From: gnas_@_.edu
Date: Sat May 8, 1999 3:59 am
Subject: [rosacea] Photoderm Treatment Advice
I have been gleaming through some of the e-mails sent to me. I noticed many
questions about Photoderm. Well, let me answer some questions and give some
advice.
First of all, I have thoroughly investigated all of the current forms of laser
treatment (from argon to pulsed dye to the newer gentle lasers to C02 lasers,
etc......). I have personally been treated by both the pulsed dye laser and
photoderm. HANDS DOWN......Photoderm is the best available treatment for our
vascular disease. Let me stress that I am not a spokesperson for photoderm (nor
any other product). I am not in bed with any physician. I am not on the
payroll of any pharmaceutical company or cosmetic industry. I am only
interested in everyone getting better! Think of me as your consumer reporter.
The pulsed dye laser was the gold standard for treating vascular lesions on the
face in the late 80s and early 90s. It is still a great laser. Many vascular
and plastic surgeons have good success with this laser. However, there is much
bruising associated with treatment and it cannot get to the deeper feed vessels
without causing considerable damage to the epidermis and dermis. In addition,
it is virtually impossible to treat the entire blush zone in one sitting (due to
pain and cost).
The argon laser is out! Too much risk of hyperpigmentation (semi-permanent
redness), hypopigmentation (semi-permanent whitening) and hypertrophic scarring
(raised scar formation). This is now well documented in the medical literature.
Photoderm is the future. In the next 6 to 9 months, there will be several
positive medical reports on the effect of Photoderm on rosacea redness and
blushing. In addition, there will be grants given out to do more extensive
research on the long-term effectiveness of this treatment.
In the past, I have recommended photoderm as an important treatment for
rosaceans who have extensive telangiactasia (broken blood vessels), chronic
facial redness or who have severe, long lasting facial blushing. Let me explain
why. First, you must understand what rosacea is. Everyone, must be impressed
with the amount of diversity to facial flushing, facial blushing, irritation to
topical products, red inflammatory bumps, burning...... as well as everyone's
response to medical and naturopathic treatments. It is so confusing. It is
overwhelming. There can be hundreds of different variables (triggers for
rosacea) as well as thousands of possible combinations of those triggers. Let
me tell you the one variable that everyone has ........ from Darlene to Carol to
Esther to Kerry to Bill........... The only variable that is present in all
rosacea sufferers is an abnormality in facial blood vessels (arterioles,
capillaries, venules). It can be an abnormal functioning of blood vessels
(altered responsiveness to substances delivered via the blood stream, altered
responsiveness to neurotransmitters released from nerves, altered
responsiveness to substances released from the epidermis or dermis) or in the
chronic stages, structural damage to blood vessels and abnormal blood vessel
growth in response to the chronic inflammatory environment. In mild cases,
there are mild abnormalities in blood vessel function and structure. In more
severe cases, there is extensive damage and dysfunction of these blood vessels.
This is the rosacea beast. This is the heart of your disease. Anything that
aggravates the beast, worsens the disease. As your blood vessels become more
abnormal and more leaky, one experiences more triggers. When the blood vessels
are irritated and damaged, it changes the resting state of the blood vessel
(length tension characteristic of the muscle layer of the blood vessel) making
it much more responsive to many substances and triggers (i.e., able to open up
much more easily to deliver more blood to the facial skin). In 'pure' rosacea,
those small red inflammatory bumps (papules) are caused by inflammatory cells
(not bacteria) in your blood stream leaking through an abnormal blood vessel and
migrating through the dermis into the top portions of the facial skin. Anyway,
I want everyone to understand what you are dealing with.
Photoderm treatments will remove the damaged and functionally abnormal blood
vessels. These blood vessels will be replaced by smaller, stronger blood
vessels. However, the treatment of rosacea with photoderm is in its infancy.
There are many questions that need to be addressed by scientific/medical
studies. There are several medical pioneers in this field who are light years
ahead of other photoderm physicians. These experts are finding several things:
1. The single biggest mistake that one can make is to stop after 1, 2 or 3
photoderm sessions. This only removes the obvious structurally damaged blood
vessels (only the tip of the rosacea beast). One must be patient and follow up
with 4, 5, 6 or even more. In addition, they are finding out that by inducing a
facial flush prior to treatment has an extremely beneficial effect on the
outcome of the treatment.
2. There is no 'right' setting for the individual patient. One must take into
consideration the skin tone, the thickness of skin, the depth of the vessels,
the orientation of the vessels, the vessels involved (blue veins, red
arterioles, or both). More important then the intial setting are the follow up
treatments. The physician should be extremely aggressive and adjust the control
settings after each session -- in order to get different size vessels, different
vessel types, different depths of vessels.
3. If your nose is involved, you MUST treat underneath the tip of the nose and
underneath the sides of the nose where a great majority of blood enters the
area.
4. You MUST NOT use EMLA anesthetic creme or any other creme. They are finding
out that EMLA is a topical vasoconstrictor and will limit the success of the
treatment. In addition, any topical creme or makeup can potentially alter the
penetration of the light treatment. This has now been proven . The patient can
use a topical 2 or 4% lidocaine gel (which is also a vasodilator -- great) or
the patient should ask the physician about oral pain killers prior to Photoderm.
5. Patients will experience swelling if the crystal is placed to close to the
delicate under eye area -- so be careful.
6. Treatment of the nose should be with the smaller crystals to allow better
contact with the curves of the nose.
7. Some of the tougher vessels respond better to double pulses (and even triple
pulses).
I hope this helps,
Geoffrey
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Dr. Geoffrey Nase, PhD