6 Photoderms Later & No Better

June 26, 2002

After spending $2600 on 6 treatments (plus travel expenses and time

from work), I am no better off. I'm really not sure what to do at

this point. On the one hand, I think perhaps I should persevere with

the treatments, but on the other hand, I think I should give up on

photoderm. I'm frustrated and confused! Any suggestions??

June 27, 2002

> After spending $2600 on 6 treatments (plus travel expenses and time

> from work), I am no better off. I'm really not sure what to do at

> this point. On the one hand, I think perhaps I should persevere

with

> the treatments, but on the other hand, I think I should give up on

> photoderm. I'm frustrated and confused! Any suggestions??

I feel the same way. I have had six done by a trained " Dr. Bitter "

physican and am still not thrilled with the results. I still have a

very bumpy complexion (the sandpaper look) with brown acne scars. I

am not sure if I should go on accutane again. That's if the doctor

lets me or try something else. Protopic worked great but I guess I

became immune to that too. I just don't know which way to turn.

June 27, 2002

The same thing for me, I have had 11 treatments and no major

change.... ??????

Enrique

> > After spending $2600 on 6 treatments (plus travel expenses and

time

> > from work), I am no better off. I'm really not sure what to do

at

> > this point. On the one hand, I think perhaps I should persevere

> with

> > the treatments, but on the other hand, I think I should give up

on

> > photoderm. I'm frustrated and confused! Any suggestions??

>

> I feel the same way. I have had six done by a trained " Dr.

Bitter "

> physican and am still not thrilled with the results. I still have

a

> very bumpy complexion (the sandpaper look) with brown acne scars.

I

> am not sure if I should go on accutane again. That's if the

doctor

> lets me or try something else. Protopic worked great but I guess I

> became immune to that too. I just don't know which way to turn.

June 27, 2002

That's terrible that some of you have spent so much and have gotten

no benefit from it. I was curious if the doctors who perform these

procedures have any explanation for patients who don't get any better

or who get worse. Does the doctor, at least, give a full or partial

refund?

Take care,

Matija

> > > After spending $2600 on 6 treatments (plus travel expenses and

> time

> > > from work), I am no better off. I'm really not sure what to do

> at

> > > this point. On the one hand, I think perhaps I should

persevere

> > with

> > > the treatments, but on the other hand, I think I should give up

> on

> > > photoderm. I'm frustrated and confused! Any suggestions??

> >

> > I feel the same way. I have had six done by a trained " Dr.

> Bitter "

> > physican and am still not thrilled with the results. I still

have

> a

> > very bumpy complexion (the sandpaper look) with brown acne

scars.

> I

> > am not sure if I should go on accutane again. That's if the

> doctor

> > lets me or try something else. Protopic worked great but I guess

I

> > became immune to that too. I just don't know which way to turn.

June 27, 2002

> I was curious if the doctors who perform these

> procedures have any explanation for patients who don't get any

> better or who get worse.

I went to Dr. Bitter, Sr, himself. After my 4th treatment, I

mentioned to him how I wasn't seeing any improvement. I asked if

there was a certain number of treatments a patient must go through

before it could be concluded that photoderm just won't help. I felt

like he just quickly dismissed my concern by saying something to the

effect of, " Everyone benefits from photoderm. " Then he said he would

go more aggressively in the 5th treatment.

Well, they certainly went more aggressively in the 5th treatment.

However, that didn't even help. Then I was told I'd have to come

back in 6-8 wks to do a follow-up to see if I'd need any further

treatments. I recently went for my follow-up and explained how my

stubborn redness just wouldn't go away. Dr. Bitter then suggested a

new thing called " Derma Cool. " Same thing as photoderm, but it

supposedly cools the skin, allowing the doctor to go even more

aggressively without the patient overheating. Boy, my cheeks swelled

up right after and it lasted 3 days. I was also blotchy red for an

entire week, as if I'd been through a hellish ordeal. All I can say

is thank god for makeup!! A week later, the skin calmed down, but I

am no better off than when I started photoderm.

I remember a few months ago, several members here wrote about the

great results they saw with sea salt. I wonder if any of those

members are still benefitting from it. Anyone??

June 28, 2002

Matija, I too am moved by the recent flurry of posts regarding

disappointing laser therapy for redness and flushing. I know nothing

about laser therapy, but I became curious and started doing some

reading.

The benefits of laser therapy on telangiectasias and other skin

vascular lesions are well-documented in independent studies. But in

skimming over Dr. Nase's section on laser therapy, I can't find the

documentation supporting his enthusiasm for laser therapy on redness

and flushing. All the direct references seem to be studies or

testimonials from the practitioners themselves, or marketing from the

equipment manufacturer -- I don't see any studies quoted from

researchers or physicians who are independent (in other words, who

don't stand to personally benefit from reporting good results).

In medical circles these types of studies are regarded as

preliminary, awaiting independent study and verification. Standing

alone, they are regarded as among the weakest evidence in the medical

literature because they are subject to deliberate and inadvertent

bias. It's typically how new treatments are made known to the medical

community, and as such are considered experimental even when the

equipment or medication is FDA approved.

I'm clearly missing why Dr. Nase is expressing such enthusiasm.

Assuming that rosacea is primarily a vascular condition, the theory

why laser therapy should help rosaceans makes sense, but medical

theories are a dime a dozen -- without proof, there are countless

ways a theory or anecdotal results can backfire, leading to

inconsistent treatment results (at best).

