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New Patient Care Options

Friday, October 23, 2009

The National Rosacea Society (NRS) has published new standard patient care options for rosacea, developed by a consensus committee and review panel of 26 rosacea experts, and articles on the various options for controlling the many potential aspects of this widespread disorder will appear in future issues of Rosacea Review.¹

"Because the full effects of rosacea tend to vary significantly from one patient to another, medical therapy and other elements of care must be tailored by physicians for each individual case for optimal results," said Dr. Richard Odom, professor of dermatology at the University of California – San Francisco, who chaired the expert committee. "The new standard options should serve as a significant tool in helping doctors provide the best possible outcomes for their rosacea patients."

The new system for managing the disorder builds off of the standard classification and grading systems, previously developed and published by the NRS consensus committee, which identified the four subtypes of rosacea. These include subtype 1 (erythematotelangiectatic) rosacea, characterized by flushing, redness and often visible blood vessels; subtype 2 (papulopustular) rosacea, including bumps and pimples; subtype 3 (phymatous) rosacea, including skin thickening, commonly of the nose; and subtype 4 (ocular) rosacea, involving irritation of the eyes.

"Patients often experience more than one subtype at the same time, and that's one of the reasons good patient-doctor communication can be so important," Dr. Odom said. He noted that the new system begins by advising health professionals to ask patients about possible features of the disorder that might not be visibly evident at the time of their visit.

For example, anyone who has significant flushing should be sure they inform their dermatologist, including how and when it occurs. Patients should also be sure to tell their doctor if they have had long-term extensive sun exposure in their job or lifestyle, as this may lead to redness and visible blood vessels from sun damage.

Beyond its facial symptoms, rosacea can also affect the eyes in some patients, and it may be especially important to note any eye discomfort, such as irritation, burning or stinging, or if the eyes tend to be watery or bloodshot. Although eye symptoms are often mild, in more severe cases they may require treatment by an eye specialist.

Also let your doctor know about any facial burning, stinging or itching, as these factors may then be addressed for your individual case. In addition, because of its effect on personal appearance, remember to be open about the impact rosacea has on your professional or social life, as well as your emotional well-being, in order to help determine the appropriate level of care.

"A wide range of measures are available for managing this potentially complex disorder," Dr. Odom said. "Along with appropriate use of oral or topical therapy, these can include lifestyle changes, surgical procedures such as laser therapy if needed, eye care when called for, proper skin care and effective use of cosmetics."

Reference
1. Odom R, Dahl M, Dover J, Draelos Z, Drake L, Macsai M, Powell F, Thiboutot D, Webster GF, Wilkin J. Standard management options for rosacea, part 1: Overview and broad spectrum of care. Cutis 2009;84:43-47.

Rosacea Research Update

Thursday, October 1, 2009

Results of research funded by donations from members of the National Rosacea Society (NRS) are not only increasing medical understanding of the disorder, but are now revealing potential causes that may lead scientists toward important new advances in therapy.

"Studies funded by the NRS research grants program are making an invaluable contribution in identifying the biological mechanisms that may be involved in rosacea, and how future medical therapies might be targeted to bring significant advances in its treatment, prevention or cure," said Dr. Jonathan Wilkin, chairman of the NRS Medical Advisory Board. He noted that further scientific investigations are now under way that may finally unlock the mysteries of this highly prevalent and often baffling disorder.

In a much-heralded study reported in Nature Medicine, widely considered the leading journal on biomedical science, a team led by Dr. Richard Gallo at the University of California-San Diego found a consistently aberrant innate immune response in individuals with rosacea to environmental and emotional triggers. When the normal immune system is faced with any of a broad range of potential dangers -- such as emotional stress, heat or spicy foods -- receptors recognize the potential harm and protect the body by prompting the production of protective molecules known as cathelicidins to neutralize any effects.

Using advanced technology to analyze the biochemical composition of proteins in rosacea patients, the researchers discovered that in rosacea patients, the forms of cathelicidins are different, due to an overabundance of another substance called kallikrein, which can spur dormant cathelicidins into action and lead to skin inflammation. They recently completed the picture when they were able to demonstrate that this process is linked to the actual formation of rosacea signs and symptoms, and are now conducting further NRS-funded research on its implications.

In addition, two new studies building off of this research have been funded by the NRS and are now under way. Dr. Curdin Conrad at the MD Anderson Cancer Center in Houston and Dr. Alexander Navarini at University Hospital of Zurich, Switzerland, are examining the body's immunological process to see whether type I interferon, which can help fight viral infections, and plasmacytoid dendritic cells, which produce interferon, are also present in rosacea. Dr. Joseph Rothnagel and Dr. Manuela Trabi at the University of Queensland, Australia, have noted the involvement of enzymes in Dr. Gallo's work, and are now studying whether other enzymes may also be elevated in rosacea.

Meanwhile, Dr. Martin Steinhoff and Dr. Thomas Luger, Department of Dermatology, University of Muenster in Germany, discovered a biological process involving substances known as proteases that may link flushing with inflammation. The researchers then conducted further investigations to define which proteases may be involved in the inflammatory responses as well as the stinging, burning and itching of rosacea. As part of their research, they recently found that endothelin-converting enzyme (ECE) plays a role, and noted that any substance that inhibits ECE may be effective in the treatment of rosacea.

In other NRS-funded studies, Dr. Robert Walters and Dr. Robert Lefkowitz at Duke University are now investigating the roles of G and beta-arrestin proteins in the flushing triggered by niacin (vitamin B3), a common rosacea trigger, and Dr. Yolanda Helfrich at the University of Michigan is comparing differences between subtype 1 rosacea and the effects of sun exposure.

In a completed study in Ireland, Dr. Noreen Lacey and Dr. Kevin Kavanagh reported that the presence of Bacillus oleronius, found on Demodex mites, produced an immune reaction in rosacea patients but not individuals without rosacea. Demodex are a normal inhabitant of facial skin but are generally present in much greater numbers in rosacea patients.

Reports on completed research can be found here, and summaries of awarded research grants can be seen here.