Tratamiento no farmacológico de la rosácea

Número de política: MA 2.071

Fecha de entrada en vigencia: 9/1/2025

Política

Nonpharmacologic treatment of rosacea, including but not limited to, laser and light therapy, dermabrasion, chemical peels, surgical debulking, and electrosurgery is considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Cross-references:

• MP 1.004 Cosmetic and Reconstructive Surgery
• MP 2.046 Light Therapies

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios, como se explica en la Sección VI. Consulte la información adicional a continuación.

FEP PPO - Consulte el Manual de Políticas Médicas del FEP. El Manual de Políticas Médicas del FEP se puede encontrar en: https://www.fepblue.org/benefit-plans/medical-policies-and-utilization-management-guidelines/medical-policies

Descripción/antecedentes

Rosacea is characterized by episodic erythema, edema, papules, and pustules that occur primarily on the face but may also be present on the scalp, ears, neck, chest, and back. On occasion, rosacea may affect the eyes. Patients with rosacea have a tendency to flush or blush easily. Since rosacea causes facial swelling and redness, it is easily confused with other skin conditions, such as acne, skin allergy, and sunburn.

Rosacea affects mostly adults with fair skin between the ages of 20 and 60 and is more common in women, but often most severe in men. Rosacea is not life-threatening, but if not treated, may lead to persistent erythema, telangiectasias, and rhinophyma (hyperplasia and nodular swelling and congestion of the skin of the nose). The etiology and pathogenesis of rosacea is unknown but may be a result of both genetic and environmental factors. Some of the theories as to the causes of rosacea include blood vessel disorders, chronic Helicobacter pylori infection, demodex folliculorum (mites), and immune system disorders.

While the clinical manifestations of rosacea do not usually impact the physical health status of the patient, there may be psychological consequences from the most visually apparent symptoms (i.e., erythema, papules, pustules, telangiectasias) that can impact quality of life. Rhinophyma, an end-stage of chronic acne, has been associated with obstruction of nasal passages and basal cell carcinoma in rare, severe cases. The probability of developing nasal obstruction, or basal or squamous cell carcinoma with rosacea is not sufficiently great to warrant preventive removal of rhinophymatous tissue.

Tratamiento

Rosacea treatment can be effective to relieve its signs and symptoms. Treatment may include oral and topical antibiotics, isotretinoin, beta-blockers, clonidine, and anti-inflammatories. Patients are also instructed on various self-care measures such as avoiding skin irritants and dietary items thought to exacerbate acute flare-ups.

Nonpharmacologic therapy has also been tried in patients who cannot tolerate or do not want to use pharmacologic treatments. To reduce visible blood vessels, treat rhinophyma, reduce redness, and improve appearance, various techniques have been used such as laser and light therapy, dermabrasion, chemical peels, surgical debulking, and electrosurgery. Various lasers used include low-powered electrical devices and vascular light lasers to remove telangiectasias, CO₂ lasers to remove unwanted tissue from rhinophyma and reshape the nose, and intense pulsed lights that generate multiple wavelengths to treat a broader spectrum of tissue.

Regulatory status

Several laser and light therapy systems have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process for various dermatologic indications, including rosacea. For example, rosacea is among the indications for:

• Vbeam laser system (Candela^®)
• Stellar M22™ laser system (Lumenis)
• Excel VT^®, excel V^®, and exo^® laser systems (Cutera)
• Harmony^® XL multi-application platform laser device (Alma Lasers, Israel)
• UV-300 Pulsed Light Therapy System (New Star Lasers)
• CoolTouch^® PRIMA Pulsed Light Therapy System (New Star Lasers)

FDA product code: GEX.

