What’s the Difference Between Varicose Veins and Spider Veins?

Most of us only pay attention to our blood vessels when something isn’t quite right. But when something is wrong, they can be hard to ignore.

That’s especially true of varicose veins and spider veins because they impact our appearance.

While they can be a source of discomfort and even annoyance, most of us don’t fully understand what varicose and spider veins are, much less how to tell them apart.

We talked to vascular medicine specialist Meghann McCarthy, DO, about the differences between varicose veins and spider veins. She explains the causes, symptoms, treatments and what the two conditions mean for your health.

Varicose veins: An overview

Varicose veins are larger than spider veins and more readily visible to the naked eye. They usually look like lumps, bumps or ropey nodules underneath your skin. Depending on its size and where it’s located, a varicose vein can also have a blue-green appearance.

Varicose veins form on your legs, feet and ankles.

Varicose veins can also form in the scrotum. Those are referred to as varicoceles, and are handled differently from other varicose veins.

Spider veins: An overview

Spider veins (telangiectasias) affect smaller blood vessels than the ones you see in varicose veins. Spider veins form when smaller venous structures — like capillaries, venules and arterioles — are damaged in some way.

Like varicose veins, spider veins can be red, blue purple or green. And, as you’ve probably already guessed, they tend to show up in clusters that resemble a spider web.

“Spider veins are more wispy and smaller than varicose veins, almost like little blue hairs on the skin’s surface. And they tend to be much more superficial,” Dr. McCarthy explains. “You usually can’t feel them if you run your hands over them.”

While you can get spider veins anywhere, they’re most common on your legs and face.

Similarities and differences

If you’re trying to figure out if you’re dealing with a varicose or a spider vein, this table may help:

Symptoms of varicose veins

For many people who get them, varicose veins are no big deal and don’t cause any complications. But others experience troublesome symptoms like itching, pain and swelling.

People with severe varicose veins occasionally develop venous leg ulcers, which are open sores that stubbornly refuse to heal and require medical attention.

Symptoms of spider veins

Most spider veins are a purely cosmetic concern. In rare cases, spider veins can cause uncomfortable symptoms like burning, itching and cramping. In those cases, it’s important to check with a healthcare provider. It could be a sign of an underlying medical condition.

Causes of varicose veins

Varicose veins are very common. Approximately one-third of us will develop them at some point in our lives.

Our vascular system has a tough job: Circulating blood throughout our body requires that our veins to fight against gravity. According to Dr. McCarthy, there are valves in our veins that help prevent blood from flowing backward toward our feet. Varicose veins form when one or more of those valves aren’t working properly.

Varicose veins develop for many reasons. Here are some of the most common:

• Having a family history of vein disorders.
• Getting older.
• Hormones.
• Being pregnant.
• Internal pressure from standing for long periods of time.
• External pressure from wearing restrictive clothing.
• Having overweight or obesity.

Causes of spider veins

Spider veins are even more common than varicose veins, but we don’t know as much about what causes them. That’s at least in part because blood vessels can be damaged in many different ways.

We do know that factors can influence how early you develop spider veins, including:

• Sitting or standing for prolonged periods of time.
• Hormonal changes.
• Being pregnant.
• Having a family history of spider veins.
• Having a connective tissue disorder.
• Experiencing injury of or trauma to the affected area.
• Spending a lot of time in the sun.
• Smoking or having smoked in the past.

Risk factors for varicose veins and spider veins

Varicose veins and spider veins are both extremely common — and having one can be an indication that you’re likely to develop the other. The two conditions also have a genetic component: If members of your immediate family have vein issues, it’s pretty likely you’ll develop them at some point, too.

Generally speaking, women and people assigned female at birth (AFAB) are more prone to both varicose veins and spider veins than men and people assigned male at birth (AMAB). Dr. McCarthy explains that’s probably because hormones like estrogen fluctuate dramatically throughout women’s lives, from puberty and possible pregnancy to menopause and post-menopause.

Your career choice and hobbies can also raise your risk for vein issues. Activities that have you on your feet all day put pressure on your legs, which Dr. McCarthy says can form spider veins. Oddly enough, being too sedentary can have the same effect!

