Title : The phlebectic crown: The importance of treatment

Background: Corona phlebectatica, also known as corona paraplantaris, is a recognized cutaneous manifestation of chronic venous insufficiency (CVI). It is characterized by dilated perimalleolar veins, blue and red telangiectasias, and capillary stasis. This clinical sign has been associated with a significantly increased risk of trophic skin disorders, with studies reporting up to a six-fold higher risk in affected patients compared to those without phlebectic crown (1,2).

Objective: To evaluate the efficacy of combined versus sequential treatment strategies involving sclerotherapy and laser therapy in patients presenting with corona phlebectatica.

Methods: A total of 578 patients with symmetrical clinical and aesthetic involvement of both lower limbs were included in this study and followed over a 5-year period. All patients were classified as C4 according to the CEAP classification. Each patient received two different treatment modalities: a combined approach (sclerotherapy immediately followed by laser therapy in the same session) on one limb, and a sequential approach (sclerotherapy followed by laser therapy after one month) on the contralateral limb.

Results: The combined treatment approach was associated with reduced procedural pain. In contrast, the sequential approach required a greater number of laser sessions to achieve comparable clinical outcomes. Furthermore, the combined modality demonstrated lower annual recurrence rates.

Conclusion: The treatment of corona phlebectatica should be considered a preventive intervention against trophic complications in patients with CVI. The combination of laser therapy and sclerotherapy enhances therapeutic efficacy while improving overall treatment quality. These findings support the integration of combined treatment strategies into routine clinical practice for optimal patient outcomes.

To be updated shortly..