Another paper stemming from the partly NRS funded research into the role of cathelicidins and its role in rosacea. A lot of publicity and publications have resulted from Dr. Gallo’s research. This avenue of research into rosacea looks promising so lets hope that more resources target involved with this area of research.

Those that interested in the role that Vitamin D3 play in immunity should also read the excellent summary over at RSRP: Vitamin D3 ; "Recent studies suggest the importance of Vitamin D3 (Vit D3) in immunity. Vit D3 has been shown to promote the production of the human antimicrobial peptides, cathelicidins (LL-37), and cathelicidins have been found to have broad spectrum antimicrobial activity. Studies also suggest that it is unusual for bacteria to develop resistance to cathelicidins as they might from standard antibiotics."

Antimicrobial peptides and the skin immune defense system, Schauber J, Gallo RL., J Allergy Clin Immunol. 2008 Apr 24, Department of Dermatology and Allergology, Ludwig-Maximilians-University, Munich, Germany.

Our skin is constantly challenged by microbes but is rarely infected. Cutaneous production of antimicrobial peptides (AMPs) is a primary system for protection, and expression of some AMPs further increases in response to microbial invasion. Cathelicidins are unique AMPs that protect the skin through 2 distinct pathways: (1) direct antimicrobial activity and (2) initiation of a host response resulting in cytokine release, inflammation, angiogenesis, and reepithelialization. Cathelicidin dysfunction emerges as a central factor in the pathogenesis of several cutaneous diseases, including atopic dermatitis, in which cathelicidin is suppressed; rosacea, in which cathelicidin peptides are abnormally processed to forms that induce inflammation; and psoriasis, in which cathelicidin peptide converts self-DNA to a potent stimulus in an autoinflammatory cascade. Recent work identified vitamin D3 as a major factor involved in the regulation of cathelicidin. Therapies targeting control of cathelicidin and other AMPs might provide new approaches in the management of infectious and inflammatory skin diseases.

Another recent abstract is also promoting the synergy of Vitamin D3 and cathelicidins in opening doors for future research and discovery ; Vitamin D regulation of cathelicidin in the skin: toward a renaissance of vitamin D in dermatology?

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Metronidazole 0.75% gel vs. ketoconazole 2% cream in the treatment of facial seborrheic dermatitis: a randomized, double-blind study, D Seckin, O Gurbuz, O Akin, JEADV, Volume 21 Issue 3 Page 345-350, March 2007.

Background: Recently, two placebo-controlled studies have shown that topical metronidazole was effective in the treatment of seborrheic dermatitis.

Objective: To compare the efficacy and safety of metronidazole 0.75% gel with that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis.

Methods: A total of 60 consecutive patients with facial seborrheic dermatitis were included. Patients were randomized into two groups. One group used ketoconazole 2% cream with metronidazole gel as vehicle; the other group used metronidazole 0.75% gel with ketoconazole cream as vehicle for a 4-week treatment period. Main outcome measures were change in clinical severity scores, patients’ and investigator’s global evaluation of improvement and frequency of side-effects.

Results: All the assessments were made by an investigator who was unaware of which group the patients were allocated to. Mean percentage decrease in clinical severity scores from baseline to last available visit was 63.4% (95% CI 57.7–69) and 54.4% (95% CI 47.9–61) in the ketoconazole- and metronidazoletreated patients, respectively (P = 0.31). Eighty-two per cent of patients in the ketoconazole group vs. 79% of patients in the metronidazole group rated their global improvement as significant or moderate (P > 0.05). No statistically significant difference in the frequency of side-effects was detected between the two groups. The results of this study need to be confirmed in further studies involving large numbers of patients.

Conclusion: Our data demonstrated that metronidazole 0.75% gel had a comparable efficacy and safety profile with that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis.

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• Sebclair for seborrheic dermatitis
• Malassezia Globosa causes seborrhea, Pyrithione Zinc is effective

This product sounds quite interesting for rosacea and rosacea/SD sufferers. Little information about Sebclair is currently available on the internet.

Seblair (MAS064D) is approved for use in the European Union to treat seborrheic dermatitis. One of Sebclair’s claim to fame is that it contains no corticosteroids or immunomodulating agents. The paper’s authors admit that it is difficult to know which compound is responsible for Sebclair’s success as a treatment.

The authors state “We believe that the major activity is probably due to the synergistic effect of both piroctone olamine, for its antimycotic action, and glycyrrhetinic acid, for its anti-inflammatory action.”

Sebclair Ingredients

The following descriptions of each ingredient is supplied in the full text of the paper.

Alglycera is a compound combining the anti-inflammatory properties of glycyrrhetinic acid and the keratolytic properties of allantoin.

Glycyrrhetinic acid, extracted from the licorice root, exhibits anti-inflammatory properties in different organs in several animal models,
with a potency similar to that of indomethacine. Its chemical structure is similar to that of cortisone and has been shown to potentiate the action of hydrocortisone

Piroctone olamine is an antimycotic effective against Malassezia spp.

