Facial Telangiectasia Research Articles

Turning Down the Fire: The Role of Botulinum Toxin Microdroplets in Refractory Rosacea Erythema

Introduction: Dermal “micro-injections" of botulinum toxin A (BTX-A) treatment can improve facial flushing and erythema in patients with refractory rosacea. We present a case of a patient with longstanding papulo-pustular rosacea with flushing, refractory to laser, topical and systemic therapies, where intradermal microdroplet BTX-A injections successfully controlled erythema and flushing. Case Description: A 49-year-old White female with a 4-year history of refractory papulo-pustular rosacea presented with bright, central facial erythema and telangiectasias after failing multiple 595 nm pulsed dye laser, topical (azelaic acid 15% gel, 0.025% tretinoin cream, and metrocream 0.75%) and systemic (isotretinoin 20 mg daily, spironolactone 25 mg daily and doxycycline 100 mg twice daily for 14 days) treatments. At treatment 1, 20 U of BTX-A was injected intradermally (0.05 mL of 1.25 IU/0.1 mL per microdroplet) to erythematous lesion. Treatment 2 was performed at her 4 week follow-up were we administer 15 U of BTX-A intradermally (0.05 mL of 1.25 IU/0.1 mL per microdroplet) . The patient was seen 4, 8, and 16 weeks after her second treatment were no BTX-A was administered due to a significant reduction in erythema and lasting results. Discussion: Significant clinical improvement and patient satisfaction was achieved. No adverse events were reported after treatment aside from mild, localized injection site pain during the procedure. BTX-A administered as intradermal microdroplet injects can be a safe and efficacious option in the treatment of refractory rosacea erythema. Microbotox may be an effective adjunct, especially when topical and systemic therapies have failed.

Lower limb ulcer and Raynaud's phenomenon

A 64-year -old patient sought medical advice for an ulcer of the lower extremities (Fig 1). He also presented with claudication, chronic dyspnea, skin thickening, and late-onset Raynaud's phenomenon (RP). There were no palpable dorsalis pedis or posterior tibial pulses. Skin examination showed reduction of forehead folds, facial and tongue telangiectasias, xerosis cutis, salt-and-pepper hyperpigmentation, sclerodactyly, digital ulcerations, and pitting scars (Fig 2). Chest auscultation revealed crackles on the lower lobes.

Novel intense pulsed light-photodynamic therapy strategy in the treatment of facial actinic keratoses concomitant with rosacea

Rosacea presents as transient or persistent erythema, papules, pustules, flushing, and telangiectasia on the middle of the face, which has some clinical similarity with actinic keratosis (AK). These two conditions can coexist in the same patient. Dermoscopy and reflectance confocal microscopy (RCM) could be useful methods for diagnosis and monitoring treatment efficacy. Novel intense pulsed light-photodynamic therapy (IPL-PDT) may have better tolerance and curative effect than traditional red-light 5-aminolevulinic acid photodynamic therapy (ALA-PDT). Herein, we present a case of facial AKs concomitant with rosacea where combination therapy of novel IPL-PDT and oral minocycline was effective in that AK lesions were eliminated and the patient’s facial erythema and telangiectasia were significantly improved.

Combination of Specific Vascular Lasers and Vascular Intense Pulsed Light Improves Facial Telangiectasias and Redness.

Background and objectives: Facial telangiectasias are dilated blood vessels that can represent a cosmetic issue for patients. They may be associated with other conditions, such as rosacea. Laser and light treatments are nowadays becoming a cornerstone in the management of these lesions. Materials and Methods: In total, 68 patients seeking medical treatment for facial telangiectasias were enrolled from 1 March 2019 to 1 March 2020 at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). A protocol consisting of a 1064 Nd:YAG laser for darker blue telangiectasias and 532 nm Nd:YAG for red lesions followed by intense pulsed light with an optimized spectrum for vascular lesion 3 weeks after the first procedure was proposed. A three-month follow-up visit assessed patient’s satisfaction using a visual analog scale (VAS). Two dermatologists measured clinical results using a 4-point scale, comparing pictures before treatment and at follow-up. Results: A total of 68 patients (32 males and 36 females) completed the study, performing all requested treatments. No severe side effects were reported. Patient satisfaction was very high (8.15 ± 1.05 out of a 10-point VAS scale), as well as dermatologists’ clinical evaluations (2.19 ± 0.74 out of 3). Conclusions: The combination of vascular lasers and Vascular Intense Pulsed Light acting specifically on small blood vessels may help to improve the aesthetic outcome, reducing side effects. A prospective study with a larger number of participants will be necessary to confirm this study’s findings.

