Yes you read correctly, some recent research conducted in the UK has found that smoking is associated with a substantially reduced risk of developing rosacea.

The study was epidemiological which means that it used statistics to match the incidence of rosacea in smokers and non-smokers in a random grouping of individuals.

Why Are Smokers Much Less Likely to get Rosacea?

Typically an epidemiological study can’t say why such associations exist, only prove their existence. It is the task of further research to establish the reason and any subsequent implications for treatment etc.

Other Nicotine and Rosacea Research

We learnt in 2008 from some NRS funded research that “The activation of nicotine receptors appeared to be associated with a significant increase in intracellular calcium, and also stimulated two major signaling proteins that may trigger a cascade of biochemical reactions associated with rosacea.”

So there will certainly be some debate about what the statically significant reduction in rosacea is smokers in the UK really means.

Other Results in This Study

• Rosacea has been diagnosed in the UK in 1.65 / 1000 person-years. By my calculation this would translate to around 13% of the population of the UK having rosacea by the time they reach the life expectancy of 80 years.
• Rosacea was diagnosed in 80% of cases after the sufferer was 30 years of age.
• Ocular Rosacea was found in 21% of cases of rosacea.
• Alcohol consumption was associated with a marginal risk increase.

As the study was funded by Galderma perhaps the incidence results would be the most interesting outcomes for them.

Latest Abstract

A Study on the Epidemiology of Rosacea in the UK.

Br J Dermatol. 2012 May 5, Spoendlin J, Voegel JJ, Jick SS, Meier CR.

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland Hospital Pharmacy, University Hospital Basel, Switzerland Galderma Research & Development, Sophia Antipolis, France Boston Collaborative Drug Surveillance Program, Boston University, Lexington, MA, USA.

Background: Rosacea is a chronic facial skin disease of unclear origin. Epidemiological data are scarce and controversial with reported prevalences ranging from 0.09% to 22%. To our knowledge, incidence rates have not been quantified before.

Objectives: In this observational study we quantified incidence rates of diagnosed rosacea in the UK and described demographic characteristics and the prevalence of ocular symptoms in rosacea patients. We compared life-style factors such as smoking and alcohol consumption between rosacea patients and controls.

Methods: Using the UK-based General Practice Research Database, we identified patients with an incident diagnosis of rosacea between 1995 and 2009 and matched them (1:1) to rosacea-free control patients. We assessed person-time of all patients at risk and assessed incidence rates of rosacea, stratified by age, sex, year of the diagnosis, and region.

Results: We identified 60,042 rosacea cases and 60,042 controls (61.5% women). The overall incidence rate for diagnosed rosacea in the UK was 1.65 / 1,000 person-years.

Rosacea was diagnosed in some 80% of cases after the age of 30 years. Ocular symptoms were recorded in 20.8% of cases at the index date. We observed a significantly reduced relative risk of developing rosacea among current smokers (odds ratio 0.64, 95% CI 0.62-0.67). Alcohol consumption was associated with a marginal risk increase.

Conclusions: We quantified incidence rates and characteristics of rosacea patients diagnosed in clinical practice in a large epidemiological study using primary care data from the UK. Smoking was associated with a substantially reduced risk of developing rosacea.

Not Time to Take up Smoking

Despite the strong result from this statistical research, I doubt whether any doctor would recommend that you take up rosacea to reduce your chances of getting rosacea.

In fact you will probably find the opposite, that the health risks associated with smoking will see doctors advising smokers to give up altogether.

Any Smokers Out There?

Have you noticed a reduction in rosacea symptoms when you were a smoker ?

Related Articles

• Smoking and rosacea

Most published abstracts are a pretty dry read. This one is about as dry as they come. How about titling it “Rosacea Sufferers Willing To Pay Less than Vitiligo, Even the Women!”. Now that makes it sound more interesting right? Well that is the gist of this paper.

Researchers have come up with the idea of quantifying the burden one feels from a disease by asking sufferers how much they would be will to spend to achieve complete healing. Apparently this sort of quantification measure is a well established method.

Rosacea sufferers were found to be willing to pay on average € 2,880 or $USD 3,700.

Vitiligo sufferers on the other hand were found to be willing to spend € 7,360 or $USD 9,400.

Surprising Result?

The suggestion that vitiligo sufferers would be willing to pay 3 times as much as rosacea sufferers to achieve a cure surprised me.

