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Summer Rosacea Review

Tuesday, August 17, 2010

The Summer Rosacea Review is now online. Highlights of this issue include results from a recent National Rosacea Society patient survey, which documents that rosacea encompasses a wide range of potential signs and symptoms, as well as treatment options for the flushing and redness of subtype 1 (erythematotelangiectatic) rosacea. Also featured are new study results that link Demodex mites to ocular rosacea and two news briefs about sunscreen and the prevalence of rosacea.

Other features include tips for cooking with rosacea-friendly spices, Q&As on relief from a flare-up and whether a computer monitor can trigger symptoms, a new success story and a new patient survey on compliance with medication.

Wide Effects of Rosacea

Monday, August 2, 2010

Not only is rosacea now estimated to affect more than 16 million Americans, but a new survey by the National Rosacea Society documents the unusually wide range of potential signs and symptoms that may be associated with the disorder.

“While rosacea tends to develop in common patterns known as subtypes, its signs and symptoms can vary substantially from one patient to another, and many experience a variety of manifestations in succession or at the same time,” said Dr. Boni Elewski, professor of dermatology at the University of Alabama-Birmingham. “That’s why it’s important for patients to be aware of the many possible effects of the disorder, so they know when to seek an evaluation and appropriate help from a dermatologist.”

In the recent survey of 1,289 rosacea patients, 71 percent of the respondents said they had experienced persistent redness, and 63 percent said they had suffered from frequent flushing -- both hallmarks of subtype 1 (erythematotelangiectatic) rosacea. In addition, 63 percent said they had suffered outbreaks of pimples (pustules) and 61 percent reported experiencing bumps (papules) –- both signs of subtype 2 (papulopustular) rosacea.

Beyond these common effects of rosacea, however, the survey found that more than half of the respondents had been affected by a number of less well-known potential effects of the condition. Although a link between a skin disorder and the eyes may seem counterintuitive to many, 61 percent of the patients said they had also experienced eye symptoms, a condition known as subtype 4 (ocular) rosacea. In addition, visible blood vessels were cited by 56 percent of the respondents, and facial burning or stinging was reported by 51 percent.

Other widely reported signs and symptoms included facial itching, experienced by 41 percent; dry appearance, named by 40 percent; raised red patches, reported by 30 percent; skin thickening or excess tissue on the nose (rhinophyma), 22 percent and facial swelling, 18 percent.

Among those who experienced eye symptoms, complaints ranged widely, including dry eye, affecting nearly 65 percent; a gritty feeling, cited by 58 percent; itching, 56 percent; bloodshot appearance, 50 percent; burning, 48 percent; watery eyes, 45 percent; reduced vision, 22 percent; and styes, 18 percent.

Of the 21 percent of survey respondents who indicated that rosacea had affected areas other than the face, 48 percent said they had signs and symptoms on the neck. Forty-six percent noted the condition had affected the scalp, while 42 percent said it was evident on the chest. Other affected areas included the ears, cited by 36 percent; the arms, 16 percent; and the legs, 8 percent.

Women experience a greater number of rosacea’s signs and symptoms, according to the survey results. Visible blood vessels, in particular, were more likely to be present in females, cited by 59 percent of the women and only 43 percent of the men. Other symptoms more common in women included frequent flushing (68 percent of women vs. 52 percent of men), facial burning or stinging (57 percent vs. 43 percent) and facial itching (45 percent vs. 35 percent). On the other hand, skin thickening or excess tissue on the nose was more common in men.

“Rosacea patients should be sure to tell their dermatologist about all of the rosacea signs and symptoms they have experienced, even if they are not present at the time of the visit, so therapy can be tailored for their individual case,” Dr. Elewski said.

Despite the broad disparity of symptoms, 86 percent of the survey respondents reported that medical therapy and lifestyle modifications had reduced the effects of their rosacea.

Mites and Eye Symptoms

Thursday, July 15, 2010

A new study has found there may be a link between ocular rosacea and bacteria associated with Demodex mites, microscopic inhabitants of normal skin that tend to occur in much greater numbers in those with rosacea.

