Is it safe to initiate vascular laser therapy in a patient with rosacea (acne rosacea) experiencing a pustular flare?

From the Guidelines

It is not recommended to start vascular laser treatment in a rosacea patient experiencing an active pustular flare, as this may exacerbate inflammation and worsen symptoms. The best approach is to first control the inflammatory component with appropriate medications, such as oral antibiotics (doxycycline 40-100mg daily or minocycline 50-100mg daily for 4-12 weeks) or topical agents like metronidazole 0.75-1% gel/cream, ivermectin 1% cream, or azelaic acid 15-20% applied once or twice daily, as suggested by the global rosacea consensus (ROSco) panel 1.

Key Considerations

• The ROSco panel recommends a phenotype-led treatment algorithm, which considers each feature and its severity individually, and bases decisions on this assessment 1.
• Oral doxycycline is considered a viable treatment option for all severities of inflammatory papules/pustules, and can be used at a dosage of 40-mg modified-release (MR) dose, which has anti-inflammatory but not antibiotic activity 1.
• Topical agents like metronidazole, ivermectin, and azelaic acid can be used to control the inflammatory component, and are considered first-choice options for the treatment of mild to moderate rosacea 1.

Treatment Approach

• Once the pustular component has resolved and only the erythema and telangiectasias remain, vascular laser therapy (such as pulsed dye laser or Nd:YAG) can be safely initiated, as the risk of adverse effects is reduced and the treatment efficacy is improved.
• General skincare, including sun protection factor 30+, moisturizers, gentle cleansers, and trigger avoidance, should be maintained throughout the treatment period, as recommended by the ROSco panel 1.
• The treatment approach should be tailored to the individual patient's expression of concern and desire for treatment, and should take into account the patient's specific needs and circumstances 1.

From the Research

Safety of Vascular Laser in Rosacea Patients with Pustular Flare

• The use of vascular laser in rosacea patients, particularly those with pustular flare, is a topic of interest in dermatology 2, 3, 4, 5, 6.
• According to the studies, vascular lasers and light-based therapies are recommended for the treatment of telangiectasias and erythema in rosacea patients 2, 4, 6.
• However, there is limited information on the safety of starting vascular laser in rosacea patients with pustular flare.
• One study suggests that laser or light-based treatment can be used for telangiectasias, but it does not specifically address the safety of using vascular laser in patients with pustular flare 5.
• Another study recommends the use of vascular lasers and light devices for telangiectases, but it does not provide information on the safety of using these treatments in patients with pustular flare 6.

Treatment Options for Rosacea Patients with Pustular Flare

• The treatment of rosacea patients with pustular flare typically involves the use of topical or oral antibiotics, such as metronidazole, azelaic acid, or doxycycline 2, 3, 4, 5, 6.
• Topical ivermectin has also been shown to be effective in reducing the severity of papulopustular rosacea 5.
• In some cases, oral isotretinoin may be used for the treatment of severe rosacea, but its use is typically reserved for patients who have not responded to other treatments 5, 6.

Considerations for Using Vascular Laser in Rosacea Patients

• When considering the use of vascular laser in rosacea patients, it is essential to weigh the potential benefits against the potential risks 2, 3, 4, 5, 6.
• Patients with pustular flare may be at increased risk of adverse effects, such as worsening of the pustules or post-inflammatory hyperpigmentation 5.
• Therefore, it is crucial to carefully evaluate the patient's condition and medical history before starting vascular laser treatment 2, 3, 4, 5, 6.