Whilst vitiligo is no doubt unsightly in the worst cases, rosacea is equally if not harder to handle psychologically. Also some forms of rosacea, for example neurogenic rosacea can be quite debilitating.

Get Your Theoretical Cheque Book Out

At your worst, what would you have been willing to expend to get rid of your rosacea ?

Willingness to pay and quality of life in patients with rosacea.

J Eur Acad Dermatol Venereol. 2012 May 14, Beikert FC, Langenbruch AK, Radtke MA, Augustin M., IVDP – Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Germany.

Background: Rosacea is a chronic inflammatory dermatosis affecting >2% of the population. Willingness to pay (WTP) is a well established method which reflects the individual burden of disease.

Objectives: Evaluation of WTP and quality of life (QoL) in patients with rosacea.

Methods: Nationwide postal survey on adult patients with rosacea affiliated with the German rosacea patient advocacy group. WTP was evaluated by three standardized items and compared to historical data on vitiligo (n = 1023). QoL was assessed using the Dermatology Life Quality Index (DLQI).

Results: Data from n = 475 rosacea patients (79.9% women, mean age 56.3, range 26-90) were analysed. On average, patients were willing to pay € 2880 (median € 500) for complete healing compared with € 7360 (median € 3000) in vitiligo.

Relative WTP was higher in women; the highest sums were registered for the age group 21-30 years.

The extent of facial involvement predicted a higher relative WTP, whereas WTP decreased with the duration of symptoms and age.

Mean DLQI total score was 4.3 compared to 7.0 in vitiligo.

In rosacea, the highest values were observed in patients < 30 years. Severe QoL reductions (DLQI>10) were less frequent (11%) than in vitiligo (24.6%).

The correlation between WTP and DLQI was significant (e.g. r = 0.249, P = 0.000 for relative WTP).

Conclusion: Rosacea patients show a moderate WTP and average QoL reduction is mild. WTP proved to be a valid tool to assess patients’ burden of disease. Patient education and the development of effective treatment options might still improve patients’ satisfaction.

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What is crowdsourcing?

Well crowdsourcing is a new buzzword which basically means to get your information from the “crowd” or as many people as you can. Online this term generally means something like “just asking everyone on the email list” or “post to that forum where thousands will see it”.

The premise of the paper is that over time, the authors hope that online groups will become the source of high volume, high quality clinical trial data.

Large scale clinical trials are extremely expensive. There may well be scope for survey based trials to become cheaper and more convenient by using online sites like curetogether.com

CureTogether Rosacea Section

Indeed curetogether.com does have a small rosacea section where you can list your symptom severity in order to gain a score and compare yourself to other members. Around 180 members have listed their symptoms thus;

(click for larger image)

Other Related Research

I did also find a somewhat related interesting project based at CureTogether;

The Skin Disease Race is ON!

CureTogether is excited to announce a new research project we’re collaborating on. Researchers Suephy Chen, Adam Sperduto, and Bob Swerlick at Emory University are doing a study to compare whether online recruiting methods can beat their traditional in-clinic recruiting methods.

Abstract

Letter: Crowdsourcing for research data collection in rosacea

April W Armstrong MD MPH, Caitlin T Harskamp BA, Safia Cheeney MS, Clayton W Schupp PhD

Dermatology Online Journal 18 (3): 15

Abstract: Several medical crowdsourcing sites are available to patients online, but few studies in the literature have compared crowdsourced data to clinical trials. Herein, we compare data from rosacea patients from a major medical crowdsourcing site with those from randomized controlled trials.

Crowdsourcing in medical research is the process of outsourcing health-related data collection to groups of people or communities. Crowdsourced data have the potential to inform clinicians on treatment effectiveness in real-world patient populations. Although several medical crowdsourcing sites are available to patients online, few studies in the literature have compared crowdsourced data to clinical trials [1, 2]. In this study, we examined how data from rosacea patients from a major medical crowdsourcing site, CureTogether (curetogether.com), compare those from randomized controlled trials.

…

Whereas limitations of the currently available crowdsourced data include low numbers of patient responses, unspecified medication dosages and duration, and unknown medication adherence rates, improvements in crowdsourcing over time will likely enable collection of high-volume, high-quality data that reflect real-world patient experiences.

Furthermore, different outcomes measures used on the crowdsourcing site from those in the clinical trials inhibit direct comparison of the treatment responses.

