
For a general description of our approach towards treatment of Acne Rosacea Click here
Pre-flush with Zimmer cold air blower
IPL treatment gel applied
Typical Treatment Parameters (updated 12th August, 2007)
1st pass 590nm 3 pulses 22-24 J/cm2*
Each triple pulse 3.5ms with 30ms delay between
2nd pass 615nm 3 pulses 24-26 J/cm2*

Each triple pulse 3.5ms with 30ms delay between
3rd pass 695nm 3 pulses 26-28 J/cm2*
Each triple pulse 3.5ms with 30ms delay between
Note - although I generally start with 590nm as the first filter, it may be necessary to reduce the filter number i.e. to 560nm (or occasionally 515nm) as treatments proceed and you can be more confident of the reaction of the patient's skin to IPL. Remember this involves 3 exposures (of triple pulses) and in the author's experience, a good clinical endpoint can be achieved by sequentially targeting the vascular layers using the three exposures using the three filters at each treatment.
People
often ask, why use three filters if the first filter includes the
wavelengths provided by the other two? It is the wish to "drive" the energy
safely deeper that underpins the three filter approach.
This diagram tries to illustrate the increasing depth of penetration using
different filters in the TRIPLC protocol. Remember that the filter cuts off
any wavelength below the filter number but that you then get everything from
the filter number up to 1200nm. The theory is that the triple filter
approach to treatment targets vessels at greater depth as the filter number
rises. In practical terms, the fluence (energy) that can be applied
increases as the filter number rises because the higher numbered filters let
a "narrower band" (of more deeply penetrating wavelengths) through without
exposing the epidermis to the lower wavelengths more likely to cause surface
side effects.
Treatment head orientation
2nd and 3rd passes at 90 degrees to the previous pass (see below).


Immediately before and during treatment
Hold the IPL head in gentle contact with the skin for a few seconds prior to IPL exposure to cool the skin. Leave the treatment head on the skin immediately after treatment to allow for post exposure cooling before moving onto the next area. Check for skin reaction for 30-40 seconds after the first exposure with any new filter and avoid stacking pulses. At the first sign of any overexposure, stop immediately and cool skin rapidly e.g. with Zimmer Air Cooler.
Post Treatment
Post cool with Zimmer Air Cooler
Post treatment (angiogenesis inhibitor - IF appropriate* for the patient to take)
Clarithromycin* 250mg twice daily for 2 weeks
Clarithromycin* 250mg once daily for 2 weeks

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.
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