Rosacea: Lasers, lights play role in treatment of some subtypes

January 1, 2009

Rosacea is a common skin disorder that affects 14 million Americans. Though the condition is sometimes mild in nature, many patients with rosacea have lower self-esteem and tend to avoid public contact or cancel social engagements.

Keypoints:

Subtyping

Some patients with these subtypes respond well to topical and systemic therapies, whereas others may see no relief at all with the available medications.

In today's high-tech world, several different wavelengths of light are increasingly used to treat components of rosacea that were once considered difficult or even impossible to correct. Laser therapy is now widely considered the primary treatment for telangiectasia and rhinophyma, and it may also be very effective for reducing extensive redness and flushing frequently seen as a component of rosacea.

Vascular lasers

Vascular lasers have remained the gold standard in the treatment of the erythematotelangiectatic forms of rosacea. Both short- and long-pulsed dye laser therapy with wavelengths of 585 nm or 595 nm have been examined for rosacea patients. These wavelengths correspond closely to the absorption peak of oxyhemoglobin (577 nm); hence, they are effective at targeting superficial vessels (Tan SR, Tope WD. JAm Acad Dermatol. 2004).

A recent study in the Journal of Lasers in Surgery and Medicine (Kligman and Bernstein, April 2008) reported on the use of the 595 nm pulsed dye laser for the treatment of rosacea. The new-generation pulsed dye lasers may be more effective for the vascular manifestations of rosacea due to their longer, more penetrating wavelength, better epidermal cooling and more adjustable pulse duration.

Long pulse-duration pulsed dye laser improves rosacea with a very favorable safety profile and less purpura than resulted from earlier-generation pulsed dye lasers. Purpura with the pulsed dye lasers typically lasts seven to 10 days, making these treatments difficult for cosmetic patients to tolerate.

On average, patients require three to four sessions for maximum improvement. Double-pass, nonpurpuric pulses seem to be as effective as purpuric doses with the pulsed dye lasers. Simply extending the pulse width on the newer long-wavelength pulsed dye systems can eliminate the purpura and make treatments very acceptable to all patients.

Dual-wavelength lasers

New dual-wavelength lasers incorporating both long pulsed dye and Nd:YAG lasers are also promising options for the treatment of erythematotelangiectatic rosacea (Larson, Goldman. J Drugs Dermatol. 2007).

In addition to PDLs, small superficial vessels can be treated with other "vascular lasers," such as the potassium titanyl phosphate lasers (KTP) and diode-pumped frequency-doubled lasers (532 nm).

In a study by Silver, 47 rosacea patients were treated with the KTP laser. In nearly 40 percent of patients, one treatment reduced facial telangiectasia by 70 percent or more (Silver BE, Liveshots YL. Cosmetic Dermatology. 1996).

IPL systems differ from true lasers in that they emit a broad spectrum of light, whereas lasers emit a single wavelength, but in clinical practice, they can function in a similar manner.