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Special Care for Summer

Thursday, June 4, 2009

While the sunny days of summer may be associated with outdoor fun, new survey results show that it is also the time when people with rosacea must take the most precautions to prevent flare-ups of this unsightly, red-faced disorder now estimated to affect well over 14 million Americans. For many, the survey also found that even the cold days of winter can present special challenges.

In a recent survey of 1,190 rosacea patients conducted by the National Rosacea Society (NRS) and published in Rosacea Review, 85 percent said their rosacea is affected by changes in seasons. Nearly half said their symptoms are at their worst when hot weather arrives, and 46 percent said they have to make the most lifestyle adjustments during this time to reduce the likelihood of a flare-up of signs and symptoms.

"The sun and hot weather are such common rosacea triggers that it should not be surprising that rosacea is often aggravated in the summer," said Dr. Lisa Maier, assistant professor of dermatology at the University of Michigan. "Everyone should minimize sun exposure and use sunscreen during all seasons, but rosacea patients should be even more cautious than most."

In addition to using sunscreen with an SPF of 15 or higher, rosacea sufferers affected by sun and heat are advised to stay in a cool, air-conditioned environment during midday or when the weather is especially hot. Overexertion is also a common rosacea trigger, and sipping a cold drink or chewing on ice chips can help prevent or reduce the facial flushing that often accompanies strenuous activity.

The survey found that cold weather may be problematic for many rosacea sufferers as well. Thirty-five percent of all respondents and 46 percent of those who live in the North said their symptoms are at their worst during cold weather, when raw wind and biting temperatures can irritate already-sensitive facial skin.

Nearly a third of the survey respondents and 44 percent of those in northern areas of the country said they make lifestyle adjustments to ward off rosacea outbreaks during winter, such as covering their face with a scarf before going outdoors or avoiding facial flushing by steering clear of the piping hot beverages often served on chilly days.

The good news is that rosacea flare-ups can often be successfully prevented. The survey found that, regardless of seasonal changes, 87 percent of the respondents said medical therapy and making lifestyle changes had helped reduce their rosacea signs and symptoms.

"If patients notice that their condition tends to worsen during a certain season, they should be on the alert to take whatever seasonal steps may be needed to avoid their personal triggers," Dr. Maier said. "They should also talk to their dermatologist for further guidance on managing their condition."

Rosacea is a chronic disorder that is often characterized by exacerbations and remissions. It typically begins at any time after age 30 as a flushing or redness on the cheeks, nose, chin or forehead that may come and go. Over time, the redness tends to become ruddier and more persistent, and small blood vessels may appear. Without treatment, bumps and pimples often develop, and in severe cases, the nose may become swollen from excess tissue. In many patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

Although the cause of rosacea is unknown, its signs and symptoms can be controlled with medical therapy and lifestyle changes to avoid factors that may aggravate the condition. The most common rosacea triggers include hot or cold weather, sun exposure, emotional stress, wind, heavy exercise, alcohol, hot baths, spicy foods, humidity, indoor heat, certain skin-care products and heated beverages.

Spring Rosacea Review

Monday, May 11, 2009

The Spring 2009 Rosacea Review is now online. This issue announces the awarding of four new research grants by the National Rosacea Society, plus an article on essential steps to successfully manage rosacea. Also featured are results of the patient survey on seasonal changes as well as study results that linked sunburn and family history to rosacea.

Other features include tips for handling hurtful comments, Q&As on ocular rosacea and the use of steroids, a new success story and a new patient survey on temperature triggers.

Rosacea Awareness Month

Monday, April 6, 2009

As if today's economy were not stressful enough, growing millions of Americans now face the embarrassment of a mysterious red-faced disorder that can wreak havoc on their emotional, social and professional lives. April has been designated as Rosacea Awareness Month by the National Rosacea Society (NRS) to alert the public to the warning signs of this chronic but treatable facial disorder now estimated to affect well over 14 million Americans.

"Whether it's a job interview or simply a social occasion, few things can be more disconcerting for many than developing a red face or blemishes," said Dr. John Wolf, chairman of dermatology at Baylor College of Medicine. "While the initial signs of rosacea may come and go, without proper diagnosis and appropriate medical therapy the disorder can grow progressively more persistent and severe."

Rosacea usually first strikes individuals between the ages of 30 and 60, and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to their cheeks, nose, chin or forehead. Then just when they start to feel concerned, the redness disappears.
Unfortunately, it happens again and again, becoming ruddier and lasting longer each time -- and eventually, visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time, and burning, itching and stinging are common.

In severe cases, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose. In some people the eyes are also affected, feeling irritated and appearing watery or bloodshot. Severe cases of this condition, known as ocular rosacea, can result in reduced visual acuity.

