Hello, aeimbi (Allen)!
You certainly have done your homework on Rosacea and the different
treatment options. You have also been careful to select two doctors
that have good references. Therefore, now matter who you decide to go
to for treatment, I doubt you can go wrong, even if their methods vary
slightly in their achievement of a similar goal.
I have tried to answer your questions as thorougly as I can. It is
very possible that some of our information may overlap due to your own
web research.
However, I hope I have made some of the information a bit clearer for
you!
Types of Dermatological Lasers and their Uses
**********************************************
Carbon Dioxide (CO2) Laser
Erbium (Er):YAG Laser
Yellow Light Lasers
Red Light Lasers
The Q-switched Neodymium YAG (Nd: Yag)
Non-Ablative Lasers and Light Sources
Read more in "Laser Applications in Dermatologic Surgery." American
Society for Dermatologic Surgery.
http://www.asds-net.org/FactSheets/laser_applications.html
Effectiveness of Intense Pulse Light Lasers for treating Rosacea
*****************************************************************
From "Pulse-Light Treatments Get the Red Out." Healthleader.
University of Texas Health Science Center at Houston.
http://www.uthouston.edu/hLeader/archive/skinhealth/010927/index.html
According to Adelaide Hebert, M.D., professor and vice chairman of
dermatology at The University of Texas Medical School at Houston, "The
only therapy that is effective to get rid of the redness, flushing and
blushing is intense pulse light."
==
The following excerpts are from:
"From "Beyond Lasers: Pulse-Light Therapy for That Fantasy Face." By
Jeanie Lerche Davis. WebMD
Medical News. (7/27/2000)
http://my.webmd.com/content/article/27/1728_59821
Growing numbers of dermatologists are now using intense pulse-light
therapy -- instead of lasers -- to smooth and soothe facial woes.
And for many people with an embarrassing condition called rosacea -- a
facial redness caused by spider veins and acne-like outbreaks -- this
may be the first true treatment, doctors say.
Intense pulse-light skin therapy won FDA approval for hair removal
five years ago. In the past few years, dermatologists have discovered
many more uses for this technology, which involves pulsed multiple
lengths of light rays, explains Yellin.
While it may sound like a laser treatment, "it's not a laser," Yellin
tells WebMD. "We can select from multiple wavelengths of light
[whereas lasers use one continuous light wavelength.] We can enter
into the computer the skin color, body area, skin type to generate
specific settings. During treatment, multiple wavelengths of light are
entering the skin, concentrating their energy at different levels.
That allows us to treat many, many different problems."
Two years ago, dermatologist Patrick Bitter Sr., MD, of Los Gatos,
Calif., developed the first treatment for rosacea. In over 20 years of
practice, he had seen no good solutions for this common but complex
disorder. "People have tried various laser treatments, but they never
were very successful," Bitter tells WebMD.
In his study of 57 patients with an assortment of problems -- photo
aging, scars, wrinkles, and rosacea -- Bitter found 89% patient
satisfaction with the level of clearing. "Patients were thrilled with
it, especially when it came to the redness of rosacea," he tells
WebMD. "People suffer from that for years ... it makes a huge
difference to them."
Typically, six treatments are necessary for most problems with a
pricetag of a little more than $2,000 for a the series." (However, the
article does not identify which problems require six treatments, so I
cannot be sure about Rosacea from this)
===
The (pulsed light) therapy works by sending light energy through the
outer skin, concentrating on the dermalvlayer just below. "Unlike any
current therapy, be it chemical peeling, dermabrasion, or resurfacing
with lasers -- all those attack the skin from the outside. This
attacks the problem from the inside; it stimulates growth of collagen.
So there is no visible damage, no healing that has to occur."
From "The (Costly) Magic of Cosmetic Laser Surgery, "By Jeanie Lerche
Davis. WebMD Medical News (7/14/2000)
http://my.webmd.com/content/article/26/1728_59430
Few Side Effects
******************.
"There are few side effects. When the light is absorbed into the red
areas of the skin, there may be some short-term discomfort. Ramey
describes it as "a tiny little shock." Patients can use an
over-the-counter cream to numb the area prior to a treatment if the
sensation bothers them."
