Laser Treatment for Perioral Dermatitis: Efficacy Examined

Perioral dermatitis is a real pain to manage. First of all, no one appreciates a rash, especially on the face. Secondly, it frequently occurs secondary to other skin  conditions, such as atopic dermatitis; dealing with two different inflammatory skin diseases at once is nothing short of an injustice. It is often triggered by the first-line treatments for these other conditions–topical corticosteroids. 

The insult to the injury is that perioral dermatitis often results in permanent redness. This understandably causes frustration and self-consciousness, leading many sufferers to search for ways to eliminate or diminish the redness. Laser therapy has offered a way forward for an increasing number of these patients.

What is perioral dermatitis, and how is it treated? 

Perioral dermatitis falls into a category of skin disorders known as “common inflammatory facial dermatoses (CIFD);” acne vulgaris, rosacea, seborrheic dermatitis, and atopic dermatitis (commonly known as eczema) also fall into this category. 

Atopic dermatitis and seborrheic dermatitis are most usually treated with topical steroids; this is inadvisable for perioral dermatitis patients. It aggravates symptoms for many. Others find their symptoms improving with steroid treatment, only for the inflammation to return once the steroids are withdrawn–and they are often more severe and intractable than they were before treatment.

Oral antibiotics and pimecrolimus (ElidelⓇ) cream are usually the first treatments offered for perioral dermatitis. If the patient is using topical steroids, they’ll likely be instructed to taper the dosage down over the course of a few weeks before discontinuing altogether. Topical azelaic acid is sometimes added, and patients may be advised to cut back on skincare products containing active ingredients (such as retinoids). 

Sometimes, despite the best efforts of both patient and doctor, the symptoms persist–alternatively, they respond, but leave behind permanent redness and puffiness. This is where laser treatments enter the discussion. 

 

 

 

 

What are lasers, and how do they work? 

We use them every time we scan a barcode at the grocery store. We print with them. We weld with them. They’ve become a staple in medicine. Lasers have a remarkable range of uses and are almost ubiquitous in everyday life. But what are they? 

The word laser is actually an acronym for Light Amplification by the Stimulated Emission of Radiation. Light travels in waves; each color of light (think of rainbows and ROY G. BIV) has a different wavelength. A laser uses light of only one wavelength, and the light waves it emits travel together with their peaks lined up at once (in phase). The resultant beams are narrower and brighter than light found in nature–this is why laser has become a synonym for precision. It’s this precision that makes lasers so useful in medicine.  

The date of the laser’s invention is a source of bitter contention, as is the name of its inventor (don’t believe me? Google “who invented the laser?” or even just “invention of laser” and look at the first few results!).  Laser technology has its roots in Albert Einstein's theory of stimulated emission. This work was built upon by physicists Charles Townes and Arthur Schawlow after World War II. 

In December 1958, the Physical Review published a paper by Townes and Schawlow that outlined their concepts. Two years later, the pair received a patent for the invention of the labor; that same year, an engineer with Hughes Aircraft Company named Theodore Maiman shot a beam from a high-power flash lamp through a ruby rod with a silver-coated surface, inventing the first working laser. Physicists have been arguing ever since about who rightfully holds the title of inventor. 

In reality, many different scientists contributed to the development of the laser, and this work evolved rapidly; the medical field embraced the technology immediately. In 1961,Dr. Charles J. Campbell used the single pulse of a ruby laser to eliminate a retinal tumor. In 1962, dermatologist Dr. Leon Goldman reported that he had successfully treated pigmented skin cells using a laser. 

This marked a revolution in medicine. Lasers allowed surgeons to focus treatment to a precise point without damaging the surrounding tissue. As the technology has developed, surgeons have a greater variety of lasers to choose from, giving them unprecedented control over the depth and intensity of the treatment–a huge win for dermatology!

Several different  lasers are now used for dermatology. The ones used depend upon the tissue targeted as well as the desired depth of treatments. A laser called a pulsed-dye laser (PDL) is most often used to treat perioral dermatitis and other CIFDs. 

Is laser treatment right for you? Let’s take a look at the pros and cons of treating perioral dermatitis with laser therapy.

 

The pros of laser treatment

 

• Treatments can be done within minutes in an in-patient setting.

• Laser treatments are relatively painless for most, thanks to local anesthetics and the targeted nature of the treatment. Some patients even describe their treatment as “pleasantly warm” and “soothing” (Your mileage may vary)! Many describe a feeling similar to mild sunburn afterwards.

