https://doi.org/10.4081/ltj.2022.303

The effectiveness of flashlamp-pumped pulsed dye laser in conjunction with topical imiquimod treatment for rosacea

Vol. 29 No. 2 (2022)
Published: 27 December 2022
Laser Therapy, pulsed dye lasers, imiquimod, rosacea, flashlamp-pumped Pulsed-Dye Laser (PDL)
Abstract Views: 1606
PDF: 93
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Chen-Jen Chang
chengjen@h.tmu.edu.tw
Department of Plastic Surgery; Department of Plastic Surgery, School of Medicine, College of Medicine; Graduate Institute of Biomedical Optomechatronics; TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan;  Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, , Taiwan, Province of China.
Yen-Chang Hsiao
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, Province of China.
Ana Elena Aviña
Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Province of China.
Yu-Fan Chiang
Medical School, University of Queensland, Australia.

Rosacea is a chronic dermatosis with no cure. Our goal was to evaluate if the combination of flashlamp-pumped Pulsed Dye Laser (PDL) treatment with topical imiquimod could improve therapeutic outcomes. Fourty patients diagnosed with rosacea and aged between 16 and 53 years were assigned for three different types of treatment: i) PDL-only, ii) imiquimod-only, and iii) PDL + imiquimod. The PDL test sites received a single treatment with the VBeam laser (λ = 595 nm; spot size = 7 mm; tp = 1500 msec) at a dosage of 10 J/cm2 with cryogen spurt duration (30 msec) and the delay time (20 msec). For the test sites of PDL + imiquimod and imiquimod-only, the patients applied imiquimod topically to the test sites once a day for 1 month. Patients were followed-up at 1, 3, and 6 months. The primary efficacy was measured with a DermoSpectrometer. Patients were also monitored for adverse effects. Pair-wise analysis showed statistically significant differences between the blanching responses for the PDL + imiquimod and PDL-only and imiquimod-only treatments (p<0.005). Transient hyperpigmentation was noted in 5% (n=2) and 20% (n=8) of patients in the PDL + imiquimod and PDL-only treatment, respectively. Hyperpigmentation resolved spontaneously within 6 months. Permanent hypopigmentation or scarring was not observed. Superior blanching responses were obtained when using PDL + imiquimod than PDL-only or imiquimod-only treatment for rosacea. A larger number of patients are required to support the results of this study.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the national rosacea society expert committee on the classification and staging of rosacea. J Am Acad Dermatol 2002;46:584. DOI: https://doi.org/10.1067/mjd.2002.120625
Odom R, Dahl M, Dover J, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis 2009;84:97.
Taub AF, Devita EC. Successful treatment of erythematotelangiectatic rosacea with pulsed light and radiofrequency. J Clin Aesthet Dermatol 2008;1:37.
Katz B, Patel V. Photodynamic therapy for the treatment of erythema, papules, pustules, and severe flushing consistent with rosacea. J Drugs Dermatol 2006;5:6.
Kassir R, Kolluru A, Kassir M. Intense pulsed light for the treatment of rosacea and telangiectasias. J Cosmet Laser Ther 2011;13:216. DOI: https://doi.org/10.3109/14764172.2011.613480
Goldberg DJ. Lasers and light sources for rosacea. Cutis 2005;75:22.
Kelly KM, Nelson JS. Update on the clinical management of port wine stains. Lasers Med Sci 2000;15:220-226. DOI: https://doi.org/10.1007/PL00011320
Nelson JS. Selective photothermolysis and removal of cutaneous vasculopathies by pulsed laser. Plast Reconstr Surg 1991;88:723-731. DOI: https://doi.org/10.1097/00006534-199110000-00028
