Derm Cases · Dermatology / Procedural Dermatology / Phlebology
OSCE — sclerotherapy for vascular lesions: selection, technique principles, consent, red flags
An 8-minute OSCE on selecting patients for sclerotherapy, liquid vs foam principles, contraindications including pregnancy, common complications, duplex when needed, and when to refer axial venous disease.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE on selecting patients for sclerotherapy, liquid vs foam principles, contraindications including pregnancy, common complications, duplex when needed, and when to refer axial venous disease.
Brief (to candidate)
A woman requests treatment of leg spider and reticular veins. She mentions she might be pregnant. In 8 minutes, assess suitability, explain sclerotherapy principles, consent risks, and red flags.
Candidate instructions
- Explain mechanism of detergent sclerotherapy.
- Contrast liquid vs foam at a principles level.
- Screen pregnancy and other contraindications — decline if pregnant.
- Consent for staining, matting, ulcer, multi-session need.
- State when duplex is needed for larger/symptomatic veins.
- Mention laser as comparator/adjunct, and specialist path for low-flow VMs.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Mechanism | Endothelial injury → thrombosis/fibrosis → occlusion |
| Agents | Names polidocanol/STS class; foam increases contact |
| Safety | Hard stop if pregnant; allergy, DVT, arterial disease |
| Complications | Pigmentation, matting, ulcer/extravasation, rare systemic events |
| Work-up | Duplex when reflux/CVD features; hierarchy beyond spiders |
| Scope | Low-flow VM = specialist; not undiagnosed nodules |
| Communication | Realistic multi-session expectations, photo consent |
Model key actions
- Decline elective sclerotherapy in pregnancy.[3]
- Match treatment to vessel size; do not ignore truncal reflux.[5]
- Counsel haemosiderin staining risk explicitly.[2]
References6ShowHide
- [1]Duffy DM. Sclerosants: a comparative review. Dermatologic Surgery, 2010.PMID 20590708
- [2]Bossart S, Daneluzzi C, Cazzaniga S, et al. Skin hyperpigmentation after sclerotherapy with polidocanol: A systematic review. Journal of the European Academy of Dermatology and Venereology, 2023.PMID 36196455
- [3]Reich-Schupke S, Leiste A, Moritz R, et al. Sclerotherapy in an undetected pregnancy - a catastrophe? VASA, 2012.PMID 22825857
- [4]Yiannakopoulou E. Safety Concerns for Sclerotherapy of Telangiectases, Reticular and Varicose Veins. Pharmacology, 2016.PMID 27104778
- [5]Wittens C, Davies AH, Bækgaard N, et al. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery, 2015.PMID 25920631
- [6]Markovic JN, Nag U, Shortell CK. Safety and efficacy of foam sclerotherapy for treatment of low-flow vascular malformations in children. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2020.PMID 32284312