For example, whereas lesion count or Investigator Global Assessment was used in the clinical trials, Likert scale was used on the crowdsourcing site. Thus, innovations in deploying validated measures for crowdsourcing – although still enticing the online users – will be key to collect high-quality crowdsourced data. In summary, crowdsourcing has the potential to yield high-volume data from diverse patient populations. With future improvements in the standardization of data collection, crowdsourcing could provide valuable insight into real-world treatment effectiveness.

The positive results from the study were based on the participants own clinical subject signs ie. how they rated their own stinging, discomfort, tightening and heat sensations. Uriage Thermal Water was able to show a statistically significant reduction in stinging sensations.

We are not told about any results for any reduction in the objective measures: erythema, edema and scaling. Even though the poster title mentions Facial Redness, the quoted results don’t specifically mention any reduction in erythema.

I’d say these results are on the weak side but could be interesting for those who want to try something like UTW.

Poster reference number 5011

Facial redness: Diagnosis and adjuvant topical use of thermal water in a series of 232 cases

American Academy of Dermatology 70th Annual Meeting, March 16–20, 2012, San Diego, California. Poster Abstracts, Supplement to JAAD, April 2012, Volume 66, Number 4.

Marius Anton Ionescu, MD, PhD, Dermatology Polyclinic, Saint-Louis Hospital, Paris, France; Luc Lefeuvre, PhD, Laboratoires Dermatologiques d’Uriage, Courbevoie, France; Michel Bohbot, PhD, Laboratoires Dermatologiques d‘Uriage, Courbevoie, France

Background: Uriage thermal water (UTW) is prescribed as topical adjuvant in post laser treatments or in chronic skin conditions as rosacea, atopic dermatitis.

Purpose: To assess the dermatologic entities included usually in the term of ‘‘facial red skin’’ and the benefit of UTW in the management of these conditions.

Methods: This open multicenter study (51 dermatologists) included adult patients consulting for a facial inflammatory, irritant or allergic skin condition (‘‘red skin’’).

UTW was prescribed in monotherapy or in association with dermocosmetic care or medical treatment. UTWwas applied for 4 weeks, with 2 examinations (baseline and week 4).

Clinical subjective criteria (stinging, discomfort, ‘‘tightening,’’ and ‘‘heat’’ sensations) and objective (erythema, edema, and scaling) were followed (scores from 0 [absent] to 4 [severe]).

Results: We included 232 patients, 81.6% female, 18.3% male, mean age 44. Fitzpatrick phototypes were: II, 50.2%; III, 35.9%; I and IV, 13.9%. The diagnosis and indications for the use of UTW were: rosacea 36.2%, postlaser 14.3%, seborrheic dermatitis 11.4%, post-dermosurgery procedure (peeling, fillers, electrocoagulation, and phototherapy) 10.5%, contact dermatitis 15.7%, atopic dermatitis 4.8%, postdermatologic treatment (AHA or isotretinoin) 3.3%, other 3.8%. UTW was prescribed in monotherapy in 52% of cases and in association with other treatments in 48%.

Clinical subjective signs were significantly improved after UTW use in monotherapy at week 4 compared to baseline (P<.001).

Self-assessment showed an improvement of ‘‘stinging’’ sensations in 80% of patients and a ‘‘soothing sensation’’ in 87%.

Skin tolerance was good to excellent in 96.6% of cases.

Conclusion: In this series of 232 patients with a diagnosis of ‘‘facial red skin’’ (postlaser, rosacea, or seborrheic dermatitis), UTW decreased significantly clinical subjective signs (P<.001).

Commercial support: 100% by Laboratoires Dermatologiques d’Uriage.

Related Articles

La Roche Posay is one of the skincare brands owned by L’Oreal. La Roche Posay may be known to rosacea sufferers through the actually little-known Rosaliac UV Fortifying Anti-Redness Moisturizer.

Poster reference number 4680

Clinical usefulness of a product developed for sensitive and allergy prone skin

American Academy of Dermatology 70th Annual Meeting, March 16–20, 2012, San Diego, California. Poster Abstracts, Supplement to JAAD, April 2012, Volume 66, Number 4.

Sophie Seite, PhD, La Roche-Posay Dermatological Laboratories, Asnieres, France; Andre Rougier, PhD, La Roche-Posay Dermatological Laboratories, Asnieres, France; Florence Benech, PharmD, L’Oreal Research & Innovation, Chevilly Larue, France; Muriel Bayer-Vanmoen, PhD, L’Oreal Research & Innovation, Chevilly Larue, France; Sophie Veyrat, PharmD, L’Oreal Research & Innovation, Chevilly Larue, France

Sensitive skin as described by the patients is an extremely polymorphous symptomatology with subjective complaints of discomfort (burning, stinging, and itching) with or without visible signs (erythema and desquamation) up to allergy.

