Male patients with telangiectasia, rosacea tend to wait to seek treatment

Key Points

Washington - Male rosacea patients present with larger facial telangiectasias and more severe erythema because they tend to minimize skin problems and delay treatment, but a treatment plan focused on laser surgery can produce excellent outcomes, and the lack of ongoing aftercare is appealing to many male patients, says Tina S. Alster, M.D.

Conventional complexities

"By the time I get male rosacea patients, they've tried other options and still have persistent conditions," she says. Those options typically include over-the-counter (OTC) acne medications as well as dermatologists' prescriptions such as antibiotics.

"I frequently get referred patients that tend to be unresponsive to other treatments," Dr. Alster explains.

Rosacea patients are often disappointed by antibiotics and acne medications, which treat only pustules and comedones and not the erythema or telangiectases that plague them more, she says.

A tailored approach

Dr. Alster says she uses a variety of lasers and light devices to treat erythema and facial telangiectasias associated with rosacea. The therapy typically consists of a series of treatments separated by about a month.

The pulsed dye laser (PDL) emits yellow (585 nm to 595 nm) light to penetrate hemoglobin-containing lesions. The potassium-titanyl-phosphate (KTP) laser also emits 532 nm and 1,064 nm wavelengths that can target superficial and deep telangiectasias, respectively.

Intense pulsed light (IPL) devices emit a broad range of wavelengths (550 nm to 1,200 nm) to treat patches of erythema (rather than discrete telangiectasias), she explains.

"Most patients require a minimum of two to three monthly treatments," Dr. Alster says. "Patients with more severe disease may need upwards of five to six treatments."

Dr. Alster suggests tailoring the laser choice to the individual patient's condition. For example, PDL is an excellent choice for small to medium vessels. However, it is not as helpful for the large nasal telangiectasias that men often have.

IPL is ideal for patients who have diffuse telangiectasias across the nose and cheeks and associated diffuse ruddy and brown dyspigmentation, she adds.

"However, if someone also has discrete telangiectases, I tend to use the PDL," she says. "This laser hones in nicely on those vessels. KTP is also a reasonable choice with discrete telangiectases."