recurrence of the spider veins in the treated area less likely. Factors that predispose to the development of varicose and telangiectatic leg veins include Age Sex: It used to be thought that females were affected far more than males. However, research has shown 79% of adult males and 88% of adult females have leg telangiectasia (spider veins). Pregnancy: Pregnancy is a key factor contributing to the formation of varicose and spider veins. Changes in hormone levels are one of the most important reasons women are more likely to develop varicose veins during pregnancy. There is an increase in progesterone, which causes the veins to relax and potentially swell more easily. There's also a significant increase in the blood volume during pregnancy, which tends to distend veins, causing valve dysfunction which leads to blood pooling in the veins. Moreover, later in pregnancy, the enlarged uterus can compress veins, causing higher vein pressure leading to dilated veins. Varicose veins that form during pregnancy may spontaneously improve or even disappear a few months after delivery. Life-style/occupation: Those who are involved with prolonged sitting or standing in their daily activities have an increased risk of developing varicose veins. The weight of the blood continuously pressing against the closed valves causes them to fail, leading to vein distention. Other acquired causes Acquired telangiectasia, not related to other venous abnormalities, for example on the face and trunk, can be caused by factors such as Cushing's syndrome Rosacea Blepharitis Environmental damage such as that caused by sun or cold exposure Age Trauma to skin such as contusions or surgical incisions. Radiation exposure such as that experienced during radiotherapy for the treatment of cancer, e.g., radiation proctitis Chemotherapy Carcinoid syndrome Limited systemic sclerosis/scleroderma (a scleroderma sub-type) Chronic treatment with topical corticosteroids may lead to telangiectasia. Spider angiomas are a radial array of tiny arterioles that commonly occur in pregnant women and in patients with hepatic cirrhosis and are associated with palmar erythema. In men, they are related to high estrogen levels secondary to liver disease. Tempi syndrome Tobacco smoking Cutaneous collagenous vasculopathy Treatment Before any treatment of leg telangectasia (spider veins) is considered, it is essential to have duplex ultrasonography, the test that has replaced Doppler ultrasound. The reason for this is that there is a clear association between leg telangectasia (spider veins) and underlying venous reflux. Research has shown that 88% to 89% of women with telangectasia