Vessel regrowth and lasers (was Re: need help with ansers from laser doc.)..

[Guest guest]

what is your opinion on VBEAM? while it is pulsed dye laser, it

supposedly is much gentler on skin (no purpura) because of cooling

and longer pulse length.

thanks

tom

> > , I think you've raised an interesting and important point.

> My

> > theoretical concerns are not only with the best method of zapping

> > vessels as you discussed above, but (even with ideal equipment

and

> > practitioner) the short- and long-term consequences of zapping

> > vessels. It may well be that zapping vessels may not result in

> > permanent change in some or even most rosaceans, and that

repeated

> > treatments will be needed. It's entirely possible that, with the

> > body's compensatory mechanisms, original or continued treatments

> may

> > make rosacea worse.

>

> I think you're right that certain forms of IPL or laser treatment

> have the capability to make things worse. Dr. Nase underwent

pulsed-

> dye laser treatment, which reduced his redness by ~50% and

eliminated

> much of his telangiectasia (he reports all this in his book).

> However, he found that his skin sensitivity to skincare products

and

> also to the environment, and flushing associated with that, was

much

> worsened. This evidence, albeit anecdotal, reminds me a little of

> the laser abstract you recently posted where the doctors were

pleased

> with improvement, but patients weren't.

>

> Anything that causes an insult to the skin has the potential to

cause

> angiogenesis (e.g. blistering, bruising, swelling). This is why

the

> newer lasers, and Photoderm in particular, are of theoretical

benefit

> because they are more selective for the blood vessel. Dr. Nase has

> *always* cautioned against casuing deep bruising or blistering of

the

> skin, because it will likely cause angiogenesis -- i.e. more

redness

> and flushing. In fact, Nase also cautioned against only having 2

or

> 3 treatments because of the potential for angiogenesis.

>

> <questions about aretries and veins snipped - pass!>

> > You know, , the more we all discuss this, the more

convinced

> I

> > am that IPL and related treatments are so in their infancy. This

is

> > really experimental stuff. I'm also reminded here of Rick's

> > insightful hammer/nail analogy. We know that laser treatments

work

> > best for specific, visible skin conditions and imperfections.

Using

> > laser-related technologies for anti-aging and rosacea is wholly

> > different. (Below you mention psoriasis, but I assume you're

> > referring to post-PUVA therapy, oral medication that is then

> > activated by UV light; I wasn't aware that angiogenesis is a

> problem there.)

>

> Dr. Ormerod's study on psoriasis followed the topical treatment of

> psoriasis patients with an NO inhibitor (L-NAME). I believe it was

> double-blind placebo controlled but don't have access to the full

> text any more. Dr. Ormerod used laser-doppler to measure blood

flow

> through the cheeks where topical L-NAME was applied. He found a

40%

> reduction in blood flow using laser-doppler. He also meausured the

> production of VEGF and found a significant decrease (can't remember

> the exact figures).

>

> > out of it? But if I'm reading this right, then theoretically

> topical

> > NOI might help stave off facial edema and inflammation, but not

> > flushing.

>

> The reasons why it's hypothesised that NO inhibition could reduce

> flushing is that NO is involved in many forms of skin flushing and

> redness, including to heat, irritation, etc. (Nase's book has a lot

> of references on this). In addition, simply blocking endothelial

NO

> production which occurs continuously from vessel walls leads to

> reduction in blood-flow through those vessels (this is what the

> Ormerod paper documented). This obviously has potential to reduce

> residual redness and discomfort. I have had discussions with

doctors

> (other than Ethan Lerner) who have run preliminary trials with NO

> inhibitors on rosacea with no visible benefit (I don't know whether

> they used laser-doppler). This raises more questions than it

> answers. Was there still the reduction in blood flow as measured

on

> Psoriasis patients? Why did this not reduce redness? Was the NO

> inhibitor getting to the larger feed vessels where it was needed?

> Was the cream base optimised? Was the NO inhibitor the lasest and

> most potent? etc. etc.

