the injection spots and induced benefits related to leg heaviness and comfort, were recorded. Results. In total, 6 patients displayed a slight venous insufficiency, 3 patients displayed patent venous insufficiency, and 11 patients did not show any venous insufficiency. Before treatment, itching was present in 18 out of 20 patients, paresthesia in 15 out of 20 patients, ecchymosis in 16 out of 20 patients, and leg heaviness in 15 out of 20 patients. At the 3-month follow-up, an improvement of 0% to 50% was observed in 4 patients who had a relapse in telangiectasia. A 51% to 75% improvement was observed in 3 patients and a 76% to 100% improvement occurred in 13 patients. At the 3-month follow-up, itching persisted only in 4 patients; paresthesia was absent in 12 patients, while 3 patients still presented this symptom; ecchymosis was absent in 16 patients; 15 patients reported a feeling of lightweight legs. Among the patients with relapsing telangiectasia, 2 patients reported pigmentation due to hemosiderin deposit in the skin at the 3-month follow-up. The slight venous insufficiency, observed at the beginning of the study, improved in 5 out of 6 patients. The patients’ compliance with the procedure was high and 16 out of 20 patients declared their willingness to repeat the whole clinical procedure, if necessary. Conclusions. This pilot clinical study supports the use of hyaluronic acid mesotherapic injections following sclerotherapy for treatment of lower leg telangiectasia without major venous insufficiency. We propose that the prolonged persistence of cross-linked hyaluronic acid, across the microvascular venous areas, is able to induce a stronger stromal tissue, thus preventing relapse. Further clinical studies, comparing this new approach with existing clinical procedures, are needed in a larger number of patients.
2016-02-23
Efficacia di un composto nutraceutico ad alto angiotropismo nel trattamento delle disfunzioni venose
AIM: This multicentre, anecdotic, spontaneous and observational study investigates by light reflection rheography modifcations of the rate of inferior venous emptying time following a nutraceutical administration based on cortex of Aesculus hippocastanus, OPC extracted from Pinus pinaster and Vitis vinifera, chondroitin sulphate, carcinine®, and organic silicium, for the treatment of chronic venous insuffciency (CVI). METHODS: Ninety-three patients (20 males and 73 females), aged between 22 and 91 years old, were enrolled at the Second Opinion Medical Network, in Modena, Italy. They were affected by CVI and 75 subjects showed signs of lymphedema, 5 subjects developed leg ulcers, 18 subjects showed phlebitis, 69 subjects showed varicose veins and 15 subjects manifested erysipelas. Patients were instructed to assume three capsules/day of the nutraceutical formulation for three months. The rate of venous emptying time (T0) of inferior legs and the volume of venous blood moved (V0) were measured by light reflected rheography before starting the treatment and at the end. Symptoms were also evaluated by a questionnaire before starting the treatment and at the end.RESULTS: The rate of venous emptying time of the right leg (T0d) increased of 10±8.7 s (45.8%). The rate of venous emptying time of the left leg (T0s) increased of 7.2±8.6 s (25.5%) after three months of treatment (P<0.001 and P<0.01, respectively). The volume of venous blood moved of the right leg (V0d) decreased of 4.2%, while volume of venous blood moved of the left leg (V0s) decreased of 17.6 (P<0.01). After three months of treatment sensation of legs heaviness was reduced (73.5%), in addition of legs oppression (57.4%), swelling of legs and calves (56.1%), pain (54.3%), cramps (105.4%) and itching (68.6%), all signifcantly (P<0.001).CONCLUSIONS: This study demonstrated that the treatment of patients affected by CVI with the nutraceutical formulation was effective to increase the rate of venous emptying time of the inferior legs and to improve related symptoms after 3 months of treatment, in absence of side effects.
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