Full Medical History
Current and Past Treatment History
Clinical Examination
Outcome of initial assessment
If not Rosacea ? Then refer on for treatment for other condition.
If Acne Rosacea?
Assess type, severity and suitability for treatment.
Treatment approaches*
Redness alone
IPL using the TRIPL-C protocol*
Redness and sensitivity - (high flush acceleration/ velocity)
IPL using the TRIPL-C Protocol* alternating with treatment using the YAG-G Protocol*
IPL Treatment Resistant Redness
Pulse Dye Laser Treatment using the PDL Protocol*
Steroid / previous treatment damaged, thin & fragile skin
Consider advising against further treatment with IPL / Laser.
Consider Cooltouch III photorejuvenation before adopting above approaches.
Seb-Derm flare following IPL treatment and the role of the "NLite Chaser"
Consider advising caution with further treatment with IPL i.e. may flare up again.
Consider Pulse Dye Laser treatment as a preventative measure (note this works for "the next time").
The NLite Pulse Dye laser can be used as a follow on treatment for IPL as an attempt to reduce the likelihood of a seb-derm flare up post IPL treatment. This is sometimes referred to as an "N-Lite Chaser". Suitability for NLite needs to be independently assessed. Treatment fluence is normally sub-purpuric and typical treatment parameters are 2.5 J/cm2 with350 µs pulse width.
Papules and Pustules
These tend to respond best to IPL provided that the patient is able to tolerate IPL. In some instances of moderate to severe rosacea (with numerous inflammatory papules and pustules), IPL with a single 560/590nm pass may be indicated moving to double then triple passes on subsequent treatments.
Key to Protocol Acronyms
TRIPL-C = Three Range Intense Pulsed Light with Clarithromycin Angiogenesis Inhibition
Yag-G = NdYag using Gemini Laser
PDL = Pulse Dye Laser
NLite Chaser = pre-treatment with sub-purpuric Pulse Dye Laser to attempt to reduce/prevent an IPL induced Deb-Derm flare
Presentation and classification system used at The Burghley Park Clinic
| Acne Rosacea | ||
| AR0 | Initial presentation with symptoms of acne rosacea - following examination/discussion conclusion that the condition is not suitable for this classification group | |
| AR1 | Sub-clinical or mild acne rosacea - responsive to IPL/ Pulse Dye Laser | |
| AR2 | Moderate acne rosacea - responsive to IPL/ Pulse Dye Laser | |
| AR3 | Severe acne rosacea - non-responsive to Pulse Dye Laser | |
| AR4 | Acne Rosacea previously non-responsive (or unlikely to be responsive) to Pulse Dye Laser | |
| Flushing | ||
| FL0 | Initial presentation with symptoms of flushing - following examination/discussion conclusion that the condition is not suitable for this classification group | |
| FL1 | No flushing, no basal redness | |
| FL2 | Flushing Alone - no basal redness - flushing responsive to Nd:YAG Laser | |
| FL3 | Mixed flushing and Basal redness - flushing responsive to ND:YAG Laser | |
| FL4 | Flushing previously non-responsive (or unlikely to be responsive) to Nd:YAG Laser | |
| Acne (Vulgaris) | ||
| AV0 | Initial presentation with symptoms of acne - following examination/discussion conclusion that the condition is not suitable for this classification group | |
| AV1 | Mild inflammatory acne - responsive to Pulse Dye Laser | |
| AV2 | Moderate inflammatory acne - responsive to Pulse Dye Laser | |
| AV3 | Mild or moderate inflammatory acne - non-responsive to Pulse Dye Laser | |
| AV4 | Severe inflammatory acne or cystic acne with no inflammatory component previously non-responsive (or unlikely to be responsive) to Pulse Dye Laser | |
| Seb Derm | ||
| SD0 | Initial presentation with symptoms of seb-derm - following examination/discussion conclusion that the condition is not suitable for this classification group | |
| SD1 | Mild Seb derm - responsive to low fluence non-purpuric Pulse Dye Laser | |
| SD2 | Moderate Seb derm responsive to low fluence non-purpuric Pulse Dye Laser | |
| SD3 | Severe Seb derm responsive to low fluence non-purpuric Pulse Dye Laser | |