Adding to medical concerns, new study results and other factors suggest that rosacea may be substantially more prevalent than is widely believed. Results of an NRS-funded study, recently presented by Dr. Maeve McAleer and colleagues from Mater Misericordiae University Hospital in Dublin, for example, found that 14.4 percent of 1,000 subjects examined in Ireland had rosacea.

"As a chronic condition characterized by flare-ups and remissions, the prevalence of rosacea may appear to be lower because the signs and symptoms are not present at all times in every individual affected by the disorder," Dr. Wolf said. "As a result, the number of people who suffer from rosacea may be substantially higher than has been traditionally reported."

Beyond its physical effects, rosacea often inflicts significant emotional, social and professional concerns because of its intrusive impact on personal appearance.

Compounding the embarrassment is the common myth that rosacea sufferers, who often have a red face and nose, are heavy drinkers. In fact, while alcohol may aggravate rosacea, these symptoms can be just as severe in a teetotaler. Another common misconception is that rosacea is caused by poor hygiene, while in reality it is unrelated to personal cleanliness.

"The good news is that, while rosacea cannot be cured, it can be effectively controlled with medical therapy and lifestyle changes," Dr. Wolf said. Individuals with any of the following warning signs of rosacea are urged to see a dermatologist for diagnosis and appropriate treatment:

• Redness on the cheeks, nose, chin or forehead

• Small visible blood vessels on the face

• Bumps or pimples on the face

• Watery or irritated eyes

New Personal Care Section

Friday, March 27, 2009

A new section on Skin Care & Cosmetics, a topic of interest to many rosacea patients, is now featured on rosacea.org. There you will find information and tips on facial cleansing, skin care and makeup for rosacea, key components of personal care that can make a visible difference in managing rosacea and improving appearance.

Sunburn Linked to Rosacea

Wednesday, March 18, 2009

Both a blistering sunburn and a family history of rosacea were associated with the presence of rosacea, according to study results presented by Dr. Alexa Boer Kimball, associate professor of dermatology at Harvard Medical School, at the recent annual meeting of the American Academy of Dermatology.

In the study, 65 individuals with rosacea and 65 healthy control subjects underwent a facial skin exam, completed a questionnaire, and were measured for height, weight and blood pressure. In general, Dr. Kimball said, the cases of rosacea were moderate to severe.

The researchers found that individuals with rosacea were three times more likely to have a family member with the disease, compared to the control subjects. In addition, rosacea patients had significantly higher rates of blistering sunburns than those without rosacea -- 44 percent versus 5.2 percent.

"Even when we did a more sophisticated analysis of the data controlling for age and gender, we found these findings were statistically significant," said Dr. Kimball. "Although these results are preliminary, they are important for future research as we start to explore their implications in controlling this condition."

The results show that it may be especially important for patients with rosacea to consistently protect against sun exposure and use a sunscreen with an SPF (skin protection factor) of 15 or higher.

While it was not clear whether sunburns contributed to rosacea or patients with rosacea were more likely to sunburn, she said, preventive measures could help lessen rosacea's severity. Sun has been named the top flare-up trigger by 81 percent of patients in a National Rosacea Society survey (NRS), and in another NRS survey nearly 52 percent said someone else in their family had rosacea.

Research Grants Awarded

Thursday, February 26, 2009

The National Rosacea Society (NRS) has awarded funding to four new studies as part of its research grants program to advance scientific knowledge of the potential causes and other key aspects of this chronic and potentially life-disruptive disorder that affects an estimated 14 million Americans.

"We are extremely grateful to the thousands of rosacea patients whose donations are used to support this important program," said Dr. Jonathan Wilkin, chairman of the NRS medical advisory board, which reviews and selects grant applications for funding. "The ongoing study results are making significant inroads toward the better understanding and management of rosacea, as well as its potential prevention or cure."

Dr. Robert W. Walters, assistant professor, Division of Dermatology, and Dr. Robert J. Lefkowitz, professor, Department of Medicine, Duke University Medical Center, were awarded $25,000 to study the role of beta-arrestin in cutaneous flushing. The researchers pointed out that niacin, or vitamin B3, long associated with severe flushing, stimulates receptors on skin cells that react by activating both G and beta-arrestin proteins. However, they noted that a recent study has identified niacin-like drugs that can stimulate only the G protein but do not induce flushing, suggesting that it is the beta-arrestins that may regulate flushing. The results of the new project are intended to lead to better understanding of changes in skin blood flow and possible treatments for this significant symptom of rosacea.