In the recently published study of 59 rosacea patients, Dr. Jianjing Li and colleagues at the Ocular Surface Center in Miami found a significant correlation between facial rosacea, infestation of the eyes with Demodex mites and reaction to certain mite-related organisms previously shown to stimulate an immune response in rosacea sufferers.¹

In an earlier study funded by the National Rosacea Society, Dr. Kevin Kavanagh and colleagues at the National University of Ireland-Maynooth found that the bacterium Bacillus oleronius, a distinct bacterium found in Demodex, stimulated an immune system response in 79 percent of patients with subtype 2 (papulopustular) rosacea, compared with only 29 percent of subjects without the disorder.²

In the new study, researchers uncovered the association with ocular symptoms by noting correlations between rosacea patients who had an ocular infestation with Demodex mites (38 subjects) and those in whom B. oleronius stimulated an immune system response (21 subjects). They also noted a borderline correlation between ocular Demodex infestation and eyelid margin inflammation, a characteristic of blepharitis (dry eye).

The Demodex mites themselves were counted by microscopic examination of lashes, and the presence of the bacteria was determined by serum reaction to proteins they produce.

The researchers pointed out that these findings support the practice of treating subtype 4 (ocular) rosacea with both medication and eye hygiene, including lid scrubbing. They noted that patients may be affected by a combination of factors, including a reaction to the proteins produced by the bacteria, a possible allergic reaction to the mites themselves and other microbes that may have been colonized in the eyelid as a result of the mites.

“Future investigation into this comorbidity between mites and microbes may shed new light not only on the understanding of the pathogenesis of this centuries-old common ailment of the skin and eye, but also other similar unresolved human diseases,” the researchers concluded.

References
1. Li J, O’Reilly N, Sheha H, et al. Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea. Ophthalmology 2010;117:870-877.
2. Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. Br J Dermatol 2007;157:474-481.

New Product Survey

Thursday, July 1, 2010

CLICK HERE TO TAKE THE SURVEY

Now your voice can be heard on the kinds of topical products you want. Please fill out the new patient survey, which may be used as a guide in the development of future therapies for rosacea.

To take the survey, click here.

Heat Worsens Rosacea

Monday, June 14, 2010

While many adults still look forward to summer as eagerly as schoolchildren, new survey results show that increased exposure to sun and hot weather can wreak havoc on those with rosacea, a widespread, red-faced skin disorder now estimated to affect more than 16 million Americans. The survey also found that a variety of common heat sources can affect the condition year-round.

In a recent survey of 431 rosacea patients conducted by the National Rosacea Society (NRS), 80 percent of the respondents said they had suffered a flare-up of symptoms as a result of being out in the sun, and 80 percent said their condition was aggravated by hot weather. Excessive indoor heat was a trigger for 56 percent of those surveyed, while 55 percent said heavy exercise had set off a rosacea flare-up.

Fifty-four percent said a hot bath had induced an outbreak of rosacea signs and symptoms, and 42 percent said heated beverages had done the same. Heavy clothing had triggered a flare-up for 32 percent, and 26 percent cited menopausal hot flashes.

“Although medical therapy is available to help control this widespread and chronic disorder, it is also important for rosacea patients to identify and minimize any environmental or lifestyle factors that may trigger or aggravate their symptoms,” said Dr. Joseph Bikowski, clinical associate professor of dermatology at Ohio State University. He said he advises patients to keep a diary to determine what factors might be affecting their individual cases.

In addition to common heat triggers, survey respondents reported a host of other sources of heat that had aggravated their individual conditions, including fireplaces and bonfires, high-intensity lamps, steam baths, saunas and cooking over a hot stove.

The good news is that the survey showed rosacea flare-ups can often be prevented. Nearly 84 percent of the respondents reported that avoiding sources of heat had reduced the frequency of their flare-ups. Seventy-four percent said they now bathe or shower in cooler water, and nearly 69 percent said they go outside less often in hot weather to avoid exacerbating their condition. Sixty-seven percent said they frequently or sometimes leave an overheated room to prevent an outbreak, and 55 percent said they had changed their exercise routine to avoid flare-ups.

