# Rosacea/Intense Pulsed Light and Laser
## Intense Pulsed Light (IPL)

Intense Pulsed Light (IPL) is a treatment where a broad spectrum of light is applied to the skin. IPL differs to dermatological lasers in that they emit a large spectrum of light while lasers emit a single wavelength, but in practice they are quite similar. IPL machines are expensive and the treatments are normally only available from dermatologists and beauty salons. Using different settings IPL machines can be used for treating vascular lesions, fine wrinkles and also for hair removal. For vascular treatments the goal is to destroy blood vessels in the inner layers of the skin by heating them to 70 °C. Although blood vessels are targeted, the light energy is also absorbed by other structures in the skin such as melanin (pigment for skin and hair) and water. IPL has only been around since 1995 and new research to maximise effectiveness while reducing side effects and new technologies and procedures are still being developed.

### IPL Machine

IPL machines are powered using a xenon flash lamp. Xenon, which is also used for camera flashes produces a flat spectrum of light from 400nm to 1200nm when excited with electricity. Different filters can be used to filter out lower wavelengths depending on the treatment performed. The size of the glass prism (spot size) varies between machines but at ~4.5x1cm they are much larger than typical lasers at ~1cm circle. A light pulse can be triggered by the operator using the hand piece. There is a delay between pulses while the capacitors recharge and the flash lamp cools down.

### Settings

* Wavelength or Filter: A Xenon flash lamp produces a wavelength from 400nm to 1200nm. For vascular/rosacea treatments the light is filtered generally at the lower end. A 590nm filter would reduce the wavelength from 400-1200nm to 590-1200nm. Lower wavelengths penetrate lower and higher wavelengths penetrate more deeply into the skin.
* Fluence or energy level: The amount of energy applies over the whole pulse generally ranges from 20-60 joules per square centimetre (J/cm$^2$) and may be spread over a series of short pulses. A joule is equal to 1 W·s (watt second).
* Pulse width: The duration of each pulse. Can be a single pulse or three short pulses.
* Repetition rate: The delay between the short pulses.
For the Matrix system of Medical Assist the settings are: 380nm-1800nm / upto 15 pulses times two. maximum 80 joules per square centimeter. This is the most powerfull IPL system in the world with the best effect. The machines are available in two different types, the first is a salon equipment and the other is a hospital use. Both are very reliable machines with high quality.

### How it works

Selective photothermolysis. The absorption of haemoglobin is significantly higher than the absorption by melanin the skins natural pigment. The haemoglobin absorb the light heating up causing the blood vessel walls to heat up causing coagulation of the blood vessels which are eventually reabsorbed by the body and replaced by scar tissue. Their are two systems. The first one is a ELOS system, which is working only for 70% for black or dark hair with a white skin. It wont work for blond, red or grey hair. Also it is not safe to use on dark skin. The second system is a Matrix system from Medical Assist. This system works on a thin part of the hair follicle which is effective for all colours of hair and is safe for every type of skin.

### Cost

Generally treatments are sold as single treatments or as discounted packages of five treatments with a period of 3-4 weeks or 6 weeks with the Matrix system, between each treatment. Prices per treatment are usually between US$300-700 (€230-500) but can vary depending on country, IPL machine type and the qualifications and skill of the operator.

### Treatment procedure

Topical anaesthesia can be applied 10-30 minutes before the treatment. Eye protection is generally worn by the patient and the operator. The operator selects the settings based on the skin type and similar characteristics and proceeds with the treatment. Each pulse of the IPL feels like having a rubber band snapped against the face. The skin will be redder and painful after the treatment and improves over the day continues to improve for months after the treatment. Newer procedures include pre flushing using a heating pad on the back of the neck and macrolide antibiotics because of their anti-angiogenesis properties which stop the regrowth of blood vessels shortly after treatments.

