Colin Dahl on Rosacea Research

[David Pascoe]

Colin Dahl is known to rosacea sufferers as the Chief Scientist from Australian Sciences. Australian Sciences released a document A Practical Understanding of Rosacea, Part 1: Heat Regulation and the Warm Room Flush Phenomenon that generated some good discussions around the thoughts about flushing that he introduced us to. (See Warm Room Flush: PDF released from Australian Sciences for the original thread where Colin Dahl discusses the document and also answers questions.) Now, two years later, the author has kindly agreed to answer some questions to update us on what he has been up to since then. Thanks indeed for your time and insights, Mr. Dahl.


1. Would you like to give us an insight into how and why you became a researcher?

My story starts like many people with Rosacea. I tried most of the conventional treatments over about a 3 year period in an attempt to stop the facial flushing that was tormenting my daily life. During this time I also read whatever literature was available for Rosacea (medical texts, published papers and Rosacea websites) in an attempt to better understand Rosacea, because at the time I was very confused.

By the end of this period I lost faith in the medical community and the treatments they were prescribing for Rosacea, with the exception of IPL/Laser, which after several sessions had noticeably helped reduce facial flushing intensity, but even so I was still suffering from facial flushing on a regular basis.

I then decided to leave my work in project management and over the next two years began researching Rosacea on a full time basis. It was my wonderful mother who instilled in me a sense of confidence and that I could do anything so long as I worked hard enough. So the decision to embark on full time research was a simple one, and I began to work harder than I had ever worked before.

During this time I was conducting vasodilation (blood vessel and nerve based) experimentation, trying to better understand the exact mechanisms of facial flushing. It wasn’t easy at the start and I was on a big learning curve. The cost of experimentation was sometimes difficult to grasp. I recall one of my early experiments required a chemical (a specific neuro-peptide inhibitor) that cost me about $25K to get produced.

At the end of this period I could see the experimentation was yielding some promising discoveries, so I decided to formalize the research and with a group of supportive investors, started Australian Sciences and the research continued with other researchers both within Australian Sciences and external university researchers.

2. What do you see as the good and bad points about researching rosacea?

Bad points:

Most of the medical and research literature on Rosacea was not very useful. The lack of understanding at all levels also made researching and finding research partners difficult. In the early years of Australian Sciences we tried to find research collaborators, so we approached a few universities and hospitals. I recall meeting the head of dermatology at a major hospital who said “I cure Rosacea everyday”. I quickly asked him how he does it. He replied “I use topical Antimicrobials”. Needless to say, we didn’t collaborate with this particular hospital.

In terms of my own research, it took me approximately 6 years of research and experimentation to get what I consider to be a good understanding of Rosacea, and a further 2 years to finally develop an approach to reverse it. I wish it didn’t take so long!

Good points:

I was able to use the knowledge gained through research and experimentation to reverse my own Rosacea to the point where I now feel like a normal person. Sometimes I like to think that this information has helped and will continue to help other people too. Also, the Rosacea research was so broad (involving blood vessels, nerves, skin, immune system and angiogenesis) that we have been able to apply the research to other conditions.

3. Your free ebook on temperature adjustment http://www.ausci.com/ROSACEA%20BOOKLET%202009.pdf has proven very effective for a number of rosaceans who had struggled to tone down severe flushes. Do you have plans to do any sort of study on the mechanisms involved?

The booklet discusses how some of the mechanisms (mostly related to heat regulation) could be employed to assist in preventing warm room flushes. These are normal heat regulation mechanisms that occur in everyone.

I now strongly believe that in those with Rosacea, the warm room flushing mechanisms are exaggerated because of the larger amount of skin infrastructure in flush zones, and I don’t believe there is anything fundamentally wrong with how these heat regulation mechanisms work in Rosacea. This remains the most logical answer to me. It seems a very simple concept but it actually took a long time and a great deal of experimentation to think along these lines.

Rather than any more experimentation or studies on mechanisms, I would rather see a study on the benefit of using the approaches outlined in the booklet to assist in a general program to reverse Rosacea. However, no study is currently planned.

4. What did you think of the level of interest in your PDF? Had you anticipated the amount and quality of questions? Did you learn anything from the feedback?

The number of downloads is fast approaching 10,000. I feel very pleased that so many people have taken an interest in the booklet, and the responses have been very positive. All of the interest I am aware of has been from those with Rosacea.

During the writing of the booklet, I didn’t anticipate answering any questions. But I did expect to read reviews of the booklet and remember reading some early posts on the rosacea-support.org website and I could completely relate to what people were saying and the questions that were raised.

Apart from the rosacea-support.org responses and questions which were genuinely interested in flushing mechanisms, most of the other feedback from the booklet was related to enquiries about the products we mentioned at the end of the 2008 version. I was disappointed that more enquiries were not related to the heat regulation component of Rosacea/Facial Flushing. Maybe people didn’t believe that heat regulation was an important part of their flushing and that it could really help them reverse Rosacea.