Fundamento

Summary of evidence

For individuals who have rosacea who receive nonpharmacologic treatment (e.g., laser therapy, light therapy, dermabrasion), the evidence includes systematic reviews and several small, randomized, split-face design trials. Relevant outcomes are symptoms, change in disease status, and treatment-related morbidity. The systematic reviews reported favorable effects on erythema and telangiectasia with several laser types, including intense pulsed light (IPL), pulsed dye lasers, and neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers. However, the systematic reviews did not pool results from individual studies and the studies differed in the specific lasers being compared. Overall, the systematic review results were insufficient to establish whether any laser type is more effective and safe than others. The randomized controlled trials (RCTs) evaluated laser and light therapy. One RCT compared combination laser and pharmacologic therapy with pharmacologic therapy alone and 2 RCTs compared combination laser and pharmacologic therapy with laser therapy alone, but the lack of an arm evaluating laser therapy alone against established pharmacologic therapy does not allow a direct assessment on the efficacy of laser or light treatment compared with alternative treatments. No trials assessing other nonpharmacologic treatments were identified. There is a need for RCTs that compare nonpharmacologic treatments with placebo controls and with pharmacologic treatments. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Definiciones

• Conjunctivitis: refers to inflammation of the mucous membrane that lines the eyelids.
• Cosmetic surgery: refers to an elective procedure performed primarily to restore a person’s appearance by surgically altering a physical characteristic that does not prohibit normal function but is considered unpleasant or unsightly.
• Functional impairment: refers to a condition that describes a state where an individual is physically limited to perform basic daily activities.
• Hyperplasia: refers to excessive proliferation of normal cells in the normal tissue arrangement of an organ.
• Telangiectasia: refers to a vascular lesion formed by dilation of a group of small blood vessels.

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen un consejo médico y están sujetas a cambios según lo exija la ley o la evidencia clínica aplicable de las pautas de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios de los miembros, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Note: this list of codes may not be all-inclusive, and codes are subject to change at any time. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado. Los códigos deben estar en orden numérico.

Investigational:

