Treatment of facial flushing by topical application of nicotinic acid cream followed by treatment with 595-nm pulsed-dye laser

Abstract

Conflict of interest: none declared. A 26‐year‐old Korean man presented with facial flushing that was easily aggravated by various conditions including emotional stress and hyperthermic stimulation. He had been treated with four sessions of intense pulsed light at private dermatological clinic without achieving satisfactory improvement. There was no pertinent personal or family history. Informed consent was obtained from the patient for treatment with a 595‐nm pulsed‐dye laser (PDL) (Vbeam®; Candela Corporation, Wayland, MA, USA) and three sessions were performed. Before each treatment, the symptoms were provoked by application of topical nicotinic acid cream (Litederm™ nicotinic acid laser preparation cream; Beauté Pacifique, Hadsund, Denmark), a vasodilator of the superficial cutaneous vasculature, which was left on the skin for 20 min (Fig. 1a). After application of the topical agent, the patient reported a mild to moderate burning sensation, but no itching or prickling sensations. The affected areas were first treated with nonoverlapping single pulses of the 595‐nm PDL (fluences of 6.5–7.5 J/cm2, spot size 10 mm, pulse duration 6–10 ms). An integrated dynamic cooling device with a setting of 30 ms on/30 ms off was applied to cool the epidermis. After the procedure, the face was completely cleansed with a mild cleanser. The redness induced by the topical agent and laser irradiation spontaneously resolved within 2 h.