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THE USE OF A VASCULAR LASER KTP - CUTERA EXCEL V IN THE

TREATMENT OF VASCULAR CHANGES IN THE COURSE OF ROSACEA – A
CASE REPORT.
Piotr Zawodny1, Wiola Kuszlewicz1, Elzbieta Stoj1, Nicole Ciula1, Jerzy Sienko2
1. Medical Center Klinika Zawodny, Poland
2. Department of General Surgery and Transplantation, Pomeranian medical University, Szczecin, Poland

#Corresponding author: Jerzy Sienko MD, PhD, Associate Professor, Department of General Surgery and Transplantation, Pomeranian
Medical University, Powstancow Wlkp. Av 72, p.o. box 70-11 Szczecin, Poland, e-mail: [email protected]

RUNNING TITLE KTP laser for treatment of rosacea

KEYWORDS rosacea; vascular laser; vascular changes; telangiectasia; erythema
WORD COUNT 2083
CONFLICT OF INTERESTS no conflicts of interest

ABSTRACT
The Rosacea is a chronic skin disease with an inflammatory nature. It is estimated that this disorder affects women to a
greater extent, but it is significantly more severe in men. The Rosacea is predisposed to bright skin with phototype I and II.
Symptoms of the disease occur most often in people between 30 and 50 years old. The patient at the age of 39 years,
came to the Clinic for the treatment of vascular lesions in the course of the previously diagnosed rosacea of rheumatic-
telangiectic type, with dilated blood vessels and accompanying paroxysmal erythema present on the face. In a history
showed the type II skin or redness and tightness associated with weather conditions, air conditioning, the family history
was also positive. In addition, the patient reported increased burning, itching and redness of the facial skin during severe
temperature changes, alcohol consumption and using of the sauna. During the treatment the Excel V laser with a
wavelength of 532 nm (KTP) was used. During laser therapy the following parameters: 9.0J/10ms/11mm were used. The
scans made by the VISIA diagnostic device show the condition of the blood vessels before and after the period of two
months from the first treatment. The visible effects of the laser treatment include a significant reduction of skin erythema,
silencing of vascular lesions and unification of the color. The mathematical analysis of VISIA shows a clear improvement
in the intensity of household changes by 29%.

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BACKGROUND The course of each of these subtypes can be mild,

moderate or severe. Primary eruptions, which include

T
The Rosacea is a chronic skin disease with paroxysmal or persistent erythema, telangiectasias,
an inflammatory nature [1]. It is estimated pustules and papules, are scored on a scale of 0-3
that this disorder affects women to a greater depending on the severity. Secondary lesions (erythema-
extent, but it is significantly more severe in inflammatory foci with visible pustules and papules,
men [2, 3, 4]. The Rosacea is predisposed to bright skin burning, edema, hypertrophic changes, dryness, ocular
with phototype I and II [2]. Symptoms of the disease occur symptoms) are systematized as present or absent [16].
most often in people between 30 and 50 years of age [2, The eruptional erythema, the presence of which indicates
5]. the sensitive skin, is considered to be the initial phase of
The pathogenesis of rosacea has not been yet clearly the erythema-telangiectatic form of rosacea. According to
explained [6, 7]. According to the latest studies on the the CERIES classification (Epidermal and Sensory
pathomechanism of rosacea, the key trigger factors is Research and Investigation Center, France), four types
assumed to the role of the Toll-like 2 receptor and of sensitive skin are distinguished:
antimicrobial peptides [2, 3]. Other determinants are • type I - erythema caused by stress, temperature
genetic, hormonal, vascular and seborrheic factors as changes, diet, alcohol,
well as local and general infections. [2, 7, 8]. Not without • type II - erythema and feeling of tightness related to
significance are also environmental factors, such as poor weather conditions, air conditioning,
diet, inadequate skin care, psychogenic and atmospheric • type III - erythema, tingling and feeling of tightness
incentives [6, 8]. Besides, 81-85% of patients have a as a reaction to a given cosmetic,
deterioration of skin condition after exposure to solar • type IV - redness of the skin, hot flushes associated
radiation [3]. Vascular disorders play a key role in the with menstruation [3].
development of rosacea [6]. The evolution of symptoms
is observed, which confirms the nature of the vascular The erythematous-telangiectatic form is the most
base in the pathogenesis of rosacea. The progress of the common variant of rosacea. Characteristic skin changes
disease initiates unstable erythema in the first phase. are recurring or permanent erythema. Accompanying
Then, the period of manifestation of primary symptoms is symptoms such as burning, pain, telangiectasias are also
prolonged and gradually goes into the phase of observed. Erythema-telangiectic changes may
permanent erythema accompanied by the appearance of occasionally also affect areas other than the face, such
telangiectasia [6, 9, 10]. During experimental studies on as the earlobe, neck, chest, hairy skin od head, periphery
blood vessels, increased blood flow in patients with of the face [3].
established rosacea was observed [9, 11]. There are
factors that indirectly affect the overall development of CASE REPORT
the disease. Stress, menopause, hot drinks, spicy foods The patient (39 years of age) was admitted to the Clinic
or UV radiation are the causes of the intensification of with dermatological diagnosed ETR type of rosacea.
vascular symptoms and thus deterioration of the skin Disease was present on the face (dilated blood vessels
condition in the course of rosacea [4, 6, 8]. The and accompanying erythema).
observations concerning the local α1-adrenergic receptor
Skin characterization: type II, redness and tightness
agonists under the influence of which erythema is
associated with weather conditions, air conditioning,
extinguished are also indicative of excessive reactivity of
positive family history. In addition, the patient reported
blood vessels. [12]. Patients also have increased
increased burning, itching and redness of the facial skin
expression of markers, which are responsible for
during severe temperature changes, alcohol
stimulating neovascularization. These include the
consumption and using of the sauna.
platelet-endothelial adhesion molecule (PECAM1),
endothelial growth factor (VEGF) and the marker of During the treatment the Excel V laser was used
lymphoid endothelial cells (D2-40) [4, 13]. The (wavelength of 532 nm; KTP). During laser therapy the
phenomenon of the increase in the expression of the following parameters were used: 9.0J/10ms/11mm.
above-mentioned markers indicates the stimulation of Scans made by the VISIA diagnostic device, show the
blood vessel and lymphatic proliferation. [4, 14]. condition of the blood vessels before and after the period
Neovascularization that is observed in patients suffering of two months from the first treatment (Figure 1).
from rosacea, also affects the activity of cathelicidin (a The mathematical analysis of VISIA shows a clear
proteinaceous antibacterial agent) inducting endothelial improvement in the intensity of household changes by
cells in various mechanisms [4, 14]. 29% and by 15% for the patient base of the system
The classification and grades of rosacea were developed (Table 1).
in April 2002 by the National Rosacea Society Expert
Commitee and are based on the morphology of skin DISSCUSION
changes. Based on these changes, four subtypes of the
disease were adopted: In 1812, Dr. Thomas Batheman made a statement about
the incurability of rosacea and this thesis is valid until
• erythematous-teleanguistic (ETR), today. However, there are many methods to maintain
• papulo-pustular (PPR), remission. The first step to take therapeutic action is to
• hypertrophic (PhR) determine the form of rosacea. This is important due to
• ocular (OR) [15, 16, 17] differences in responses to individual therapeutic

