Clinic of Dermatology

The Department of dermatology is a clinic of long-standing experience in the treatment of varicose veins located on the legs and their complications. The disease is very common and carries a great social impact, because it affects between 50 and 70 % of the population. The problem is managed by collaboration between the dermatologist and a vascular surgeon.

The venous system of the legs includes deep and superficial veins, connected to each other by the so-called communication veins.

The veins carry poorly oxygenated blood from the periphery towards the heart. The venous valves master the process, because they hinder the return of the blood backwards and together with the leg muscles push the venous blood towards the heart. Valve injure leads to blood stagnation in the veins, increase of the pressure on the vein wall and consequently to their permanent dilatation. The disorder is called venous insufficiency and is manifested by formation of varicose veins.

What are the varicose veins?

Dilated superficial and deep veins are called varicose veins that lead to substantial discomfort, pain and swelling of the feet, predominantly in the end of the day. The condition is considered to carry increased risk for the patient and should be supervised regularly and treated by specialists in vascular surgery in order to avoid certain complications: thrombophlebitis, phlebothrombosis, stasis dermatitis (permanent alteration of the appearance of the skin of the legs), development of persistent ulcerations, etc. The dermatologist has to manage the dermatitis changes and offer treatment that would lead to epithelization of the varicose ulcerations. Varicose veins are treated with medications and in severe forms of venous insufficiency “stripping” is applied – surgical removal of varicose vessels.

What about laser therapy?

Laser therapy is considered to be the most effective method for treatment of varicose veins and teleangiectases of the legs in the past 20 years. Teleangiectases are dilatations of the endpoints of the veins with a diameter of 1-2 mm.

How do they look like?

Superficial vessels, thin like hair, red or blue in colour that create a significant cosmetic disfigurement. They may be solitary and short, without connections between each other or multiple teleangiectases may appear in groups reminding the spider’s net or the branches of a tree. Usually, venectases of the legs involve a small area and are almost unnoticeable, but may spread across a vast region and appear extremely unattractive, especially when combined with varicose veins.

What is the reason for these alterations?

These changes appear in genetically predisposed people and are commonly found in the members of one family tree. The condition also appears as a marker of internal disorders. The female predominance confirms the role of the female sex hormones in the genesis of the teleangiectases. Key factors that play role for teleangiectases formation are adolescence, pregnancy and delivery, "the pill" or hormone therapy. They may also appear after trauma or excessive sunlight and heat exposure.

Is it possible to prevent the formation of teleangiectases?

Prevention is not always possible but genetically predisposed people may benefit from wearing elastic socks, weight control, dietary changes and application of sunscreens.

What is the most effective treatment?

Invasive methods of treatment like surgery or injecting different substances in the teleangiectases may be painful sometimes, they carry the risk of possible side effects and allergic reactions, they require anaesthesia and the final results may be unsatisfactory. The golden standard for management of vascular lesions is the Nd:YAG laser – the most effective treatment method for teleangiectases in the recent years.

What does it work?

The mechanism of action is based on the phenomenon called selective photothermolysis. The oxyhemoglobin in the blood is a chromofore – a substance that absorbs light and transforms it into heat energy. The final result is destruction of undesired vessels by the heat. The dermatologist sets the optimal parameters that would guarantee maximal results and minimal side effects in accordance with the vessel size and depth, and the skin type of the patient.

What result can we expect?

Results from clinical studies point that the effect depends primarily on the diameter of the vessel. Undesired vessels smaller than 1 mm in size disappear after one procedure in 50% of the patients. 75% of the patients benefit from two procedures and the rest require three or four procedures. Larger vessels - 1-2 mm in size require more than one procedure for optimal result. Nevertheless the long-pulsed high energy Nd:Yag laser is an excellent alternative of the invasive techniques, safer for patients, without risk of complications and side effects.

What does hemangioma mean?

Hemangiomas are common benign tumors of the vascular endothelium. Childhood hemangiomas are the most common soft tissue tumors of infancy occurring in 10%-12% of the children younger than 1 year of age. Fewer than 20% of hemangiomas are present at birth, while 80% - 90% appear within the first 4 weeks. They are characterized by initial rapid proliferative phase and later involutional phase with a probability of reducing the size of the hemangioma.

Despite the benign nature of hemangiomas, complications may arise during the proliferative phase. Usual problems include painful ulceraton on the buttocks area, infections, bleeding or functional disturbances, when located in the zone of the eyes, nose, mouth and ear canal. Lesions located on the face are cosmetically disfiguring and cause psychological discomfort in both children and their parents. Kids become irritable, feed poorly, show disturbed sleeping patterns and their general condition deteriorates. That makes the visit to a dermatologist crucial, who sends the patient to perform the necessary tests and sets up an individual therapeutic plan in accordance with the type, location, size, depth, developmental stage of the hemangioma and its complications, etc.

The Department of Dermatology documents the clinical findings using the method of photography on each visit and if necessary performs ultrasonography for observing details or CT scan - in critical cases.