Referencias

1. Chang HC, Chang YS. Pulsed dye laser versus intense pulsed light for facial erythema of rosacea: a systematic review and meta-analysis. J Dermatolog Treat. Jun 2022; 33(4): 2394-2396. PMID 34291712
2. Husein-ElAhmed H, Steinhoff M. Light-based therapies in the management of rosacea: a systematic review with meta-analysis. Int J Dermatol. Feb 2022; 61(2): 216-225. PMID 34089264
3. van Zuuren EJ, Fedorowicz Z, Carter B, et al. Interventions for rosacea. Cochrane Database Syst Rev. Apr 28 2015; 2015(4): CD003262. PMID 25919144
4. van Zuuren EJ, Fedorowicz Z, Tan J, et al. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol. Jul 2019; 181(1): 65-79. PMID 30585305
5. Wat H, Wu DC, Rao J, et al. Application of intense pulsed light in the treatment of dermatologic disease: a systematic review. Dermatol Surg. Apr 2014; 40(4): 359-77. PMID 24495252
6. West TB, Alster TS. Comparison of the long-pulse dye (590-595 nm) and KTP (532 nm) lasers in the treatment of facial and leg telangiectasias. Dermatol Surg. Feb 1998; 24(2): 221-6. PMID 9491116
7. Mark KA, Sparacio RM, Voigt A, et al. Objective and quantitative improvement of rosacea-associated erythema after intense pulsed light treatment. Dermatol Surg. Jun 2003; 29(6): 600-4. PMID 12786702
8. Taub AF. Treatment of rosacea with intense pulsed light. J Drugs Dermatol. Jun 2003; 2(3): 254-9. PMID 12848109
9. Schroeter CA, Haaf-von Below S, Neumann HA. Effective treatment of rosacea using intense pulsed light systems. Dermatol Surg. Oct 2005; 31(10): 1285-9. PMID 16188180
10. Karsai S, Roos S, Raulin C. Treatment of facial telangiectasia using a dual-wavelength laser system (595 and 1,064 nm): a randomized controlled trial with blinded response evaluation. Dermatol Surg. May 2008; 34(5): 702-8. PMID 18318728
11. Papageorgiou P, Clayton W, Norwood S, et al. Treatment of rosacea with intense pulsed light: significant improvement and long-lasting results. Br J Dermatol. Sep 2008; 159(3): 628-32. PMID 18565174
12. Neuhaus IM, Zane LT, Tope WD. Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea. Dermatol Surg. Jun 2009; 35(6): 920-8. PMID 19397667
13. Lane JE, Khachemoune A. Use of intense pulsed light to treat refractory granulomatous rosacea. Dermatol Surg. Apr 2010; 36(4): 571-3. PMID 20402938
14. Nymann P, Hedelund L, Haedersdal M. Long-pulsed dye laser vs. intense pulsed light for the treatment of facial telangiectasias: a randomized controlled trial. J Eur Acad Dermatol Venereol. Feb 2010; 24(2): 143-6. PMID 20205349
15. Fabi S, Peterson J, Goldman M. Combination 15% azelaic acid gel and intense pulse light therapy for mild to moderate rosacea. Lasers Surg Med 2011;43:9689
16. Kassir R, Kolluru A, Kassir M. Intense pulsed light for the treatment of rosacea and telangiectasias. J Cosmet Laser Ther. Oct 2011; 13(5): 216-22. PMID 21848421
17. Kim TG, Roh HJ, Cho SB, et al. Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial. Br J Dermatol. Mar 2011; 164(3): 573-9. PMID 21143465
18. Huang YE, Li XL, Li TJ. [Clinical research of topical tacrolimus ointment combined with 585 nm pulsed dye laser in the treatment of rosacea]. J Clinical Dermatol 2012; 41:3089.
19. Tanghetti EA. Split-face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece. Lasers Surg Med. Feb 2012; 44(2): 97-102. PMID 22180317
20. Alam M, Voravutinon N, Warycha M, et al. 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. J Am Acad Dermatol. Sep 2013; 69(3): 438-43. PMID 23688651
21. Salem SA, Abdel Fattah NS, Tantawy SM, et al. Neodymium-yttrium aluminum garnet laser versus pulsed dye laser in erythemato-telangiectatic rosacea: comparison of clinical efficacy and effect on cutaneous substance (P) expression. J Cosmet Dermatol. Sep 2013; 12(3): 187-94. PMID 23992160
22. Friedmann DP, Goldman MP, Fabi SG, et al. The effect of multiple sequential light sources to activate aminolevulinic Acid in the treatment of actinic keratoses: a retrospective study. J Clin Aesthet Dermatol. Sep 2014; 7(9): 20-5. PMID 25276272
23. Seo HM, Kim JI, Kim HS, et al. Prospective Comparison of Dual Wavelength Long-Pulsed 755-nm Alexandrite/1,064-nm Neodymium:Yttrium-Aluminum-Garnet Laser versus 585-nm Pulsed Dye Laser Treatment for Rosacea. Ann Dermatol. Oct 2016; 28(5): 607-614. PMID 27746641
24. Handler MZ, Bloom BS, Goldberg DJ. IPL vs PDL in treatment of facial erythema: A split-face study. J Cosmet Dermatol. Dec 2017; 16(4): 450-453. PMID 28752575