Increased oxidative stress and imbalance dynamic thiol–disulfide homeostasis in Rosacea

Background: Rosacea is a chronic progressive inflammatory disease and characterized by facial erythema, telangiectasias, papules, and pustules. The disease is more common in women than in men while affecting 2%–10% of the population. Though the pathogenesis of rosacea is not fully understood, oxidative stress is one of the asserted pathogenic factors. In this study, we purposed to assess the oxidative stress and thiol–disulfide homeostasis (TDH) in rosacea disease. Materials and Methods: Forty patients with rosacea and 40 healthy people as a control group, both in ages of 18–70 years, with the same demographic characteristics were included, who were applied to the Istanbul Training and Research Hospital Dermatology Clinic. Serum total antioxidant status (TAS), total oxidant status (TOS), total thiol (TT), and native thiol (NT) levels were evaluated by using the automated and spectrophotometric method according to Erel and Neselioglu. Oxidative stress index (OSI), disulfide (DIS) levels, and NT/TT, DIS/TT and DIS/NT percentages were calculated mathematically. Results: TAS, TT, and NT levels were decreased in rosacea patients compared with the healthy group, whereas TOS, OSI, and DIS levels were increased. Additionally, although DIS/TT and DIS/NT percentages were higher in patients, NT/TT ratio was lower than the healthy group, and these findings were statistically significant (p < 0.001). Conclusion: The results showed that oxidative stress levels were increased in rosacea patients and TDH shifted toward DIS formation. It has been thought that oxidative stress is a parameter that may be utilized in the clinical evaluation of the disease.

Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia.

Facial erythema is one of the most common outpatient complaints in dermatology. There are various causes of facial erythema and several devices are available for its treatment. Pulsed dye laser (PDL) and intense pulsed light (IPL) are the two common light devices used for these conditions. In this review, we evaluated the literature to assess efficacy of IPL versus PDL in facial erythema and telangiectasia. We searched published articles including clinical trials or reviews articles, case series, and case reports. Electronic databases (MEDLINE and PubMed) were searched to retrieve the articles. Reference lists of selected articles were also considered for the review. Articles published in English language until June 2021 were considered for this review.

Evaluation of the efficacy of pro-yellow laser in the management of vascular skin disorders.

Lasers have great importance in the management of vascular skin lesions. To determine the efficacy of 577-nm pro-yellow laser in cure of certain vascular skin diseases. Seventy-four patients who are diagnosed as vascular skin diseases were involved in this study. All participants were treated with 577-nm pro-yellow laser with 4-week intervals. The photographs that were taken before and at every following visit were used to evaluate improvement. A significant improvement occurred in port-wine stain, rosacea, facial telangiectasia, venous lake, scrotal angiokeratoma, and cherry angioma cases. Vascular skin lesions can be treated with 577-nm pro-yellow laser with a minimal adverse effect and great success rate.

Blue Laser (450 nm) in the Treatment of Port Wine Stains and Telangiectasia.

This study aimed to test a blue light source for the treatment of port wine stains (PWS) and telangiectasia and to compare this with the application of green and yellow lasers based on data in the literature. A total of 22 patients with PWS were treated with radiation from a novel, high-power 450 nm blue laser that was created for this project. The group contained 15 patients with red PWS and 7 with pink PWS. The best results were achieved for red PWS, using 15–20 ms light pulses and 47 W power. For patients with pink malformations, the results were unsatisfactory. The group with telangiectasia consisted of six patients with facial lesions and three with leg lesions. The recovery was completed for all patients with facial telangiectasia, while the blue laser therapy was ineffective for patients with leg telangiectasia. This study shows that, in some cases, the use of a blue laser may be an alternative to the use of green and yellow lasers.

