Safety of Combination Laser or Intense Pulsed Light Therapies and Doxycycline for the Treatment of Rosacea

Efficacy of fractional radiofrequency in the treatment of erythematous capillary rosacea: A split-face study

OBJECTIVE

To assess the effectiveness and safety of treating erythematotelangiectatic rosacea using fractional radiofrequency (FRF).

METHODS

Twenty patients with a confirmed diagnosis of erythema capillaris rosacea were selected, and one side of each patient's face was randomly assigned to receive FRF treatments for three to six times, with an interval of 2 weeks between each treatment. VISIA, dermoscopy, and the Clinician's Erythema Evaluation Scale (CEA) were applied to evaluate the efficacy of the treatment before and after the treatment, to record the VAS scores and adverse reactions, and to conduct a patient satisfaction survey.

RESULTS

The characteristic counts and scores of red zone and porphyrin as assessed by VISIA test were significantly decreased, and the difference between the treated side and the pretreatment side was statistically significant (p < 0.05), and the efficacy of the treatment was statistically insignificant compared with the control side, except for the red zone and porphyrin which were statistically significant before and after the treatment (p > 0.05). By CEA score, the difference between the treated side after treatment and the control side was statistically significant (p < 0.05), and the difference between the treated side before and after treatment was statistically significant (p < 0.05); the difference between the control side before and after treatment was not statistically significant (p > 0.05). Dermatoscopic observation showed reduction in pore size, reduction of yellowish-white and black horn plugs within the pores, lightening of the red background and thinning and blurring of the capillary structure on the treated side of the skin compared to the control side, and the skin on the treated side showed the above mentioned changes before and after the treatment as well. The mean pain score of the subjects was obtained by VAS score 3.67 ± 0.90. Adverse effects included mild edema, erythema, and microscopic crusting; no long-term adverse effects were seen in all patients. The efficacy of FRF treatment was evaluated 1 month after the final treatment, and 85% of the subjects rated it as satisfactory, very satisfactory, and very satisfactory.

CONCLUSION

FRF for the treatment of erythematous capillary dilatation rosacea is effective, safe, and suitable for clinical promotion.

Intense pulsed light treatment for the management of meibomian gland dysfunction

PURPOSE OF REVIEW

Meibomian gland dysfunction (MGD) is one of the most common disorders encountered by ophthalmologists, and its management can prove challenging for both clinicians and patients. Intense pulsed light (IPL), which has been historically used in the field of dermatology, has emerged as a tool to help improve meibomian gland function. The goal of this review is to assess the clinical efficacy, utility, and safety of IPL for the treatment of MGD.

RECENT FINDINGS

In recent randomized controlled trials, IPL has been shown to improve meibomian gland function, and subsequently tear film quality and dry eye symptoms. The mechanism of action still remains unclear. Recent literature suggests that IPL may also be used in conjunction with other therapies, such as meibomian gland expression, low-level light therapy, and thermal pulsation. Careful attention should be placed on each patient's Fitzpatrick skin type, as well as protecting the ocular structures to reduce the risk of adverse effects. Cost, accessibility, as well as a limited duration of efficacy may be drawbacks.

SUMMARY

There is significant evidence supporting that IPL may be used as a potential well tolerated and effective treatment for MGD, though there are certain caveats regarding its long-term efficacy, accessibility, and cost.

Treatment of sensitive skin by short-wave radiofrequency combined with intense pulsed light

BACKGROUND

Sensitive skin is a widespread dermatologic condition, and no optimal treatments have been established so far.

OBJECTIVE

To investigated the efficacy and safety of the combined therapy of short-wave radiofrequency (SWRF) and intense pulsed light (IPL) in improving transepidermal water loss (TEWL) and facial erythema in sensitive skin patients.

METHODS

Twenty-two patients with sensitive skin received the SWRF treatment once per week for 4 weeks and IPL treatment once. Digital photographs and three-dimensional images were taken at each follow-up. The clinical efficacy was evaluated by the improvement of sensitive scale-10 including irritant symptoms and facial erythema. In addition, erythema area and TEWL values were measured.

RESULTS

All patients showed subjective and objective improvement in irritant sensations and facial erythema after treatment. The TEWL values decreased from 20.29 ± 5.97 g·h^-1 ·m^-2 at baseline to 14.70 ± 6.02 g·h^-1 ·m^-2 after SWRF treatment and 13.78 ± 4.70 g·h^-1 ·m^-2 after combined therapy (p = 0.000). The clearance of the erythema area was statistically significant, with 14.05% ± 5.71% at baseline, 9.38% ± 4.08% after SWRF treatment, and 5.73% ± 2.79% after combined therapy (p = 0.000). No adverse events were observed.

CONCLUSIONS

The combination of SWRF with IPL was effective in relieving skin irritant sensations and facial erythema of sensitive skin by repairing skin barrier function.

Lasers for cutaneous lesions: An update

There are several types of medical settings which use lasers. Dermatologists use lasers as it is non-invasive with preferential cosmetic outcomes and finer wound healing. The types of lasers are relying on their wavelengths and delivery systems. Over time, by using several distinct devices and strategies, new lasers have been generated; as a consequence, they are manipulated in a wide range of dermatological settings. In this review, laser applications in various vascular, infectious, and hyperpigmented cutaneous lesions were framed. We aimed to represent the fitness of phototherapy for each condition as well as the overall challenges that face laser. In addition, low-level laser therapy, and laser resurfacing were noted as the marketable line of lasers in the current time for cosmetic purposes.