• Laser treatment gives collagen production a boost, making your skin firmer and more elastic.

• Laser treatment reduces inflammation in the skin and stimulates healing. The reduction of inflammation is a relief for those who have struggled with the redness, swelling, and itchiness of perioral dermatitis. 

• Most patients see immediate improvements; while the number of treatments is dependent upon the extent of the redness, dermatologists say that most patients immediately recognize some improvement in skin tone and texture after their first treatment.

• Recovery time is quick; patients are usually able to get back to their daily routine within a day or so. In some cases, makeup can be worn the next day. This depends upon the type of laser treatment your dermatologist uses.

• Side effects are usually minimal and short-lived.

 

 

 

 

Now for the cons…

 

Sadly, nothing is perfect. Laser therapy comes with its own drawbacks.

• Laser therapy can cause hypopigmentation (spotty loss of color) in darker skin tones. Patients with more pigmented skin should thoroughly research laser products and discuss their concerns with their doctors. 

• It may be contraindicated for those with unstable vitiligo, a history of keloids, and those on isotretinoin. 

• It usually takes more than one session; while patients tend to notice immediate improvements, most will have to return at least once to get the best possible results, and they will have to wait 4-6 weeks between treatments.

• Patients may have to modify their skincare routines, using products designed for sensitive skin.

• Treatment can cause unwanted side-effects, including bruising (most common), intensified redness, swelling, itching, and scabbing. In rare cases, infection can occur. 

• Skin is sometimes resistant to treatment. 

• Treatments are expensive and are usually out-of-pocket expenditures. The cost of a single treatment can range from $400 to $800, a significant expenditure when you consider several treatments over time. 

 

 

If you think laser treatment is right for you…

 

Discuss laser therapy with your board-certified dermatologist. It isn’t for everyone, and many dermatologists will only recommend it after other therapies have failed. If you do decide upon laser treatment, there are things you can do to maximize its benefits while minimizing discomfort. 

 

 

Before laser treatment:

 

• Avoid sun exposure as much as possible, and wear sunscreen every day. 

• Replace skincare products containing active ingredients such as retinoids and benzoyl peroxide with gentler products.

• Moisturize faithfully with a gentle, fragrance-free moisturizing cream. 

 

After laser treatment: 

 

• Follow the same guidelines as above, asking your physician for guidance about products; you may need to moisturize more than twice a day. 

• Many laser therapy providers recommend using a healing ointment such as those made by AquaphorⓇ and CeraVeⓇ for the first several days after treatment.

• Use cool compresses or ice packs to reduce redness, swelling and pain. If using ice packs, make sure the pack is wrapped in something like a tea towel, and only use it for about two minutes at a time. 

• Take diphenhydramine (BenadrylⓇ) for itching. 

• Use SmartLotionⓇ to reduce redness, swelling, and itching. While it does contain hydrocortisone, which is generally contraindicated for perioral dermatitis patients,  SmartLotionⓇ uses a gentler form of hydrocortisone at a lower-than-usual dosage (0.75%). It cannot cause topical steroid withdrawal, and the risk of adverse effects is minimal. 

SmartLotionⓇ also contains sulfur, which has been used for many years to soothe and heal skin affected by perioral dermatitis. Sulfur is prebiotic, meaning that it fosters the development of a healthy skin microbiome–this promotes a healthy skin barrier that allows for faster healing. 

Under a physician’s supervision, SmartLotionⓇ is also helpful in the treatment of future perioral dermatitis outbreaks. It was developed by Dr. Steve Harlan, a board-certified dermatologist with years of experience in treating chronic, inflammatory skin disorders. He advises his perioral dermatitis patients to apply SmartLotionⓇ two times a day for up to two weeks.

If patients improve during those two weeks, Dr. Harlan usually recommends tapering down to a single daily treatment for two weeks. Tapering is determined by how quickly the rash improves. 

For post-treatment and chronic perioral dermatitis, he instructs his patients to place cold compresses on the affected area for three minutes after applying the SmartLotionⓇ. 

If you are frustrated by lingering redness from perioral dermatitis, speak to your dermatologists about your options for treatment. Laser therapy may be right for you. Whether you choose laser therapy or not, talk to your dermatologist about adding SmartLotionⓇ to your treatment plan–it is a safe and effective treatment for itching and discomfort after laser therapy, and it is also beneficial in treating perioral dermatitis. 

 

 

  Cee Van

  Medical Writer

  HarlanMD.com