Pre-flushing enhances Laser Treatment Efficacy - Rosacea Knowledge Forum by Geoffrey Nase PhD

Dr. Geoffrey Nase · #1 (**permalink**) 18th May 2011, 09:26 AM

We've been discussing pre-flushing for nearly a decade since I fooled around with a Niacin dilator cream in my lab and this was followed by years of preflushing Rosacea Laser Treatment by Dr. Patrick Bitter and colleagues.

Finally some peer reviewed medical journals show support of this methodology:

DERMATOLOGICAL SURGERY AND LASERS
British Journal of Dermatology [2011]

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

Summary

Background Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow.

Objectives We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea.

Methods Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale.

Results Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). Based on physician assessment the overall clinical improvement on the niacin side was significantly better (P = 0·005), and patient satisfaction was also higher on the niacin-pretreated side (P = 0·007). There were no remarkable side-effects, with the exception of transient erythema and oedema.

Conclusions Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.

Journal of the European Academy of Dermatology and Venereology [2011 Publication in Process]

2011 Pre-print Highlights: Topical niacin cream-enhanced 595-nm pulsed-dye laser treatment for facial flushing: ... Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment and thus must be pre-flushed for best therapeutic outcome.

Dr. Nase Editorial: The Argument for Pre-Flushing Dating back to 1998 -- Microvascular PhD Conclusion

Many laser and photoderm specialists get good to excellent results without ever inducing a flush. No question about that. Some also attained phenomenol results with the argon laser and 577 nm short pulsed dye lasers which are now extinct. It happens all the time.

The point is ....... ensuring better treatment of redness and flushing that doctors dont always have a full grasp of unless you walk one day in the shoes of a rosacea sufferer who flushes severely or spontaneously every few hours. Push that envelope. Dont close the box. Do not ever become satisfied. Strive for even better.

However, there are two well-documented microvascular and neurovascular reactive phenomenons that can occur during laser treatment that can dramatically reduce laser efficacy without preflushing the patient.

1. The areas immediately adjacent to the laser spot treatment constrict due to a conducted constrictor response via depolarized vascular smooth muscles. These vessels can stay shut for hours and thus never be treated.

2. The constrictor response that occurs in some patients that experience pain during treatment. For some reason, the pain response activates sympathetic constrictor fibers in some patients and these powerful nerves close multiple layers of vessels and hide them from treatment.

Interesting phenomenon. Wish we could predict which patients this would happen to without active laser doppler readings, the new vascularscope, or a portable confocal system that takes real time imaging of the blood vessels to see if they have been photocoagulated and form thromboses inside.

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Dr. Geoffrey Nase · #2 (**permalink**) 18th May 2011, 09:59 AM

There are several recent medical journal articles that show that you can improve rosacea laser treatment of chronic facial redness, active bouts of flushing, and sensory burning/itching/stinging/sensations by inducing a flush prior to laser and constricting the blood vessels (and adding Vitamin K1 injections to improve clotting factors) to the treatment protocol.

Based on companies following my posts, there is now a patent for pre- and post laser flushing but the ingredients are less then optimal:

Biochemics Patents Vasoactives to Enhance Laser Treatments
March 30th, 2010, by E.L. Hodge | flushing, laser therapy, patents

How to best optimize laser and IPL treatments has long been debated. Should the rosacean deliberately engineer a flush prior to treatment? Should anti-inflammatories or anti-hypertensives be taken after treatment? Of course, many have long since reached their own (perhaps tentative) conclusions and employed diverse means to prompt pre-treatment flushing and soothe post-treatment inflammation.

Yet, if sufferers have been quick off the mark, the givers of treatment – with a few laudable exceptions – and the makers of drugs, have been characteristically slow to catch on: too complacent to investigate and too un-enterprising to experiment.

The news that a bunch of presumably bright people have decided to plough considerable resources into the development of a product comprising a topical vasodilator for pre-treatment, a topical vasoconstrictor for post-treatment, and a set of instructions on how and when to apply both, might just indicate that definitive answers to these questions are around the corner.

