Spider Veins vs. Varicose Veins: Which Do You Have and What Can You Do?
- Jeffrey H. Miller, M.D.
- Jul 31
- 4 min read
Ever notice small red or blue veins on your legs?
Or maybe you’ve seen thicker, bulging veins that twist beneath the skin?
While these visible veins can be confusing or a little alarming, understanding what they are can help you take the right steps to keep your legs healthy and beautiful.
So, when it comes to spider veins and varicose veins, what's really the difference?
Spider Veins (Telangiectasias)
Spider veins are the tiny red, purple, or blue veins that often appear on the thighs, calves, or even the face. They’re called “spider veins” because they can look like little spider webs.
Size: Less than 1 mm
Appearance: Flat, web-like
Symptoms: Usually painless, but may cause mild itching or burning
Cause: Often from genetics, hormones, sun exposure, or increased pressure in leg veins
Cosmetic vs. Medical: Spider vein treatments are considered cosmetic, not medical, which means treatment is not typically covered by insurance
Although spider veins are usually a cosmetic issue, they can sometimes point to deeper vein problems. They may also cause itching or mild discomfort.
One study revealed that 50% of people with spider veins had symptoms. Out of 200 patients treated with sclerotherapy, 53 % had symptoms (such as tiredness, pain, or burning), and 85% reported relief following treatment. (Weissand Weiss, J Derm Surg Oncol, 1990)
If you notice a cluster of spider veins around your ankle, it could be a sign of a more serious condition called chronic venous insufficiency (CVI). This condition often comes with symptoms like leg heaviness, aching, swelling, throbbing, or itching.
If you see this cluster around the ankle, contact a vein specialist immediately.
Reticular Veins
Reticular veins are the “middle child” of visible veins. They’re larger than spider veins but smaller than varicose veins.
These bluish-green veins lie just under the skin and may not bulge, but they’re often visible on the back of the legs or behind the knees.
Size: 1–3 mm
Appearance: Flat or slightly raised, blue or green
Symptoms: Often painless but can be tender or itchy
Fun fact: They often act as feeder veins to spider veins—treating them may help prevent new spider veins from forming
Cosmetic vs. Medical: Reticular vein treatments are also considered cosmetic, not medical, which means treatment is not typically covered by insurance
Notice any spider or reticular veins?
If so, it's time to see a specialist.
Varicose Veins
Varicose veins are the ones that get the most attention. That's for good reason. These thick, rope-like veins bulge under the skin, often appearing twisted and swollen.
Size: 3 mm or larger
Appearance: Raised, twisted, bulging
Symptoms: Aching, heaviness, fatigue, throbbing, swelling, and sometimes skin changes or ulcers
Cause: Faulty valves in the veins allow blood to pool, increasing pressure and stretching the vein walls
Cosmetic vs. Medical: Varicose veins are considered a medical issue, not cosmetic, so treatment is almost always covered by insurance
Unlike spider veins, varicose veins are more than a cosmetic issue. They are part of a medical condition known as venous reflux disease or, when more severe, chronic venous insufficiency. These veins cause significant symptoms, and therefore treatment is covered by insurance.
Are you dealing with varicose veins?
If so, it's time to see a specialist.
Spider vs. Varicose Veins: Why Knowing the Difference Matters
Understanding the difference between spider veins vs. varicose veins can help you take action early—whether that means improving circulation with lifestyle changes, wearing compression stockings, or seeking treatment.
In-office procedures today are minimally invasive, highly effective, and require no downtime.
And remember: what you see on the skin is only part of the picture. A vein specialist can use ultrasound to look deeper and guide the best treatment.
References
Caggiati A, et al. Nomenclature of the veins of the lower limbs: An international interdisciplinary consensus statement. Phlebology. 2005.
Labropoulos N, et al. Classification of venous disease: Guidelines and practical applications. J Vasc Surg. 2004.
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333–346.
Parsi K. Reticular veins: Definitions and management. Australasian Journal of Dermatology. 2017;58(2):87–91.
Gloviczki P, et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines. J Vasc Surg. 2011;53(5 Suppl):2S–48S.
Weiss RA, Weiss MA. Treatment of reticular and spider veins with sclerotherapy and lasers. Dermatol Surg. 2000;26(5):403–414.
Stop Letting Your Legs Hold You Back
If you have restlessness, heaviness, aching, swelling, throbbing, or itchiness in your legs—or you notice varicose veins or spider veins—it's time to see a vein specialist.
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