Varicose Veins

Unlike arteries, which carry oxygen-rich blood to all our extremities, veins are responsible for returning oxygen-depleted blood back to the heart. In our veins, the movement of oxygen-depleted blood from our extremities back to the heart is dependent on two things: muscular contraction, which squeezes blood towards the heart, and one-way valves, which keep the venous blood from traveling backwards. If the valves inside the veins are not working, the one-way flow is interrupted and the subsequent pooling of blood leads to enlargement of the veins.

If valvular malfunction occurs affects the smaller veins close to the skin surface, these veins become engorged and take on the appearance of spiders, hence the term spider veins. Spider veins can be red, purple, or even blue. If valvular malfunction occurs with the larger veins deeper under the skin, this can result in the large tortuous varicose veins. It is important to note that spider veins may be an external manifestation of underlying varicose veins.

The most predominant cause of varicose veins is heredity. Other risk factors include female gender (due to pregnancy and hormonal factors), age, occupations requiring prolonged standing and sitting, obesity, and physical trauma. Symptoms associated with varicose veins include aching, cramping, heaviness, tiredness, burning, tingling, swelling, and throbbing. Complications that can arise from varicose veins include inflammation (phlebitis), blood clots (superficial or deep), skin discoloration (hyperpigmentation), skin ulcers, and spontaneous bleeding.

Conservative therapy utilizing preventative techniques (regular exercise, avoidance of prolonged sitting and standing, weight control, etc) or compression stockings may help alleviate symptoms and slow the progression of varicose veins. However, if there is limited resolution of symptoms utilizing conservative therapy, minimally invasive techniques are now available such as endovenous laser ablation, radiofrequency ablation, ambulatory phlebectomy, and sclerotherapy. These minimally invasive techniques all individuals to have their veins treated with little to no downtime.

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Hemorrhoids

Hemorrhoids are enlarged varicose veins of the rectal region. They are subdivided into internal hemorrhoids, which develops inside the rectum, and external hemorrhoids, which develop around the outside of the anus. Hemorrhoidal veins become abnormally enlarged because of constant increase in pressure such as that due to constipation and pregnancy.

Symptoms from internal hemorrhoids include painless bleeding (which can be noted on the outside of stool, or on the toilet paper), itching, a constant bulging sensation, or pain (if they become thrombosed). Internal hemorrhoids may swell so large that they protrude (prolapse) outside the anus.
Most of the times, external hemorrhoids can be felt since they develop around the anus. They can be painless fleshy growths or painful hard lumps.

The treatment of external hemorrhoids is usually conservative. Warm sitz baths three times a day is usually sufficient to relieve the pain associated with external hemorrhoids. If the external hemorrhoid is hard and tender, this may suggest a clot and they may need to be incised and drained, followed by warm sitz baths.

If internal hemorrhoids are mild, they can typically be managed conservatively by increasing fiber supplements and avoidance of straining during bowel movements. If conservative treatment fails, options for therapy include nonsurgical treatments such as sclerotherapy (injecting them with a chemical to help shrink them), cryotherapy (freezing them off), laser (burn them off), band ligation, or infrared coagulation. These mentioned treatments are an excellent means of therapy if severe prolapse has not yet occurred. If significant prolapse has occurred, then surgery (hemorrhoidectomy) may be necessary.

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Rosacea

Rosacea is a chronic skin condition that typically arises after the age of 30. It affects facial areas such as the cheeks, chin, nose, and forehead. It can also affect the scalp and chest. There are four different manifestations of rosacea (as described below). Some individuals can be affected by one manifestation, or they can have a combination.

• Facial Redness -This is the most typical manifestation of rosacea. Intermittent intense blushing or flushing is often the earliest sign of rosacea. This type of rosacea may progress to persistent facial redness that may cause facial warmth resulting in burning and itching. These individuals are often mistaken as having facial sunburn. In some cases, the vessels of the skin can become so engorged as to result in dilated blood vessels or “facial spider veins.
• Pimples and pustules - This is the second manifestation of rosacea. This is also commonly referred to as acne rosacea. The papules and pustules associated with this type of acne are typically more red and solid than that of teenage acne. This type of acne also responds to different medications than that of teenage acne.
• Skin Thickening - The most common manifestation of this form of rosacea is thickened skin of the nose that can cause a bulbous presentation.
• Eye irritation - Rosacea can affect the eyes leading to frequent or persistent eye redness, irritation, burning, and tearing. Affected individuals are often mistaken of having allergies.
  

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