Spider veins: why is winter leg care so important?

Spider veins: a common occurence

If you have noticed small, spider-like lines in blue, purple, or red appearing on your legs or face, then you are probably one of the many people who have spider veins. It may please you to hear that there is no need for alarm, as spider veins are so common that experts consider them to represent 'the norm'.

Spider veins have a higher occurrence in women, but it's worth noting that prevalence in both men and women is high. One study of 1,566 people diagnosed spider veins in 88% of women and 79% of men.

If you don't have spider veins and are now wondering why, it could be down to your age, as most people first notice these thin lines between 30 and 50 years. Regardless of whether you currently have spider veins or not, many studies conclude that the majority of adults will develop spider veins at some point in their lives.

What are spider veins?

"Spider veins are small, dilated blood vessels that are visible through the skin," explains Professor Mark Whiteley, consultant venous surgeon and founder of The Whiteley Clinic.

"They may be red, purple or blue and most often appear on the legs or face in the form of thin lines, webs or branches. People often refer to them as 'thread veins' although they are called 'telangiectasia' medically."

Spider veins are different to varicose veins, which are larger and protrude from the legs. These two common venous conditions also occur for different reasons, as Dr Whiteley describes: "Varicose veins occur when the valves in our veins stop working properly, meaning the blood falls down the veins when standing up, rather than flowing upwards towards the heart (chronic venous insufficiency).

"Spider veins can occur for different reasons. The commonest is when pressure from underlying hidden varicose veins allows blood to fall into the surface veins, dilating them and making them visible. Sometimes this is from a high pressure 'incompetent perforator' vein (veins that prevent backflow of blood down to other veins) in the lower leg.

"In both cases, valves inside the veins stop working properly allowing blood to fall back down the leg and pool in the veins under the skin. Therefore, spider veins on the legs are almost always due to underlying hidden varicose veins or incompetent perforator veins."

When should I be worried about spider veins?

The good news is most people who have spider veins don't experience any significant medical symptoms or complications. Most complaints are purely aesthetic, as some people don't like how they look.

Unfortunately, the appearance of these small, spider-like lines can make some feel self-conscious, leading people to cover the affected areas or even avoid certain social occasions. One study found that 17% of 223 people with spider veins met the criteria for a body dysmorphic disorder diagnosis. If spider veins are impacting your life in this way, there are cosmetic treatment options to reduce their visibility.

More rarely, people with spider veins complain of symptoms including leg fatigue, cramps, itching, or burning.

Dr. Whiteley advises that people with spider veins also have a small risk of developing other health complications, although this is because they have common risk factors, not because spider veins are themselves a direct cause of the complications. These include:

• Eczema.
• Skin damage.
• Blood clots.
• Leg ulcers.
• Superficial venous thrombosis/'phlebitis' (a blood clot in the superficial veins).
• Deep vein thrombosis (a blood clot in the deep veins).

Can cold weather cause spider veins?

Simply put, there is no evidence to suggest that cold weather causes spider veins. This said, we can look after our venous health during the winter months when temperatures drop and affect our circulation. In terms of veins, this means that it's important to move our legs to pump blood back to the heart.

"The cold weather can slow down the rate at which blood is pumped around the body as the arteries and blood vessels become more constricted," says Dr Whiteley. "However, there are easy ways to improve circulation in the winter months, such as following a simple exercise plan or wrapping up warm."

Dr Whiteley goes on to explain that exercise increases the amount of blood flow down the arteries which keeps them healthy by the release of nitric oxide into the arterial wall. In addition, movement makes the muscle pumps in the leg contract, which in turn pumps the venous blood back to the heart.

"The faster the flow of blood in the veins, the less chance of blood clotting (such as superficial venous thrombosis and deep vein thrombosis) and of inflammation caused by venous stasis. This in turn reduces the chances of aching of the legs, leg swelling, damage to the skin such as eczema, brown stains (haemosiderin), and leg ulceration."

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What lifestyle changes can reduce your risk of complications?

It's important to note that lifestyle changes can't prevent us from developing spider veins. However, there are benefits to looking after our venous health. This is especially true over winter, when cold weather can lead to poorer venous circulation, and when we tend to become more sedentary.

"Research seems to show that lifestyle changes make little or no difference to getting spider veins or varicose veins, as the failure of the venous valves runs in families," explains Dr Whiteley.

"However, there is good evidence that regular exercise reduces how quickly the problem deteriorates and reduces the risks of complications from varicose veins, including aching, eczema, skin damage, clots and leg ulcers."

Numerous studies also suggest that obesity, lack of physical exercise, and prolonged sitting increase the risk of chronic venous insufficiency, an underlying cause of both spider veins and varicose veins.