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Awareness Month in April

Thursday, February 4, 2010

Although the number of people with rosacea continues to rise with the growth and aging of the U.S. population, most fail to recognize the warning signs of this potentially life-disruptive disorder now estimated to affect well over 14 million Americans. The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to alert the public to the signs and symptoms of this chronic and conspicuous facial condition and to emphasize the importance of seeking medical help.

“The early signs of rosacea are often overlooked because they are easily mistaken for something else and tend to come and go," said Dr. John Wolf, chairman of dermatology at Baylor University. "Unfortunately, without medical treatment the effects of rosacea usually persist and may become increasingly severe. Through greater public awareness, more individuals should seek early diagnosis and treatment before the condition becomes a serious intrusion on their emotional, social and professional lives."

In an effort to reach the growing number of rosacea sufferers, public education activities will be conducted by the NRS to increase awareness and understanding of this widespread disorder, emphasizing the warning signs and urging those who suspect they may have rosacea 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, the primary signs of rosacea may include flushing or transient erythema (redness), persistent or nontransient 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.

“While rosacea can cause physical discomfort for many patients, the emotional pain from its effect on personal appearance may be far worse for many more,” Dr. Wolf said. “Fortunately, long-term medical therapy, along with avoidance of lifestyle and environmental factors that exacerbate the condition in individual cases, can effectively control the signs and symptoms of this disorder.”

For more information, visit All About Rosacea.

Rosacea on Television

Thursday, January 28, 2010

Rosacea is the featured topic of a recent segment on ABC-TV’s Good Morning America Health. Dr. Doris Day, clinical assistant professor of dermatology at New York University, discusses signs and symptoms of the disorder as well as treatment options and avoidance of triggers.

To watch the entire interview, click here.

Effects of Heat in Winter

Thursday, January 21, 2010

Heat often brings on the signs and symptoms of rosacea, and this can be a problem even in the frosty winter months, according to a recent National Rosacea Society survey of 424 rosacea patients.

Overly warm rooms, common in winter, often induce rosacea flare-ups, as 56 percent of survey respondents said indoor heat had caused an outbreak. Hot baths, another frequent antidote for chilly winter days, were a temperature-related trigger for 53 percent, while the heat generated by heavy exercise caused a flare-up in 55 percent. Other heat-related triggers included the hot beverages favored by many after a foray into the cold, cited by 42 percent of the respondents, as well as the ubiquitous heavy clothing of winter, named by 31 percent.

“While medical therapy is fundamental in managing rosacea, avoidance of lifestyle or environmental factors that trigger flare-ups in individual cases is also crucial,” said Dr. Lisa Maier, associate professor of dermatology at the University of Michigan. “Patients who both comply with medical therapy and avoid their individual triggers are much more likely to maintain remission of their rosacea symptoms.”

Respondents indicated they make an effort to avoid temperature-related flare-ups as much as possible. The biggest behavioral change reported was in the way people bathe: Seventy-three percent of the respondents said they always or sometimes bathe or shower in cooler water since their rosacea diagnosis. Sixty-seven percent said they frequently or sometimes leave a heated room in an effort to avoid a flare-up.

The sun and warm weather were nearly universal heat-related rosacea triggers identified by the survey, both cited by 81 percent of the respondents. Menopausal hot flashes were another common source of heat-related flare-ups for 26 percent.

Rosacea.org offers an extensive list of common rosacea triggers, as well as tools for identifying and avoiding them.

Flushing Cause Uncovered

Monday, January 11, 2010

Researchers have now identified the molecular pathway for flushing caused by niacin -- also known as vitamin B3 or nicotinic acid, and found in many foods -- according to a study recently completed by Dr. Robert Walters and colleagues at Duke University and funded by the National Rosacea Society (NRS). The new findings may lead to future improvements in the treatment or prevention of rosacea, which is commonly associated with flushing.

"So little is known about the flushing responses in rosacea, and the first step toward their control is to understand the nature of their causes," Dr. Walters said. "Since niacin is often a trigger factor for flushing, it was important to investigate this response at the molecular level."

He noted that this substance is an essential vitamin found in an extensive range of foods, including foods reported to trigger rosacea flare-ups in some individuals, such as beef liver, yeast, avocadoes and spinach. While niacin deficiency leads to pellagra -- a disease associated with skin problems, weakness and dementia -- he noted that it has also been associated with severe flushing in individuals taking large amounts as a supplement.

