Rosacea, Thread Veins and Telangiectasia

Rosacea, Thread Veins and Telangiectasia

Rosacea, Thread Veins and Telangiectasia are common symptoms of aging and sun damage.

The gemini 532laser can vapourize small superficial facial thread veins and reduce flushing. Each treatment is £200.  Tel 01482 662480 for an appointment.

Facial Telangectasia

Dr Paul Charlson GPSI Dermatology East Yorkshire

 

Facial telangectasia are common. There are a few rare congenital causes but a vast majority are acquired. The definition of telangectasia is small dilated blood vessels between 0.5 and 1mm diameter. They can occur anywhere but are common on the face especially the cheeks , chin and nose. This is an area causing patients significant anxiety and distress and resulting in consultation.

The common causes of acquired facial telangectasia

Rosecea

Weathering (exposure to sunlight and wind)

Trauma

Excessive alcohol use

 

Rarer causes of facial telangectasia

 

Lupus

Scleroderma

Cirrhosis

Dermatomyositis

Cushings syndrome

 

 

Facial telangectasia can be effectively treated. It is clearly important to exclude rare causes of the condition but usually there are fairly obvious associated symptoms and signs or abnormal blood tests which can aid the diagnosis of these rare conditions. Simply being alert for these conditions and investigating accordingly prevents misdiagnosis. Bloods for auto-antibodies, inflammatory markers, biochemical profile and liver function tests are useful in cases where the diagnosis is in doubt. Skin biopsy might also be required.

 

Avoidance of precipitants of flushing such as alcohol and spicy foods are useful in reducing the impact of facial telangiectasia.

 

 Rosecea frequently causes marked telangectasia and sometimes this is the dominant sign of the condition. Treatments used for the pustular form of the condition such as topical and oral antibiotics appear to have a fairly minor effect on the telangectasia. Topical Azeliac Acid 15% applied bd for 8 weeks may have a better effect than Metronidazole Gel on the erythema[i]. However Azeliac Acid does cause side effects with about 10% experiencing burning, itching and reddening[ii]

 

The recent introduction of Mirvaso Gel (Brimonide Tartrate 0.5% ) appears to be a useful addition to treating the erythema associated with facial telangiectasia in Rosecea[iii] This lasts up to 12 hours and appears to have minimal side effects and tachyphylaxis. The preparation has not been trialled for other types of facial telangiectasia.

Physical treatments of telangiectasia including those caused by Rosecea are Laser, IPL and radiofrequency. Laser treatment tends to be the gold standard for facial telangectasia

There are a wide variety of lasers and IPL that have proven useful in treating facial telangiectasia. Wavelengths around 525- 595 nm are usually used to treat the vessels. These lasers do not penetrate deeply but as the vessels are superficial the lasers are effective. Large spot size and cooling of newer lasers together with better treatment parameters makes side effects less frequent. Purpura due to rupture of some smaller vessels during treatment can be an issue and takes one to two weeks to clear. Sometimes using a combination of a longer wave laser such as a 1064nm [iv]and one around 525-595nm particularly useful. Longer wavelength devices can be more painful and there is probably a greater risk of burns and other side effects due to the narrower therapeutic window but are better for larger and slightly deeper vessels. Multiple passes tend to be more effective than single passes. One to two treatments tend to provide a good clearance of vessels.

IPL machines have variety of spot sizes, cooling mechanisms and filters but some are effective in treating facial telangiectasia with similar side effect profile to a vascular laser.[v]

Radiofrequency devices are used to treat larger leg veins but are not used frequently for small vessels although these devices are quite useful for the treatment of spider naevii.

[i] Arch Dermatol. 2003 Nov;139(11):1444-50

[ii] http://www.nhs.uk/medicine-guides/pages/MedicineSideEffects.aspx?condition=Acne&medicine=azelaic%20acid

[iii] Long-Term Safety and Efficacy of Once-Daily Topical Brimonidine Tartrate Gel 0.5% for the Treatment of Moderate to Severe Facial Erythema of Rosacea: Results of a 1-Year Open-Label Study

J Drugs Dermatol. 2014; 13(1):56-61

 

[iv] Sarradet DM , Hussain M, Goldberg DJ Dermatol Surgery 2003;29 56-8

[v] Lasers Surg Med. 2012 Feb;44(2):97-102. doi: 10.1002/lsm.21151. Epub 2011 Dec 16. Split-face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece

 

Conflict of Interest

 

Dr Charlson is President Elect of the British Association of Cosmetic Doctors. He is medical director of Skinqure Clinic which provides treatment for telangectasia