Dr. Curdin Conrad, senior postdoctoral research fellow, Department of Immunology, MD Anderson Cancer Center, and Dr. Alexander Navarini, senior postdoctoral research fellow, Department of Dermatology, University Hospital of Zurich, Switzerland, were awarded $21,450 to study the role of plasmacytoid dendritic cells and interferon alpha in rosacea.

They noted that their work is a logical follow-on to the studies by Dr. Richard Gallo and colleagues, also supported by the NRS, which found that in rosacea, antimicrobial peptides such as cathelicidins are involved. Given that these peptides are part of the innate immune system, their work will examine the next steps in the body's immunological process to see whether type I interferon, glycoproteins that help fight viral infections, and plasmacytoid dendritic cells, which produce interferon, are present in rosacea. They noted that these mechanisms contribute to psoriasis, and a similar finding in rosacea could form a sound basis for newer treatment strategies for rosacea.

Dr. Richard Gallo, chief of the division of dermatology at the University of California-San Diego, and Dr. Kenshi Yamasaki of the Veterans Medical Research Foundation were awarded $25,000 to continue their NRS-funded research of how cathelicidins may play a role in the development of subtype 2 (papulopustular) rosacea.

Past support from the NRS has enabled them to show that people with rosacea have too much of a molecule known as cathelicidin, and using mice and artificial cell culture techniques, they showed that this excess leads to rosacea symptoms. They have also shown that the overabundance of cathelicidin is the result of an excess of an enzyme in the facial skin.

In the new study, the researchers will test their hypothesis that the abnormal enzyme is a critical step in the development of rosacea. Too much cathelicidin and too much of this specific class of enzyme may explain its presence, which may in turn suggest a therapy that will inhibit the production or action of these molecules.

Dr. Joseph Rothnagel, associate professor, and Dr. Manuela Trabi, adjunct lecturer, Department of Molecular and Microbial Sciences, The University of Queensland, Australia, were awarded $18,000 for their study, "The role of tissue kallikreins in rosacea." This study will also build from the work of Dr. Gallo and colleagues. They noted that these previous studies reported involvement of the enzyme hK5 and protein CAP18, and hypothesize that at least one other enzyme is also elevated in rosacea. They will study whether proteins known to be crucial for skin integrity are also digested at a higher than normal rate by these enzymes, allowing easier access for pathogens.

Researchers interested in applying for grants may obtain forms and instructions in the research grants section of rosacea.org, or by contacting the National Rosacea Society, 800 South Northwest Highway, Suite 200, Barrington, Illinois 60010, telephone 1-888-662-5874, e-mail rosaceas@aol.com. The deadline for submitting proposals for research grants in 2009 is October 15.

Members of the NRS medical advisory board include Dr. Jonathan Wilkin, former director of dermatologic and dental drug products for the U.S. Food and Drug Administration; Dr. Mark Dahl, chairman of dermatology at Mayo Clinic-Scottsdale and former American Academy of Dermatology (AAD) president; Dr. Michael Detmar, professor of pharmacogenics, Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland; Dr. Lynn Drake, Harvard Medical School and former AAD president; Dr. Marian Macsai, vice chair of ophthalmology at Northwestern University; Dr. David Norris, chairman of dermatology, University of Colorado and former president of the Society for Investigative Dermatology; Dr. Richard Odom, professor of clinical dermatology, University of California-San Francisco and former president of the AAD; Dr. Frank Powell, consultant dermatologist, Regional Centre of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland; Dr. Bryan Sires, clinical associate professor of ophthalmology, University of Washington; and Dr. Diane Thiboutot, professor of dermatology, Pennsylvania State University.

Rosacea Awareness in April

Thursday, February 5, 2009

While the negative impact of rosacea on personal and professional life is increasingly recognized, new research continues to suggest that this often life-disruptive disorder may be far more common than is widely believed. The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to alert the public to the warning signs of this conspicuous, red-faced condition now estimated to affect well over 14 million Americans.

"The early clues to rosacea are confusing for many people because the signs and symptoms often come and go, and are easily mistaken for something else," said Dr. Jonathan Wilkin, chairman of the NRS medical advisory board. "Unfortunately, without medical treatment rosacea usually continues and may become worse, and can have substantial impact not only physically but on an individual's emotional, social and work life."

In NRS surveys, more than 76 percent of rosacea patients said their condition had lowered their self-confidence and self-esteem, and 52 percent reported that it had caused them to avoid public contact or social engagements. Among rosacea patients with severe symptoms, nearly 70 percent said the disorder had adversely affected their professional interactions and nearly 30 percent said they had even missed work because of their condition -- which may be especially harmful in today's economic setting.

The good news is that 80 percent of the survey respondents reported that medical therapy had also improved their emotional, social and professional well being.

