Spot size matters: enhancing rosacea treatment with pulsed-dye laser

The importance of spot size in pulsed dye lasers for treatment of rosacea is frequently undervalued. This study aimed to compare the efficacy of 7-mm and 10-mm spot sizes of a 595-nm pulsed dye laser for treating erythematotelangiectatic rosacea.Twenty participants with erythematotelangiectatic rosacea were enrolled and received three treatments at 4-week intervals. The left and right cheeks were treated with a circular beam with diameters of 7 mm and 10 mm, respectively. The pulse duration was 10 ms. Therapeutic energy was adjusted by 5-10% based on the immediate reaction after treatment. The skin type, sex, age, lesion site, erythema severity score, telangiectasia severity score, VISIA percentile score, and clinical photographs were recorded at baseline and at 4-week intervals thereafter. The clinical erythema (CEA) score, patient global assessment (PGA) scale score, visual analog scale (VAS) score, and adverse events were evaluated at 4-week intervals. Two physicians blindly evaluated the results.Significant improvements in CEA and telangiectasia scores, VISIA percentile score, and PGA scores were observed on both sides at 3 months, without significant differences between the left and right cheeks. Participant satisfaction with the right side (10 mm; 90%) was significantly higher than that with the left side (7 mm; 85%). The average pain score (VAS) on the left (4.85 ± 0.81) was significantly higher than that on the right (3.95 ± 1.00).This study demonstrated that a 10-mm-diameter therapeutic beam can safely improve rosacea symptoms. The 10-mm light spot was less painful than the 7-mm light spot and had the same therapeutic efficacy; therefore, it is the optimal choice for rosacea.