Rosacea

Rosacea or Acne Rosacea is a common inflammatory skin condition that physically appears as redness spread across the face. Common areas where rosacea may develop are the cheeks, chin forehead and nose.

Flare-ups are common in many patients and they may leave a stinging and/or burning sensation at times. During flare-ups, the blood vessels which may become more visible in the skin of the face may be accompanied by tiny red bumps filled with pus.

Due to the harmless nature and appearance of the bumps, rosacea is often easily confused with other common skin conditions such as seborrheic dermatitis or acne vulgaris.

What Causes Rosacea?

While the exact pathogenesis of rosacea is still being researched by experts, it has been confirmed that a combination of genetic predisposition and environmental factors are most likely to aggravate the condition.

Rosacea on the skin can be aggravated by the following factors:

• Skin organism called Demodex Folliculorum
• Certain alcoholic beverages, such as red wine
• Cosmetic products
• Spicy foods
• Hot drinks
• Extreme temperatures
• Medications that cause blood vessels to dilate
• Mites
• Sun or wind exposure

What Are The Symptoms of Rosacea?

As rosacea is often mistaken for acne, there are many symptoms that patients can take note of in order to differentiate both conditions.

These symptoms include:

• Broken blood vessels visible through the skin
• Dryness of eyes
• Enlarged nose
• Enlarged pores
• Inflamed eyelids
• Irritated eyes
• Red, swollen bumps
• Stinging or burning sensation in the skin

Melasma

On the other hand, melasma is another chronic pigmentary skin disorder that mostly affects women of Southeast Asian descent as well as patients living close to the equator. Melasma is also known as chloasma.

Physically, melasma presents itself as a mild and faint discolouration of the face before it darkens. Melasma patches may vary in size and distribution. Usually, they tend to develop at a gradual pace depending on the person.

For patients who are pregnant, these patches may gradually disappear a few months after pregnancy. However, this does not always happen. For patients whose melasma patches are not disappearing, they may want to consider undergoing treatment to remove the patches.

What Causes Melasma?

According to experts, the pathology of melasma is complex due to its combination of both extrinsic and intrinsic factors with the inclusion of genetic susceptibility. Studies have shown that excessive UV damage and exposure may aggravate the condition and cause further harm. Melasma may also complicate the process of post-inflammatory hyperpigmentation, which is caused by damage to the skin such as chemical peels or allergic reactions to certain facial creams.

Studies have also shown that melasma disproportionately affects more women who have darker skin, higher oestrogen sensitivity or are facing excessive stress. While this fact is not one hundred percent verified, melasma may also be caused by the overstimulation of melanocytes when the skin is under heavy exposure to ultraviolet light (UV) from the sun, which is especially common in tropical countries such as Singapore.

The most at risk of developing melasma are:

• Pregnant women in their second or third trimesters
• Women who are undergoing hormone therapy
• Women who take birth control pills, and
• Women who use skincare products that are not gentle to the skin

The condition may appear to be more insidious than others and is also sometimes called the “mask of pregnancy” due to it being a common occurrence among pregnant women. Despite this, women who are not pregnant and men may also develop melasma.

Home Remedies

For some patients, the thought of seeking professional medical treatment for their skincare troubles may be a hassle or simply too daunting. While home remedies can be easily sourced through the Internet, these “tried and tested” methods only provide short-term solutions to long-term problems which may grow more complicated over time. Nonetheless, patients may also be bound by time or financial constraints which may stop them from seeking out professional melasma or rosacea treatment.

Vitamin C

Vitamin C has been deemed as one of the most essential skincare products in anyone’s skincare routine. It’s packed with antioxidants and ingredients which even out skin tone. It also reduces the appearance of scarring through the increase in collagen production.

A 2019 scientific report found that Vitamin C at levels from 3 to 10% are one of the quickest long-term solutions for managing hyperpigmentation. [1]

Vitamin C can be applied mostly through serums. It is also included in some brightening creams and sunscreens. Ideally, it should be applied once daily after cleansing and moisturising.

Retinoids

Retinoids are also known as Vitamin A and they are just as powerful as Vitamin C. Mainly used to treat signs of ageing, they also double up as solutions to treat acne and hyperpigmentation.

A 2016 study which took place for 24 weeks learnt that 4% hydroquinone and 1% retinol treatment significantly improved the photodamage and melasma, which are 2 types of hyperpigmentation, in participants. [2]

Retinol products of up to 2% can be purchased over the counter at most pharmacies. However, you should consult a dermatologist if you would like to use retinol products of a higher concentration.

For retinol to work without any harmful side effects, incorporate it once or twice weekly into your skincare routine.

Glycolic Acid

Known as the most popular and strongest AHA (alpha hydroxy acid), the sugar cane derived acid exfoliates and thickens skin as well as prevents acne and fades dark spots. It also adds another strong barrier in the skin layers which enable the skin to be thickened.

