Dr. Bitter Sr. -- Derm and Laser Specialist -- next intervie

[drnase]

Hello Group,

Dr. Patrick Bitter Sr. who is a dermatologist and Laser Specialist will be our next Physician Q and A member.

Please start listing any questions under this thread for him. Utilize his dermatology background and his laser experience with rosacea. Fire away.

[Steve95301]

Hi Dr. Bitter, I've had 4 treatments with you already and the results have been excellent. I'll be back on August 19th for my fifth.

I have two questions,

1.) What's your take on the macrolide antibiotics post-IPL to reduce angiogenesis? I almost ordered some roxithromycin, but I wanted to get your take on it first.

2.) Everyone on these boards talks about the machines involved, so I'm wondering what machine you use in the Los Gatos office? (Whatever it is, it works great- I'm more than satisfied with my progress.)

Thanks!

-Steve

[Bob Bear]

Dr Bitter,

Thank you for contributing to our forum!

What do you think has been the most significant step forward since you pioneered the IPL treatment for rosacea? What would you predict will be the next major stride?

Many thanks,

Bob Bear

[Andy]

Dr. Bitter,

In your opinion, what would be the best way to try to re-build skin which have been thinned, by a high dose Accutane for example, and has become ultrasensitive. Is there a way back to it's former, original thickness and thougher barrier?

Thanks,
Andy

[drnase]

Hey Group,

Lets take advantage of his dermatology experience:

How do you treat acne with rosacea

How do you treat seb derm with rosacea

How do you treat enlarged pores

How do you treat sebaceous gland hyperplasia

[Mermaid]

Welcome Dr Bitter and thank you for your time. Some of these questions pertain to myself but others are questions I know will be of interest to others suffering.

1) In your opinion, what is the best way to treat and hopefully reverse irritant dermatitis caused by the use of harsh skin care products?

2) Many have been devestated by either Steroid induced rosacea or the use of the CO2 laser. Would your treatment approach be similar in order to repair some of the damage caused and if not how would you approach each case individually?

3) How important is it to avoid flushing of any type in the 2 weeks after IPL/Laser treatment and if it is important, how do we stop spontaneous flushing in it's tracks?

4) What is your treatment approach with regards to treating Acne which is independent of Rosacea but merely co-exists and is not a result of rosacea? How do you determine whether the Acne is independent? How do you determine that the papules and pustules are actually caused by the rosacea itself?

5) For those who can only use bottled water on their faces, what can be done to ease them back into a healthy skin care routine? Is daily cleansing, very gently a must in your opinion?

6) In your opinion, do you think that the current research and advances made in areas such as psoriasis, dermatitis, seb derm etc and other inflammatory skin conditions, will eventually become the platform which will allow for much better treatment options and perhaps even a cure for rosacea? What can we learn from these skin conditions and apply them to ourselves?

7) How do you think we can improve communication between dermatologists and other physicians such as vascular specialists etc in order to receive optimum treatment methods from the various specialties?

Thank you Dr Bitter.

Mermaid

[GJ]

Hello Dr Bitter

Is there a danger in aggressive pre-flushing? Might an abundance of dilated and angry vessels somehow cause the energy to dissipate?

Thankyou
GJ

[KHM]

Lets see if I can make this sound coherent:

Right now to actually attack the root of Rosacea rather than just the symptoms it looks like our best options are Laser/IPL and Accutane (low dose).

Both of these are really shotgun approaches, and each is a radical treatment in its own way. Do you see anything on the horizon that would allow us to normalize our skin /blood vessel response without going to such drastic measures. Perhaps a topical treatment that is aimed specifically at the underlying disfunction(s)?

I am kind of hoping tha some day there will be a simpler way to keep this under control, or ideally retrain my skin, vessels and nervous system to act more "normally".

For consideration.

KHM

[PeaceFroggy]

Dr. Bitter,

When using a laser on a patient that has symptoms in a specific area of the face (e.g. nose, chin, cheeks), do you recommend that the patient have just that area treated, or do you prefer to still do a full-face treatment?

