Laser Treatment For Rosacea

Rosacea is a chronic and frustrating skin condition marked by constant redness of the face, sensitive skin, and pimples. There are several forms of rosacea, but the type with diffuse redness and prominent blood vessels on the face (type I) is the most widely studied with laser therapies. Some studies show that lasers may be used for inflammatory rosacea (type II) as well,^[1,2] although there are fewer studies on this subtype of rosacea. Lasers are powerful tools that can be used for skin care and here is what you need to know about the use of lasers for rosacea. 

Lasers Can Selectively Target in the Skin

Laser treatments for the skin are based on a concept of selective photothermolysis.^[3] When putting this into plain English, this means that in selecting the specific color, (i.e. wavelength) the laser shines matters! The specific light from a laser can accurately target parts of the skin to selectively deliver its energy. At the same time, the heat and destruction delivered to these portions of the skin should not affect the healthy portions of the skin. This makes lasers extraordinarily specific. Lasers have been used to target multiple compounds in the skin.  The three major skin targets are:  

• Melanin: Melanin is what makes up the pigment in the skin. Targeting melanin allows for selective destruction of pigment in the skin. This is used to improve dark spots on the skin or for hair reduction (most hairs are rich with pigment). 
• Water: Water is found everywhere in the skin. Therefore, lasers that target water are used to heat and destroy entire sections of skin.  These procedures are often called “ablative” and are often used for facial rejuvenation (think of an extreme peel).  
• Hemoglobin: Hemoglobin and oxyhemoglobin are found in red blood cells that flow in blood vessels. When lasers target hemoglobin and oxyhemoglobin, it heats and destroys blood vessels. This is used to treat any collection of unwanted blood vessels in the skin such as those seen in rosacea. 

Several types of lasers can be used for the treatment of blood vessels seen in rosacea: 

• Pulse-dye laser (PDL, 594 nm)
• Potassium titanyl phosphate (KTP, 532 nm)
• Neodynium:yitrium aluminum garnet (Nd:YAG, 1064 nm): This laser is typically selected for those with darker pigmentation.

In type I rosacea, the excess of blood vessels in facial skin leads to redness from blood flow. In addition, fixed vessels (i.e. blood vessels that do not change day-to-day) are also present in the facial skin of people with rosacea and increase the red appearance. Lasers are used to selectively target and destroy these fine facial vessels to reduce blood flow to facial skin and to eliminate the fixed vessels resulting in improvement of facial redness.  

Lasers Improve the Quality of Life in Those with Rosacea

In type I rosacea, known as erythematotelangiectatic rosacea, there is increased redness of the face due to the visibility of fine blood vessels on the face. This is usually a result of years of sun exposure or repeated episodes of facial flushing.  Facial redness can be a source of social embarrassment and uncomfortable facial flushing. Studies show that laser treatment of rosacea leads to an improvement in quality of life in several objective measures.^[4] In one study, 96% of those that were treated with a pulse-dye laser said that they would get the laser treatment again.^[5] 

Know Some of the Side Effects of Lasers 

Darkening or Lightening of Skin
Lasers are not perfect in the way that they target the skin. The lasers that are used to target the blood vessels will also slightly target the pigment on the skin. If the surface of the skin is not cooled well, this can lead to damage to the pigment-producing cells in the skin that can cause light or dark spots. This is why medical professionals that perform laser treatments will cool the surface of your skin. 

Bruising 
When lasers are used to heat and destroy blood vessels, this can lead to bruising. The bruising is typically temporary and will improve over a course of days to weeks. Laser settings can be adjusted to decrease the risk of bruising^[6] and should be discussed with the medical professional. 

Scarring
Laser treatments carry the risk for the development of blisters as a side effect, and this can lead to permanent scarring.  An experienced professional will know how to select laser settings to reduce the chances of scarring.

Pain
The effects of lasers that treat blood vessels reach into the layers of the skin that have nerves that transmit pain. Practitioners can reduce this pain by cooling the skin surface to make the skin less sensitive to pain. In some cases, a professional may numb the skin to reduce the pain to the area. 

Laser Treatments Require Several Treatment Sessions 

Several treatment visits are needed and these are typically spaced several weeks apart. One small study showed that 9 of 12 participants had a 25% improvement in facial redness while only 2 of 12 participants had a 75% improvement in facial redness after a single treatment session.^[6] Most research studies have participants receive laser treatment several times with the idea being that there is more improvement with each treatment session.

Trying to achieve a large improvement in one session can put you at risk for more side effects such as bruising and scarring. If the treatment sessions are separated in time, this allows for a good balance between getting a good response from the laser and reducing the side effects of laser treatments.  

Laser treatments may be considered cosmetic and not covered by medical insurance. For this reason, the costs of multiple treatments should be taken into account and discussed with the medical provider when planning these treatments.