Combining Light-Based Treatments and Topicals for Rosacea: Dr. David J. Goldberg, MD

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Dr. David J. Goldberg, MD, director of Skin Laser & Surgery Specialists of New York and New Jersey and a clinical professor of dermatology and director of laser research at Mount Sinai School of Medicine in New York, has kindly answered a few questions for us on his Dermatology Times article, "Combining light-based treatments, topicals for rosacea". Dr. Goldberg's research interests include laser dermatology, laser hair removal, laser facial rejuvenation, and the treatment of photodamaged skin. Dr. Goldberg's publications in his field are numerous and include many directly related to these areas of interest:

We asked Dr. Goldberg to discuss his experience of treating rosacea with a combination of light-based treatments and topicals.

Q: Would you elaborate on your experiences as to which treatment or combination of treatments seem to work best for different rosacea symptoms (e.g.: flushing, generalized redness, burning, papules & pustules, inflammation and swelling)?

A: Flushing, burning, and swelling are ideally treated with either yellow or red LED, generally in combination with IPL (or laser) treatments. The effect of IPL and LED appears to be additive. That is, the combination works better than each one separately. Papules & pustules are generally best treated with oral and/or topical agents. Inflammation or swelling is best treated with a combination of IPL and yellow/red LED. This group also is treated with near-infrared LED.

Q: Can you explain to our members how Yellow LED treatment seems to help minimize the redness associated with rosacea (e.g. are there any studies suggesting a possible mechanism of action, are excess blood vessels destroyed, when is Yellow LED treatment contraindicated, etc)?

A: The evidence seems to suggest the vessels get smaller after treatment. The beauty of all LED is how safe they are. They can be used in all skin types.

Q: Can you explain how Red LED treatment seems to help minimize the inflammation associated with rosacea (e.g.: are there any studies suggesting a possible mechanism of action, what type of results does Red LED treatment produce, etc)?

A: Red and near-infrared LED have a major impact on many cells that cause inflammation. Basic rule is yellow LED for mild redness, red LED for more inflamed rosacea, combination of red and near-infrared for inflammation and swelling.

Q: What would a typical series of treatments with Yellow or Red LED entail (e.g.: how many treatment sessions are necessary, how often should treatment sessions be performed, how many minutes of treatment are typical, is there a possibility of problems caused by treatment occurring too often, of too long a duration, or too much LED intensity, are there any problems associated with photosensitizing drugs or OTCs, do you have any experience with patients using home Yellow or Red LED units, etc)?

A: We generally provide a series of 5-7 LED treatments. They are given 2-4 weeks apart. Yellow LED treatments take only seconds; red and near-infrared are 20 minute sessions. There is no evidence that too much LED can be given. We are always careful in people who take photosensitizing drugs. Home units generally are not powerful enough to lead to same results as medical quality units. Also the danger in home units is the lack of appropriate eye protection especially for deeper penetrating red/near infrared LED.

Q: Do you have any experience in treating rosacea with Blue LED?

A: Blue LED can help general acne, but does not seem to help rosacea.

Q: Do you have experience in using these protocols to treat rosaceans who also have facial seborrheic dermatitis (e.g. are light based treatments effective on seb derm)?

A: Red and near infrared LED can help the inflammation of seborrheic dermatitis. I have not found blue or yellow LED to be helpful in this group.

The Support group would like to express our deepest thanks to Dr. Goldberg for kindly taking the time to help us.