Pneumatic Skin Flattening uses a vacuum to compress the skin underneath the area being treated. Blood is eliminated from the treatment area. The technique is said to block pain naturally. One more more technical explanation for this effect is “The rational for applying negative pressure is the well-documented afferent inhibition of sensory nerves in the dorsal horn by activating tactile pressure nerves in a sufficiently large surrounding area.”

Note that this study relates to a treatment not directly related to the sorts of treatment regimes that are commonly associated with rosacea. Nonetheless any technique that reduces the pain of laser treatments is good news for rosacea sufferers.

Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening, Lasers Med Sci. 2009 Jul;24(4):617-20, Lanigan S, Birmingham Skin Centre, City Hospital, Birmingham, UK.

The treatment of vascular lesions, including port wine stains (PWSs), with a pulsed dye laser is very painful and often requires general anaesthesia. This is particularly problematic with children.

Pneumatic skin flattening (PSF) is a new technology that naturally reduces pain in laser-based aesthetic treatments. The objective of this study was to test pain reduction, as well as lesional clearance, by combining pneumatic skin flattening (PSF) technology with a pulsed dye laser in the treatment of vascular lesions.

Twenty-one patients (three of them children) were treated for vascular lesions, mostly PWSs (13 patients). The patients were treated with a 595 nm pulsed dye laser operated at energies of 5.75–13.25 (median 9.25) J/cm².

Acute pain was evaluated in all 21 patients. Topical anaesthetic (EMLA cream) was applied before treatment in six cases. Identical energies were applied to both sites. The pain during PSF treatment was compared to pain during regular treatment without PSF. Blanching response to treatment was evaluated in 18 patients after 6–12 weeks.

Significant pain reduction was observed in 21/21 patients (100%). The average reduction in pain score was from 10 without PSF (painful) to 2.6 with PSF (comfortable).

Follow-up examination of 18 patients after 6–12 weeks showed identical blanching of tissue in both the PSF-treated areas and those not treated with PSF in all patients. It was concluded that the PSF technology significantly reduced pain in the treatment of vascular lesions with a pulsed dye laser without affecting efficacy.

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Clinical Trial NCT00945373: Combination Therapy for the Treatment of Rosacea

The purpose of this study is to determine the efficacy of calcium dobesilate in combination with pulsed dye laser for the treatment of rosacea.

Drug: calcium dobesilate 2.5% gel

Procedure: pulsed dye laser

All study patients will be treated with 595 nm PDL (Vbeam, Candela Corp, Wayland, Mass) with an initial test spot using a fluence of 10 J/cm2, 7-mm spot size and 1.5-ms pulse duration. Based on the biologic response of the test area, the fluence will accordingly be adjusted up or down to find a fluence that produces a transient purpuric effect for a few seconds only.

Several studies have shown successful treatment of rosacea-associated telangiectasia and erythema with pulsed dye laser. Moreover, calcium dobesilate (2,5-dihydroxybenzene sulfonate) is a drug that inhibits vascular smooth muscle cell growth and inhibits cellular proliferation. As a synthetic inhibitor of fibroblast growth factor (FGF), calcium dobesilate targets angiogenic growth factors which lead to uncontrolled blood vessel growth. In light of the fact that angiogenesis has been implicated in erythematotelangietatic rosacea, calcium dobesilate will be useful in the treatment of this subtype of rosacea.

Thus, combination treatment with PDL and calcium dobsilate will act in a synergistic manner to reduce the erythema, flushing and telangectasia associated with erythematotelangietatic rosacea.

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Alpine Pharmaceuticals are promoting SinEcch as a natural homeopathic dose of Arnica Montana. I have to say that I am unconvinced by the whole homeopathic story. Can treating `like with like’ really offer provable results ? Their FAQ pages go on to say that for bruising and swelling, a single remedy, Arnica, can be prescribed for everyone, rather than a regime customized for each person.

The herb Arnica Montana is toxic, but the homeopathic doses are not toxic. According to their web site “the smaller doses seen in Homeopathic preparations may exhibit the reverse effect of the larger doses used in herbal medicine. However, even Homeopathic doses may be cumulative over time. Prolonged pre-operative dosing regimens of Arnica Montana, for example, may increase intra-operative bleeding, whereas the single pre-operative dose used in the SinEcch protocol has been reported to increase intra-operative bleeding in only one case out of over 300,000.”

SinEcch is approved by the FDA and is available over the counter. One package is designed to treat one patient for one surgery and consists of 12 capsules.

