The update mentions the `Gallo Research’ and describes it ; “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.”

Spin-off research related to type I interferon, plasmacytoid dendritic cells and enzyme involvement is also underway.

A possible link between flushing and inflammation via endothelin-converting enzyme (ECE) is being studied and gets a mention.

Finally the role of G and beta-arrestin proteins in a particular type of flushing and the demodex bacteria Bacillus oleronius are also discussed.

Check out the full rosacea research update for more information.

More Background

Also see the related Rosacea News items around these some of these studies:

demodex bacteria, one baby step at a time

demodex mite bacteria causes the inflammation ?

Focus on cathelicidin and its role in rosacea

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From 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.

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Sadly there was no conclusion as to whether the extra incidence of sunburn contributed to the severity of their rosacea or if the rosacea symptoms lead to more sunburn events.

Sunburn Linked to Rosacea

Both a blistering sunburn and a family history of rosacea were associated with the presence of rosacea, according to study results presented by Dr. Alexa Boer Kimball, associate professor of dermatology at Harvard Medical School, at the recent annual meeting of the American Academy of Dermatology.

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While it was not clear whether sunburns contributed to rosacea or patients with rosacea were more likely to sunburn, she said, preventive measures could help lessen rosacea’s severity. Sun has been named the top flare-up trigger by 81 percent of patients in a National Rosacea Society survey (NRS), and in another NRS survey nearly 52 percent said someone else in their family had rosacea.

I think any possible thought that sun damage can cause rosacea is enough to highlight the fact that rosacea sufferers should use a sunscreen every day. A daily sunscreen will also help mitigate any weakness in the skin’s natural protection that might be caused by the diseased skin of rosacea.

Many rosacea sufferers find that physical sunscreens i.e. those that contain zinc oxide or titanium dioxide as their main protective agent can work quite well to protect against the sun and elements. Additionally tinted sunscreens can also help hide the redness often associated with rosacea.

[Update] The presentation from Dr. Kimball is available online: STUDY FINDS FAMILY HISTORY, HIGHER INCIDENCE OF SUNBURNS ASSOCIATED WITH ROSACEA

Whilst no link was found between body mass index and rosacea, Dr. Kimball notes “Future studies should explore the possible connection between a higher BMI and rosacea, as excess weight could be found to be a contributing factor to the condition.” This is worth considering as a possible contributing factor to rosacea – perhaps being overweight places and extra burden on our bodies and could cause problems with increasing our tendency to flush for eg.

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• Dr. Richard Gallo, who has received a lot of press coverage from the research on the role of cathelicidins, and Dr. Kenshi Yamasaki of the Veterans Medical Research Foundation were awarded $25,000 to continue their NRS-funded research of how cathelicidins may play a role in the development of subtype 2 (papulopustular) rosacea.
• Dr. Curdin Conrad, senior postdoctoral research fellow, Department of Immunology, MD Anderson Cancer Center, and Dr. Alexander Navarini, senior postdoctoral research fellow, Department of Dermatology, University Hospital of Zurich, Switzerland, were awarded $21,450 to study the role of plasmacytoid dendritic cells and interferon alpha in rosacea.
• Dr. Robert W. Walters, assistant professor, Division of Dermatology, and Dr. Robert J. Lefkowitz, professor, Department of Medicine, Duke University Medical Center, were awarded $25,000 to study the role of beta-arrestin in cutaneous flushing. The researchers pointed out that niacin, or vitamin B3, long associated with severe flushing, stimulates receptors on skin cells that react by activating both G and beta-arrestin proteins. However, they noted that a recent study has identified niacin-like drugs that can stimulate only the G protein but do not induce flushing, suggesting that it is the beta-arrestins that may regulate flushing. The results of the new project are intended to lead to better understanding of changes in skin blood flow and possible treatments for this significant symptom of rosacea.
• Dr. Joseph Rothnagel, associate professor, and Dr. Manuela Trabi, adjunct lecturer, Department of Molecular and Microbial Sciences, The University of Queensland, Australia, were awarded $18,000 for their study, "The role of tissue kallikreins in rosacea." This study will also build from the work of Dr. Gallo and colleagues. They noted that these previous studies reported involvement of the enzyme hK5 and protein CAP18, and hypothesize that at least one other enzyme is also elevated in rosacea. They will study whether proteins known to be crucial for skin integrity are also digested at a higher than normal rate by these enzymes, allowing easier access for pathogens.