Complications of varicose veins

Most people with varicose veins don’t have any complications. But complications are possible. And when they happen, they can be dangerous.

• Venous leg ulcers. Before a venous leg ulcer forms, it’s common for the skin in the affected area to become discolored. The sores themselves don’t heal on their own, and often ooze. Leg ulcers are difficult to treat and can cause serious complications. If you think you’re developing a venous leg ulcer, let a healthcare provider know.
• Bleeding. It’s possible for varicose veins close to the skin’s surface to burst. Even if the bleeding itself isn’t severe, it’s still important to seek medical attention. If the bleeding is severe, call 911.
• Blood clots. People with varicose veins have a higher risk of developing blood clots, including deep vein thrombosis, superficial thrombophlebitis and pulmonary embolism. It’s important to have your healthcare provider monitor your veins to check for signs of clotting.

Severe varicose veins may also be a sign of a condition called chronic venous insufficiency (CVI). If you have varicose veins and your legs are swollen and discolored all the time, speak to a doctor.

Complications of spider veins

Unlike varicose veins — which can have a host of complications and may be a sign of an underlying health condition — spider veins are usually harmless.

“When you look up spider veins online, you may see a lot of scary stuff,” Dr. McCarthy notes. “But they generally are a benign thing and don’t usually indicate a health problem.”

How to prevent varicose veins and spider veins

There’s only so much you can do to prevent varicose veins and spider veins. For many of us, they’re inevitable. But doing the following things can help keep your vein issues from getting worse:

• Get plenty of exercise. You’ve probably heard the phrase, “Get your blood pumping.” Exercise can increase the blood flow to your legs and keep your cardiovascular system healthy. If you’re unable to exercise because of a health condition or mobility impairments, try flexing your feet and ankles instead. That will activate your calf muscles and encourage the blood in your veins inside to pick up the pace.
• Try to avoid both standing or sitting for long periods of time. Even getting up once every 30 minutes can help.
• Elevate your legs. Gravity is a big part of the reason vein disorders happen to begin with, so routinely putting your legs at or above the level of your heart can improve blood flow.
• Wear loose clothing. Those yoga pants you love aren’t doing your circulatory system any favors.
• Maintain a healthy weight. The more we weigh, the more pressure we put on our legs. Keep in mind, though, that the definition of “healthy weight” looks different from person to person. Speak with a healthcare provider before beginning a weight loss regimen of any kind.
• Wear compression stockings. Compression socks can help keep your blood moving in the right direction. They’re especially helpful for people who work in jobs that require a lot of standing. If you already have varicose and/or spider veins, consider speaking to your healthcare provider about compression therapy.

Varicose vein treatments

The first step in varicose vein treatment involves making a series of lifestyle changes, including wearing compression stockings, elevating your legs throughout the day, adjusting your diet, etc.

If home remedies are unsuccessful, or if you’re bothered by your veins’ appearance, there are three different procedures available: endovenous thermal ablation (laser therapy), injection therapy (sclerotherapy) or vein surgery (ligation and stripping).

Spider vein treatments

Spider veins rarely require any kind of treatment, as they don’t cause symptoms and aren’t normally a sign of a larger health problem. But a lot of people don’t like how spider veins look — especially as, unlike varicose veins, you can get them all over your body.

“If the appearance is bothersome to you, then that’s a good enough reason to talk to your doctor,” Dr. McCarthy says. “There’s always things that can be done to treat just for appearance purposes.”

The most common spider vein treatments are laser and injection therapy.

At the end of the day

Varicose veins and spider veins are two distinct medical conditions, but they have a lot in common, including causes, risk factors and even some treatment options. In fact, it’s common for people who have spider veins to develop varicose veins — and vice versa!

At the end of the day, there’s one very important question you need to ask yourself: “Are my veins bothersome or causing me any symptoms?”

If the answer to that question is yes, Dr. McCarthy encourages you to get your veins seen by a healthcare provider. They’ll be able to tell you whether your symptoms are a sign of an underlying health condition and recommend the best treatment option for your specific situation.