by David A. Jones, MD, PhD
Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts

Abstract
Rosacea is a common skin condition thought to be primarily an inflammatory disorder. Neutrophils, in particular, have been implicated in the inflammation associated with rosacea and mediate many of their effects through the release of reactive oxygen species. Recently, the role of reactive oxygen species in the pathophysiology of rosacea has been recognized. Many effective agents for rosacea, including topical azelaic acid and topical metronidazole, have anti-inflammatory properties. In-vitro models have demonstrated the potent antioxidant effects of azelaic acid, providing a potential mechanistic explanation for its efficacy in the treatment of rosacea.

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by Jonette E. Keri, MD, PhD, and Adena E. Rosenblatt
Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida

Disclosure: The authors identified no conflicts of interest. Read the rest of this article »

by Amy Forman Taub, MD, Assistant Clinical Professor of Dermatology, Northwestern University Medical School, Chicago, Illinois; Founder/Director of Advanced Dermatology, Skinfo, SkinQRI, Lincolnshire, Illinois

Erin C. DeVita, CST, CMSLO, CCRC, Advanced Dermatology, SkinQRI, Lincolnshire, Illinois

Abstract

Introduction: Many laser and light devices have reported to be successful in the treatment of the flushing, background erythema, and telangiectasias that characterize erythematotelangiectatic rosacea including pulsed dye laser, potassium titanyl phosphate, intense pulsed light, and dual-wavelength lasers. A technology called ELOS (electro-optical synergy) combines pulsed light or laser with bipolar radiofrequency. This combination, developed in 2000, was based on the premise that these two forms of energy could be synergistic. One such device (Aurora SRA—skin-rejuvenation advanced handpiece, Syneron Medical Ltd., Yokneam, Israel) has a light spectrum of 470 to 980nm, energy up to 45J/cm2, and a range of radiofrequency energy of 5 to 25J/cm3 and is indicated for the treatment of vascular and pigmented lesions. Methods: We attempted to quantify the improvement of moderate-to-severe type-1 rosacea after three and five full-face treatments with this modality. Twenty-one patients with moderate-to-severe rosacea underwent five monthly full-face treatments with this device. The patients were evaluated with high-resolution photographs (Canfield Visia CR, Canfield, Fairfield, New Jersey) and self-evaluated via the National Rosacea Society’s official “Scorecard.” Results: Erythema and telangiectasia (physician assessed) as well as flushing and global status (patient assessed) achieved improvement that was statistically significant. Five treatments were no more effective than three, although the photographs reveal subtle improvements. There were no significant adverse events. Conclusion: The results of this study suggest that the combination of optical and RF energies is effective for the treatment of rosacea. ELOS, as well as other vascular-focused lasers and light sources, provides an important treatment option for patients who fail medical therapy, reach a plateau in their response to medical therapy, or wish to avoid chronic oral therapy. Read the rest of this article »