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Thread: Laser treatment for papules and pustules, demodex mites, and sebaceous glands

  1. #1
    Join Date
    Nov 2013
    Country: United States

    Default Laser treatment for papules and pustules, demodex mites, and sebaceous glands

    The following are my thoughts on rosacea (I am but a humble physical therapist (36 year old male living in Boston) but I feel that I have a good baseline level of knowledge about the body and have picked the brains of many dermatologists and have reviewed many research articles and have just done a ton of reading regarding rosacea). I apologize in advance as this gets long. I post here to help direct further treatments and research, and education is the key to solving any problem, and I feel that I have some good ideas on the topic of fixing rosacea. I have had rosacea and tried many things for at least 15 years and consider myself very knowledgeable about rosacea. I actually have mine under very good control (40 mg doxy daily, finacea 2x daily, olay moisturizer/sunblock regularly, vbeam yearly), but I want perfection (as I have a consistent 2 or 3 P and Ps (papules and pustules) which bother me). I have posted in differing categories regarding the route cause of rosacea, as I feel that it is hard for the average person to ty to understand what it means to be a primary, secondary, tertiary cause of rosacea. I feel that ultimately, us "fair-skinned" people do not have melanin to protect our skin from UV light, and we get more blood vessel growth and are much more prone to INFLAMMATION, and this is the primary route CAUSE of type 2 rosacea (which I believe has further subtypes).

    So that being said, I believe that this propensity for flushing and INFLAMMATION is the route cause. There are many mechanisms which can feed the fire of inflammation. All of our "triggers" are simply things which promote inflammation in our body and face, and these will be different for different people depending on our genetics. So for some, eating habits and diet are a big factor, for others it is stress, hot showers, coffee, etc, etc..

    For some people, the demodex mite seems to play more of a role. These people who post and report that no treatments worked (not even a little), but then try ivermectin/soolantra and it is a godsend and really helped their condition, I believe that they have demodex folliculitis and not rosacea at all. Either that or this should be classified as a subtype of type 2 rosacea. These people seem to have very generalized P and Ps throughout their entire face (from what I've seen from pictures). Some people have a degree of seborrheic dermatitis that either underlies their rosacea, or is just seborrheic dermatitis that was mis-diagnosed. They also respond differently to medications and such as there is a different cause of redness and breakouts (I won't elaborate here as I know much less about SD).

    So getting around to papules and pustules, and especially I'd like to focus on pustules. I believe that the route cause of P and Ps is INFLAMMATION. I feel that this inflammation causes more sebaceous gland activity and cause a feeding frenzy for demodex mites. So the secondary cause of pustules (after the inflammation) is some combination of demodex mite activity and also sebaceous gland activity. As I have already stated, the people whose demodex mites seem to be the issue, they are doing well with ivermectin/soolantra.

    For people like me, who I believe the mite has little to do with my pustules, I feel that my sebaceous glands are the main secondary source of my pustule formation (and probably papule when I get them) (have I mentioned that INFLAMMATION is the primary source. I feel that either from my genetics or from UV damage to my glands, my sebaceous glands are either swollen and enlarged in some areas, or are simply overactive. So, the following was taken from the international rosacea foundation's website:

    "A pustule is an inflamed small red blister-like lesion on the skin surface which contains pus. Pustules are the result of vascular flushing that occurs around sebaceous glands. Over time the inflamed tissue leaks out of the blood vessels and deposit in the skin. The inflamed tissue cells slowly migrate toward the sebaceous gland or pore, causing in inflammatory pustules. The surrounding skin tissue may be sensitive to the touch, thicken or cause localized swelling. The resulting redness will flare and then ease off but over time may become permanent. A pustule is quite common in acne and is identified as a yellowish-tipped pus-filled lesion. Note: A Pustule is NOT a pimple. A Pimple has a bacterial component and occurs in and around the hair follicle."

    So given this, wouldn't it make sense to have a medication or laser to address the sebaceous gland activity? So this is where isotretinoin (accutane) has come about. I took a high does for 4 months when I was younger (for acne and rosacea) and my skin did not have a single blemish after the second month. My P and Ps from rosacea returned after several more months however (after discontinuation). I believe that a low dose of isotretinoin for people like me where the sebaceous gland is the main issue (as opposed to the demodex mite) will have a very good response. However, this medication has gotten such a bad reputation and derms and patients are afraid to prescribe and take, and for someone like me who has a relatively mild case, it may be hard to justify any unnecessary risks.

    So I decided to look more into lasers for treatment (I have had at least 20 ipl treatments in the early to mid 2000s, and have had at least 15 vbeam sessions since then). What I noticed is that in the hands of a well-trained derm at higher settings, the ipl drastically reduced redness and P and Ps (even though the research wasn't conclusive on whether or not it helps P and Ps). I've also noticed that the vbeam does not seem to help P and Ps as much. So this got me thinking. There are ideas that certain lasers temporarily kill p acnes and skin mites which lead to a temporary decrease in P and Ps. There are others (like me) who believe that the ipl helped with P and Ps because reducing the amount of vasculature reduced the amount of inflammation, and also because the ipl device had a broader spectrum of light energy, that it helped to shrink sebaceous glands as well. The vbeam is more concentrated to red blood vessels with a narrow spectrum of light, and does not really have much effect on the sebaceous glands. The research for lasers helping with P and Ps shows that some get a little worse, some have no effect, some have a little effect, and some have a significant effect of reduction. That was me, I had a significant reduction in P and Ps. Why is that do you ask? Because my P and Ps are from inflammation and sebaceous gland activity, not skin mites. Those with more demodex activity probably have no effect from lasers. The research needs to subcategorize people with "rosacea" and also look at the intensity of energy used with the ipl/laser before generalizing results about whether or not they help with P and Ps.