25. Kim SJ, Lee Y, Seo YJ, et al. Comparative Efficacy of Radiofrequency and Pulsed Dye Laser in the Treatment of Rosacea. Dermatol Surg. Feb 2017; 43(2): 204-209. PMID 27893539
26. Kwon WJ, Park BW, Cho EB, et al. Comparison of efficacy between long-pulsed Nd:YAG laser and pulsed dye laser to treat rosacea-associated nasal telangiectasia. J Cosmet Laser Ther. Oct 2018; 20(5): 260-264. PMID 29388843
27. Campos MA, Sousa AC, Varela P, et al. Comparative effectiveness of purpuragenic 595 nm pulsed dye laser versus sequential emission of 595 nm pulsed dye laser and 1,064 nm Nd:YAG laser: a double-blind randomized controlled study. Acta Dermatovenerol Alp Pannonica Adriat. Mar 2019; 28(1): 1-5. PMID 30901061
28. Kim BY, Moon HR, Ryu HJ. Comparative efficacy of short-pulsed intense pulsed light and pulsed dye laser to treat rosacea. J Cosmet Laser Ther. Aug 2019; 21(5): 291-296. PMID 30285506
29. Tirico MCCP, Jensen D, Green C, et al. Short pulse intense pulsed light versus pulsed dye laser for the treatment of facial redness. J Cosmet Laser Ther. Feb 17 2020; 22(2): 60-64. PMID 32041440
30. Maxwell EL, Ellis DA, Manis H. Acne rosacea: effectiveness of 532 nm laser on the cosmetic appearance of the skin. J Otolaryngol Head Neck Surg. Jun 2010; 39(3): 292-6. PMID 20470675
31. Park S, Lee JH, Kang E, et al. A randomized split-face comparative study of long-pulsed alexandrite plus low-fluence Nd:YAG laser versus pulsed-dye laser in the treatment of rosacea. Lasers Surg Med. Nov 2022; 54(9): 1217-1225. PMID 36183378
32. Yang J, Liu X, Cao Y, et al. 5-Aminolevulinic acid photodynamic therapy versus minocycline for moderate-to-severe rosacea: A single-center, randomized, evaluator-blind controlled study. J Am Acad Dermatol. Oct 2023; 89(4): 711-718. PMID 37356626
33. Sodha P, Suggs A, Munavalli GS, et al. A Randomized Controlled Pilot Study: Combined 595-nm Pulsed Dye Laser Treatment and Oxymetazoline Hydrochloride Topical Cream Superior to Oxymetazoline Hydrochloride Cream for Erythematotelangiectatic Rosacea. Lasers Surg Med. Dec 2021; 53(10): 1307-1315. PMID 34233378
34. Osman M, Shokeir HA, Hassan AM, et al. Pulsed dye laser alone versus its combination with topical ivermectin 1% in treatment of Rosacea: a randomized comparative study. J Dermatolog Treat. Feb 2022; 33(1): 184-190. PMID 32141785
35. Tong Y, Luo W, Gao Y, et al. A randomized, controlled, split-face study of botulinum toxin and broadband light for the treatment of erythematotelangiectatic rosacea. Dermatol Ther. May 2022; 35(5): e15395. PMID 35187781
36. Barbarino SC, Bucay VW, Cohen JL, et al. Integrative skincare trial of intense pulsed light followed by the phyto-corrective mask, phyto-corrective gel, and resveratrol BE for decreasing post-procedure downtime and improving procedure outcomes in patients with rosacea. J Cosmet Dermatol. Sep 2022; 21(9): 3759-3767. PMID 35765796
37. Tanghetti E, Del Rosso JQ, Thiboutot D, et al. Consensus recommendations from the American acne rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices. Cutis. Feb 2014; 93(2): 71-6. PMID 24605343
38. Del Rosso JQ, Tanghetti E, Webster G, et al. Update on the Management of Rosacea from the American Acne Rosacea Society (AARS). J Clin Aesthet Dermatol. Jun 2019; 12(6): 17-24. PMID 31360284
39. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. Jun 2020; 82(6): 1501-1510. PMID 32035944
40. Schaller M, Almeida LM, Bewley A, et al. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. Feb 2017; 176(2): 465-471. PMID 27861741
41. Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. May 2020; 182(5): 1269-1276. PMID 31392722
42. Blue Cross Blue Shield Association Medical Policy Reference Manual. 2.01.71, Nonpharmacologic Treatment of Rosacea. January March 2025

Historial de políticas

• MA 2.071 - 08/13/2025 Policy Created. 100% Commercial Adoption of the Policy

Programas de beneficios de atención de la salud emitidos o administrados por Capital Blue Cross y/o sus subsidiarias, Capital Advantage Insurance Company^®, Capital Advantage Assurance Company^® y Keystone Health Plan^® Central. Licenciatarios independientes de Blue Cross BlueShield Association. Comunicaciones emitidas por Capital Blue Cross en su condición de administrador de programas y relaciones con los proveedores para todas las empresas.