From "Pulse-Light Treatments Get the Red Out." Healthleader.
University of Texas Health Science Center at Houston.
http://www.uthouston.edu/hLeader/archive/skinhealth/010927/index.html
===
"Anyone who has a pronounced vascular component to their disease -- I
strongly recommend this treatment as an important part of their
normalization process. It is new, so many primary care physicians may
not know about it -- but multiple clinical studies have recently
documented it to be the least painful with the most benefit (compared
to lasers).
Dr. Geoffrey Nase
From "Subject: [rosacea] Re: photoderm in Indiana." (3/16/1999)
Rosacea Support. Yahoo Groups.
http://rosacea.ii.net/toc.html
=====
No Downtime
***********
Best of all, there's no "downtime" as there is with laser treatments.
"It's truly a lunchtime therapy," says Yellin, who is assistant
professor of facial plastic surgery at Emory University School of
Medicine.
From "Beyond Lasers: Pulse-Light Therapy for That Fantasy Face." By
Jeanie Lerche Davis. WebMD Medical News. (7/27/2000)
http://my.webmd.com/content/article/27/1728_59821
===
What are the alternative laser treatments? What are the indications,
problems, side effects, limitations?
********************************************************************************
As excerpted from Dr. Geoffrey Nase and the Rosacea Support Group,
"Subject: [rosacea] Photoderm Answers. (3/10/ 1999)
http://rosacea.ii.net/toc.html
"I have been treated with both the pulsed dye laser and Photoderm.
The pulsed dye laser was the 'gold standard' of laser therapy for
facial blood vessels. The results range from good to excellent.
However, one usually has a swollen, blue-crusted face for 14-25 days
following the surgery. Furthermore, the laser is not as specific for
blood vessels as the newer photoderm. In addition, the pulsed dye
laser is sometimes quite painful and very hard to treat large sections
of the face due to its small size. Lastly, if your insurance does not
cover it, the pulsed dye laser is quite expensive. I had good results
with the pulsed dye laser. However, the photoderm is absolutely the
way to go!"
===
As excerpted from the Rosacea Support Group, in a message from Dr.
Geoffrey Nase under the subject "Photoderm vs. Laser." (3/12/1999)
http://rosacea.ii.net/toc.html
"I do highly recommend that you find a photoderm center. Hands down,
it is the best treatment for us. The lasers, including pulsed dye,
argon and YAG, are not as versatile and usually result in much more
nonselective damage to the skin.Furthermore, those newer gentle lasers
don't even come close to the photoderm -- I know I have personally had
different treatments and have spoken to the different surgeons, seen
many before and after pictures and have spoken to patients who
underwent different laser treatments.
Photoderm is a computer-based machine which uses bright light similar
to a camera's flashbulb. The light works much like a laser, but
instead of having just one wavelength of light,
Photoderm produces a spectrum of light. Other advantages when used in
an expert's hands:
1. Extremely selective for just the blood vessels so very little
damage to dermis. Should be normal within 48 hrs. Sometimes increased
sensitivity of certain parts of face for a couple of weeks -- this is
normal and tolerable.
2. Extreme degree of flexibility when trying to get after the larger
feed vessels deep in the skin -- can use 1 pulse for superficial
vessels, 2 pulses for stubborn vessels and even use 3 pulses -- all
depending on the size, location and damage to the vessel.
3. Large treatment area per flash. The largest crystal treats an area
in one zap that might take the pulsed dye laser 17-20 zaps (painful).
This is why you can get a complete facial with this treatment method.
Furthermore, the physician doesn't have to worry about overlapping
treatment spots (which is bad because it causes more thermal damage to
the dermis).
I am not trying to put lasers out of business, but I just want
everyone to use the best technology that is available.
Dr. Geoffrey Nase
What about the Physicians who go for the multiple treatments over
time? What's going on with them?
