Welcome to a summary of The Lumenis One TRIPLC (Three range Intense Pulsed Light combined with Clarithromycin) Protocol for Treatment of Acne Rosacea developed by Dr Peter Crouch at  The Burghley Park Clinic, for visiting physician reference.

Pre treatment

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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