Treatment for telangiectasias and reticular veins

Luis CU Nakano; Daniel G Cacione; Jose CC Baptista-Silva; Ronald LG Flumignan

doi:10.1002/14651858.CD012723.pub2

Rawatan untuk telangiektasias dan vena retikular

Appendices

Appendix 1. Sources searched and search strategies

Source

Search strategy

Hits retrieved

VASCULAR REGISTER IN CRSW

1. telang* AND INREGISTER

2. Spider AND INREGISTER

3. reticular near3 vein* AND INREGISTER

4. #1 OR #2 OR #3

29.8.17 ‐ 63

21.1.19 ‐ 2

16.3.21 ‐ 82

CENTRAL via CRSW

#1 MESH DESCRIPTOR Telangiectasis EXPLODE ALL TREES 146

#2 telangiectas*:TI,AB,KY 551

#3 microvaric*:TI,AB,KY 1

#4 (reticular near3 vein*):TI,AB,KY 27

#5 (reticular near3 varic* ):TI,AB,KY 1

#6 (reticular near3 venous ):TI,AB,KY 0

#7 (thread near3 vein* ):TI,AB,KY 0

#8 (thread near3 varic* ):TI,AB,KY 1

#9 (thread near3 venous ):TI,AB,KY 0

#10 (spider near3 vein* ):TI,AB,KY 10

#11 (spider near3 varic* ):TI,AB,KY 1

#12 (spider near3 venous ):TI,AB,KY 1

#13 angioectasias:TI,AB,KY 6

#14 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 574

#15 01/01/2017 TO 22/01/2019:CD 324775

#16 #14 AND #15 177

29.8.17 ‐ 547

21.1.19 ‐ 117

16.3.21 ‐ 228

Clinicaltrials.gov

Telangiectasis OR telangiectatic OR "reticular veins" OR "reticular vein" OR "spider veins" OR "spider vein" OR "thread veins" OR "thread vein" OR angioectasias | Interventional Studies

29.8.17 ‐ 136

21.1.19 ‐ 18

16.3.21 ‐ 30

ICTRP Search Portal

Telangiecta* OR reticular vein* OR spider vein* OR thread vein* OR angioectasias

29.8.17 ‐ 131

21.1.19 ‐ 31

16.3.21 ‐ 43

Ovid MEDLINE Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE 1946 to Present

1 exp Telangiectasis/

2 telangiectas*.ti,ab.

3 microvaric*.ti,ab.

4 (reticular adj3 varic*).ti,ab.

5 (reticular adj3 vein*).ti,ab.

6 (reticular adj3 venous).ti,ab.

7 (thread adj3 vein*).ti,ab.

8 (thread adj3 varic*).ti,ab.

9 (thread adj3 venous).ti,ab.

10 (spider adj3 vein*).ti,ab.

11 (spider adj3 varic*).ti,ab.

12 (spider adj3 venous).ti,ab.

13 angioectasias.ti,ab.

14 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13

15 limit 14 to yr="2017"

16 randomized controlled trial.pt.

17 controlled clinical trial.pt.

18 randomized.ab.

19 placebo.ab.

20 drug therapy.fs.

21 randomly.ab.

22 trial.ab.

23 groups.ab.

24 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23

25 exp animals/ not humans.sh.

26 24 not 25

27 15 and 26

29.8.17 ‐ 45

21.1.19 ‐ 235

16.3.21 ‐ 230

Embase Ovid

1 exp Telangiectasis/

2 telangiectas*.ti,ab.

3 microvaric*.ti,ab.

4 (reticular adj3 varic*).ti,ab.

5 (reticular adj3 vein*).ti,ab.

6 (reticular adj3 venous).ti,ab.

7 (thread adj3 vein*).ti,ab.

8 (thread adj3 varic*).ti,ab.

9 (thread adj3 venous).ti,ab.

10 (spider adj3 vein*).ti,ab.

11 (spider adj3 varic*).ti,ab.

12 (spider adj3 venous).ti,ab.

13 angioectasias.ti,ab.

14 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13

15 limit 14 to yr="2017"

16 randomized controlled trial/

17 controlled clinical trial/

18 random$.ti,ab.

19 randomization/

20 intermethod comparison/

21 placebo.ti,ab.

22 (compare or compared or comparison).ti.

23 ((evaluated or evaluate or evaluating or assessed or assess) and (compare or compared or comparing or comparison)).ab.

24 (open adj label).ti,ab.

25 ((double or single or doubly or singly) adj (blind or blinded or blindly)).ti,ab.

26 double blind procedure/

27 parallel group$1.ti,ab.

28 (crossover or cross over).ti,ab.

29 ((assign$ or match or matched or allocation) adj5 (alternate or group$1 or intervention$1 or patient$1 or subject$1 or participant$1)).ti,ab.

30 (assigned or allocated).ti,ab.

31 (controlled adj7 (study or design or trial)).ti,ab.

32 (volunteer or volunteers).ti,ab.

33 trial.ti.

34 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33

35 15 and 34

29.8.17 ‐ 99

21.1.19 ‐ 581

16.3.21 ‐ 487

AMED (Allied and Complementary Medicine)

1. telangiectas*.ti,ab.

