The Effect of 0.5% Sodium Tetradecyl Sulfate: DISCUSSION part 2
The two most commonly used kind of sclerosants for sclerotherapy are osmotic agents and detergents. Hypertonic saline and Sclerodex® (Omega Laboratories Ltd, Montreal, Canada) are osmotic agents that damage cells by shifting the water balance. Polidocanol, sodium morrhuate and STS are detergents that disrupt a vein’s cellular membrane. STS is a synthetic long-chain fatty acid salt of an alkali metal, and STS has detergent properties. It has been approved by the US Food and Drug Administration (FDA) since 1946 and STS has a long record of safety and effectiveness. Intravenous injection of STS causes intimal inflammation and thrombus formation, which occludes the injected vein and the partial or complete vein obliteration may or may not be permanent. The endothelial damage depends on the concentration of STS and this occurs immediately after injection, and the result is rapid thrombus formation. This leads to the vascular sclerosis.
Although it is cost effective and safe with few major complications, 0.5% STS injection does have a few risks. The side effects to be considered while using 0.5% STS are allergic reactions, pain, burning, itching and swelling. To avoid these negative reactions, we have to consider a patient’s age, the presence of underlying disease, the patient’s condi¬tion and the type and location of his or her venous lake before performing the treatment. In the presence of local infection, or if the patient has uncontrolled diabetes mellitus, injection therapy must be withheld. In addition, when a patient uses an anticoagulant such as heparin, it is hard to treat this type of patient because thrombosis does not form very well. The 1 cc insulin syringe needle should be precisely placed to the venous lake, and then 0.5% STS is injected slowly after being sure that the tip of the needle is located within the venous lake by aspiration of the venous blood. Thereafter, the treatment should be followed by immediate compression for 10 minutes. If the patient complains of severe pain, then the physician should stop the treatment because of the possibility of extravasation of the sclerosant. If the effect of the first injection is not sufficient, then further injections of sclerosing agent should be carried out after 2 to 3 weeks or at longer intervals.
In this study, we performed a biopsy to make an exact diagnosis on the first visit (for all the patients except No. 3 and No. 10). In the upper dermis, close to the epidermis, they showed either one greatly dilated space or several interconnected dilated spaces filled with erythrocytes and these spaces were lined by a single layer of flattened endothelial cells and a thin wall of fibrous tissue (Fig. 1). There was no statistical difference in the number of treatments between the group with one greatly dilated space and the group with several interconnected dilated spaces (Wilcoxon two-sample test, p=0.7546). Viagra Professional
Complete clearance was achieved for all the cases with no recurrence or complications. Our results with this treatment were better that those reported by the previous studies, although it is difficult to exactly compare between the studies because there are many factors that can affect the outcome, including the location, and size of the venous lakes and if skin biopsy was done. Because there were no significant complications and all the lesions were cleared with an average of 2.15 treatments, we found that 0.5% STS injection for treating venous lakes was highly effective.
The limitation of this study was that the number of cases was small and there was no control group. We think a further study that will include a control group is needed in the future.
In conclusion, although many therapies exist for the eradication of venous lake lesions, the use of 0.5% STS injection appears to be a promising method that is safe, simple and effective.
