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.

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 another NRS-funded study, Dr. Robert Walters and Dr. Robert Lefkowitz at Duke University are investigating the roles of G and beta-arrestin proteins in the flushing triggered by niacin, a common rosacea trigger.

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.