The experience of launching the booklet and the feedback from readers taught me two things. Firstly there is a big need for better Rosacea information and more useful Rosacea information. Secondly that even with all my years of Rosacea study, I still don’t know everything about Rosacea.

5. Could you tell us something about other research projects mentioned, such as:

(a) the reduction of “excessive skin infrastructure” by developing better pulsed light devices to stimulate collagen growth;
(b) the creation of nutritional supplements based on herbs such as licorice root and silymarins (as found in Milk Thistle);
(c) testing to see whether hyperbaric oxygen therapy “can significantly increase oxygenation of the blood” and whether that might “reduce the number of blood vessels in the body” as hypothesized.

These research projects were initiated before the discovery of how important heat regulation is in Rosacea and how it can be used in a general flush reduction program to help reverse Rosacea. So the company is no longer focusing on these projects for Rosacea. The goal of Australian Sciences is now focusing on helping to educate people with Rosacea so that they can help themselves, because the condition is actually simple to understand.

6. We know you have spent recent winters in China setting up a rosacea clinic. Is this for both treatment and research? What kind of treatments are available?

I have been collaborating with NorthWest University for Nationalities in North Western China. To date the work has involved in-vitro and in-vivo experimentation as well as investigations into treating Rosacea. Due to the collaboration, Australian Sciences hasn’t needed to open a clinic. The work has led to the development of a treatment approach for Erythema/Facial Flushing, which is based on IPL (to reduce skin infrastructure in flush zones) and a series of educational classes, which we envisage adopting in future Rosacea clinics.
I have been invited there again this May/June to conduct an epidemiological study of Rosacea in the region. As I have visited the region many times before, I would not be surprised if the results showed a Rosacea incidence of between 10% and 15% of the population. I hope the results of this study will open some eyes and help facilitate the establishment of several Rosacea clinics in the region.

My experience mostly relates to North Western China, where IPL is now being used in major cities to treat Rosacea. The cost of this treatment is often too large for many poorer Chinese who would have to fork out a large portion of their monthly salary for this treatment. I would very much like to change this.
Also, the region is one where Chinese medicine is widely used, however my colleagues have not found an effective Chinese medicine treatment for Rosacea.

7. How is rosacea regarded in China, and have you gained any new insights from working there? Any thoughts on the similarities / differences of treating rosacea and demodicosis?

China is very diverse in climate, ethnicity and Rosacea incidence. South China is tropical with long warm humid summers and very short mild winters. Rosacea is almost unseen in South China. North Western and Western China have short summers and very long cold winters. Interestingly, the region is also thousands of meters above sea level. Rosacea is very common in this region.

As stated in the booklet on warm room flushing, my experiences in South China helped me to develop the approaches on warm room flushing, so I have gained tremendous insight from my time in South China and also in North Western China, which may be the world Rosacea epicenter.

In my opinion Rosacea is not regarded as a serious condition by the wider public or medical community in China (or Australia for that matter). It is just seen as a red face or cosmetic condition. But speaking with those who have serious Rosacea in China, the opinion is of course very different.

8. Any thoughts on the similarities/differences of treating rosacea and demodicosis?

In my opinion ‘treating Rosacea’ means reducing the excessive amount of skin infrastructure in flush zones. So I am not aware of any demodicosis medication that can do this. But I am aware that Rosacea related acne/papules/pustules can respond to the same antimicrobials used in Demodicosis treatment. But all this suggests is a microbial involvement for this one aspect of Rosacea, and mites are but one of the many possible microbes involved. Demodicosis can cause a Rosacea-like appearance, or more accurately an Acne-Rosacea like appearance. However, in my opinion this is where the similarity ends. No need for any more studies about mites and Rosacea, thank you.

9. Are there any other projects you are currently working on?

I am currently working on two projects for Australian Sciences. The first is ongoing Rosacea work, which now involves the epidemiological study. Once the study has been completed the next objective will be to finally open Rosacea clinics in China, with a Chinese medical institution. I am also working on a non-medical project, involving magnetics and magnetizable materials. Having spent many years on medical projects, I felt like spending some of my time on something different.

10. Is Australian Sciences hoping to spend more effort researching rosacea, whether causes or treatments, and what do you see coming up in the near / distant future?

We could easily find some kind of Rosacea research and experimentation to keep us busy for many more years, especially on the causes, because there are likely to be many different causes. But I believe that whatever the cause of your Rosacea, once you have an excessive skin infrastructure in your flush zones, then everyone is in the same boat, regardless of the initial cause.

