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Awareness Month in April

Thursday, February 2, 2012

Emotional stress and physical pain are among the invisible components of rosacea beyond its red-faced, conspicuous appearance, according to new patient surveys by the National Rosacea Society (NRS). The NRS has designated April as Rosacea Awareness Month to alert the public to the warning signs of this chronic and often life-disruptive facial disorder now estimated to affect more than 16 million Americans.

“Emotional stress is not only a common rosacea trigger but is often the result of its symptoms, creating a tailspin for many patients,” said Dr. John Wolf, chairman of dermatology at Baylor University. “Add to this the social impact and potential physical discomforts of the disorder, and there are many aspects of rosacea that go well beyond its effects on personal appearance.”

In recent NRS surveys, 69 percent of rosacea patients said they experienced a flare-up related to emotional stress at least once a month, and more than 90 percent of the respondents said they had suffered some form of physical discomfort from their condition. In earlier surveys, more than 76 percent said rosacea had lowered their self-esteem, and 88 percent of those with severe symptoms reported that it had adversely affected their professional interactions.

“It’s important for people to know that rosacea can be effectively controlled with medical therapy and lifestyle modifications,” Dr. Wolf said. “This can substantially improve the quality of their lives.”

During Rosacea Awareness Month and throughout the year, the NRS will conduct public education activities to reach the millions of rosacea sufferers who may not realize they have a medical condition that can be treated, emphasizing the warning signs and urging those who suspect they may have rosacea to see a dermatologist. Educational materials are also available to health professionals for their patients through the NRS Web site at www.rosacea.org.

Although rosacea varies from one patient to another, the primary signs may include flushing or transient erythema (redness), persistent or nontransient erythema, papules (bumps) and pustules (pimples), or 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.

For more information, visit All About Rosacea.

Rosacea on 'Today' Show

Thursday, January 19, 2012

Rosacea and winter skin care were in the news recently as a featured segment on NBC-TV’s “Today” show. Dermatologist Dr. Jeanine Downie discussed how rosacea is often more noticeable during the colder months, and offered some tips on how to protect and soothe sensitive skin.

To watch the entire interview, click here.

New Research Results

Thursday, January 5, 2012

Two recent studies, funded by individual donations to the National Rosacea Society (NRS), have discovered potential key factors in the development of rosacea that open new possibilities for important advances in its treatment and prevention.

A malfunction in part of the body’s nervous system may be linked to the redness as well as the bumps and pimples of rosacea, according to a recently completed study by Dr. Akihiko Ikoma and colleagues at the University of California-San Francisco.

The investigators took blood and biopsy samples from members of 10 families in which some individuals had rosacea. Through innovative biochemical and genetic testing, they found those with rosacea suffered from irregularities in a variety of transient receptor potential (TRP) ion channels, which serve as prominent components of the nervous system. Because a variety of TRP channels can be activated by factors that trigger rosacea symptoms, the researchers noted, impaired functioning of these channels may play a critical role in the development of the disorder.

For example, TRPV1 is activated by capsaicin, a substance present in spicy food, as well as by heat or under inflammatory conditions. TRPV2 may play a role in innate immunity, inflammation and the sensing of heat. TRPV4 is also activated by moderate heat and may promote flushing, stinging and burning.

The researchers also found the immune system of those with subtype 1 (erythematotelangiectatic) rosacea, characterized by flushing and redness, showed significantly increased reactivity for TRPV2 and 3, as well as gene expression of TRPV1. Subtype 2 (papulopustular) rosacea, characterized by bumps and pimples, showed enhanced reactivity of the immune system for TRPV2 and 4, and had gene expression of TRPV2. These TRP nerve channels may therefore be promising targets in the development of future rosacea therapy, the researchers said.

In a separate study of 27 patients with subtype 1 rosacea, 18 with subtype 2 rosacea, 19 with photodamaged skin and prominent telangiectasia and 11 control subjects without rosacea or sun damage, Dr. Yolanda Helfrich, assistant professor at the University of Michigan, found that patients with subtype 1 rosacea had a greater number of mast cells that were discharging their contents than the control subjects.

Mast cells are found in skin tissue surrounding blood vessels and nerves, and release many mediators involved in rosacea, including histamine, associated with flushing. Since virtually all the mast cells in the rosacea patients were positive for interleukin 17, Dr. Helfrich noted that this cytokine – which plays a key role in development of rheumatoid arthritis and psoriasis – may also contribute to rosacea.

