Latest Advances: Triple-pass laser tx

Indianapolis - 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.

"Physicians 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."

"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.

Associated problems Other problems rosacea can cause include the potential for patients' eyes to swell shut and for inflammation on the ocular surface to cause corneal lacerations, chronic ocular pain and chronic blurred vision.

Though rosacea sufferers can lose vision, Dr. Nase says this possibility is often glossed over by general physicians and in many current publications. He surmises, after reading 2,500 articles about all aspects of rosacea, that experts are clearly warning all general dermatologists about the seriousness of rosacea.

Personal experience Doctors 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 a case of mild-stage rhinophyma that was certain to progress over time until he became a candidate for surgery.

As 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.

After extensive research into lasers, multiple medical publications and in-depth discussions with leaders in the field, Dr. Nase developed a treatment regimen that focuses on the underlying disorder - vascular dysfunction, vascular damage and angiogenesis. He urges interested physicians to learn his entire regimen (available at http://www.drnase.com/) in detail before attempting to use it on patients.

Alternative treatment method Dr. Nase describes an overview of his treatment as follows:

"We do a triple pass where we induce flushing with sublingual or topical niacin or adding adenosine to the topical anesthetic. We also heat patients with heating pads underneath their necks 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 spot."

To treat microvessels located directly beneath the epidermis, Dr. Nase uses the Photoderm VL-Flashlamp (Lumenis Aesthetics) set at 550 to 570 nm in wavelength, a moderate energy pulse and a long-pulse duration.

Dr. 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.