Laser Therapy for Rosacea: Separating the Myth from Reality

Rosacea laser treatment has been an option in rosacea treatment for time now, but to date, there have not been a lot of studies to either support or discredit its use in treating rosacea. The National Rosacea Society along with Rebecca Prescott with Acne-to-Health state that, “Despite years of use and significant technological advances, data on the effectiveness and safety of these products is limited. The U.S. Food and Drug Administration (FDA) classifies laser and light therapies as procedures, so stringent, long-term studies are not required. Most of what is known comes from observations made by dermatologists while treating individual patients.” Note: I wasn’t sure which one of them stole this statement from the other so I gave both credit. Rebecca further states: “IPL is not effective for everyone. However, most patients notice some reduction in dilated blood vessels and redness after only one or two treatments. In one case, a patient’s flush response returned to normal”. In one case the flush response returned to normal? But there have been hundreds if not thousands of procedures that have been performed in the last 40 years.

Rebecca goes on to explain how laser works: “the first working laser was produced in 1960, and they are in common use in medicine today. The laser works by applying energy to subatomic particles; this places them in an 'excited' state and they gain energy. These particles then move back to their original energy level and as they do, they release energy in the form of particles of intensely focused light - the laser. The light emits heat and the laser destroys the targeted tissue of rosacea. Laser treats rosacea by selectively destroying the inflamed, dilated, and hyper-responsive blood vessels without damaging surrounding skin. The laser 'energy' is absorbed by oxyhemoglobin (hemoglobin is the molecule in the blood cells that carries oxygen; oxyhemoglobin is hemoglobin that is saturated with oxygen) in the blood. This generates thermal energy that damages the adjacent blood vessel wall blood. The exact intensity of the wavelength is carefully chosen to destroy the dilated blood vessels using thermal energy without significant damage to the surrounding skin and to avoid surface scarring.”

In many diseases, doctors help the body do what it already wants to do. For example, if you get an infection, your doctor prescribes an antibiotic that works together with your body's immune system to clear the infection. Once you're better, you stop taking the antibiotic. In laser therapy your doctor is trying to oppose what your body wants to do. The body wants to make blood vessels grow, while your doctor tries to prevent that growth. Laser treatment can destroy or kill the blood vessels, but sooner or later the body will try to make blood vessels grow again, our bodies have an instinct for survival, rejuvenation and life. As the skin heals and rejuvenates it stands to reason that the blood vessels will re-grow. Then, the treatment needs to be repeated.

The success of rosacea laser treatment can depend on several factors, and there are many treatment protocols and many different types of lasers that can be used; argon, pulse dye, neodymium, carbon dioxide and krypton lasers have all been tried. Multiple treatments are often necessary and these are time consuming and expensive. There is certainly anecdotal evidence for the effectiveness of the laser in clearing up erythrosis and teleangiectasia, and many patients are satisfied. But surprisingly - given that rosacea laser treatment therapy is not new (it's been around since the 1980s) and is in widespread use - there is relatively little substantiated information about how useful it is; there is a distinct lack of controlled studies, and the Food and Drug Administration classifies laser therapy as a procedure, so its effectiveness has not evaluated in the same way as drugs.

Laser cannot be used for everyone. You should not have laser therapy if you have dark skin or a tan, it is contraindicated for people who have disorders of blood clotting, people who easily develop scars (keloids), or people with insulin-dependent diabetes. And although rosacea laser treatment can work for some people, it is not a cure. Relapses are possible and it is possible that the laser can make your rosacea worse.

"Laser therapy is now widely considered the primary treatment for telangiectasia (visible blood vessels) and rhinophyma (enlarged nose), and may also be very effective for reducing extensive redness," said Dr. Philip Bailin, chairman of Dermatology at the Cleveland Clinic Foundation. "At the same time, medications must continue to be used to manage the papules (bumps) and pustules (pimples) that often go along with rosacea, and to help maintain remission. "Generally, at least three treatments are required at six-week intervals, depending on the severity of redness and telangiectasia," Dr. Bailin said. "Most patients will experience redness, swelling and soreness within the first 12 to 24 hours, but then they subside. Some patients also may have peeling, similar to that of a sunburn, and others may experience some bruising under the skin that lasts five to 10 days. He emphasized that, because of the chronic and relapsing nature of rosacea, patients should be given a proper perspective on their condition, including the need for continuing preventive therapy and avoidance of lifestyle and environmental factors that may trigger flare-ups. "The underlying cause of rosacea will still be there, and further laser treatment may again be required at a later time," he said. "There are no cures for rosacea, only good treatments."

Thinking about laser or light therapy?
If you are considering laser therapy or IPL to treat your rosacea, it is important to keep the following points in mind:

· Laser therapy is not a cure. While some patients experience dramatic results (such as the return of a normal flushing response) and the results can be long-lasting, neither laser nor light therapy cures rosacea. You still need to continue to see your dermatologist for treatment and avoid your personal rosacea triggers. To maintain results, additional laser or light treatment may be needed at a later time.

· Some patients not candidates for laser therapy. Do you have a suntan or any of the following medical conditions?

o Clotting disorder

o Tendency to develop keloids

o Insulin-dependent diabetes

Anyone with a suntan should not receive laser or light treatments. If you have any of the medical conditions listed above, be sure to tell your dermatologist because these conditions may increase your risk of developing an infection or problems with wound healing. Additionally, laser and light treatments are not recommended during pregnancy, as the effects on pregnancy are unknown.

· Have realistic expectations about the results of laser therapy. Most patients do see improvement; however, with any medical procedure there is always the possibility that you will only see a minor change or not see a response. Rosacea also may worsen. Your dermatologist can determine if you are a good candidate. To date, dermatologists have found that people with lighter skin who limit their sun exposure after the procedure tend to have better results.

· Successful treatment depends on several factors. Several factors — including your skin type, condition of your skin, your lifestyle, and the amount of sun exposure you get following the procedure — affect the short- and long-term results. For example, not protecting your skin from the sun after treatment can provoke a strong reaction, which can make rosacea worse.

· Check credentials, get an experienced dermatologist. As with any surgical technique, finding a dermatologist who is skilled in using lasers or IPL is essential. You should ask prospective doctors about their experience and training in this area. Ask who will be performing the treatment, the dermatologist or their assistant. Extensive experience in performing laser or light procedures helps ensure the best possible results.

· Laser treatment is not covered by insurance. Typically, the laser and light therapies used to treat rosacea are not covered by medical insurance. If you opt for laser or IPL therapy, you can expect to pay from $300 to $600 per treatment session. Laser therapy usually requires one to three treatment sessions to achieve the best results, and sessions are generally spaced four to eight weeks apart. IPL may require one to five sessions. IPL treatments are usually repeated every three weeks. With both laser and IPL, follow-up treatment may be necessary to maintain the results.