Rosacea -- Hot Topics by Dr. Geoffrey Nase:
Rosacea Treatments, Rosacea Research & Rosacea Advice
Geoffrey Nase

Better Laser Treatments with Vitamin K Supplements, Medications or Injections.

Disclaimer:  The information below is not medical advice and should only be read for informational purposes.  This information has been discussed multiple times over the last 12 months at Laser Symposiums and in Medical Laser Articles.  There are a few anecdotal cases, but It is still primarily theoretical in nature.

How to Ensure the Most Effective Laser Treatment for Rosacea Redness & Flushing?

Two things are needed:

1. The laser must be able to treat the top, middle and bottom portion of blood vessels.  If any portion of the vessel is left intact, it will regrow and become hyper-reactive from the laser “insult”.
    
2. The body must be able to clot normally.  A decrease in clotting will allow vessels that are on the brink of dying to remain intact.  Conversely, a strong clotting ability will ensure the vessels’ death even if laser treatment is incomplete because that vessel will clot and not allow oxygen or nutrients to assist recovery.

Why do Rosacea Sufferers Need to Know this Information?

1. Multiple drugs or stomach disturbances decrease Vitamin K levels and thus alter the ability to clot.  In particular, any rosacea sufferer that has been on antibiotics for more than one month (e.g. most rosacea sufferers) have significantly altered their ability to clot by interfering with Vitamin K produced by intestinal bacteria.
    
2. Other drugs and herbs that decrease Vitamin K:

Salicylates (aspirin): High doses may increase vitamin K requirements.

 

Antacids: Sucralfate or high doses of aluminum hydroxide antacids may decrease absorption of fat-soluble vitamins such as vitamin K.

 

Cholestyramine (Questran), mineral oil: May decrease absorption of oral vitamin K and increase vitamin k requirements.

 

Quinine, Quinidine: May increase vitamin K requirements.

  

Basic Information about Vitamin K:

Forms of vitamin K: The name "Vitamin K" refers to a group of chemically similar fat-soluble compounds called naphthoquinones. Vitamin K1 (phytonadione) is the natural form of vitamin K, which is found in plants and  Vitamin K2 compounds (menaquinones) are made by bacteria in the human gut.

 Vitamin K1 is commercially manufactured for medicinal use under several brand names (Phylloquinone, Phytonadione, AquaMEPHYTON, Mephyton, Konakion). A water-soluble preparation is available for adults only as vitamin K3 (menadione).

Natural sources: Vitamin K is found in green leafy vegetables like spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Cooking does not remove significant amounts of vitamin K from these foods. People who eat a balanced diet including these foods are likely ingesting enough vitamin K and do not require supplementation.

Blood clotting: Vitamin K is necessary for normal clotting of blood in humans. Specifically, vitamin K is required for the liver to make factors that are necessary for blood to properly clot (coagulate), including factor II (prothrombin), factor VII (proconvertin), factor IX (thromboplastin component), and factor X (Stuart factor).

Does Vitamin K supplementation, oral medications or intramuscular injections help laser treatment?

In those rosacea sufferers that are taking antibiotics, Vitamin K supplementation should significantly increase the effectiveness of laser treatments because after a couple of months on antibiotics Vitamin K blood levels fall off the chart.  Some forms of supplementation include:

1. Increase in natural foods high in Vitamin K
   
   
2. Top-of-the-line bioavailable Vitamin K supplements
    
3. Intramuscular injections of Vitamin K 24 hours prior to laser treatment
    
4. Use of oral prescription Vitamin K Tablets like Mephyton

TABLETS

MEPHYTON®

(PHYTONADIONE)

Vitamin K1

DESCRIPTION

MEPHYTON* (Phytonadione) tablets containing 5 mg of phytonadione are yellow, compressed tablets, scored on one side. Inactive ingredients are acacia, calcium phosphate, colloidal silicon dioxide, lactose, magnesium stearate, starch, and talc.

MEPHYTON tablets possess the same type and degree of activity as does naturally-occurringvitamin K, which is necessary for the production via the liver of active prothrombin (factor II), proconvertin(factor VII), plasma thromboplastin component (factor IX), and Stuart factor (factor X).

MEPHYTON tablets generally exert their effect within 6 to 10 hours.A dosage of 2.5 to 25 mg or more (rarely up to 50 mg) is recommended, the amount and route of administration depending upon the severity of the condition and response obtained. The oral route should be avoided when the clinical disorder would prevent proper absorption.

Merck and Co.

