Hi,

Here's another article from the June 2004 issue of Dermatology Times.

I love the first line of this article. I hope it brings rosaceans a
cure....

Maybe we should be writing the National Institutes of Health (NIH)
for more research on rosacea. The author makes a compelling case for
it.

Take care,
Matija

URL that will break:

http://www.dermatologytimes.com/dermatologytimes/article/articleDetail
.jsp?id=102154

Shortcut to above url:

http://tinyurl.com/2w9g4

Rosacea: turning all stones for source of pathology

June 1, 2004
By: Rebecca Bryant
Dermatology Times

Providence - Rosacea is a potential gold mine for researchers.

According to Michael Detmar, M.D., "It occurs more frequently than
psoriasis and melanoma, but little is known about what causes it."

What's more, only a few scientists are involved in the study of the
disease. He notes that, in 2003, only one paper was published for
every 144,000 rosacea patients in the United States, compared to a 1-
to-11 ratio for melanoma and 1 to 4,900 for psoriasis.

An associate professor of dermatology at Harvard Medical School, Dr.
Detmar suggests that one reason for the paucity of research is
that "rosacea is seen by many as a cosmetic problem. That's not the
case," he says. "The effect of the disease can be very traumatic."

He said another contributing factor may be a lack of NIH funding.

The National Rosacea Society launched a grant program several years
ago to fill the gap. Dr. Detmar, who serves on the Society's board,
says that while there were only a few applicants the first year, the
number of proposals has been growing steadily.

A chronic syndrome
Usually diagnosed in people between the ages of 30 and 50, rosacea is
a chronic syndrome that affects approximately 14 million Americans.
It is more prevalent among women and people with fair skin than men
or dark skin ethnic groups. For a diagnosis of rosacea, a patient
must have one or more primary features (flushing, nontransient
erythema, papules and pustules, and telangiectases) at the center of
his or her face. Ocular signs are also common.

Research has been stymied by the lack of a widely accepted
classification system. In 2002, Dr. Detmar co-authored an article in
the Journal of the Academy of Dermatology - together with a committee
of experts and with support by the Society - outlining a taxonomy of
the disease.

"The idea was to propose a system that would be generally accepted
and facilitate clinical studies," he says. "Most of the worldwide
experts were consulted."

The new system establishes diagnostic criteria on the basis of
morphological characteristics, avoiding assumptions about
pathogenesis and progression, since rosacea is anything but
predictable. Evolution from one subtype to another does not always
occur, and any given element may or may not progress in severity.

Rosacea subtypes
The four main subtypes of rosacea are erythematotelangiectatic,
papulopustular, phymatous, and ocular. Granulomatous variants
constitute a special subgroup and tend to be similar, numerous,
indolent, hard, brownish-yellow to red papules (and occasionally
small nodules) that persist for months with little change.

While the complete pathology of rosacea is unknown, Dr. Detmar says
some aspects are coming into focus.

He notes, "Bacteria are likely involved because what works to some
extent as a treatment are antibiotics. Also there appears to be a
relationship to photo damage. The nervous system may be involved,
because exertion, emotions, and weather trigger the disease, in
addition to other triggers such as heat, certain types of food,
alcoholic beverages, various topical balms and cosmetics, and various
drugs. We're clear that blood vessels are dilated but don't know if
that comes first or later. A new area of research suggests that
lymphatic vessels are involved."

Sun triggers
Most patients rate sun exposure as the trigger most likely to cause
rosacea. This leads to vasodilation, particularly in genetically
susceptible patients of Celtic extraction and in patients with sun
damage. Increased flow of blood induces flushing. It's possible that
inflammation and skin thickening may follow a long-standing edema
elicited by proteins much the way dermatoliposclerosis follows
certain long-standing pedal edemas.

For more information:

Guarrera M, et. al. Arch Dermatol Res. 1980;272:311-316.
Wilkin J. K. J Invest Dermatol. 1981;76:15-18.
Powell F. C., et. al. J Am Acad Dermatol. 1993;28:132-133.
Wilkin J., et. al, J Am Acad Derm. 2002;46:584-587.
Dahl M. V. Adv Dermatol. 2001;17:29-45.
Ramelet A. A. et. al. Ann Dermatol Venerol. 1988;115:801-806.