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Phlebitis (Superficial Vein Inflammation) & Varicose Veins

Phlebitis is inflammation of a vein near the surface of the skin. It is usually not serious and often settles in a week or two, but a red, hot, painful leg can also be a deep vein clot, so get it checked. Varicose veins are swollen, twisted veins that can cause aching and, sometimes, phlebitis.

Chest pain or trouble breathing — call 911 right away. Sudden shortness of breath, chest pain that gets worse with a deep breath or a cough, coughing up blood, a fast or irregular heartbeat, or feeling lightheaded or faint can be signs that a clot has reached the lungs (a pulmonary embolism) (CDC, NHS). The CDC says to seek medical help immediately (CDC).

A swollen, painful, warm leg — get medical care the same day. Swelling, pain or tenderness, warmth, and redness or discoloration in one leg or arm can be signs of a deep vein thrombosis (DVT), a clot in a deep vein (CDC). The CDC says to see a doctor as soon as possible (CDC). The UK’s NHS gives the same warning for throbbing or cramping pain, sudden swelling, warm skin, red or darkened skin, or hard, sore veins, because a vein that looks like phlebitis may be something more serious such as a DVT (NHS). If you cannot be seen quickly, go to an emergency room. You cannot tell the two apart by looking: a DVT is diagnosed with an ultrasound scan (NHS).

Hot, red, painful skin with a fever — ask for an urgent visit. Skin that is painful, hot and swollen can be cellulitis, a skin infection treated with antibiotics. The NHS advises an urgent appointment, and emergency care if you also have a very high temperature or feel hot, cold or shivery, a fast heartbeat or fast breathing, dizziness or faintness, or confusion (NHS). See our Cellulitis guide.

A bleeding varicose vein is an emergency — call 911 (NHLBI).

About half of people with a DVT have no symptoms at all, and a pulmonary embolism can happen without any leg symptoms (CDC). Do not rub or massage a vein that is red, hard, warm or sore (see the massage section below). No chiropractic, herbal or other complementary approach can treat a clot.

What is phlebitis?

Phlebitis is inflammation of a vein near the surface of the skin. It is also called superficial thrombophlebitis or superficial vein thrombosis (“thrombosis” means a clot). The NHS says it is not usually serious and often gets better on its own after one or two weeks (NHS).

Superficial vein clot versus deep vein clot

A deep vein thrombosis is a clot in a vein deep in the body, most often in the lower leg or thigh. It can break loose and travel to the lungs, causing a pulmonary embolism (MedlinePlus). Superficial phlebitis is usually the milder problem, but the two can overlap:

  • A 2020 case report, reviewing the research, says a superficial clot has been linked to DVT and pulmonary embolism. It notes that a DVT was reported alongside a superficial clot in up to 44% of people in some studies, and that a meta-analysis found roughly 18% had a DVT and 7% a pulmonary embolism (case report, 2020).
  • The risk seems to be greater when the clot is close to a point where a superficial vein joins the deep veins (the saphenofemoral and saphenopopliteal junctions) (case report, 2020).
  • Because of this, the case report says an ultrasound is now considered essential both to confirm superficial thrombosis and to rule out a DVT (case report, 2020). For a suspected DVT, the NHS says you should be referred to hospital within 24 hours for an ultrasound scan (NHS). Read more in our Blood Clots guide.

What causes it?

The NHS says it is not always clear what causes phlebitis. Often the inflammation is linked to varicose veins; to conditions that make blood clot more easily, such as thrombophilia; to autoimmune conditions such as Behçet’s disease; or to injections or a small plastic tube (cannula) placed in a vein (NHS).

  • IV lines and needle sticks: in the case report, a man developed phlebitis in an arm vein about a month after a routine blood draw on that arm (case report, 2020).
  • Injury and not moving: a blow or compression of a vein can damage its lining, and the case report lists prolonged immobilization and recent surgery among the risk factors (case report, 2020).
  • Other things that raise the chance: getting older, obesity, being pregnant, cancer, having had phlebitis before, smoking, and hormonal treatments such as hormone replacement therapy (NHS).

What are varicose veins?

