Rosacea is a chronic skin condition affecting the aesthetic appearance of the skin. It affects both men and women, predominantly those between 30–50 years of age. The degree of severity varies from mild flushing to severe telangiectatic lesions depending on the subtype of this condition.
Presentation varies in the early stages from symptoms of blushing and erythema to dilated blood vessels of 0.1–1.5 mm in diameter, otherwise known as telangiectasias. In the later stages, symptoms may be triggered by excessive sun exposure, emotional triggers, spicy foods, wind, hot or cold water, alcohol, oral contraceptive pills, hormonal influence, or topical corticosteroids.
The erythematotelangiectatic variation can often be accompanied by burning or stinging, with affected areas of the face appearing rough to the touch due to the low grade dermatitis.
Some theories propose the causes of rosacea are neurogenic and vasogenic in origin. Patients with rosacea have also been noted to have defective skin barriers and increased transepidermal water loss in the skin. A deposition of cathelicidin-derived peptides caused by serine protease activity may play a role in the inflammatory process. The integrity of blood vessels is reduced by the action of elastase, which degrades extracellular matrix and type IV collagen and the reduction of upper dermal connective tissue results in passive dilation of the vasculature, causing telangiectasia.
Several treatments are available for rosacea. Topical and oral medications include topical metronidazole, benzoyl peroxide, tetracyclines such as doxycycline and isotretinoin for treating inflammatory lesions, and topical vitamin C preparations to help protect against free radical production in inflammation.
The mainstream treatment for rosacea is lasers. The intense pulse light (IPL) laser uses photothermolysis and specific wavelengths to selectively destroy blood vessels. Energy density is customised based on the lesion being treated. Light wavelengths in the range of 500–1200 nm are emitted with larger vessels requiring higher fluences of between 50–75 J/cm2, while smaller vessels can be successfully treated at fluences ranging from 25–45 J/cm2. Pulses are delivered as single, double, or triple with each pulse lasting 2–25 ms for larger vessels. Pulse durations should be maintained between 0.5–88.5 ms with an interval ranging from 10–500 ms. The IPL laser can allow a large surface area to be treated. With pulse delays and the ability to adjust the number of pulses delivered, the skin can be cooled between pulses preventing adverse effects from occurring, such as burning of the skin or pigmentation changes.
Retrospective studies have found IPL treatment to be a safe and effective treatment for the symptoms of redness, flushing, and telangiectasias, while also improving skin texture and resulting in fewer acneiform breakouts with virtually no adverse effects. On average, relief of symptoms was seen after seven treatment sessions. Set at specific parameters and customised according to patient skin type, severity of rosacea, and tolerance to treatment, IPL therapy can help patients achieve a relief from symptoms. Overall, IPL treatments can provide long lasting results with no downtime, making this an excellent choice for treating rosacea.