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Beneath the Surface of Lasers

Posted: 05/02/2007

New clues to help unlock the mystery of rosacea were identified in a recent study in which researchers used advanced technology to evaluate the skin of patients successfully treated with pulsed dye lasers (PDL) or intense pulsed light (IPL).

"We are pleased to see interesting findings in this small pilot study that not only help reveal the underlying disease process, but may also provide a basis for developing more targeted therapy in the future," said Dr. Nancy Samolitis, visiting instructor in dermatology at the University of Utah and an investigator in the new study funded by the National Rosacea Society (NRS).

In the study, the researchers examined biopsies of 10 rosacea patients before and after five received PDL treatment and five IPL treatment for the presence of biochemical components previously associated with rosacea. Each patient received four monthly treatment sessions on one side of the face, with the untreated side serving as a clinical control.

Before treatment the researchers found elevated levels of vascular endothelial growth factor (VEGF), associated with the development of visible blood vessels (telangiectasia), in five of the 10 rosacea patients. In four of these subjects -- three in the PDL group and one in the IPL group -- the level decreased after therapy.

Eight of the patients were also found to have elevated cathelicidins, natural antimicrobial agents linked in previous research to rosacea inflammation, and the level was reduced in three IPL- and two PDL-treated patients after treatment.

Although elevated factor XIII, potentially linked to rosacea, was found in five of the patients, the level did not change following therapy. In addition, an elevated ratio of the antigens CD4 to CD8 was found in nine of 10 patients, but this also did not change significantly after treatment. It has been hypothesized that such an elevated ratio, common in rosacea patients, suggests a delayed hypersensitivity reaction to some allergen. Though these elements were unaffected by PDL or IPL therapy, the initial findings were similar to associations with rosacea found in other studies.

"The results of this study confirm the effectiveness of PDL and IPL in the reduction of telangiectasia and redness, and demonstrate the near-term effect these modalities may also have on the underlying disease process," Dr. Samolitis said. "Our findings particularly suggest that cathelicidins and VEGF may play a role in the pathogenesis of rosacea and warrant further study."

Both the physicians and patients rated significant improvement in rosacea severity in the 10 individuals treated, with improvement in redness (erythema) found in all patients treated with IPL, and improvement in visible blood vessels in all of those treated with PDL. Though four PDL-and three IPL-treated patients had a decreased number of bumps (papules) and pimples (pustules) following treatment, the results were not statistically significant when compared to controls.

Although light sources are commonly used to remove visible blood vessels, their usefulness in reducing the redness of rosacea requires further study. Drug therapy is usually prescribed to control the bumps and pimples of rosacea, and has been shown to significantly reduce the incidence of flare-ups.

Special thanks to the Rosacea Research Foundation, which donated to the NRS toward funding this study. For information on results of other NRS studies, visit the research results page of the research grants section.

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The National Rosacea Society is a 501(c)(3) nonprofit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but little-known disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace

consultation with a qualified physician. The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us.