Varicose veins are swollen, twisted veins that lie just under the skin, usually in the legs (NHLBI, NHS). They happen when the one-way valves inside the veins are weak or damaged, so blood pools and can flow backward (this is called reflux) (NHLBI).

Related guides

See also our Circulation guide, Lymphedema guide and Stroke guide. A guide to veins and arteries is planned.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) First, make sure it is not a DVT or an infection. For phlebitis: keep using the limb, raise it when resting, a warm moist cloth, and an over-the-counter pain reliever; anti-inflammatory gel or cream for a small area; sometimes compression stockings or a blood thinner. For varicose veins: leg raising, walking and weight care, compression stockings, and procedures such as endovenous ablation or sclerotherapy when symptoms or complications call for them. Cost estimate being researched. Phlebitis often settles in one to two weeks. Varicose veins may return or new ones may form after treatment, and compression only relieves symptoms.
Chiropractic No role in treating phlebitis or varicose veins. A red, hot, sore vein needs a medical check first, and no one should press on it or manipulate it. Not a treatment for phlebitis or varicose veins, so no cost is listed. Tell any chiropractor about vein problems and any blood thinner. If a vein looks red, hard or warm, treatment should wait until a doctor has checked it.
Acupuncture Little research and no established role. It is not a treatment for a vein clot or infection. Typical private follow-up visits run about $90–$185; community clinics about $50–$90 (The Pricer). One small randomized trial found less pain with acupuncture around a vein procedure. Other reports are uncontrolled. Tell the acupuncturist about any blood thinner, and avoid needling an inflamed vein.
Herbal medicine Horse chestnut seed extract has been studied for chronic venous insufficiency (poor blood flow in the leg veins), not for phlebitis. It can't treat a clot. Cost estimate being researched. A Cochrane review found it improved leg pain and swelling in the short term and side effects were usually mild. Raw horse chestnut seeds, bark, flowers and leaves are unsafe to swallow. Check with your pharmacist first.
Massage therapy Not over a red, hard, warm or painful vein or a swollen leg. It is not a treatment for phlebitis or varicose veins. One national chain, Massage Envy, charges about $70–$90 a month for a membership (The Pricer). Massage over a vein with clot or inflammation can make pain worse, and leg massage with an unrecognized DVT can dislodge a clot. Get a medical check before any leg massage.
MBHA Wellness Coach Movement and walking, leg raising, avoiding long stretches of sitting or standing, healthy weight, quitting smoking, travel habits, and preparing for appointments. Cost estimate being researched. Quitlines (1-800-QUIT-NOW) are free. Supports — never replaces — your doctors. The same habits that help varicose veins may also lower your chance of a DVT.

Approach 1 of 6

Conventional medicine (AMA)

Conventional care begins with a question: is this a superficial vein problem, a deep vein clot, or an infection? The NHS says to get a throbbing, swollen, warm or sore limb checked in case it is a DVT (NHS). A duplex ultrasound is the usual test for both varicose veins and superficial clots (NHLBI, case report, 2020).

1. Self-care for phlebitis

The NHS says treatment may not be needed if symptoms are mild (NHS). Things you can do:

2. Anti-inflammatory medicines (NSAIDs)

  • Gel or cream: anti-inflammatory cream or gel can be used if the affected area is small (NHS). A Cochrane review found topical treatments improved local symptoms compared with placebo, but there were no data on whether they prevent clots or spread (Cochrane review, 2018).
  • Tablets: in one placebo-controlled trial summarized in that review, NSAIDs reduced the extension and recurrence of the superficial clot (low-quality evidence), without a significant effect on symptomatic venous thromboembolism (Cochrane review, 2018).
  • Caution: NSAIDs such as ibuprofen may raise the risk of heart attack or stroke, and may cause ulcers or bleeding in the stomach or intestine. The risk may be higher with long use. Tell your doctor if you take blood thinners, aspirin or other NSAIDs (MedlinePlus). We don’t list doses; ask your doctor or pharmacist what is right for you.

