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Thread: 2010 Q and A Interview with Dr Crouch

  1. #11
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    Hi Dr Crouch,

    Thank you so much for once again agreeing to answer our questions.
    In your opinion is it possible for IPL treatment, that has always been well tolerated in the past, to suddenly cause adverse effects?
    I've had 15 or so IPL treatments over the past 7 years and have always had great success. Unfortunately I recently had two treatments (same Doctor, same settings) and they have caused extreme dryness all over my face and a huge flare of pustules and oily skin on my nose. I am pretty certain that it was the IPL that caused this because it happened after both treatments, but once again I should stress that IPL has never caused me any problems in the past.

    My second question links to the first and concerns the relationship between Seb Derm, IPL and the N-Lite laser. I understand that IPL can flare Seb Derm (maybe this is what has happened to me) and I was just wondering if we had any idea why exactly IPL causes Seb Derm symptoms to worsen? I understand that you advocate the use of N-Lite to try and counter these effects, and was once again wondering if you know why N-Lite specifically helps in the treatment of Seb Derm.

    Obviously I understand that it is difficult for you to recommend a particular treatment without viewing my skin personally (I believe I am currently on your waiting list for a consultation anyway), but do you think N-Lite would be beneficial for somebody that has very large pores, pustules, and severe oiliness (all on the nose)? I'm hoping that I can eventually turn to N-Lite to help undo some of the damage recently caused by IPL.

    Once again thank you for all that you do to try and help fellow sufferers of Rosacea.

    Kind regards,

    James

  2. #12
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    Hello Dr Crouch,

    Over time, I have read a fair bit about IPL (and also spoken to some practitioners too), with the thought that it might be an effective treatment for my rosacea. However, it sometimes seems that, as time goes on, more problems seem to be reported as being associated with IPL treatment. Do you think this is a reasonable assessment – would you say there are increasing reservations held amongst practitioners about IPL? And if so, is there a feeling that enthusiasm for IPL as a ‘relatively new’ (?) treatment has meant that it has perhaps not been used selectively enough?

    Also, I understand that there are limits as to how close you can get to the eyes when carrying out any kind of laser/light treatment. Can you give any idea, for someone who has thread veins which veer up towards, nearby and over the eye socket, how far is ‘far enough’ away?

    I seem to have largely ‘managed’ the rosacea so far, with the spots, veins and blotches wreaking havoc on my face occasionally, rather than most or all of the time; however, I feel that recently the symptoms have started to ‘accelerate’ and so I want to try and head things off at the pass before things worsen considerably. Are you able to say how long, approximately, is the waiting list for an appointment at your clinic; and do you have any update on the new methods getting in contact with you (recently announced elsewhere on these boards)? Apologies if this isn't the right place for this question, but I’m having difficulty getting in touch thus far.

    Many thanks in advance, and best regards.

  3. #13
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    Dr. Crouch,

    if you're dealing with severe vascular rosacea accompanied by debilitating flushing, do you prefer to treat it with IPL or V Beam? Which have you gotten better results with?

    I've had both, and am seeing that V Beam seems to rupture more blood vessels while putting less heat into the skin and causing less post treatment flushing.

    Would love to get your opinion on this. Thank you for taking the time to answer our questions.

  4. #14
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    Dear Dr. Crouch,

    1. I have a friend who has mild rosacea, one or 2 bumps appear on and off. She had Vbeam about 3 years ago and it helped to keep the redness/flushing away. Her cheecks have started to flush and get red more often again. She is wondering which is better for this Vbeam or IPL? The Vbeam helped her 3 years ago, she had 3 Vbeam treatments. Also, she is Latin, tan color skin.

    2. I flush badly on my ears even when my face is not flushing. I've had 3 IPL treatments and they seem to be helping my face but my derm says he can not treat the ears. Do you have any recommendations for the ears?

    Thank you so much for your help and taking time to answer our questions.

    Gratefully,

    Alba
    using elidel at night, taking atelenol, had 2 vbeam laser treatments, 46 year old female

  5. #15
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    Dr. Crouch: Thank you so much for doing this.

    I have had rosacea for 15 years. When first diagnosed I was put on MetroGel. . .after some time I did very well on that - got an occasional bump but the MetroGel took care of it. I was almost symptom free for 14 years until a year ago. I tried a new mineral make-up and it caused a flare-up and it was like nothing I'd ever had before. . .not so much bumps, but rather getting more and more red and then the flushing began and the burning pain and I would swell up every day. It would ease some for part of the day and start all over. I went to dermatologist after dermatologist but all they could offer were creams - I finally found a Dermatologist who did V-Beam. She diagnosed me with Eczema on top of the rosacea and put me on Elidel which cleared up the Eczema quickly. My dermatologist kept me on Elidel and said I needed 3-4 V-Beam treatments. I have completed those and my last V-Beam was two weeks ago. After each V-Beam I would flush some and had some minor burning . . .the swelling would go down in about five days.
    I haven't had a flush or a burn in 7 days.

