confocal scope question (again)

[prryjones]

Hi Dr. Nase,
You probably posted the abstract below, but for those that have not seen it, there you go.
It's extremely frustrating to realized that: 1) efficacious meds for us are years away, 2) Most MD's don't really give a hoot about our dissorder, and most of all 3) the technology exists that could greatly increase IPL efficacy, yet isn't being used.
IS the confocal microscope in our near future? I mean reading an abstract about the capabilities of some wonderful new gadget is great, but until some Dr. chooses to give it a try...it's usess IMO.
Do they (MD's) want us to pay for their renting the dang thing or what?
I would pay umpteem more for a laser tx THAT I KNEW WORKED.
Thank you, and this will be my last gripe (maybe) about this subject.
Perry

Abstract Title:
REAL-TIME CONFOCAL MICROSCOPY IMAGING OF ROSACEA IN VIVO

Authors:
R. Tachihara, C. Choi, R.R. Anderson and S. Gonzalez

Institutions:
Department of Dermatology, Wellman Laboratories of Photomedicine, Massachusetts Genaral Hospital, Harvard Medical School, Boston, MA, USA

Key Words:
Confocal microscopy, Rosacea, Lasers

Abstract:
Rosacea is a common, sunlight-exacerbated inflammatory disorder on the face. The pathophysiology still remains unknown. The clinical hallmarks of rosacea are papules and papulopustules, vivid erythema and telangiectasia. Sometimes histology is required to make differential diagnosis and yet it is often difficult to take a biopsy because of the site.
Confocal reflectance microscopy (CM) can noninvasively image thin en face sections within living skin with high resolution and contrast. The image contrast is mainly due to the detected variation in singly back-scattered light due to variation in the refractive index (n) of tissue microstructures (typically, n=1.33-1.40). A laser scanning confocal microscope was used to image rosacea. Using water immersion objective lenses of numerical aperture 0.7-1.2 and wavelengths of 800-1064 nm, the lateral resolution is 0.5-1.0 microns and the axial (virtual section thickness) resolution is 3-5 microns, comparable to routine histology.
In this research study, we demonstrated that the major features that histologically characterize each clinical stage of rosacea can be visualized in vivo. These features include dilated pilosebaceous units surrounded by dilated and tortuous capillary loops in the superficial dermis, perivascular and perifollicular infiltration of inflammatory cells, and infiltration of neutrophils, forming follicular pustules.
In conclusion, real-time CM may provide a noninvasive tool for studying the pathophysiology of this common disorder, and a clinically useful diagnostic in some cases.

[drnase]

Yep,

That is what I am talking about. As you read below, the "torturous" hair pin loops make it difficult to treat some successfully doing it blind. But with a pretreatment routine you could figure out the pattern (there is always a pattern) and devise a much better treatment protocol.

You may see this soon with a few laser specialists in large Medical Universities. Will keep you posted.

[prryjones]

Dr. Nase,
I hope so.
I would hope (and expect) that a practicioner who is aware of a techonology that could improve the quality of care given to a patient would take advantage of such technology. This doesn't seem to be the case, however, and I say shame on em.
I am sort of hard nosed on this, but I think that some get "soft", idly sitting on their duffs collecting revenue. Practicioners should constantly, in my opinion, push the envelope for the benefit of their patients. That is their duty. When I grad from pharmacy school, it will be my duty and obligation to stay on top of the current developments in drug therapy for use in advancing patient care. When I stop feeling the need to do this, then it's time to get out of the field.
Laser/rosacea practicioners should feel the same way.
My last post on this matter. Just venting because I know It'll be at least ten years before use of this technology (which has been around for some time) becomes mainstream.
Again, shame on em.
Perry

[drnase]

Perry,

You hit the nail right on the head. Some laser physicians are getting good results and are satisfied with that. They dont want to push the envelope to get great results that put people into remission.


I was the first one (to my knowledge) to use pre-flushing protocols for rosacea (it had been done with mastocytosis on a much smaller level), but I used three intense forms of flushing. My photoderm doctor looked at me as if I was crazy, but the clearance was amazing. He could not believe it. I wanted to write a case study with him and he said he would rather go home after the day and spend time with his family. Such is life.