Laser and Pulsed Light: Alternatives Against Rosacea?

Laser and Intense Pulsed Light (IPL) are two aesthetic dermatology methods with a mode of operation quite similar. Indeed, both are based on the principle of selective photothermolysis, which specifically targets dilated blood vessels responsible for the redness associated with rosacea. The difference lies in the type of light emitted : monochromatic for the laser and polychromatic for the IPL.

From a technical standpoint, the laser utilises a single type of wavelength, which allows it to selectively target dilated blood vessels without damaging the surrounding tissues. In contrast, pulsed light emits a range of wavelengths between 500 and 1200 nm, which can result in less specific absorption and adverse effects on the surrounding tissues. This is why the laser is generally preferred. Moreover, the laser can be used on all phototypes unlike pulsed light, which is only recommended for individuals with very fair to slightly tanned skin.

Note : laser and pulsed light sessions are not recommended for pregnant women. The data regarding the effect of these techniques on foetal development is limited, hence the principle of caution applies. Furthermore, during pregnancy, women are more prone to pigmentation disorders (and the infamous pregnancy mask) due to the hormonal upheavals they experience. To avoid them, it is preferable to avoid laser and pulsed light sessions.

Rosacea is a dermatosis that is a chronic and rather complex condition. The initial clinical signs of rosacea are the emergence of a diffuse redness, typically in the centre of the face, accompanied by tingling, hot flushes, and an increased sensitivity of the skin. These symptoms are the result of the dilation of blood vessels on the skin's surface, also referred to as telangiectasias. The origins of rosacea are still not fully understood, but genetics, stress, heat, or even the consumption of spicy foods could play a role. This disease can worsen over time without appropriate management and can notably cause a skin rash or affect the eyes. That's why it is very important to consult a dermatologist at the first signs.

It is possible to improve rosacea, which corresponds to the first stage of rosacea, and to reduce redness with sessions of laser or pulsed light. Painless and quick, several studies have demonstrated the effectiveness of these techniques in reducing symptoms and spacing out flare-ups. However, it is important to emphasise that a laser or pulsed light intervention does not guarantee a permanent cure and a recurrence remains possible. The choice of laser used to manage rosacea depends on the diameter of the vessels and the size of the area concerned. It often proves useful to combine several devices during the same session. Furthermore, 2 to 6 sessions depending on the extent of the rosacea are necessary. The table below summarises the main lasers used to treat rosacea.

A session of laser or pulsed light treatment is not insignificant and it is important to follow certain precautions before, during and after the treatment.

• How to prepare for a laser or pulsed light session?

  Before undergoing a session of laser or pulsed light treatment, it is crucial that the patient does not take any photosensitising medication, that is, drugs that increase the skin's sensitivity to light. Indeed, certain antibiotics or anti-inflammatory drugs possess this property and can heighten the risk of burns or hyperpigmentation during the session. Furthermore, it is advised against exposing oneself to the sun in the two weeks leading up to the appointment.

• What precautions should be taken during a session of laser or pulsed light treatment?

  During a laser or intense pulsed light session, it is crucial to protect the patient's eyes. This is particularly true if the redness to be treated is located on the face. Indeed, the rays from the laser or intense pulsed light can cause severe and irreversible damage to the cornea, retina, lens, and other ocular tissues. That's why protective pads or glasses are always provided to the patient. Furthermore, it is recommended for the patient to not wear makeup, in order not to reduce the effectiveness of the laser or intense pulsed light treatment.

• What should be done after a session of laser or pulsed light treatment?

  Following a session of laser or pulsed light treatment, the skin tends to be more sensitive and vulnerable. It is therefore important to hydrate and nourish it daily with a suitable skincare product. Opt for rich textures with humectants such as glycerine, aloe vera or panthenol, and ensure that the cream is non-comedogenic, meaning it is not likely to cause the appearance of comedones. Finally, in the month following the laser or pulsed light session, it is necessary for the patient to avoid sun exposure and to protect their skin with a sun care product of SPF 50 during sunny periods.

• SAURAT J.H., LIPSKER D., THOMAS L., BORRADORI L., LACHAPELLE J.M. Dermatology and Sexually Transmitted Infections. Elsevier Masson (2017).

• STEINHOFF M. & al. Recent advances in understanding and managing rosacea. F1000 Research (2018).

• TAN J. & al. Rosacea: New Concepts in Classification and Treatment. American Journal of Clinical Dermatology (2021).

• ALI F. & et al. Rosacea. British Journal of Hospital Medicine.(2021).