From: gnas_@_.edu
Date: Wed Mar 10, 1999 11:36 pm
Subject: [rosacea] Photoderm Answers
Hello Group,
I am trying to respond to each e-mail with as much speed as I can. I am
also trying to respond to the posts on the message board -- however, I am
swamped. I will do the best that I can. I see more and more messages
pertaining to laser therapy and Photoderm therapy. For anyone that has
chronic facial redness or intense blushing/flushing, this will be an
important part of your treatment regimen. 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!
Photoderm is not a laser, but is a incoherent intense pulse of light. With
proper use by an experienced physician, one can achieve excellent results.
I must stress though that there are several things that need to be done in
order for each one to achieve these results:
1. You must find a Physician who has extensive experience with photoderm
(especially pertaining to facial blood vessels)
2. Only that Physician must operate on you (not the technicians or various
other helpers)
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.
Below are three medical abstracts showing Photoderm to be highly effective
in treating various diseases of facial blood vessels.
1. Dermatol Surg 1998 Jul;24(7):743-8
An intense light source. The photoderm VL-flashlamp as a new treatment
possibility for vascular skin lesions.
Schroeter CA, Neumann HA
Department of Lasertherapy, Medical Centre Maastricht, The Netherlands.
BACKGROUND: Up to now, vascular diseases were treated with various lasers,
such as argon, pulsed dye, and copper vapor lasers, which can lead to side
effects like hypopigmentations,hyperpigmentations, and scarring. We
treated patients with vascular lesions with an incoherent intense light
source, the PhotoDerm VL-flashlamp.
OBJECTIVE: The aim of the study was to test the effectiveness and safety
of the PhotoDerm VL for vascular skin lesions.
METHODS: One hundred and twenty patients with facial or leg
telangiectasias, spider nevi, erythrosis interfollicularis, and senile
angiomas were treated with the PhotoDerm VL.
RESULTS: In 73.6% of patients there was an immediate clearing, and in
84.3% a clearing after 1 month was found of leg telangiectasias up to 1 mm
in diameter. Facial telangiectasias and erythrosis interfollicularis
colli showed clearance up to 90%. Spider nevi and senile angiomas often
only needed to be treated once.
CONCLUSION: From our experience we conclude that the PhotoDerm VL is an
excellent device to treat vascular lesions as there were hardly any side
effects seen, however, the user needs a sufficient experience to get good
results.
2. Dermatol Surg 1997 Oct;23(10):941-5;
Treatment of essential telangiectasias with an intense pulsed light
source.
Raulin C, Weiss RA, Schonermark MP
Center for Dermatologic Laser Therapy, Karlsruhe, Germany.
BACKGROUND: The flashlamp-pumped pulsed dye laser (585 and 577 nm) has
proven to be a very effective and safe treatment option in the therapy of
essential telangiectasias (ETE). Nevertheless, the postoperative
intracutaneous hematomata, which most patients see as cosmetically
disfiguring, always has been a matter of concern.
OBJECTIVE: To test the efficacy and safety of a new, large spot size,
intense pulsed light source, the PhotoDerm VL, which omits noncoherent
light adjustable within the 515-1200-nm range, in the treatment of ETE.
METHODS: Fourteen patients were treated with the PhotoDerm VL. They
suffered from ETE of the face, postoperative teleangiectasis of the nose,
ETE of both legs, and poikiloderma of Civatte.
RESULTS: All treated lesions could be abrogated with excellent results by
this new device. There were no unpleasant side effects of the treatment.
Additionally, due to the large spot size (2.8 cm2), a larger area could be
treated within one session. No anesthesia was required.
CONCLUSION: The PhotoDerm VL is an innovative, highly effective, and
comparably safe therapeutic alternative to the laser in the treatment of
ETE. The rate of cosmetically relevant side effects is considerably
smaller, the patient compliance is excellent, and the method can be
applied easily in an outpatient setting.
3. Lasers Surg Med 1997;21(2):203-8
Treatment of a nonresponding port-wine stain with a new pulsed light
source (PhotoDerm VL).
Raulin C, Hellwig S, Schonermark MP
Center for Dermatologic Laser Surgery, Karlsruhe, Germany.
BACKGROUND AND OBJECTIVE: The pulsed dye laser is effective and safe in
the treatment of port-wine stains. It is the laser of choice for port-wine
stains and initial superficial hemangiomas in children. For the treatment
of darker port-wine stains in adults that have not responded to pulsed dye
laser treatment, excellent results can be achieved using the PhotoDerm VL,
a new technology based upon the emission of wide band, noncoherent intense
pulsed light.
METHODS: Our report presents a patient with a facial port-wine stain that
hardly responded to previous pulsed dye laser therapy. After the first
ineffective treatment trial, the patient refused further dye laser
applications. An intense pulsed light source (Photoderm VL) was applied
instead.
RESULTS: The lesion responded well after the first treatment session and
was completely resolved after four treatments with the PhotoDerm VL.
CONCLUSIONS: The new intense pulsed light source Photoderm VL seems to be
a promising treatment alternative for the therapy of otherwise
nonresponding port-wine stains due to its special technical features.
Hope this helps,
Geoffrey
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Dr. Geoffrey Nase