Tuesday, May 17, 2022

Efficacy, Before and Afters, Cost and More

  • Rosacea is an inflammatory skin disorder characterized by facial flushing, visible red blood vessels, thickened skin, and papules or pustules
  • Laser treatments are a safe and effective means of reducing these symptoms 
  • Options include erbium: YAG lasers, pulsed-dye and CO2 lasers
  • Results can last as long as 3–5 years

Laser treatments for rosacea are a safe, effective method of addressing red, thickened skin and visible blood vessels. These treatments are generally considered safe and are typically combined with other methods to control rosacea symptoms.

What Is Rosacea? 

Rosacea is a common and chronic condition that affects facial skin and causes flushing,  inflamed lesions, thickened skin and enlarged pores. Secondary symptoms include itching, burning or stinging which can develop due to inflamed hair follicles caused by ingrown hair or Staphylococcus bacteria. Depending on severity, this disorder can have a significant impact on quality of life.

While the exact causes of rosacea are not well understood, certain factors have been identified including genetics, environmental factors and an overactive immune system.  

Certain triggers have also been linked to flare-ups. These include dietary items such as hot beverages, spicy foods, alcohol and processed or fried foods. Science has also established a possible relationship between the gut-skin connection and have advised a high-fiber diet to support a healthy gut microbiome.  

Other rosacea instigators include hot baths, stress or irritants found in some cosmetics. Demodex folliculorum mites have also been identified, as well as UV light, one of the most frequently reported triggers.

Can Laser Treatments Get Rid of Rosacea?

Rosacea is not curable, but symptoms can be successfully managed with a combination of lifestyle changes, oral medications, topical ointments and professional procedures such as laser treatments. 

With rosacea, treatment involves the use of different types of lasers to target the various symptoms. Lasers work to reduce the appearance of redness by collapsing dilated blood vessels. 

Phymatous rosacea causes a red bulbous nose or thickened skin on the ears, chin and forehead. These irregularities can be treated with laser resurfacing to remove thickened tissue and to restore the natural shape. 

Laser resurfacing works by debulking excess tissue and promoting skin cell growth and collagen production. This is a gentle alternative to traditional surgery and allows for more precise results.

Unfortunately, for this type of rosacea, results are temporary, as skin tends to thicken over time; repeat treatments are necessary to maintain effects.

How effective are they? 

In one small study, pulsed dye laser treatments significantly improved redness and the accompanying sensations of burning, itching, dryness, swelling and sensitivity. Quality of life scores were also positively impacted as a result.

In another study of Nd: YAG lasers, researchers found good to excellent improvement of lesions in 50% of rosacea patients, with the majority of patients self-reporting a significant improvement. It was determined that this laser was safe and effective, and could be used as first-line therapy in the early stages of rosacea. 

The number of treatments required are based on skin severity and symptoms. Typically, it takes a series of 3–6 treatments, scheduled 6 weeks apart, before significant results are visible. Results can last as long as 3–5 years.

Best Laser Treatment for Rosacea 

Lasers work to collapse visible blood vessels which in turn reduces the appearance of flushing and redness. They also treat areas of thickened skin by resurfacing the outer layers. 

CO2 lasers

CO2 lasers are ablative lasers that can effectively treat phymatous rosacea by delivering an intense beam of light to resurface the skin and reshape features disfigured by thickened layers of skin and excess tissue.  

This laser has demonstrated impressive results, excellent tolerability and minimal downtime.

It can precisely control the depth of injury and has a superpulse-mode which has been shown to produce a consistent leveling of treated regions.

In one study of patients who underwent CO2 laser treatment for phymatous rosacea, 77% rated their satisfaction as 10/10. In this study, a fully ablative CO2 laser was used in continuous mode for debulking and resurfacing mode for reshaping. Of note is that 92% of patients reported they would recommend the treatment to others with rhinophyma.

Erbium: YAG

The Erbium: YAG not only targets visible blood vessels and inflammatory lesions, but can also remove excess tissue to reshape thickened features.

In one small study, researchers examined the efficacy of this laser against mild, moderate or severe rhinophyma and found it allowed for increased precision, decreased risk of complications, less downtime and better outcomes compared to other available treatments. They concluded that the Erbium: YAG laser was an effective treatment for rhinophyma of any severity.

