We performed an IPL tx on a skin type 3 male for rosaca on a Palomar medilux. The following day he got these "track marks" a line on one area of his face where you could see where the tip went. It's brown and looks like a slight superficial burn or the way hyperpig. spots look after they are treated. Some even look like little tanglectasia. However, it only occured in one area, not the whole face which was treated.

The doctor here says it will heal up and the pt will be just fine. This is the first time I have seen this complication (regardless of following all the proper guidelines). The pt. does not seem to care too much as he's really seeing some of the rosaca go away already, so he's happy. The DO here just says it's a complication that will heal, not a big deal.

I was wondering if any of you could share your advice on what this streak mark could be caused by, what tips to give to prevent it (if it is preventable), how long will it be before the marks go away, if any topicals will speed up the healing, etc. (We apply Pandel post tx and send pt home with some).

I also called Palomar to see what they have to say. I will post their response when I get it.

Thanks for any input!

Hi
The streaks are pigment that is being pulled up from the green handpiece on the Medilux IPL. It will go away in 7-14 days and look great. Sometimes there is slight hypopigmentation in that area but it will repigment quickly. Remember that is what the IPL does-it "pulls" brown and closes red pigment from the skin. This does not sound like a complication in your case. The medilux handpiece can become hot and increse your risk of epidermal injury however so you have to be careful. The way to prevent it would be to lower your fluence (energy) but then you may not be treating the rosacea effectively. Rosacea requires higher fluence and lower pulsewith (requires Starlux to change this) and multiple tx's to be effective and usually there is swelling which is a good sign the vessals are injured. A FST 3 has significant pigment so I would expect for some to lift as you have seen.
I have read your some of your other posts and would advise you to become VERY knowledgable on Laser/IPL physics and get much more experience before "hiring a doctor" as an independant contractor even in Florida. There is more to all this than pushing a button and following the Palomar Guidelines!!

Thank you for the post and for sharing your knowledge with me, LAMD!

I heard from Palomar today, they said this could be due to not keeping the tip of the G cold enough, that the pt. may have had more sun exposure in that area and/or that he may have had more pigment in that area. They said the only thing to do to is apply cortisone cream within the first 24 hrs. After 24 hrs. no topicals will help, only time will make it fade, 1-2 weeks.

The weird thing that threw me off is that the streak is in the shape of the handpiece tip. Like LAMD said, the G handpiece can pull pigment that is not seen superficially to the surface and cause this.

Several points:

1. Make sure the tip is cooled frequently.
2. Start with low enery and move up after test spots.
3. Make sure the patient uses spf 30 and above every day in between treatments.
4. Do not start treatment on the patient until you are sure they have been using spf 30 or above for about 2 weeks. This will bring out their natural skin tone.

Remember, the sun contributes to the rosasea and vascular lesions on the face.