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Rosacea: Stages, Laser Treatment
Rosacea is a chronic inflammatory skin disease affecting approximately 5-10% of the population and significantly impacting patients' quality of life. The disease manifests with facial redness, dilated blood vessels, papules, and pustules in the central part of the face.
At Venus Clinic in Kyiv (Podil, Kontraktova Square), we offer a comprehensive approach to rosacea treatment using modern laser technologies and evidence-based methods.
Contents
- What is Rosacea?
- Stages of Rosacea
- Causes and Pathogenesis
- Diagnosis
- Rosacea Treatment
- Laser Treatment
- Prevention and Care
- Frequently Asked Questions
What is Rosacea?
Rosacea is a chronic relapsing inflammatory skin disease that primarily affects the central part of the face: cheeks, nose, chin, and forehead. The disease is characterized by episodes of exacerbations and remissions, with a tendency to progress in the absence of treatment.
Clinically, rosacea presents with the following symptoms:
- Redness of the central facial zone (erythema)
- Dilated blood vessels (telangiectasia)
- Papules and pustules resembling acne
- Burning, itching sensation of the skin
- Increased skin sensitivity
- Skin thickening (in late stages)
Who is Prone to Rosacea?
Rosacea most commonly occurs in people with fair skin of Northern European descent, although it can develop in people of any phototype. The disease affects women more frequently than men, but men experience more severe forms. The typical age of onset is 30-50 years.
Stages of Rosacea
In clinical practice, 4 main stages of rosacea are distinguished, each with characteristic features and requiring a specific approach to treatment.
Stage I: Pre-rosacea (Episodic Erythema)
The first stage is characterized by periodic episodes of redness (flushing) that occur in response to various triggers:
- Temperature changes
- Emotional stress
- Hot food and drinks
- Alcohol
- Solar radiation
At this stage, redness is temporary and resolves spontaneously. Patients may experience discomfort, burning, or increased skin sensitivity.
Stage II: Erythematotelangiectatic Rosacea (ETR)
The second stage is characterized by persistent erythema of the central part of the face with the presence of telangiectasia (dilated capillaries). Redness becomes permanent and does not completely disappear even after eliminating provoking factors.
Key features of stage II:
- Diffuse central erythema
- Visible dilated vessels (telangiectasia)
- Impaired skin barrier
- Increased transepidermal water loss
- Constant feeling of discomfort
Stage III: Papulopustular Rosacea (PPR)
The third stage is characterized by the appearance of inflammatory elements against the background of persistent erythema. Papules (dense red nodules) and pustules (elements with purulent content) develop, which resemble acne but are not accompanied by comedone formation.
Features of papulopustular form:
- Papules and pustules against erythema background
- Absence of comedones (unlike acne)
- Preservation of telangiectasia
- Possible appearance of edema
- Pronounced discomfort
Stage IV: Phymatous Rosacea
The fourth, most severe stage, is characterized by sebaceous gland hyperplasia and skin thickening. The nose is most often affected (rhinophyma), leading to its enlargement and deformation. This form is observed predominantly in men.
Signs of phymatous rosacea:
- Skin thickening and deformation
- Rhinophyma (in most cases)
- Sebaceous gland hyperplasia
- Uneven, bumpy skin surface
- Irreversible tissue changes
Ocular Rosacea
Ocular rosacea is separately distinguished and can accompany any stage or develop in isolation. Eyes and eyelids are affected with the development of blepharitis, conjunctivitis, sandy eye sensation, and photophobia.
Causes and Pathogenesis of Rosacea
Although the exact cause of rosacea remains unknown, modern research indicates the multifactorial nature of the disease involving innate immunity, neurovascular dysregulation, and skin microbiome.
Key Pathogenetic Mechanisms
1. Innate Immunity Dysfunction
Patients with rosacea show increased expression of Toll-like receptors (TLR-2), which are activated by various stimuli: ultraviolet light, microorganisms, temperature changes. This leads to excessive production of antimicrobial peptides, particularly cathelicidin LL-37, which in rosacea patients has pathological forms that cause inflammation and vascular dysfunction.
2. Neurovascular Dysregulation
Activation of peripheral sensory nerve endings (TRPV1, TRPA1 receptors) by triggers (heat, cold, spicy food, alcohol) leads to the release of vasoactive neuropeptides. This causes vasodilation, increased capillary permeability, and neurogenic inflammation.
3. Role of Demodex Folliculorum
Demodex folliculorum mites are found in 70% of rosacea patients compared to 32% of healthy individuals. Mite antigens and associated bacteria Bacillus oleronius activate TLR-2, enhancing the inflammatory response.
