Article on IPL

August 1, 2002

Hi,

I found this article in the July 2002 issue of Dermatology Times.

It's not a scientific study and it looks like the doc they're writing

about has ties to the laser company.

Take care,

Matija

Here's a link to the article if you want to look at the pictures of a

few of her patients:

http://www.dermatologytimes.com/dermatologytimes/article/articleDetail

..jsp?id=24834

Laser offers relief in diminishing rosacea

IPL technology eliminates redness, severity with visible results

after two treatments

July 1, 2002

By: Fred

Dermatology Times

Atlanta - Treatment of rosacea with an intense pulsed light laser not

only eliminates telangiectasia but reduces background redness and the

severity and frequency of flushing episodes.

" Lasers can get rid of blood vessels, " said Amy Forman Taub, M.D.,

director, division of dermatology, Northwestern Memorial Physicians

Group, Northbrook, Ill. " You've got somebody a lot better with

medical treatment, but then you have fixed and dilated vessels and

background redness that you can't get to go away. Lasers pick up

where the medical treatment leaves off. " Dr. Taub presented her

findings at the annual meeting of the American Society of Laser

Medicine and Surgery.

According to Dr. Taub, conventional treatment of rosacea consists of

oral and topical antibiotics, particularly tetracycline and its

derivatives. " We don't know the etiology of rosacea, but the

prevailing theory is that it's bacterial because the only thing that

can be used successfully to treat it is antibiotics, " she said. There

are other theories, she added, but most agree that rosacea results in

a huge number of tiny blood vessels that create background redness

and another population of larger vessels that have dilated and

constricted so many times that they've lost their ability to

constrict. " The laser can get rid of both populations, " Dr. Taub

said. " Like any treatment, some patients are treated more

successfully than others. I tell all my patients that the laser

doesn't cure rosacea and it may have to be repeated.

" I use the Vasculight Plus intense pulsed light source (Lumenis) with

the Skin Rejuvenation Treatment Head and a 570nm cutoff filter, " Dr.

Taub said. " As an adjunct, I occasionally use a 1064nm pulsed YAG

laser to get rid of the larger telangiectasias around the nose. "

Depending on vessel size and instrument parameters, she added, 532nm

to 600nm lasers can also be used.

Although any vascular laser would work, Dr. Taub said, the long-

pulse, pulsed dye laser produces results that most closely resemble

her own. " You wouldn't want to do an overall facial treatment with a

regular pulsed dye laser because the patient would look completely

purple, " she said. " The long-pulse, pulsed dye laser doesn't create

as much purpura as the regular pulsed dye laser and has essentially

the same target. But the wavelength is fixed at 595nm and the system

has a smaller spot size piece. It might have a 1cm spot size; my spot

size is 4cm x 1cm. "

Dr. Taub's laser has no built-in cooling unit, so she uses the Cryo-

5, a separate air cooling system (Zimmer, Germany). " The Cryo-5 has

enabled us to increase the aggressiveness of our treatments, decrease

our incidence of complications, and reduce the need for topical

anesthesia, " she said.

Most patients know that insurance companies do not usually cover

laser treatment of rosacea, Dr. Taub said. If a patient wants to try

for reimbursement, Dr. Taub writes a letter stating that (1) the

patient has rosacea, a medical condition; (2) the patient has tried

medical therapy with less success than hoped; and (3) Dr. Taub has

elected to try the laser as a valid treatment of the rosacea. " The

insurance company can decide whether or not it's medically

necessary, " Dr. Taub said. " Some companies have covered it. "

With proper precautions, the complication rate of laser procedures is

low, according to Dr. Taub. " Wearing goggles for eye safety is a

given, " she said. A burn on the skin may result if the energy is too

high or the patient absorbs too much energy, she added. " The skin of

a tanned person could absorb a lot of the light energy because the

melanin is high up in the epidermis and the epidermis could become

overheated, " she said. " We want the heat in the blood vessel in the

superficial dermis. The skin can become hyperpigmented if heated too

much, or you can slough the epidermis. I've never had a single scar,

even with hyperpigmentation or sloughing epidermis, and I've given

300 to 400 laser treatments (including some to men) with no permanent

adverse events. " There is also one paper showing that this treatment

works quite well for the redness of lupus, she added.

No lasers for pregnant patients

Dr. Taub does not give laser treatments to pregnant women. Although

she asks patients if they have a history of herpes simplex, she has

seen no cases of exacerbation of herpes as a result of stimulation by

the flashing laser light. As for medication restrictions, Dr. Taub's

treatments have not caused problems in patients taking

photosensitizing drugs. " People on anticoagulants have a tendency to

bruise more, but I don't restrict it. " she said. " I just warn them

they will bruise more. "

Dr. Taub's procedure requires no time away from work in >95 percent

of her patients. " Patients have down time if they are very tanned,

have lentigines, or get bruises, " she said. " If a patient is tanned,

I decrease the dosage and delay the treatment. Lentigines get darker

with treatment because the epidermal cells in the area have become

coagulated and they peel off during the week after treatment. The

patient can put makeup over it because it's not a deep slough. If a

patient has really severe rosacea, I may have to push the laser hard

enough to cause purpura, and I just warn the patient about this. " In

>95 percent of the cases, however, there is no break in the skin and

patients can apply makeup immediately after treatment, she added.

Dr. Taub tells rosacea patients not to expect improvement until two

weeks after the second treatment. " Some get a great response after

the first treatment, " she said. " Patients usually have three to five

treatments with four weeks between treatments. " Dr. Taub is

experimenting with the cooling unit so she can increase the energy

per treatment, thus potentially reducing the number of treatments and

the expense to the patient.

" Patients must be made aware that laser treatment is not a cure for

rosacea, " Dr. Taub said. With that caveat, she cited three primary

goals her patients want to achieve: (1) reduce redness, (2) reduce

the frequency or intensity of flushing episodes, (3) and stop wearing

makeup and taking antibiotics. " Until I started doing this laser

treatment, I didn't realize how profoundly rosacea affects people's

lives, " Dr. Taub said. " They feel self-conscious, and it's hard to

hide with makeup. "

Dr. Taub is a consultant to Lumenis Inc. Her study received no

funding.

For more information

Angermeier MC. Treatment of facial vascular lesions with intense

pulsed light. J Cutan Laser Ther 1999;1:95-100.

Laughlin SA, Dudley DK. Laser therapy in the management of rosacea. J

Cutan Med Surg 1998;2 Suppl 4:S4-24-9.

August 1, 2002