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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.

Missing Link for Rosacea?

Monday, September 15, 2008

In an article [PDF] in Experimental Dermatology, Dr. Richard Gallo and colleagues at the University of California-San Diego reported that vitamin D3 may be a critical step in an inflammatory pathway that could be a therapy target against the bumps and pimples of rosacea.¹

In ongoing studies investigating the specific chemical interactions to rosacea triggers, the researchers have noted that the normal immune system protects the body by producing protective substances called cathelicidins that isolate and neutralize any harmful effects.² The missing link, however, has been what prompts the production of these cathelicidins.

Cathelicidins are produced in many cell types. The researchers noted that a breakthrough in the understanding of cathelicidin expression in the skin came with the identification of a vitamin D response element. Several research groups confirmed that cathelicidin is a direct target of vitamin D3 in keratinocytes, they reported. Though cathelicidin expression is found to be high in rosacea patients, its exact mechanism had been unclear as classic triggers of inflammation did not prompt it.

The missing link involved the discovery that skin injury or infection causes a local increase in expression of an enzyme that activates vitamin D3, which in turn induces cathelicidin. However, in previous studies funded by the National Rosacea Society, the researchers found that the forms of cathelicidins are different in rosacea patients from those in normal subjects. Like overzealous guards, they turn the body on itself, leading to inflammation.

References
1. Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin's immune response? [PDF] Experimental Dermatology 2008;17:633-639.

2. Yamasaki K, Di Nardo A, Bardan A, Masamoto M, Ohtake T, Coda A, Dorschner RA, Bonnart C, Descarques P, Hovnanian A, Morhenn VB, Gallo RL. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nature Medicine 2007;13:975-980.

Summer Rosacea Review

Monday, August 25, 2008

The Summer 2008 Rosacea Review is now online at rosacea.org. This issue highlights two new studies that trace the effect of rosacea triggers in the search for the cause or causes of this chronic disorder, as well as information on how rosacea patients can track their own triggers in an effort to better manage their condition. Also featured are results from a recent survey on rosacea research, which showed that rosacea patients are most interested in supporting research into potential causes, and two brief articles recapping new scientific reports pertaining to rosacea, one about the possibility of ocular rosacea in children and the second about cinnamon as a potential rosacea trigger.

Other features in the issue include tips for applying topical medication, Q&As on sunscreen and the prevalence of rosacea among those with dark skin, a new success story and a new patient survey on rosacea and flare-ups.

Detective Work for Rosacea

Wednesday, August 13, 2008

In addition to complying with medical therapy, an important part of managing rosacea for many patients is to identify and avoid environmental and lifestyle factors that may trigger or aggravate their individual conditions.

"In essence, rosacea patients can often benefit by playing the role of detective, examining suspects and evidence carefully to determine the culprits that are responsible for a rosacea flare-up," said Dr. John Wolf, chairman of dermatology at Baylor University. In a survey of 1,066 rosacea patients conducted by the National Rosacea Society (NRS), some of the most common triggers included sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, humidity, alcohol and spicy foods.

"It must be remembered, however, that what affects one individual may not affect another," Dr. Wolf said. To help patients identify those factors that affect their personal condition, the NRS offers free of charge a "Rosacea Diary" booklet to help keep track of the most common things that may trigger a flare-up of signs and symptoms.

The diary guides patients on a daily basis to observe and record weather conditions, foods and beverages consumed, lifestyle factors such as strenuous exercise, products used on the face, compliance with medical therapy and the occurrence of any flare-ups. By keeping track for a period of two weeks, or at least on the days when a flare-up occurs, patients may identify which culprits to avoid.

For example, if sun exposure triggers rosacea flare-ups, patients can minimize outdoor exposure between 10 a.m. and 4 p.m. when the sun is at its strongest. A broad-brimmed hat can be used to shield the face, and all rosacea patients are advised to apply a sunscreen of SPF 15 or higher all year-round.

In NRS surveys of patients who identified and avoided personal rosacea triggers, more than 90 percent reported their condition had improved.

For tips on how to minimize or eliminate the most common rosacea triggers, the NRS also offers the free booklet, "Coping with Rosacea." Both the booklet and the Rosacea Diary may be viewed online, and hard copies may be ordered using the NRS's Materials Request Form.

Ruling Out Carcinoid

Wednesday, July 23, 2008

While the various potential signs and symptoms of rosacea may mimic a variety of other disorders from acne to lupus erythematosus, an accurate diagnosis may be especially important to rule out the possibility of carcinoid syndrome, a rare cancer caused by a tumor that is often curable if detected early but may be fatal if left untreated.

"A very rare disorder, carcinoid produces flushing and visible blood vessels that are also common to rosacea," said Dr. Joseph Bikowski, clinical assistant professor of dermatology at The Ohio State University. "However, while they often appear on the face, with carcinoid syndrome these symptoms also may extend over the entire body and be accompanied by other manifestations such as diarrhea, abdominal cramping and swelling of the ankles, legs, hands and arms."

Caused by carcinoid tumors that damage organs, carcinoid syndrome is estimated to occur in only 20 to 40 individuals per one million in the U.S. Individuals with carcinoid syndrome may be at significantly greater risk of death than those with tumors alone because the damage is a consequence of the excessive amounts of potent hormones released into the circulation, rather than the size or spread of the tumors themselves.

"Carcinoid may not always be considered because of its rarity," Dr. Bikowski said. "Anyone who may have signs and symptoms of carcinoid should see their doctor."

