Electrosurgery or Electrodesiccation: What is this new procedure being proposed to treat rosacea?

E'lectrosurgery is a surgical technique that utilises the heat generated by a high-frequency electric current passing through biological tissues. It is used therapeutically to coagulate, vaporise, cut or destroy tissues. Electrosurgery is employed in various types of surgical procedures, including orthopaedic surgery, reconstructive surgery and dermatological surgery. It should be noted that electrosurgery generators typically operate within a frequency range of 200,000 kHz to 5 MHz. Sensitive tissues do not depolarise at frequencies higher than 10,000 Hz, hence the application of high frequency is crucial to avoid acute pain.

Several electrodes are required to perform electrosurgery. Often, the practitioner applies the active electrode to the area to be treated. The dispersive electrode is placed elsewhere on the patient's body to complete the electrical circuit. The electric current generated in the form of an electron flow thus passes through the tissues, which act as a resistance according to their water content. This resistance allows the conversion of electrical energy into thermal energy. The increase in temperature of the tissues traversed results in their coagulation.

In the context of rosacea, electrodessication causes the instant coagulation of facial blood vessels, which helps to reduce the redness characteristic of this dermatosis. The telangiectasias, or dilated blood vessels, are also targeted and their diameter is reduced. The electro-surgery procedure is generally quick and only requires local anaesthesia, or even no anaesthesia at all in some cases. It provides the practitioner with precise control at the target tissue level, which reduces the risks of bleeding and damage to surrounding tissues.

Electrosurgery is a minimally invasive procedure, subsequently allowing for a swift recovery of patients.

The number of electro-surgery sessions required to treat rosacea varies depending on the severity of the disease and the individual's response. Generally, several sessions, spread over several weeks, are required. Electro-surgery is particularly beneficial for patients suffering from telangiectasia, the vascular form of rosacea. It is also used to treat patients with rhinophyma ranging from moderate to severe.

Electrosurgery has indeed demonstrated good efficacy during a recent clinical trial conducted on patients suffering from moderate to severe forms of rhinophyma. In total, seven individuals aged between 40 and 69 were treated, and the results were very satisfactory for all these patients. Electrosurgery allowed a return to their original nasal shape while maintaining a good condition of the cartilage. Thus, patients were able to regain a certain level of comfort. As for side effects, only 3 patients exhibited minor scarring post-operation.

Rosacea and Electro-surgery: Special Precautions for Use?

Electrosurgery treatment can present side effects due to the high current it utilises. This technique can particularly expose one to a risk of cartilage necrosis, a complication that remains relatively rare. Regarding post-operative care, recommendations are tailored to each patient but generally include good skin hydration, to support healing, as well as the daily application of sun protection. This latter advice helps to prevent the risks of post-inflammatory hyperpigmentation. Finally, it should be noted that particular vigilance is recommended for people with dark skin as they may exhibit pigmentation disorders following the treatment.

Electrosurgery must always be performed by a healthcare professional. When carried out at home, this treatment poses high risks of infection, bleeding, and cartilage necrosis.

• MILES J. & al. Electrosurgery. Surgery Oxford (2011).

• WILLIFORD P. & al. Electrosurgery. Journal of the American Academy of Dermatology (2014).

• LEHMANN P. & al. Physical modalities for the treatment of rosacea. Journal of the German Society of Dermatology (2016).

• MOTTA A. & al. Electrosurgery for the treatment of moderate or severe rhinophyma. Actas Dermo-Sifiliograficas (2018).