CHOICE Australia did a review of natural first aid remedies and had this to say about arnica:

Arnica montana is a medicinal herb with a long history of use for treating swelling and bruising resulting from blows, and injuries such as sprains. Arnica flower is commonly available in both herbal and homeopathic preparations.

Clinical evidence for arnica as an effective first aid treatment is lacking, but people with osteoarthritis might want to give it a go.

Another related natural/herbal treatment is the anti-flushing protocol as used by Dr. Soldo between IPL treatments. This protocol uses, amongst other things, either aloe vera gel or Calendula Gel from Califlora.

Paula Begoun, in her article, When Blushing is Not by Choice: Causes and Treatments for Rosacea (web archive link), lists Arnica as something that potentially should be avoided.

Related Product:

We want your help !

Please give us your feedback. Have you ever used Arnica or Calendula as part of your laser or IPL treatments, or even as part of your daily regime ? I’m looking for some good feedback on other naturopathic remedies as well. Please leave a comment below and let us know how you got on.

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Recalcitrant rosacea successfully treated with multiplexed pulsed dye laser.

J Drugs Dermatol. 2007 Aug;6(8):843-5, Larson AA, Goldman MP

There are few treatments that address both papulopustular and telangiectatic components of rosacea. We present a case of rosacea that was unresponsive to treatment with antibiotics. We report the novel use of a new laser technology, the multiplexed laser, for treatment of both papular and telangiectatic rosacea.

The author has kindly sent a copy of the paper, so if you would like to read a copy, let me know. Here is a quote describing the laser used in the report.

Cynergy MultiPlex (Cynosure, Westford, MA) is a new technology combining a long-pulse PDL with a 1064-nm Nd:YAG laser. The 595-nm wavelength targets the yellow absorption peak of oxyhemoglobin. It is thought that the laser also stimulates the ferrous iron (Fe2+) molecule of heme to ferric iron (Fe3+), converting hemoglobin to methemoglobin. Methemoglobin is unable to bind oxygen, and is a greenish-black pigment. The Nd:YAG laser treats this new chromophore more effectively than hemoglobin. Sequential lasering with this combination is thought to be more effective than either laser alone in the treatment of vascular lesions. It not only treats a broader spectrum of vascular lesions at various depths, but also decreases the number of treatments needed.

Disclosure: Dr. Goldman serves as a consultant for Lumenis, Cynosure,
and Dusa Pharmaceuticals but has received no specific funding
for performing treatment or writing this article.

The patient showed a 50% improvement of papules and telangiectasia after one treatment with Cynergy PL. The paper ends by saying that one of the advantages of this combination laser is less need to treat at purpuragenic causing energy levels – i.e. it can offer less downtime compared to other Pulse Dye Laser treatments.

For more information on the laser, see Cynergy Vascular Workstation.

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This paper is stating that even though the latest versions of the Pulse Dye laser don’t produce the same amount of purple/black scabbing as previous versions, it can still produce a lot of redness, swelling and pain. I know that I looked like a koala with a black scabby nose after my pulse dye laser treatment a few years ago. Sadly my treatments didn’t really help my symptoms, but the Pulse Dye Laser has had several technology updates since then.

Clinically Significant Facial Edema After Extensive Treatment With Purpura-Free Pulsed-Dye Laser, Alam M.; Omura N.E.; Dover J.S.; Arndt K.A., Dermatologic Surgery, Volume 29, Number 9, September 2003, pp. 920-924(5)

Background. Long-pulsed pulsed-dye lasers permit treatment of facial erythema and telangiectasia with purpura-free technique, which may be more comfortable for the patient than purpura-inducing treatment. However, there are anecdotal reports of treatment-associated discomfort even when purpura is not elicited.

Objective. To determine whether patients experience clinically significant erythema, edema, and pain after purpura-free treatment with pulsed-dye laser.

Methods. In this prospective, controlled study, subjects included 15 patients who were undergoing purpura-free treatment of diffuse erythema and fine telangiectasia of at least half the facial surface area with purpura-free pulsed-dye, and it included 15 age, gender, and skin-type matched control subjects who were undergoing similar treatments but with the induction of trace to mild purpura. Patients were seen in person and were surveyed by phone regarding symptoms and signs during their postoperative courses.

