Effectiveness of 577-nm Yellow Laser in the Management of Steroid-Induced Rosacea: A Prospective Study.

backgroundSteroid-induced rosacea (SIR) is a challenging condition resulting from prolonged topical corticosteroid use and is characterized by persistent erythema, telangiectasia, papules, and pustules. Although the 577-nm yellow laser has demonstrated efficacy in rosacea and other vascular dermatoses, its role in the treatment of SIR has not previously been investigated.

objectiveTo evaluate the safety and short-term clinical outcomes of 577-nm yellow laser therapy in patients with steroid-induced rosacea and to assess treatment outcomes according to clinical and telangiectatic subtypes.

methodsIn this prospective study, 50 consecutive patients with steroid-induced rosacea were enrolled. Exclusion criteria included age <20 years, pregnancy, autoimmune disorders, and Fitzpatrick skin phototypes V-VI. Baseline assessment included eight symptoms and eleven clinical signs evaluated using standardized grading scales. Patients were treated with a 577-nm yellow laser (FlexSys®, GME GmbH, Germany) using a power of 20-23 W, pulse duration of 16-20 ms, and 50% coverage density. Clinical evaluations were performed before each treatment session and one month after the final session.

resultsThe mean duration of topical corticosteroid use was 43.2 ± 36.95 months (range: 4-240 months). The erythematotelangiectatic subtype was the most common clinical presentation (38/50, 76%), followed by the erythematous subtype (8/50, 16%) and papulopustular subtype (4/50, 8%). Among patients with a classifiable telangiectatic morphology (n = 42), network-like vessels were the predominant telangiectatic pattern (28/42, 66.7%), followed by arborizing superficial capillaries (10/42, 23.8%) and blue deep venules (4/42, 9.5%). After a median of two treatment sessions (range: 1-7), significant clinical improvement was observed. The greatest improvement among symptoms was seen in stinging sensation (13/50, 26%; 85.8%), diffuse redness (43/50, 86%; 84.1%), and papulopustular nodules (8/50, 16%; 79.7%). Among clinical signs, erythema (47/50, 94%; 87.0%) and flushing (33/50, 66%; 79.3%) demonstrated the highest response rates. In contrast, dryness (32/50, 64%; 17.7%), xerosis (17/50, 34%; 23.5%), wrinkles (2/50, 4%; 27.8%), and comedones (9/50, 18%; 35.1%) showed more limited improvement. Among telangiectatic morphologies, network-like vessels exhibited the most favorable therapeutic response.

conclusionThe findings of this prospective study suggest that a 577-nm yellow laser may represent a safe and promising adjunctive treatment for steroid-induced rosacea, particularly for improving erythema and superficial telangiectatic lesions when used as part of a standardized treatment protocol. To our knowledge, this is the first prospective study evaluating 577-nm yellow laser therapy in steroid-induced rosacea. Treatment outcomes appeared to vary according to telangiectatic morphology, with network-like vessels demonstrating more favorable responses than deeper vascular patterns. Larger controlled studies with longer follow-up are warranted to validate these findings.