The present study evaluates the benefits of a specially developed product for patients with sensitive or pathologic skin.

Having taken the battery of safety testing including repeated insult patch test, use tests on patients with sensitive skin or with a medical history of sensitivity to at least 2 allergens of the European standard series, the product was evaluated first in 41 women with sensitive skin (positive to a lactic acid stinging test) then in 102 women with atopy prone (n = 49) or with erythrocouperosis/rosacea prone (n = 53) skin.

They all applied the product twice daily for 4 weeks.

Evaluation at baseline and after 4 weeks included stinging test, Sensiscore questionnaire, clinical grading with a 9-point scale and self-evaluation questionnaire of skin reactivity with a 5-point scale.

In the second test, clinical grading of functional signs and of physical signs using a 4-point scale and self evaluation of reactivity to exogenous factors via a 10-cm visual analog scale were performed at the same times.

A good tolerance was noticed together with a significant reduction of physical and functional symptoms of skin reactivity at the end of the 4-week treatment as well as a reduction of skin reactivity in both studies.

Commercial Support: La Roche-Posay Dermatological Laboratories Asnieres France.

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The following Poster Session from the 2012 AAD meeting in San Diego aimed to raise the profile of the use of sulphur as a treatment in rosacea. Did you know that Sulfur was first proposed as a treatment for rosacea in 1855 !

I wasn’t aware that sulphur was able to kill demodex mites, this is news to me. I do have to wonder, though, why such a common element, available as a demodex treatment since 1955, it was not tested when researchers published a list of How to Kill Demodex Mites. I would want to see further proof of this first.

Those interested in trying an easy to obtain topical sulphur treatment, have a look at Prosacea or even Rosacea-LTD. Prescription preparations worth looking at include: Clarifoam EF, Klaron and Rosanil. Plexion has been discontinued in early 2011.

An Underrated Treatment ?

I am impressed with how well Prosacea is liked. This cheap and easily available treatment seems to be well received, especially for the usual papules and pustules of rosacea. I was also a fan or the Sulfur based Rosacea-LTD as well.

This poster session is a good reminder to re-examine topical sulfur.

Poster Session 5503

Sulphur for rosacea: Are we reinventing the wheel?

American Academy of Dermatology 70th Annual Meeting, March 16–20, 2012, San Diego, California. Poster Abstracts, Supplement to JAAD, April 2012, Volume 66, Number 4.

Catherine McKay, MBBS, Skin and Cancer Foundation, Darlinghurst, Australia; Keiron Leslie, MD, Department of Dermatology, San Francisco, CA, United States; Leone Snowden, NSW Medicines Information Centre, Darlinghurst, Australia; Margot Whitfeld, MBBS, Department of Dermatology, Darlinghurst, CA, United States

Rosacea is a common, chronic inflammatory facial condition that affects approximately 13 million individuals in the United States alone. It has been a human affliction since time immemorial. Despite this, the pathogenesis remains largely unclear.

Cutaneous Demodex mites, altered vascular reactivity, alcohol ingestion, Helicobacter pylori, and Staphylococcus epidermidis have all been implicated.

The therapeutic armamentarium to treat rosacea is extensive, and some rosacea remedies date back to before the Middle Ages. Sulphur, as a treatment for cutaneous disease, was described in the Ebers Papyrus, an ancient Egyptian medical scroll, dated circa 1550 BC.

James Morris in Lancet describes the first effective sulphur containing formulation to treat rosacea in 1855. This was followed by a modification of the Danish formula, originally used to treat scabies, by Ayers and Ayers in 1932. This formulation contained 11% sublimed sulphur.

In the 1950s, 10% sulphur with 5% Peruvian balsam was used for Demodex-associated eruptions. Modern sulphur containing formulations for rosacea incorporate 10% sodium sulfacetamide combined with 5% sulphur. The new foam formulations are easier to apply and exude fewer odors.

Antiseptic, antibacterial, and antifungal properties have been attributed to sulphur. These antibacterial properties have been demonstrated against Propionibacterium acnes, some Streptococci, and Staphylococcus aureus.

