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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.

New Grants Available

Monday, July 27, 2009

New grants are available from the National Rosacea Society (NRS) to support research on potential causes and other key aspects of rosacea that may lead to improvements in its treatment and potential cure or prevention. Medical researchers can obtain application forms by contacting the National Rosacea Society, 800 South Northwest Highway, Suite 200, Barrington, Illinois 60010, telephone 888/662-5874, fax 847/382-5567, e-mail rosaceas@aol.com or by filling out the request form here.

The deadline for submitting applications is November 15, 2009. Grants will be issued following selection by the NRS medical advisory board.

Because the etiology of rosacea is unknown, a high priority in awarding grants will be given to studies relating to such areas as the pathogenesis, progression, mechanism of action, cell biology and potential genetic factors of rosacea. Research in such areas as epidemiology, predisposition, quality of life and relationships with environmental and lifestyle factors may also be funded.

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

Trigger Aids Research

Friday, July 10, 2009

The same biochemical process that causes people to flush when alarmed or embarrassed may be linked to the development of rosacea, according to findings presented by Dr. Richard Granstein, chairman of dermatology at Cornell University, during the recent Society for Investigative Dermatology annual meeting.

"By exploring the potential inflammatory pathways associated with common triggers of rosacea signs and symptoms, we hope to increase our biological understanding of what causes the disorder and how it progresses," Dr. Granstein said. "Such knowledge can then provide a basis for developing improvements in its treatment and control."

In research funded by the National Rosacea Society, Dr. Granstein and colleagues found that emotional stress, a common rosacea trigger, may activate the sympathetic nervous system with the release of adenosine triphosphate (ATP) from sympathetic nerves running throughout the skin’s blood vessels. In turn, the researchers discovered that ATP can induce a cascade of biochemical events within the body that may play a role in the inflammation of subtype 2 (papulopustular) rosacea.

"ATP may act as a messenger within the nervous system to regulate blood flow to the skin by signaling the dilation of blood vessels after exposure to various rosacea triggers, such as emotional stress," Dr. Granstein said.

He noted that flushing may ultimately be prompted by the nerves surrounding the blood vessels of the skin. These dermal vessels are associated with nerves containing substances such as the calcitonin gene-related peptide (CGRP), which dilate the vessels and thus may be associated with facial redness and the growth of the tiny blood vessels called telangiectasia, both signs of subtype 1 (erythematotelangiectatic) rosacea.

Upon investigating the potential significance of CGRP in prompting subtype 1 signs and symptoms, the researchers found that CGRP may play the opposite role in inflammation -- the bumps and pimples characteristic of subtype 2 rosacea. In recent tests, Dr. Granstein and colleagues observed that CGRP inhibits the stimulated release of certain chemokines (small proteins that recruit inflammatory cells) from the cells lining skin blood vessels (endothelial cells).

These results suggest that while the nerves containing CGRP may be linked to flushing, they may also serve to regulate inflammation by modulating chemokine production by the cells lining the blood vessels.

"Although there is still much work to be done to fully examine and define this complex process, substances that block or enhance the individual components of such pathways may ultimately lead to the effective control or prevention of rosacea," Dr. Granstein said.

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