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strategies [2, 18]. The most problematic in terms of UV rays, which over the years may cause skin cancer.
treatment is the erythematous-telangiectatic form, while The device has the ability to simulate the photoaging
papule-pustular erythrophy is best responding to local process. There is a possibility to visualize how the patient
and systemic pharmacotherapy [2]. The simplest basic will look over the course of 5-7 years, after removing
division of therapeutics are locally and orally admitted discoloration and wrinkles. VISIA's patented comparison
medications, the choice of which depends on many with the standards analysis, which uses one of the world's
factors, such as the subtype of the disease or the severity largest skin characteristics databases to assess the
of symptoms [8]. In the treatment of vascular changes, patient's skin compared to other people of the same age
laser light therapy is beneficial. It is used to reduce who have the same skin type, is also a great help [22, 23,
paroxysmal erythema, fixed telangiectasia and has a 24].
positive effect on the prolongation of the remission
period. For therapeutic purposes, intense laser light (IPL) CONCLUSION
is used, which oscillates in various lengths (515-1200
nm). Depending on the individual predisposition of the 1. Analysis of the patient's skin, after a period of two
patient's skin, the appropriate filter is selected. During the months from the first treatment with the Cutera Excel
treatment of rosacea, also a pulsed dye laser is used. V laser, showed visible effects: significant reduction of
Besides, a CO2 laser is used to treat hypertrophic skin erythema, silencing of vascular lesions and
changes. Therapy using laser light has a positive unification of the color.
therapeutic effect, although the effect of treatment 2. The mathematical analysis of VISIA shows a clear
depends on the individual predispositions and the phase improvement in the intensity of household changes by
of the disease [4, 19]. 29% and by 15% for the patient base of the system.
Essential to therapy is to avoid triggering/intensifying
factors that can significantly contribute to exacerbation of CITE THIS AS
clinical symptoms. MEDtube Science Mar, 2019, Vol. VII (1), 32 – 35
In the treatment of vascular changes, the Cutera Excel V
laser was used to emit a laser beam with two different ABBREVIATIONS
wavelengths (KTP 532, ND-YAG 1064 nm). The laser is
equipped with a CoolView head with a sapphire cooling CERIES – Epidermal and Sensory Research and
window - used to treat veins, telangiectasia and other Investigation Center
vascular lesions. These types of lasers are used to treat ETR – erythematous-teleanguistic
vascular changes through selective photothermolysis, or KTP – titanium-potassium phosphate (KTiOPO 4)
selective action on hemoglobin, limiting the thermal ND-YAG – neodynium-doped yttrium aluminum garnet
damage to the surrounding tissues. In vascular OR – ocular
procedures, laser generates the heat which stimulates PECAM1 – platelet-endothelial adhesion molecule
photocoagulation and leads to the destruction of the PhR – hypertrophic
blood vessel walls, thus preventing their recanalization PPR – papulo-pustular
[20]. The design of the Laser Cutera Excel V device UV – ultraviolet
allows effective treatment of many diseases, including: VEGF – endothelial growth factor
rosacea, telangiectasias, flat and cavernous
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FIG. 1. SCANS MADE BY THE VISIA DIAGNOSTIC DEVICE, SHOW THE CONDITION OF THE BLOOD VESSELS
BEFORE AND AFTER THE TREATMENT.

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