Sulphur has also been shown to kill Demodex mites, which have been implicated as a possible causative factor in rosacea.

In recent times, sulphur has declined in popularity, largely because of its odor.

With the emergence of antibacterial resistance to other agents, as well as sensitivity to other topical antibiotics, topical sulphur has once again become a useful therapeutic option.

We have translated these older formulations into modern recipes that can be compounded today.

The aim of this poster is to remind the modern dermatologist of a safe, affordable and currently underused ‘‘remedy’’ for the treatment of an age old dermatologic condition.

Commercial support: None identified.

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Powell has been a consultant dermatologist at the Mater Private Hospital in Dublin, Ireland for 25 years. He has received rosacea research grants from the NRS, has been on the Medical Advisory Board of the NRS since 2000 and was also a co-author of the ground-breakingStandard Classification of Rosacea and the companion Standard Granding System for Rosacea.

Even though you may not have been able to sit in on the discussion, you can still benefit from reading his book.

Scientific Sessions

American Academy of Dermatology, 70th Annual Meeting

D013 Rosacea

Director: Frank C. Powell, M.D.

Following this discussion group, the attendee should be able to:

1. Recognize the clinical spectrum of rosacea.
2. Select the appropriate treatment for each subtype of rosacea.
3. Discuss current research and etiologic theories relating to rosacea.

This discussion group will begin with a review of the historical background of rosacea.

The clinical spectrum of what constitutes rosacea will be presented with emphasis on the importance of distinguishing the different subtypes of this disorder.

Treatment options will be outlined with practitioners guided to the most appropriate therapeutic approach to each subtype of rosacea.

The discussion group will then focus on current research and etiologic theories relating to each subtype of the disorder with the potential for new therapeutic approaches to be developed.

Related Book

Available at Amazon.com

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For some background on Prof. Powell and his research into rosacea, see the 3 articles;

• Rosacea Sufferers Less Interested in Alternative Medicine
• Demodex Mite Bacteria Causes the Inflammation ? 
• Rosacea: Its All In The Follicles !

No searching could find a product from L’Oreal that contained the following ingredients;

• palmitoyl tripeptide-8
• epurea extract
• bisabolol
• caffeine
• zinc gluconate

So it would appear that this is a new product under development from L’Oreal. This is potentially very good news for rosacea sufferers.

If you find the name of this product please let us all know in the comments below.

Rosacea sufferers will be aware that Rosacea heavyweight Galderma started life in 1981 as a joint venture between L’Oreal and Nestle.

Poster Session 5554

Clinical evaluation of the effectiveness and tolerance of a facial lotion on subjects with rosacea

American Academy of Dermatology 70th Annual Meeting, March 16–20, 2012, San Diego, California. Poster Abstracts, Supplement to JAAD, April 2012, Volume 66, Number 4.

Susana Raab, L’Oreal Research and Innovation, Clark, NJ, United States; Christian Oresajo, L’Oreal Research and Innovation, Clark, NJ, United States; Margarita Yatskayer, L’Oreal Research and Innovation, Clark, NJ, United States; Zoe Draelos, MD, Duke University School of Medicine, Durham, NC, United States

Background: Rosacea is a chronic skin condition involving inflammation of the cheeks, nose, chin, and forehead. It causes redness, flushing, and inflammatory papules. Subjects with rosacea have sensitive skin that is easily irritated by skin care products. There is a need for a topical product that reduces the signs and symptoms of rosacea without exacerbating the disease.

Methods: This study evaluates a facial lotion formulated with palmitoyl tripeptide-8, epurea extract, bisabolol, caffeine and zinc gluconate, in female volunteers with mild to moderate facial rosacea and the presence of a minimum of three inflammatory papules.

This clinical study included 50 female subjects between the ages of 25 and 60 with evaluations at baseline, postapplication, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after product application.

For the duration of the study, volunteers used the facial lotion twice daily, and continued using any rosacea medications provided the type and dosage was stable for 3 months prior to study participation.

Evaluations were performed by a board-certified dermatologist and included objective and subjective tolerance grading, clinical efficacy grading of facial skin attributes for redness, flushing, smoothness, radiance, skin tone evenness, overall appearance, and rosacea severity using a 5-point ordinal scale.

Lesion counts, noninvasive bioinstrumentation to assess transepidermal water loss (TEWL), hydration and skin redness, subject self-assessment questionnaires, and digital photography were also included in the study.

