chemical peel IPL and rosacea

[thefifers]

Hi,

I am 28 years old female with a very senstive and thin skin. I have a very mild acne (especially on my forehead) and was recommended a light exfoliation treatment to help treat it.

I had a fruit acid facial peel (15%)almost 8 months ago now - after this exfoliation treatment my face turned red and peeled for a week. When the redness faded away I was left with slightly dilated capillaries on my cheeks. I decided to return to this beauty salon where the treatment was performed and was seen by their dermatologist who was in a total disbelieve that these broken capillaries on my face were result of the facial peel I had. After a very unpleasant discussion I was offered an IPL treatment, which I accepted and had so far two IPL treatments on my cheeks and also for some reason on my nose.

I found that the first treatment had a very good impact on the affected areas but the second one didn't make much difference. I am now due a third IPL (it's been more than 6 weeks after the second IPL). Between these IPL treatments I had a series of flushing and burning to my cheeks and nose. My face has also become intolerant to my usual facial cleanser and other cream and lotions I have used before. I'm really worried as the flushing is becoming more and more regular and prominent. I suspect that I might be developing rosacea.

I will be greatfull for any suggestions and comments.

thefifers

[Mike T]

If im right you had/ have mild acne which when treated led to broken cappillaries. They offer to give you free laser therapy to get rid of broken capaliries which leads to flushing.

If I was you I would not let them do anything further to my face ( even if it's free) and see a dermatologist right away to confirm what condition you have. You may just need rest and recovery from that fruit peel thing. You should discuss with the dermatologist the treatment they are providing you and make sure it's right. Different lasers treat different things.

All the best. Sorry I could not be more helpfull.

[Naturaltreatments]

I agree that you should probably not have any more IPL for now. You can always have more later if necessary. It is normal to flush after IPL if what you have is rosacea, but some experts at treating rosacea with lasers would suggest you left 2-3 months ideally rather than just 6 weeks between treatments, especially if the skin is flared badly. You could try a good cleanser for rosacea such as Cetaphil Sensitive soap bar or liquid cleanser. You might find visiting the Sher System helpful also if you are based in Britain - the lady who runs this understands how medications and treatments can lead to people getting rosacea. Doctors are quite often not that sympathetic to the idea that rosacea is triggered by medication or other treatments (the medical literature officially tends to say that it's not known what causes rosacea). You should be quite careful what you put on your skin for now. Feel free to send me a Private Message if you want any help with this.

[drsoldo]

Disclosure
This information does not constitute medical advice. Any individual who believes they are suffering from any medical condition, including, but not limited to rosacea, should seek treatment from a licensed medical physician who is qualified to diagnose and treat the particular condition. Nicholas Soldo, M. D.

Over the years I have seen many patients who have had their history of Rosacea begin with chemical peels, sunburns, RetinA use etc---First you should establish if this truly represents Rosacea or is persistent damage from a peel--The ultimate treatment for Rosacea is still IPL and oral and/or topical anti-inflammatories--Skin irritation might benefit from the same but often steroids are used as well--ALL Ipls should be done with MILD settings and on a more frequent basis--I do mine at 2 to 3 week intervals but again I 3pass with 3 different depth crystals and lower settings and NO preflushing---You need another opinion as to diagnosis and proceed from there--Hope this helps and I wish you well N Soldo MD

[peter.crouch]

Important pre-requisite disclosure for information provided.
Any advice or information provided here does not, 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. Dr Peter Crouch

Clearly, having not met you and examined you, another practitioner wouldnt be in a position to offer an opinion which contradicted the dermatologist who has had the opportunity to see and examine you. Whilst it is possible that the fruit peel had nothing to do with the emergence of the blood vessels - I can imagine why you mght seem sceptical that having the peel and the emergence of the vessels were not related. It might be prudent to obtain a seond dermatologist opinion however just to re-confirm the diagnosis of rosacea and to reassure you that you have a truly independent opinion.

