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The use of dye laser in the treatment of rosacea

The world scientific community is inclined to believe that the combination of pulsed dye lasers and photosystems with combination therapy is the prevailing method in rosacea therapy. Let’s consider a question in more detail.

Rosacea is a chronic relapsing disease, usually of the skin of the face, which has a polyetiological nature and is characterized by a staged course.

Currently, rosacea can be safely attributed to the number of common dermatoses. The disease usually begins in the third or fourth decade of life and reaches its peak between 40 and 50 years. Women suffer more often (Kubanova, Makhakova 2015).

Clinically, rosacea is manifested by primary facial flushing, edematous papules, pustules, telangiectasias, as well as hyperplasia of the sebaceous glands and connective tissue. The pathogenesis of the disease is based on changes in the tone of the superficial arterial vessels of the skin, due to the action of various exogenous and endogenous factors.

Until now, the etiology of the disease is not known, and the mechanisms of its formation are largely unclear. Hypotheses regarding the pathogenesis of rosacea are numerous, contradictory, and sometimes mutually exclusive. None of these hypotheses can claim to be universal and be acceptable to all patients with rosacea; at the same time, each of them reflects the peculiarities of the pathogenesis of a certain group of patients with this dermatosis.
Currently, the following pathogenetic concepts exist, which are considered as the main or essential links in the development chain of rosacea (see, for example, Cribier 2017):

exogenous factors, including the presence of Demodex folliculorum tick in the skin,
disorders of the gastrointestinal tract, endocrine and nervous systems,
changes in immune status,
primary pathological vascular reactions,
the role of components of kallikrein-kinin and coagulation systems.

There are several subtypes of rosacea (Wilkin et al. 2004):

erythematous-telangiectatic (40%)
papular (34%)
pustular (22%)
hypertrophic (6%)
In cases of established hemodynamic disturbances, patients with rosacea are dominated by the vasodilation type of microcirculation (MC) (35%), the spastic-stagnant type of MC (58%) and the atonic-stagnant type of MC (7%) (Dubrovina 2011).

Despite the exogenous or endogenous causes of the disease, a significant role in the pathogenesis of rosacea is attributed by most researchers to vascular disorders. The cause of such conditions is vascular pathology.

Rosacea has been proven to show abnormalities of the capillary endothelium, represented by its thickening, tearing of the basement membrane and insufficiently dense articulation of endothelial layer cells (see, for example, Kajiya et al. 2017; Holmes, Steinhoff 2017; Tsiskarishvili et al. 2018).

There are many treatments for rosacea aimed at stopping inflammatory processes in the skin. This is cryodestruction, electrocoagulation, dermabrasion, phototherapy.

The currently far-reaching means and methods of treating rosacea give a positive result. Therefore, the search for new effective methods is extremely relevant.

At the present stage, the most promising is the method of laser correction by high-intensity lasers with a selective effect on blood vessels.

Classification of Vascular Lasers
For the first time, lasers began to be used to treat vascular pathology in 1970, after the creation of an argon laser with a wavelength of 488 and 514 nm. However, treatment with this laser, generating continuous radiation, unfortunately, very often led to scarring and impaired skin pigmentation due to damage to its upper layers (Zhukova et al. 2013).

In 1981, cw copper vapor lasers were produced, generating radiation with a wavelength of 578 nm. They were used in the treatment of facial telangiectasias, senile hemangiomas and pyogenic granulomas, but their use was limited to I – II skin phototypes, as patients with III – V phototypes had a high risk of developing dyschromia, as well as the risk of burns and scars.

And only the appearance in 1989 of a pulsed dye laser, first with a wavelength of 577 nm and then 585 nm, which corresponded to the region of maximum absorption of oxyhemoglobin, as well as the use of effective methods of cooling the skin, led to improved clinical results and minimized side effects .

Currently, in the treatment of vascular skin pathology with a different degree of success, they use:

CTF laser (532 nm);
pulsed dye laser (PDL) (585 nm);
Nd: YAG laser (1064 nm);
alexandrite laser (755 nm);
diode laser (800 nm).
Combined laser stations are also used that emit two wavelengths in series:

pulsed dye laser (585 nm) / Nd: YAG laser (1064 nm);
alexandrite laser (755 nm) / Nd: YAG laser (1064 nm);
IPL systems (515, 550, 570, 590 nm).

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