The standardized extract of V. vinifera (grapevine) in Sebclair contains 40% of epigallocatechin gallate, a proanthocyanidine that prevents oxidative damage to the endothelium, with maintenance of optimal blood supply. It works as an antioxidant synergistically with telmesteine and Vitamin E.

Shea butter, from Butyrospermum parkii, is composed of tryglycerides and fatty acids, including linoleic acid, rich in phytosterols and tocopherols. The action of shea butter is enhanced by isohexedecane, another emollient present in the formulation.

If you live in the EU and suffer from SD, please do let us know how you like Sebclair, but leaving a comment below.

Treatment of mild to moderate seborrhoeic dermatitis with MAS064D (Sebclair), a novel topical medical device: results of a pilot, randomized, double-blind, controlled trial, J Eur Acad Dermatol Venereol. 2008 Mar;22(3):290-6. S Veraldi, A Menter, M Innocenti, Institute of Dermatological Sciences, University of Milan, IRCCS Foundation, Policlinico, Mangiagalli and Regina Elena Hospital, Milan, Italy; Baylor University Medical Centre, Dallas, TX, USA, European Institute of Dermatology, Milan, Italy

Aim: MAS064D (Sebclair) is a novel steroid-free cream containing multiple active ingredients. Objective of this pilot study was to evaluate the efficacy and safety of MAS064D in the treatment of mild to moderate SD of the face.
Methods: Patients (n= 60) with SD were randomized to receive MAS064D (n= 40) or a matching vehicle (n = 20). The primary study endpoint was investigators’ global assessment (IGA) score at day 28, compared with baseline. Secondary endpoints included: IGA score at day 14; investigators’ assessment of erythema and scaling; patients’ assessment of burning/stinging, pruritus and global response to MAS064D; resort to rescue medication; quality of life.
Results: Use of MAS064D for 4 weeks was associated with a higher percentage of success in the MAS064D group than in the vehicle group (~68% vs 11%, P < 0.0001). The effects of MAS064D were significantly better than those of vehicle for investigator-assessed erythema and scaling, and patients’ assessed pruritus and global response to MAS064D (P ≤ 0.01). No patient in the MAS064D
group required rescue medication, compared with two patients in the vehicle group. Four patients (two each in the MAS064D and vehicle groups) reported a total of six non-serious adverse events.
Conclusions: MAS064D appears to be an effective and well tolerated cream for the treatment of mild to moderate SD of the face. Further clinical evaluation of MAS064D in SD is warranted.

Sinclair Pharma: Sebclair

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What would be interesting to explore further would be what causes the SIBO. Could that cause point back to something triggering papules and pustules ?

If you view the AbstractPlus you will see that SIBO has been linked by the same team to Scleroderma, abnormalities in acromegaly, and IBS.

Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication ,Clin Gastroenterol Hepatol. 2008 May 2, Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi AU, Savarino V.

Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy.

….

CONCLUSIONS: This study demonstrated that rosacea patients have a significantly higher SIBO prevalence than controls. Moreover, eradication of SIBO induced an almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.

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• 100mg doxycycline no better than oracea
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Update: there is a thread over a the forum SIBO diet/treatment, where Artist mentions that Rifaximin doesn’t leave the gut so doesn’t directly have any effect on the skin. This leads to the question of what inflammation has it blocked and what can we prove that this means ?

On a related note Seth Kendall speculates in his paper Remission of rosacea induced by reduction of gut transit time, that

“It is possible that intestinal bacteria are capable of plasma kallikrein–kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones.”

Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine ( Pinus pinaster  ssp.  atlantica ), which is grown in coastal south-west France. Pycnogenol® contains oligomeric proanthocyanidins (OPCs) as well as several other bioflavonoids: catechin, epicatechin, phenolic fruit acids (such as ferulic acid and caffeic acid), and taxifolin. Procyanidins are oligometric catechins found at high concentrations in red wine, grapes, cocoa, cranberries, apples, and some supplements such as Pycnogenol®.

From Pine bark extract is a potent antioxidant, and may help boost the effects of vitamin C and other antioxidants, UC Berkeley scientists report

BERKELEY — An extract of pine bark has proven to be one of the most potent antioxidants, a property that may explain why pine bark has been used in folk medicine around the world, according to a new report by scientists at the University of California, Berkeley.

Lester Packer and his colleagues at UC Berkeley screened many natural compounds for antioxidant activity and found that pine bark extract, marketed as Pycnogenol® (pik-nah-je-nal), is the most potent of the lot.

Antioxidants are chemicals that deactivate free radicals — highly destructive chemicals that damage cells and contribute to many diseases, ranging from stroke and heart attacks to degenerative diseases such as Alzheimer’s. Free radicals even contribute to aging.

In the past year and a half, Packer and his colleagues have documented a number of strong antioxidant effects of Pycnogenol that place it among the most potent antioxidants, ranking with vitamins E and C, and lipoic acid.

Packer also recently found that Pycnogenol extends the lifetime of vitamin C in the body, prolonging its beneficial effects as an antioxidant.

I just noticed that Derma E Skin Care is selling Pycnogenol Redness Reducing Serum. This is a topical product that also contains some interesting looking ingredients such as aloe, calendula and arnica montana extract.