Nd:YAG Laser in the Treatment of Nail Psoriasis: Clinical and Dermoscopic Assessment.

The Nd:YAG laser has emerged as a promising modality for the management of nail psoriasis owing to its ability for deep penetration of the skin surface, which has the advantage of destroying deep vessels. To assess the efficacy and safety of Nd:YAG laser in treating nail psoriasis. The present study was a randomized controlled study, conducted on 20 patients of both sexes (age older than 12 years) with mild to moderate psoriasis with nail involvement. We utilized facial telangiectasia parameters of Nd:YAG laser and beam diameter of 2.5 mm. Laser energy started with 110 J/cm2 in the first session and 130 J/cm2 in the rest of the sessions. Sessions were performed once monthly for up to 6 sessions. We found no statistically significant difference in total Nail Psoriasis Severity Index (NAPSI) and nail bed scores before and after treatment among the treated group. However, there was statistically significant improvement in nail matrix score after treatment. On the other hand, the control group did not show any statistically significant changes for all scores throughout the study, except for the nail matrix score mean difference (0.35 ± 1.23 vs -1.00 ± 1.86 in the treated group). The degree of dermoscopic improvement was evident in the treated group (45% vs 25% in the control group). However, it was not statistically significant because of small sample size. The patients' satisfaction and the external investigator's assessment showed statistically significant negative correlation with total NAPSI mean difference in the treated group. The role of Nd:YAG laser in nail psoriasis is still controversial.

IATROSACEA FOLLOWING ABUSE OF TOPICAL STEROIDS AS A FACE-WHITENING CREAM IN MOSUL CITY

Objectives: To highlight the knowledge, frequency, types, and the clinical aspects of overusing TCs on the face as well as the motivation for such practice, with the aim of rising the public awareness in Mosul City. Methods: This prospective observational study included 180 patients aged 13-53 years, with steroid dermatitis resembling rosacea "Iatrosacea" with history of using TCs on face &gt; 1 month, were evaluated at Al-Qudis Health Center for Family Medicine. Patients contradicted using TCs, or with classical rosacea were excluded. Results: The majority were females (90%). Duration was 2 months to 7 years. The motives were fairness (55%) and melasma (19%). The commonly abused drug was Betamethasone Valerate (35%). The reported side effects were facial erythema (84%), telangiectasia (79%), rebound phenomenon (66%), rosacea (56%), and acne (42%). The exacerbation on stopping TCs (63%) and skin lightening (37%) were the main reasons behind continued use; 59% were unaware about side effects of TCs; 42% obtained the products from cosmetic shop/Beautician and 27% from nurse clinic. In spite of observable side effects, 74% of abusers didn't feel guilty for applying them for protracted periods. Conclusion: Inappropriate use of TCs for cosmetic purposes is still commonly encountered in our environment, with believe TCs will correct any facial imperfection. As fair skin is correlated with beauty and social privilege, both genders of different ages, social, and educational status are indulged in this practice that exposed them to medical and social problems. It is a multiphase issue necessitates collaboration of different sectors to raise public awareness and control their easy availability to overcome this dilemma.

Cellulose Nanocrystals for Skin Barrier Protection by Preparing a Versatile Foundation Liquid.