Congratulations to the successful applicants.

If you would like to directly donate to rosacea research, just visit the NRS Donate to Research page. All donations received via the NRS web site are automatically directed towards their research program. You may also designate donations towards their research program by noting so on your check.

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From Taking Science Personally;

What makes the story of the Michael J. Fox Foundation different — nay, what makes it important — is that it doesn’t just dole out money to scientists and hope for the best. It has used its money to take control of Parkinson’s research like few other foundations have ever done. In the process of trying to solve the mysteries of Parkinson’s, it has upended the way scientific research is done, and the way academics interact with pharmaceutical and biotech companies, at least in its little corner of the world. It demands accountability and information sharing that is almost unheard of in the broad scientific community. And it has managed to become, in its short seven-year life, the most credible voice on Parkinson’s research in the world.

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They all use their money, unabashedly, as weaponry, to finance targeted research, hold conferences where scientists must share information and underwrite clinical trials conducted by drug companies. They are hard not to admire.

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Meanwhile, the Fox Foundation wanted a change: in how it financed research, and what kind of research it financed. Instead of simply doling out money for a certain period of time — and hoping for the best — it began to keep closer track of researchers, using its money to accelerate research that was going well, or shift direction if it wasn’t. It expected its researchers to report problems and progress. It established markers and other goals that researchers were expected to meet. It insisted that the money it gave went very specifically to research that was directly related to Parkinson’s — and it was unafraid to finance risky ideas. “We throw 100 ideas up against the wall,” Ms. Brooks said. “One of the most important things we do is de-risk ideas” — and in so doing make them more palatable for industry and other researchers to pursue.

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A few years later, Ms. Brooks and Mr. Fox made another important shift. Instead of relying on the scientific advisory board to make “yea” or “nay” decisions on grants, it decided to hire its own Ph.D.’s. It now has six in-house scientists. The Ph.D.’s allow the foundation to move faster still, since it no longer has to wait for the scientific advisory board to meet to make decisions. But it has other benefits as well: the Fox scientists are young, early enough in their careers that they are not set in their ways. There are perfectly happy to ask different kinds of questions and do things in a different way. In effect, they have allowed the Michael J. Fox Foundation to not just pursue important research already being done, but also to set the agenda for research it thinks ought to be pursued. And that is what has happened.

I find this really interesting. It obviously helps to have a rich contributor like ex Intel boss Andy Grove, but nonetheless a fresh approach to keenly develop treatments is working for Parkinson’s Disease.

I’m also reminded of the efforts of Lance Armstrong who is returning to professional racing next season with the primary idea of advancing his cancer foundation.

These sorts of approaches certainly differ from what we see in rosacea, where rosacea sufferers are for eg. left waiting for a bigpharma company to push through a product like sansrosa.

I’m also impressed with the idea to employ your own Ph.Ds. After reading what I can of the last few year’s worth of rosacea research I do sometimes wonder just who exactly is undertaking truly forward thinking research.

Over to you:

What are your thoughts ? Do you think rosacea research needs an overhaul from the current thinking and way of doing things ? Are we missing a motivated celebrity sufferer to head up our cause ?

My wife believes that our 10-year-old son might have rosacea. She is a sufferer, and he flushes a lot and has a lot of pimple-like bumps. Do children get rosacea?

While rare, cases of rosacea during childhood have been reported in the medical literature. Whether your son has rosacea or not, he may benefit from seeing a dermatologist for a proper examination, diagnosis and treatment as may be appropriate.

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Also, if your son experiences any eye discomfort, make sure the doctor is informed of this as ocular rosacea may be especially important to identify and treat during childhood.

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Although the two disorders are unrelated, a recent clinical study found that 26 percent of patients with rosacea also had facial seborrheic dermatitis and 28 percent had seborrheic dermatitis of the scalp. Additionally, a survey by the National Rosacea Society of 1,100 rosacea patients found that 25 percent had also been diagnosed with this condition.