2. microvaric*.ti,ab.

3. (reticular adj3 varic*).ti,ab.

4. (reticular adj3 vein*).ti,ab.

5. (reticular adj3 venous).ti,ab.

6. (thread adj3 vein*).ti,ab.

7. (thread adj3 varic*).ti,ab.

8. (thread adj3 venous).ti,ab.

9. (spider adj3 vein*).ti,ab.

10. (spider adj3 varic*).ti,ab.

11. (spider adj3 venous).ti,ab.

12. angioectasias.ti,ab.

13. or/1‐12

14. exp CLINICAL TRIALS/

15. RANDOM ALLOCATION/

16. DOUBLE BLIND METHOD/

17. Clinical trial.pt.

18. (clinic* adj trial*).tw.

19. ((singl* or doubl* or trebl* or tripl*) adj (blind* or mask*)).tw.

20. PLACEBOS/

21. placebo*.tw.

22. random*.tw.

23. PROSPECTIVE STUDIES/

24. or/14‐23

25. 13 and 2

29.8.17 ‐ 0

21.1.19 ‐ 0

16.3.21 ‐ 0

CINAHL

S30 S28 AND S29

S29 EM 2017 OR EM 2018 OR 2019 EM

S28 S14 AND S27

S27 S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26

S26 MH "Random Assignment"

S25 MH "Single‐Blind Studies" or MH "Double‐Blind Studies" or MH "Triple‐Blind Studies"

S24 MH "Crossover Design"

S23 MH "Factorial Design"

S22 MH "Placebos"

S21 MH "Clinical Trials"

S20 TX "multi‐centre study" OR "multi‐center study" OR "multicentre study" OR "multicenter study" OR "multi‐site study"

S19 TX crossover OR "cross‐over"

S18 AB placebo*

S17 TX random*

S16 TX trial*

S15 TX "latin square"

S14 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13

S13 TX angioectasias

S12 TX spider venous

S11 TX spider varic*

S10 TX spider vein*

S9 TX thread venous

S8 TX thread varic*

S7 TX thread vein*

S6 TX reticular venous

S5 TX reticular varic*

S4 TX reticular vein*

S3 TX telangiectas*

S2 (MH "Telangiectasis+")

S1 TX Telangiectasis

29.8.17 ‐ 49

21.1.19 ‐ 41

16.3.21 ‐ 23

Appendix 2. LILACS/BECS search strategy

((MH: "Telangiectasis" OR MH: "Telangiectasia" OR MH: "Telangiectasia" OR "Spider Veins") AND (MH: "Lasers" OR MH: "Rayos Láser" OR MH: "Lasers" OR "Masers" OR E07.632.490$ OR E07.710.520$ OR SP4.011.087.698.384.075.166.027$ OR VS2.006.002.009$ OR MH: "Laser Coagulation" OR MH: "Coagulación con Láser" OR MH: "Fotocoagulação a Laser" OR "Laser Thermocoagulation" OR "Thermocoagulation, Laser" OR E02.520.745.410$ OR E02.594.530$ OR E04.014.520.530$ OR E04.350.750.410$ OR E04.540.630.410$ OR MH: "Low‐Level Light Therapy" OR MH: "Terapia por Luz de Baja Intensidad" OR MH: "Terapia com Luz de Baixa Intensidade" OR "Laser Therapy, Low‐Level" OR "Laser Biostimulation" OR "Laser Irradiation, Low‐Power" OR "LLLT" OR E02.594.540$ OR E02.774.500$ OR MH: "Laser Therapy" OR MH: "Terapia por Láser" OR MH: "Terapia a Laser" OR "Laser Knife" OR "Laser Scalpel" OR "Surgery, Laser" OR "Vaporization, Laser" OR E02.594$ OR E04.014.520$ OR MH: "Lasers, Gas" OR MH: "Láseres de Gas" OR MH: "Lasers de Gás" OR "Argon Ion Lasers" OR "Carbon Dioxide Lasers" OR "CO2 Lasers" OR "Copper Vapor Lasers" OR "Gas Laser" OR "Gas Lasers" OR "Gold Vapor Lasers" OR "Helium Lasers" OR "Helium Neon Gas Lasers" OR "Metal Vapor Lasers" OR "Nitrogen Lasers" OR "Xenon Ion Lasers" OR E07.632.490.367$ OR E07.710.520.367$ OR MH: "Intense Pulsed Light Therapy" OR "Tratamiento de Luz Pulsada Intensa" OR "Terapia de Luz Pulsada Intensa" OR MH: "Sclerotherapy" MH: "Escleroterapia" MH: "Escleroterapia" OR MH: "Sclerosing Solutions" OR MH: "Soluciones Esclerosantes" OR MH: "Soluções Esclerosantes" OR "Injections, Sclerosing" OR "Sclerosing Agents" OR D26.776.708.822$ OR D27.505.954.411.700$ OR D27.505.954.578.822$ OR D27.720.752.822$)) AND (DB:("IBECS" OR "LILACS"))