Trigger Factors
Various external and internal factors can provoke rosacea exacerbations:
- Climatic: sun, wind, heat, cold
- Dietary: spicy food, hot drinks, alcohol
- Emotional: stress, anxiety
- Physical: intense physical activity
- Cosmetic: irritating cosmetic products
- Hormonal: menopause, menstrual cycle
Rosacea Diagnosis
Rosacea diagnosis at Venus Clinic is based on clinical assessment and modern instrumental methods of skin examination.
Clinical Diagnosis
Rosacea diagnosis is established based on diagnostic criteria developed by the National Rosacea Society (2017):
Diagnostic features (presence of one is sufficient for diagnosis):
- Persistent central facial erythema
- Skin thickening (phymas)
Major features (confirm diagnosis):
- Flushing (episodes of redness)
- Papules and pustules
- Telangiectasia
- Eye irritation symptoms
Instrumental Skin Diagnostics
At Venus Clinic, we perform comprehensive skin diagnostics using a professional system that allows us to:
- Determine the degree of erythema severity
- Detect hidden telangiectasia
- Assess skin barrier condition
- Determine transepidermal water loss
- Objectively monitor treatment dynamics
Diagnostics allows selecting the optimal treatment protocol and monitoring therapy effectiveness.
Comprehensive Rosacea Treatment at Venus Clinic
Rosacea treatment requires an individual approach considering the disease stage, skin type, and associated problems. At Venus Clinic, we use evidence-based methods confirmed by international clinical studies.
Treatment Principles
- Elimination of trigger factors
- Restoration of skin barrier
- Inflammation control
- Correction of vascular changes
- Long-term maintenance therapy
Rosacea Treatment Methods at Venus Clinic
1. Instrumental Skin Diagnostics
Skin diagnostics is a mandatory step before starting treatment. It allows accurate assessment of skin condition, identification of hidden problems, and selection of the optimal therapy program.
2. Therapeutic Oat Milk Mask — Soothing Procedure
Therapeutic Oat Milk Mask care procedure is a professional soothing therapy for reactive sensitive skin. The procedure effectively reduces skin reactivity, eliminates redness, moisturizes, and restores the skin barrier.
Benefits:
- Quickly eliminates redness and irritation
- Strengthens skin barrier
- Moisturizes sensitive skin
- Suitable for any stage of rosacea
- Can be performed before laser procedures
3. SensiPeel for Sensitive Skin
SensiPeel by PCA Skin is the world's only peel specifically developed for sensitive skin with rosacea. Unlike traditional aggressive peels, SensiPeel gently restores skin barrier properties without irritation.
Mechanism of action in rosacea:
- Restores skin barrier integrity
- Normalizes hydrolipid mantle
- Reduces transepidermal water loss
- Increases resistance to triggers
- Reduces skin reactivity
Studies show that gentle chemical peels with modified formulas can be effective in rosacea when properly selected and professionally performed.
Course: 3-5 procedures at 2-3 week intervals
4. BBL Photorejuvenation for Erythematotelangiectatic Rosacea
BBL Sciton photorejuvenation is the gold standard for treating erythematotelangiectatic rosacea with diffuse redness and multiple small vessels.
BBL advantages in rosacea:
- Complex action: simultaneously works on erythema, telangiectasia, skin texture
- Cooling: powerful cooling system (accuracy to 1°C) allows working even with sensitive skin
- Controlled energy: uniform energy distribution across the entire crystal surface without "hot spots"
- Evidence base: BBL Sciton is the only system with clinically proven effectiveness in rosacea
Mechanism of action: broadband light energy is absorbed by hemoglobin in dilated vessels, leading to their heating, coagulation, and subsequent resorption. Simultaneously, collagen synthesis is stimulated and healthy skin structure is restored.
Clinical studies confirm that BBL therapy significantly reduces erythema, telangiectasia, and inflammation in rosacea. The combination of BBL with other methods shows better results than monotherapy.
Indications for BBL:
- Diffuse erythema of both cheeks
- Multiple small telangiectasia
- Late stages of rosacea with large affected area
- Combination of vascular changes with pigmentation
Course: 3-4 procedures at 3-4 week intervals, maintenance therapy every 4-6 months
5. Laser Vascular Removal MedArt VariMed
Laser vascular removal on MedArt equipment (Denmark) is the optimal method for targeted removal of individual telangiectasia and spider veins.
