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

[Guest guest]

> , 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]

> , 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.

.