Pulsed-dye lasers

Pulsed-dye lasers have been an effective and reliable treatment for rosacea for decades. 

With this treatment, light is pulsed at an optimal wavelength to target visible blood vessels. The light is converted into heat which destroys the blood vessels but leaves the surrounding skin unharmed.

In one study of a novel long-pulse duration, higher energy dye laser, the average improvement was 54%. Another study also reported successful outcomes with visible improvements in redness and blood vessels; all participants felt the treatment was worthwhile.

What to Expect During Treatment

Before you seek treatment, see your doctor for a routine physical exam, discuss your medical history and discuss whether you would be a good candidate for laser treatment. 

Once cleared, your provider will recommend a skin care regimen to help you prepare your skin; this regimen can last up to 6 weeks. They will likely prescribe an antibiotic to treat or prevent infection and an antiviral drug if you’re prone to cold sores. 

At your appointment, your provider will thoroughly cleanse your skin and give you protective eyewear. They will then numb your skin with a local anesthetic, and you may also be given a sedative, particularly if you’re undergoing an ablative CO2 laser treatment.

During treatment, your provider will move the laser slowly over the targeted area; time needed will be between 30 minutes to 2 hours. Afterward, they will apply a layer of ointment and dressing to your skin, and may prescribe a medication for pain. 

After a laser session, you’ll be free to go home afterward, however if you have been sedated, you’ll need someone to drive you.

Recovery time

It can take 1–2 weeks for your skin to fully recover following Erbium: YAG or pulsed dye laser treatments. C02 lasers involve a longer recovery – typically 10–21 days and will depend on the severity of your skin and the intensity of the laser settings. 

To help your skin heal faster and to reduce discomfort after your treatment, wash your face with a gentle cleanser. You may be advised to apply antibiotic ointment to lower the risk of infection and you will be instructed to apply petroleum jelly to prevent moisture loss and form a protective barrier on skin. Use liberal amounts of a high-quality moisturizer to combat dryness.

As your skin will be in a fragile state, it is especially important to apply a broad spectrum sunscreen with an SPF of at least 30. If you normally use products containing Retin-A or glycolic acid, it should be safe to resume using these after about 6 weeks. 

Side Effects of Laser Treatments for Rosacea

The most common side effects of laser treatments is elevated redness immediately following the procedure. In general, side effects are typically mild and resolve within 2 weeks These include bruising, itching, swelling, peeling, a feeling of tightness, changes in skin color and a mild rash. Skin may feel sunburned, and with the ablative CO2 laser, you may experience raw, oozing or blistering skin.

Cost

Laser treatment costs will vary depending on the number of required treatments, your location and your provider’s fee. Cost will also be influenced by the size of the treatment area (such as nose, forehead and chin versus full face and neck. If you commit to a number of sessions, you might receive a reduction on the full amount. 

  • Erbium: YAG starts at $300
  • IPL costs $700 to $1,200
  • CO2 lasers average $2,500

Does insurance cover laser treatments for rosacea?

Laser treatments usually aren’t covered by insurance as it is considered an elective procedure. However, your provider may offer financing options to help you cover costs. 

Other Rosacea Treatments

If laser treatments aren’t right for you, there are topical and oral medications available as well as other professional treatments. Your provider will determine the correct treatment based on your treatment history and severity of your symptoms.

Creams 

Topical ointments and creams such as oxymetazoline hydrochloride, metronidazole, brimonidine tartrate and azelaic acid can help ease rosacea symptoms. These work to constrict visible blood vessels or reduce swelling and inflammation. They can be used as a sole treatment or alongside other professional treatments. 

IPL Treatment 

Intense pulsed light (IPL) works by sending multiple wavelengths of light into the layers of the skin in a controlled manner. In doing so, it targets the enlarged veins beneath the skin to reduce their appearance and alleviate redness and inflamed lesions, and improve skin tone. 

IPL is an effective option for treating rosacea. In one study, these treatments were shown to achieve long-term results of clearance of 78%, with minimal side effects.