Results. Postoperative erythema of a mean 3.3-days duration and 3.4/5.0 intensity was reported by 73% (11 of 15) of the purpura-free patients. Among purpura patients, the duration was 5.6 days. The intensity was 4.0, and again, 73% of patients reported this finding. Postoperative edema occurred among 87% of purpura-free patients, but such edema occurred in all of the purpura patients, in whom it lasted longer and was more intense. Symptomatic eye swelling and uncomfortable/painful edema were seen in 27% and 20%, respectively, of purpura-free patients, but in 40% and 53% of purpura patients. Among purpura-free patients receiving fewer than 250 laser pulses per treatment, erythema and edema lasted less than 1 day and 2.5 days, whereas the mean durations were 3.4 and 5.0 days for purpura-free patients receiving greater than 250 pulses.

Conclusion. Extensive purpura-free treatment for erythema and telangiectasia of the face with the long-pulsed pulsed-dye laser can lead to clinically significant erythema, edema, and discomfort in patients. The duration, magnitude, and frequency of these undesired effects are markedly less with purpura-free treatment compared with purpura-inducing treatment and are also less for less extensive purpura-free treatments.

• PubMed Extract
• Abstract Online

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Candela Corporation today announced the introduction of a new Pulsed Dye Laser Platform featuring three new models – the Aesthetica, the Platinum and the Perfecta.Practitioners will now be able to choose from three product configurations to treat patients looking for skin rejuvenation, removal of brown sun spots, leg and facial veins, facial redness, treatment of rosacea and much more

…

This new platform is a continuation of the successful Vbeam® product line. The new lasers feature a sleek, new look, a simplified user interface, can be customized and are fully upgradeable. The Aesthetica provides optimal rejuvenation results for patients looking to remove both vascular (red) and pigmentation (brown) spots on the skin, while the Platinum is ideal for treating patients with a wide variety of vascular (red) lesions. For practitioners looking for one machine that does it all, the Perfecta is designed for rejuvenation, vascular and pigmented lesions.

Faster and more powerful than other pulsed dye lasers, the new Platform allows practitioners to treat stubborn skin conditions more aggressively than before. With the new “Micro-Pulse” design, practitioners can now perform more aggressive treatments producing faster results without bruising that causes unnecessary downtime for patients.

…

• Read the full press release

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Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life., Journal of the American Academy of Dermatology, Volume 51, Issue 4, October 2004, Pages 592-599. Division of Dermatologic Surgery, Indiana University School of Medicine, University of Minnesota

BACKGROUND: Persistent erythema and dysesthetic symptoms are typical manifestations of rosacea.

OBJECTIVE: We sought to assess improvement in erythema, symptoms, and quality of life after pulsed dye laser treatment.

METHODS: Sixteen patients with erythematotelangiectatic rosacea participated. Spectrophotometric erythema measurements were taken from the right and left malar prominence; chin; and nasal alae, dorsum, and tip. A questionnaire rating the Dermatology Life Quality Index and symptoms of flushing, burning, itching, dryness, swelling, and skin sensitivity was completed. Treatment was undertaken with the pulsed dye laser at purpuragenic fluences. Measurements and treatment were repeated at 8-week intervals for a total of two treatments.

RESULTS: A statistically significant improvement was observed in symptoms, quality-of-life score, and erythema in all areas with the exception of erythema of the left nasal ala.

CONCLUSIONS: Pulsed dye laser treatment at purpuragenic fluences is a safe and effective treatment for symptomatic rosacea, resulting in a significant improvement in erythema, symptoms, and quality of life.

• PubMed Abstract
• Abstract Online (purchase article for $30)

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Flashlamp pulsed dye laser (FPDL) did not cure papulopustular rosacea, Laster in Surgery and Medicine, Volume 34, Issue 3 , Pages 266 – 268, Published Online: 5 Mar 2004, Mats Berg, PhD MD, Desiree Wiegleb Edstrom, PhD MD

Keywords: erythematotelangiectatic, flashlamp pulsed dye laser, papulopustular rosacea treatment

Abstract: Pharmacological treatment has a fairly good effect on the papulopustular lesions in rosacea, but not as good an effect on the erythema and telangiectases. The aim was to treat rosacea patients with both erythematotelangiectatic and papulopustular lesions with flashlamp pulsed dye laser (FPDL) until telangiectases/erythema disappeared, and to evaluate whether the treatment might also be effective on papulopustular lesions.

Ten patients were treated on one side of the face with FPDL. The final examination was blinded and performed on the average 10 months after the last treatment.

Two of the patients had more lesions after treatment, three were unchanged, three had only slightly less, and two had markedly less papulopustular lesions.

Our conclusion from this small sample of patients is that FPDL probably has limited value on papulopustular lesions in rosacea. This indicates that the origin of rosacea may not be only vascular.

• Abstract Online

Read more about pulse dye laser.