3. Blood thinners (anticoagulants)

  • The NHS says treatment may include a blood-thinning medicine to reduce the risk of DVT or further clots and to help stop phlebitis coming back (NHS). Blood thinners prevent clots from forming and do not break up clots you already have, but they can stop them from getting bigger (MedlinePlus).
  • The Cochrane review looked at 33 studies of 7,296 people with superficial clots in the legs. Many were small and of poor quality. In one large placebo-controlled trial of 3,002 people, an injected blood thinner reduced symptomatic clots, spread of the clot and recurrence (moderate-quality evidence), and major bleeding was infrequent. The authors concluded that a preventive-strength injection of that kind, given for 45 days, appears to be a valid option for most people; evidence on other treatments, including surgery and topical treatments, was too limited to guide care (Cochrane review, 2018).
  • A review in the case report says blood thinners are seldom needed for a superficial clot unless it progresses toward the deep veins, inflammation persists, or reflux is found at those junctions in someone with varicose veins (case report, 2020). Whether you need one depends on where the clot is and how long it is, so this is a decision for your clinician after an ultrasound.
  • The main side effect of blood thinners is bleeding (MedlinePlus). Never stop one without talking to your prescriber.

4. Compression stockings

  • The NHS says stockings increase blood flow to the legs but are only suitable for some people with phlebitis and should be recommended and fitted by a health professional (NHS).
  • For varicose veins, compression may relieve pain, swelling and heaviness, especially for people who sit or stand a lot, and is usually worn for at least a week after a procedure. It only relieves symptoms; most providers now recommend a procedure to correct the reflux (NHLBI). Some people get discomfort, itching, skin irritation or swelling from them (NHLBI).
  • They are not suitable if you have problems with blood flow in your arteries (NHS), and the NHS advises not wearing them with cellulitis until you are better (NHS).

What it costs

Cost estimate being researched. We have not yet found a Medicare.gov or Pricer page for vein ultrasound, procedures or stockings, so we list no figures.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care does not treat phlebitis or varicose veins, and we found little research suggesting it does. The useful questions are about safety.

When the problem is a vein, not a muscle

A published case report describes a 31-year-old man who went to a chiropractic clinic with tension in his arm. It was first treated as a muscle strain or nerve problem. After a session of soft-tissue therapy his symptoms worsened, and an ultrasound then found a nearly blocked, inflamed vein. The authors concluded that vein problems should be considered by those who treat muscles and joints, since missing one can prolong the problem and discomfort (case report, 2020).

Staying safe

  • A vein that is red, hard, warm, sore or swollen needs a medical check before any hands-on treatment (NHS). As a precaution, MBHA suggests that no one press on, rub or manipulate such an area.
  • Tell the chiropractor about your health history, medical conditions, medicines and supplements (NCCIH). That includes any blood thinner.
  • Serious side effects of spinal manipulation are very rare, but may be more likely in people with underlying health problems (NCCIH). Neck manipulation has been linked to rare artery tears that can lead to a stroke (NCCIH).

What it costs

Not a treatment for these conditions, so no cost is listed. For back or joint care you may have for another reason, Medicare Part B covers only adjustments of the spine to correct a subluxation by hand or with an activator (Medicare.gov), and self-pay follow-up visits typically run about $55–$100 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is not a treatment for a vein clot or infection, and it is never a substitute for a medical check of a swollen, painful leg. We found little research on it for phlebitis or varicose veins.

What the research shows

  • Around a vein procedure: a small randomized trial of 70 people having non-thermal vein closure (with medical glue) compared acupuncture the day before with a control group. Pain scores during the procedure and use of pain medicine by day 3 were lower in the acupuncture group. It is one small study of pain around a procedure, not of the veins themselves (Orak et al., 2022).
  • For varicose veins themselves: a 2023 report described 260 people treated with trigger-point acupuncture plus self-massage and stretching. It described one group, with no comparison group mentioned, scored with the authors’ own evaluation system. That kind of study can’t show that the treatment, rather than time or other factors, made the difference, and we do not repeat its stronger claims (Liu et al., 2023).