“Rosacea sufferers should wear a sunscreen with an SPF of at least 15 year-round, and especially in the summer, they should minimize time outdoors from 10 a.m. to 2 p.m. when sunlight is the strongest,” Dr. Bikowski said. He noted that a fan or chewing on ice chips can effectively reduce flushing from heavy exercise or excessive indoor heat.

For more information on lifestyle and environmental factors that may trigger flare-ups or aggravate rosacea, visit Rosacea Triggers. The NRS also offers a Rosacea Diary to help patient’s identify and avoid rosacea triggers that may affect their individual cases.

New Treatment Section

Tuesday, June 1, 2010

You asked for it and now you have it. In the ongoing Opinion Survey on Rosacea.org content, 88 percent of the respondents have said they are “very interested” in information on medical treatments for rosacea.

Following this guidance, Rosacea.org now features a new section on Management Options for rosacea, including Medical Therapy by subtype and What to Tell Your Physician to aid in diagnosis and treatment selection. The new section also emphasizes the importance of avoiding Rosacea Triggers, as well as appropriate Skin Care and effective use of Cosmetics.

If you have not yet participated in the online Opinion Survey, the National Rosacea Society welcomes your input on current and possible future content of Rosacea.org to help make this site as useful as possible.

Spring Rosacea Review

Tuesday, May 18, 2010

The Spring Rosacea Review is now online. This issue announces the awarding of new research grants by the National Rosacea Society, as well as the Society’s efforts to increase visibility of the disorder during Rosacea Awareness Month. Also featured are treatment options for the bumps and pimples of subtype 2 (papulopustular) rosacea and suggestions from readers on ways to avoid heat-induced flare-ups.

Other features include tips for a successful summer vacation, Q&As on sunscreen and the effects of vitamin D, a new success story and a new patient survey on topical therapy delivery.

Therapy for Inflammation

Tuesday, May 11, 2010

While some signs and symptoms of rosacea can be challenging to control, effective medical therapies have been extensively studied and approved for the treatment of the bumps and pimples of subtype 2 (papulopustular) rosacea, according to the standard management options for rosacea recently published by the National Rosacea Society.¹

"Fortunately today, there are proven therapies that can be tailored by a physician for each individual case to help bring this common form of rosacea under control on both an immediate and on a long-term basis," said Dr. Richard Odom, professor of dermatology at the University of California-San Francisco, chairman of the consensus committee and review panel of 26 rosacea experts who developed the new standard options. Subtype 2 rosacea is characterized by persistent facial redness and acne-like bumps and pimples, and is often seen after or at the same time as the flushing and redness of subtype 1 (erythematotelangiectatic) rosacea.

In mild to moderate cases, doctors often prescribe oral and topical therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission, Dr. Odom said. He noted that a controlled-release formulation of oral therapy with low blood levels may also be used for an indefinite period.

"Clinical research has demonstrated that rosacea patients who continue therapy on a long-term basis are substantially more likely to maintain remission," Dr. Odom said. In a study of rosacea sufferers over a six-month period, 77 percent of the patients who continued long-term topical therapy remained in remission, while 42 percent of those who did not experienced a relapse.²

In addition to long-term medical therapy, Dr. Odom stressed the importance of a gentle skin care program and minimizing environmental and lifestyle factors that aggravate the condition in individual cases.

For more information on treating rosacea, see the All About Rosacea section.

References
1. Odom R, Dahl M, Dover J, et al. Standard management options for rosacea,
part 2: Options according to subtype. Cutis. 2009;84:97-104.
2. Dahl MV, Katz I, et al. Topical metronidazole maintains remission of rosacea. Archives of Dermatology. 1998;134:679-683.