Results: The results of this study showed significant improvements in redness, flushing, smoothness, radiance, overall appearance and
rosacea severity. The results showed a significant reduction in lesion count at all time points when compared to baseline.

There was a statistically significant drop in facial redness at week 4 and the TEWL measurements remained steady throughout the study demonstrating that the lotion is a gentle to the skin. Tolerance evaluations indicated the facial lotion was well tolerated by the study  panel.

Commercial support: 100% is sponsored by L’Oreal Research and Innovation.

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Cathelicidin has been in the rosacea news since around 2002, gaining publicity because of the discoveries like the fact that rosacea sufferers have abnormally high levels of cathelicidin in their facial skin.

Previous research has also attempted to explain how Finacea works in rosacea as well as understanding how metrogel works.

Doxycycline Indirectly Inhibits Proteolytic Activation of Tryptic Kallikrein-Related Peptidases and Activation of Cathelicidin.

J Invest Dermatol. 2012 Feb 16.

Kanada KN, Nakatsuji T, Gallo RL.

The increased abundance and activity of cathelicidin and kallikrein 5 (KLK5), a predominant trypsin-like serine protease (TLSP) in the stratum corneum, have been implicated in the pathogenesis of rosacea, a disorder treated by the use of low-dose doxycycline. Here we hypothesized that doxycycline can inhibit activation of tryptic KLKs through an indirect mechanism by inhibition of matrix metalloproteinases (MMPs) in keratinocytes.

The capacity of doxycycline to directly inhibit enzyme activity was measured in surface collections of human facial skin and extracts of cultured keratinocytes by fluorescence polarization assay against fluorogenic substrates specific for MMPs or TLSPs. Doxycycline did inhibit MMP activity but did not directly inhibit serine protease activity against a fluorogenic substrate specific for TLSPs.

However, when doxycycline or other MMP inhibitors were added to live keratinocytes during the production of tryptic KLKs, this treatment indirectly resulted in decreased TLSP activity.

Furthermore, doxycycline under these conditions inhibited the generation of the cathelicidin peptide LL-37 from its precursor protein hCAP18, a process dependent on KLK activity.

These results demonstrate that doxycycline can prevent cathelicidin activation, and suggest a previously unknown mechanism of action for doxycycline through inhibiting generation of active cathelicidin peptides.

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• Ferritin positive cells are much more prevalent in rosacea sufferers
• Severe rosacea sufferers have significantly more ferritin positive cells
• Blood peroxide levels are higher in rosacea sufferers
• Total anti-oxidative levels are significantly lower in rosacea patients

The conclusion of the paper is that exposure to UV light results in ferritin positive cells that are fundamental to the resulting oxidative stress.

What is Oxidative Stress?

Oxidative stress has to do with the amount of reactive oxygen species present in our bodies. When there are too many, damage to cell components result.

In broad terms, antioxidants are helpful when the balance is wrong and too many ROS are present.

It is a complicated science; oxidative stress has been linked to many diseases and needs to carefully dissected to understand any real implications for a particular disease.

We do know that rosacea is the end result of an inflammatory pathway. We need to describe the entire system before we can say that we have rosacea licked.

The role of oxidative stress and iron in pathophysiology of rosacea

Lijec Vjesn. 2011 Jul-Aug;133(7-8):288-91.

[Article in Croatian], Tisma VS, Poljak-Blazi M., Poliklinicki odjel za kozne i spolne bolesti, KB Dubrava, Zagreb.

Rosacea is a common skin disease of unknown etiology.

The aim of the present paper is to explain the role of oxidative stress triggered by UV light and iron metabolism in the pathophysiology of rosacea.

It was recently described that the number of ferritin positive cells was significantly higher in skin samples of rosacea patients compared to controls of healthy skin samples.

The presence of ferritin was significantly higher in patients with the severe stage of disease. In addition, serum peroxide levels were significantly higher and serum total antioxidative potential levels were significantly lower in rosacea patients than in healthy controls.

These results support the role of oxidative stress and affected metabolism of iron in etiology of rosacea.

The higher presence of ferritin in skin cells of rosacea patients explains the exacerbation of symptoms by exposure to UV light, that releases ferritin free iron, which is fundamental in the generation of oxidative stress.

This paper appears to be a followup to a 2009 paper , Oxidative stress and ferritin expression in the skin of patients with rosacea, J Am Acad Dermatol. 2009 Feb;60(2):270-6.

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