How to Treat Rosacea Properly

What is Rosacea?

Rosacea can occur on any type of skin, mostly starting in adolescence, and is typically characterized by transient or persistent erythema, telangiectasias, papules, and pustules on the central part of the face.

The pathogenesis of rosacea is a multifactorial, genetically based, chronic inflammatory dermatological disorder characterized by natural immune and vasodilator dysfunctions associated with altered innate immune responses, vascular and neurological dysfunctions, multiple microbial infections, and impaired skin barrier function. Currently, medically identified triggers include consumption of spicy and irritating foods, alcohol consumption, emotional stress, helminthic mite infections, heat or cold stimuli, and ultraviolet light.

Rosacea is characterized by episodic flushing of the skin, erythema and telangiectasias, papules, and pustules. In some patients, hyperplasia of the sebaceous glands and connective tissues may result in thick nodules and patches on the nose or jaw, cheeks, and forehead.

We can divide rosacea into three types as follow, depending on the location, period, and lesion characteristics of our clients,

1. Erythema telangiectasia (typeⅠ)

This is the most common type of rosacea and is characterized by erythematous flushing and persistent telangiectasias on the face, predominantly around the nose and midface, and can involve the cheeks and forehead. Initially, it usually presents with paroxysmal flushing of the cheeks bilaterally, which can be triggered or made worse by emotional stress, changes in environmental temperature, or sun exposure, with varying degrees of skin sensitivity.

After several months of recurring symptoms, there may be a gradual onset of persistent erythema or telangiectasia, culminating in type I rosacea.

2. Papules (Type Ⅱ)

In the erythematous and telangiectatic clients, some patients may gradually develop papules, pustules, most often on the cheeks, or both erythema, papules, and pustules, most often on the periorbital or nasal areas.

3. Granulomatous proliferation (Type Ⅲ)

The third type of rosacea is based on erythema, telangiectasia, and as the sebaceous glands become hypertrophied, there may be progressive fibrosis, manifesting as hypertrophic proliferative changes in the lesions.

How to treat Rosacea?

The first step in treating rosacea is to avoid all external triggers that tend to irritate the client, along with a combination of photorejuvenation products, including topical applications, oral medications, and laser physical therapy. Although antibiotics and topical medications have been shown to be effective in treating the inflammatory lesions of rosacea, traditional treatments are often ineffective when it comes to erythema and telangiectasia. A variety of laser technologies have been used to treat rosacea with good results. Common devices include the 1927nm thulium laser, IPL, and CO2 fractional laser.

1. Erythema telangiectasia (typeⅠ) treatment

LED red and blue light therapy

For recurrent flushing, erythematous lesions, other photoelectric treatments may induce or aggravate erythema, papules and pustules as they may reduce the skin barrier function to varying degrees. Therefore, LED red light therapy can be preferred, and after the lesions are stabilized, other laser treatments can be used to improve capillary dilation.

1927nm thulium fractional laser is the preferred treatment device for most clients with erythema telangiectasia symptoms, with good efficacy, fast onset of action and less susceptibility to post-operative adverse reactions such as discoloration, purpura and crusting.

Because the blood water in the capillaries to the 1927nm light wave absorption peak of 120, has a very good penetration depth and dermal photothermal effect, without damaging the epidermal tissue, can kill the pores of creeping mites, stimulate the skin to produce self-healing mechanism, reduce capillary expansion, anti-inflammatory effect is very good. For most of the type I customers, the energy of 3-4mJ, pulse width 1-2ms has good tolerance, 2*2cm light spot area, can focus on the location of the nose for multiple treatments.

IPL Intense Pulsed Light is a non-coherent, pulsed, broad spectrum light in the wavelength range of 420-1200nm, with adjustable pulse interval and pulse width. The targets are hemoglobin, water, and melanin particles, which can improve erythema and capillary dilation while inhibiting sebum production and stimulating collagen regeneration. Intense pulsed light has a large spot area, thus treating larger lesions quickly and with minimal post-operative response and short downtime, for multiple long-term treatments.

In recent years, with the continuous development of IPL technology, narrow-spectrum intense pulsed light has emerged as a good solution to the vascular and pigment selectivity challenge. This technology, also known as precision light technology (DPL), shortens the broad spectrum of intense pulsed light to 500-600 nm with two oxygenated hemoglobin absorption peaks (shown in the figure below), combining the advantages of dye pulsed laser and intense pulsed light, solving the problem of laser treatment prone to purpura, scabbing and the spectral imprecision of intense pulsed light, and achieving satisfactory therapeutic efficacy in clinical applications.

2. Papules (Type Ⅱ) treatment

With the same application of the above methods, LED light, thulium laser and IPL have been found to improve inflammatory papules and pustules. In addition, research has shown that IPL, dye laser, radiofrequency and photodynamic methods can improve acne-like lesions.

In addition, pimple-like rosacea is mainly an antibacterial treatment to kill the helminthic mites (follicle mites) that live in our sebaceous glands and hair follicles, so in addition to laser treatment, we also need to take oral doxycycline or minocycline, topical metronidazole cream, and fusidic acid cream.

3. Granulomatous proliferation (Type Ⅲ) treatment

The third type falls into the ultimate style of rosacea, and this is where we have to use the CO2 fractional laser, which is able to remove hypertrophic proliferative tissue through a vaporized exfoliation action, as well as destroy and seal the thick proliferative blood vessels, thus further preventing tissue growth.