    Now that the ipl seems to have become somewhat obsolete (especially as most derms don't want to take the time to learn the ipl which is a much more complicated device, and the vbeam is very much user friendly and more specific to blood vessels, I don't have a great way to address my P and Ps But, this has made me look and see if any new lasers have come onto the market to address shrinking sebaceous glands. The cooltouch and smoothbeam lasers are in the higher end of the light spectrum and do address sebaceous glands. According to researchers at mgh, getting a wavelength closer to 1700 nm will address sebaceous glands, and thy are using this for regular acne vulgaris now. I actually had a smooth beam/cooltouch treatment when I was younger (maybe 13 years ago) but I just went with what the derm told me and I didn't know as much then. I can't remember if it helped or not, as I was also getting ipl sessions done and my skin was just about perfect, so I wasn't as concerned about which was helping.

    So I have a few questions to anyone who has an intelligent opinion on this matter:

    1. Does it make sense that the route cause of true type 2 rosacea is Inflammation-based, and that secondary mechanisms such as mites and sebaceous glands are to blame for P and Ps? If so, we should be looking to address inflammation through vbeam/ipl, anti-inflammatory topicals and oral meds, and then addressing either the mite or the sebaceous glands.
    2. Has anyone out there talked to a derm or tried smooth beam/cooltouch or any other laser used to address sebaceous gland size/activity? Did it work?
    3. Would it make sense that those who had acne as an adolescent are more likely to have rosacea as an adult (as they're sebaceous glands are and were overactive)?
    4. Does it make sense that we need to subcategorize rosacea, and that those who had no response from isotretinoin probably had more of an issue with mites, and those that don't respond to ivermectin probably have more of a sebaceous gland issue? Are there other tertiary causes that I'm missing other than mites and sebaceous glands? I believe that triggers to be secondary as they will effect inflammation, and either the mite or sebaceous gland, and these will always need to be monitored and addressed.

    If anyone out there agrees with anything i have said, please help spread some of this information. We can't treat our genetics and inability to be protected from harmful UV light (although we should be using sunblock and minimizing direct sunlight exposure). But we can treat the secondary factors such as the increased vasculature (with vbeam), the demodex mite (with ivermectin/soolantra), and hopefully the sebaceous gland dysfunction with either isotretinoin or lasers used to address the sebaceous glands (smoothbeam/cooltouch).

    Does this help solve the mystery of rosacea, or just make me feel better to vent what I feel that I know about this disease that other professional dermatologists don't seem to be doing? Thanks for reading!

  2. #2
    Junior Member
    Join Date
    May 2016
    Country: United States

    Default Newbie Here

    I found your write-up very informative. I'm printing it out to ask my doctor the next time I see her.

    I'm near 60 and have been fighting this mess my entire life, but a recent round of Oracea, Rosula Wash & Soolantra Cream have somewhat got me under control. My doc does the laser treatments, but she's never said I need them.

    Thanks for sharing that much research and information.


  3. #3
    Junior Member
    Join Date
    Jul 2016
    Country: United States

    Default Thank you

    Many thanks for your detailed write up! I am new to type 2 rosacea and have a derm appointment in 6 weeks. Your post has helped me in getting prepared.

  4. #4
    Junior Member
    Join Date
    Nov 2016
    Country: Canada


    Hello Dram,

    Thanks for sharing your thoughts about the disease! It's been really informative and interesting.

    I've had this Subtype 2 rosacea for 3 years now and am just starting to really address this issue because it's gotten progressively worse to a point I can no longer ignore it. (Im 32 now)

    I have a derm appointment in 2 weeks myself and it's helping me prepare as well.

    In your opinion, what would be the easiest way to figure if your P and Ps are gland or mite related?


    I will be posting pics of my progress and experience within a few weeks. I have we will have the opportunity to keep in touch.

  5. #5
    Join Date
    Nov 2013
    Country: United States


    My humble thoughts are that if you have papules and pustules all over your face, it may be mites, but if its just in the T-zone/central area of your face and you notice that that area is very oily in the morning when you wake up (especially if the heat is on in your home), then I believe it to be gland.

    But my final belief on type 2 rosacea is that if you eat an organic diet of natural occurring foods and abstain from foods that spike your blood sugars, and avoid coffee and alcohol, then your papules and pustules will vanish. I also belief that external elements such as heat, hot showers, wind, cold, etc. will fuel the formation of papules and pustules (if you've already had the internal inflammation from poor diet, alcohol, coffee, etc). But with a perfect diet and avoidance of those things, the external elements of heat and cold and wind will only make your face a little red, but will not cause acne breakouts of papules and pustules.

  6. #6
    Junior Member
    Join Date
    Sep 2018
    Country: Canada


    I honestly think ur right. But what can we really do if our rosacea is inflammation/enlarged sebaceous gland based? Im considering Simply going on accutane as that seems to be the only cure for my type. Soolantra did nothing.

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