Glucose as a cause of and treatment for cutaneous necrosis

Nd:Yag laser combined with injection sclerotherapy in the treatment of reticular veins and telangiectasias (CLaCS method): A triple-blind randomized clinical trial comparing two sclerosing agents associated with same laser patterns

BACKGROUND

Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows -20°C air onto the skin and needle in a pre-, parallel-, and post-fashion.

OBJECTIVE

Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities.

METHODS

Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%.

RESULTS

The results were evaluated 30 days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found.

CONCLUSION

The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear.

Efficacy and safety of glucose, glucose and polidocanol combination, liquid polidocanol and polidocanol foam in the treatment of reticular veins: A randomized study in rabbits

OBJECTIVE

To compare the efficacy and safety of sclerosing agents injected in dorsal veins of rabbit ears.

METHODS

Sixty ears of 30 rabbits were randomly allocated in: 1% liquid polidocanol, 1% polidocanol foam, 0.2% polidocanol-glucose 70% solution, glucose 75% or 0.9% saline. Outcomes included efficacy (luminal occlusion), complications (phlebitis, neovascularization, ulceration at the puncture site, necrosis and local inflammation) and histology (sclerosis, recanalization vein and surrounding tissues inflammation, blood extravasation, recanalization, lymphangiogenesis, destruction of cartilage and neoangiogenesis).

RESULTS

Sclerosis was superior in Foam Group (76.9%), but also with 30.7% necrosis (p = 0.003), 46.15% ulceration (p = 0.003), and 69.2% local inflammation (p < 0.0001). Neovascularization were similar. Histology showed 38.5% phlebitis (p = 0.004) and necrosis (p = 0.03) in the foam group.

CONCLUSIONS

Sclerosis with foam and liquid polidocanol were superior to the other groups, but specially polidocanol foam at the expense of greater frequency of adverse events.