I performed a Medline search to see if anything new was published

since Dr. Nase's book. I see two new studies on laser therapy and

rosacea. One is from a group in the UK which I already posted a month

or so ago, and a second is a case report from Dr. Jay in France on

one of his rosacean patients.

Curiously, I don't see anything in Medline when searching for

photofacial; has Dr. Bitter not published in the mainstream medical

literature?

So from what I can gather, laser therapy for telangectiasias (and

phyma) is well-documented treatment for rosaceans with those

findings. However, without any independent studies or work that I can

find, it seems that laser therapy for rosacean redness and flushing

seems to be still in the experimental stage.

That means that there's little to guide us in patient selection,

treatment type, number of treatments or known risks/benefits. Those

looking to identify a subset of patients who do particularly well, or

poorly, with laser therapy are showing good insight. I don't see any

such studies out there (yet), and we're not likely to find any

correlations in this small group with so many variables. But it's a

very good thought.

Those practitioners who boast of their experience and good outcomes

may very well be telling the truth, but it awaits independent

verification.

Here's my key question: does anyone know of independent evaluations

of any of the laser treatments? There may well be something I'm

missing. There's so much discussion regarding Dr. Bitter, I was

wondering if any of his patients are aware of work others may have

published about his work by someone other than him, unless there's

something in the medical or scientific literature that my Medline

search missed.

Marjorie

Marjorie Lazoff, MD

PS: this is not a topic for debate, but I hope you're tolerate the

luxury of my expressing an opinion: I hope no doctor gives refunds

unsuccessful outcomes, as that could set a precedent for treating

only patients one can assure a good outcome and/or easy quick

treatments, or even create a temptation to mislead patients into

believing their care was an improvement when it was not. Such a

system ends up hurting patients and health care delivery in other

countries. A far better option, I believe, is for a patient to be

fully informed at time of care as to realistic expectations and

risks, and for patients to retain the full option to sue their

caregiver in cases of malpractice (that is, unsuccessful outcome

arising from inappropriate care, rather than arising from the

condition itself).

> That's terrible that some of you have spent so much and have gotten

> no benefit from it. I was curious if the doctors who perform these

> procedures have any explanation for patients who don't get any

better

> or who get worse. Does the doctor, at least, give a full or partial

> refund?

>

> Take care,

> Matija

June 28, 2002

I agree that it is terrible to spend so much money and see no results. I

feel very sorry for all these people and the messages have certainly

discouraged me from considering photoderm treatments.

Re: 6 Photoderms Later & No Better

> That's terrible that some of you have spent so much and have gotten

> no benefit from it. I was curious if the doctors who perform these

> procedures have any explanation for patients who don't get any better

> or who get worse. Does the doctor, at least, give a full or partial

> refund?

>

> Take care,

> Matija

>

> > > > After spending $2600 on 6 treatments (plus travel expenses and

> > time

> > > > from work), I am no better off. I'm really not sure what to do

> > at

> > > > this point. On the one hand, I think perhaps I should

> persevere

> > > with

> > > > the treatments, but on the other hand, I think I should give up

> > on

> > > > photoderm. I'm frustrated and confused! Any suggestions??

> > >

> > > I feel the same way. I have had six done by a trained " Dr.

> > Bitter "

> > > physican and am still not thrilled with the results. I still

> have

> > a

> > > very bumpy complexion (the sandpaper look) with brown acne

> scars.

> > I

> > > am not sure if I should go on accutane again. That's if the

> > doctor

> > > lets me or try something else. Protopic worked great but I guess

> I

> > > became immune to that too. I just don't know which way to turn.

>

> --

> Please read the list highlights before posting to the whole group

(http://rosacea.ii.net/toc.html). Your post will be delayed if you don't

give a meaningful subject or trim your reply text. You must change the

subject when replying to a digest !

>

> See http://www.drnase.com for info on his recently published book.

>

> To leave the list send an email to

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>

June 28, 2002

I, too, would like to say that I am sorry to hear so many sad testimonials

of useless laser treatments. So many expectations, so much money that went

into it, and so much frustration at the end!

Marjorie, I appreciate your post about this topic. You said:

> The benefits of laser therapy on telangiectasias and other skin

> vascular lesions are well-documented in independent studies.

I would like to ask you - is there any danger of leaving telangiectasias

untreated? Especially in mild cases. Is the laser treatment purely for

cosmetic purposes or is supposed to prevent the condition from worsening

with progressing years?

Thank you in advance.

Alena

June 28, 2002

Just to chime in, I havent seen any significant improvements after 12 of

them with 3 different docs now. Im almost ready to give up.

June 28, 2002

Just to chime in, I havent seen any significant improvements after 12 of

them with 3 different docs now. Im almost ready to give up.

June 28, 2002

I also had 5 photoderms by a Bitter-trained derm, spent $2500, and

had zero improvement in any symptoms. My derm even said she emailed

Dr. Bitter about my case, and she stated his reply was that " it just

takes some people more treatments, sometimes as many as 10 " . I asked

why I wasn't responding to treatment and why it takes some people

more treatments, but she was unable to explain why, just that

everyone else she treated before had at least some improvement.

After considering this lack of explanation, I decided not to have any

more treatments because there was no guarantee from anyone that even

after 10 treatments there would be any improvement. I could have

used this money for so many other different things. I was so

dissapointed after this failed photoderm experience. After reading

Dr. Nase's book, it seemed like photoderm was the best thing you

could do to treat rosacea.

le

> > > > After spending $2600 on 6 treatments (plus travel expenses

and