Research Grants Awarded

Thursday, April 22, 2010

The National Rosacea Society (NRS) has awarded funding to three new studies and continues to fund three ongoing studies as part of its research grants program to advance scientific knowledge of the potential causes and other key aspects of this potentially life-disruptive disorder.

"Our understanding of rosacea has continued to expand as researchers pursue important new leads in the search for rosacea’s causes," said Dr. Michael Detmar, professor of pharmacogenomics at the Federal Institute of Technology in Switzerland and a member of the NRS medical advisory board, which selects grant applications for funding. "We are grateful for the support of the many thousands of patients whose donations for rosacea research are leading toward important advances in its treatment and potential prevention or cure."

Dr. Jamison Feramisco, molecular medicine fellow in dermatology, and Dr. Martin Steinhoff, professor of dermatology, University of California-San Francisco, were awarded $25,000 for their study, "Cellular and molecular analysis of transient receptor potential (TRP) ion channels and neurovascular regulation in rosacea patients."

The researchers hypothesize that, based on earlier studies, the flushing, bumps and pimples of rosacea may be the result of a dysfunctional regulation in the neurovascular system, with subsequent vascular and chronic inflammatory reactions.

Their study has four aims, they noted: to establish a relationship between certain sensory nerves and immune cells in different subtypes of rosacea; to genetically characterize crucial components of the neurovascular network with regard to disease stage, gender, age and the presence or absence of Demodex mites; to investigate the role of specific temperature and irritant receptors as neurovascular regulators in mice; and to identify families suffering rom rosacea with prominent trigger factor-induced flushing/redness and isolate their DNA for analysis.

Dr. Thad Wilson, associate professor of physiology and medicine; Dr. Kumika Toma, postdoctoral fellow; Dr. Michael Tomc, associate professor of otorhinolaryngology; and Dr. Dawn Sammons, assistant professor of dermatology, Ohio University, were awarded $25,000 for their study, "Role of skin sympathetic nerve activity in rosacea."

The researchers noted that events triggering flare-ups such as emotional stress and hot or cold weather are associated with fight-or-flight stressors that increase nervous activity to the skin, including skin blood flow regulation and skin gland secretions. The researchers plan to compare this nerve activity in the facial skin of rosacea patients with control areas such as leg skin.

Using microneurography, they will quantify the nerve activity during three trigger events, including mental stress, physical stress and thermal stress. If facial nerve activity is found to be higher in individuals with rosacea, therapies may then be developed to decrease symptoms and possibly prevent disease progression.

Dr. Noreen Lacey, postdoctoral researcher, and Dr. Siona Ni Raghallaigh, research fellow, University College Dublin Clinical Research Centre and Mater Misericordiae University Hospital in Dublin, Ireland, were awarded $25,000 to undertake their study, "Evaluation of the effect antibiotics used in the management of rosacea have on the immortalized human sebocyte cell line (SZ95) -- in vitro studies."

The researchers noted that although the effectiveness of oral antibiotics is believed to be due to their anti-inflammatory properties rather than from destroying bacteria, more powerful anti-inflammatory drugs are ineffective and may even make the condition worse.

Because patients with dry, sensitive skin often report less irritation and dryness after antibiotic treatment, the investigators analyzed the oil on the skin surface before and after treatment with antibiotics and found that abnormalities of the sebum had been altered after treatment. In the new study, the researchers will determine the effect of antibiotics on the production of lipids, as well as properties that may affect rosacea.

The NRS is also continuing to fund additional studies, including the work of Dr. Richard Gallo and colleagues at the University of California-San Diego, on the potential role of cathelicidins and the innate immune system in rosacea; Dr. Curdin Conrad and colleagues at MD Anderson Cancer Center on the role of interferon in rosacea; and Dr. Joseph Rothnagel and colleagues at The University of Queensland, Australia, on kallikreins and rosacea.

To support the NRS research grants program, visit How to Donate. Detailed information on this program can be found in the Research Grants section, including How to Apply and reports on Awarded Grants and Research Results.