In addition, though some individuals with skin aging due to sun exposure also had prominent facial telangiectasia, she found significant biological differences between this group and those with rosacea, suggesting that the presence of visible blood vessels alone should not necessarily lead to a diagnosis of rosacea.

Holiday Coping Tips

Monday, December 19, 2011

The changing weather, combined with a social calendar packed with get-togethers and parties, can wreak havoc on rosacea. Here are some tips for navigating the holiday season successfully:

• Take care of yourself. A hectic schedule can lead to stress-induced flare-ups. Get plenty of rest, eat right, maintain a daily exercise routine and don't over-commit yourself.


• Follow your prescribed medical therapy. Now more than ever is the time to use your rosacea medication. Surveys have suggested that patients who use medication have greater success in maintaining remission of their signs and symptoms.


• Keep the kitchen cool. Holiday cooking can quickly heat up the kitchen and lead to a rosacea flare-up. Open the window. Keep a damp towel nearby to pat your face and take a break to a cooler part of the house when you can.


• Be vigilant about food and beverage triggers. Holiday parties often feature an array of tempting dishes, but avoid items that affect your condition. Patient surveys cite alcohol (especially red wine), heated beverages and spicy foods as particularly common rosacea triggers.


• Protect your skin. Holiday activities can mean a lot of running in and out of doors. Take care to protect your face with a scarf in cold or windy weather.

Reduce Stress Flare-Ups

Tuesday, December 6, 2011

Although emotional stress is reported to be one of the most common rosacea triggers, effective stress management can lead to a reduction in the number of stress-related flare-ups, according to results of a new National Rosacea Society (NRS) survey.

In the survey of 748 rosacea patients, 69 percent of the respondents said they experience a flare-up related to emotional stress at least once a month. Thirty-one percent said this happens every few days, while 14 percent said it happens once a week, 16 percent said it occurs every few weeks and 9 percent said once a month. Twenty-two percent reported a rosacea outbreak due to stress only every few months, and 5 percent noted a frequency of once a year. Only 5 percent said they had never experienced a stress-related flare-up.

"Emotional stress appears to be linked to a growing range of reactions in the body that have been increasingly shown to affect the skin, including flushing and inflammation,” said Dr. Richard Granstein, chairman of dermatology at Cornell University. “As a result, a great many rosacea patients should be able to benefit from either minimizing stressful situations or learning to modify their reactions to them.”

Family problems were the top causes of stress triggering a flare-up, cited by 49 percent of the survey respondents who had experienced a stress-related outbreak, followed closely by problems at work, named by 48 percent. Other common causes of stress included relationship problems, mentioned by 40 percent; financial concerns, cited by 38 percent; health problems, named by 33 percent; social events, 31 percent; criticism, 31 percent; uncertainty, 30 percent; public speaking, 27 percent; deadlines, 22 percent; and loss of a loved one, 18 percent.

Anxiety was the leading form of emotional stress, cited by 76 percent of the survey respondents, followed by worry, named by 63 percent. Other types of emotions mentioned included frustration, affecting 52 percent; anger, reported by 49 percent; embarrassment, 40 percent; fear, 27 percent; excitement, 23 percent; grief, 20 percent; indecision, 14 percent; and guilt, 13 percent.

The good news is that more than 67 percent of the survey respondents said they have been able to minimize the causes of stress and their reactions to stress to reduce their rosacea flare-ups. The NRS offers a “Rosacea Diary” that can help patients pinpoint which situations or reactions may be causing stress-related flare-ups. Once those are identified, patients can employ strategies to alter their activities as well as adopt techniques to reduce emotional stress, such as moderate exercise, cognitive therapy, relaxation or meditation routines.

“Stress can exacerbate a variety of health concerns, including rosacea, but medical therapy is also available to help rosacea patients keep their condition under control,” Dr. Granstein said. “Faithful compliance with prescribed therapy, coupled with stress-reduction techniques, can go a long way toward breaking the cycle of stress-related flare-ups.”

Fall Rosacea Review

Tuesday, November 22, 2011

The fall edition of Rosacea Review is now online at rosacea.org. This issue summarizes new results of medical research funded by the National Rosacea Society, and also offers advice to rosacea patients on the use of cosmetics to camouflage rosacea symptoms. Also highlighted are results of a patient survey showing that controlling stress can mean fewer rosacea outbreaks, as well as a summary of a new study that suggests there may be a potential new subset of rosacea that includes patients with prominent neurologic symptoms.

Other features include tips for dining out without flare-ups, Q&As on the possibility of relationships between rosacea and the inner ear, and rosacea and small intestinal bacteria overgrowth (SIBO), success story tips from readers and a new patient survey on the physical discomforts of rosacea.