Indications for MedArt laser:
- Single spider veins on nasal wings
- Point telangiectasia on cheeks
- Individual dilated capillaries
- Large vessels (diameter > 2 mm)
Laser advantages:
- High precision — working with individual vessels
- Effectiveness on large vessels
- Quick results after the first procedure
- Safety — does not damage healthy tissues
Course: usually 1-3 procedures at 2-4 week intervals
6. BBL Acne Therapy for Pustular Form
For papulopustular rosacea, BBL acne therapy is effective, which acts on Propionibacterium acnes and reduces inflammatory elements.
Method Selection Depending on Stage
| Stage | Main Methods |
|---|---|
| Stage I (episodic erythema) |
|
| Stage II (erythematotelangiectatic) |
|
| Stage III (papulopustular) |
|
| Stage IV (phymatous) |
|
Laser Treatment for Rosacea: Evidence Base
Mechanism of Laser and BBL Therapy Action
Laser and broadband light therapy is based on the principle of selective photothermolysis. Light energy is selectively absorbed by the target chromophore (hemoglobin in dilated vessels), converted to heat, and leads to vessel coagulation without damaging surrounding tissues.
BBL Effectiveness in Rosacea: Scientific Data
Modern studies confirm high BBL therapy effectiveness in rosacea:
- A controlled study (2022) showed significant reduction in erythema index, improved skin hydration, and decreased transepidermal water loss after BBL therapy
- Combination of BBL with botulinum toxin injections demonstrates better results than BBL monotherapy
- Stanford University research proved that BBL changes gene expression related to aging at the molecular level
- It was found that BBL reduces Demodex mite population, which participates in rosacea pathogenesis
Advantages of Laser Methods Over Traditional Ones
| Criterion | Topical Agents | Systemic Therapy | BBL/Laser |
|---|---|---|---|
| Speed of Action | Slow (weeks-months) | Medium (weeks) | Fast (days-weeks) |
| Effect on Vessels | Minimal | Indirect | Direct, selective |
| Side Effects | Irritation | Systemic | Minimal, local |
| Effect Duration | Only during application | Limited | Long-lasting (months-years) |
Prevention and Home Care for Rosacea
Avoiding Triggers
A key element of rosacea control is identifying and avoiding individual trigger factors:
- Sun protection: daily use of SPF 30-50 with broad spectrum protection (UVA/UVB)
- Temperature regime: avoiding sudden temperature changes, saunas, baths
- Nutrition: limiting spicy food, hot drinks, alcohol
- Skin care: using gentle products for sensitive skin
- Stress management: emotional state control
Proper Home Care
Cleansing:
- Gentle cleansers without soap and detergents
- Avoiding hot water
- Delicate cleansing without rubbing
Moisturizing:
- Moisturizers with barrier-restoring components
- Products without irritating ingredients
- Regular application 2 times a day
Protection:
- Daily sun protection SPF 30-50
- Physical filters (zinc oxide, titanium dioxide) — best choice
- Application 20 minutes before going out
What to Avoid with Rosacea
Dangerous ingredients in cosmetics:
- Alcohol
- Menthol, peppermint
- Witch hazel
- Sulfates
- Citrus essential oils
- High concentrations of acids
Dangerous procedures:
- Mechanical scrubs
- Aggressive peels
- Facial steaming
- Facial massage (may worsen redness)
Frequently Asked Questions
Can rosacea be completely cured?
Rosacea is a chronic disease that cannot be completely cured but can be successfully controlled. Modern treatment methods, especially laser technologies, allow achieving stable remission for years. The key to success is timely treatment, properly selected therapy, and adherence to care recommendations.
How many BBL procedures are needed for rosacea?
The course is individual and depends on the stage and severity of symptoms. Typically, 3-4 procedures at 3-4 week intervals are recommended. First results are visible after the first procedure, maximum effect is evaluated 2-3 months after course completion. For result maintenance, procedures every 4-6 months are recommended.
Is laser vascular removal painful for rosacea?
The procedure involves minimal discomfort. Patients describe sensations as light tingling or rubber band snapping. MedArt and BBL Sciton equipment have cooling systems that protect the skin and reduce discomfort during the procedure.
Can laser procedures be done in summer?
For rosacea, laser procedures can be performed year-round, including summer, with proper sun protection. After the procedure, it's necessary to avoid active sun for 2-4 weeks and mandatory use of SPF 50.
Is systemic therapy needed for rosacea?
Systemic therapy (antibiotics, isotretinoin) is indicated for moderate to severe papulopustular form. Mild and erythematotelangiectatic forms are successfully controlled by device methods and topical agents. The decision on the need for systemic therapy is made by a dermatologist after examination.