Rosacea Incidence on Rise

Thursday, April 1, 2010

The National Rosacea Society (NRS) announced today that the estimated number of Americans now suffering from rosacea has increased to 16 million, while untold millions more may be in temporary remission. April is designated as Rosacea Awareness Month by the NRS to alert the public to the warning signs of this red-faced, acne-like and often life-disruptive disorder, and the importance of seeking early diagnosis and treatment.

"Many people assume that rosacea is simply a sunburn or complexion problem that will eventually go away, and fail to realize they have a chronic condition that may get worse without medical treatment and lifestyle modifications," said Dr. Jonathan Wilkin, chairman of the NRS medical advisory board. He noted that the steady growth and aging of the population over the past decade have significantly raised the incidence of this widespread but poorly understood disorder, and its effects are now in full force among the massive numbers in the baby boom generation.

The NRS had previously estimated the number of rosacea sufferers in the United States at 14 million, and recent epidemiological studies have also found the incidence may be much higher. Despite its prevalence, however, most Americans are unaware of its signs and symptoms, and medical data suggest that only a small percentage of rosacea sufferers are being treated.

"It's especially important for people to know about rosacea, not only because of its potential for the development of other skin and serious eye effects, but its negative impact on personal appearance can be even more devastating to their emotional, social and professional lives," Dr. Wilkin said.

In NRS surveys of more than 1,200 rosacea patients, more than 76 percent said their condition had lowered their self-confidence and self-esteem, and 41 percent said it caused them to avoid public contact or cancel social engagements. Among those with severe symptoms, nearly 70 percent said it had adversely affected their professional lives, and nearly 30 percent said they even missed work because of its effect on their personal appearance.

Adding to the embarrassment is a common myth that rosacea sufferers, who often have a red face and nose, are heavy drinkers. In fact, while alcohol may aggravate the condition, the 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.

Rosacea typically begins between the ages of 30 and 60 as a redness on the cheeks, nose, chin or forehead that comes and goes. Over time, the redness tends to become ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases -- especially in men -- the nose may become swollen and bumpy from excess tissue. This is the condition, called phymatous rosacea, that gave the comedian W.C. Fields his trademark red bulbous nose.

In many rosacea sufferers, the eyes are also affected, feeling irritated and appearing watery or bloodshot. Severe cases of this condition -- known as ocular rosacea -- can lead to corneal damage and reduced vision.

In a recent study, Dr. Maeve McAleer and colleagues at 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. Moreover, in a 1989 study of 800 office workers in Sweden, the prevalence of rosacea was 10 percent -- including 14 percent in women and 6 percent in men.

"While these incidence rates are very high, rosacea is more commonly seen in fair-skinned individuals, and an assessment of rosacea in the U.S. must take into account the diversity of its population," Dr. Wilkin said.

In a study of photos of 2,933 random women volunteers in the U.S., presented by Dr. Alexa Boer Kimball of Harvard Medical School at an NRS research workshop, the rosacea prevalence rate in all of the women regardless of ethnic background was 9.6 percent. At the same time, the prevalence rate in the Caucasian women alone was 16 percent -- comparable to the rates found in the studies in Ireland and Sweden.

"In actuality, all of these studies may understate the true incidence of rosacea because they examined only the presence of signs and symptoms at the time of the study, while rosacea is often a chronic underlying condition whose outward signs and symptoms are characterized by relapses and remissions," Dr. Wilkin said. "Thus, at any given time, millions of additional rosacea sufferers may simply be in temporary remission."

While the cause of rosacea is unknown, a vast array of lifestyle and environmental factors can trigger flare-ups in various rosacea sufferers. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products and many others.

"The good news is that although the incidence of rosacea has increased in the United States, medical therapy is available to bring many aspects of rosacea under control," Dr. Wilkin said. Individuals with any of the following warning signs of rosacea are urged to see a dermatologist for diagnosis and appropriate medical treatment:
o Redness on the cheeks, nose, chin or forehead
o Small visible blood vessels on the face
o Bumps or pimples on the face
o Watery or irritated eyes