Laser and light therapies for acne rosacea

Journal of Drugs in Dermatology, Jan, 2006 by Kimberly J. Butterwick, Lorren S. Butterwick, Amy Han

Table 1. Rosacea Subtypes.

Subtype #  Type                      Main features

1          Erythematotelangiectatic  Flushing, persistent central facial
                                     erythema, possible telangiectasias
2          Papulopustular            Persistent erythema with papules
                                     and pustules
3          Phymatous                 Thickening of skin and enlargement,
                                     most commonly on the nose
4          Ocular                    Eye irritation, blepharitis, watery
                                     or bloodshot appearance of eyes,
                                     any ocular manifestation

Table 2. Published Studies of Laser and Light Therapies for Rosacea.

          Number of    Number
Laser     patients     of treatments  Laser Parameters

PDL        27          1-3            PW 450 [micro]s
(585 nm,                              SS 5 mm
short)                                Fluence 6-7 J/[cm.sup.2]
           12          3              PW 450 [micro]s
                                      Fluence 5.5-7.5 J/[cm.sup.2]
           32          1              PW 450 [micro]s
                                      Fluence 6-6.75 J/[cm.sup.2]
           40          2.4            PW 450 [micro]s
                                      SS 5 or 7 mm
                                      Fluence 5.4-6.5/[cm.sup.2]
           10          1              PW 450 [micro]s
                                      SS 5 mm
                                      Fluence 6.5 J/[cm.sup.2]
PDL        16          2              PW 1.5 ms
(595 nm,                              SS 7 mm
long)                                 Fluence 9.5-11.5 J/[cm.sup.2]
           12          1              PW 6 ms
                                      SS 7 mm
                                      Fluence 7-9 J/[cm.sup.2]
KTP        47          1
IPL       188          2              PW 2.5-6 ms, double
          (74-                        Delay 20-30
          rosacea)                    Filter 550 or 570 (type III or
                                        tan)
                                      Fluence 35-45 J/[cm.sup.2]
           32          3.6            PW 2.4/4.0 ms, 20 ms delay
                                      Fluence 32-36 J/[cm.sup.2], 570 nm
                                        filter
                                      Fluence 27-32 J/[cm.sup.2], 560 nm
                                        filter
            4          5              PW 3 ms
                                      Fluence 22-25 J/[cm.sup.2], 515 nm
                                        filter

          Number of
Laser     patients   Results                              Author

PDL        27        Good to excellent results in all     Lowe
(585 nm,               treated areas
short)
           12        50% decrease in erythema             Clark
                     75% decrease in telangiectasias
           32        24/32 patients had a decrease in     Lonne-Rahm
                       stinger test score
           40        Moderate overall improvement         Tan
                     Slight to moderate improvement in
                       erythema and telangiectasias
           10        Laser of limited value               Berg
PDL        16        Significant improvement in           Tan
(595 nm,               quality of life
long)                Decrease in flushing and other
                       symptoms
           12        2 patients with 75% improvement      Jasmine
                     2 patients with 50-75% improvement
                     5 patients with 25-50% improvement
KTP        47        70% reduction of telangiectasias     Silver
                       in 38% of patients
IPL       188        Facial clearing 75-100% in 93%       Angermeier
          (74-         of patients
          rosacea)
           32        83% improvement in redness           Taub
                     75% improvement in flushing and
                       skin texture
                     64% improvement with acne outbreaks
            4        30% decrease in blood flow           Mark
                     29% decrease in actual area of
                       cheek occupied by telangiectasias
                     21% decrease in erythema intensity

PW = pulse width
SS = spot size