Q. How long is a topical medication effective? I think I have had my tube for a while, and it isn't working.

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 investigator in the NRS-funded study.

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.

While many individuals may fear the growth of excess tissue on the nose that often heralds subtype 3 rosacea (phymatous rosacea), a bulbous enlarged nose need not be permanent. Today, surgical methods such as electrocautery and laser surgery may be used to take away the distorted shape and bring back a normal appearance.

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.

A recent controlled study of laser therapy for rosacea found that the procedure substantially reduced visible blood vessels (telangiectasia) and also helped reduce redness (erythema) and flushing after an average of three treatments, according to results presented by Dr. S. M. Clark and colleagues of the Department of Dermatology, University Hospital of Wales, at the American Academy of Dermatology annual meeting.

Q. Will laser surgery get rid of telangiectasias (spider veins or tiny visible blood vessels)?

A. Laser surgery using a pulse dye or other laser can be an effective way to treat telangiectasias on the legs. For many sufferers, laser treatment can provide long-term relief from these unwanted spider veins.

The unsightly redness, papules and pustules of rosacea can be controlled with medical therapy combined with lifestyle modifications. But untreated symptoms may progress to rhinophyma, a conspicuous condition that sometimes appears at the advanced stage of this common and embarrassing disorder. Most often occurring in men, rhinophyma is the red swollen nose often mistakenly attributed to heavy drinking, such as in the case of the late comedian W. C. Fields.