Find Right Triggers

Monday, November 7, 2011

While medical therapy is an essential weapon in the battle against rosacea, identifying and avoiding the individual lifestyle and environmental factors that may aggravate the disorder can be a critical tactic to include in the arsenal. In National Rosacea Society (NRS) surveys of patients who pinpointed and steered clear of their personal rosacea triggers, more than 90 percent reported that this had reduced their rosacea flare-ups.

“In managing rosacea, it’s important for patients to know they do not have to avoid every potential trigger, because what may cause a flare-up in one person may not affect another,” said Dr. Lisa Maier, assistant professor of dermatology at the University of Michigan, during the annual meeting of the American Academy of Dermatology. “The key is to identify and avoid those specific factors that affect their individual cases.”

Although the array of potential rosacea triggers may be endless, some of the factors most commonly identified by rosacea patients include sun exposure (affecting 81 percent), emotional stress (affecting 79 percent), hot weather (75 percent), wind (57 percent), heavy exercise (56 percent), alcohol (52 percent) and spicy foods (45 percent). Other common triggers include cold weather, indoor heat, heated beverages, humidity, and certain skin-care and cosmetics products.

To help patients identify factors that affect their individual cases, the NRS offers a “Rosacea Diary.” 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 time, patients may identify which lifestyle and environmental factors to avoid in their particular case.

A new smartphone app is now available free online at app stores to help rosacea patients better manage their condition. The rosacea app acts as a personal journal with a “trigger tracker” section to identify triggers, and includes a “substitution finder” that suggests alternate foods and drinks that may be used in place of those causing flare-ups.

Patients can look for various ways to minimize their individual triggers, such as heat and cold weather. Use a scarf to protect against the wind and cold, and wear layered clothing to adjust from outdoors to inside. Avoid excessive indoor heat and do not sit next to a fireplace or hot stove. Some patients may also want to limit or avoid alcohol, especially red wine, during holiday festivities.

“Rosacea doesn’t have to take all of the enjoyment out of life,” Dr. Maier said. “Rosacea can be successfully managed by adhering to medical therapy and making the right lifestyle adjustments on an individual basis.”

New Subset for Rosacea?

Monday, October 24, 2011

Individuals with prominent neurologic symptoms might be considered a subset of rosacea, according to a report by Dr. Tiffany Scharschmidt and colleagues at the department of dermatology, University of California-San Francisco.¹

In their study of 14 rosacea patients, the researchers found that a high percentage had neurologic (43 percent) or neuropsychiatric (50 percent) conditions such as headache, depression, essential tremor and obsessive-compulsive disorder.

Rosacea is likely to have many causes, they explained, such as contributions from dysfunction of blood vessels as well as the innate immune system – the body’s own self-defense. Based on their clinical findings, they proposed that improper functioning in the nervous system may be comparably important in developing the symptoms of rosacea, and that the role of the nervous system may be a significant consideration for the optimal treatment of this disorder. Nerve dysregulation may contribute to rosacea via various mechanisms, they said, including the release of inflammatory chemical substances, vascular instability and nerve injury leading to symptoms of burning and stinging.

While these early findings are intriguing, this is a small sample size and points to the need for further study. They suggested that further research is needed to better define the underlying pathophysiologic characteristics and to identify additional effective treatment methods.

Reference:

1. Scharschmidt TC, Yost JM, Truong SV, et al. Neurogenic rosacea: a distinct clinical subtype requiring a modified approach to treatment. Arch Dermatol 2011;147:123-126.

Cosmetics and Therapy

Monday, October 10, 2011

The knowledgeable use of cosmetics combined with topical medication prescribed by your dermatologist can camouflage the embarrassing redness, bumps and pimples of rosacea with a smooth appearance while medical therapy works to minimize or banish the underlying condition.

“From both medical and appearance standpoints, it makes sense to apply medication before makeup,” said Dr. Zoe Draelos of Dermatology Consulting Services, who conducted a recent study to assess the use of facial cosmetics and topical rosacea therapy.¹ The new study found that most patients had a good cosmetic appearance after applying facial foundations following topical therapy, and their use did not cause rosacea symptoms to worsen.

In the study of 28 women with moderate rosacea by Dr. Draelos and colleagues, investigators gave a mean score of 9.4 out of 10 points for the subjects’ overall appearance after application of therapy followed by foundation for two weeks. The women were rated as equally at ease applying foundation after medication as they were when the study began. Moreover, after just the second week, only 18 of the participants continued to be classified as having moderate rosacea while the others were reclassified as mild.

