Clinically significant facial edema after extensive treatment with purpura-free pulsed-dye laser

BACKGROUND. Long-pulsed pulsed-dye lasers permit treatment of facial erythema and telangiectasia with purpura-free technique, which may be more comfortable for the patient than purpura-inducing treatment. However, there are anecdotal reports of treatment-associated discomfort even when purpura is not elicited. OBJECTIVE. To determine whether patients experience clinically significant erythema, edema, and pain after purpura-free treatment with pulsed-dye laser. METHODS. In this prospective, controlled study, subjects included 15 patients who were undergoing purpura-free treatment of diffuse erythema and fine telangiectasia of at least half the facial surface area with purpura-free pulsed-dye, and it included 15 age, gender, and skin-type matched control subjects who were undergoing similar treatments but with the induction of trace to mild purpura. Patients were seen in person and were surveyed by phone regarding symptoms and signs during their postoperative courses. RESULTS. Postoperative erythema of a mean 3.3-days duration and 3.4/5.0 intensity was reported by 73% (11 of 15) of the purpura-free patients. Among purpura patients, the duration was 5.6 days. The intensity was 4.0, and again, 73% of patients reported this finding. Postoperative edema occurred among 87% of purpura-free patients, but such edema occurred in all of the purpura patients, in whom it lasted longer and was more intense. Symptomatic eye swelling and uncomfortable/painful edema were seen in 27% and 20%, respectively, of purpura-free patients, but in 40% and 53% of purpura patients. Among purpura-free patients receiving fewer than 250 laser pulses per treatment, erythema and edema lasted less than 1 day and 2.5 days, whereas the mean durations were 3.4 and 5.0 days for purpura-free patients receiving greater than 250 pulses. CONCLUSION. Extensive purpura-free treatment for erythema and telangiectasia of the face with the long-pulsed pulsed-dye laser can lead to clinically significant erythema, edema, and discomfort in patients. The duration, magnitude, and frequency of these undesired effects are markedly less with purpura-free treatment compared with purpura-inducing treatment and are also less for less extensive purpura-free treatments.