Thankyou.

[Blondie]

Hello Dr. Bitter!

1) Can you explain what causes the enlarged pores which accompany Rosacea?

2) As my Rosacea progresses my skin is now extremely oily, causing clogged pores, blackheads and breakouts. Can IPL treatments stimulate this oil production?

3) What regimen do you recommend to your Rosacea patients who cannot use exfoliants yet want to control the oilyness?

Thank you for your support and willingness to participate in this Q & A.

[Tricia]

Hello Dr. Bitter and welcome! How nice to have someone of your level of expertise participate in this way.

In your opinion, what are the best topicals you can reccomend for keeping down inflammation and that could help repair the barrier of our compromised skin? Is there anything that you feel is a "must have" for someone with rosacea?

Also, any thoughts on seb derm and how to best treat it without causing irritation? And anything new in the way of anti-aging products that you feel might be good for us?

Thanks for participating.

Tricia

[prryjones]

Dr. Bitter,
When is someone finally going to make use of available imaging technology - eg confocal microscopy - to derive at the most efficacious IPL tx methods and regimens?
Years of guesswork and experimentation could be eliminated by the objective evaluations allowed by this technology. With experimentation, the best tx regimens could be devised. No more quesswork as to why someone is 'resistant', etc.

Regards,
Perry Jones

[drnase]

Thank you Perry.

[Chris23]

First I want to thank you for taking part in this Dr.Bitter, it is greatly appreciated.
I wonder what kind of experience you have treating people who suffer from a chronic red nose and nose-swelling? Also, what kind of laser devices and protocols are in your opinion the mose effective tools treating these symptoms?

Best regards
Chris


I haven't seen a question regarding this yet, so I hope we can squeeze one in..

[Kelli]

Howdy!

I'm rather reluctant to ask anything, because I'm not sure if it will be worded properly. I don'tknow a lot about the various lasers and the medical terms...

I just know that I have Moderate to severe Papulopustular Rosacea. I was first idagnosed with rosacea at age 11. I'm now 26 and it is getting to a severe stage. Constant papules and pustuals - cysts that keep me awake at night because I can feel my pulse in them. I've tried antibiotics, and metrogel/cream, and noritate, and the sulfur washes, and 5 IPL treatments (I guess you could label me as laser resistant. I am slightly less red 3-4 weeks after my last treatment, but getting worse overall symptoms) - it just gets worse.

For me and others like me, what is there to do? If you had me in your clinic, what would you recommend?

[celticgirlie]

Thank you Dr. Bitter for participating in this question/answer session and sharing your expertise.

In your experience have you found that after sufficient IPL treatments to achieve clearance, both males and females are equally able to maintain clearance with touchups only every 6 months to a year? I ask this only because I have only heard of males maintaining clearance in this way.

Also, I have recently heard that there is a link between those people who have had acne in earlier years and those who will go on to develop rosacea. Are there a significant number of your acne patients who indeed have developed rosacea?

What do you think of Photodynamic therapy to enhance the effect of IPL? My derm. tells me that this method targets many more vessels.

Elizabeth

[tryingtogetoverit]

Dr. Bitter,
Thank you for doing this for all of us. I really appreciate it.

I know the use of ablative lasers for "rosaceans" is controversial, but I'm wondering what other treatment options are available for those of us that also have depressed acne scarring and texture differences? Both of these problems are causing me a lot of psychological stress, and I feel that something needs to be done. I cannot treat my rosacea without worsening everything else, and vice versa. How can I go about this without destroying my skin? Simply treating my rosacea is not enough, as I have other problems...I was leaning toward Erbium YAG.

Thank you very much.
Orion
PS, I have large pores as well.

[grooney]

Hello Dr. Bitter and thank you in advance for your assistance. My question relates to lumpy, bumpy skin texture.