    My Question: What have you been seeing as the amount of time V-Beam (after 4 treatments) will keep me from flushing before I need to get a couple more treatments? I ask because I need to start putting some money aside to pay for these treatments.
    Have been actually gone a year without the flushing and burning?

    Thank you. Darcy

  6. #16
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    Dear Dr Crouch,
    Just a quick question. Is there any possibility that repeated V-Beam treatments may successfully zap veins/capillaries in one place but somehow shift them elsewhere? (Sorry for not articulating this properly). I've had a number of successful V-Beam treatments that have eliminated the telangectasia (sp?) but over the past year I have witnessed the emergence of patches of diffuse redness which look in a magnifying mirror as though they are about to blossom into fully-blown veins. In short, does the eradication of veins from one part of the face lead to others appearing elsewhere, in places where they've never been before?

    Hope you get my drift!
    best,
    Colin

    PS Thanks for giving your time to answer our questions.

  7. #17
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    Dr Crouch has emailed the answers to me and I want to extend a big thanks to him for all the time and expertise he so generously shares with us always.

    For now I am posting the Q and A answers in the only format I know how but as soon as Warren has time he will be able to display it in a more orderly format.
    Without further ado, here is the 2010 Q and A with Dr Crouch.

  8. #18
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    Quote Originally Posted by dpart View Post
    Dear Dr Crouch. I had an V-beam treatment around 3 months ago. The treatment was not particulary aggressive and not purpuric (I think it was 8,5 joule in strength). Both my nose, left and right side was treated and the right side was treated a little more than the left side since the right side was my worst side prior to the procedure. What happened was that both sides reacted with swelling, the left side had minor swelling and the right side had a pretty intense swelling with burning and pain. The swelling on my left side subsided pretty fast and has never returned. The problem is my right side, the intense swelling lasted five days and then it subsided a lot, BUT the problems is that it returns when I flush. The more intense I flush the more intense the swelling, in addition the area has been very sore to the touch and generally not very good.

    My questions is as follows:
    Prior to V-beam I did NOT swell when flushing, now I swell pretty much on my right side when I flush (not the left). It also seems the more I flush the more I swell. The area also becomes a little sore and painful to touch.

    1) Have you seen this kind of reaction before, and do you think it will resolve over time?

    2) Why do you think this is happening, is it my lymph system or blood vessels that creates the swelling?

    3) Do you have any suggestions on how to deal with it?

    Dear Dpart,
    Thank you for your question. Haven’t seen it myself – it may resolve given time
    Hard to know without examining you – even then it might not be possible to say exactly why. Have you spoken to the practitioner who did the procedure?
    Tricky issue will be – go for more treatment? Is one side under treated?
    ?Switch strategy – I have to say that continuing with the same treatment bearing in mind the previous treatment didn’t give you the end result you wanted would not necessarily be advisable. You might want to look at IPL or ND YAG as an alternative but be guided as to continuing with more V Beam by your existing practitioner who may have seen this with their treatments and their laser before.
    I hope that this advice helps,
    Kind regards,
    Peter


    Disclaimer
    Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.

  9. #19
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    Quote Originally Posted by mattdog323 View Post
    hey Dr crouch,

    Do you ever surpass 26J's with the 590?

    And have u ever taken the 640filter or the 695 filter up to and passed 30J's

    Ive just recently had a pass with the 590 at 26J's and the 640 at 28J's(lumenis one)A little bit of crusting in the skin but overall it went well,Its my eighth treatment with that laser all spaced 5-6 weeks apart,We started off low and slowly raised the energies(being careful suffered damage before With a dodgy old ipl and fat loss with a very aggressive pdl(different people)every things gone great and ive improved alot so just wondering with all your experance what is the cut off level in your mindset with lumenis one ipl??

    Thank you for your time,

    Regards Matt.
    Dear Matt,
    Thank you for your question. Yes, The highest I go is 28J on single or double or triple pass at 515, 560, 590 or 695
    I advise going very carefully i.e. using extreme caution with 515 at 28J even with those with very light tolerant skin
    No, I haven’t taken 640 or 695 above 28J with the lumenis One so the cut off I use is 28J.
    The filter combination I use is 515nm (alone)
    OR 515nm OR 560nm OR 590nm with 615nm AND 695nm
    In my experience, if someone has tolerated a treatment with no prolonged skin reaction (no post-treatment redness lasting more than a few hours at most) then provided that there is no change in the state of the skin e.g. no additional skin exposure / new treatments etc it is usually safe to increase the settings on at least one filter by 2J/cm2. Crusting, however mild, is not a sign that the skin is tolerating the treatment.
    What is often much misunderstood is how to take the settings up safely. I generally apply the filters in multiple passes in ascending order but when increasing the fluence in successive treatments, I generally increase the fluence settings of the higher number filters first.
    I hope that this advice helps,
    Kind regards,
    Peter
    Disclaimer
    Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.

