Managing female patient needs

July 1, 2005

National report — With the hope of presenting practical advice that can be applied clinically to female patients by dermatologists across the country, five experts brought forward issues that regularly require attention — including one therapy that may forever change leg vein therapy by an invasive approach once thought not possible in the office setting.

Topics covered Lucinda Buescher, M.D., associate professor of dermatology at Southern Illinois University School of Medicine, detailed body dysmorphic disorder (BDD), which causes many women to seek dermatologic treatment or cosmetic procedures, at the annual meeting of the American Academy of Dermatology (AAD).

Mary Gail Mercurio, M.D., clinical director, department of dermatology, University of Rochester Medical Center, Rochester, N.Y., offered a work-up of the hyperandrogenetic patient when polycystic ovarian syndrome is suspected.

Sarah M. Boyce, M.D., assistant professor and director of cosmetic dermatologic surgery, department of dermatology, University of Alabama, Birmingham, Ala., gave a cost analysis of cosmetic procedures for the general dermatologist.

"One new topic is the modern approach for the evaluation and treatment of leg veins. (This) innovative therapy for leg veins offers a different approach that many may have not considered," Dr. Edison tells Dermatology Times.

Applying leg vein tx advances While the mainstay of leg vein therapy for many dermatologists is sclerotherapy and ambulatory phlebectomy, one of the biggest advances in terms of comprehensive leg vein treatments is endovenous ablation, according to Jaeyoung Yoon, M.D.

"With endovenous ablation, studies show that you can achieve an efficacy of 90 percent in the closure of the greater saphenous vein and sapheno-femoral junction," says Dr. Yoon, assistant professor of dermatology and dermatologic surgeon, department of dermatology, University of Missouri, Columbia, Mo. "This can be performed with lower morbidity than traditional leg vein stripping."

Endovenous ablation can be performed in an outpatient setting in one to two hours under conscious sedation. Most often, the incompetent great saphenous vein is accessed near the knee. A catheter is advanced to the junction where the great saphenous vein meets the common femoral vein. The tip of the catheter is then heated using either radiofrequency or laser, and is slowly withdrawn, closing the saphenofemoral junction and vein, improving venous insufficiency.

"While patients who have ligation and stripping undergo general anesthesia or an epidural and can remain in the hospital overnight, endovenous ablation patients are sent home that day, and are back to normal activities within a few days," Dr. Yoon says.

More invasive Increasingly, dermatologists are embracing this more invasive approach to leg vein therapy, but some contend that this technique should remain in the hands of radiologists and vascular surgeons. Regardless, the advent of radiofrequency technology and further advancement of lasers make endovenous ablation a common procedure in the dermatologist's office.

"I want to show dermatologists that they are capable of offering patients a more comprehensive approach to leg vein treatment," Dr. Yoon says. "Most (dermatologists) only think of sclerotherapy of superficial telangiectasias for leg veins, but we can do more."