Eliminating rosacea with vascular laser treatment?

There are three different types of vascular lasers: the pulsed dye laser, the KTP laser, and the Nd-Yag laser. The goal is to destroy the blood vessels responsible for skin defects.

• The Pulsed Dye Laser: This laser targets red vessels with its wavelength around 595 nm, allowing for good absorption of oxyhemoglobin, a combination of hemoglobin with oxygen. The laser light will be absorbed by the oxyhemoglobin contained in the blood of the vessels to treat effectively all the blood vessels involved in the concerned lesions. The energy of the light radiation will transform into heat with the aim of breaking down the walls of the capillaries. Thus, it will be possible to select the vessels that one wishes to destroy.

  An epidermal cooling step is necessary to prevent skin burns. Often, the laser is coupled with a cooling system. The size of the impacts and the pulse durations are variable. Generally, the shorter the pulse duration, the more it will act on fine blood vessels. The longer the pulse duration, the more effective it can be on telangiectasias. One or more sessions may be necessary depending on the lesions. Sometimes, bruises or purpuras may appear after this type of treatment but they eventually disappear on their own.

• The KTP Laser: This laser has a beam with a wavelength of 532 nm. The duration of the pulses is rather long, which allows it to be effective on significant telangiectasias. The size of the impacts varies from 1.2 mm to 10 mm, allowing for quicker treatment of larger areas. The application of a gel is necessary to protect and cool the epidermis. Two to six sessions are needed to observe a 60 to 80% improvement in rosacea.Some redness and slight swelling may persist up to 6 days after the session.

• The Nd-Yag Laser: This is a solid-state laser composed of a yttrium aluminum garnet (YAG) crystal doped with a neodymium ion. This laser, with a beam wavelength of 1,064 nm, has good skin penetration. It is used at long pulse durations and is effective for the treatment of violet or bluish telangiectasias. Two to three sessions are typically required for this type of laser. Short-term side effects include the appearance of redness (erythema), itching, and swelling (edema).

Thanks to the immediate effects of laser treatment, unsightly dilated vessels fade instantly, providing lasting results. It can reduce redness by several degrees. Moreover, it does not require anesthesia. However, it is important to note that rosacea is often a chronic condition, so new dilated blood vessels may form over time. Therefore, although vascular laser treatment can offer lasting results, it may be necessary to schedule follow-up sessions to treat any new blood vessels that appear.

There are precautions to be taken during the treatment period. Generally, the session proceeds in the following manner:

• Before the session, the patient should not take photosensitizing medications such as antibiotics or anti-inflammatories. These types of medications make the skin more sensitive and it can react excessively to light, which can increase the risk of burns, hyperpigmentation, or other complications during a vascular laser treatment. The patient should also avoid sun exposure 2 weeks prior to the session.

• The patient should not be wearing makeup at the time of treatment in order not to reduce its effectiveness.

• Protective pads or goggles will be applied for each session, which lasts approximately fifteen minutes. These goggles serve to shield the eyes from the laser's radiation which can cause severe and irreversible damage to ocular tissues, including the cornea, retina, and lens.

• It is necessary to avoid sun exposure for a month after a laser session and to regularly protect your skin with a sunscreen of SPF 50 during sunny periods. Indeed, after a laser session, the skin tends to be more sensitive and vulnerable. Therefore, it is important to protect it to prevent the appearance of redness, sunburns...

The contraindications for laser treatment of rosacea also include pregnancy, untreated skin tumors, recent exposure to the sun, and a herpes outbreak in the area to be treated.

Indeed, pregnancy is a period during which the body undergoes numerous hormonal and physiological changes that can affect skin reactivity and tolerance to treatments. Furthermore, data on the effects of vascular laser on the fetus are limited, and as a precaution, it is preferable to avoid any non-essential laser treatment during pregnancy. Additionally, this treatment is not recommended after recent sun exposure, particularly on tanned skin, as melanin quickly absorbs the laser, which can cause burns and spots.

• DAHAN S. Prise en charge par laser et lampes pulsées de la couperose et de la rosacée. Annales de Dermatologie (2011).