Most of the foundation liquids in the market need makeup removers for cleaning, while the excessive use of makeup removers might lead to skin barrier damage, which would further lead to many kinds of dermatosis, such as skin sensitivity, facial telangiectasia, rosacea, acne, as well as various cosmetic contact dermatitis. Inspired by the protective effect of fiber-rich diet on the intestinal mucosal mechanical barrier, a novel hemp/cellulose nanocrystals (CNCs)-based foundation liquid featuring easy-wiping property has been constructed, which will effectively solve the post-makeup skin cleaning problems. In this experiment, the formula of the foundation liquid can be obtained through hemp/CNCs instead of mineral oil and titanium oxide, which are considered to have undesirable local tolerance, sensitizing potential, and are environmental pollutants, to create a moisture barrier. Industrial hemp is a hot issue in cosmetic research, and a great quantity of discarded industrial hemp stalk is available to be used to produce hemp/CNCs through grinding and acidification. The graft technique is adapted to obtain hemp/CNCs-g-polylactic acid (PLA). By replacing the hydroxyl group on the side of hemp/CNCs, hemp/CNCs-g-PLA reduces the intermolecular hydrogen bonding, resulting in a higher dispersion in the oil phase. The hemp/CNCs-g-PLA has excellent performance in terms of biological compatibility, water resistance, and non-penetration into the skin. With basic features of a foundation liquid to alleviate discoloration, age spots, and skin roughness, the foundation liquid based on hemp/CNCs-g-PLA provides a novel characteristic of easy-wiping, which helps to avoid the damage to the skin barrier caused by excessive cleansing.

The association of photo-induced collagen degeneration and the development of telangiectasias in rosacea.

Rosacea is a chronic, often progressive disorder characterized by facial erythema, telangiectasias, papules, pustules, and/or rhinophyma. In this study, we investigated the tissue structure in rosacea compared to controls. We performed a case-control study between five patients with mild-to-moderate erythematotelangiectatic rosacea (ETR) and five matched controls. Facial biopsy samples from rosacea patients and controls were stained with picrosirius red for collagen and CD31 for microvessel identification. Mean collagen content was significantly greater in control samples (19.603% ±8.821%) compared to rosacea samples (16.812%±7.787%, p=0.030). In contrast, mean microvessel density was significantly higher in rosacea patients (4.775 E-5±1.493 E-5µm-3 ) compared to controls (2.559 E-5±8.732 E-6µm-3 , p=0.004). Mean microvessel lumen area was also significantly higher in rosacea patients (491.710±610.188µm2 ) compared to controls (347.879±539.624µm2 , p=0.003). We identified a correlation between decreased collagen content and increased microvessel size and density in rosacea patients that was not observed in controls. These structural changes to the dermal matrix may contribute to the characteristic vessel growth and dilation in rosacea.

EXACT LASER FLUENCE FOR SUCCESSFUL TREATMENT OF FACE AND LEG TELANGIECTASIA

The aim: Facial and leg telangiectasia are usual cosmetic concern for females who have different skin phototypes and ages. Until now, the various treatments for these problem have frequently failed or led to unwanted side-effects. Based on approved pre-calculated doses, the present study highlights the clinical effects and safety of treatment after using the exact laser parameters from 1064-nm Nd: YAG laser. Materials and methods: Twenty people with facial and leg telangiectasia underwent a single laser treatment, based on pre-calculated laser parameters for each case. Results: All subjects showed visible improvement, with 95–100% clearance of face telangiectasia directly after the first treatment, and 50–100% clearance of the lower extremity vessels after one to three days; with minimal side-effects. Conclusions: Treatment of facial and leg telangiectasia by using true, exact, and mathematically pre-calculated parameters of long pulse 1064 nm Nd: YAG laser was an effective and safe procedure of clearing face and leg telangiectasia.

