Can Rosacea be treated with lasers?

There are 4 main subtypes of rosacea:

1. Persistent central facial redness (erythema) and broken blood vessels (telangiectasia)

2. Red bumps that look like "pimples"

3. Ocular rosacea where the lower eyelid margin is inflamed, red, itchy.

4. Skin thickening of the nose (rhinophyma), or chin (mentaphyma)

These subtypes are not mutually exclusive.  Also, if you have one subtype it does not imply you will develop another.

So to answer your question, if you have subtype 1 or 4 (above), then lasers can significantly help.

For subtype 1, there are lasers that target the blood vessels and can erase telangiectasias, improve baseline redness as well as your threshold to flushing.

For subtype 4, resurfacing lasers can remove the thickened skin.

Many people, especially fair-skinned people in sunny climates (like North Carolina), will develop areas of the face as they age where superficial veins and capillaries in the skin become enlarged and highly visible. Because of their typically irregular and spidery appearance, these superficial cutaneous vessels are commonly referred to as 'spider veins'.

The medical term for this phenomenon is 'telangiectasia', which is essentially Greek for 'the stretching out of the very end of a blood vessel'. And that's essentially what 'spider veins' are. They occur most frequently in the central face, particularly on the anterior cheeks and at the base of the nose. Some people develop very prominent spider veins on the dorsum and tip of the nose, where they are difficult to conceal.

Rosacea is a condition of the facial skin where the central face (nose, cheeks, chin, central forehead) gradually turns red and develops numerous fine telangiectasias. These areas easily become flushed, particularly after physical exertion, eating spicy food, or having a glass of wine. Rosacea has traditionally been treated with topical agents and oral antibiotics, however most patients experience improvement only when the medications are in use, with return of rosacea once the treatment is stopped. For many patients, rosacea is fairly resistant to topical and oral medications.

The cause of spider veins and rosacea is not completely understood, and appears to be multi-factorial. Contributing factors may be a genetic predisposition, the chronic use of topical steroid agents, and solar damage to the facial skin that gradually builds up over many years. Rosacea occurs most commonly in warm climates where people get a great deal of year-round sun exposure.

These conditions can perhaps be prevented (in part) by the avoidance of excessive exposure to ultraviolet radiation (the sun, that tanning bed), the avoidance of chronic topical steroid use, and by the daily use of a high-SPF facial sunblock. In some cases, telangiectasias are associated with a systemic autoimmune disorder, such as scleroderma. Once a person develops facial telangiectasias and/or rosacea, these conditions in general do not spontaneously disappear.

So how do I get rid of rosacea, or my facial spider veins, or both?

The ideal treatment for 'spider veins' and rosacea should be easily administered, safe for the patient, reliably effective, should not require an excessive number of treatments, should be non-invasive, and should not have a prolonged recovery period.

Here's the good news: such a vein treatment does exist. The V-Beam Laser, a pulsed-dye laser developed specifically for the treatment of cutaneous vascular disorders, can completely eliminate most facial 'spider veins', usually in two to three treatments (large areas of long-standing spider veins may require more treatments), and can reverse the cutaneous manifestations of rosacea as well. In addition, the laser energy pulse delivered by the V-beam has been modified to limit the development of post-treatment bruising (purpura), a problem associated with older pulsed-dye lasers.

The V-Beam laser uses light energy of a wavelength that is specifically absorbed by structures which are reddish or purple in color, i.e. capillaries and small arteries and veins. The V-beam incorporates a Dynamic Cooling Device which sprays the skin with a cooling agent immediately before every laser pulse. This advanced technology both protects the skin from thermal energy and reduces the discomfort previously associated with pulsed-dye laser treatment. The laser pulses are generally described by patients as feeling like 'a rubber band snapping against the skin'. No anesthesia (topical or otherwise) is required.

While pulsed-dye laser technology has been available for decades, pulsed-dye laser treatment of rosacea and facial telangiectasia was not frequently performed as the laser energy tended to explode superficial blood vessels, producing facial bruising that may persist for several weeks. The V-Beam Laser modulates both the peak energy and the duration of the laser pulse in order to coagulate rather than explode dermal blood vessels, which allows treatments to be performed that produce little or no bruising. This advanced technology makes it possible to achieve significant clearance and even complete elimination of facial redness and spider veins with no 'downtime'.

Although there is no cure for rosacea, it may be well-controlled with the use of pulsed dye lasers. Oftentimes, traditional treatments consist of prolonged use of oral or topical medications.

In our practice, patients are looking for another option in controlling this skin condition. With lasers, the concept is to harness thermal (heat) energy to heat the superficial blood vessels that are causing the redness to the skin. By heating the vessels, we are coagulating the blood and causing the vessel walls to seal together. The body's lymphatic system then plays an active role by slowly and progressively removing the destroyed vessels away from the area treated. It usually takes several treatments spaced 4 weeks apart to accomplish this.

There are two options when choosing laser treatments for rosacea: bruising doses or non-bruising doses. Bruising doses refers to delivering an aggressive treatment that results in very noticeable purple/blue bruising (purpura) to the skin and tissue. When the vessels are destroyed with this type of treatment, the result is a bruise(s). Research supports that these type of aggressive treatments render quicker more effective results. However, not everyone is agreeable to this due to their work and social schedules. Also, skin type may preclude someone from receiving this type of treatment. Most patients prefer a non-bruising dose which allows for a more gentler heating of the vessels that does not result in a bruise but will require more treatments. Either technique is quite effective.

Besides effectively resolving redness, the other benefit of laser treatments is an improvement in the texture of the skin. Superficial, prolonged vascularity may lead to textural changes to the skin such as thickening. Pulsed dye lasers stimulate the body to make new collagen and remodel existing collagen. This, in turn, will promote a more appealing appearance and feel to the skin.

We believe in setting realistic expectations for our patients - the aim is to control the condition and educate on how to avoid exacerbations and flares. Education and good sun protection go hand in hand.