Speakers - CARWC2025

Abstract

Rosacea is a chronic vascular dermatosis characterized by persistent facial erythema and telangiectasias. Pulsed dye laser (PDL) systems have effectively reduced these symptoms, particularly those utilizing a 585-nm wavelength. However, in darker-skinned populations such as Asians, subpurpuragenic settings are often used to avoid adverse pigmentary effects, which may compromise treatment outcomes. To overcome this limitation, our study investigated topical niacin (vitamin B3) as a photobooster—a vasodilatory agent designed to enhance laser absorption by increasing cutaneous blood flow and chromophore density.

In a randomized, split-face clinical study, 18 Korean rosacea patients received three PDL sessions at three-week intervals. Each patient's face was divided into two treatment zones: one side was pretreated with a topical niacin cream before each session, while the other received PDL treatment alone. Objective assessments were performed using polarization color imaging, and three blinded dermatologists evaluated clinical improvement. Patient satisfaction was measured on a 10-point visual analogue scale (VAS).

Fifteen patients completed the study. Both treatment sides exhibited erythema reduction, but the niacin-pretreated side showed significantly greater clinical improvement based on physician assessments and patient satisfaction. Objective erythema scores showed comparable improvement between sides, indicating that visible clinical differences may not always be captured by imaging tools. Aside from transient erythema and mild edema, no serious adverse events were observed.

Importantly, these findings have implications beyond rosacea. Topical niacin as a photo booster represents a promising adjunct to vascular-targeted laser therapy for a range of dermatoses, including telangiectasias, poikiloderma of Civatte, angiomas, and early port-wine stains. By enhancing vascular visibility and laser uptake, niacin could improve treatment efficacy while maintaining safe parameters, especially in patients with melanin-rich skin where aggressive laser settings are contraindicated.

This presentation will highlight the clinical trial data supporting photo booster PDL treatment in rosacea and explore its potential as a novel strategy to optimize outcomes across a broader spectrum of vascular skin conditions. Integrating topical vasodilators with energy-based devices may represent a paradigm shift in vascular dermatology, offering both efficacy and safety tailored to individual skin types.