Staying safe

  • In the U.S., acupuncture needles must be sterile and labeled single-use (NCCIH).
  • Tell your acupuncturist about a blood thinner or any vein condition. As a precaution, MBHA suggests avoiding needles over an inflamed vein, a swollen leg or a suspected clot until your doctor says it is safe.

What it costs

Typical private follow-up visits run about $90–$185, with a first visit up to about $230; community clinics may charge about $50–$90 (The Pricer). Medicare Part B covers acupuncture only for chronic low back pain, so it would not cover it for these conditions (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement treats a vein clot, and we found little research on herbs for phlebitis itself. The most-studied herb for leg vein problems is horse chestnut, and it has been studied for a related condition.

Horse chestnut seed extract

  • What it is studied for: chronic venous insufficiency (CVI), meaning poor blood flow in the leg veins that may cause pain, swelling and itchiness (NCCIH). CVI is not the same as phlebitis, and we found little research on it for superficial vein inflammation.
  • The evidence: NCCIH says a 2012 systematic review of 17 studies suggested it can improve symptoms of CVI, and one study suggested it may be as effective as compression stockings, but better, larger trials are needed (NCCIH). The Cochrane review reached a similar conclusion: leg pain and leg volume improved compared with placebo in the short term, adverse events were usually mild and infrequent, and larger trials are needed (Cochrane review, 2012).
  • Safety: the raw seeds, bark, flowers and leaves are unsafe to swallow because they contain a toxic component. Standardized seed extracts, from which it has been removed, are likely safe for short-term use and have been used safely in studies for up to 12 weeks. Side effects can include dizziness, digestive upset, headache and itching. Little is known about use in pregnancy or breastfeeding (NCCIH).

If you take a blood thinner or other medicine

Talk with your provider before using any herbal product, because some herbs and medicines interact in harmful ways (NCCIH). For example, taking ginkgo with warfarin is associated with more major bleeding than warfarin alone, and cat’s claw may interact with anticoagulant drugs (NCCIH). We don’t list doses.

Don’t use an herbal product in place of a medical check for a swollen, painful, red or warm leg. Tell your pharmacist and doctor about every supplement you use.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage does not treat phlebitis or varicose veins, and over an inflamed or clotted vein it can do harm. This is the most important safety point in this guide.

Don’t massage over a red, hard, warm or painful vein, or a swollen leg. Two published case reports point the same way. In the first, a man whose inflamed arm vein was not recognized had a worse reaction after soft-tissue therapy; the authors write that local massage or manual therapy is generally contraindicated over an area of venous disease (including phlebitis, thrombophlebitis, DVT or superficial clots) because it may worsen inflammation and pain (case report, 2020). In the second, a pregnant woman with an unrecognized DVT collapsed with a massive pulmonary embolism shortly after a leg and foot massage. The authors concluded that leg massage in people with a DVT can dislodge clots and cause a life-threatening PE, and should not be done (case report, BMC Pregnancy and Childbirth, 2020). NCCIH lists a blood clot among the rare serious problems reported with massage, some involving vigorous types such as deep-tissue massage (NCCIH).

With varicose veins

The same case report says that with varicose veins, the area with the veins should be avoided if pressure causes pain or if the person has risk factors for clots (case report, 2020). The authors cite a massage-pathology textbook for this advice, and we found little research testing massage on varicose veins. In a Cochrane review of treatments for varicose veins and leg swelling in pregnancy, one trial of foot massage found no significant difference in lower-leg circumference compared with routine care (Cochrane review, 2015).

Staying safe

  • If a leg is swollen, painful, warm or red, see a doctor first. Don’t use massage to put off seeing a health care provider (NCCIH).
  • Pregnancy raises the chance of a clot; the pregnancy case report’s authors urged caution with traditional massage in pregnancy unless the risk has been ruled out (case report, 2020).
  • Once a clot or phlebitis has been ruled out or treated, ask your doctor whether gentle massage elsewhere on the body is fine, and tell the therapist about vein problems and any blood thinner. Avoid the vein area itself.

