Tactics for Choosing Optimal Parameters of Intense Pulsed Light in Treatment of Erythematotelangiectatic Subtype of Rosacea

Abstract

INTRODUCTION: There exist several approaches to treatment of rosacea: systemic, external or complex therapy. Many practitioners note the effectiveness of using intense pulsed light in treatment of rosacea acne. Along with hardware techniques, azelaic acid-based gel is actively used in treatment. Despite the growing popularity of phototherapy, there is insufficient scientific literature on the study of optimal parameters of intense pulsed light for patients using azelaic acid.

AIM: To describe the experience of application of a combination of intense pulsed light and azelaic acid in erythematotelangiectatic subtype of rosacea.

A clinical case of a 52-year-old female patient with severe erythematotelangiectatic rosacea. Phototherapy was conducted in a course of 7 procedures with an interval of 3 weeks; azelaic-based gel was prescribed twice a day for 5 months, sunscreen cream with protection factor 50 for daily use. For the first procedure, a filter with 640 nm wave length was used, fluence 22 J/cm², pulse duration 3.5 ms, number of subpulses — 3; filter with 590 n wavelength, fluence 22 J/cm², pulse duration 3.5 ms, number of subpulses — 3; filter with 560 nm wavelength, fluence 20 J/cm², pulse duration 3.5 ms, number of subpulses — 3; filter with 515 nm wavelength, fluence 16 J/cm², pulse duration 3.5 ms, number of subpulses — 3. After 3 weeks, a second phototherapy procedure was conducted according to the same protocol. In the third procedure, the energy flow on each filter was increased by 1 J, pulse duration and number of subpulses did not change. On examination in 3 weeks, there was a reduction of the number of small and large telangiectasias, significant reduction of redness, no disturbing subjective sensations. In the subsequent procedures it was decided not to increase the energy flow on filters to avoid recurrent undesired phenomena.

CONCLUSION: Clinical observation demonstrated the effectiveness of using a combination of intense pulsed light and azelaic acid in erythematotelangiectatic rosacea when selecting the maximum permissible parameters of phototherapy. When treating with intense pulsed light it is permissible to increase the energy flow by 1 J/cm²–2 J/cm² on condition of normal tolerance. In case edema and hyperemia are present for more than 3 days, it is necessary to reduce the energy flow.

Keywords

rosacea / erythematotelangiectatic subtype / intense pulsed light / phototherapy / azelaic acid

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