Comparative effectiveness of nonpurpuragenic 595-nm pulsed dye laser and microsecond 1064-nm neodymium:yttrium-Aluminum-garnet laser for treatment of diffuse facial erythema: A double-blind randomized controlled trial

Background: Facial erythema is a common symptom that responds to vascular laser treatment, but there are few comparative studies. Objective: We sought to compare the effectiveness of microsecond 1064-nm neodymium:yttrium-Aluminum- garnet (Nd:YAG) laser with nonpurpuragenic 595-nm pulsed dye laser (PDL) for diffuse facial erythema. Methods: This was a split-face, double-blind randomized controlled trial. Bilateral cheeks received 4 treatments each at one month intervals with PDL or Nd:YAG. Spectrophotometer measurements, digital photographs, pain scores, and patient preferences were recorded. Results: Sixteen patients enrolled and 2 dropped out. Fourteen patients, all skin types I to III, 57% women, mean age 42 years, completed the study and were analyzed. Spectrophotometer readings changed after both PDL (8.9%) and Nd:YAG (2.5%), but varied by treatment type, with PDL reducing facial redness 6.4% more from baseline than Nd:YAG (P =.0199; 95% confidence interval -11.6 to -1.2). Pain varied (P =.0028), with Nd:YAG associated with less pain, at 3.07, than PDL at 3.87. Subjects rated redness as improved by 52% as a result of PDL, and 34% as a result of Nd:YAG (P =.031; 95% confidence interval -34.6 to -1.94). No serious adverse events were observed. Limitations: Lasers settings are not standardized across devices. Conclusion: Facial erythema is safely and effectively treated with PDL and Nd:YAG. Nonpupuragenic PDL may be more effective for lighter-skinned patients, but microsecond Nd:YAG may be less painful.