During Rosacea Awareness Month, public education activities will be conducted by the NRS to increase awareness and understanding of this widespread disorder, emphasizing its warning signs and urging those who suspect they may have the condition to see a dermatologist or other physician. In addition, bulk quantities of NRS educational materials are available to health professionals for their patients.

Although rosacea varies from one patient to another, its primary signs may include facial flushing or transient erythema (redness), persistent erythema, papules (bumps) and pustules (pimples), and telangiectasia (visible blood vessels), according to the NRS standard classification of rosacea, developed by a consensus committee and review panel of 17 experts worldwide. Secondary features may include burning or stinging, plaques (raised patches on the skin), a dry appearance, edema (swelling), ocular manifestations and phymatous changes, in which the skin thickens.

The standard subtypes of rosacea reflect the most common patterns of signs and symptoms, and characteristics of more than one subtype may occur at the same time. Subtype 1 (erythematotelangiectatic) rosacea is characterized by flushing and persistent redness on the central portion of the face, while subtype 2 (papulopustular) rosacea also features papules and pustules. Subtype 3 (phymatous) rosacea includes thickening of the skin, irregular nodularities and enlargement, especially of the nose. Subtype 4 is ocular rosacea, where the eyes may have a watery or bloodshot appearance, the sensation of a foreign body, burning or stinging, dryness, itching, light sensitivity or a host of other signs and symptoms.

Fall Rosacea Review

Tuesday, November 25, 2008

The Fall 2008 Rosacea Review is now online. This issue highlights two ongoing studies funded by the National Rosacea Society that investigate how specific substances in the body may produce the signs and symptoms of rosacea, as well as a new prevalence study that shows the disorder may be far more common than widely believed. Also featured is a report on a presentation by a dermatologist and psychologist on the emotional impact of the condition. Results from the patient survey on rosacea flare-ups are also included.

Other features in the issue include tips for surviving holiday cuisine, Q&As on topical medication and the use of lasers, a new success story and a new patient survey on the seasonal effects of rosacea.

Study Shows High Incidence

Tuesday, October 21, 2008

A new study funded by the National Rosacea Society provides further evidence that rosacea may be far more common than widely believed, and also assesses the potential significance of sun exposure.

The recently completed study, presented at the 2008 British Association of Dermatologists meeting by Dr. Maeve McAleer and colleagues at Mater Misericordiae University Hospital and the School of Public Health and Population Science, University College, Dublin, found that 14.4 percent of 1,000 subjects examined in Ireland had rosacea.

This high prevalence rate is comparable to preliminary study results that found rosacea in 16 percent of Caucasian women in the United States.¹ The U.S. data, reported last year by Dr. Alexa Boer Kimball, director of the clinical unit for research in skin care at Harvard Medical School, were based on examination of high-resolution digital photographs of 2,933 volunteers. An earlier study of 806 office workers examined in Sweden found a rosacea prevalence of 14 percent in women and 6 percent in men.²

While the more recent studies are based on the standard classification system published by the National Rosacea Society Expert Committee for the Classification and Staging of Rosacea in 2002, Dr. McAleer noted that earlier studies did not have defined criteria for diagnosing the condition.

To investigate the potential effects of sun exposure, the Irish study included 500 residents of the Aran Islands, an area off the western coast of Ireland, and 500 hospital workers in Dublin. The Aran Islanders reportedly had greater sun exposure due to their outdoor occupations of fishing and farming, compared with the hospital workers.

The researchers found that the Aran Islanders and the hospital workers had similar rates of subtype 2 (papulopustular) rosacea, characterized by bumps and pimples, at 2.8 percent and 2.6 percent, respectively. However, they found that 16.3 percent of the Aran Island group had subtype 1 (erythematotelangiectatic) rosacea, characterized by facial redness, compared with a subtype 1 prevalence rate of 6.8 percent in the hospital workers.

The NRS is currently funding a study led by Dr. Yolanda Helfrich, assistant professor of dermatology at the University of Michigan, to examine the potential differences and similarities between rosacea and sun damage.

References
1. New studies show high incidence of rosacea and possible new causes. Rosacea Review 2007;summer:1.

2. Berg M, Liden S. An epidemiological study of rosacea. Acta Dermato-Venereologica 1989;69:419-423.

Rosacea and Seborrhea

Wednesday, October 1, 2008

A new section on Seborrheic Dermatitis, the most common concurrent condition with rosacea, is now featured on rosacea.org. Here readers will find information on the signs and symptoms, potential causes and treatment of this other common disorder.

The new section was edited by Drs. Mark Dahl, chairman of dermatology at the Mayo Clinic Arizona, and Richard Odom, professor of dermatology at the University of California-San Francisco. To view the new information on seborrheic dermatitis, click here.