Postsclerotherapy Hyperpigmentation

Abstract

Cutaneous pigmentation is a common complication of sclerotherapy of dilated lower limb veins. Histologic examination has shown that the pigment is due to hemosiderin deposition predominantly in the superficial dermis. Optimal technique will reduce the incidence of pigmentation but it is likely that patient factors such as total body iron storage may explain why some patients are more prone to develop pigmentation. Traditional exfoliation therapies have not given reliable reproducible results and there is need to develop an effective treatment without adverse sequelae. In this study 16 patients with refractory postsclerotherapy pigmentation were treated with the copper vapor laser. Within 3 months of treatment 11 (69%) had significant clearing of the pigmentation. Four (25%) had slight improvement and one patient had no discernible improvement. No adverse sequelae were reported or observed. The treated patients and 16 matched control patients who had not developed pigmentation were investigated with serum iron, ferritin and transferrin levels. There was a trend towards higher serum iron and ferritin levels and lower transferrin levels in the patients who developed pigmentation compared with those who did not develop this sequela. This trend was statistically significant for ferritin levels in patients 50 years of age and younger. The results indicate that serum ferritin may be a good indicator of susceptibility to postsclerotherapy pigmentation.