Appendix 3. Glossary

acne vulgaris	skin disease caused by overactivity of sebaceous glands
ambulatory	people treated out of the hospital setting
angiomas	dilatation or new formation of blood vessels
arterioles	small branches of an artery
atrophic blanche	small smooth ivory‐white areas on the skin with hyperpigmented borders and telangiectasias
chromophore	chemical group that absorbs light at a specific frequency
dermal	relating to skin and specially to the dermis
dorsum	the dorsal part of an organism such as human body
endothelium	tissue that forms a single layer of cells lining various organs
epidermal	non sensitive layer of the skin
erythema	superficial reddening of the skin
extravasation	escape of blood from a vessel into the tissues
fibrosis	the thickening and scarring of connective tissue
hypopigmentation	decreased pigmentation of skin area
hyperpigmentation	increased pigmentation of skin area
lipodermatosclerosis	chronic fibrosing panniculitis associated with venous insufficiency
matting	new telangiectasis after treatment
melanin	pigment responsible for determining skin and hair colours
microthrombi	small thrombus (blood clot formed in situ within the vascular system)
necrosis	death of most or all of the cells in an organ or tissue
occlusion	blockage of blood vessel
oedema	excess of watery fluid collecting in the tissue of the body and outside of blood vessels
osmotic	diffusion of fluid through a semipermeable membrane
oxyhaemoglobin	substance formed by the combination of haemoglobin with oxygen
periorbital	tissues surrounding or lining the orbit of the eye
photocoagulation	coagulation of tissue using a laser or other intense light source
photothermolysis	a method of laser skin resurfacing
polychromatic	various wavelengths or frequencies
recanalisation	process of restoring flow of the blood vessels
subcutaneous	situated or applied under the skin
subdermal	situated or lying under the skin
thermocoagulation	coagulation of tissue with high‐frequency currents
thermosclerosis	coagulation of blood vessels for heat
thrombosis	local coagulation or clotting of the blood in a part of circulatory system
vascular	relating to blood vessels
venous	relating to a vein
venules	very small veins
vesicles	small fluid‐filled bladders, sacs, or cysts

Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1: Sclerotherapy (any sclerosing agent) versus placebo, Outcome 1: Resolution or improvement of telangiectasias

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Analysis 1.2

Comparison 1: Sclerotherapy (any sclerosing agent) versus placebo, Outcome 2: Adverse events

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Analysis 1.3

Comparison 1: Sclerotherapy (any sclerosing agent) versus placebo, Outcome 3: Pain

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Analysis 2.1

Comparison 2: Sclerotherapy (polidocanol) versus sclerotherapy (any sclerosing agent), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 2.2

Comparison 2: Sclerotherapy (polidocanol) versus sclerotherapy (any sclerosing agent), Outcome 2: Adverse events

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Analysis 2.3

Comparison 2: Sclerotherapy (polidocanol) versus sclerotherapy (any sclerosing agent), Outcome 3: Pain

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Analysis 3.1

Comparison 3: Sclerotherapy (STS) versus sclerotherapy (any sclerosing agent), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 3.2

Comparison 3: Sclerotherapy (STS) versus sclerotherapy (any sclerosing agent), Outcome 2: Adverse events

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Analysis 3.3

Comparison 3: Sclerotherapy (STS) versus sclerotherapy (any sclerosing agent), Outcome 3: Pain

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Analysis 4.1

Comparison 4: Sclerotherapy (hypertonic saline) versus sclerotherapy (any sclerosing agent), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 4.2

Comparison 4: Sclerotherapy (hypertonic saline) versus sclerotherapy (any sclerosing agent), Outcome 2: Adverse events

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Analysis 4.3

Comparison 4: Sclerotherapy (hypertonic saline) versus sclerotherapy (any sclerosing agent), Outcome 3: Pain

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Analysis 5.1

Comparison 5: Sclerotherapy (chromated glycerin) versus sclerotherapy (any sclerosing agent), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 5.2

Comparison 5: Sclerotherapy (chromated glycerin) versus sclerotherapy (any sclerosing agent), Outcome 2: Adverse events

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Analysis 5.3

Comparison 5: Sclerotherapy (chromated glycerin) versus sclerotherapy (any sclerosing agent), Outcome 3: Pain

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Analysis 6.1

Comparison 6: Foam versus sclerotherapy (any sclerosing agent), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 6.2

Comparison 6: Foam versus sclerotherapy (any sclerosing agent), Outcome 2: Adverse events

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Analysis 6.3

Comparison 6: Foam versus sclerotherapy (any sclerosing agent), Outcome 3: Pain

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Analysis 7.1

Comparison 7: Laser versus sclerotherapy (any sclerosing agent), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 7.2

Comparison 7: Laser versus sclerotherapy (any sclerosing agent), Outcome 2: Adverse events

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Analysis 7.3

Comparison 7: Laser versus sclerotherapy (any sclerosing agent), Outcome 3: Pain

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Analysis 8.1

Comparison 8: Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 8.2

Comparison 8: Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol), Outcome 2: Adverse events

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Analysis 8.3

Comparison 8: Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol), Outcome 3: Pain

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Analysis 9.1

Comparison 9: Sclerotherapy (polidocanol plus glucose) versus sclerotherapy (glucose), Outcome 1: Resolution or improvement of telangiectasias