Though found mostly in professional chemical peels, it is also an active ingredient in many face washes, moisturisers and serums.

Most products usually contain about 8-30% of glycolic acid. While some may find this concentration mild, it is not typically recommended to use more than 30% once or twice a week to avoid irritation or harmful side effects.

Similar to the application of retinol, it is vital to apply glycolic acid gradually by working your way upwards. Regardless of skin type, glycolic acid is guaranteed to make your skin more sensitive to the sun.

Pro Yellow Laser for Melasma and Rosacea Treatment

At Cambridge Medical, treatment for rosacea is completed using the Quadrostar Pro Yellow Laser. Derived from the Dual Yellow / Combination laser, the Quadrostar Pro Yellow is an improved version that releases an accurate laser beam wavelength of 577nm. This means that treating the affected areas will be more precise and targeted.

During Treatment

The Quadrostar Pro Yellow Laser helps in rosacea treatment by emitting a yellow light through the skin. This reaches the affected blood vessels and shrinks them. At this stage, the appearance of the red blood vessels on the skin becomes less prominent and makes the skin look evenly toned. The improved yellow laser is more effective than its previous development as the laser’s yellow light is absorbed more by red blood cells, giving it an elusive edge compared to other technology in the market.

What can I expect during a Quadstar Pro Yellow Laser Melasma Rosacea Treatment?

The whole laser melasma or rosacea treatment process will last for about 45 minutes including the preparation time. Patients will experience minimal pain and the treatment is quite mild. Often, patients do not require the application of a topical numbing cream. However, the laser may give a mild prickling sensation.

Post Treatment

For most cases of melasma and rosacea treatment, patients will need to undergo about 4-6 treatment sessions with a rest period of about 3 weeks in between each session for the condition to improve.

There is no downtime for this treatment. As the treatment is non-invasive and non-surgical, patients will be able to resume their regular daily activities after receiving treatment. However, patients may experience redness and appear more sensitive and pink on their skin after treatment.

Pico 450 Laser

The Picocare 450 ND is the second generation of Picocare 450 ND: Yag. Its revamped technology is more advanced than many other picosecond laser technologies in the market. It is the first and only FDA-approved Pico laser technology that targets pigmentation removal and skin rejuvenation. One of the skin conditions which it can treat is Melasma.

How does a Pico 450 Laser treatment work?

The Pico 450 Laser targets laser energy into the skin’s layers which are absorbed by pigments. They break apart the pigments into smaller forms. The damage caused to the pigmentation layer triggers the body’s immune response and starts to remove the fragmented pigments. 

The Pico Laser incorporates PicoCare 450 to speed up its treatment. It emits light pulses at a rate faster than a nanosecond and allows the treatment session to be completed at a faster rate and makes the process more effective.

With a reduced number of shots, there would be less thermal heat generated as well as reduced pain. Patients would experience fewer side effects and little to no skin irritation after the treatment is completed.

Pico Laser Pigmentation Removal Benefits Patients with:

• Freckles
• Melasma
• PIH (Post-Inflammatory Hyperpigmentation)
• Age spots (Senile lentigos)
• Sunspots (Solar lentigos)
• Café au Lait
• Seborrheic Keratosis
• Flushed skin
• Becker’s Nevus
• Acne scars: Box, Ice Pick, Rolling, Hypertrophic

Advantages of Pico Laser Pigmentation Removal:

• High speed with 4 picoseconds of wavelength power
• Reduces the size of pigments into fragmented pieces at a higher speed
• Effective and safe pigmentation treatment
• Treats a variety of pigment types
• Beam quality is highly accurate to minimise damage caused to healthy tissues
• Treatment has little to no pain and is relatively comfortable

Post Treatment

As the treatment is generally painless and comfortable, there is a quick downtime and patients will be able to resume their daily activities soon after treatment is completed.

Hopefully, this article has helped guide you in exploring your options for clearer, rosacea and melasma-free skin. If you are still in doubt, book a session with us for a skin consultation so we may advise you on what treatment plan suits your skin best.

1. De Dormael, R., Bastien, P., Sextius, P., Gueniche, A., Ye, D., Tran, C., Chevalier, V., Gomes, C., Souverain, L., & Tricaud, C. (2019). Vitamin C Prevents Ultraviolet-induced Pigmentation in Healthy Volunteers: Bayesian Meta-analysis Results from 31 Randomized Controlled versus Vehicle Clinical Studies. The Journal of clinical and aesthetic dermatology, 12(2), E53–E59.
2. FAAD, M. I. R. M. (2016). Clinical evaluation of a 4% hydroquinone+ 1% retinol treatment regimen for improving melasma and photodamage in Fitzpatrick skin types III-VI. Journal of Drugs in Dermatology, 15(11), 1435-1441.