“The high degree of patient acceptance of this therapeutic regimen could be expected to have a favorable effect on patient compliance and treatment outcomes,” the investigators noted.

“When considering or reading about the latest looks, the key for rosacea patients is to choose products that are appropriate for sensitive skin,” Dr. Draelos said. “In other words, be sure to avoid anything that stings, burns or causes irritation.”

She noted that using fragrance-free and allergy-tested products may reduce risk of skin irritation, and a patch test on a peripheral area like the neck may be useful before using a product on your face to determine whether a product affects your individual skin.

Although irritants can vary among individuals, reading the fine print on the product label may reveal ingredients that are common irritants. Liquid or semi-liquid products may contain such potential rosacea triggers as alcohol, witch hazel, menthol, peppermint and eucalyptus oil. For dry products, Dr. Draelos said, consider using mineral powder or eye shadow, which typically do not contain irritating ingredients.

“Cover-corrective makeup may be especially useful for individuals with more severe rosacea symptoms,” Dr. Draelos said. A sheer, green-tinted primer or foundation may be ideal as a base, followed by a yellow-toned powder to help further tone down the look of redness, she noted. Use a light touch when applying foundation, and you may want to use an antibacterial brush, she said, which can be washed easily, rather than a sponge or your fingertips.

“Always replace your cosmetics on a regular basis, about every three to six months,” she said. This will minimize the chance of contamination.

Reference

1. Draelos ZD, Colón LE, Preston N, et al. The appearance of facial foundation cosmetics applied after metronidazole gel 1%. Cutis 2011;87:251-259.

Research Grants Awarded

Thursday, September 22, 2011

The National Rosacea Society (NRS) has awarded funding for three new studies in addition to continuing support for five ongoing studies as part of its research grants program to increase knowledge and understanding of the potential causes and other key aspects of rosacea.

“We are pleased to award new grants for these additional avenues of rosacea research that may lead to important advances in its treatment and potential prevention or cure,” said Dr. Jonathan Wilkin, chairman of the NRS Medical Advisory Board, which selects grant applications for funding. “Studies to date have made significant progress toward the more effective control of this disorder, and we are grateful for the support of the many thousands of patients whose donations make these studies possible.”

Dr. Ferda Cevikbas, postdoctoral fellow at the University of California-San Francisco, and colleagues were awarded $25,000 to assess the role of PACAP, a neuropeptide that may affect rosacea. They plan to define the distribution of PACAP in skin samples from rosacea patients, determine whether PACAP induces inflammation and test whether cathelicidin – a known factor in rosacea’s pathophysiology – modulates the release of PACAP. The researchers also plan to test whether countering the effects of PACAP is beneficial and may thus be used as a rosacea therapy.

Dr. Edward Wladis, assistant professor of ophthalmology at Albany Medical College, was awarded $12,100 to identify specific cytokines – molecules that regulate the immune system – that are involved in ocular rosacea by studying eyelid tissue from individuals with and without the disorder. Dr. Wladis noted that while inflammation is normally a healthy part of the immune response, aberrations in the cytokines’ concentrations and functioning in rosacea may result in unhealthy prolonged inflammation.

This knowledge may have significant therapeutic implications for ocular rosacea, as medications have been designed to suppress specific cytokines. Dr. Wladis will also investigate the role of toll-like receptors (TLRs) – proteins that identify invading agents and alert the innate immune system to begin protective reactions.

Dr. Richard Granstein, chairman of dermatology at Cornell University, and colleagues were awarded $25,000 to study the potential role of Th17 cells, a newly discovered class of cells that appear to be involved in a number of inflammatory and autoimmune disorders. Earlier study results strongly indicated that release of ATP – a neurotransmitter and carrier of chemical energy throughout the body – from nerves under stressful situations may initiate a sequence of events leading to or exacerbating inflammation in the skin. This study will investigate whether this inflammation results because Th17 cells are produced during this process in rosacea.

The NRS is also continuing to fund studies by Dr. Richard Gallo and colleagues at the University of California-San Diego on the potential role of cathelicidins in rosacea; Dr. Joseph Rothnagel and colleagues at the University of Queensland, Australia, on kallikreins and rosacea; Dr. Thad Wilson and colleagues at Ohio University on nerve activity in rosacea; Dr. Aki Ikoma and colleagues at the University of California-San Francisco on the neurovascular system and rosacea; and Dr. Noreen Lacey and colleagues at the University College in Ireland on the effect of antibiotics on sebocyte cells in rosacea.