In today's high-tech world, powerful and nearly painless beams 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 (visible blood vessels) and rhinophyma (enlarged nose), and may also be very effective for reducing extensive redness," said Dr. Philip Bailin, chairman of Dermatology at the Cleveland Clinic Foundation. "At the same time, medications must continue to be used to manage the papules (bumps) and pustules (pimples) that often go along with rosacea, and to help maintain remission."
Vascular lasers emit wavelengths of light targeted for the tiny visible vessels just under the skin. Heat from the laser's energy builds in the vessels, causing them to disintegrate.
"Generally, at least three treatments are required at six-week intervals, depending on the severity of redness and telangiectasia," Dr. Bailin said. "Most patients will experience redness, swelling and soreness within the first 12 to 24 hours, but then they subside. Some patients also may have peeling, similar to that of a sunburn, and others may experience some bruising under the skin that lasts five to 10 days. Over two to three weeks, the visible blood vessels will disappear."
New laser technology has been developed to minimize bruising, and recently developed devices called intense pulsed light sources (IPL's) mimic lasers but generate multiple wavelengths of light to treat a broader spectrum of tissue.1
Vascular lasers can also help to retard the advancement of rhinophyma, according to Dr. Bailin. In more advanced stages, he said a CO2 laser is used as a scalpel to shave off and vaporize the area to reshape and resculpt the nose.
"Laser treatment is by far more elegant, more refined and less painful than previous treatment options for these conditions," Dr. Bailin said. He noted that in mild cases each treatment session may cost from $150 to $300, while more extensive sessions may run up to $500 or more. Laser treatment for rhinophyma is a one-time procedure that may cost between $1,500 and $3,000.
"As with any surgical technique, finding a skilled physician is very important and patients need to ask prospective doctors about their experience and training with lasers," Dr. Bailin said.
He emphasized that, because of the chronic and relapsing nature of rosacea, patients should be given a proper perspective on their condition, including the need for continuing preventive therapy and avoidance of lifestyle and environmental factors that may trigger flare-ups.2
"The underlying cause of rosacea will still be there, and further laser treatment may again be required at a later time," he said. "There are no cures for rosacea, only good treatments."
Connolly CS, Bikowski J: Understanding the evolving role of lasers in rosacea therapy. Skin & Aging. 2000;8:27-28.
Laughlin SA, Dudley DK: Laser therapy in the management of rosacea. Journal of Cutaneous Medicine and Surgery. 1998;2(suppl 4):S4/24-S4/29.