While medications have long been used to keep the inflammation -- the bumps (papules), pimples (pustules) and some of the related redness -- of rosacea at bay, many dermatologists have found certain types of lasers and light sources offer important options for addressing components of the disorder that are more difficult to treat.
"Laser technology is now well established as an effective means of removing telangiectasia (visible blood vessels), and it may also be used to reduce severe redness," said Dr. Jeffrey Dover, associate clinical professor of dermatology at Yale University School of Medicine.
Vascular lasers, in which wavelengths of powerful light destroy targeted blood vessels as heat from the laser's energy builds in the vein, are frequently used as an elegant and relatively painless way to eradicate telangiectasia. These specific wavelengths of light are well-absorbed by the hemoglobin, or red blood cells. Short pulses target only the blood vessels, reducing the chance of damage to surrounding facial tissue.1
"Typically, three or more treatments at four- to six-week intervals are required," Dr. Dover said. Side effects may include redness and swelling within the first day or so. However, bruising that may last up to five to 10 days is uncommon with the newest techniques. "The visible blood vessels will disappear almost immediately, but some recur within six weeks, hence the need for further treatments," Dr. Dover said.
In a controlled study of laser therapy for rosacea, one side of the faces of 12 patients was treated with a pulsed dye laser, while the other side remained untreated as a control. The investigators noted a reduction of visible blood vessels by 75 percent, as well as a 55 percent reduction in flushing and a 50 percent reduction in redness.2 The treatment had no effect on papules and pustules.
Other, non-laser light sources called intense pulsed light (IPL) devices are also increasingly used for the redness, visible vessels and flushing of rosacea, Dr. Dover said. These devices are similar to lasers but generate a broader spectrum of light to treat a broader spectrum of tissue. Like the newer lasers, IPL devices used properly are associated with little or no bruising.
In addition, certain lasers can be used to correct the enlargement of the nose from excess tissue, often associated with subtype 3 (phymatous) rosacea. According to Dr. Dover, a device known as an ablative laser -- such as a CO2 or erbium YAG laser -- may be used, as can an electric cautery device to shave off and vaporize the area to reshape and resculpt the nose.
"Patients need to realize that lasers are a treatment, not a cure, for rosacea," Dr. Dover said. "This is a chronic condition that usually requires long-term preventive measures such as medical therapy and avoidance of lifestyle and environmental factors that trigger flare-ups. Because underlying rosacea remains, laser treatment may again be required one to three years after a series of treatments."
Goldberg DJ. Lasers and light sources for rosacea. Cutis. 2005;75(suppl 3):22-26.
Clark SM, Lanigan SW, Marks R. Laser treatment of erythema and telangiectasia associated with rosacea. Lasers in Medical Science. 2002;17:26-33.