Rosacea management

The Concept of Erythematotelangiectatic Rosacea

Rosacea common areas

The concept of rosacea is gaining increasing attention among dermatologists specializing in aesthetic medicine. Rosacea primarily manifests as transient flushing and persistent erythema in the central face, often accompanied by telangiectasia on the cheeks, perioral area, or nose, as well as papules or pustules. Among these, transient flushing and persistent erythema are the two most crucial diagnostic indicators and are also the primary concerns reported by many patients.

When designing treatment plans for erythema, understanding the underlying mechanisms of skin issues is essential. The pathogenesis of rosacea is highly complex, involving numerous cellular and molecular activities. However, we can simplify the understanding of rosacea’s progression into four key "abnormalities": vascular dysfunction, immune dysregulation, skin barrier impairment, and microbial imbalance.

For rosacea-related erythema, "reducing redness" should not be approached as a purely destructive treatment targeting blood vessels. Instead, personalized treatment strategies should be designed based on addressing these four abnormalities in the disease process.

Principles of Phototherapy(IPL) for Rosacea-Associated Erythema

Phototherapy is one of the most commonly used treatments in aesthetic dermatology. Many consider it an "entry-level" medical aesthetic procedure, and to some extent, this is true—it is relatively non-invasive, offers good comfort, and is widely accepted by patients. However, compared to other energy-based devices, phototherapy is actually more complex in terms of operation and has a broad range of indications. It can be applied to various skin conditions, including rosacea-associated erythema, which is our focus here.

Understanding the Mechanism of Phototherapy(IPL)

Phototherapy follows four fundamental principles of laser treatment:

1. Photothermal Effect – This is the foundational theory of laser treatments. When light energy is delivered to skin tissue, it generates heat accumulation, which stimulates regeneration, destroys target tissues, and modulates tissue activity.

   
   

2. Selective Photothermolysis – This principle aims to minimize damage to normal tissues while maximizing the destruction of target structures such as blood vessels and pigmentation.

   
   

3. Photobiomodulation – Low-intensity light energy stimulates cellular activity, regulating the function of various immune cells in the skin without significantly increasing surface temperature.

   
   

4. Photodynamic Therapy – Light is absorbed by microbial metabolic products such as porphyrins, releasing singlet oxygen, which in turn destroys microorganisms and inhibits their proliferation.

   
   

These four fundamental principles align perfectly with the four key abnormalities in rosacea pathogenesis—vascular dysfunction, immune dysregulation, skin barrier impairment, and microbial imbalance. This makes phototherapy(IPL) a logical and effective treatment approach for rosacea-associated erythema.

Related article:

Combined Treatment Strategies for Rosacea