Varicose Veins vs Stretch Marks
Varicose veins are blood vessels that have stretched and now bulge under the skin. They are blue, green or purple, you can feel them standing proud of the surface, and they often ache. Stretch marks are scars in the skin left by stretching too fast. They sit flat or slightly sunken, start red or purple, and fade to silver over years. Raised and blue means a vein. Flat and striped means a stretch mark.
What it is
Small valves inside leg veins are meant to keep blood moving upward. When they leak, blood pools, the vein widens and it pushes up against the skin.
The skin stretched faster than the collagen and elastin underneath could keep up with. Those fibres tore, and the mark is the scar that healed over the tear.
Colour
The colour comes from blood inside the vessel, so it is fairly even along the whole length.
New marks are pink, red or purple. Over a year or two they fade to pale silver or white.
Can you feel it
Run a finger over it and there is a cord standing up from the skin. It is soft and squashy, not hard.
The surface may feel a little thinner or crinkly, but there is nothing to feel standing up.
Shape
Snaking, branching, uneven in width, and the pattern goes wherever the vein goes.
Bands of a similar width, running side by side in the same direction — across the direction the skin was pulled.
Does it hurt
Heavy, tired legs. Aching or throbbing after standing for a long time, sometimes cramping at night or swollen ankles by evening. Putting your legs up helps.
New stretch marks can itch or feel slightly tender while they form. Once they settle they cause no symptoms at all.
Where they show up
Almost always the legs, because that is where gravity works against the veins.
Thighs, hips, backs of the knees, stomach, breasts, upper arms and lower back. Teenagers in a growth spurt, weight changes, and rapid muscle gain from lifting.
What happens over time
Left alone, varicose veins usually widen over years. They do not fade on their own.
The colour fades a lot. The texture change stays. A silver stretch mark is a permanent scar that has become hard to see.
Does it need treating
Treatment exists — sclerotherapy, laser and vein closure — and it works well. Whether you need it depends on whether the veins ache, swell or affect your skin, not on how they look.
Stretch marks are harmless. Treatments fade them, they do not remove them, and none of them work as well as the advertising implies.
The test you can do sitting down
Press it, then lift your leg: A varicose vein pales when you press on it, because you are squeezing blood out of it, and refills when you let go. Lying down and lifting the leg has the same effect: the vein empties and flattens.
A stretch mark does none of that: Press it and the colour does not shift. Lift the leg and it looks exactly the same. There is nothing inside it to move.
Why the two get mixed up
Both can look like purple lines on the legs: Spider veins in particular are flat, fine and reddish-purple, which is close to a new stretch mark on the thigh.
The clue is the pattern: Spider veins branch and web out from a central point, like a spill. Stretch marks run in straight bands, side by side, all pointing the same way.
They also often turn up together: A fast weight change stretches the skin and puts extra load on the leg veins at the same time. Having both is common, and having one does not cause the other.
What actually helps each one
Varicose veins respond well to treatment: Compression stockings ease the ache. Sclerotherapy closes small veins with an injection, and heat or glue closes larger ones through a pinhole. These are day procedures, and most people go back to normal activity straight away.
Stretch marks respond partially: Red and purple marks are the ones worth treating, because they are still new and vascular lasers, microneedling and prescription retinoids all help while they are at that stage. Silver marks are settled scars and improve very little.
Creams do less than they claim: Nothing in a tub reverses a tear in the dermis. Keeping the skin moisturised is worth doing, but expect a modest change at best.
See a doctor if
A leg vein aches, throbs, or your ankles swell by the end of the day
The skin around an ankle is turning brown, hard or itchy
A vein bleeds, or the skin over it breaks down
One leg is suddenly swollen, warm and painful compared to the other
You cannot tell what you are looking at, and it appeared quickly