The researchers studied this process in microscopic cultures of cells and found that when one of the body’s niacin receptors -- cell surface protein GPR109A -- is stimulated, both G-proteins and beta-arrestin proteins are activated. A receptor is a cellular structure that accepts the molecular structure of a specific chemical agent, and then acts on nervous tissue to produce a physiological response.

In the new study, the investigators found that niacin-like drugs stimulating only G-proteins do not induce flushing, suggesting that it is instead the beta-arrestins that cause the flushing. The beta-arrestins were further implicated when it was observed that they are required for activation of the enzyme cPLA₂, which produces molecules that act directly on blood vessels in the skin to increase blood flow. As final proof, beta-arrestin activated by niacin was demonstrated to be a requirement for the flushing to occur.

"By defining the molecular pathway for flushing that begins with niacin, new therapies might be developed to block this process," Dr. Walters said. He noted that other causes of flushing may utilize the same pathway, suggesting it could also be an important mechanism for flushing in general.

More information on the NRS research grants program may be found in the Research Grants section.

Survey on Future Content

Thursday, December 10, 2009

CLICK HERE TO TAKE THE SURVEY

The National Rosacea Society constantly strives to provide relevant, accurate and up-to-date information on all aspects of this widespread disorder. To help make Rosacea.org as useful as possible, please give us your input on current and possible future content. The information you provide will serve as a guide for the continuing expansion of the site. Thank you very much for your help.

To take the survey, click here.

Fall Rosacea Review

Thursday, November 19, 2009

The Fall Rosacea Review is now online. This issue announces the publication of new standard patient care options developed by a consensus committee of 26 rosacea experts as well as results of ongoing research that is increasing medical understanding of the disorder. Also highlighted is new evidence that rosacea patients may be more prone to allergies than the general population and results of a recent survey on the use of oral antibiotics for rosacea.

Other features include tips for managing stressful times, Q&As, a new success story and a new patient survey on the signs of rosacea.

Advice on Looking Your Best

Thursday, November 12, 2009

The best offense against a common skin problem such as rosacea is a strong defense, according to Charla Krupp, noted beauty expert and best-selling author, in offering some "makeup makeover" tips and other advice to help rosacea sufferers look their best.

One of the first and most important steps a rosacea patient should take is to ask his or her dermatologist for help in formulating a skin-care plan as early in treatment as possible, Ms. Krupp said. "The average woman spends $100 on beauty products each month, and trial and error is just too expensive." Facial cleansers and makeup often contain additives such as fragrances, peppermint and alcohol, which are frequently cited as rosacea triggers, she said. "But there are plenty of products without these ingredients, so make sure to read the labels before primping."

A variety of makeup brands offer products with a green tint that can help counteract the appearance of redness, Ms. Krupp said. She suggested using gel or cream makeup formulations to create a "dewy" look that hides blemishes and wrinkles. Because many rosacea patients suffer from eye irritation or extremely sensitive skin, Ms. Krupp recommended using eye pencils instead of liquid eyeliner and water-based mascara instead of waterproof mascara for easier removal.

Makeup brushes that are cleaned frequently are a better choice than sponge applicators, and replacing makeup every three to six months will also minimize contaminants, she said. Ms. Krupp noted that clothing can also play a role in helping rosacea patients optimize their appearance. She advised choosing "red-reducing" colors such as yellows and blues and avoiding red, white and black, all of which emphasize a red face. In addition, she emphasized the benefits of long scarves, which can serve double duty as both a fashion accessory and a shield against the wind on wintry days.

A "bad skin day" doesn’t have to turn into a disaster, Ms. Krupp said. "If you have a flare-up despite your commitment to following a rosacea-friendly routine, get over it and treat yourself. I recommend a manicure or pedicure, a massage or even buying a new top."

For more beauty advice, visit Makeup Tips and Rosacea Relief Squad.

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.

Summer Rosacea Review

Tuesday, August 25, 2009

The Summer Rosacea Review is now online. This issue highlights the National Rosacea Society’s efforts to increase awareness of the condition, as well as new study results on the potential link between emotional stress and rosacea. Also covered are results of a recent survey showing the need for greater education, plus expert beauty advice for looking your best at all times.

Other features include tips for avoiding summer flare-ups, Q&As on menopause and whether rosacea is contagious, a new success story and a new patient survey on rosacea and oral antibiotics.