Comparative Effectiveness of Different Laser Treatments for Facial Erythema

Rosacea on face
Rosacea on face
Investigators examined the efficacy of microsecond 1064-nm neodymium:yttrium-aluminum-garnet laser with nonpurpuragenic 595-nm pulsed dye lase for diffuse facial erythema.

Both microsecond 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers and nonpurpuragenic 595-nm pulsed dye lasers (PDLs) reduced facial erythema without marked discomfort or pain, bruising, or other adverse events, and although PDL was found to be relatively more effective objectively and subjectively, Nd:YAG proved less painful, according to study results published in the Journal of the American Academy of Dermatology.

This split-face, double-blind randomized controlled trial was designed to compare the effectiveness of Nd:YAG with PDL for diffuse facial erythema. Bilateral cheeks were given 4 treatments with Nd:YAG or PDL, each at 3- to 4-week intervals. Patient preferences, digital photographs, spectrophotometer measurements, and pain scores were recorded for 16 patients in Atlanta and Chicago, 14 of whom completed the study (all skin type I to III; mean age, 42; 57% women).

Spectrophotometer readings changed after both Nd:YAG (2.5%; 95% CI, −6.37 to 1.29; P =.1762) and PDL (8.9%; 95% CI, −12.9 to −4.95; P =.0003), but PDL produced 6.4% more reduction in facial redness from baseline than Nd:YAG (95% CI, −11.6 to −1.2; P =.0199). The pain associated with each treatment varied (P =.0028), with PDL associated with more pain at 3.87 than Nd:YAG at 3.07. Participants rated redness 52% improved by PDL compared with 34% improved by Nd:YAG (95% CI, −34.6 to −1.94; P =.0311). No serious adverse events occurred with either treatment.

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Although the settings selected for each laser treatment were standard for the treatment of facial redness, there was no way to be completely certain that the settings were comparable between devices. Nevertheless, either laser can safely and effectively treat facial erythema. Pulsed dye lasers may be more effective for patients with lighter skin, but Nd:YAG may be less painful. Study investigators concluded, “Future research may consider comparison of additional laser devices and settings.”

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Alam M, Voravutinon N, Warycha M, et al. Comparative effectiveness of nonpurpuragenic 595-nm pulsed dye laser and microsecond 1064-nm neodymium:yttrium-aluminum-garnet laser for treatment of diffuse facial erythema: a double-blind randomized controlled trial. J Am Acad Dermatol. 2013;69(3):438-443.