| SD4 | Seb derm previously non-responsive (or unlikely to be responsive) to low fluence non-purpuric Pulse Due Laser | |
| Telangectasia | ||
| TE0 | Initial presentation with "telangectasia" - following examination/discussion conclusion is that the condition is not suitable for this classification group | |
| TE1 | Mild superficial fine calibre telangectasia responsive to Intense Pulsed Light /KTP Laser and Pulsed Dye Laser | |
| TE2 | Moderate mixed depth and calibre telangectasia responsive to Intense Pulsed Light /KTP Laser and Pulsed Dye Laser | |
| TE3 | Severe deep large calibre telangectasia responsive to Intense Pulsed Light /KTP Laser and Pulsed Dye Laser | |
| TE4 | Telangectasia (any depth or calibre) previously non-responsive (or unlikely to be responsive) to Intense Pulsed Light /KTP Laser and Pulsed Dye Laser | |
Graph to illustrate three filters used with TRIPL treatments
Diagram to illustrate likely course of effect on redness following IPL
Diagram
Diagram to illustrate likely course of effect on flushing following NdYAG
Graph to illustrate role of PDL in the reduction/prevention of the Seb Derm Flare post IPL
Please note:- Presentation and outcome classification system used at The Burghley Park Clinic
Although this is outside the scope of this presentation, in addition to the Initial Presentation Classification, Fitzpatrick Skin Type & energy tolerance, pigmentation and hirsuitism classifications may influence clinical decisions to treat.
Tissue Energy Tolerance, Immediate Treatment response, Patient Treatment Experience, Condition Relapse, and Overall Patient Satisfaction is also measured:-
A) This score introduces the concept of the tissue tolerance to treatment energy.
|
Score |
ITET = Immediate Tissue Energy Tolerance |
|
-2 |
Serious / permanent unwanted effects on treated or bystander tissue |
|
-1 |
Minor / transient unwanted effects on treated or bystander tissue |
|
0 |
No apparent unwanted effects on treated or bystander tissue |
|
1 |
Treatment and bystander tissue tolerant to low treatment fluences |
|
2 |
Treatment and bystander tissue tolerant to moderate treatment fluences |
|
3 |
Treatment and bystander tissue tolerant to high treatment fluences |
|
4 |
Treatment and bystander tissue tolerant to highest treatment fluences |
B) And this score measures the response to an individual treatment / set of treatments
|
Score |
ITR=Immediate Treatment Response |
|
-2 |
Serious / permanent side effects |
|
-1 |
Minor / transient side effects |
|
0 |
No response |
|
1 |
Slight response |
|
2 |
Moderate response |
|
3 |
Good response |
|
4 |
Very good response |
C) And the patient’s satisfaction with that treatment/set of similar treatments
|
Score |
PTE=Patient Treatment Experience |
|
-2 |
Extremely unhappy |
|
-1 |
Somewhat unhappy |
|
0 |
No satisfaction expressed |
|
1 |
Partly satisfied |
|
2 |
Moderately Satisfied |
|
3 |
Very satisfied |
|
4 |
Ecstatic |
D) This score records whether there has been any relapse
|
Score |
CRO=Condition Relapse Outcome |
|
0 |
No relapse |
|
1 |
Slight relapse |
|
2 |
Moderate relapse |
|
3 |
Complete relapse |
E) And the overall patient satisfaction with all the treatments:-
|
Score |
OPS=Overall Patient Satisfaction |
|
-2 |
Extremely unhappy |
|
-1 |
Somewhat unhappy |
|
0 |
No satisfaction expressed |
|
1 |
Partly satisfied |
|
2 |
Moderately Satisfied |
|
3 |
Very satisfied |
|
4 |
Ecstatic |
Important Note:-
This protocol is not intended to replace clinical judgement* and the author accepts no responsibility for any damage caused by other practitioners adopting these treatment protocols in place of their own clinical judgement. Physicians must assess each patient's suitability based on their medical history, skin type, severity of rosacea and co-morbidity. This expert medical protocol remains the copyright of the author and The Burghley Park Clinic and permission must be obtained from the author before reproduction of this material in full or in part in written, electronic or other form.
visits to this page since 1/8/2005