Phlebitis (superficial thrombophlebitis)
Phlebitis is inflammation of a vein running just under the skin. A small clot almost always forms inside that vein at the same time, which is why the…
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Medicines commonly prescribed for Phlebitis (superficial thrombophlebitis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 68.34 mg/mlActive substance: ibuprofenManufacturer: Laboratorio De Aplicaciones Farmacodinamicas S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 40 mg/mlActive substance: ibuprofenManufacturer: Laboratorios Cinfa S.A.Prescription not requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Sandoz Farmaceutica S.A.Prescription required
Phlebitis is inflammation of a vein running just under the skin. A small clot almost always forms inside that vein at the same time, which is why the condition is more accurately called superficial thrombophlebitis. In itself it is not dangerous and usually settles within a week or two, but it has one awkward habit: the inflammation can creep up the vein and cross into the deep veins, and that is a different matter altogether. So a vein that has "just gone red" is worth showing to a doctor rather than simply waiting out.
What it looks and feels like
The veins of the calf and thigh are affected most often, the arm less often, and the chest wall and neck more rarely still. The picture is fairly recognisable:
- a firm, tender cord can be felt along the line of the vein, like a taut piece of rope;
- the skin over it is red or purplish, warm to the touch, sometimes itchy;
- the pain is dull and dragging, worse on pressing and on standing on the leg;
- there is slight puffiness along the vein, but not swelling of the whole limb;
- later the redness fades while the hardening under the skin stays for several more weeks and slowly resolves;
- body temperature is usually normal or only slightly raised.
A firm knot where the inflammation was, and a brownish stain on the skin, are the usual trace rather than a sign that the condition was left half treated.
Why a superficial vein becomes inflamed
Often no clear cause is found, but some circumstances raise the odds considerably:
- Varicose veins. The commonest background: blood moves more slowly through a widened vein and clots more readily.
- A cannula or a drip. Phlebitis in the arm after intravenous fluids is a typical story, especially if the cannula stayed in a long time or an irritant medicine was given through it.
- Long immobility. A flight, a long journey, bed rest, a plaster cast.
- Injury to the vein. A knock, an injection, sclerotherapy.
- A raised tendency to clot, inherited (thrombophilia) or acquired.
- Hormonal influences. Pregnancy and the first weeks after birth, combined contraceptives, hormone replacement therapy.
- Age, excess weight, smoking, dehydration.
- Inflammatory and malignant disease. Behçet's disease and other forms of vasculitis; cancer.
- Phlebitis in the past — it has a habit of returning.
What it may turn out to be instead
A red, painful streak on the leg does not only mean phlebitis, and the treatment depends on what it actually is.
- Deep vein thrombosis. The main thing to rule out. The whole calf or the whole leg swells, its circumference is clearly greater than on the other side, the skin is tight and the pain is bursting, deep in the calf. There may be no palpable cord at all. Deep vein thrombosis carries the risk of the clot breaking off and needs anticoagulant treatment.
- Erysipelas and other skin infections. The redness does not follow a vein but forms a solid patch with sharp edges, the skin is hot, there is fever with shivering and the person feels markedly unwell.
- Lymphangitis. A thin red track running from a wound or a boil towards the nearest lymph nodes, which are tender and enlarged.
- Erythema nodosum. Painful red lumps on the front of the shins, usually on both sides, often after an infection or alongside another illness.
- A ruptured Baker's cyst. Sudden pain behind the knee with a swollen calf; it looks very much like a thrombosis.
- Migratory phlebitis. The inflammation flares in one place, then another, settles and returns. This pattern calls for a separate search for the cause: vasculitis or an as yet undetected cancer sometimes lies behind it.
When help is needed straight away
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single number is 112) if you develop:
- sudden breathlessness or a feeling that you cannot get enough air;
- chest pain that gets worse when you breathe in;
- coughing up blood;
- sudden weakness, fainting, a racing heartbeat.
These suggest that a clot may have broken away and reached the lungs.
See a doctor the same day if:
- the whole leg or arm has swollen, not just the strip along the vein;
- the hardened area is climbing quickly up the thigh towards the groin, or towards the armpit;
- you have a temperature or shivering, or pus is coming from an injection site or cannula;
- the redness is spreading sideways and getting brighter;
- the pain has sharply worsened, or the leg has gone numb and pale.
How it is confirmed
Examination is usually enough: the doctor finds the tender cord along the vein and works out where it begins and where it ends. This matters, because the treatment depends on how far the inflammation extends and how close it comes to the groin or the back of the knee.
A duplex ultrasound scan of the veins is arranged when the segment is long, when the inflammation is approaching the point where the superficial vein joins the deep one, when the whole limb is swollen, after repeated episodes, and always when deep vein thrombosis has to be excluded. Examination does not replace it: deep veins cannot be felt through the skin, and their state cannot be judged from how the leg looks.
Blood tests are not needed by everyone. Thrombophilia testing is discussed after repeated episodes, in a young person with phlebitis and no obvious trigger, and where thrombosis runs in the family. If phlebitis migrates or keeps returning for no reason, the doctor looks for an underlying illness.
What helps at home
Home measures ease the pain and speed recovery, but they do not replace being examined:
- keep moving and walking as usual — staying still makes phlebitis worse, not better;
- when resting, keep the leg or arm raised on a cushion;
- put a warm, damp compress on the sore area for fifteen to twenty minutes, several times a day;
- wear compression stockings if a doctor has fitted them: the compression class and the size matter, and they must not be used if there is arterial disease in the legs;
- drink enough fluid and do not smoke.
The simplest painkiller is paracetamol. Anti-inflammatory medicines of the non-steroidal group work better in phlebitis, but they do not suit everyone: they irritate the stomach, cause fluid retention, can harm the kidneys and increase the effect of blood-thinning medicines. If you take anticoagulants, have had an ulcer, or have kidney disease, heart failure or asthma, use them only in agreement with your doctor. Anti-inflammatory creams and gels applied to a small area are safer than tablets.
What a doctor will prescribe
Treatment depends not on how much it hurts but on where the inflammation is and how far it has gone.
- A short segment well away from the deep veins. Local measures are enough: gels containing an anti-inflammatory or a heparinoid, compression and movement. It clears in a week or two.
- Extensive thrombosis of a superficial vein, or inflammation near the groin or the back of the knee. Here an anticoagulant at a preventive dose is given for several weeks, so that the clot does not extend into the deep system. The dose and length of the course are set by the doctor.
- Cannula-related phlebitis. The cannula is removed, the arm is rested, and local treatment follows.
- Infected phlebitis. If infection has set in, antibiotics are needed and occasionally a minor procedure. That is the only reason to use them: in ordinary phlebitis antibiotics do nothing.
- Underlying varicose veins. When episodes keep recurring, treating the varicose veins themselves is discussed: while the widened veins remain, the phlebitis will keep coming back.
Online consultation
In an online consultation the doctor judges from your description and photographs whether this looks like superficial phlebitis or something else, decides whether a vein scan is needed urgently, advises what to use for pain given your other conditions and medicines, and explains how long improvement should take. It helps to measure the circumference of both calves at the same point beforehand, mark where the hardened area starts and ends, recall any recent flight, operation, injury or drip, and list everything you take, contraceptives included.
With breathlessness, chest pain or swelling of the whole leg an online consultation is not the right route: emergency care is needed.
This material is for information only and does not replace medical advice.
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