What are the available treatments for rosacea?

The first form of rosacea, couperose is characterised by widespread and diffuse redness on the face caused by a significant dilation of the blood vessels in this area. The redness can also be accompanied by increased skin sensitivity and hot flushes. The causes of couperose are numerous: they notably include genetic predisposition, exposure to heat and sun, stress, spicy food and parasitic colonisation. The prevalence of couperose is about 15% in women and 5% in men.

Rosacea is a chronic disease. The available treatments can only help to manage the symptoms.

One of the primary medications prescribed for rosacea is brimonidine. Brimonidine causes a constriction of the blood vessels, which are dilated in cases of rosacea, thus allowing a reduction in redness in about half an hour. From a mechanistic perspective, it triggers a stimulation of post-synaptic α-2 adrenergic receptors belonging to the sympathetic nervous system and involved in the processes of vasoconstriction/vasodilation. However, like any medication, the application of brimonidine can sometimes lead to side effects such as burning sensations or itching.

There are alternatives in the event that brimonidine, prescribed as a first-line treatment, proves not to be effective enough or is poorly tolerated. Creams based on metronidazole or azelaic acid, molecules known for their anti-inflammatory and antibacterial actions, can be recommended as a second-line treatment. However, like brimonidine, these medications can only temporarily alleviate the symptoms of rosacea and are not capable of completely curing the dermatosis.

The use of laser treatments in the context of rosacea can help to diminish redness and the visibility of telangiectasias while reducing the risk of disease recurrence. There are several types of lasers available for treating rosacea, which can sometimes be used in combination. However, regular maintenance sessions are necessary to maintain the results achieved.

It is important to note that laser treatment sessions are not covered by Health Insurance, as they are considered to be performed for aesthetic purposes.

Treating Rosacea: The Benefits of Nd-YAG Laser.

The Nd-YAG laser is a relatively recent discovery in the treatment of rosacea. It is capable of emitting light at a specific wavelength of 1064 nm. This laser utilises the principle of thermocoagulation. A current is applied at the level of the blood vessels, producing intense heat which causes the blood within the vessels to coagulate. Due to the blue colour that blood vessels can present, they are particularly receptive to the Nd-YAG laser, whose wavelength absorbs this colour and penetrates deeply into the dermis. The Nd-YAG laser generally requires two to four sessions to achieve an optimal result. It is especially beneficial for vessels with a significant diameter.

How does the KTP laser work in the case of rosacea?

The KTP laser is a part of a subclass of YAG lasers often used in the treatment of rosacea. Its light emits a wavelength of 532 nm and its beam is green in colour. The rays of the KTP laser tend to be absorbed less deeply due to their shorter wavelength compared to that of the Nd-YAG laser. This is why the KTP laser is more suitable for treating small superficial vessels.

Unlike the Nd-YAG laser, the KTP laser utilises the principle of photocoagulation. It operates by selectively targeting pigments. Most of the time, it is haemoglobin, found in the blood. The KTP laser thus induces the coagulation of vessels by sealing them: this is referred to as controlled coagulation. Generally, three to four sessions are required for an optimal result.

The effects of Pulsed Dye Laser on rosacea.

This type of laser is commonly used in the treatment of rosacea. It emits light pulses at a modifiable wavelength of 585 to 595 nm. The pulsed dye laser operates in two distinct modes: thermocoagulation and photothermolysis. As with the Nd-YAG laser, thermocoagulation requires three to four sessions for optimal effectiveness.

Photothermolysis, on the other hand, results in the bursting and destruction of blood vessels through the application of light that transforms into intense heat. It is used for severe forms of rosacea as it is a fairly aggressive technique. Generally, one to two sessions are required. Photothermolysis can sometimes cause the appearance of purplish spots, which can persist for up to three weeks. The two modes used by pulsed dye lasers can be combined within a single session.

Laser sessions are preferably carried out in winter, during periods of low sunlight. Good skin hydration is necessary, as is the daily application of a sunscreen in the weeks following the sessions.

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

• BELASCO K. & al. The role of brimonidine tartrate gel in the treatment of rosacea. Clinical, Cosmetic and Investigational Dermatology (2015).

• KERROUCHE N. & al. Brimonidine gel 0.33% rapidly improves patient-reported outcomes by controlling facial erythema of rosacea: a randomized, double-blind, vehicle-controlled study. Journal of the European Academy of Dermatology and Venereology (2015).

• SCHÄFER G. & al. Improving treatment of erythematotelangiectatic rosacea with laser and/or topical therapy through enhanced discrimination of its clinical features. Journal of Clinical and Aesthetic Dermatology (2016).