الفهرس 
RosaceaOnly 14 pages are availabe for public view
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Abstract
Rosacea is a chronic and relapsing inflammatory disease characterized by the presence of persistant or transient central facial erythema and visible telangiectasia. It is often associated with papules and pustules and may finally develop cutaneous tuberosities (phymas). It occurs more oftenly in fair skinned females aged 20 – 60 years. Due to the fact that rosacea mainly affects the facial region, many patients feel that their professional and social life is affected.
The exact cause of rosacea is unclear, many hypotheses have been proposed. These include abnormal vasculature, climatic exposure, dermal matrix degeneration, pilosebaceous abnormalities, genetic factors, microbial organisms and immunological factors.
The National Rosacea Society’s Expert Committee created a standard classification system for rosacea. Four subtypes were identified: erythemato-telangiectatic rosacea (ETR), papulopustular rosacea (PPR), phymatous and ocular. Several other variants of rosacea are also found, including granulomatous rosacea, rosacea fulminans, steroid rosacea, extrafacial rosacea, persistant edema of rosacea and rosacea conglobata.
Therapy for the treatment of rosacea is not curative. First, all trigger factors should be avoided by the patients. Topical agents can sometimes be successful, such as metronidazole, azelic acid and sulfacetamide agents. Papulopustular rosacea and ocular rosacea can be controlled by oral tetracycline, metronidazole or isotretinoin, but no medical therapy can permanently eradicate the erythema or visible telangiectasia seen in ETR.
Different lasers and light therapies are the most effective line of treatment for persistant erythema and telangiectasia found in ETR. These include argon lasers, copper-bromide lasers, krypton lasers, KTP lasers, PDLs and IPL.
The purpose of this study is to evaluate the further efficacy of PDL in the treatment of rosacea in the erythemato-telangiectatic stage, and evaluating its impact on the patient’s quality of life.
Twenty patients with ETR were enrolled in this study and treated with PDL of 595 nm wavelength, fluence of 7 J/cm2, pulse duration of 10 ms and a 10 mm spot size. They underwent 3 monthly treatment sessions and were evaluated 4 weeks after the last laser session.
Full-face photographs of the patients were taken before and after the treatment sessions, under identical camera settings and lighting conditions. At each session, the erythema and telangiectasia were evaluated using a visual analogue score (VAS). The patients were also asked to answer the DLQI questionnaire before the treatment sessions and again after the three treatment sessions (on the evaluation session).
After the three treatment sessions, 85% of the patients showed marked improvement of erythema. The telangiectasia totally disappeared in 14% of the patients and showed significant improvement in 50% of the patients. The DLQI score also showed a 59% decrease, indicating an improvement in the patients’ quality of life.
There was a significant correlation between the duration of the disease and the response to treatment. The more recent the onset of the disease, the better the improvement in erythema. Also the younger the patient the better the improvement in both the erythema and telagiectasia. Patients with skin types II and III showed a better response to treatment than those of skin type IV.
Our study concluded that PDL is a safe and effective line of therapy in the treatment of erythema and telangiectasia of ETR, with minimal unwanted side effects. It also has the ability to improve rosacea patients’ quality of life, as it induces a good to excellent reduction of erythema and telangiectasia, as well as the unpleasant symptoms such as the burning and stinging which accompany the disease.
Improvements can be done in the assessment of the erythema and telangiectasia by using more objective measures such as a spectrophotometer for skin colour, a scanning laser doppler to measure blood flow or a computer image analysis to quantify the telangiectasia and erythema. This would allow the assessment to be more accurate. Further studies are also needed to investigate the ideal number of treatment sessions so an ideal maintenance schedule of treatment can be determined.