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Rosacea Article #3:
"The Latest Advances in Rosacea Treatment"
Advances in Rosacea Treatment: Triple-Pass Laser Treatment
John Jesitus and Dr. Geoffrey Nase
Report on Rosacea Treatments - Upated June 1, 2005
- A detailed three-step laser process
provides a far more effective treatment for rosacea than current
therapies, according to Geoffrey Nase, Ph.D., a leading rosacea
researcher who has battled the disorder himself.
Nase says the standard treatment regimen for rosacea only focuses
on the superficial symptoms such as papules and pustules and does
not address the underlying neurovascular disorder. Though not a
dermatologist, Dr. Nase bases these assertions on his medical physiology
training, his numerous publications on rosacea, his clinical work
with dermatologists and collaboration with leading laser specialists
like Dr. Jerry Darm. Dr. Nase is a rosacea research specialist for
the Indiana American Medical Association Affiliate and rosacea treatment
analyst, Indiana University School of Medicine, Indianapolis .
often use harmful topical medications, steroids or irritating exfoliating
treatments," Dr. Nase tells Dermatology Times . "But these
treatments are counterproductive; they anger the underlying rosacea
beast by sensitizing facial blood vessels and nerves." He says
doctors can be too focused on the superficial papules and pustules
and are often confused when patients come back with clear faces,
but are complaining that their faces are fire-red, flushed or burning
from rosacea triggers. "It is never a good tradeoff to clear
the papules at the expense of pushing the underlying disorder into
the more serious stages," he says.
put Dr. Nase on various oral and topical antibiotics during a five-year
period when he was in his mid-20s. He says dermatologists also prescribed
topical medications clearly contraindicated for rosacea, triggering
"angry face syndrome." His rosacea continued to worsen,
but he was told there was nothing else doctors could do for him.
He was told he would have to live with his red, burning face, and
his rhinophyma that was certain to progress over time until he became
a candidate for surgery.
do many rosacea patients, Dr. Nase experienced frequent flare-ups
triggered by a wide variety of causes, from skincare products to
temperature changes, mental concentration, and any form of stress
and light exercise. The typical patient can have hundreds of triggers,
which can include steam radiating from hot foods and warmth created
by the face against a pillow or exertion associated with doing simple
household chores. Avoiding such triggers proves almost impossible.
Many patients wind up having to choose between their jobs, for example,
and their health.
extensive research into lasers, multiple medical publications and
in-depth discussions with leaders in the field, Dr. Darm and Dr.
Nase developed a treatment regimen that focuses on the underlying
disorder - vascular dysfunction, vascular damage and angiogenesis.
He urges interested physicians to learn more about this cutting-edge
treatment regimen (available at www.drnase.com/
Treatment Protocols for Rosacea Symptoms :
Collaboration with Dr. Darm
Nase describes a brief overview of this treatment as follows:
Darm performs a triple pass and sometimes a quadruple pass with
two lasers and Intense Pulsed Light while inducing severe facial
flushing in patients with multiple prescription topical dilators,
oral dilators and thermoregulatory heating units.. He notes that
they often heat patients with thermoregulatory heating units to
induce a thermoregulatory flush to bring out vessels that normal
lasers never treat. Inducing a strong, deep flush in rosacea patients
is of the utmost importance because many of the vessels adjacent
to the treatment area constrict during laser treatment due to a
propagated constrictor response induced by thrombosis at the treatment
treat microvessels located directly beneath the epidermis, Dr. Darm
uses two passes with the Photoderm VL-Flashlamp (Lumenis Aesthetics)
set at short- and medium-wavelengths in order to remove several
superficial vessel types intimately involved in rosacea.
Nase says this is where dermatologists usually stop treatment, missing
the damaged and dysfunctional vessels just below the microvessels,
which are central to vascular pathogenesis
treat these vessels, Dr. Darm uses a 1064 nm Nd:YAG laser, with
low energies, short pulse durations and multiple passes, continually
checking to see that the patient still has an active deep flush
and constantly stopping to determine the level of vascular photocoagulation
with portable magnification systems. The final laser step involves
a single pass with an N-Light 350 ms pulsed dye laser (ICN Pharmaceuticals)
to treat papules, pustules and the lumpy-bumpy facial texture.
multi-pass treatment protocol with several different laser and IPL
devices has changed the face of laser treatment as we know it. This
protocol is able to treat the facial redness, flushing intensity
& duration, swelling and neuropathic pain that no other single
pass traditional treatment or pharmacological agent has ever been
able to successfully treat..
collaboration with Dr. Nase, Dr. Darm follows up for two weeks after
treatment with macrolide antibiotics to decrease regrowth of blood
vessels into the laser-treated areas.
says neurovascular dysfunction is the root of the disorder and that
it does not make sense to focus on the papules as though they were
acne lesions. Additionally, he says a new clinical subtype of rosacea
has recently been identified. Though not officially recognized yet,
neuropathic rosacea (Subtype 5) is believed to be the most debilitating
form of the disease.
of neuropathic rosacea include bouts of centrofacial burning and
pain sensations following exposure to triggers. Such bouts usually
last more than 30 minutes. More serious cases can become semi-permanent
if dermal inflammation or various inflammatory cytokines damage
or permanently activate sensory nociceptors. In severe cases, inflammation
may trigger these sensory nociceptors in the absence of external
triggers (Izumi H. Pharmacol Ther. 1999;81:141-161).
the future, hope for rosacea sufferers may ultimately lie in attacking
the disease at the genetic level, as many pharmaceutical companies
are now doing for atopic dermatitis (AD) and other inflammatory
although Dr. Nase has contacted 17 pharmaceutical companies in the
months since co-founding the Rosacea Research Foundation (see editorial),
he says he has found companies unwilling to explore such options.
companies are working with VEGF antagonists, angiogenesis inhibitors,
vascular smooth muscle modulators, nerve hyperpolarizers, signal
transduction kinase inhibitors and drugs that could really get to
the heart of rosacea," he says. "But I was told, 'we have
no interest in rosacea. There's no money to be made. It's already
been cured.' Sadly, this is a common misconception. For the last
10 years, there have been no real advances in rosacea treatment.
It certainly has not been cured and is far from being treated effectively."
This laser protocol is the first real new effective advancement
in the treatment of rosacea symptoms and triggers.
more information: www.drnase.com/
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