IPL Eradicates Demodex Mites...

[Guest guest]

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.