What should Rosacea Sufferers on Antibiotics do to Evaluate their Clotting Ability?

First, evaluate simple signs:  Do they bleed easily to minor cuts, do they bleed for extensive amounts of time, do they bruise easily, etc.

Second, you can get an inexpensive test performed to evaluate Vitamin K1 levels by a hospital or laboratory.  For example:

ARUP's Laboratory Test Directory

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Top Nutraceuticals for Rosacea: Alpha Lipoic Acid

Rosacea sufferers have many nutraceuticals to choose from to help reduce rosacea symptoms and triggers.  Nutraceuticals are supplements, vitamins and minerals that have a strong biological action in the body by reducing inflammation or other pathological processes.

Alpha Lipoic Acid has two methods by which they may reduce rosacea inflammation:

1.  It significantly reduces Cellular Adhesion Molecules (ICAMs) which build up in rosacea blood vessels.  Cellular Adhesion Molecules cause dilation of blood vessels, skin flushing, and act as “gateways” through which blood vessels become leaky and allow inflammatory neutrophils into the epidermis (refer to medical article "Rosacea is a Neutrophilic Dermatose" by Dr. Millikan).  This in turn causes rosacea papules.  Below is a simplified illustration of skin inflammation caused by Cellular Adhesion Molecules (this is analagous to inflammation that occurs in blood vessels in atherosclerosis). 

1. Dilation of blood vessels
2. Skin Flushing
3. Adhesion of Molecules
4. Leakage of leukocytes and neutrophils through blood vessel wall -- papule develops
5. Blood vessels maintain weakened, leaky and dilated state

Copyright Permission 2006

Recent studies in animals and humans have demonstrated that treatment of inflamed blood vessels coated with cellular adhesion molecules (ICAMs and VCAMS) with Alpha Lipoic Acid can completely clear the blood vessels of these inflammatory substances, stop the migration of neutrophils to the skin’s surface, and strengthen leaky blood vessels.  These findings are exciting because this demonstrates that a neutraceutical can indeed have positive actions on disorders of blood vessels and skin papules.  Based on these findings, alpha lipoic supplementation (in fast dissolving capsules) should be placed near the top of the list of supplements for rosacea sufferers.  The dose treatment ranges from 100 mgs twice a day to 300 mgs twice a day depending on the severity of inflammation.  Below are the studies that demonstrate alpha lipoic acid’s positive actions listed above:

1.  The Role of Alpha Lipoic Acid in Inflammation

 Linus Pauling Institute of Antioxidant Research

Weijian Zhang, M.D., Ph.D.
LPI Assistant Professor (Sr. Res.)

http://lpi.oregonstate.edu/ss03/lipoicacid.html

 

 

2.  Alpha lipoic acid inhibits human T-cell migration

 Alternative Medicine Review,  Dec, 2004  

J Neurosci Res 2004;78:362-370.

GH, McKeon GR Marquardt WE

 

3.  Alpha-lipoic acid reduces expression of vascular cell adhesion molecule-1 and endothelial adhesion of human monocytes after stimulation with advanced glycation end products.

  Department of Endocrinology, Langenbeckstr. 1, University of Mainz, 55131 Mainz, Germany.

 

2.  It significantly reduces dilation associated with ingestion of meals and “glucose spikes” which induce flushing and inflammation.  When taken at the beginning of a meal, Alpha Lipoic Acid reduces whole body flushing because it aids in immediate delivery of glucose into cells and reduces glucose-induced skin inflammation because glucose levels are significantly decreased (e.g. they are taken out of the blood stream and blood vessels and delivered into cells)

1.  Development of a sustained release dosage form for alpha-lipoic acid. II. Evaluation in human volunteers.

 Drug Dev Ind Pharm. 2004 Jan;30(1):35-42.

 Institute of Pharmacy, Department of Pharmaceutical Technology, Leopold-Franzens-University Innsbruck, Innsbruck, Austria.

 

 

2.  Effects of dietary lipoic acid on plasma lipid, in vivo insulin sensitivity, metabolic response to corticosterone and in vitro lipolysis

Br J Nutr. 2006 Jun;95(6):1094-101.  

