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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.

Experts Answer Questions

Wednesday, April 16, 2008

A new question-and-answer section called Ask the Doctors is now featured on Rosacea.org. Leading dermatologists, ophthalmologists, researchers and other experts will answer a wide variety of readers' questions about rosacea, from potential causes to skin care and lifestyle factors. An interactive form on the home page of the new section makes it easy to submit questions, and new questions will be posted every month. In addition, all entries will be archived, creating another important resource for rosacea patients. To view the new Ask the Doctors section, click here.

Rosacea Awareness Month

Tuesday, April 1, 2008

While rosacea has grown increasingly common as the baby boom generation enters the most susceptible ages, mounting evidence has shown that this conspicuous red-faced disorder may be more devastating and prevalent than widely believed. The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to alert the public to this chronic and often embarrassing condition now estimated to affect well over 14 million Americans.

"Although the image of a blushing bride may inspire feelings of warmth and endearment, if the redness persists it can be an early sign of rosacea," said Dr. Richard Odom, professor of dermatology, University of California - San Francisco. "Often the initial signs will come and go, but without proper care and treatment the disorder can grow progressively more persistent and severe, with potentially serious consequences both physically and on people's emotional, social and professional lives."

In NRS surveys of more than 1,200 rosacea patients, 76 percent said rosacea's effect on their personal appearance had lowered their self-confidence and self-esteem; 69 percent felt embarrassed; and 63 percent reported difficulty in establishing new relationships because of the condition. Of those who described their rosacea as severe, 94 percent said it had damaged their self-confidence, and 77 percent reported that it had diminished their outlook on life.

"Public awareness is especially important because the disorder is far more common than many people realize," Dr. Odom said. "Anyone with signs of rosacea should seek medical help and protective measures before it becomes increasingly intrusive on their daily life."

In preliminary study results presented at the NRS research workshop during the Society for Investigative Dermatology annual meeting, researchers found that nearly one in 10 American women had rosacea to some degree, and the rate was 16 percent among Caucasians only. Presented by Dr. Alexa Boer Kimball, director of the clinical unit for research in skin care at Harvard Medical School, the study was based on examination of high-resolution digital photographs of 2,933 women aged 10 to 70 who volunteered from the general population.

She noted that subtype 1 (erythematotelangiectatic) rosacea, characterized by facial redness, affected nearly 15 percent of the Caucasian women, compared to 1.5 percent who had the bumps and pimples of subtype 2 (papulopustular) rosacea.

Although it is often more severe in men, rosacea has been found to occur up to three times more frequently in women and can affect individuals of all ages and ethnic backgrounds. In a recent NRS survey of 1,391 rosacea patients, 44 percent said the disorder first appeared between the ages of 30 and 50, while 39 percent reported that the condition began after age 50 and for 17 percent it developed before age 30.

"The good news is that while rosacea cannot be cured, it can be effectively controlled with medical therapy, lifestyle changes and proper skin care," Dr. Odom 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.

Because the underlying causes and other key aspects of rosacea are unknown, the NRS conducts a research grants program to encourage and support greater scientific knowledge of this poorly understood disorder. The society is now funding a growing number of research studies on rosacea that may lead to improvements in its treatment, management and potential cure or prevention.

Update on Angiogenesis

Wednesday, March 19, 2008

Results of two recent studies provide new understanding of how and when angiogenesis -- the formation of new blood vessels -- may contribute both to the initial development of rosacea and its persistent presence.

In a study of skin samples with and without rosacea, Dr. Amal Gomaa and colleagues at Boston University found evidence of angiogenesis in both the blood and lymphatic circulatory systems in skin with rosacea lesions. ^[1]

While the development of visible blood vessels, called telangiectasia, has long been recognized in rosacea, evidence of lymphatic vessel growth has not been previously reported, the researchers said. They also noted that study results suggested lymphatic involvement occurs at the beginning of the disease rather than later in its progress. The lymphatic circulatory system consists of vessels that carry a clear liquid that bathes the tissues of the body and may fight infection.

"Our study may highlight new players in the pathogenesis of rosacea," the researchers said in the article. They pointed out that the lymphatic angiogenesis was not expected as no patient had facial swelling, but that the findings support the long-held belief that the lymphatic system is involved in the process of skin inflammation.

The researchers also noted that increased expression of vascular endothelial growth factor (VEGF), which plays a role in angiogenesis, was found only in rosacea-affected skin samples. Interestingly, the study found no difference in VEGF levels between subtype 1 (erythematotelangiectatic) rosacea, characterized by facial redness, and subtype 2, (papulopustular) rosacea, characterized by bumps and pimples, which suggests that telangiectasia may be present in each.

In another study of affected and unaffected skin, Dr. Kyriaki Aroni and colleagues of the University of Athens studied the potential role of angiogenesis and mast cells in rosacea. ^[2]

"It seems increasingly possible that rosacea pathology is a multifactorial process, which opens up areas of research with regard to potential links between different contributing factors," the researchers said. Mast cells, connective tissue cells that release chemical substances in response to injury or allergic reaction, are known to augment inflammatory processes and occur in increased numbers in conditions associated with angiogenesis.

In their study of 69 rosacea patients, the researchers found that the number of mast cells was significantly higher in skin with rosacea, especially later in the disease, suggesting that the cells may be involved in the longer duration of rosacea. They pointed out that rhinophyma (enlargement of the nose), usually a later manifestation of rosacea, is also characterized by increased numbers of mast cells.

References
1. Gomaa AHA, Yaar M, Eyada MMK, Bhawan J. Lymphangiogenesis and angiogenesis in non-phymatous rosacea. Journal of Cutaneous Pathology 2007;34:748-753.
2. Aroni K, Tsagroni E, Kavantzas N, Patsouris E, Ioannidis E. A study of the pathogenesis of rosacea: how angiogenesis and mast cells may participate in a complex multifactorial process. Archives of Dermatological Research DOI: 10.1007/s00403-007-08162.

Rosacea in Children

Thursday, March 6, 2008

Although rosacea rarely appears in children, its potential occurrence should be considered during medical examinations because of the possible severity of ocular (eye) involvement, according to a report in the February 2008 issue of the Archives of Dermatology. Researchers Dr. Mélanie Chamaillard and colleagues at the National Reference Center for Rare Skin Disorders, Bordeaux, France, suggested that an ophthalmologic (eye) examination be carried out for all children with skin signs of rosacea.

The signs and symptoms of ocular rosacea in children may be frequently underdiagnosed or misdiagnosed, the researchers said. They examined the records of 20 children with rosacea from 1½ to 14 years old, and noted that though most had minor ocular involvement, five had more serious eye manifestations that if undetected could lead to severe infection and visual impairment.

Reference
Chamaillard M, Mortemousque B, Boralevi F, Marques da Costa C, Aitali F, Taïeb A, Léauté-Labrèze C. Cutaneous and ocular signs of childhood rosacea. Archives of Dermatology 2008;144:167-171.