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Issues in Dermatology
This Expert Shares Problem-Solving Insights About a Challenging Rosacea Case.
May 2002
A 48-year-old woman presented with a history of flushing since, “as long as she could remember.” She specifically recalled her erythema bothering her as a teenager and that it had progressively worsened over the years. In her adult life, she said she managed to learn to live with her condition, but it was a factor in her daily life. She denied any specific food triggers, but noted significant exacerbation with minimal activity, including merely walking from her car to her desk at work. Her episodes were severe enough that her co-workers would often ask if she felt okay.
On physical examination, prominent telangiectasias were noted on the bilateral cheeks and nasal ala. The challenge was to decrease the erythema and telangiectasias of this woman’s face and to improve her quality of life.
Diagnosis
She was diagnosed with stage 1 rosacea. The erythema of this and of subsequent stages of rosacea is often very difficult to treat with topical or oral medications. Significant improvement usually requires surgical intervention with one of several laser or light sources.
Treatment
The patient was treated with the Photoderm VL system five times at 3-week intervals. The 515 nm filter and single pulse duration of three msec were utilized. The fluence ranged from 22 to 24 joules/cm2.
The photo above at left shows the patient at baseline. The photo above right, taken at the completion of treatment, reveals dramatic decrease in erythema and significant clearing of the telangiectasias of the right cheek. As a matter of contrast, one can appreciate no change in the nasal alar telangiectasias, which were not treated.
According to a survey conducted by the National Rosacea Society:
• 70% of rosacea sufferers have decreased self-esteem.
• 41% have avoided/canceled social engagements.
• 70% of patients with severe disease described adverse professional interactions.
• 36% missed work because of flares.
With today’s technological advances, we can dramatically improve the quality of our patients’ lives.
A 48-year-old woman presented with a history of flushing since, “as long as she could remember.” She specifically recalled her erythema bothering her as a teenager and that it had progressively worsened over the years. In her adult life, she said she managed to learn to live with her condition, but it was a factor in her daily life. She denied any specific food triggers, but noted significant exacerbation with minimal activity, including merely walking from her car to her desk at work. Her episodes were severe enough that her co-workers would often ask if she felt okay.
On physical examination, prominent telangiectasias were noted on the bilateral cheeks and nasal ala. The challenge was to decrease the erythema and telangiectasias of this woman’s face and to improve her quality of life.
Diagnosis
She was diagnosed with stage 1 rosacea. The erythema of this and of subsequent stages of rosacea is often very difficult to treat with topical or oral medications. Significant improvement usually requires surgical intervention with one of several laser or light sources.
Treatment
The patient was treated with the Photoderm VL system five times at 3-week intervals. The 515 nm filter and single pulse duration of three msec were utilized. The fluence ranged from 22 to 24 joules/cm2.
The photo above at left shows the patient at baseline. The photo above right, taken at the completion of treatment, reveals dramatic decrease in erythema and significant clearing of the telangiectasias of the right cheek. As a matter of contrast, one can appreciate no change in the nasal alar telangiectasias, which were not treated.
According to a survey conducted by the National Rosacea Society:
• 70% of rosacea sufferers have decreased self-esteem.
• 41% have avoided/canceled social engagements.
• 70% of patients with severe disease described adverse professional interactions.
• 36% missed work because of flares.
With today’s technological advances, we can dramatically improve the quality of our patients’ lives.
A 48-year-old woman presented with a history of flushing since, “as long as she could remember.” She specifically recalled her erythema bothering her as a teenager and that it had progressively worsened over the years. In her adult life, she said she managed to learn to live with her condition, but it was a factor in her daily life. She denied any specific food triggers, but noted significant exacerbation with minimal activity, including merely walking from her car to her desk at work. Her episodes were severe enough that her co-workers would often ask if she felt okay.
On physical examination, prominent telangiectasias were noted on the bilateral cheeks and nasal ala. The challenge was to decrease the erythema and telangiectasias of this woman’s face and to improve her quality of life.
Diagnosis
She was diagnosed with stage 1 rosacea. The erythema of this and of subsequent stages of rosacea is often very difficult to treat with topical or oral medications. Significant improvement usually requires surgical intervention with one of several laser or light sources.
Treatment
The patient was treated with the Photoderm VL system five times at 3-week intervals. The 515 nm filter and single pulse duration of three msec were utilized. The fluence ranged from 22 to 24 joules/cm2.
The photo above at left shows the patient at baseline. The photo above right, taken at the completion of treatment, reveals dramatic decrease in erythema and significant clearing of the telangiectasias of the right cheek. As a matter of contrast, one can appreciate no change in the nasal alar telangiectasias, which were not treated.
According to a survey conducted by the National Rosacea Society:
• 70% of rosacea sufferers have decreased self-esteem.
• 41% have avoided/canceled social engagements.
• 70% of patients with severe disease described adverse professional interactions.
• 36% missed work because of flares.
With today’s technological advances, we can dramatically improve the quality of our patients’ lives.
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