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Analysis 9.2

Comparison 9: Sclerotherapy (polidocanol plus glucose) versus sclerotherapy (glucose), Outcome 2: Adverse events

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Analysis 9.3

Comparison 9: Sclerotherapy (polidocanol plus glucose) versus sclerotherapy (glucose), Outcome 3: Pain

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Analysis 10.1

Comparison 10: Sclerotherapy plus compression versus sclerotherapy alone, Outcome 1: Resolution or improvement of telangiectasias

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Analysis 10.2

Comparison 10: Sclerotherapy plus compression versus sclerotherapy alone, Outcome 2: Adverse events

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Analysis 10.3

Comparison 10: Sclerotherapy plus compression versus sclerotherapy alone, Outcome 3: Quality of life

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Summary of findings 1. Sclerotherapy compared to placebo for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures* (studies)	Certainty of the evidence (GRADE)	Comments
Sclerotherapy compared to placebo for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: sclerotherapy (any) Comparison: placebo
Outcomes	Risk with placebo	Risk with sclerotherapy	Relative effect (95% CI)	№ of participants/procedures* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 4 ‐ 12 weeks)		SMD 3.08 higher (2.68 higher to 3.48 higher)	‐	613 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 4 ‐ 12 weeks)	Study population		RR 11.88 (4.54 to 31.09)	528 (3 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
	25 per 1000	299 per 1000 (114 to 784)	RR 11.88 (4.54 to 31.09)	528 (3 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
Adverse events ‐ matting (follow‐up: 4 ‐ 12 weeks)	Study population		RR 4.06 (1.28 to 12.84)	528 (3 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
Adverse events ‐ matting (follow‐up: 4 ‐ 12 weeks)	17 per 1000	68 per 1000 (22 to 216)	RR 4.06 (1.28 to 12.84)	528 (3 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
Pain (follow‐up: 1 day)		SMD 0.7 higher (0.06 higher to 1.34 higher)	‐	40 (1 RCT)	⊕⊕⊝⊝ LOW^c	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* Three studies used participants as the unit of analysis and one study used the number of procedures as the unit of analysis for each comparison. ^aWe downgraded by one level due to high clinical heterogeneity of the included studies. ^bWe downgraded by one level due to high clinical heterogeneity of the included studies and wide CI of the included studies (imprecision). ^c We downgraded by two levels due to high clinical heterogeneity of the included studies and only one included study with few participants.

Summary of findings 1. Sclerotherapy compared to placebo for treatment of telangiectasias and reticular veins

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Summary of findings 2. Sclerotherapy (polidocanol) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Sclerotherapy (polidocanol) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: sclerotherapy (polidocanol) Comparison: sclerotherapy (any sclerosant)
Outcomes	Risk with sclerotherapy (any sclerosant agent)	Risk with sclerotherapy (polidocanol)	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 4 ‐ 16 weeks)		SMD 0.01 higher (0.13 lower to 0.14 higher)	‐	852 (7 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 4 ‐ 16 weeks)	Study population		RR 0.94 (0.62 to 1.43)	819 (6 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
	476 per 1000	447 per 1000 (295 to 680)	RR 0.94 (0.62 to 1.43)	819 (6 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 4 ‐ 16 weeks)	Study population		RR 0.82 (0.52 to 1.27)	859 (7 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 4 ‐ 16 weeks)	144 per 1000	118 per 1000 (75 to 183)	RR 0.82 (0.52 to 1.27)	859 (7 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Pain (follow‐up: 1 day)		SMD 0.26 lower (0.44 lower to 0.08 lower)	‐	480 (5 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* Three studies used participants as the unit of analysis and four studies used the number of procedures as the unit of analysis for each comparison. ^aWe downgraded by one level due to wide CIs.

Summary of findings 2. Sclerotherapy (polidocanol) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

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Summary of findings 3. Sclerotherapy (STS) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Sclerotherapy (STS) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: sclerotherapy (STS) Comparison: sclerotherapy (any sclerosant)
Outcomes	Risk with sclerotherapy (any sclerosant)	Risk with sclerotherapy (STS)	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 4 ‐ 16 weeks)		SMD 0.07 lower (0.25 lower to 0.11 higher)	‐	473 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 4 ‐ 24 weeks)	Study population		RR 1.71 (1.10 to 2.64)	478 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
	371 per 1000	634 per 1000 (408 to 979)	RR 1.71 (1.10 to 2.64)	478 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 4 ‐ 24 weeks)	Study population		RR 2.10 (1.14 to 3.85)	323 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 4 ‐ 24 weeks)	82 per 1000	173 per 1000 (94 to 318)	RR 2.10 (1.14 to 3.85)	323 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Pain (follow‐up: 1 day)	Study population		RR 1.49 (0.99 to 2.25)	409 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Pain (follow‐up: 1 day)	275 per 1000	410 per 1000 (273 to 619)	RR 1.49 (0.99 to 2.25)	409 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* Two studies used participants as the unit of analysis and four studies used the number of procedures as the unit of analysis for each comparison. ^aWe downgraded by one level due to wide CIs and small number of participants.