********************************************************************************
It seems the most obvious answer is that different people (faces)
react differently to treatment. Depending on the severity of the
rosacea, as described in the following excerpt, an individual may
require a series of treatments.
You would have to be able to trust an individual doctor on that
determination. If you find a trustworthy doctor, then I believe you
can trust their judgment about the number of treatments necessary for
a specific individual.
===
From "Subject: [rosacea] Re: Photoderm. (Mar 18, 1999) "Rosacea
Support Group." Yahoo groups.
http://rosacea.ii.net/toc.html
"The key to the success of the photoderm treatment is based on its
versatility -- each individual is so unique (from skin tone to
vascular damage to skin reactivity). They can change the energy of the
treatment, the pulse, the pulse duration, the wavelength, the size of
the treatment crystal etc...... It does you no good to have someone
just put the crystal on your face and zap away."
Dr. Geoffrey Nase
===
Another response from Dr. Nase about the number of photoderm
treatments that are most effective can be found under his letter
titled "Subject: [rosacea] Photoderm Answers." (3/10/1999) Rosacea
Support. Yahoo groups.
http://rosacea.ii.net/toc.html
3. You will need to have your entire facial blush zones treated -- not
just spot treatment. Most physicians only spot treat. This is an
unacceptable form of treatment. You only remove the superficial
vessels that are damaged. This is only the tip of the iceberg for us.
Most of the damage is much deeper in the skin where we can't see the
damage (ie. If you have a small red patch of obvious vascular damage,
then it is probable that the size of vascular damage under the skin is
3 to 5 times that size).
4. You should get treated 5-8 times over a period of 9 months. I know
this sounds long and hard, but if you want to have this done
right......5. The first 2 to 3 treatments will remove the damage to
the top superficial blood vessels.
6. Then, the parameters for the photoderm should be adjusted to go
after the deeper vessels. Furthermore, the experts in this field have
learned that the best treatment method (after the first 2 to 3
treatments) is to make the rosacea sufferer flush or blush prior to
treatment. This allows the laser to reach those vessels that are
semi-damaged and dysfunctional. This step is an absolute key to
excellent results. You can induce a flush with oral or topical niacin,
heat, emotions, chinese food, alchohol etc....Have fun. The more
intense the flush the better the results.
Results from photoderm:
1. Removes damaged facial vessels.
2. Decreases inflammation and nerve-mediated facial pain.
3. If vessels grow back they are always smaller with thicker vessel
walls (so less blood and faster removal). Interesting side note --
with just one or two treatments, many times vessels grow back by the
handful (angiogenesis), thus negating some of the initial results.
However, studies demonstrate that for some unknown reason, when you
get treated the additional 4 to 6 times, that signal for growth
diminishes (ie. Less blood vessel regrowth).
4. Photoderm treatment also increases the strength and elasticity of
the skin supporting the facial blood vessels (dermis). It disrupts the
collagen just enough so that the body sends in reinforcements to
support and bind to collagen and elastin (wrinkle treatment). This
benefit is also not seen until 5 to 8 treatments.
5. Significantly decreases facial swelling.
6. Significantly decreases papules and pustules within treated areas.
===
Adelaide Hebert, M.D., professor and vice chairman of dermatology at
The University of Texas Medical School at Houston, also does more than
one laser pulse treatment for rosacea. "Usually patients will see
results by the third or fourth treatment, which gradually eradicates
the blood vessels," Hebert said.
From "Pulse-Light Treatments Get the Red Out." Healthleader.
University of Texas Health Science Center at Houston.
http://www.uthouston.edu/hLeader/archive/skinhealth/010927/index.html
====
According to the American Association of Dermatology, an individual
may need a number of treatments. "Intense light and laser therapy uses
multiple wavelengths of light to treat dilated blood vessels in the
face. Both treatments, laser and intense light and laser sources, take
15-to-30 minutes and are performed at six-to-12 week intervals.
Patients may require several treatments initially, and may return
annually for treatment of new blood vessels."