Water (Aqua), Glycerin, Macadamia Ternifolia Seed Oil, Aloe Barbadensis Leaf Extract, Cetearyl Alcohol, Ceteareth 20, Caprylic/Capric Triglyceride, Panthenol, Allantoin, Pinus Pinaster (Pycnogenol®) Bark Extract, Epilobium Angustifolium (Canadian Willowherb™) Extract, Olea Europaea (Olive) Leaf Extract, Calendula Officinalis Flower Extract, Arnica Montana Flower Extract (6C), Alteromonas Ferment (Abyssine® 657) Extract, Xanthan Gum, Simmondsia Chinensis (Jojoba) Seed Oil, Ammonium Acryloyldimethyltaurate/VP Copolymer (Aristoflex®), Phenoxyethanol, Ethylhexylglycerin, Potassium Sorbate.

If anyone gets to try this product please do leave us a comment below. I will be interested to know if pycnogenol is effective in a topical or whether it is better as a supplement.

Featured Product

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• Read all the Rosacea Support Group User Reviews

For product manufactured prior to July 2007

Clarisonic is voluntarily recalling Clarisonic handles and chargers in response to product safety concerns. The issue is limited to the product’s internal components, not to its effect on the skin. In some instances, the Clarisonic handle or charger can overheat, with the potential for injury or even catching fire. While there are no reports of serious injury or property damage, and the reported incidence rate has been less than 1 in 10,000, we are choosing to act with an abundance of caution.

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European Regulatory Authority (EMEA) Recommends Granting Of Marketing Authorization For MediGene’s Drug Oracea

MediGene AG announced that the European Medicines Agency (EMEA) Committee for Medicinal Products for Human Use (CHMP) has concluded the approval procedures for Oracea for the treatment of rosacea by issuing a positive opinion. The formal marketing authorization by the European Commission is therefore expected within the next few weeks.

I find it hard to get excited about Oracea press releases. Do we really need all this hooplah about just another antibiotic ? I sometimes feel that Oracea is a bit of a straw tower. Surely everyone out there knows that you can just take a similar dose of generic doxycycline and get the same benefits for a fraction of the cost ? Rather than just continue to be a bit grumpy, here are some reasons that I think Oracea might actually be a good thing for rosacea sufferers.

Low Dose Doxycycline: because of the development and testing of Oracea the concept of a low dose, or sub-antibiotic dose of doxycycline has come to prominence. Proving that it was still possible to get a therapeutic benefit from a low dose has been an achievement. The documented reduction in side effects from a low dose was also worth proving.

Benefits targeted at rosacea: The makers of Oracea, Collagenex previously held a patent related to another low dose doxycycline called Periostat. This drug was mainly prescribed for gum disease. Much of the supporting research around Periostat was motivated by treating gum disease. Periostat could be used to treat rosacea, but that would be off-label - something that some doctors would avoid. The patent relating to Periostat expired, so Collagenex looked to create a replacement product.

Oracea was developed from the start as a treatment for rosacea. Thus we now have some research telling us what dose is considered to be `low-dose doxycycline’, what benefits can be expected for rosacea sufferers and also proof of the long term safety.

Further R&D possible: by purchasing Oracea in large volumes, rosacea sufferers are sending a message to the parent company (Collagenex, which is now owned by Galderma) that this is a market that is worth investing in. Collagenex currently has another drug for rosacea in test: COL-118, or Sansrosa as it is also known. If profits from Oracea are channeled into new ground breaking drugs then that is obviously good for all rosacea sufferers.

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Google hasn’t found any clues to IDP-115 or Dow Pharmaceutical Sciences. If you know anything more about this product, please leave a comment below.

From Clinical Trial NCT00667173

A Clinical Study Evaluating the Safety and Efficacy of IDP-115 in Patients With Rosacea. The purpose of this study is to assess the safety and effectiveness of IDP-115 in treating patients with rosacea.

Rosacea is a common, progressive and often misunderstood disease. We hope that you find some useful resources on this site.

On this site you will find hundreds of news and research items. Use the Articles links on the left hand side to find a link and short description of the areas of interest to you. You may also like to checkout the User Reviews and Fact Sheets for some more detailed information. Feel free to leave a comment or two.

There are also 2 related forums you can join to connect with other rosacea sufferers. Firstly there is the rosacea-support Yahoo!Group that uses email and also the online Rosacea Support Forum. The email group is fully moderated to prevent SPAM, whilst the forum is a fast and fun place to connect for those who prefer a bulletin board service.

Again, welcome ! We are really happy to see Rosacea get some mainstream media attention.

According to their web site, Rosacea Relief contains, “Proprietary blend of Barbadensis vulgaris (aloe vera), Hamamelis virginiana (witch hazel), Melaleuca alternifolia (tea tree) oil, and other natural ingredients.”

See her post at the Rosacea Support Forum - Free 1 oz Sample of Rosacea Relief for more information.

In a special promotion tied to one of this year’s goals of helping as many people as possible improve their skin, and knowing how each individual’s skin varies, we are offering a free sample of our Rosacea Relief. The sample comes in 1 oz which will provide approximately 15 applications, if not more.

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