Summary of findings 3. Sclerotherapy (STS) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

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Summary of findings 4. Sclerotherapy (hypertonic saline) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Sclerotherapy (hypertonic saline) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: sclerotherapy (hypertonic saline) Comparison: sclerotherapy (any sclerosant)
Outcomes	Risk with sclerotherapy (any sclerosant)	Risk with sclerotherapy (hypertonic saline)	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 4 ‐ 12 weeks)	‐	SMD 0.01 higher (0.2 lower to 0.22 higher)	‐	348 (3 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 8 ‐ 12 weeks)	Study population		RR 0.74 (0.59 to 0.93)	288 (2 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
	493 per 1000	365 per 1000 (291 to 459)	RR 0.74 (0.59 to 0.93)	288 (2 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
Adverse events ‐ matting (follow‐up: 8 ‐ 12 weeks)	Study population		RR 0.89 (0.58 to 1.36)	288 (2 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
Adverse events ‐ matting (follow‐up: 8 ‐ 12 weeks)	215 per 1000	192 per 1000 (125 to 293)	RR 0.89 (0.58 to 1.36)	288 (2 RCTs)	⊕⊕⊕⊝ MODERATE^b	‐
Pain (follow‐up: 1 day)	‐	SMD 6.22 higher (5.7 higher to 6.73 higher)	‐	348 (3 RCTs)	⊕⊕⊕⊝ MODERATE^c	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standard mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* All studies used the number of procedures as the unit of analysis for each comparison. ^aWe downgraded by one level because of high risk of other bias in the included studies. ^bWe downgraded by one level because of wide CIs. ^cWe downgraded by one level because of clinical heterogeneity between included studies.

Summary of findings 4. Sclerotherapy (hypertonic saline) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

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Summary of findings 5. Sclerotherapy (chromated glycerin) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Sclerotherapy (chromated glycerin) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: sclerotherapy (chromated glycerin) Comparison: sclerotherapy (any sclerosant)
Outcomes	Risk with sclerotherapy (any sclerosing agent)	Risk with sclerotherapy (chromated glycerin)	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 5 ‐ 24 weeks)	‐	SMD 0.45 higher (0.11 lower to 1.02 higher)	‐	125 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 5 ‐ 24 weeks)	Study population		RR 0.49 (0.09 to 2.50)	125 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
	66 per 1000	32 per 1000 (6 to 164)	RR 0.49 (0.09 to 2.50)	125 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ matting (follow‐up: 5 ‐ 24 weeks)	Study population		RR 0.31 (0.01 to 7.53)	99 (1 RCT)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ matting (follow‐up: 5 ‐ 24 weeks)	21 per 1000	6 per 1000 (0 to 157)	RR 0.31 (0.01 to 7.53)	99 (1 RCT)	⊕⊕⊝⊝ LOW^a	‐
Pain (follow‐up: 1 day)	Study population		RR 1.50 (0.30 to 7.55)	26 (1 RCT)	⊕⊕⊝⊝ LOW^a	‐
Pain (follow‐up: 1 day)	154 per 1000	231 per 1000 (46 to 1000)	RR 1.50 (0.30 to 7.55)	26 (1 RCT)	⊕⊕⊝⊝ LOW^a	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* One study used participants as the unit of analysis and one study used the number of procedures as the unit of analysis for each comparison. ^a We downgraded by two levels due to few included studies and participants.

Summary of findings 5. Sclerotherapy (chromated glycerin) compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

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Summary of findings 6. Foam compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Foam compared to sclerotherapy (any sclerosant) for telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: foam Comparison: sclerotherapy (any sclerosant)
Outcomes	Risk with sclerotherapy (any sclerosing agent)	Risk with foam	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 5 ‐ 10 weeks)	‐	SMD 0.04 higher (0.26 lower to 0.34 higher)	‐	187 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 5 ‐ 10 weeks)	Study population		RR 2.12 (0.44 to 10.23)	187 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
	26 per 1000	55 per 1000 (11 to 265)	RR 2.12 (0.44 to 10.23)	187 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ matting (follow up: 5 ‐ 10 weeks)	Study population		RR 6.12 (1.04 to 35.98)	187 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ matting (follow up: 5 ‐ 10 weeks)	9 per 1000	53 per 1000 (9 to 310)	RR 6.12 (1.04 to 35.98)	187 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Pain (follow up: 1 day)		SMD 0.1 lower (0.44 lower to 0.24 higher)	‐	147 (1 RCT)	⊕⊕⊝⊝ LOW^a	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* One study used participants as the unit of analysis and one study used the number of procedures as the unit of analysis for each comparison. ^aWe downgraded by two levels due to wide CIs and few participants in the included studies.