Department of Bioproduction, Akita Prefectural College of Agriculture, Ohgata

 

 

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Melanotan II: Updates, Photos and Potential Treatment for Rosacea in the Near Future

Five years ago an intriguing substance called Melanotan came to my attention via a colleague at the University of Arizona School of Medicine.  They were studying a Melanin Stimulating Hormone for the treatment of photosensitive skin disorders and prevention of skin cancer.  In pilot studies on Lupus Erythematosus patients with central facial redness (the classic butterfly mask), Melanotan significantly reduced facial redness via camouflauge tan color and unknown anti-inflammatory actions of melanin.  Most of these same patients did not burn to mild doses of UVA and UVB exposure.  The results were excellent with few transient side effects.

Melanotan I:  Epidermal Thickening Agent  

For 3 years studies on Melanotan I were primarily conducted at:

1. The University of Arizona School of Medicine Cancer Center
2. The University of Arizona School of Medicine Department of Dermatology
3. The Mayo Clinic at Scottsdale Arizona

One of the most interesting findings demonstrated that after 3 months of treatment with Melanotan I, epidermal thickness increased significantly in all subjects.  Histological studies on superficial biopsies and in vivo confocal microscopy demonstrated an increase in thickness from 107% (double the thickness) to 304%.  This is noteworthy because the average thickness of the epidermis in facial skin is approximately 0.8 mm (15 sheets of paper in a pile).  In rosacea sufferers the epidermis can be half that of normal subjects; thus doubling or tripling the thicknesss of the epidermis should be extremely beneficial to rosacea sufferers.

Melanotan II:  All Studies Indicate that this Polypeptide will benefit Rosacea Patients

Melanotan progressed into Melanotan II and was then sold to an Australian based company (Epitan) and a US based drug delivery manufacturer (Clinuvel).  It has passed multiple phase iII studies and is tentatively set for release in mid-2008.  This will be utilized by many rosacea sufferers as it  thickens the epidermis considerably (up to 300%), and has an anti-inflammatory effect throughout the epidermis and top portion of the dermis.  Furthermore, it protects blood vessels and pain nerves via a much stronger and thicker epidermis -- this will lessen rosacea symptoms and triggers (Reference: " Papulosquamous skin dermatoses on dark skin" Hautarzt. 2002 Feb;53(2):126-9).

Melanotan II: Camouflauges Rosacea Symptoms

The cosmetic advantage will also play a role as it can hide a moderate flush underneath a medium to dark tan (Reference: "Skin of color may occlude rosacea's classic, clinical signs"  Dermatologic Therapy March 1, 2005 ).  This works in all types of skin down to the most porcelain white skin.  As long as you have melanin it will make a substantial change in skin color. 

New Insight into Melanotan II: Anti-inflammatory action and Antifibrogenic action

Rosacea is known to involve an inflammatory response via neutrophilic action.  Rosacea also causes fibrosis in the dermis.  Both of these negative actions are reversed while on Melanotan II:

J Invest Dermatol. 2006 Sep;126(9):1966-75

The melanocortin (MC) system is probably the best characterized neuropeptide network of the skin. Most cutaneous cell types express MC receptors (MC-Rs) and synthesize MCs, such as alpha-melanocyte-stimulating hormone (alpha-MSH), that act in autocrine and paracrine fashion.

The anti-inflammatory activity of alpha-MSH includes immunomodulatory effects on several resident skin cells and antifibrogenic effects mediated via MC-1R expressed by dermal fibroblasts.

Melanin Production and Rosacea:

One of the facial skin's main defensive mechanism is activated upon exposure to sunlight -- melanocytes produce melanin.  The melanin fortifies every layer of the epidermis and stimulates at least two known anti-inflammatory substances.  Production of melanin thickens the epidermis, absorbs light rays from the sun and absorbs heat from the external environment.  Thus rosacea blood vessels and inflammed nerves will not "see" multiple insults as the epidermis will repel or absorb rosacea triggers.  It is germane to note that rosacea sufferers are often caught in a catch 22 because they are told to avoid the sun and wear sunscreen (wise advice) .............. but, this results in a thinner, weaker epidermis.  Melanotan II holds the potential to help fortify our main barrier, the stratum corneum, to many insults such as sun, heat, wind, cold and skin care products.

I have included two photos of a person using Melanotan II below:

Before Melanotan II Treatment -- Light Skin, Type II

After 16 days of Melanotan II Treatment: This Photo was taken 2 months after the final treatment.  This person did not tan during the 2 months post treatment demonstrating the long acting effect of Melanotan II on Melanin production.

Now this gentleman was treated with the highest dose and thus is quite tan.  With Melanotan II you can choose to induce a light, medium or dark tan by changing the dose. A word of caution should be noted right now -- please wait until the FDA approved version of Melanotan II is available.