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When seborrheic dermatitis appears with rosacea, a safe and effective antifungal alone may often be prescribed because the long-term use of topical steroids is associated with rosacea-like symptoms. This condition is known as steroid-induced rosacea. Treatment of seborrheic dermatitis of the scalp may include medicated anti-dandruff shampoos.

Rosacea patients who suspect they may have this disorder are urged to see a dermatologist for diagnosis and appropriate treatment.

Nothing too ground breaking, but it is good to see the NRS writing about SD as it is so common for rosacea sufferers.

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`What guidelines should I follow regarding contacts if I have ocular rosacea? Response by Dr. Marian Macsai, vice chairman of ophthalmology at Northwestern University.’

Dr. Macsai’s advice includes comments about soft lenses, using a hydrogen peroxide cleansing fluid, the possible use of artificial tears and having a good eye hygiene routine. The recommendations also include finding a specialist who is familiar with ocular rosacea and ensuring that your corneal surface is closely monitored.

As an aside, I have recently changed to using AO Sept, which is a `hydrogen peroxide + catalyst’ based cleanser. Even though I don’t have ocular rosacea symptoms I do find that the lenses are cleaner than ever and I’m enjoying wearing them more.

Related reading from Dr. Mannis

Also worth reading is background from Dr. Mannis – wearing contact lenses and ocular rosacea. This article is one of the best ocular rosacea and contact lens resources you can find online. Dr. Mannis is well known to rosacea sufferers as a contributor to the Standard Classification of Rosacea as well as contributing to a question and answer session with members of rosacea-support.

More Background

Dr. Mannis and Dr. Macsai have also published research together including the hard-to-find 1996 hardcover, Eye and Skin Disease. Thankfully for rosacea sufferers, we can read the extensive  Chapter 41 Acne Rosacea online.

This book has been described as “The most extensive text/atlas to date on eye and skin diseases, this volume is two books in one–it is both a full and detailed clinical reference and a superb full-color photographic atlas. It provides rapid and reliable access to definitive diagnostic and management guidelines for ophthalmic dysfunction related to dermatologic disease.”

Plenty of background reading there, hope you find these links helpful.

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So reading that aim you will understand that the AARS will promote and discuss the well established and proven mainstream treatment options for rosacea.

These guidelines have also been published as American Acne & Rosacea Society rosacea medical management guidelines, J Drugs Dermatol. 2008 Jun;7(6):531-3

The AARS have a distinguished group of professionals listed as their Officers, Directors and Chairmen. Their stated overall aim is to provide information about the quality of life of rosacea sufferers and to promote the available research-supported treatments.

An interesting quote from their Disease State Fundamentals: “There is no definitive evidence that rosacea is caused by a microbial pathogen, such as a bacterium, parasite or virus.”

The topical treatment listing contains the usual suspects: sulfacetamide/sulfur, metronidazole, azelaic acid – but also mentions benzoyl peroxide/clindamycin 1% as well as the controversial topical permethrin as a treatment for rosacea that was diagnosed as demodex folliciulitis based.

The discussed oral treatments mention the well known agents anti-inflammatory dose doxycycline, the tetracycline family, and accutane. Skin care such as a gentle cleanser and moisturizer along with a sunscreen also gets a mention.

So the guidelines are a good description of what the published research supports as rosacea treatments. Whilst many rosacea suffers may want to look outside the standard regime for rosacea treatments, this management guideline will be useful for establishing a baseline to educate sufferers and practitioners.

There are plenty of other rosacea treatment regimes that do show promise such as IPL and laser. Given that the AARS will only promote treatments that FDA approved (and based on phase 3 trials), I think it is unlikely that we will see these sorts of alternative therapies discussed by the AARS.

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Just click on Reader Survey and you will be taken to a survey where you will be asked questions like ;

• Which areas of research are you most interested in supporting?
• Which potential causes of rosacea do you think merit the most research?
• Which kinds of products are important to develop?
• Which kinds of products need improvement?

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