  10. #20
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    Quote Originally Posted by Kalypso View Post
    Dear Dr Crouch,

    I would very much like your opinion and advice. I am 27 years old, living in London. I believe I have had mild-ish rosacea since my teens, with permanent background redness of the skin (which I was previously able to cover with foundation). At the age of 22, I experienced a short episode of 'hot flushes' where my skin would 'burn' and feel very hot, and look extremely red. I had no other After a few weeks I didn't suffer any hot flushes for several months, except for the occasional one when I was in a very hot environment.

    I have recently had my first baby and in the latter part of my pregnancy experienced 3 weeks of very severe facial flushing, which was more excessive on one cheek. This time, my cheeks not only felt very hot but stung when I had a hot flush. The redness was really extreme, practically plum coloured. I also noted the skin seemed shiny and swollen and it hurt to smile. The skin also went very dry.

    The hot flushes have since stopped although I have been left extremely depressed by this as the background redness has increased and I have been left with a redder patch on one cheek. I also have a redder nose with visible blood vessels on the sides of my nose.

    At the age of 20 I had one IPL treatment for the sides of my nose (as I had a visible vein on one side - pretty minor in comparison to what's happened recently). Although I think it improved the vein, I'm sure it increased the background redness of the sides of my nose, and I now have visibly enlarged pores there too.

    I now feel depressed that IPL will not work for me and there is no way out and no way to improve my appearance. I am concerned about IPL resistant skin and stories about fat loss from IPL.

    I am currently being treated for severe depression due to this condition but various medics have told me that they think my face is a hormonal thing - not rosacea 'because I do not have obvious telangiectasia' - and should be left to settle after the pregnancy before referral to a dermotologist (they don't want to refer me when I am depressed). The thing is, the depression is absolutely secondary to the rosacea and I feel the argument that this is not rosacea is poor because I am displaying all the symptoms of it. I know that very visible veins in the cheeks do not necessarily come until later.

    My 68 year old mother also has rosacea and a red face (with visible veins) but she is not at all bothered by this - I wish I wasn't either.

    Is there any hope that this can be improved? I want desperately to be able to enjoy my new baby and my wonderful husband but I feel so low about what has happened to me.

    Kind regards
    Kalypso

    Dear Kalypso,
    Thank you for your question. Well, first off, depression secondary to chronic conditions is well recognised but don’t give up hope - there may be a treatment that could help.
    Certainly I would respect the opinion of the medics who have had a chance to see you ad provide an opinion based on first hand knowledge. The hormonal issue may be part of the reason why things progressed during pregnancy but it seems like you had the issue before the pregnancy and clearly you have a family history of rosacea (many people do and some people with parents with rosacea don’t go on to have it themselves so the family history link isn’t always as inevitable as some may assume). I would advise taking the precaution ( the practitioners you have seen so far may have done this already but it might be worth checking) of checking that vasculitis has been excluded
    You may benefit from a range of strategies including:-
    Gently Progressive IPL . I am confident that I can state that none of our patients have never experienced fat loss attributable to IPL treatments delivered at our clinic using treatment settings using our protocols for the Lumenis One IPL.We have delivered over 20,000 treatment shots using our Lumenis One over 5 years and have experienced one tiny overlap blister (which healed within a few days with no ongoing impact) and a couple of slightly singed eyebrow hairs in all that time and with all of those treatments. I have seen at least one patient who has seen us for follow up treatments and who has attributed fat loss and indentations to previous more aggressive treatments with a Nd:YAG laser (treatment delivered elsewhere) and the patient knows that they are welcome to continue to have gentle restorative IPL treatments with us. I always advise a test patch first.
    Nd:YAG
    We have a protocol which may help with the flushing. A test patch would be advisable.
    Pulse Dye Laser
    This may help with the redness. A test patch would be advisable.
    Medication
    A specialist dermatologist would be able to advise if this route might be sensible to try. If you are depressed, antidepressant medication and psychological therapies might offer some benefit – your GP should be able to advise you about this.
    Allow time to heal
    Sometimes leaving time to allow healing after a partially successful treatment is a sensible approach. If the condition is progressive then simply waiting without doing anything else is probably not practical. This might give you time to explore what benefit medication and psychological therapies could offer.
    I hope that this advice helps,
    Kind regards,
    Peter
    Disclaimer
    Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific medical advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical condition should seek professional advice from a qualified, registered/licensed physician who has the opportunity to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a physician able to meet with the patient, take a medical history, examine the patient and provide specific advice and or treatment based on their experience diagnosing and treating that condition or range of conditions.



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