Re: IPL Eradicates Demodex Mites...

[Guest guest]

Matija, from what I've read, a small subgroup will definitely improve

when treated specifically for mites, but that most rosaceans don't

respond to eradication, even if their mite count is very high. But I

don't believe even a person in that subgroup needs to go through the

expense or potential risks of IPL, since there are medications that

reportedly do the job well.

To me, the big weakness is that Dr. Sadick never made a connection

between the eradication of mites and the increased fibroblast

activity or decreased melatonin or anything else that he theorizes

explains some of IPL's benefits. Nor has he related the eradication

of mites with the mild (not cystic) acne responsive to IPL.

Marjorie

Marjorie Lazoff, MD

> Although the jury is still out on the role of Demodex Mites in

> rosacea and people have had mixed results with IPL treatments, I

> thought the article below from June 2002 Skin and Allergy News was

> interesting.

>

> Take care,

> Matija

>

> Improves acne, rosacea

> Intense Pulsed Light Eradicates Demodex Mites

>

> F. Kirn

> Sacramento Bureau

>

>

> VAIL, COLO. — Intense pulsed light appears to kill Demodex mites

> around hair follicles and sebaceous glands, which could make it

> useful in treating acne, Dr. Neil Sadick said at a symposium

> sponsored by the American Academy of Facial Plastic and

> Reconstructive Surgery.

>

> Dr. Sadick of Cornell University, New York, conducted an

> investigation in which 24 patients with a mean age of 47 years and

> Fitzpatrick skin types I-IV were treated with an intense pulsed

light

> device (Quantum SR, ESC-Lumenis, Palo Alto, Calif.), which emits a

> noncoherent, multiwavelength of light of 500-1,100 nm. All patients

> were treated monthly, up to five times, using an average fluence of

> 25-45 J/cm2.

>

> Patients were then evaluated using a number of techniques that

> included observer rating of photographs, computer-based optical

> profiling, histology, and the use of monoclonal antibodies to

measure

> cytokine production.

>

> Histology showed no evidence of appreciable new collagen formation,

> either by ultrastructural observation or by monoclonal antibody–

> binding concentration, even though there were indications of

> increased fibroblast activity, he said at the symposium, also

> sponsored by the American Society of Dermatologic Surgery.

>

> " There is some attempt at `neocollagenesis' occurring, but, in my

> opinion, there is not significant new collagen to the point where

you

> can tell your patients that their wrinkling will be markedly

improved

> because of new collagen formation, " he said.

>

> Likewise, there did not appear to be new elastin fiber formation.

But

> there was " normalization " of the elastin fibers.

>

> Histology also did not reveal any necrosis, or fibrin thrombi, and

> only minimal new blood vessel formation.

>

> On the other hand, since intense pulsed light wavelengths target

> melanocytes, the investigation did find decreased melanin

production

> at the dermoepidermal junction and eradication of the Demodex mites

> in the pilosebaceous units. Perhaps as a consequence, there was a

> decrease in inflammatory infiltrate in the skin, both in rosacea

but

> also in photodamaged areas.

>

> " If you treat patients with intense pulsed light, you can eradicate

> almost all the organisms, " he said.

>

> The findings help explain the results already observed with intense

> pulsed light, Dr. Sadick said. They also suggest that the patient

who

> will benefit most is the person in his or her mid-40s who wants to

> reverse early sun damage but does not need dramatic rhytid

> improvement.

>

> Killing of the Demodex organisms, and consequently toning down

> inflammatory processes, probably explains why intense pulsed light

> improves redness. Many patients believe that they have a decrease

in

> pore size, and this may be due to shrinkage of the sebaceous

glands.

> Normalization of the elastin fibers may improve elasticity and

> account for some of the smoothing of texture that is seen.

Decreased

> melanin production accounts for the improvements in dyschromia.

>

> The study did demonstrate fairly significant improvement, he said.

> The independent observer assessment of the 17 patients who

completed

> five treatments found that 47% achieved more than a 50% improvement

> in skin tone, texture, and color.

>

> Based on the results, Dr. Sadick said he tells patients that they

can

> expect a 25%-50% improvement in skin contour and redness.

>

> Because of the eradication of Demodex, Dr. Sadick has begun to

> investigate using intense pulsed light for acne. " In our

experience,

> we have found it is helpful in treating mild acne ... but not as

> helpful in treating cystic acne. "

>

> SHARON WORCESTER, Tallahassee bureau, contributed to this story.