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Clinical Treatment for Rosacea Redness and Flushing is about to Commence.  Biotechnology Firm that Specializes in Diseases of Vascular Dysfuncion and Vasculopathy takes Rosacea Head on! 

I have been in contact with the Research & Development Director and the CEO of a Biotechnology Firm that is going to commence clinical studies on a topical treatment that has been shown to stabilize hyperreactive blood vessels via G-Protein antagonism -- red blotches in skin disappear, active skin flushing is halted, and inflammation in the skin is reduced.  We have been communicating for 2.5 months now -- I have been following their work for almost 2 years now.  This is the first real promise for remission of the elusive rosacea redness and flushing subtypes.  Please remember this term -- "Biologic Response Modifiers" because they are the future of dermatology and have the potential to clear rosacea symptoms and triggers........ putting rosacea sufferers into remission.  It should be stressed that this is not a cure, because a cure must address the genetics behind the disorder, but it is the next best thing -- no symptoms, very few triggers (if any), and complete remission while on a monthly or quarterly treatment plan.  In addition, G-Protein antagonism is very specific and thus minimizes the chance for side effects. 

Publication in Dermatology Times Article on G-Protein Biologic Response Modifiers

I published a Dermatology Times article on this future treatment in April 2005 (refer to New Rosacea Treatments Offer Hope to Rosacea Sufferers; Dermatology Times, April 1, 2005: http://drnase.com/articles_future_treatments.htm) 

Below is an excerpt from that article on G-Protein Biologic Response Modifiers:

"Several biotechnology and pharmaceutical companies are racing to develop the first topical biologic response modifier for skin redness and flushing. Three of the most exciting agents that show great promise in preliminary studies are focused on normalizing dysfunctional smooth muscle cells in blood vessels of rosacea skin.

These include selective agonists of kinase enzymes in the smooth muscle wall, intercellular gap junction blockers that stop conducted dilation, and uncoupling G-proteins to prevent countless dilator triggers from reaching the intercellular Ca++ stores in smooth muscle cells of rosacea blood vessels."

This can now be accomplished via sonophoresis followed by iontophoresis of these selective irreversible blockers.

When the Biotechnology company can release information about the study, I will be conducting an extensive interview and publishing it in "The Journal of Investigative Dermatology.  I will also place part of the interview on this site under a revamped Clinical Trials section here.

G-Protein Biologic Response Modifiers for Rosacea

This has already been shown to be effective in flushing disorders of the skin, disorders of weakened blood vessels that burst and form shunts (like rosacea), and Vasculopathy disorders.  Initial pilot studies on 12 rosacea sufferers resulted in 95% reduction in facial redness and flushing episodes decreased from an average of 17.5 times a day to 0 times per day (could not be visibly noticed by clinicians nor felt by patients).  Furthermore, topical application of irritants (retin A and glycolic acid) produced no visible redness in 11 of the 12 subjects, and heated environments (90 degrees Farenheit for 30 minutes) produced no visible redness in all subjects. I was present for several of these tests during recent interviews with the company.  This is by far the most exciting treatment for rosacea.  BTW, it is not related in any way to SansRosa.

Most Likely Methods for Topical Application of G-Protein Modifiers

While it is much too early to predict, the specialists have pointed out the two most obvious choices for treatment of rosacea:

1. Multipronged Fine Needle Automated Microinjectors -- These are painless and can treat the entire facial area in approximately 20 minutes (Harvard Apparatus Multi-Pronged Automated Microinjector).  The conservative guestimate on treatments would be one treatment every 5 to 6 months.
   
2. Sonophoresis followed by Iontophoresis -- Sonophoresis opens up intracellular gaps so larger molecules can then be driven into the blood vessels via painless iontophoresis.  Similar treatment frames would apply.

G-Protein Biologic Response Modifiers for Vascular and Neural Disorders are Already Available

While this is a different company, it clearly shows that oral and topical G-Protein Biologic Response Modifiers are already approved orally and topically by the FDA.  Predix, based in Lexington, MA, is a pharmaceutical company focused on the discovery and development of novel, highly selective, small-molecule drugs that target G-Protein Coupled Receptors (GPCRs) and ion channels. Using its proprietary drug discovery technology and approach, Predix has advanced three internally discovered drug candidates into clinical trials and has six additional programs in preclinical development and discovery. Predix is expected to complete the first of at least two pivotal Phase III clinical trials for generalized anxiety disorder for its lead drug candidate, PRX-00023, in the second half of 2006. Predix has two other clinical-stage drug candidates: PRX-03140 for the treatment of Alzheimer's disease, which is expected to enter Phase IIa later this year; and PRX-08066 for the treatment of pulmonary hypertension (PH), which recently completed a Phase Ib trial and is expected to enter Phase IIa in mid-2006. Additional information about Predix can be found on the company's website at www.predixpharm.com.