>

> .

[Guest guest]

what is your opinion on VBEAM? while it is pulsed dye laser, it

supposedly is much gentler on skin (no purpura) because of cooling

and longer pulse length.

thanks

tom

> > , I think you've raised an interesting and important point.

> My

> > theoretical concerns are not only with the best method of zapping

> > vessels as you discussed above, but (even with ideal equipment

and

> > practitioner) the short- and long-term consequences of zapping

> > vessels. It may well be that zapping vessels may not result in

> > permanent change in some or even most rosaceans, and that

repeated

> > treatments will be needed. It's entirely possible that, with the

> > body's compensatory mechanisms, original or continued treatments

> may

> > make rosacea worse.

>

> I think you're right that certain forms of IPL or laser treatment

> have the capability to make things worse. Dr. Nase underwent

pulsed-

> dye laser treatment, which reduced his redness by ~50% and

eliminated

> much of his telangiectasia (he reports all this in his book).

> However, he found that his skin sensitivity to skincare products

and

> also to the environment, and flushing associated with that, was

much

> worsened. This evidence, albeit anecdotal, reminds me a little of

> the laser abstract you recently posted where the doctors were

pleased

> with improvement, but patients weren't.

>

> Anything that causes an insult to the skin has the potential to

cause

> angiogenesis (e.g. blistering, bruising, swelling). This is why

the

> newer lasers, and Photoderm in particular, are of theoretical

benefit

> because they are more selective for the blood vessel. Dr. Nase has

> *always* cautioned against casuing deep bruising or blistering of

the

> skin, because it will likely cause angiogenesis -- i.e. more

redness

> and flushing. In fact, Nase also cautioned against only having 2

or

> 3 treatments because of the potential for angiogenesis.

>

> <questions about aretries and veins snipped - pass!>

> > You know, , the more we all discuss this, the more

convinced

> I

> > am that IPL and related treatments are so in their infancy. This

is

> > really experimental stuff. I'm also reminded here of Rick's

> > insightful hammer/nail analogy. We know that laser treatments

work

> > best for specific, visible skin conditions and imperfections.

Using

> > laser-related technologies for anti-aging and rosacea is wholly

> > different. (Below you mention psoriasis, but I assume you're

> > referring to post-PUVA therapy, oral medication that is then

> > activated by UV light; I wasn't aware that angiogenesis is a

> problem there.)

>

> Dr. Ormerod's study on psoriasis followed the topical treatment of

> psoriasis patients with an NO inhibitor (L-NAME). I believe it was

> double-blind placebo controlled but don't have access to the full

> text any more. Dr. Ormerod used laser-doppler to measure blood

flow

> through the cheeks where topical L-NAME was applied. He found a

40%

> reduction in blood flow using laser-doppler. He also meausured the

> production of VEGF and found a significant decrease (can't remember

> the exact figures).

>

> > out of it? But if I'm reading this right, then theoretically

> topical

> > NOI might help stave off facial edema and inflammation, but not

> > flushing.

>

> The reasons why it's hypothesised that NO inhibition could reduce

> flushing is that NO is involved in many forms of skin flushing and

> redness, including to heat, irritation, etc. (Nase's book has a lot

> of references on this). In addition, simply blocking endothelial

NO

> production which occurs continuously from vessel walls leads to

> reduction in blood-flow through those vessels (this is what the

> Ormerod paper documented). This obviously has potential to reduce

> residual redness and discomfort. I have had discussions with

doctors

> (other than Ethan Lerner) who have run preliminary trials with NO

> inhibitors on rosacea with no visible benefit (I don't know whether

> they used laser-doppler). This raises more questions than it

> answers. Was there still the reduction in blood flow as measured

on

> Psoriasis patients? Why did this not reduce redness? Was the NO

> inhibitor getting to the larger feed vessels where it was needed?

> Was the cream base optimised? Was the NO inhibitor the lasest and

> most potent? etc. etc.

>

> .