I might be inclined to let things completely settle down for a while after the peel. I would be very careful about trying too many new products if your skin is increasingly sensitive following the peel. Sometimes a topical i.e. cream holiday is what is needed as you encourage the skin to calm down. I would stick with with the minimum quantity of whatever products you know from experience suit your skin best. Further treatments may be possible in time but probably not just at the moment until everything has calmed down (thihs could take as long as 6-12 months).

I hope that this is helpful - good luck with your condition - I do hope it calms down soon.

Kind regards,

Peter

Dr Peter Crouch

[Aurelia]

Thanks very much, Dr Soldo and Dr Crouch, for so kindly interrupting your week-end to help our new member ("thefifers") with her unfortunate problem.

Kind regards,

Aurelia

(for the mods)

[thefifers]

Hi,

Thank you so much for all your replies. I think that it is important to add that my GP referred me in March to see a dermatologist who 'suggested' that I had mild acne and normal flushing (at the higher range of normal). I was asked to give a 24h urine sample for testing - this has returned negative. It's worth noting that there were no visible signs of flushing during my appointment with the specialist back then. The intense redness and burning have only started to appear on my face two weeks ago. My face felt normal before the first IPL back in December, was still good or even better than ever after the 1st IPL, continued to be good after the 2nd IPL and only started to flush and burn 6 weeks after the 2nd IPL. I haven't changed anything in my morning or evening cleansing routine but my face became intolerent to the products that I tend to use on a daily basis.

Last week my GP prescribed me "Clonidine" 25mg to take three times a day to regulate the flushing. I'm worried that if I take this drug it will make things even worse - I know that Clonidine dilates blood vessels and I am worried that it may be a contraindication to the IPL treatments I have had.

I'm going to see another dermatologist later this week to get a second opinion. Symptoms are more prominent now than they were back in March so I am hoping that some sort of diagnosis can be made.

Thanks again for all your help and quick replies.

thefifers

[Mike T]

This is my very basic understanding.

Clonodine widens the blood vessels thereby reducing blood pressure and in turn blushing.

IPL therapy uses differeing lights to penetrate to differing depths of the dermis (inner skin). The light transfers its energy in the form of heat to the darker areas (just as you feel hotter wearing darker clothes) in the dermis e.g blood veins. With enough heat the smaller veins can be broken away so to speak (however they can return in time). That is why IPL works better for people with lighter skin. In dark skinned people the lights energy is largley absorbed (and wasted) by there epidermis (outer skin), leaving only a negligible amount to be absorbed by the veins.

Based on how these two treatments work i can not see a decrease in effectivness of either wether used together or seperatley. To be extremely pedantic the answer to wether the increase in the size of the veins due to Clonodine will mean more laser treatment is needed to eliminate them is no. The veins increase in diamater is accompanied by a decrease in thickness.

Do make sure to get your dermatologists opinion on this as i could have it completley wrong .

All the best.

[Naturaltreatments]

Flushing at the "higher end of normal" is a strange thing to say. I would suggest you take some photos of when your skin is flushing particularly badly and show these to your dermatologist, as quite often early stage rosacea can be difficult to identify because the skin can look fairly normal when it is not in a flushed state, but as the condition progresses flushing episodes last longer, you flush in response to more things, and permanent redness starts to appear (this permanent redness can help the dermatologist to diagnose the rosacea, but it's really a bit late as a lot of damage is already done by this stage, so it's important to say exactly what happens with the flushing when it is at its worst and have pictures of this). It sounds like your GP is seriously considering rosacea however with the prescription of Clonidine. I think one of the main risks of starting to take Clonidine is that it can be difficult to stop without making the flushing worse (very common side effects are things like dry mouth but there are some more serious side effects too), but some people on the board can give you their long term experiences of taking it.

[Naturaltreatments]

The intense burning and redness are a particular sign to be careful of what you put on your face, as the skin is likely to be very sensitive. So if you were just to use one thing on your face such as Cetaphil sensitive soap bar which is very mild and rosacea friendly this might help. Also take short, luke warm showers, not long hot ones and use luke warm water to wash your face (otherwise everytime you take a shower or wash your face you will likely get flushing).