What it costs

One national chain, Massage Envy, currently charges about $70–$90 a month for a membership that includes one 60-minute session a month (The Pricer). Prices at independent therapists vary.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits that ease varicose veins and lower the chance of clots — alongside, never instead of, your doctors. Some of the lifestyle changes that help varicose veins may also lower your chance of a DVT and other medical problems (NHLBI).

Daily habits for varicose veins

Quitting smoking

Smoking damages veins (NHS, NHLBI) and is on the NHS list of things that raise the chance of phlebitis (NHS). Free, confidential coaching is available at 1-800-QUIT-NOW, and using counseling and medicine together gives you the best chance of quitting for good (CDC).

Be ready to act

  • Know the warning signs at the top of this page and share them with the people close to you.
  • Keep a list of your medicines and supplements, especially any blood thinner, and bring it to every visit.

Another approach

Varicose vein procedures

Varicose veins do not always need treatment. A provider may suggest it for symptoms such as pain, heaviness, swelling, itching or skin changes, or for complications such as leg ulcers (NHS). The goals are to relieve symptoms, keep the veins from worsening, improve appearance, and prevent ulcers and bleeding. New varicose veins may form even after treatment, and some people need treatment more than once (NHLBI). A specialist will usually do a duplex ultrasound first (NHS).

The main options

  • Endovenous (endothermal) ablation: a thin tube (catheter) is placed in the vein under ultrasound and uses radio-wave or laser heat to close it off. You are usually awake with a local anesthetic and go home the same day (NHS). The NHS calls it usually the first choice of treatment. Bruising, pain and skin color changes are common; more serious problems such as numbness, blood clots and skin burns are rare (NHLBI).
  • Sclerotherapy: a chemical, as a liquid or foam, is injected to seal the vein shut. Liquid is used more often for spider veins. Foam sclerotherapy can cause skin color changes and, rarely, blood clots, nerve damage, a serious allergic reaction or stroke; some people have temporary vision problems, headaches or confusion afterward (NHLBI).
  • Phlebectomy: small cuts are used to remove small varicose veins near the skin (NHLBI).
  • Vein ligation and stripping (surgery): larger, deeper veins are tied off and removed. It may be more painful with a longer recovery, so it is usually recommended only for people who cannot have a less invasive procedure (NHLBI). The NHS says you may need 1 to 2 weeks off work (NHS).

After a procedure, providers will probably recommend compression stockings for at least a week (NHLBI).

Which works best?

A 2021 Cochrane review of 24 randomized trials (5,135 people) compared heat ablation, foam sclerotherapy, glue and surgery for varicose veins of the great saphenous vein. It found technical success was comparable for most methods, laser ablation may have done better than foam sclerotherapy or surgery in the shorter term, and there was no clear difference in recurrence except a possible long-term benefit for radiofrequency ablation. The authors said their conclusions were limited because there were few studies for each comparison, and that more evidence is needed (Cochrane review, 2021).

Pregnancy

The NHS says procedures or surgery are not usually recommended during pregnancy, compression stockings may help, and varicose veins often improve or go away after the baby is born (NHS). NHLBI says a provider may suggest compression therapy and pain medicine (NHLBI). A Cochrane review found only seven small trials (326 women); one 69-woman trial suggested a medicine called rutoside relieved symptoms, but there were not enough data to judge its safety in pregnancy (Cochrane review, 2015). See our Pregnancy guide.

What it costs

Cost estimate being researched.

Another approach

Travel, movement and lowering your clot risk

Not moving for long periods is a recognized risk for clots. Anyone traveling more than 4 hours by air, car, bus or train can be at risk, and the risk grows the longer you stay still (CDC). The NHS lists people with varicose veins among those more likely to get a DVT (NHS).

On a long trip

Everyday movement

  • After surgery or in hospital, ask about a plan to prevent clots. It may include moving as soon as you can, foot and calf exercises if you can’t walk, compression, and blood thinners (NHLBI).
  • If you have a DVT, the NHS says to stay active, keep the leg raised when sitting, and delay flights or long trips until at least 2 weeks after starting blood thinners (NHS). Your own doctor’s advice comes first.

The symptoms of a DVT and pulmonary embolism are listed at the top of this page (NHLBI).

Member stories

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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