From "Combination Therapies Offer New Management Options for Acne and
Rosacea." American Academy of Dermatology.(10/17/2001)
http://www.aad.org/PressReleases/combination.html
=====
.
I have quoted a number of excerpts from the Rosacea Forum Yahoo
Group. There is so much information on the site, it would be
beneficial for you to read the rest of the messages. Since the web
link http://rosacea.ii.net/toc.html does not target a particular
message, please start where I left off, which is under the Subject
"Treatments", the Folder "Photoderm", and the message "Dr Nase - vs.
laser.
You can continue on *down* through the thread.
You may have noticed that the forum messages I have chosen to
highlight have been from Dr. Geoffrey Nase. Dr Nase is "a Ph.D.
Microvascular Physiologist. He performs biomedical research at a major
medical university in the United States. His research is funded by
both the American Heart Association and the National Institutes of
Health (NIH) to study blood vessels under normal conditions and in
human disease. Based on his vascular research, Dr. Nase has published
eight major articles in peer- reviewed medical journals."
(You can read more about him on his website, "Beating Rosacea" at
http://www.drnase.com/ )
===
However, I will provide one more excerpt from a doctor who sheds a
little bit different, and complex angle, on the whole procedure of
laser and pulsed light for Rosacea. It is provided to give you an idea
about each particular doctor's reasoning for their choices about the
number of treatments, and types of treatments for Rosacea.
==========
It is a very complicated and confusing subject, as you mentioned.
This article might be more technical than you care to delve into.
However, the basic point is that there seems to be no magical
consensus on pulsed dye versus some of the other more modern laser
treatments. It appears to be due to training, affordability of
equipment, skin condition of the individual and personal preferences
of the doctor.
===========
This string is under the folder, Photoderm and the subject "laser doc,
background."
As excerpted from "Lasers, Photoderm, Photofacial,Epifacial,etc."
(2/11/2001)
http://rosacea.ii.net/toc.html
"I have read with great interest many of the messages posted on this
wonderful web site. As a physician and laser specialist, I have
treated many patients with Rosacea. For this reason, I understand to
some degree what many of the members of this group are experiencing. I
feel an obligation to try to make clear some of the mysteries of
laser/pulsed light device treatments. I am not identifying myself as
this is not a solicitation for patients. I will try to explain the
lasers and light devices in a simple manner as it is a bit more
complicated than what I will describe below.
First, lasers are devices that emit a particular singular wavelength
of light. This wavelength will determine a specific target. With
respect to Rosacea, the wavelength should be partial to absorption by
hemoglobin ( i.e red blood cells ). There are many wavelengths of
light that meet this criteria. Many laser systems were developed to
capitalize on these absorption points. The pulsed dye lasers which
have wavelengths of 577nm (earliest), 585nm (standard for years), and
595nm (newest- includes the Sclerolaser and the V-Beam; the KTP lasers
at wavelengths of 532nm ( classically the Versapulse, Aura, or Nd:YAG
lasers); and now the longer wavelength Nd:YAG lasers at 1064 nm. The
photolight devices such as Photoderm and Epilight are machines that
produce a flash of intense light of many wavelengths. For this reason
they are not considered lasers. The particular
filter(15nm,550nm,570nm,590nm,615nm,etc..) will cut off wavelengths of
light below the number stated. [For example, with a 570nm filter
wavelengths less than 570nm do not reach the skin. This prevents
unwanted absorption of energy by other targets such as pigment. With
shorter filters, a darker skin individual could blister or burn due to
this undesired absorption.]
The main difference between Photoderm and Epilight are the filters.
Epilight was developed as a system for hair removal and uses higher
filters to try to concentrate the light energy on pigmented structures
above the absorption peaks for blood vessels. However, one can use
the Epilight machine like a photoderm machine by utilizing lower
filters. To be fair, the Epilight is the second generation of the
Photoderm but it is very much similar. A new attachment on these
machines is a Nd:YAG laser (1064nm) which has a variable pulse
duration (see below) that works best for deep and large blood vessels
- specifically leg veins.