So we think it is time for us to use what we currently know to start treating and educating the people who are in this boat. The booklet was a first step for us. The clinics will be the next step. I would also like to get further information out beyond our clinics. Maybe have online Rosacea courses? Just a thought.

11. How would you sum up your best advice for rosaceans?

The fundamental difference between someone who develops Rosacea and someone who does not develop Rosacea is that people with Rosacea are more prone to build skin infrastructure (especially in flush zones).

You should also know that your body controls the amount of this infrastructure on a usage basis. The more this skin infrastructure is used (via facial flushing, skin irritation, etc) the more signals are sent to this infrastructure to build, and this infrastructure needs these signals to sustain itself. So when this skin infrastructure is used less (via less flushing and less skin irritation, etc) the signals reduce and in turn your body has a process to reduce this skin infrastructure.

These natural processes are slow, which is why we also recommend IPL to reduce as much excessive skin infrastructure in flush zones as possible.

Many people will need to make MAJOR long term lifestyle changes to significantly reverse Rosacea via this process. How well this process works is dependent on how well you can identify what changes are required in your own lifestyle. Reversing Rosacea is basically in your own hands.

I found this approach very rewarding.

[Mike T]

Very good article to explain the mechanism behind flushing.

It states that frequent flushing, in any individual, (from heat, cold, reactions etc) leads the body to create more veins to accomadate the increased volume of blood for future flushes... And so the condition progresses

I don't recall it mentioning this in the article, but clearly something or other predisposes certain individuals to a greater sensitivity to the above effect. It may be that those who eventually develop Rosacea create an abnormally excessive amount of the chemical which leads to flushing?

For whatever reason some distinction must be present, as there are individuals who spend years in sub zero climatic conditions, and years in very hot climatic conditions but do not ever end up developing Rosacea or increased flushing. Just like stated in the report any individual who gets hot experiences a dilation of veins and increased blod flow. Why do most non-rosaceans bodies not develop more veins as a result of repeated dilation to heat?

I don't know if the answer is already out there, but it would be a start to truly understanding how to reduce the network of veins in us which grow every time we flush.

It is somewhat relieving to read that just as our network of veins can expand due to flushing (dilation) it can also be reduced during extended periods of non-flushing. This then brings up the idea that if one took Clonodine, which restricts blood flow to the face, for extended period on a daily basis, would this then send the signal that less blood is needed around the face so the network of veins can be reduced? The reasoning in the attached report suggets this.

If the effects of an over-developed nerve network will be reversed during extended periods of non-flushing, just as slowly as they were created, then as suggested in the report it would seem the best approach to reduce flushing would be to destroy as much of the facial veins as possible with IPL treatment and then just avoid flushing as best as possible, which should be easier due to reduced flushing capabilities as a result of less veins in the face.

But unless we can establish the process as to why our faces response to vein dilation is to create more viens, wereas in non-rosaceans this does not seem to be the case (or may be the case but too a much lesser, unnoticable degree) then we can not treat the cause only the symptom, being reducing the network of veins so slowly only to get them back so fast, as experienced by the author of the attached document who states that a years worth of flushing avoidance led to significant Improvement in facial redness, but then 3 hrs in a cold lab was enough to reverse this effect.

Mike

[AustralianSciences]

Dear David,

Thank you for the invitation to do the interview.



Dear Mike,

I would like to correct your last paragraph.

But unless we can establish the process as to why our faces response to vein dilation is to create more veins, whereas in non-rosaceans this does not seem to be the case (or may be the case but too a much lesser, unnoticeable degree) then we can not treat the cause only the symptom, being reducing the network of veins so slowly only to get them back so fast, as experienced by the author of the attached document who states that a years worth of flushing avoidance led to significant Improvement in facial redness, but then 3 hrs in a cold lab was enough to reverse this effect.

This is what is stated in the booklet:

"I was spending eight hours a day in a cold lab that was only 15 degrees
Celsius. After just a few days I began to experience something that hadn’t happened for more than a
year, I began to experience warm room flushing again!"

"The experimentation finished after just 3 weeks and I was able to work in a heated room for the rest of
my stay in China. Needless to say the warm room flushing abruptly ceased. Even short periods in
below zero weather did not cause the warm room flushing to re-appear."

I don't want people to think that 1 years effort of flush reduction is a waste of time, because it isn't.

By this method (of flush reduction) you are actually REVERSING the condition, not just treating the symptoms.
Think of it like this: the less excessive skin infrastructure you have in flush zones, the more normal your vasodilation and angiogenesis becomes (in flush zones).

What was happening in this case of extended cold room exposure over a number of days, was related to neuropeptide (inflammatory chemical) buildups, not the re-building of skin infrastructure. In my experience, I have only reduced, not re-gained skin infrastructure.