### Risks/parameters that affect outcome

* For men if the area of facial hair growth is treated then it could result in temporary stunted hair growth and possible hair loss.
* If the patient has dark skin or has a tan or sunburn then this will reduce the effectiveness of the treatment, this is not for the Matrix system from Medical Asist which can treat all skin types and skin colors.
* If the operator presses too hard with the handpiece on your skin, the effectiveness of the treatment will be reduced because the blood will be pushed out of the area being treated.
* If the energy levels are too high then purpura or bruising can result. Purpura is the appearance of purple discolourations on the skin caused by bleeding underneath the skin. Purpura can last up to 2 weeks.
* Blisters
* Alcohol, isotretinoin

### Effectiveness

In a study of 63 patents with telangiectasia owing to rosacea that were treated with IPL concluded that IPL is an effective tool in achieving meaningful and lasting rosacea clearance. The study found a mean clearance of 77.8% was achieved and was maintained for a follow-up period averaging 51.6 months (range 12-99 months).>
Another study was performed in order to detect the effect of IPL application with simultaneous topical antibiotics in inflammatory rosacea and to assess the efficacy of IPL therapy in routine treatment of rosacea. Twenty patients aged between 34 and 70 with papulopustular rosacea (14 female and 7 male) were included in the study. Ten patients (group I) were treated for 21 weeks with topical metronidazole. The other ten patients (group II) received an additional 3 sessions with IPL 515-755 nm Photoderm VL technology over 4 weeks. Treatment effectiveness was recorded by digital visualisation and patient satisfaction scale before each IPL session. In all patients, significant reductions in papulopustular elements were observed. Eight out of 10 patients (group I) still showed permanent erythema and telangiectasias despite topical treatment. In 3/10 patients a few telangiectasias remained following the treatment in contrast to 5/10 satisfied group I patients. MD Ferdinand Bisselink did a study on 116 patients for the treatment rosacea and found out that 103 from the 116 patients see that there whas a reduction of more as 70% after four treatments with the Medical Assist Matrix IPL system.

### Trademarks and procedures

* Photoderm®: ESC Medical (now Lumenis) first introduced IPL machines for dermatological use in 1995. The Photoderm VL machine for vascular lesions was among the line-up and the treatments were often marketed as "Photoderm".
* Photofacial™: A trade secret procedure developed by Dr. Patrick Bitter Sr. M.D. and Dr. Patrick Bitter Jr, who train IPL operators in their protocols for a fee.
* FotoFacial™: Dr. Patrick Bitter Jr later developed the Fotofacial protocol and the FotofacialRF using Syneron ELOS technology.
* Photorejuvenation is not trademarked.
* Intens Pulsed Light Matrix system is developed by Medical Assist (medicalassist@hotmail.com)

## Laser

Dermatological Lasers can be used to treat rosacea and work by applying a high energy single wavelength beam to the skin to target blood vessels. This heats them up, damaging them and they are then removed by the body's defence mechanism.

## External links

* IPL treatment updates Dr. Geoffrey Nase
* IPL treatment reviews at Rosacea.co.uk
* Rosacea Support archives - 10 pointers to a good IPL treatment
* Rosacea Support archives - Text of article: Nonablative laser, IPL source both shown to stimulate dermal proteins
* Article abstract at PubMed - Flash lamp pumped dye laser for rosacea-associated telangiectasia and erythema.
* Article abstract at PubMed - Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life.

## References

* ↑ Dr. Geoffrey Nase, PhD. Latest Advances: Triple-pass laser tx. Dermatology Times, 1 March 2005 Issue. Full text
* ↑ Schroeter CA, Haaf-von Below S, Neumann HA. Effective treatment of rosacea using intense pulsed light systems. Dermatol Surg. 2005 Oct;31(10):1285-9. Abstract.
* Angermeier MC. Treatment of facial vascular lesions with intense pulsed light. J Cutan Laser Ther. 1999 Apr;1(2):95-100. Abstract
* Mark K.A.; Sparacio R.M.; Voigt A.; Marenus K.; Sarnoff D.S. Objective and Quantitative Improvement of Rosacea-Associated Erythema After Intense Pulsed Light Treatment. Dermatologic Surgery, June 2003, vol. 29, no. 6, pp. 600-604(5).
* MD Ferdinand Bisselink, Medical Assist. IPL and Rosacea Study 2011.
* Christian Raulin, Bärbel Greve, Hortensia Grema. IPL technology: A review. Lasers in Surgery and Medicine, Volume 32, Issue 2, 2003. Pages 78-87. Full text link (PDF).