Second, beyond the selection of a wavelength or filter, the ability
of the laser/light device to work efficiently to destroy vessels also
has a lot to do with the duration of laser/light exposure. This is
often measured in millisecond pulses or ms for short. The optimum
pulse duration varies depending on the blood vessel size. This is
where the difficulty in treatment lies.
******
Rosacea is a complex vascular disorder with vessels of variable sizes.
One laser or light device alone may not meet the needs of the whole
process without manipulating pulse duration and energy.
*****
One should not necessarily think that one system, laser or pulsed
light device, is better than the other. Both can be good for any given
person. The main reason that some doctors have only one particular
laser or a pulsed light device for treating Rosacea is that these
machines cost up to and over $100,000. The maintenance alone on a
machine can be $10,000 - $20,000 a year. The more important fact
about the treatments given is what experience the doctor has with
his/her system.
When the photoderm first came out over 5 years ago, nobody really
knew what were the best parameters. There are several parameters to
manipulate: filter, fluence (measured in J/cm2 - the energy directed
in a given area per second), # of pulses, delay between multiple
pulses and very importantly, the pulse durations. Early on in
photoderms history, people were learning what parameters to use. Now
several years later the parameters are better known.
I have read in these posted messages the varied experiences of many
people with both lasers and photoderm units. These different
experiences may be related to the experience of the doctor performing
the treatment. With the rise in desire for cosmetic procedures in the
U.S., the number of doctors buying machines without formal training in
lasers is skyrocketing. It should take more than a weekend course to
really understand what one is doing with these systems. A curious
fact is that you have to be a physician to buy a laser but not to buy
a pulsed light device. In addition, you don't have to be a physician
to treat someone with these devices. In fact, in most offices, nurses
or technicians are performing these treatments. You should know who
is treating you.
*****
Also, and just as important, one must consider that every person with
Rosacea is different and what works well for one may not work for
another. I know that people in this support group are trying to get a
set of parameters to send around to each other. Remember, each
machine is slightly different and each machine may vary compared to
itself over time as the lamps get older.
*****
Speaking as a doctor and a laser specialist, there are constant
attempts to produce better systems. In fact, a new laser is developed
almost annually for the treatment of vascular disorders.
One last comment about terminology. Photoderm and Epilight are
intense pulsed light devices. The terms photofacial, epifacial and
fotofacial are not really applying to rosacea directly. These
procedures are treatments with the intense pulse light devices to
stimulate collagen growth in the skin and reduce wrinkles. In the
process of doing a treatment, small vessels and some brown spots
(lentigines or sun spots) may also be eliminated giving a freshened
look to the skin. Severe Rosacea would best be treated with higher
energies and different settings as stated above
===========
Another reference you may want to look through is from the Rosacea Net
Treatment Report Page:
"Rosacea treatment responses...(to Photoderm, vascular lasers, ETS,
etc)"
http://rosacea.ii.net/treatments.html
The page has some interesting individual experiences with different
treatments from Rosacea sufferers.
==========
In the end, it is up to you to decide which doctor you ultimately
prefer. I have pointed you to numerous references regarding laser and
pulse therapy, and the pros and cons of each. While the number of
treatments recommended is higher than what you have mentioned, I can
imagine that the technology and effectiveness of laser treatment is
changing from year to year. It may very well be that one or two
treatments is enough, depending on the severity of your condition.
I am not a doctor of any sort, and certainly cannot recommend which
physician is better than the other. It appears you have certainly done
your homework and decided on two, highly reputable doctors who are
similar in cost and effectiveness, even if they might use slightly
different means to achieve the same goal. Therefore, you have done
your utmost to find the best doctors you can, and I doubt you can go
wrong.
If any of the links I have provided do not work, please let me know.
Also, do not hesitate to ask for clarification if anything is unclear,
and I will help you further if I can.
I wish you all the best!
umiat-ga
Google Search Strategy
rosacea
pulse lasers AND rosacea |