Fiskerstrand EJ, Ryggen K, Norvang LT, Svaasand LO. Clinical effects of dynamic cooling during pulsed laser treatment of port-wine stains. Laser Med Sci 1997;12:320-327. DOI: https://doi.org/10.1007/BF02767154
Van der Horst CMAM, Koster PHL, de Borgie, et al. Effect of the timing of treatment of port-wine stains with the flash-lamp-pumped pulsed dye-laser. N Engl J Med 1998;338:1028-1033. DOI: https://doi.org/10.1056/NEJM199804093381504
Yohn, JJ, Huff, JC, Aeling, JL, et al. Lesion size is a factor for determining the rate of port-wine stain clearing following pulsed dye laser treatment in adults. Cutis 1997;59:267-270.
Phung TL, Oble DA, Jia W, et al. Can the wound healing response of human skin be modulated after laser treatment and the effects of exposure extended? Implications on the combined use of the pulsed dye laser and a topical angiogenesis inhibitor for treatment of port wine stain birthmarks. Lasers Surg Med 2008;40:1-5. DOI: https://doi.org/10.1002/lsm.20599
Serrao VV, Paris FR, Feio AB. Genital vitiligo-like depigmentation following use of imiquimod 5% cream. Eur J Dermatol 2008;8:342-343.
Celwstin Schartz NE, Chevret S, Paz C, et al. Imiquimod 5% cream for treatment of HIV-negative Kaposi's sarcoma skin lesions: A phase I to II, open-label trial in 17 patients. J Am Acad Dermatol 2008;58:585-91. DOI: https://doi.org/10.1016/j.jaad.2007.11.005
Kouba DJ, Yip D, Fincher EF, Moy RL. Topical imiquimod in the treatment of a long-standing capillary malformation. Br J Dermatol 2007;157:1071-1072. DOI: https://doi.org/10.1111/j.1365-2133.2007.08181.x
Ho NT, Lansang P, Pope E. Topical imiquimod in the treatment of infantile hemangiomas: A retrospective study. J Am Acad Dermatol 2007;56:63-8. DOI: https://doi.org/10.1016/j.jaad.2006.06.011
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524-527. DOI: https://doi.org/10.1126/science.6836297
Change CJ, Nelson JS. Cryogen spray cooling and higher fluence pulsed dye laser treatment improve port wine stain clearance while minimizing epidermal damage. Drmatol Surg 1999;25:766-771. DOI: https://doi.org/10.1046/j.1524-4725.1999.99100.x
Nelson JS, Kimel S. Safety of cryogen spray cooling during pulsed laser treatment of selected dermatoses. Lasers Surg Med 2000;26:2-3. DOI: https://doi.org/10.1002/(SICI)1096-9101(2000)26:1<2::AID-LSM2>3.0.CO;2-S
Nelson JS, Majaron B, Kelly KM. Active skin cooling in conjunction with laser dermatologic surgery. Sem Cut Med Surg 2000;19:253-266. DOI: https://doi.org/10.1053/sder.2000.18365
BM Achauer, Chang CJ, VM Vander Kam: Management of hemangiomas of infancy：review of 245 patients. Plast Reconstr Surg 1997;99:1301-1308. DOI: https://doi.org/10.1097/00006534-199704001-00014
Chang CJ, Kristen M Kelly, Nelson JS. Cryogen spray cooling and pulsed dye laser treatment of cutaneous hemangiomas. Ann Plastic Surg 2001;46:577-583. DOI: https://doi.org/10.1097/00000637-200106000-00001
Chang CJ, Kelly KM, van Gemert MJC, Nelson JS. Comparing the effectiveness of 585-nm vs. 595-nm wavelength pulsed dye laser treatment of port wine stains in conjunction with cryogen spray cooling. Lasers Surg Med 2002;31:352-358. DOI: https://doi.org/10.1002/lsm.10102
Huang PS, Chang CJ: Cryogen spray cooling in conjunction with pulse dye laser treatment of port wine stains of the head and neck. Chang Gung Med J 2001;24:469-475.
Tan SR and Tope WD. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life. J Am Acad Dermatol 2004;51:592–9. DOI: https://doi.org/10.1016/j.jaad.2004.04.010
