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ERYTHEMA AND TELANGIECTASIAS

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SUMMARY

  • Erythema and telangiectasias are a common patient complaint.

  • The mainstay of therapy is laser and IPL treatments; IPL confers the advantage of larger spot sizes, and thus more efficient treatments.

  • Patients should always understand that multiple treatments will be needed, and maintenance therapy is generally required.

image Beginner Tips

  • Regardless of the device chosen, a slight amount of overlap of pulses is necessary to achieve uniform improvement of the treated area.

  • KTP causes more swelling and bruising compared to PDL and IPL.

  • PDL is safer than KTP in those with darker skin types given increased depth of penetration.

  • Do not use IPL on those with tanned or sunburned skin.

  • There should be approximately 10% overlap with IPL to avoid a “stamping” appearance following treatment.

image Expert Tips

  • Telangiectasias of the nose can be very treatment resistant; recurrence rates are quite high, necessitating maintenance treatments.

  • In many patients, it can be difficult to permanently eliminate alar telangiectasias altogether; caution patients from the outset that maintenance treatments are often necessary.

  • Another factor for the physician to consider when treating large areas is the wear and tear to the laser itself—larger areas consume more of the dye kit and cryogen.

image Don’t Forget!

  • The neck and chest skin have a thinner epidermis and dermis compared to the face, so typically gentler settings should be used.

  • It is important to become familiar with the device you choose to use. Devices of the same wavelength do not necessarily have interchangeable settings, and the time to development of erythema or purpura following a single pulse varies between devices. Also, service of the laser (such as replacement of a dye kit) may influence the performance and actual energy delivered.

image Pitfalls and Cautions

  • Do not pulse stack with a 1,064-nm laser, which increases the risk for scarring.

  • 1,064 nm has the greatest risk for causing retinal damage because of its deep penetration, so caution should be exercised near the eye with appropriate shielding.

  • Many laser experts avoid 1,064-nm laser treatments on the nasal ala due to an increased risk for depressed scarring.

INTRODUCTION

Prominent erythema and telangiectasia of the face, neck, and chest are frequent complaints and reasons for presentation to the dermatology office. The most common etiologies of these signs are rosacea and photodamage, with less common reasons being alcoholism, medication use, connective tissue diseases, and genetic disorders, such as hereditary hemorrhagic telangiectasia. Sun exposure damages and weakens collagen and elastin, and cumulative exposure results in vascular ectasias and physical signs of erythema and telangiectasias.

UV photodamage is believed to contribute to the development of rosacea. Rosacea symptoms typically include frequent flushing associated with facial erythema, telangiectasias, papules, and pustules. Patients with CREST (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) often present with what are classically referred to as mat-like telangiectasias. ...

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