My goal was to reverse Rosacea, not stop vasodilation and angiogenesis from occurring, which are natural and needed processes.
But having said that, by reversing Rosacea you are reducing facial flushing and facial erythema.

Best regards,
Colin Dahl.
Australian Sciences.

[Mike T]

Thanks for your response Colin.

Apologies for downplaying any benificial effects from flush reduction.

Would you be able to shed some light as to why neuropeptide buildups, being the skin infrastructures natural response to colder climates, affected you by form of flushing, whereas most non-roseans would not experience flushing under the same circumstances?

Or why if vasodilation is a natural and common response to warmer climatic conditions do only some people (Rosaceans) experience a gradual development in there facial nervous networkin such conditions? I know some labourers who spend day on end in the hot sun during summer but there facial infrastructure does not seem to progress as a result of vasodilation, which as you state is a common response to heat in all of us.

The way i see it, If the reason for the differences in response to these common phenomena between Rosaceans & Non-Rosaceans can be identified, then one can attempt to treat the actual cause?

What do you think?

Regards,

Mike

[AustralianSciences]

Dear Mike,

Would you be able to shed some light as to why neuropeptide buildups, being the skin infrastructures natural response to colder climates, affected you by form of flushing, whereas most non-roseans would not experience flushing under the same circumstances?

Those without Rosacea don't flush in these situations because the amount of skin infrastructure in their flush zones is much smaller than those with Rosacea.
Less skin infrastructure means less production and release of inflammatory chemicals.
Therefore, I would assume that most people without Rosacea would not be able to generate enough of a buildup to cause a flush.

Or why if vasodilation is a natural and common response to warmer climatic conditions do only some people (Rosaceans) experience a gradual development in there facial nervous network in such conditions? I know some labourers who spend day on end in the hot sun during summer but there facial infrastructure does not seem to progress as a result of vasodilation, which as you state is a common response to heat in all of us.

According to the National Rosacea Society, climactic factors (both cold and warm) are major triggers for those with Rosacea.
But even within this group a large variation can occur.
Severe Rosacea suffers only need a minimal stimulus for a flush to occur.
Those people with minimal Rosacea require larger stimulus for a flush or significant vasodilation to occur.
So it should not be unreasonable to consider that those without any Rosacea (those with much less skin infrastructure) need an even greater stimulus for a flush or significant vasodilation to occur.

Why some develop an excessive skin infrastructure in flush zones as a result of this vasodilation/stimulus, or why they don't, is related to how the individual responds to this stimulus. Those with Rosacea respond by developing more skin infrastructure. This is basically the difference between those with Rosacea and those without Rosacea.

The way i see it, If the reason for the differences in response to these common phenomena between Rosaceans & Non-Rosaceans can be identified, then one can attempt to treat the actual cause?

I disagree.

The initial cause that leads to the development of a minimally excessive skin infrastructure, may play a small role in the continuation of the growth of this skin infrastructure, which may ultimately lead to severe Rosacea.
Those with severe or moderate Rosacea need not wait for any new research findings. They can reverse Rosacea now.

Best regards,
Colin Dahl
Australian Sciences

[Mike T]

Thankyou for your patience and detailed responses Colin.

I just like knowing how/why things happen when possible.

It seems that this is another case of correlation rather than causation.

Our skin sensitivity, flushing to heat, foods, drinks, stress, excercise, anxiety and in turn progression of Rosacea is predominatley a function of the extent to which our skin infrastructures have progressed. So if skin infrastrucutre was significantly destroyed by Light Methods then flushing to the previously mentioned factors should be greatly reduced. This in turn will assist to reduce vasodilation and the futher development of skin infrastructure. It is noted however that the Rosacean specific response to vasodilation (skin infrastructure development) will continue to exist aslong as one has Rosacea, which for all intensive purposes is indefinatley. So the best that one can do, after intitial Light treatment, is to primarily try and avoid triggers and then to continue to destroy excessive skin infrastructure build up as the need arises, preferably in its earlier/less advanced stages.

I am interested to read user reviews of this method of combating Rosacea, as it seems alot safer/effective then the daily use of a number of topical/oral treatments. Maybe Rosaceans would benifit if Light Therapy was not seen as a "last line" treatment, rather an intial response to prevent the development of the condition, rather than topical & oral treatments which only seem to slow down the progression process somewhat, and in many cases accelerate it by constant reactions to products in the testing phase (which can usually last for years).

I will put this question out here, in my knoweledge that noone to date knows exactly the mechanism of action by which Low Level Light Therapy (i.e Red Led Light Arrays) assist Rosacea sufferers. Have you any ideas?

Regards,

Mike

[Mike T]

Where i have used the words "Light Treatment/Methods" in my previous post i actually meant "Laser methods".

When i use the words "Low Level Light Therapy" this relates to Light Therapy.

Apologies for any confusion caused.

Mike