Reader Survey Now Online

Thursday, June 19, 2008

Now you can make your voice heard with the simple click of a mouse. For the first time ever, the Reader Survey that long has been a staple of the Rosacea Review newsletter is available in an interactive format on rosacea.org.

Just click on Reader Survey and you will be taken directly to an online survey that is identical to the current printed version. Both online and printed results will be consolidated and reported in subsequent issues of Rosacea Review, both in print and on the website.

The current survey is on rosacea research, allowing you to indicate your preference for future scientific investigation. There's also a place for comments, and ideas for future survey topics are welcome.

Can Rosacea Be Inherited?

Tuesday, June 10, 2008

Rosacea, a chronic and often embarrassing disorder of the facial skin that affects an estimated 14 million Americans, may be linked to genetics, according to a new survey conducted by the National Rosacea Society (NRS) and published in Rosacea Review.

The NRS survey of 600 rosacea patients found that nearly 52 percent of the respondents had a relative who also suffered from the condition and that people of some nationalities are more likely than others to develop the disorder.

Of those who said they had a relative with rosacea, most indicated it was an immediate family member. Thirty percent reported their mother has or had rosacea, while 35 percent indicated their father, 28 percent cited a sister and 24 percent named a brother. In some cases more than one family member was indicated.

In addition to family history, the survey found that national ancestry also may be an indication of relative risk for rosacea.

Rosacea has often been called the "Curse of the Celts," and data from the new survey support the theory that it is especially prevalent among the Irish. Thirty-one percent of the respondents reported they had at least one parent of Irish ancestry, while only 11 percent of the U.S. population is of Irish heritage, according to the 2000 U.S. Census figures.

However, those of German and English heritage seem to be highly prone to rosacea as well. Forty-one percent of patients responding to the survey reported they had some German ancestry, compared to 15 percent of the U.S. population, and more than 30 percent reported English ancestry, versus 9 percent reporting English ancestry in the national census.

Other nationalities in which rosacea was present at a higher rate than the ethnicity is represented in the U.S. population include Scandinavian, Scottish, French, Polish, Russian, Lithuanian, Hungarian and Czech.

Although little was known about rosacea years ago, some of the survey respondents could trace the condition back more than one generation. Nearly 16 percent reported one of their grandmothers had rosacea, while 14 percent noted that their grandfather was affected.

The facial disorder may be targeting the next generation as well, since nearly 15 percent of the respondents reported one or more of their children have been diagnosed with rosacea. Many also indicated that an aunt, uncle or cousin had been diagnosed with the condition, too.

Spring Rosacea Review

Thursday, May 22, 2008

The Spring 2008 Rosacea Review is now online at rosacea.org. This issue highlights the National Rosacea Society's efforts to increase visibility of the condition during Rosacea Awareness Month, including evidence of rosacea's impact and prevalence and news of a college student's project that raised both public awareness and funds for the NRS research grants program. Also featured are results from a recent survey on rosacea and heredity, which showed that rosacea tends to run in families and is especially prevalent among those of northern European descent, as well as results from two studies regarding the role of angiogenesis in the development and progression of rosacea.

Other features in the issue include tips for looking your best in photos, Q&As on oily skin and any links between rosacea and other diseases, a new success story and a new patient survey on rosacea and research.

Sensitivity to Heat

Thursday, May 1, 2008

The skin of individuals with rosacea has a greater sensitivity to heat, according to a recent study in the Journal of the American Academy of Dermatology.

Patients with rosacea "often complain of increased skin sensitivity and frequently describe a burning sensation," said Dr. Daniela Guzman-Sanchez and colleagues of the Wake Forest University School of Medicine. They noted that although this heightened sensitivity is well recognized in practice, there had been no formal research on the phenomenon.

In their study of 24 individuals, 16 had rosacea, half with subtype 1 (erythematotelangiectatic) rosacea, characterized by redness and flushing, and half with subtype 2 (papulopustular) rosacea, characterized by bumps and pimples. The remaining eight individuals served as a control group without rosacea.

All of the study subjects were exposed to a device that warmed the skin of the cheek beginning at almost 90 degrees Fahrenheit, with a potential high of about 122 degrees. Individuals were asked to rate their perception of burning, and skin blood flow and skin temperature were also measured.

The researches found that individuals with both subtypes of rosacea had a significantly greater sensitivity to heat pain on symptomatic skin, compared to skin without symptoms and to the skin of individuals without rosacea. Moreover, when patients rated pain themselves, there was a significantly greater perception of pain in the subtype 1 group with flushing than in those with subtype 2 rosacea.

Skin blood flow was significantly higher in areas with bumps and pimples than in normal skin, and there was a high correlation between skin temperature and skin blood flow in all three groups.

The researchers pointed out that while 15 of the 16 rosacea patients reported burning, none reported itching, and thus it is possible that the increased skin sensitivity explains the common complaint of burning sensation in rosacea. They noted that, although they found no correlation between blood flow and burning perception, future research on the effect of vasodilators such as alcohol and heat on blood flow and heat pain thresholds may be especially valuable.

Reference
Guzman-Sanchez D, Ishiuji Y, Patel T, Fountain J, Chan YH, Yosipovitch G. Enhanced skin blood flow and sensitivity to noxious heat stimuli in papulopustular rosacea. Journal of the American Academy of Dermatology 2007;57:800-805.