Summary of findings 6. Foam compared to sclerotherapy (any sclerosant) for treatment of telangiectasias and reticular veins

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Summary of findings 7. Laser compared to sclerotherapy for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Laser compared to sclerotherapy for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: laser Comparison: sclerotherapy
Outcomes	Risk with sclerotherapy	Risk with laser	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 4 ‐ 24 weeks)	‐	SMD 0.09 lower (0.25 lower to 0.07 higher)	‐	593 (5 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 4 ‐ 24 weeks)	Study population		RR 0.57 (0.40 to 0.80)	262 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
	328 per 1000	187 per 1000 (131 to 263)	RR 0.57 (0.40 to 0.80)	262 (4 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 16 ‐ 24 weeks)	Study population		RR 1.00 (0.46 to 2.19)	162 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 16 ‐ 24 weeks)	123 per 1000	123 per 1000 (57 to 270)	RR 1.00 (0.46 to 2.19)	162 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Pain (follow‐up: 1 day)	Study population		‐	100 (2 RCTs)	⊕⊝⊝⊝ LOW^b	We were not able to pool the data due to high heterogeneity
Pain (follow‐up: 1 day)	See comment	‐	‐	100 (2 RCTs)	⊕⊝⊝⊝ LOW^b	We were not able to pool the data due to high heterogeneity
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* Two studies used participants as the unit of analysis and three studies used the number of procedures as the unit of analysis for each comparison ^aWe downgraded by one level due to wide CIs. ^bWe downgraded by two levels because of few included participants.

Summary of findings 7. Laser compared to sclerotherapy for treatment of telangiectasias and reticular veins

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Summary of findings 8. Laser plus sclerotherapy compared to sclerotherapy for treatment of telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Laser plus sclerotherapy compared to sclerotherapy for treatment of telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: laser plus sclerotherapy Comparison: sclerotherapy
Outcomes	Risk with sclerotherapy	Risk with laser plus sclerotherapy	Relative effect (95% CI)	№ of participants/procedures^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 12 ‐ 16 weeks)	‐	SMD 5.68 higher (5.14 higher to 6.23 higher)	‐	710 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ Hyperpigmentation (follow‐up: 12 ‐ 16 weeks)	Study population		RR 0.83 (0.35 to 1.99)	656 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
	64 per 1000	53 per 1000 (22 to 128)	RR 0.83 (0.35 to 1.99)	656 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ matting (follow‐up: 12 ‐ 16 weeks)	Study population		RR 0.83 (0.21 to 3.28)	656 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Adverse events ‐ matting (follow‐up: 12 ‐ 16 weeks)	18 per 1000	15 per 1000 (4 to 60)	RR 0.83 (0.21 to 3.28)	656 (2 RCTs)	⊕⊕⊝⊝ LOW^a	‐
Pain (follow‐up: 1 day)	Study population		RR 2.44 (1.69 to 3.55)	596 (1 RCT)	⊕⊕⊝⊝ LOW^b	‐
Pain (follow‐up: 1 day)	266 per 1000	649 per 1000 (449 to 944)	RR 2.44 (1.69 to 3.55)	596 (1 RCT)	⊕⊕⊝⊝ LOW^b	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^* All studies used participants as the unit of analysis. ^aWe downgraded by two levels because of clinical heterogeneity in the included studies and the fact that the two studies were conducted by the same group of investigators. ^bWe downgraded by two levels due to having one included study.

Summary of findings 8. Laser plus sclerotherapy compared to sclerotherapy for treatment of telangiectasias and reticular veins

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Summary of findings 9. Sclerotherapy (hypertonic glucose plus polidocanol) compared to sclerotherapy (hypertonic glucose)

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	No of Participants^* (studies)	Certainty of the evidence (GRADE)	Comments
Sclerotherapy (hypertonic glucose plus polidocanol) compared with sclerotherapy (hypertonic glucose) for telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Settings: outpatient Intervention: sclerotherapy (hypertonic glucose plus POL) Comparison: sclerotherapy (hypertonic glucose)
Outcomes	Risk with hypertonic glucose	Risk with hypertonic glucose plus POL	Relative effect (95% CI)	No of Participants^* (studies)	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 12 ‐ 16 weeks)	‐	SMD 0.79 higher (0.50 higher to 1.09 higher)		191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up: 16 weeks)	Study population		RR 0.79 (0.62 to 1.01)	191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
	649 per 1000	513 per 1000 (403 to 656)	RR 0.79 (0.62 to 1.01)	191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 16 weeks)	Study population		RR 0.78 (0.51 to 1.20)	191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 16 weeks)	351 per 1000	273 per 1000 (179 to 421)	RR 0.78 (0.51 to 1.20)	191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Pain (follow‐up: 16 weeks)	Study population		RR 1.02 (0.83 to 1.24)	191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Pain (follow‐up: 16 weeks)	443 per 1000	442 per 1000 (359 to 537)	RR 1.02 (0.83 to 1.24)	191 (2 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; POL: polidocanol; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
^* All studies used participants as the unit of analysis. ^aWe downgraded one level because of few participants in included studies.

