what causes them?
Red lesions are caused by abnormal blood vessels that can result from a variety of conditions. Red marks or facial redness can be distracting and affect patients’ mood and self esteem. The most common conditions we see are
- Acne rosacea, a chronic inflammatory skin condition with intermittent blushing, facial redness, acne like bumps, thickened skin
- Red marks from blood vessel malformations such as angiomas, port wine stain, haemangiomas
- Dilated blood vessels such as nasal spider veins or leg veins
to treat red lesions safely and effectively
Vascular lasers target haemoglobin in blood vessels destroying them. The long pulse duration produces a photothermal effect that causes damage to the walls of the blood vessel. The body then naturally eliminates the damaged vessel.
Examples of such lasers include:
- Long-pulsed green Nd:YAG laser (532nm)
- Yellow laser (577nm)
- Pulsed dye lasers (585nm/595nm)
- Diode lasers (585nm/940nm)
- Long-pulsed infrared Nd:YAG laser (1064nm)
Generally, as the laser wavelength increases. absorption in haemoglobin and melanin decreases. The degree of scattering in the skin also decreases hence longer wavelength lasers would be able to penetrate deeper.
The most suitable vascular laser would depend on the characteristics of your skin and the targeted blood vessels. Longer wavelengths such as 940nm diode would be more suitable for larger or deeper vessels, thicker marks or patients with darker skin colour whereas shorter wavelengths such as the 585nm laser may be more suitable for small, bright red vessels close to the skin surface. Shorter wavelengths have more melanin absorption, hence they may have a higher risk of complications in dark skin types compared to longer wavelengths.
Intense Pulsed Light
Intense Pulsed Light can be used with vascular filters selectively target haemoglobin in blood. Normal IPLs without vascular specific filters (common in spas) would not be as safe or effective.
Intradermal neurotoxin has been reported to decrease the intensity and duration of erythema and rosacea flushing. Neurotoxins work as a neuromodulator at the neuromuscular junction and appears to interfere with normal acetylcholine signalling pathways to provide symptomatic relief even in refractory cases of rosacea.
Irritant medication solutions or foam are injected into blood vessels using super fine needles. The irritant solutions damage the walls of the vessels causing them to clot, collapse and eventually close. The body then absorbs the blocked vessels. It is less suitable for vessels on the face.
Insulated radiofrequency needles are used to puncture the skin along the course of the blood vessels and coagulate them while sparing the skin surface. The body then absorbs the damaged vessels.
Medications are mainly useful for rosacea
Topical medications (creams, gels, etc)
- Antimicrobials produce an anti-inflammatory effect
- Topical alpha adrenergic agonists cause temporary blood vessel shrinkage (vasoconstriction) and have a dramatic but temporary effect on redness
- Antibiotics reduce inflammation
- Adrenergic blockers, alpha2 agonists, opiate blockers, serotonin blockers
- Oral contraceptives can be helpful in patients who have worsening rosacea with their hormonal cycle
- Oral retinoids thought to downregulate the local skin immunity
dr wan's perspective
- Triggers such as sun exposure, alcohol, spicy foods should be identified using a symptom diary and controlled or avoided
- Topical and oral medications to suppress the inflammatory process
- Long pulse lasers such as 585nm laser or vascular IPL to target facial redness and dilated vessels
- Intradermal neurotoxins to control flushing
- Benign capillary tumours
- Respond well to 585nm laser
- 940nm laser works better in thicker angiomas or darker skin types
- Radiofrequency can be used as well
Port wine stains
- Vascular malformations, usually flat and pink but may develop darken or develop small lumps or thickening
- May be associated with
- Sturge Weber syndrome if found in the head
- Glaucoma if found near the eye
- Gut bleeding if found in the mouth
- Respond well to 585nm laser
- 940nm laser works better in thicker lesions or darker skin types
Dilated blood vessels
- Can be found in the face especially beside the nose or on the legs such as thighs and cakes
- Maybe genetic or acquired such as due to sun exposure, varicose veins
- Bright red vessels usually respond well to 585nm laser
- 940nm laser works better in bigger or deeper vessels, or darker skin types
- Sclerotherapy and radiofrequency can be used as well
Post Inflammatory Erythema (PIE)
- localized skin redness following skin inflammation that may progress to scarring
- should be understood as a scar with erythematous components and not as a simple erythematous or vascular lesion
- Fractional Radiofrequency, Fractional Lasers, Fractional Microneedling Radiofrequency improve both PIE and concomitant active acne and scarring
- if there is no depressed scarring, Fractional Radiofrequency may be most suitable