Careful, caring IPL treatment clears 'untreatable' rosacea

Feb 1, 2006 
By: Bill Gillette 

New York — When rosacea sufferer Alice Barker (not her real name) scheduled a consultation appointment with Manhattan dermatologist Harvey Jay, M.D., it wasn't a second or even third opinion she was seeking. It was a fourth.

Alice's history
"Alice came to me in 2000 after having been to at least three top dermatologists in New York, two of them at major medical centers in the city," Dr. Jay says.

"She'd been diagnosed with rosacea, but was told her condition was untreatable. She wanted another opinion because she'd read that I treat rosacea with IPL (intense pulsed light) and wanted to know about it. Her rosacea was not typical in terms of severity — it was the worst case I'd seen in 25 years of practice."

Dr. Jay, who also serves as clinical assistant professor of dermatology at Weill Medical College of Cornell University in New York, says Alice's bright red facial rosacea developed to the point that the then-59-year-old secretary had left her job due to her embarrassment at being seen and the frequent severe pain and burning sensations she was suffering.
 
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"At the time she came in she was still under another doctor's care, so I told her to go back to her doctor to finish the work-up," Dr. Jay says. "I didn't hear from her for a while, but she finally came back last year. Her condition was no better, but even though it was obvious this would be a particularly challenging case, I felt I could help her."

Treating Alice
Dr. Jay started Alice's treatments in December 2004. He says he used a standard IPL device "that's been on the market for 10 years" and began very cautiously with Alice.

"Initial stages of treatment were crucial in this case because of the extreme redness and sensitivity," Dr. Jay says."I began by doing test areas at very low dosages to see what she could bear in terms of dosage. I started at 16 joules per square centimeter, where normally I would start a patient at 30, 40 or 50 joules. Just as with my other rosacea patients, I treated Alice every three to four weeks."

Small steps
Dr. Jay says he began treating small spots below Alice's chin, was able to eventually increase the IPL dosage and then started on the cheeks with narrow strips of IPL exposure.

"I was looking for clearing, and I finally saw some on one strip on the cheek after the April treatment," he says.

By that time, Dr. Jay had found that the ideal IPL setting for Alice's rosacea was 52 joules to 54 joules per square centimeter, but cautioned that that setting is particular to Alice's condition and can vary with each machine. He says he also used a 550 nm cut-off filter.

"I saw immediate blanching after Alice's fifth treatment, in May, and after the June treatment, I saw the dramatic clearing improvement," Dr. Jay says.

Dr. Jay's cautiously executed IPL treatment has resulted in the almost total clearance of Alice's rosacea on the left cheek.

Alice, who is now 64, is still undergoing treatment by Dr. Jay, who says that though there has been substantial improvement in Alice's appearance due to the clearance of the rosacea, he's hoping continued IPL treatment will minimize or eliminate the flushing and the burning symptoms that Alice continues to experience.

Hopeful message
As for the significance of Alice's case, Dr. Jay says he thinks it provides a message of hope for those who suffer severe cases of rosacea.

"In all honesty, I see people who come in with cases less severe than Alice's who've been told their rosacea is untreatable," Dr. Jay says.

"I think there are patients and doctors who feel there's no way to treat this. My message is that people who have rosacea should know that there is treatment available, even in severe cases, and that we're constantly working on ways to improve effectiveness of our treatment. My message to physicians is the same, really: With careful, caring treatment, even severe cases of rosacea can be treated effectively."