Summary of findings 9. Sclerotherapy (hypertonic glucose plus polidocanol) compared to sclerotherapy (hypertonic glucose)

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Summary of findings 10. Sclerotherapy plus compression compared to sclerotherapy alone for telangiectasias and reticular veins

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)^*	Certainty of the evidence (GRADE)	Comments
Sclerotherapy plus compression compared to sclerotherapy alone for telangiectasias and reticular veins
Patient or population: people with telangiectasias and reticular veins Setting: outpatient Intervention: sclerotherapy plus compression Comparison: sclerotherapy
Outcomes	Risk with sclerotherapy	Risk with sclerotherapy plus compression	Relative effect (95% CI)	№ of participants (studies)^*	Certainty of the evidence (GRADE)	Comments
Resolution or improvement of telangiectasias (follow‐up: 4 ‐ 8 weeks)	‐	SMD 0.09 higher (0.19 lower to 0.37 higher)	‐	196 (2 studies)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ hyperpigmentation (follow‐up:4 ‐ 8 weeks)	Study population		RR 0.93 (0.41 to 2.07)	196 (2 studies)	⊕⊕⊕⊝ MODERATE^a	‐
	112 per 1000	104 per 1000 (46 to 232)	RR 0.93 (0.41 to 2.07)	196 (2 studies)	⊕⊕⊕⊝ MODERATE^a	‐
Adverse events ‐ matting (follow‐up: 8 weeks)	Study population		RR 1.84 (0.17 to 19.62)	96 (1 study)	⊕⊕⊝⊝ LOW^b	‐
Adverse events ‐ matting (follow‐up: 8 weeks)	22 per 1000	40 per 1000 (4 to 427)	RR 1.84 (0.17 to 19.62)	96 (1 study)	⊕⊕⊝⊝ LOW^b	‐
Pain	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Recurrence	See comment	‐	‐	‐	‐	The studies in this comparison did not assess this outcome
Time to resolution	See comment		‐	‐	‐	The studies in this comparison did not assess this outcome
Quality of life (follow up: 8 weeks)		SMD 0.02 lower (0.42 lower to 0.39 higher)	‐	93 (1 study)	⊕⊕⊝⊝ LOW^b
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SMD: standard mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
^*All studies used participants as the unit of analysis. ^aWe downgraded one level because of few participants in included studies. ^bWe downgraded two levels because of few participants and only one included study.

Summary of findings 10. Sclerotherapy plus compression compared to sclerotherapy alone for telangiectasias and reticular veins

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Comparison 1. Sclerotherapy (any sclerosing agent) versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Resolution or improvement of telangiectasias Show forest plot	4	613	Std. Mean Difference (IV, Random, 95% CI)	3.08 [2.68, 3.48]

1.2 Adverse events Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.2.1 Hyperpigmentation	3	528	Risk Ratio (M‐H, Random, 95% CI)	11.88 [4.54, 31.09]
1.2.2 Matting	3	528	Risk Ratio (M‐H, Random, 95% CI)	4.06 [1.28, 12.84]
1.3 Pain Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 1. Sclerotherapy (any sclerosing agent) versus placebo

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Comparison 2. Sclerotherapy (polidocanol) versus sclerotherapy (any sclerosing agent)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Resolution or improvement of telangiectasias Show forest plot	7	852	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.13, 0.14]

2.2 Adverse events Show forest plot	8		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.2.1 Hyperpigmentation	6	819	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.62, 1.43]
2.2.2 Matting	7	859	Risk Ratio (M‐H, Random, 95% CI)	0.82 [0.52, 1.27]
2.2.3 Bruising	4	558	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.56, 1.06]
2.2.4 Microthrombosis	4	394	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.69, 1.34]
2.2.5 Allergy	4	472	Risk Ratio (M‐H, Random, 95% CI)	0.68 [0.23, 2.01]
2.2.6 Necrosis	4	558	Risk Ratio (M‐H, Random, 95% CI)	0.07 [0.02, 0.29]
2.3 Pain Show forest plot	5	480	Std. Mean Difference (IV, Random, 95% CI)	‐0.26 [‐0.44, ‐0.08]

Comparison 2. Sclerotherapy (polidocanol) versus sclerotherapy (any sclerosing agent)

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Comparison 3. Sclerotherapy (STS) versus sclerotherapy (any sclerosing agent)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Resolution or improvement of telangiectasias Show forest plot	4	473	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.25, 0.11]

3.2 Adverse events Show forest plot	5		Risk Ratio (IV, Random, 95% CI)	Subtotals only

3.2.1 Hyperpigmentation	4	478	Risk Ratio (IV, Random, 95% CI)	1.71 [1.10, 2.64]
3.2.2 Matting	2	323	Risk Ratio (IV, Random, 95% CI)	2.10 [1.14, 3.85]
3.2.3 Bruising	3	418	Risk Ratio (IV, Random, 95% CI)	1.62 [1.14, 2.30]
3.2.4 Microthrombosis	1	129	Risk Ratio (IV, Random, 95% CI)	1.04 [0.78, 1.39]
3.2.5 Allergy	3	452	Risk Ratio (IV, Random, 95% CI)	1.38 [1.01, 1.88]
3.2.6 Necrosis	2	392	Risk Ratio (IV, Random, 95% CI)	16.31 [3.14, 84.79]
3.3 Pain Show forest plot	4	409	Risk Ratio (M‐H, Random, 95% CI)	1.49 [0.99, 2.25]

Comparison 3. Sclerotherapy (STS) versus sclerotherapy (any sclerosing agent)

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Comparison 4. Sclerotherapy (hypertonic saline) versus sclerotherapy (any sclerosing agent)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Resolution or improvement of telangiectasias Show forest plot	3	348	Std. Mean Difference (IV, Random, 95% CI)	0.01 [‐0.20, 0.22]