Tejasvi T, Sharma VK, Kaur J. Determination of minimal erythemal dose for narrow band-ultraviolet B radiation in north indian patients: comparison of visual and Dermaspectrometer readings. Indian J Dermatol Venereol Leprol 2007;73:97-9. DOI: https://doi.org/10.4103/0378-6323.31893
Wilkin J. A role for vascular pathogenic mechanisms in rosacea: implications for
patient care. Cutis 2008;82:100.
Aksoy B, Altaykan-Hapa A, Egemen D, et al. The impact of rosacea on quality of life: effects of demographic and clinical characteristics and various treatment modalities. Br J Dermatol 2010;163:719. DOI: https://doi.org/10.1111/j.1365-2133.2010.09894.x
Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol 2004;51:327. DOI: https://doi.org/10.1016/j.jaad.2004.03.030
Guarrera M, Parodi A, Cipriani C, et al. Flushing in rosacea: a possible mechanism. Arch Dermatol Res 1982;272:311. DOI: https://doi.org/10.1007/BF00509061
Wilkin JK. Effect of subdepressor clonidine on flushing reactions in rosacea. Change in malar thermal circulation index during provoked flushing reactions. Arch Dermatol 1983;119:211. DOI: https://doi.org/10.1001/archderm.1983.01650270029012
Craige H, Cohen JB. Symptomatic treatment of idiopathic and rosacea-associated cutaneous flushing with propranolol. J Am Acad Dermatol 2005;53:881. DOI: https://doi.org/10.1016/j.jaad.2005.07.021
Wilkin JK. Effect of nadolol on flushing reactions in rosacea. J Am Acad Dermatol 1989;20:202. DOI: https://doi.org/10.1016/S0190-9622(89)70022-0
Brunner RL, Aragaki A, Barnabei V, et al. Menopausal symptom experience before and after stopping estrogen therapy in the Women's Health Initiative randomized, placebo-controlled trial. Menopause 2010;17:946. DOI: https://doi.org/10.1097/gme.0b013e3181d76953
Rada G, Capurro D, Pantoja T, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev 2010;CD004923. DOI: https://doi.org/10.1002/14651858.CD004923.pub2
Hsu CC, Lee JY. Carvedilol for the treatment of refractory facial flushing and persistent erythema of rosacea. Arch Dermatol 2011;147:1258. DOI: https://doi.org/10.1001/archdermatol.2011.204
Hsu CC, Lee JY. Pronounced facial flushing and persistent erythema of rosacea effectively treated by carvedilol, a nonselective β-adrenergic blocker. J Am Acad Dermatol 2012;67:491. DOI: https://doi.org/10.1016/j.jaad.2012.04.017
Tan ST, Bialostocki A, Armstrong JR. Pulsed dye laser therapy for rosacea. Br J Plast Surg 2004;57:303 DOI: https://doi.org/10.1016/j.bjps.2004.02.011
Lonne-Rahm S, Nordlind K, Edström DW, et al. Laser treatment of rosacea: a pathoetiological study. Arch Dermatol 2004;140:1345. DOI: https://doi.org/10.1001/archderm.140.11.1345
Schroeter CA, Haaf-von Below S, Neumann HA. Effective treatment of rosacea using intense pulsed light systems. Dermatol Surg 2005;31:1285. DOI: https://doi.org/10.1097/00042728-200510000-00004
Dahl MV, Ross AJ, Schlievert PM. Temperature regulates bacterial protein production: possible role in rosacea. J Am Acad Dermatol 2004;50:266. DOI: https://doi.org/10.1016/j.jaad.2003.05.005
Glaich AS, Friedman PM, Jih MH, Treatment of inflammatory facial acne vulgaris with combination 595-nm pulsed-dye laser with dynamic-cooling-device and 1,450-nm diode laser. Lasers Surg Med 2006;38:177-80 DOI: https://doi.org/10.1002/lsm.20209

How to Cite

Chang, C.-J., Hsiao, Y.-C., Aviña, A. E., & Chiang, Y.-F. (2022). The effectiveness of flashlamp-pumped pulsed dye laser in conjunction with topical imiquimod treatment for rosacea. Laser Therapy, 29(2). https://doi.org/10.4081/ltj.2022.303
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.


Similar Articles

1 2 3 4 5 > >> 

You may also start an advanced similarity search for this article.