Venous disease
Spider Veins
Fine red or purple vein webs on the legs — usually cosmetic, sometimes the surface sign of deeper valve leakage. Assessment tells the difference.
Last reviewed 30 Jun 2026
Reviewed by Dr Tay Jia Sheng · Vascular, Endovascular & General Surgeon
What are spider veins?
Spider veins (telangiectasia) are fine red, purple or blue vessels visible in the skin, most often on the thighs, calves and ankles. They are extremely common, more so in women, and are influenced by heredity, pregnancy, hormones, prolonged standing and age.
Cosmetic nuisance or warning sign?
Most spider veins are harmless. The important exception: they can be the visible tip of underlying venous disease — leaking valves in veins you cannot see. Clues that something deeper is going on include aching or heaviness by evening, ankle swelling, clusters of veins around the inner ankle, or spider veins appearing together with bulging varicose veins.
This is why I never treat before a scan. A duplex ultrasound maps the underlying veins; treating surface veins while a feeding vein still leaks gives disappointing, short-lived results.
Treatment options
- Microsclerotherapy — the mainstay: a fine needle places a small volume of sclerosant into each vessel, causing it to close and fade over weeks. Performed in the clinic, no anaesthesia needed, walk in and walk out.
- Treating the source first — where the scan shows underlying reflux, the feeding vein is dealt with (ablation, adhesive closure or sclerotherapy) before or alongside the surface work.
Several sessions may be needed, and new vessels can appear over the years — honest expectations are part of the consultation.
When to see a doctor promptly
Spider veins with skin darkening around the ankle, swelling of one leg, or a non-healing spot near the ankle suggest venous disease that deserves proper assessment rather than cosmetic treatment alone.