Control of Blood Vessel Physiology to Treat Skin Disorders

In a method for treating an affected skin region of a patient having a skin disorder, a vasodilation composition is applied to an affected skin region of a patient, the affected skin region exhibiting a skin disorder characterized by at least one abnormal blood vessel, and the affected skin region is then treated so as to non-invasively disrupt tissue architecture, e.g., by inducing ischemia, of the at least one abnormal blood vessel.

A vasoconstriction composition can then be applied to the skin region to cause vasoconstriction of the at least one blood vessel in order to promote healing. [Full PDF]

Biochemics’ rationale for the use of the vasodilator is that it makes vessels easier to target and more susceptible to irreversible damage. The vasoconstrictor is applied to render vessel collapse and shrinkage more likely. Biochemics are collaborating with the laser manufacturer Cynosure and they have already conducted a trial of sorts.

There is an OTC company, Bioscriptives who has entered this arena and is making a killing. I spoke to the owner who has followed my work for several years and my posts on preflushing stimulated the production of this unique product.

www.bioscriptives.com

Pre VAS-ex by Bioscriptives

Enhances laser or light sources performance in targeting abnormal blood vessels by preflushing blood vessels and increasing the oxygenated hemoglobin.

Improve phototherapy performance in reducing facial redness
Bio-Scriptives Pre VAS-ex has been scientifically formulated as a pre-treatment for laser and light therapy procedures to reduce facial redness and is only available through a skin care professional.

The Pre VAS-ex skin care product utilizes Derma-Release technology to penetrate a unique natural extract and amino acid combination through the skin barrier. Pre VAS-ex dilates the targeted blood vessels during phototherapy treatments, making the blood vessels better targets for the light source. Pre VAS-ex can increase the percentage of blood vessels targeted resulting in better treatment outcomes.

Benefits of Pre VAS-ex

In clinical trials we have shown a 67% average increase in redness reduction performance. (Results may vary between 20% to 90%.)
Even a minor (20%) reduction will benefit patients by further reducing the
roseatic induced blood vessel dilation and flushing
After each photo therapy treatment the reduction will increase and will become even more visually noticeable.

Allows light sources to target abnormal blood vessels more effectively
Treats smaller blood vessels reducing rosacea symptoms between treatments
Enhances collagen and skin tightening benefits of photo facials
Improves patient compliance to phototherapy with faster and improved results

More information about Pre VAS-ex
Learn how VAS-ex works
See before and after photos
View Ingredients
Browse frequently asked questions
Read the protocol for VAS-ex
Review the indications for VAS-ex

Post VAS-ex

Unique vasoconstrictive formulation enhances laser or light source performance - reduces facial redness.

Optimize results of phototherapy in reducing facial redness
Bio-Scriptives Post VAS-ex is a lightweight formulation with self-stimulating moisturizers designed to optimize the long-term results of laser or light treatments for reducing facial redness. Post VAS-ex assists the body’s natural process of shrinking abnormal blood vessels and reducing facial redness with a proprietary formulation of anti-inflammatory and vasoconstrictive natural extracts and proven patented compounds. For best results, use Pre VAS-ex prior to phototherapy procedures and Post VAS-ex twice daily following treatment.

Benefits of Post VAS-ex

In clinical trials we have shown a 67% average increase in redness reduction performance. (Results may vary between 20% to 90%.)
Even a minor (20%) reduction will benefit patients by further reducing the roseatic induced blood vessel dilation and flushing.
With continued use of Post VAS-ex and with each photo therapy treatment the reduction will increase and will become more visually noticeable.
Reduces post procedure bruising, swelling, and tenderness
Minimizes painful and visual symptoms of rosacea
Helps prevent vessels from becoming visible in the future with continued use
Soothes and protects skin without clogging pores

More information about Post VAS-ex
Learn how Post VAS-ex works
See before and after photos
View Ingredients
Browse frequently asked question
Read the protocol for Post VAS-ex
Review the indications for Post VAS-ex

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