4.2 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.2.1 Hyperpigmentation	2	288	Risk Ratio (M‐H, Random, 95% CI)	0.74 [0.59, 0.93]
4.2.2 Matting	2	288	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.58, 1.36]
4.3 Pain Show forest plot	3	348	Std. Mean Difference (IV, Random, 95% CI)	6.22 [5.70, 6.73]

Comparison 4. Sclerotherapy (hypertonic saline) versus sclerotherapy (any sclerosing agent)

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Comparison 5. Sclerotherapy (chromated glycerin) versus sclerotherapy (any sclerosing agent)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Resolution or improvement of telangiectasias Show forest plot	2	125	Std. Mean Difference (IV, Random, 95% CI)	0.45 [‐0.11, 1.02]

5.2 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.2.1 Hyperpigmentation	2	125	Risk Ratio (M‐H, Random, 95% CI)	0.49 [0.09, 2.50]
5.2.2 Matting	1	99	Risk Ratio (M‐H, Random, 95% CI)	0.31 [0.01, 7.53]
5.2.3 Bruising	1	26	Risk Ratio (M‐H, Random, 95% CI)	0.14 [0.02, 1.00]
5.2.4 Microthrombosis	1	99	Risk Ratio (M‐H, Random, 95% CI)	1.32 [0.45, 3.87]
5.3 Pain Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

Comparison 5. Sclerotherapy (chromated glycerin) versus sclerotherapy (any sclerosing agent)

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Comparison 6. Foam versus sclerotherapy (any sclerosing agent)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Resolution or improvement of telangiectasias Show forest plot	2	187	Std. Mean Difference (IV, Random, 95% CI)	0.04 [‐0.26, 0.34]

6.2 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.2.1 Hyperpigmentation	2	187	Risk Ratio (M‐H, Random, 95% CI)	2.12 [0.44, 10.23]
6.2.2 Matting	2	187	Risk Ratio (M‐H, Random, 95% CI)	6.12 [1.04, 35.98]
6.2.3 Bruising	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.35, 1.04]
6.2.4 Microthrombosis	2	187	Risk Ratio (M‐H, Random, 95% CI)	1.39 [0.70, 2.76]
6.3 Pain Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 6. Foam versus sclerotherapy (any sclerosing agent)

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Comparison 7. Laser versus sclerotherapy (any sclerosing agent)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Resolution or improvement of telangiectasias Show forest plot	5	593	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.25, 0.07]

7.2 Adverse events Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

7.2.1 Hyperpigmentation	4	262	Risk Ratio (M‐H, Random, 95% CI)	0.57 [0.40, 0.80]
7.2.2 Matting	2	162	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.46, 2.19]
7.2.3 Bruising	1	40	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.60, 1.04]
7.2.4 Necrosis	3	202	Risk Ratio (M‐H, Random, 95% CI)	1.60 [0.20, 12.74]
7.3 Pain Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

Comparison 7. Laser versus sclerotherapy (any sclerosing agent)

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Comparison 8. Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 Resolution or improvement of telangiectasias Show forest plot	2	710	Std. Mean Difference (IV, Random, 95% CI)	5.68 [5.14, 6.23]

8.2 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

8.2.1 Hyperpigmentation	2	656	Risk Ratio (M‐H, Random, 95% CI)	0.83 [0.35, 1.99]
8.2.2 Matting	2	656	Risk Ratio (M‐H, Random, 95% CI)	0.83 [0.21, 3.28]
8.3 Pain Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

Comparison 8. Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol)

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Comparison 9. Sclerotherapy (polidocanol plus glucose) versus sclerotherapy (glucose)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
9.1 Resolution or improvement of telangiectasias Show forest plot	2	191	Std. Mean Difference (IV, Random, 95% CI)	0.79 [0.50, 1.09]

9.2 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

9.2.1 Hyperpigmentation	2	191	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.62, 1.01]
9.2.2 Matting	2	191	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.51, 1.20]
9.3 Pain Show forest plot	2	191	Risk Ratio (M‐H, Random, 95% CI)	1.02 [0.83, 1.24]

Comparison 9. Sclerotherapy (polidocanol plus glucose) versus sclerotherapy (glucose)

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Comparison 10. Sclerotherapy plus compression versus sclerotherapy alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
10.1 Resolution or improvement of telangiectasias Show forest plot	2	196	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.19, 0.37]

10.2 Adverse events Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

10.2.1 Hyperpigmentation	2	196	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.41, 2.07]
10.2.2 Matting	1	96	Risk Ratio (M‐H, Random, 95% CI)	1.84 [0.17, 19.62]
10.3 Quality of life Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 10. Sclerotherapy plus compression versus sclerotherapy alone

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The Cochrane Library

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Rawatan untuk telangiektasias dan vena retikular

Appendices

Appendix 1. Sources searched and search strategies

Appendix 2. LILACS/BECS search strategy

Appendix 3. Glossary

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Idioma de la Revisión Cochrane

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Appendices

Appendix 1. Sources searched and search strategies

Appendix 2. LILACS/BECS search strategy

Appendix 3. Glossary

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