Blocking One G-Protein Family is the Best Approach to Rosacea Remission

Journal of Investigative Dermatology (2006) 126, 1937–1947.

Neuropeptide Control Mechanisms in Cutaneous Biology: Physiological and Clinical Significance

The approach is simple.  Instead of developing dozens of drugs to treat rosacea, just focus on the main G-Protein that allows blood vessels to dilate and cause neural and immune-mediated inflammation.  This is called "uncoupling" the receptor so that the signal never reaches the blood vessel.  G-Protein Biologic Response Modifiers address the myriad of inflammatory disorders detailed below in this excellent article abstract.

The skin as a barrier and immune organ is exposed to omnipresent environmental challenges such as irradiation or chemical and biologic hazards. Neuropeptides released from cutaneous nerves or skin and immune cells in response to noxious stimuli are mandatory for a fine-tuned regulation of cutaneous immune responses and tissue maintenance and repair. They initialize host immune responses, but are equally important for counter regulation of proinflammatory events. Interaction of the nervous and immune systems occurs both locally – at the level of neurogenic inflammation and immunocyte activation – and centrally – by controlling inflammatory pathways such as mononuclear activation or lymphocyte cytokine secretion. Consequently, a deregulated neurogenic immune control results in disease manifestation and frequently accompanies chronic development of cutaneous disorders. The current understanding, therapeutic options, and open questions of the role that neuropeptides such as substance P, calcitonin gene-related peptide, vasoactive intestinal peptide/pituitary adenylate cyclase-activating polypeptide, neuropeptide Y, or others play in these events are discussed. Progress in this field will likely result in novel therapies for the management of diseases characterized by deregulated inflammation, tissue remodeling, angiogenesis, and neoplasm.

G Protein Mediates Nicotinic Acid and Niacin-Induced Facial Flushing and Facial Burning

J. Clin. Invest. 115:3634-3640 (2005). doi:10.1172/JCI23626.
 

GPR109A (PUMA-G/HM74A) mediates nicotinic acid–induced flushing

Zoltán Benyó1, Andreas Gille1, Jukka Kero1, Marion Csiky1, Marie Catherine Suchánková1, Rolf M. Nüsing2, Alexandra Moers1, Klaus Pfeffer3 and Stefan Offermanns1

“The major unwanted effect of nicotinic acid when given at pharmacologically active doses is flushing. Although harmless, this side effect limits patient compliance. Nicotinic acid–induced flushing can be observed even at relatively low doses (50–100 mg per os) and consists of a cutaneous vasodilation accompanied by a burning sensation mainly affecting the upper body and face (12, 13).”

“Recently, a G-protein–coupled receptor for nicotinic acid termed GPR109A (HM74A in humans and PUMA-G in mice) has been identified (22-24) and been linked to facial flushing and burning sensations.”

G-Protein Biologic Response Modifier Treatment Holds Strong Potential to Reduce and Even Inhibit Facial Blushing

In addition to Rosacea flushing, G-Protein anatagonism of vascular smooth muscle walls in facial blood vessels holds the potential to stop the neural blushing signal from the brain.  In effect, it is like cutting the telephone line to your phone.  The brain makes a blushing "phone call" to your facial skin, but the line is severed, so it never receives the message.  This is done by selectively altering the influx of Calcium ions into blood vessel walls.  This has not been tested yet by the Biotechnology Company, but will be tested according to the Research Spokesman.  "Blushing is a very strong neural dilatory signal, but our excellent results in pilot studies on rosacea flushing coupled with the theoretical pathophysiology indicate that it should be quite beneficial to those people who blush frequently or intensely".  It will be interesting to see how effective this treatment will be on facial blushing.

