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Lasers and intense pulsed light (IPL) have become standard therapy for treating the redness associated with rosacea, according to Joel Schlessinger, M.D., president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. The Omaha dermatologist and general cosmetic surgeon believes these tools enhance and improve the dermatologist's arsenal of treatment options.
Most dermatologists' offices did not perform laser or IPL treatments a decade ago. Many dermatologists who did provide these treatments were either not adequately trained or rented their equipment on an as-needed basis. Today, many more dermatologists are trained in laser and light treatment, with lasers ready and available in their offices. This has propelled the treatments into the mainstream for fighting rosacea.
"The paradigm of treatment for rosacea has dramatically shifted with the advent of lasers that are available and affordable," Dr. Schlessinger tells Dermatology Times.
Benefits of lasers, IPLs
Today's lasers and IPLs offer a relatively low likelihood of risk if used properly, with a very "do-able" learning curve, according to Dr. Schlessinger.
"I strongly recommend that dermatologists purchase rather than rent their equipment," he says. "The worst disservice to the entire laser 'concept' is not having the piece of equipment in the office at all times. It's difficult to sell the idea of lasers and IPLs to the patient with rosacea when you don't have the equipment available."
Lasers have become much more affordable for both the physician and the patient, Dr. Schlessinger says. For this reason, many dermatologists can afford to have both lasers and IPLs in their offices.
Although IPLs are a bit more effective for a broad range of conditions because of the larger spectrum of wavelengths, IPLs and lasers are not the best choice in people who are either tanned or have type V or VI skins, and some type IV skins, Dr. Schlessinger says.
"What we've seen are IPLs that are relatively quicker than they were in the past and much easier to use," he says. "In addition, patient comfort has been very much improved from previous years."
Length of treatment of rosacea with lasers and IPLs varies, but generally, patients receive one to four treatments a year for one to two years.
"Then, they typically don't need treatments for a period of time . . . some of my patients haven't come back for seven or eight years, at which point mild redness returned," Dr. Schlessinger says.
Flushing is often undiagnosed in rosacea patients, but with IPL or lasers, the problem is very treatable.
"Many physicians don't recognize that flushing is a huge issue for patients," he says. "Oftentimes, they come into the office and aren't flushed at the time and may seem perfectly normal. Still, the flushing troubles them, and this can be treated with IPL or laser with good results."
Today, IPLs and lasers are creating success stories from satisfied patients who, prior to treatment, were reluctant to go outside because of considerable redness.
"I had one patient who was a member of a band, and the hot lights led to significant redness and flushing of her face," Dr. Schlessinger says. "She was absolutely stricken by it and even considered giving up the band. After two or three treatments of IPL, she had a dramatic recovery and was able to perform without any difficulty."
Lasers and IPLs also lend themselves well to combination therapy for treating rosacea. A patient with blood vessels on his or her face who also has significant amounts of pustules from rosacea, for example, will see improvements in these manifestations of the disease from use of both medical and laser treatment.