1. Introduction

Vascular disorders affecting the skin, particularly facial erythema, facial telangiectasia, and many others, negatively influence the psychological status of individuals [1]. As Lavada et al. published in 2012, mostly all skin conditions can be associated with heightened levels of psychological morbidity, suggesting the need for psychological interventions [1]. Laser is one of the most common options, which can be used in the management of vascular lesions [2] and for the treatment of erythema [3]. It targets intravascular oxyhaemoglobin to destruct cutaneous vascular disorders. The diode laser, at 577 nm, has an ideal wavelength for treating cutaneous vascular disorders and targets intravascular haemoglobin [4]. The aim of this case report was to assess the efficacy and safety of the 577nm diode laser in facial erythema.

2. Materials and methods

The study was conducted retrospectively. A total of 4 female patients in an age from 28-43 years, who were seen at our clinic with facial erythema were retrospectively evaluated. Patients were diagnosed by a clinical examination and detailed anamnesis. No biopsy was taken from any patient for the diagnosis. Pre-treatment the patients were advised to use sun blocker, Papulex Oilfree (Bioderma/Naos, France) and in case of an associated melasma also tretinoin 0.1%. All the patients were treated with 577nm diode laser (QuardoStarPRO YELLOW, Asclepion Laser Technologies GmbH) in 4-week intervals, for four sessions. Directly before the treatment the skin was cleaned with a mild cleanser and a thin layer of clear coupling gel was applied to the skin. No topical anaesthetic was needed. The chilled scanner tip of the handpiece was placed perpendicular to the treatment area. Two passes with fluence ranges from 12-18 J/cm² were applied in scanner mode. The treatment itself took less than 10 minutes. For the aftercare we recommended Sensibiolight moisturizer (Bioderma/Naos, France), sun blocker and for melasma maintenance a mixture of 0.1% tretinoin and 4% hydroquinone.

The assessment of the treatment was made based on clinical examination, the digital photographs (Program Photo Manager) and fading of the erythema and telangiectasias at baseline and four weeks after the last session. Improvement was rated as excellent (75% – 100%), very good (50% – 74%), good (25% – 49%), and poor (<25%).

3. Results

For all four patients before and after pictures were taken (Figure 1-4). Strong clinical improvement (75 – 100%) was observed in all patients. The treatment was very well tolerated. No serious side effects were observed. In 2 of 4 patients mild to moderate erythema occurred which was transient and disappeared within 12 – 24 h. Patients reported high satisfaction concerning the outcome of the treatment.

Fig. 1: Erythematous rosacea and melasma [5].  Female, 43 years; Fitzpatrick’s skin type III; 4 sessions within 16 weeks, scanner mode (12 – 15J/cm², two passes).

Fig. 2: Erythematous rosacea [5]. Female, 28 years; Fitzpatrick’s skin type III; 4 sessions within 16 weeks, scanner mode (12-15J/cm², two passes).

Fig. 3: Erythematous, papular rosacea and melasma [5]. Female, 42 years; Fitzpatrick’s skin type III; 4 sessions within 16 weeks, scanner mode (15-18J/cm², two passes).

Fig. 4: Ideopathic facial erythema [5]. Female, 37 years; Fitzpatrick’s skin type III; 4 sessions within 16 weeks, Scanner Mode (12-15J/cm², two passes).

4. Conclusions

This case series has shown that the 577-nm diode laser is a very effective, safe, and well-tolerated treatment for facial erythema. The QuardoStarPRO YELLOW is a 577-nm diode laser whose wavelength is ideal for treating vascular lesions [5]. It is a highly effective and safe method for the treatment of vascular disorders, with the intended target being intravascular haemoglobin. Theoretically, wavelengths that match the absorption maximum of oxyhaemoglobin, such as 577nm, should produce the greatest effect [3]. We consider that the 577nm diode laser is a useful treatment choice with pleasing outcomes for both patients and physicians in the treatment of vascular lesions or other vascular-based lesions such as facial erythema.

Compliance with ethical guidelines

Conflicts of interest for the study: The author declares that she has no competing interests. The author has legally purchased the laser mentioned in this article and used it in her practice. Her research did not involve animals. Informed consent was obtained. The author has indicated no significant interest with commercial supporters.

All Photos courtesy of Dr. Yuwita Wulan, Immanuel Hospital Bandung, Jawa Barat, Indonesia