Cutaneous Manifestations of Juvenile Dermatomyositis: A Case Series

Juvenile Dermatomyositis (JDM) is an idiopathic inflammatory myopathy characterized by the weakness of skeletal muscle and pathognomonic skin rashes. Studies focusing on the cutaneous manifestations of JDM are sparse. The objectives of the study were (1) to describe cutaneous changes seen in JDM and (2) to observe nailfold capillaroscopy (NFC) changes in patients with JDM. This was a retrospective case series. All children under the age of 15 years who were diagnosed to have dermatomyositis according to the Bohan and Peter criteria and on histopathology presenting to the dermatology outpatient department during a period of 1.5 years (January 2017–June 2018) were included in the series. Details including clinical features and finding from investigations such as NFC, muscle magnetic resonance imaging, electromyography, muscle enzymes, and biopsy were noted. Statistical analysis was performed on the basis of measures such as percentage and frequency of cutaneous manifestations. A total of eight cases of JDM were included, with average age at presentation being 7.62 years. Among the cutaneous manifestations, the most common presenting features were heliotrope rash and Gottron's papule. Facial telangiectasias, calcinosis cutis, and hypertrichosis were seen in 37.5% of cases. Other cutaneous features seen were confluent and reticulate violaceous erythema, cutaneous ulcer, and periungual telangiectasia with cuticular overgrowth. NFC was suggestive of scleroderma-dermatomyositis pattern in all six patients in whom it was conducted. JDM has classic, pathognomonic skin manifestations that may or may not correspond with muscle inflammation. To avoid complications, early diagnosis and prompt treatment is the mainstay. NFC acts as an important diagnostic tool and also helps to characterize the phase of disease.

Genetics of facial telangiectasia in the Rotterdam Study: a genome-wide association study and candidate gene approach.

The severity of facial telangiectasia or red veins is associated with many lifestyle factors. However, the genetic predisposition remains unclear. We performed a genome-wide association study (GWAS) on facial telangiectasia in the Rotterdam Study (RS) and tested for replication in two independent cohorts. Additionally, a candidate gene approach with known pigmentation genes was performed. Facial telangiectasia were extracted from standardized facial photographs (collected from 2010-2013) of 2842 northwestern European participants (median age 66.9, 56.8% female) from the RS. Our GWAS top hits (P-value <10-6 ) were tested for replication in 460 elderly women of the SALIA cohort and in 576 additional men and women of the RS. Associations of top single nucleotide polymorphisms (SNPs) with expression quantitative trait loci (eQTL) in various tissues were reviewed (GTEx database) alongside phenotype associations in the UK biobank database. SNP-based associations between known pigmentation genes and facial telangiectasia were tested. Conditional analysis on skin colour was additionally performed. Our most significant GWAS signal was rs4417318 (P-value 5.38*10-7 ), an intergenic SNP on chromosome 12 mapping to the SLC16A7 gene. Other suggestive SNPs tagged genes ZNF211, ZSCAN4, ICOS and KCNN3; SNP eQTLs and phenotype associations tagged links to the vascular system. However, the top signals did not pass significance in the two replication cohorts. The pigmentation genes KIAA0930, SLCA45A2 and MC1R, were significantly associated with telangiectasia in a candidate gene approach but not independently of skin colour. In this GWAS on telangiectasia in a northwestern European population, no genome-wide significant SNPs were found, although suggestive signals indicate genes involved in the vascular system might be involved in telangiectasia. Significantly associated pigmentation genes underline the link between skin colour and telangiectasia.

Skin vascular lesions: A new therapeutic option with sequential laser-assisted technique.

Treatment of skin unaesthetic vascular lesions is still suboptimal. In this article, we present a multicenter study evaluating the efficacy and safety of the sequential 755 nm Alexandrite and 1064 nm ND:YAG lasers for the treatment of acquired and congenital vascular lesions of the skin. A total of 171 patients were included in the study (141 female and 30 male), median age 38, skin type from I to IV. Numbers of patients categorized for treated disease: 22 spider angiomas, 67 facial telangiectasia/spider veins, 58 leg telangiectasia/reticular leg veins, 24 port wine stains (PWS). Of those lesions 30.7% was on legs, 63.7% on face (6.7% on forehead, 10.1% on temples, 21.7% on cheeks, 25.2% on nose, 1.7% on chin) and 5.6% on chest. Spider angiomas required from 1 to 3 treatments. Facial telangiectasias had been treated from 1 to 4 times. Leg telangiectasias needed from 2 to 6 treatment sessions. Regarding PWS, it takes from 6 to 9 laser treatment to reach the clearance of the lesion. All the vascular disorders treated showed marked improvement while side effects were limited to low pain sensation and transitory fenomena. This sequential treatment is an effective, safe, and new approach for unaesthetic skin vascular lesions.

