Combining light-based treatments, topicals for rosacea

"Systemic or topical treatments are clearly efficacious in the treatment of acne that occurs within the setting of rosacea, but do little for the redness or flushing," says David Goldberg, M.D., director of Skin Laser & Surgery Specialists of New York and New Jersey and a clinical professor of dermatology and director of laser research at Mount Sinai School of Medicine in New York.

"Conversely, laser and laser light technology are highly effective in the treatment of rosacea-induced redness and flushing, but don't work well for the acne component of the condition. Nothing says you can't combine standard treatment - that is, topical - with light-based treatment," he says.

The advantage of a therapy like IPL is that it decreases erythema and decreases the number of vessels in the skin and, therefore, the flushing of the skin. The IPL is frequently combined with LED treatments of various colors that have unique properties.

Technology differences

"Each technology does something a little different," Dr. Goldberg says. "The yellow LED and IPL both lessen redness, so they work in synergy. We will often combine the yellow LED with red LED, the latter of which works well on the inflammation of the condition."

The LED devices do not cause pain and are not thermal, in contrast to laser technologies, according to Dr. Goldberg.

"There is no risk such as scarring when using LED devices," Dr. Goldberg says. "They can also work on any skin type, including ethnic skin. You have to be more careful in using laser and laser-like technologies because of their thermal effect."

Because lasers target melanin and there is greater melanin present in darker-skinned individuals, light absorption via the laser is inhibited, Dr. Goldberg explains. In contrast, the use of LED treatments for rosacea is an option for all patients.

If a treatment such as metronidazole formulation is applied, and inflammation arises, an LED device can treat the inflammation. In addition, the use of LED minimizes the amount of topical metronidazole that needs to be applied to the skin.

"Some topical treatments are effective and very commonly used, but potentially very irritating," Dr. Goldberg says.

Antibiotics

If patients have severe rosacea, characterized by acne and inflammation, clinicians may prescribe antibiotics, such as minocycline administered orally; a topical agent; and light-based treatment.

"The symptoms vary, so the treatments vary," Dr. Goldberg says. "You might have the patient on antibiotics for a month or two, but the goal would be to get them off antibiotics. If the patient, for instance, were planning to get pregnant, being on antibiotics would be an issue. It would be preferable to use topical treatment and IPL/LED. They can have that treatment throughout pregnancy."

For middle-aged men who have rosacea and dilated blood vessels, typically on the sides of their nose, IPL is not effective to treat their larger blood vessels, so other light devices are necessary.

"In that instance, we would use a KTP (potassium-titanyl-phosphate) or Nd:YAG (neodymium:yttrium aluminum garnet) laser, allowing us to selectively target the dilated blood vessels and make them smaller," Dr. Goldberg says.

The most severe form of rosacea is rare, but features a bulbous nose, and is treated with a more aggressive laser, Dr. Goldberg notes.