I have had several IPL treatments, and I do notice a reduction in flushing. In addition to a rather blotchy red complexion, my skin texture is my main concern. The skin is rather lumpy and bumpy with larger pores. If you would look up close my skin looks as if each pore was clogged - it doesn't look smooth. There are certain patches on my face, where I seem to have flesh colored bumps about the size of a pin head. If I were to squeeze one, nothing comes out...it's just a bump of skin.

IPL treatments, reduce this for a few days and then the texture issue comes right back. Is there anything I can safely do to prevent this?

Regards,
Gina

[nataljaoo]

Dear Dr. Bitter, Dr. Nase and hi group,

I think all questions here are great, especially Mermaids. Two of hers that I would love to have an answer to as well are:

3) How important is it to avoid flushing of any type in the 2 weeks after IPL/Laser treatment and if it is important, how do we stop spontaneous flushing in it's tracks?

5) For those who can only use bottled water on their faces, what can be done to ease them back into a healthy skin care routine? Is daily cleansing, very gently a must in your opinion?

Going on with question 3), Dr. Bitter, can you recommend what is best to do if someone flushes uncontrolably after IPL? (This was the case with me after beeing treated once with the 560 filter double pulse from the Quantum IPL machine). It hasn't turned back to normal for 6 months now. I believe many people and specialists have warned that flushing post IPL might cause neogenesis. Are macrolide antibiotics the only remedy to prevent this from happening? i'm allergic to all antibiotics (turn me bright red), so is there maybe anything else that can be done or taken to calm the inflammation and flushings post treatment down?

best wishes, Natalja (Holland)

[francois]

Thank you once more for your great contributions to rosaceagroup,

I have seen a derm here in Turkey who was trained by you. She diagnosed me with seborrha (seb derm?) but much of my syptoms seems to be rosacea. Do you think, is there a appropriate method for me to diagnose myself, whether its seb derm, rosacea or both?

[RachelRose]

Dr. Bitter, thank you for your research and how it has eased the suffering of many. My questions are about damage to the immune system.

I understand that the constant, ongoing inflammation from rosacea harms the skin's immune system so that it is susceptible to other diseases. Is this correct?

I would imagine that getting the inflammation under control would be the first step before the damage to the immune system can stop, is this correct? (IPL has not helped me in that area so I am turning to Genesis Laser.) Can lasers be used to improve the immune system even when inflammation is present?

Is this damage to the immune system reversible? Will the immune system gradually heal itself if the inflammation is gone and stays gone? Are there things that can be done to help it to heal?

Thank you Dr. Bitter.

[keisha06]

First, as many have said, thank you for your contribution to this group, your time and expertise is much appreciated.

My questions relate to such topicals as Ellidel and Protopic, non steroidal creams.

What do you think of the use, and effectiveness of such topicals in helping to control inflamation in general (either on an ongoing basis or after a nastly flush or flare). Also, would the use of such topicals be good specificaly after IPL for the same type of effect.

I have not used them myself but have heard from others that they have found them effective and would greatly appreciate the opionion of an individual such as yourself.

Once again, thank you for your time,
warm regards,

[gerryc]

Hello Doctor Bitter

WELCOME

Would it be possible to use low dose Accutane to help remain clearance after successful IPL txt instead of touch up IPL procedures every 6-12months and if so how long after IPL txt would it be safe to use use low dose Accutane for this purpose.


Thanxs Gerry

[fanta]

Is Dr. Bitter not going to participate anyway?

[Warren]

Is Dr. Bitter not going to participate anyway?

Could you not bring up old threads please.

[fanta]

OK, but you could just Pm me this,delete the post or the thread

[prryjones]

Hello,
I, too, have wondered the status of the Dr. Bitter interview.
Perry Jones

[drnase]

Hi Perry,

I spoke with Patrick about this. He loves the questions. Patrick wont be answering any questions until our case is settled though. He will answer this interview once everything is settled and the hate site taken down,

...[edited by the moderator]...


The answers to the gene therapy interview should be finished late this week. Ill be interested to see what Dr. Berens has to say to the indepth questions that this group asked him.

[prryjones]

Thank you, Geoff.
Perry