Systemic Lupus Erythematosus with Unusual Manifestations

Abstract Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology, presenting with variable clinical picture. Having a high heterogeneity and lacking pathognomonic features, very often the diagnosis poses a great challenge for the clinician. Several unusual clinical manifestations such as nasal septal perforation and digital gangrene can occur in LES patients. Case report. We report the case of a 42-year-old woman, known with SLE, hospitalized in our department for a clinical presentation consisting of a recent major epistaxis, physical asthenia and acral necrosis of the upper limbs. Physical examination revealed an afebrile patient, with a cushingoid facies, facial telangiectasias, and necrotic scars localized on the distal phalanges, bilaterally. A diagnostic nasal endoscopy showed a large septal perforation with the absence of the cartilaginous nasal septum. CT highlighted an extended defect at the level of the cartilaginous part of the nasal septum. Conclusion. Nasal septal perforation remains an underdiagnosed invalidating complication of lupus and treated and discovered early could have an important impact on the general health of an already burdened by disease patient.

Enhanced Pulsed Dye Laser for Facial Rejuvenation.

To evaluate the efficacy of an enhanced pulsed dye laser (PDL) for treatment of facial-dyschromia. Thirteen patients were enrolled in the study. Nine patients were female, four were male, with a mean age of 61 years. All patients presented with either facial telangiectasia, rosacea, pigment, or a combination thereof. At the initial evaluation, test spots were performed to determine the subject's response to selected treatment parameters. In the study, the enhanced 595 nm PDL deployed a spot size range of 5-12 mm with fluences ranging from 8 to 18 J/cm2 . Pulse duration was 10 milliseconds. Enhancements in this device included the option for contact or cryogen spray cooling, increased maximum pulse energy, increased repetition rate, option for addition of radiofrequency (RF), an option for a 15 mm spot size, and longer dye life. The smaller spots were used only for focal low contrast pigmented lesions that persisted after overall facial treatment with the larger spot. Smaller fluences were applied for general rejuvenation with the 12 mm spot (mean ~9 J/cm2 ). Sapphire contact cooling was applied at 10°C. A smaller area of the skin was reserved (typically pre-auricular area) for addition of RF energy just before the pulse (40-70 J/cm3 ) over 100 milliseconds with a 20 milliseconds delay between the end of the RF pulse and beginning of the laser pulse. The minimum fluence that achieved vessel closure/vessel bluing and/or slight immediate pigment darkening was applied based on test spots performed just before treatment to the entire face. Determinations of improvement were made by evaluation of photographs with standard settings using polarized and nonpolarized images. Up to three treatments were performed approximately 1 month apart with follow-up visits 1 and 3 months after the final treatment. Evaluation by a panel of blind observers determined a mean clearance of at least 50% in all lesions, while 77% of lesions had 50-75% clearance, and 23% of lesions had 76-100% clearance. Pain was approximately 4/10. Subjective lesion improvement and satisfaction rates were 3 out of 4 and 3.6 out 4, respectively. An enhanced PDL is effective in one pass treatments for facial rejuvenation with considerably less operative time than previous commercially available systems. A second pass applied to focal challenging lesions results in even more improvement, in a single treatment session. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Differential diagnosis of rosacea

The clinical picture of rosacea, including facial skin erythema, telangiectasia, and popular, and pustular elements, is similar to other dermatoses, thereby causing difficulties in the differential diagnosis. Original photos and descriptions of the clinical signs that distinguish these diseases from rosacea are provided. Therefore, the possibility of rare skin lesions that are sometimes mistaken for a more frequent pathology should be considered to avoid diagnostic errors.

Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias

Background: An intense pulsed light (IPL) narrowband KTP/PDL-like filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. Methods: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. Results: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. Conclusions: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834