Calbiochem Enters Race for G-Protein Testing and Human Research: G Protein Antagonists -- Biological Response Modifiers by Calbiochem

	GP Antagonist-2A Calbiochem	Quantity: 1 mg Type: G Protein antagonist
	Guanosine 5′-O-(2-Thiodiphosphate), Trilithium Salt Calbiochem	Quantity: 20 mg Type: G Protein antagonist
	Isotetrandrine Calbiochem	Quantity: 1 mg Type: G Protein antagonist
	NF007 Calbiochem	Quantity: 10 mg Type: G Protein antagonist
	NF023 Calbiochem	Quantity: 10 mg Type: G Protein antagonist
	Suramin, Sodium Salt Calbiochem	Quantity: 50 mg Type: G Protein antagonist
	Suramin, Sodium Salt Calbiochem	Quantity: 200 mg Type: G Protein antagonist

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Patent by Dr. Bitter, Sr. and Dr. Nase for Treating Rosacea Redness, Papules and Increasing the Effectiveness of Laser Treatment through Use of Topical Phenylephrine

Dr. Patrick Bitter Sr. and I have been working on a mild topical constrictor over the past two years for rosacea treatment.  This dermatologic invention was developed through the study of the receptors on facial blood vessels and the selectivity of phenylephrine for one receptor subtype.  Through Microvascular Physiology techniques we found that phenyleprhine can constrict skin blood vessels by 20% to 35%.  This is strong enough to induce a physical change, but is not so strong as to result in rebound flushing.  That was the key.  I continue to test it in the biomedical arena and Dr. Bitter still tests it out on certain patients.  The tested and proposed uses are:

1.  Phenylephrine injected Silicone pads for rosacea redness and papules:  Overnight treatment of rosacea redness and papules through slow diffusion of phenylephrine on to resistant areas of rosacea.  The complete effect of this treatment is usually noted within 24 hours.

2.  Phenylephrine treatment post laser:  Phenlyephrine added to a soothing lotion base can be used post laser to ensure constriction of treated blood vessels and ensure a much better treatment outcome.  This lotion can be used for up to three days post treatment.

The results were positive enough to develop this product and patent it.  The most likely avenue is for a biotech or pharmaceutical company to pick up the rights and perform all the necessary Research and Development to get it to the market.

*Please note that the Patent Application that is listed online is incomplete -- it only printed one inventor in error.  Below is the proper application with both inventors listed.  Dr. Patrick Bitter Sr. is correcting this and it should be in the final format on the United States Patent and online Patent information with both inventors listed very soon. 

Topical phenyl-epinephrine Rosacea treatment

Abstract

A near-permanent skin treatment includes photothermolysis of reddened facial skin to induce ischemia. Reperfusion of the photothermolysis treated skin is inhibited by following with regular applications of phenyl-epinephrine carried in a lotion until vascular necrosis is complete. Alternatively, a temporary treatment for reddened facial skin includes only cosmetic as-needed applications of phenyl-epinephrine carried in lotion to induce vasoconstriction in Rosacea and other similarly embarrassing skin disorders.

Below is the link to the full patent:

Topical phenyl-epinephrine for Rosacea treatment

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Reducing Ocular Rosacea via Proper Laser Treatment of the Nose -- Treating Arterial Branches that Supply the Eyelids and Ocular Surface

Laser physicians who perform rosacea treatments and have a thorough understanding of the nose and eye blood vessels are finding that they can significantly reduce ocular rosacea symptoms by treating arterial branches that supply the eyelids and ocular surface.  By reducing the number of blood vessels and blood flow via laser removal, inflammation decreases, immune cells normalize, and skin is able to repair itself through natural enzymatic processes. 

As you can see below in the diagram, the Angular Artery that runs vertically up the nose supplies most of the blood to the eyelids and eye surface via 3 to 6 branches from the main artery; the overly simplistic diagram does not show the multiple branches extending into the eyelid area (refer to the second diagram for more detail).  In addition, at the bottom of the eye socket, more angular arteries can be found.  By removing some of these arteries physicians can reduce inflammation of the eyelids and ocular surface, as well as help normalize meibomian glands in the eye.

Important Note:  Many of the goggles used by patients cover up the most important Angular Artery target-site near the bridge of the nose.  For best treatment, eye goggles that have a high bridge along the eyebrow line should be used to shield the eye (or individual goggles that stay attached via slight suction) and the smallest laser treatment crystal should be used for targetting blood vessels in the tight crevices of the nose and inner cheeks.

Reprinted with Copyright Permission 2006

As you can see below in the illustration of the outer eyelid,  the Angular Artery branches on the right side (# 3 and # 12) supplying most of the blood to these important rosacea-affected areas.  Many of the top laser physicians now treat these areas quite effectively.  In addition, Ocular Physicians who specialize in treating diabetic retinopathy now have the correct lasers and the expertise to treat these areas with great success.

Reprinted with Copyright Permission 2006

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