▸ Lasers and light-based therapy. These excel where pharmacotherapy is weakest: rosacea involving severe erythema and telangiectasias. In addition, the CO2 and other ablative lasers are highly useful for removal of rhinophymas and prevention of recurrences, Dr. Baldwin said.
Vascular lasers make a great deal of sense for erythematous/telangiectatic forms of rosacea because they cause vascular destruction without collateral tissue damage.
Polychromatic light of multiple wavelengths from yellow to infrared has been used with great success in rosacea. Large areas are easily treated using this method.
This form of therapy doesn't result in purpura, and patients are quite happy with the results, but a good deal of individual tailoring is required to target multiple chromophores at different skin depths, she explained.
Photodynamic therapy with either a polychromatic or monochromatic light source along with a photosensitizing agent preferentially targets sebaceous glands, but treats papulopustular forms of rosacea as well—and offers the side benefit of improved skin quality.
Erbium:YAG lasers and nonablative lasers are believed to work in rosacea by inducing proliferation of fibroblasts and endothelial cells, Dr. Baldwin said.
She is a consultant to CollaGenex Pharmaceuticals Inc., which is developing Oracea.
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'By treating a nonbacterial disease with antibiotics, we're adding to the problem.' DR. BALDWIN