Can peels be done for rosacea?
Traditional aggressive peels are contraindicated for rosacea. However, specially developed gentle peels for sensitive skin, such as SensiPeel, are not only possible but also indicated for skin barrier restoration. It's important that the peel is performed by an experienced specialist considering skin condition.
How much does rosacea treatment cost in Kyiv?
Cost depends on the chosen method and number of procedures: skin diagnostics — from 800 UAH, Therapeutic Oat Milk Mask — from 1500 UAH, SensiPeel peel — 2400 UAH, BBL facial photorejuvenation — from 4500 UAH, laser vascular removal — from 600 UAH per element. The exact course cost is determined at consultation after skin diagnostics.
Can rosacea treatment be combined with other procedures?
Yes, with controlled rosacea, combination with other procedures is possible: biorevitalization, mesotherapy, botulinum therapy. Conversely, some procedures are contraindicated: deep peels, aggressive laser resurfacing, microdermabrasion. Combined treatment plan is developed individually.
Which specialist treats rosacea?
Rosacea treatment is conducted by a dermatologist. At Venus Clinic, consultations are conducted by experienced dermatologists with over 10 years of experience working with rosacea. The first consultation includes instrumental skin diagnostics and development of an individual treatment plan.
How quickly do results appear after treatment?
Speed of results depends on the method: after BBL and laser vascular removal, first changes are noticeable within 1-2 weeks, maximum effect — within 4-6 weeks. SensiPeel peel restores skin within 2 weeks. Stable rosacea control is achieved after a complete course of procedures.
Does rosacea return after treatment?
Rosacea is a chronic disease with a tendency to relapse. However, properly conducted treatment allows achieving long-term remission (from several months to years). For exacerbation prevention, it's important to follow care recommendations, avoid triggers, and undergo maintenance procedures every 4-6 months.
Book a Consultation
At Venus Clinic in Kyiv (Podil, Kontraktova Square), we offer a comprehensive approach to rosacea treatment using the most advanced world technologies. Our dermatologists have over 10 years of experience working with rosacea and develop individual treatment programs considering your skin's characteristics.
📞 Phone: +38 (044) 537-08-06
📍 Address: 6 Yaroslavska St., Kyiv 04071 (Kontraktova Square metro)
🕐 Working hours: Mon-Sun 10:00-18:00
The first step to clear healthy skin is a consultation with diagnostics.
References
- Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501-1510.
- Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7:F1000 Faculty Rev-1885.
- van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L. Interventions for rosacea. Cochrane Database Syst Rev. 2015;2015(4):CD003262.
- Tong Y, Luo W, Gao Y, et al. A randomized, controlled, split-face study of botulinum toxin and broadband light for the treatment of erythematotelangiectatic rosacea. Dermatol Ther. 2022;35(5):e15395.
- Chang ALS, Raber I, Xu J, et al. Assessment of the Genetic Basis of Rosacea by Genome-Wide Association Study. J Invest Dermatol. 2015;135(6):1548-1555.
- Moustafa F, Lewallen RS, Feldman SR. The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol. 2014;71(5):973-980.
- Rainer BM, Fischer AH, Luz Felipe da Silva D, Kang S, Chien AL. Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study. J Am Acad Dermatol. 2015;73(4):604-608.
- Liu Y, Wang Z, Yu Y, et al. Assessment of the Efficacy and Safety of 30% Supramolecular Salicylic Acid Peeling for Papulopustular Rosacea Treatment. Clin Cosmet Investig Dermatol. 2023;16:375-382.
- Wu ZQ, Yin YM, Gong L, et al. Retrospective analysis of 19 papulopustular rosacea cases treated with oral minocycline and supramolecular salicylic acid 30% chemical peels. Exp Ther Med. 2020;20(2):1367-1373.
- Schaller M, Almeida LM, Bewley A, et al. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017;176(2):465-471.
- Farshchian M, Daveluy S. Rosacea. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557574/
- Tan J, Steinhoff M, Berg M, et al. Shortcomings in rosacea diagnosis and classification. Br J Dermatol. 2017;176(1):197-199.
- Two AM, Wu W, Gallo RL, Hata TR. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015;72(5):749-758.
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- Tsiskarishvili NV, Katsitadze A, Tsiskarishvili Ts. New possibilities in the treatment of early stages of rosacea. Georgian Med News. 2013;(214):23-28.
This article was written by Venus Clinic doctors based on the latest international research and clinical experience. The information is for informational purposes only. Diagnosis and treatment require consultation with a dermatologist.
