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Objectives: Dermoscopy is by definition a non-invasive diagnostic technique for the assessment of skin lesions with an instrument called dermoscope. Dermoscopy has been extensively studied and is widely accepted as a useful tool in dermatological practice. In our daily routine, we tested dermoscopy as a tool for predicting laser treatment results. By using dermoscopic exam performed immediately before a laser or IPL session, we are able to better diagnose different pathologies characterized by facial erythema.

Introduction: Telangiectasias are defined as broken or widened small blood vessels sited
underneath the surface of the skin (or mucous membrane) creating a visible pattern of redviolet lines, often occurring in fair-skinned patients with long-term sun damage. Facial erythema is characteristic in many dermatological disease such as acne volgare or rosacea, couperose, sarcoidosis, lupus erythematosus, etc.

Materials / method: Fifty consecutevely patients with facial erythema have been observed at the Skin Centers and at the Department of Dermatology, Cattolica University. All patients received a dermoscopic examination were made to establish the correct diagnosis and to decide the right topical, systemic of physical treatment.

Results: Dermoscopy was fundamental to diagnose different skin pathologies characterized by facial erythema in more than 90% of patients enrolled for this study.

Conclusion: Dermoscopy is a first level exam for skin conditions characterized by facial erythema.

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Objectives: The management of Rosacea includes, according to current international guidelines, the use of physical therapy in the treatment of rosacea. Laser and pulsed light therefore play a decisive role. For the treatment of telangectatic lesions of the face, the ND: YAG 1064 nm laser and the KTP 532 nm laser represent the most widely used systems, while for erythrosis it is more appropriate to use classical intense pilse light or more recent rodaminated light (more selective for vascular tissue). Surgical lasers are the treatment of choice for rhinophyma remodeling.

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Objectives: 1: Diagnose rosacea
2: Formulate a tailored approach to rosacea with PDL
3: Understand how to increase the therapeutic effect of 585-nm PDL treatment with rosacea-associated erythema.

Introduction: Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow.

Materials / method: We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea. Methods Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale.

Results: Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment. There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher, and patient satisfaction was also higher on the niacin-pretreated side. There were no remarkable side-effects, with the exception of transient erythema and edema.

Conclusion: Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.

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Objectives: This study evaluated the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermal resurfacing system to increase skin permeability for BOTULINUM TOXIN A in the treatment of facial flushing of rosacea.

Introduction: Rosacea is a common, chronic facial skin disease. Facial erythema is a frequent and often distressing complaint of patients with rosacea. Treatment of facial erythema with botulinum toxin has previously been proposed and reported. However, the current literature has mixed results.The device used is a thermal resurfacing system which can generate ablative as well as non-ablative micropores opening the skin for transdermal delivery of compounds with no associated pain, bleeding or downtime.

Materials / method: 12 Patients were enrolled in the study. Affected facial areas were treated by Tixel operated at 400 C for 6ms - 10ms. Immediately after skin treatment, 40 units of abobotulinum toxin-A were applied over the treatment area and blocked with occlusion For 30 minutes. After 30 minutes the block was removed, and the patient discharged home. All patients received 3 consecutive treatment 1 month. Evaluation at baseline in FU visits included Demodex culture and blinded physicians and patients evaluation of the facial erythema using a standardized grading system (0 = absent, 3 = severe erythema)

Results: There was a significant mean improvement of pre- and post-treatment independent assessment. 9 subjects (75%) reported moderate-to-high satisfaction. No adverse effects were noted.

Conclusion: Thermal decomposition of the stratum corneum using the novel mechanothermal system increases skin permeability for BOTULINUM TOXIN A in the treatment of facial flushing of rosacea seems both effective and safe.

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Objectives: Rosacea represent a chronic relapsing inflammatory skin disease, with an increasing prevalence (generally underdiagnosed and often overlooked), and multiple risk factors (genetics, age, phototype, alcohol consumption and ultraviolet exposure).

The etiopathogeny of rosacea is unknown, but age, phototype, gender, alcohol consumption, genetics, ultraviolet exposure and infections (Demodex with Bacillus oleronius, Staphylococcus epidermidis, Helicobacter pylori) are strong involved in the development of the disease.

Introduction: Rosacea is frequently associated with systemic diseases (neurologic and cardiovascular disorders, diabetes and metabolic disorders, autoimmune diseases and digestive disorders) and have an important negative impact on quality of life (anxiety, depression, embarrassment, frustration, social and professional isolation etc.).

The triad of rosacea care are represented by education (about triggers factors, diet, proper use of photoprotection methods), skin care, and treatment (including local treatment and general treatment, and the use of EBD for rosacea treatment).

Materials / method: Laser treatment have a lot of effects, like ablation of vascular anomalies (destroy small vessels and reducing the symptoms), reorganization and remodeling of dystrophic dermal connective tissue and interruption of the release of inflammatory mediators.

Results: We present a scientific work, starting from clinical practice, about the implication of various triggers in development of rosacea (endocrinological, pharmacological, immunological, infectious, climatic, thermal and alimentary) and the management of rosacea (holistic approach), including general treatment and laser interventions.

Conclusion: My way, based on 15 years of experience in laser, are NOT laser treatment at the first visit, complex and holistic evaluation, changing the life style of patient (diet, sun exposure, skin care), proper local and general treatment, evaluation clearly of indications and contraindications for laser, and an individualized follow up.

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