Oral antibiotics

Oral antibiotics are prescribed for severely inflamed skin and for skin that fails to respond to conventional treatments. They can effectively kill bacteria to calm itching and stinging, and reduce the redness and swelling that characterize inflammation. 

Antibiotics such as tetracycline and doxycycline are prescribed for long-term therapy of up to 6 months. Additional courses may be prescribed due to the chronic nature of this skin condition.

Takeaway

While rosacea is not curable, symptoms can be controlled and managed through a multimodal approach. Combination therapy provides the best outcomes when several treatments are working in tandem to control the various symptoms. Laser treatments have been proven to be an effective choice alongside oral antibiotics and topical applications.

Laser treatments can effectively calm redness, reduce the appearance or inflamed lesions, destroy visible blood vessels and resurface thickened skin. They can also effectively kill bacteria and subdue uncomfortable sensations of burning, itching and swelling.

The number of treatments required to achieve visible results will depend on individual response and the severity of rosacea; results can last as long as 3–5 years; phymatous rosacea is particularly challenging to treat and requires repeat treatments to maintain results.

Sources

  • Mikkelsen CS, Holmgren HR, Kjellman P, et al. Rosacea: a Clinical Review. Dermatol Reports. 2016;8(1):6387. Published 2016 Jun 23. doi:10.4081/dr.2016.6387
  • Zhang H, Tang K, Wang Y, Fang R, Sun Q. Rosacea Treatment: Review and Update. Dermatol Ther (Heidelb). 2021 Feb;11(1):13-24. doi:10.1007/s13555-020-00461-0
  • Farshchian M, Daveluy S. Rosacea. [Updated 2021 Dec 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557574/
  • Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017;7(4):31-37. Published 2017 Oct 31. doi:10.5826/dpc.0704a08
  • Forton FMN. The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea?. Dermatol Ther (Heidelb). 2020;10(6):1229-1253. doi:10.1007/s13555-020-00458-9
  • Morgado-Carrasco D, Granger C, Trullas C, Piquero-Casals J. Impact of ultraviolet radiation and exposome on rosacea: Key role of photoprotection in optimizing treatment. J Cosmet Dermatol. 2021 Nov;20(11):3415-3421. doi:10.1111/jocd.14020
  • Rivero AL, Whitfeld M. An update on the treatment of rosacea. Aust Prescr. 2018;41(1):20-24. doi:10.18773/austprescr.2018.004
  • Tan SR, Tope WD. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life. J Am Acad Dermatol. 2004 Oct;51(4):592-9. doi:10.1016/j.jaad.2004.04.010
  • Say EM, Okan G, Gökdemir G. Treatment Outcomes of Long-Pulsed Nd: YAG Laser for Two Different Subtypes of Rosacea. J Clin Aesthet Dermatol. 2015;8(9):16-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587890/
  • Comeau V, Goodman M, Kober MM, Buckley C. Fractionated Carbon Dioxide Laser Resurfacing as an Ideal Treatment Option for Severe Rhinophyma: A Case Report and Discussion. J Clin Aesthet Dermatol. 2019;12(1):24-27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405248/
  • Mathis J, Ibrahim SF. Erbium-doped Yttrium Aluminium Garnet (Er:YAG) Laser Resurfacing Restores Normal Function and Cosmesis in Patients with Severe Rhinophyma. J Clin Aesthet Dermatol. 2019 Jul;12(7):28-33. https://pubmed.ncbi.nlm.nih.gov/31531160/
  • Bernstein EF, Schomacker K, Paranjape A, Jones CJ. Pulsed dye laser treatment of rosacea using a novel 15 mm diameter treatment beam. Lasers Surg Med. 2018;50(8):808-812. doi:10.1002/lsm.22819
  • Tan ST, Bialostocki A, Armstrong JR. Pulsed dye laser therapy for rosacea. Br J Plast Surg. 2004 Jun;57(4):303-10. doi:10.1016/j.bjps.2004.02.011
  • Schroeter CA, Haaf-von Below S, Neumann HA. Effective treatment of rosacea using intense pulsed light systems. Dermatol Surg. 2005 Oct;31(10):1285-9. doi:10.1111/j.1524-4725.2005.31204

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