RosaceaNet Article
Is laser treatment right for your rosacea?

Dermatologists have been using lasers since the mid-1980s to treat rosacea. Today, an ever-increasing number of lasers and a non-laser light therapy called intense pulsed light (IPL) are available for treating rosacea.

Despite years of use and significant technological advances, data on the effectiveness and safety of these products is limited. The U.S. Food and Drug Administration (FDA) classifies laser and light therapies as procedures, so stringent, long-term studies are not required. Most of what is known comes from observations made by dermatologists while treating individual patients.

Recently, a few studies investigated the effectiveness and potential side effects of using lasers and IPL to treat rosacea. Here are the findings along with some general information about these devices.

Lasers
Today, lasers are used to treat these signs of rosacea:

• Dilated blood vessels

• Persistent redness

• Thickening skin on nose and cheeks (also known as rhinophyma)

The pulsed dye laser (PDL) has been used for years to treat the flushing and visible blood vessels of rosacea. Recently, a study looked at the effects of treating 16 patients with one or more of these signs of rosacea — flushing, persistent redness, and visible blood vessels.

After just one treatment, every patient in the study experienced significant improvement. With two treatments, redness decreased by 40% to 60%. Patients also reported reductions in flushing, burning, itching, dryness, swelling, and sensitivity, which they said significantly improved their quality of life. Side effects included crusting and spots of darkened skin on the treated areas. These side effects were successfully treated. All improvements were maintained from one treatment to the next.

This study also found that effectiveness increases when the pulsed dye laser causes temporary bruising, which may last for 1 to 2 weeks. While bruise-free treatment is possible with some of the newer pulsed dye lasers, researchers concluded that inducing bruising leads to a consistent decrease in redness and other symptoms, such as burning and itching. The researchers firmly believe that inducing bruising increases effectiveness. They also realize that this may not be acceptable for some patients.¹

Other lasers used to treat visible blood vessels include the KTP laser, diode laser, and Nd:YAG laser. These lasers are less likely to cause bruising. Each is used to treat single, large, visible blood vessels. Findings indicate that these lasers may not be as effective in reducing redness as the pulsed dye laser.

Some patients with longstanding rosacea develop thickening skin on the nose and cheeks, which is called rhinophyma. The CO₂ laser and erbium:YAG laser can be used to remove this thickening skin and improve the contour of the nose. Other surgical procedures used to treat this condition include dermabrasion and excision with a scalpel. Treatment options may be combined to obtain best results.

Dermatologists recommend early treatment of rhinophyma to help prevent the condition from progressing and becoming more difficult to treat. In the advanced stages, rhinophyma can cause difficulty breathing through the nose. It also is possible for the nostrils to collapse.

Intense Pulsed Light (IPL)
A newer form of therapy, IPL uses a non-laser light source. The first IPL product received FDA approval in 1995 for treating fine dilated blood vessels on the face. Since then several other products have been approved. Recent studies conclude that IPL can safely and effectively reduce the following signs of rosacea in some patients:

• Dilated blood vessels

• Persistent redness

• Flushing

• Acne-like breakouts

To investigate the safety and effectiveness, four patients with dilated blood vessels and persistent redness received five IPL treatments, which were given at three-week intervals. Patients averaged a 30% drop in blood flow, a 29% reduction in visible blood vessels, and a 21% decrease in redness.²  Since only four patients were evaluated, these numbers cannot predict how people with rosacea in general will respond. Some dermatologists believe, IPL is more effective than these numbers indicate.

Another study looked at the effects of IPL treatment on the persistent redness, flushing, and breakouts associated with rosacea. In this study, 32 patients received between one and seven IPL treatments. Following treatment, 83% experienced reduced redness, 75% said they had less flushing and improved skin texture, and 64% reported fewer acne-like breakouts.³

As the above studies indicate, IPL is not effective for everyone. However, most patients notice some reduction in dilated blood vessels and redness after only one or two treatments. In one case, a patient’s flush response returned to normal. Side effects from IPL are temporary and include redness, swelling, bruising, and skin lightening.

Thinking about laser or light therapy?
If you are considering laser therapy or IPL to treat your rosacea, it is important to keep the following points in mind:

• Not a cure. While some patients experience dramatic results (such as the return of a normal flushing response) and the results can be long-lasting, neither laser nor light therapy cures rosacea. You still need to continue to see your dermatologist for treatment and avoid your personal rosacea triggers. To maintain results, additional laser or light treatment may be needed at a later time.

• Some patients not candidates. Do you have a suntan or any of the following medical conditions?

  • Clotting disorder

  • Tendency to develop keloids

  • Insulin-dependent diabetes

   

  Anyone with a suntan should not receive laser or light treatments. If you have any of the medical conditions listed above, be sure to tell your dermatologist because these conditions may increase your risk of developing an infection or problems with wound healing. Additionally, laser and light treatments are not recommended during pregnancy as the effects on pregnancy are unknown.
   

• Realistic expectations essential. Most patients do see improvement; however, with any medical procedure there is always the possibility that you will only see a minor change or not see a response. Rosacea also may worsen. Your dermatologist can determine if you are a good candidate. To date, dermatologists have found that people with lighter skin who limit their sun exposure after the procedure tend to have better results.
   

• Success depends on several factors. Several factors — including your skin type, condition of your skin, your lifestyle, and the amount of sun exposure you get following the procedure — affect the short- and long-term results. For example, not protecting your skin from the sun after treatment can provoke a strong reaction, which can make rosacea worse.
   

• Experience required. As with any surgical technique, finding a dermatologist who is skilled in using lasers or IPL is essential. You should ask prospective doctors about their experience and training in this area. Extensive experience in performing laser or light procedures helps ensure the best possible results.
   

• Not covered by insurance. Typically, the laser and light therapies used to treat rosacea are not covered by medical insurance. If you opt for laser or IPL therapy, you can expect to pay from $300 to $600 per treatment session. Laser therapy usually requires one to three treatment sessions to achieve the best results, and sessions are generally spaced four to eight weeks apart. IPL may require one to five sessions. IPL treatments are usually repeated every three weeks. With both laser and IPL, follow-up treatment may be necessary to maintain the results.

Looking to the Future
Laser and light therapy could become a preferred treatment option for the redness, flushing, and dilated blood vessels of rosacea. Benefits include few short-term side effects, no downtime with many products, and some long-lasting results.

However, more research is needed to determine the long-term side effects and optimal use of the different laser and light therapies. If you believe that a laser or light therapy may be the right choice for treating your rosacea, be sure to discuss this treatment option with your dermatologist.

References:
¹ Tan SR and Tope WD. “Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life.” Journal of the American Academy of Dermatology. 2004 Oct;51(4):592-9.

² Mark KA et al. “Objective and quantitative improvement of rosacea-associated erythema after intense pulsed light treatment.” Dermatologic Surgery. 2003 Jun;20(6):600-4.

³ Taub, AF. “Treatment of rosacea with intense pulsed light.” Journal of Drugs in Dermatology. 2003 Jun;2(3):254-9.
 

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