When sclerotherapy leaves its mark: prevention and management of cutaneous complications

Sclerotherapy represents a cornerstone in the treatment of chronic venous disease and superficial venous disorders, combining effectiveness, versatility, and a favorable safety profile. Despite these advantages, cutaneous complications remain clinically relevant because of their potential impact on aesthetic outcomes, patient satisfaction, and, in rare cases, tissue integrity. Cutaneous adverse events range from common and usually self-limiting manifestations, such as ecchymosis, hyperpigmentation, and telangiectatic matting, to uncommon but potentially severe complications including skin ulceration and necrosis. This narrative review provides a clinically oriented and critical overview of cutaneous complications associated with sclerotherapy, focusing on pathophysiological mechanisms, patient- and procedure-related risk factors, prevention strategies, and management options. Particular emphasis is placed on practical clinical decision-making, patient counseling, and early recognition of warning signs, with the aim of supporting safe practice and identifying areas in order to support future research.