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Rosacea Remission

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A question that has come up is whether or not rosacea goes into remission? The medical journals dealing with rosacea seem to ignore this subject. We know that rosacea treatment can control rosacea reasonably well. What are your thoughts on whether rosacea actually goes into remission or whether is has a life cycle and 'burns itself out?' This would be a comforting hope for rosaceans but there is no evidence in the medical journals on this subject. Could you please help us understand rosacea remission better?

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The following are replies by email to this question:

From: Jerry Darm, MD

Subject:

Date: November 30, 2007 3:19:55 PM HST

To: Brady Barrows

Hi Brady I have forgotten my password etc--Will you post for me

I have seen hundreds of patients achieve reasonable remissions for almost all of the rosacea symptoms that are generally described using IPL and laser therapy--For the spider veins around the cheeks and nose the best laser we have found the 1064 Yag devices which can ablate the spider veins in one or two treatments--It takes several years for these veins to reaccumulate--IPL treatments can also ablate these veins but the 3mm spot size on the Yag laser with high fluence (power) is much more effective--

The redness of rosacea is probably due to the proliferation of thousands of smaller blood vessels beneath the surface of the skin--This can be treated with the IPL or with the Yag in the painting mode( 10 pulses/second at a very low fluence)--Redness can be reduced but is very hard to completely eradicate--It generally comes back over time but again takes many years to regenerate--

Papules, pustules and red raised plaques can be removed given enough treatments with IPL or with the painting mode with the Yag--We have seen remissions lasting 1-3 years--Recurrences are less severe than the original outbreaks and are easily retreated leading to remissions again lasting several years--

Flushing can be treated with the Yag but does not respond as well to the IPL--Flushing can be reduced but is hard to completely eliminate--Many treatments are needed

The most dreaded form of rosacea is flushing rosacea associated with pain--This can be treated with the Yag and can even be put into remission given enough treatments--These patients can truly suffer--

Obviously not all of the patients treated achieve remissions--However in our experience it may take up to 20 treatments to achieve this in the most severe patients and not all rosaceans have the patience or the money to do this--In addition post treatment flares can cause a lot of anxiety and may last for 1-2 months in the most severe patients and can easily derail any treatment plan--Thanx J Darm

_________________________________________________________________

From: Robert Brodell, MD

Subject: Re: Rosacea Remission Question

Date: December 1, 2007 11:41:05 AM HST

To: Brady Barrows

Rosacea, like teenage acne, has proven to be easier to control than to cure. Remission is a period of varying length when no treatment is required and the disease is quiet...in a way, a period when the acne is cured. While I have certainly had many patients enter remission, I do not take credit for this. It is just as likely that the patient experienced hormonal changes that led to the remission as it is that my medication led to the remission. I favor controlling acne....hope to get patients off systemic therapy over time....eventually get them off topical therapy if possible, but NEVER promise too much.

Dr. BOB

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What is YAG and how is it different from IPL

YAG is a laser and IPL is Intense Pulsed Light. Different types of light devices.

Nd:YAG (neodymium-doped yttrium aluminium garnet; Nd:Y3Al5O12) is a crystal that is used as a lasing medium for solid-state lasers. The dopant, triply ionized neodymium, typically replaces yttrium in the crystal structure of the yttrium aluminium garnet, since they are of similar size. Generally the crystalline host is doped with around 1% neodymium by weight.

Laser operation of Nd:YAG was first demonstrated by Geusic et al. at Bell Laboratories in 1964. Source

IPL is a focused, broad-spectrum light that is applied to the surface of the skin. More Info

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