Efficacy Comparison of Pulsed Dye Laser vs. Microsecond 1064-nm Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Rosacea: A Meta-Analysis

Purpose

The advantage of pulsed dye laser (PDL) for the treatment of rosacea is not yet clear. This meta-analysis compared the curative effect of PDL to neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for the treatment of rosacea.

Methods

The PubMed, Embase, and Cochrane Library databases were searched for clinical studies on the efficacy of PDL for the treatment of rosacea through October 13, 2021, and heterogeneity tests among studies were evaluated. Meta-analysis was conducted to combine the effects of physicians' clinical assessments, patient global assessment, erythema index, and visual analog scale.

Results

A total of 326 articles were obtained from three databases and ten articles were finally included. The clinical improvements of >50% clearance of up to 68.6% in the PDL group and 71.4% in the control group, and the subjective satisfaction rate of patients in the PDL group of 88.6% compared to 91.4% in the Nd:YAG group, but there were no significant differences in the rates of patients with rosacea with clinical improvement (>50% clearance) (relative risk [RR] = 0.94, 95% confidence interval [CI]: 0.75–1.17, P = 0.578) or patient subjective satisfaction rate (RR = 0.96, 95% CI: 0.70–1.33, P = 0.808) between PDL and Nd:YAG groups for rosacea treatment. Also, the pain score for PDL and Nd:YAG were not significant (mean = 3.07, 95% CI: 1.82–4.32, P = 0.115).

Conclusion

Two treatments all showed clinical efficacy and patient satisfaction for the treatment of rosacea, with no significant differences observed between treatments. The pain scores for PDL and Nd:YAG were not significant.

Comparison of intense pulsed light and near-infrared light in the treatment of dry eye disease: a prospective randomized study

PURPOSE

To compare the efficacy of intense pulsed light (IPL) and near-infrared light (NIL) treatments in alleviating symptoms and signs of dry eye disease (DED).

METHODS

Patients diagnosed with DED at the Peking University Third Hospital Eye Center from January 2019 to October 2019 were randomized to undergo either NIL therapy combined with meibomian gland expression (MGX; NIL Group) or IPL combined with MGX (IPL Group). Treatments were performed three times at 1-month intervals. DED signs and symptoms were evaluated before every treatment. We compared the clinical improvement within and between the groups. Additional comparisons were made according to the meibomian gland (MG) dropout grade.

RESULTS

A total of 260 eyes of 130 patients (mean age, 49.68 ± 18.01 years) were included. The dryness and total symptom scores and the MG expressibility and secretion quality (upper and lower eyelids) significantly improved after the three treatments in both groups (p < 0.05). However, IPL had superior efficacy in improving blurred vision, photophobia, burning, increased secretions and the total symptom score at 2 months in patients with more severe MG dropout.

CONCLUSIONS

Both IPL and NIL treatments were effective in the treatment of DED, but IPL provided greater symptom improvement, particularly in patients with severe MG dropout. NIL can be a new therapeutic option for the treatment of DED.

Use of Botulinum Toxin in Treating Rosacea: A Systematic Review

Background

Rosacea is a chronic skin disorder characterized by erythema, flushing, telangiectasia, papules and pustules, phymatous changes, and ocular involvement. The aim of this study was to examine all published research articles in which botulinum toxin was used to treat rosacea and to evaluate the efficacy and safety of this treatment.

Methods

PubMed, Embase, Cochrane Library, and Web of Science database were used to identify articles eligible for systematic review on March 26, 2021. Prospective or retrospective studies which directly used botulinum toxin to treat rosacea were included and reviewed.

Results

Nine studies were included in this systematic review. Two were randomized controlled trials, graded as Level 2 for the quality of evidence. The total number of participants was 130, and the number of participants in each study ranged from 1 to 25. The improvement was observed in all studies in signs and symptoms compared with baseline. Adverse events were transitory and self-limited.

Conclusion

Botulinum toxin could have overall satisfying efficacy and safety in the treatment of rosacea, though limited by small sample size, imperfect study design, and short follow-up visits.

Laser and light-based therapies in the management of rosacea: an updated systematic review

Unlike other rosacea therapies which need daily takings or applications over long periods, the edge of lasers and light-based therapies (LLBT) is the limited number of sessions to achieve improvement. The proper selection of the adequate physical device in accordance with the patients' skin features and rosacea-related signs and symptoms should be considered and the management with physical sources should be updated as new data become available. This article reviews and discusses the current use of lasers and light-based therapies in rosacea with reference to all the available literature.This systematic review demonstrates the quality of evidence to support any recommendation on LLBT in rosacea is low-to-moderate. Among all the available devices, PDL holds the most robust evidence. Treatments options should be tailored for each specific clinical scenario as it is unlike that single modality results in complete resolution. Platforms that include two or more devices and combined therapies with topical agents are suitable and they warrant further investigations.