Facial VeinsFacial spider veins may suddenly appear during pregnancy, usually on very conspicuous parts of the face such as the nose and cheeks. They are caused by an increase in oestrogen hormones. They may also occur when the oral contraceptive pill is taken. They are not caused by exposure to hot or cold weather and are not due to drinking coffee. Many of these spider veins do not disappear after pregnancy and may require treatment with laser or fine needle diathermy.
Spider Leg VeinsDisfiguring spider leg veins, which are mostly hereditary, often become established during pregnancy. They are not caused by excessive standing or sitting with the legs crossed. It seems that a combination of hereditary and hormonal factors stimulate growth of these vessels. Once they appear, they rarely disappear. Spider leg veins can be readily treated by a technique called microsclerotherapy. A concentrated salt solution or polidocanol is injected into the veins, which initially become inflamed and then disappear over the following six weeks. The technique causes very little pain and can be done as an outpatient procedure.
Varicose VeinsVaricose veins may also make their debut during pregnancy due to the combination of hormonal changes and pressure placed on the abdominal veins by the growing uterus. Because varicose veins can be extremely uncomfortable, maternity compression stockings are invaluable. Support pantyhose, on the other hand, are counterproductive as they provide irregular compression, usually on the wrong parts of the veins. If varicose veins do not resolve after pregnancy, they may eventually be treated by either surgery or sclerotherapy. It is preferable to wait until all pregnancies are over before embarking on any surgical treatment, although sclerotherapy can be performed at any time after pregnancy and between pregnancies.
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The treatment of an itch will take two general forms. Firstly, it is essential to treat the cause, whether it is curable or only controllable. Secondly, the itch itself should be relieved so that further skin damage does not occur, and the individual may remain sane.
Specific measures of treatment include adequate explanation of what is wrong and what is proposed to be done, 80 that the patient is involved with, and understands the aim of, the treatment.
Physical restraints, particularly with children, are most helpful as a means of preventing scratching and further skin damage. This may involve, for example, splinting of the arms; thick wrapping of the worst affected areas, or the wearing of boxing gloves to bed.
Cooling of the worst affected areas or of the whole body has a fairly specific anti-itch effect. This may be achieved by cold compresses, tar baths, and the avoidance of hot showers, electric blankets and excessive clothing. Simple applications such as calamine lotion, with menthol or phenol, also give relief due to their chilling action. The avoidance of hot drinks and alcohol can be most helpful.
Various common proprietary preparations may have a nonspecific soothing action on an itch. These include calamine lotion, zinc cream, tar creams and antihistamine creams. The latter should be completely avoided, as should local anaesthetic creams, because of their strong capacity to sensitize the skin and cause a contact dermatitis. Similarly, provocative influences such as friction from rough clothing should be avoided.
Topical corticosteroids (cortisone creams or ointments) These are very effective in diminishing the itch associated with certain conditions. This is probably due to their non-specific anti-inflammatory action. Some conditions, however, such as hives or drug allergies, are unresponsive. On the other hand, if they are used for treating an itch—condition which is itself responsive to corticosteroids, then both the primary disorder and the associated itch will settle. On rare occasions oral corticosteroids may be required, not for the itch itself, but to suppress the underlying disorder causing an itch.
Anti-histomines. These specifically antagonize histamine, one of the known chemical causes of itching. Unfortunately they also have a sedative affect, which is enhanced by alcohol. There are currently about 20 antihistamines available, and there is unfortunately very little evidence from which to make a rational choice between them. They do, however, fall into several different structural or chemical groups. This is useful to know, as individuals will vary in the way they respond to various anti-histamines.
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