Facial nerves play a key role in rosacea flushing and progression.
Very recently, several medical experts have indicated that rosacea
is primarily a neuro-vascular disorder (i.e., facial nerves release
potent dilators onto blood vessels which trigger facial flushing and
cause rosacea progression). (1-3)

There are four different types of nerves that may cause facial
flushing:

(1) Sympathetic nerves

(2) Parasympathetic nerves

(3) Sensory nerves

(4) Other nerves

Each type of nerve has a different function in the human body, and
has its own set of neurotransmitters (substances that are released
from the nerve endings and diffuse to nearby blood vessels), and
thus each set of nerves must be discussed individually.

Dr. Jonathan Wilkin, an expert on rosacea and flushing syndromes,
indicates that the most common nerve-mediated facial flushes are
those induced by high internal body temperatures, warm environments,
and hot foods or beverages. (4, 5) Flushing to all of these
triggers is mediated primarily by the powerful sympathetic nervous
system.

For more detailed reading, I refer interested readers to three
superb medical articles on this topic:

• An excellent, 20-page review, in Pharmacology and Therapeutics
(1999), "Nervous Control of Blood Flow in the Orofacial Region" by
Dr. Izumi. (49)

• An authoritative review in Clinics in Dermatology (1993), "The Red
Face: Flushing Disorders", by Dr. Jonathan Wilkin. (4)

• An outstanding article on nerves, neurotransmitters, and nerve
blockers in Immunopharmacology (1997), "Sensory Neuro-peptides:
Their Role in Inflammation and Wound Healing", by Dr. S.D. Brain.
(68)


Effects of neuropeptides and sebocyte-derived factors on human
dermal microvascular endothelial cells of the skin: A possible
mechanism for the development of vascular and inflammatory lesions
of rosacea.

Dr. Richard Granstein, chairman, Department of Dermatology, Cornell
University.

Dr. Granstein and colleagues were awarded $23,283 to continue
research on how neuropeptides and hormones produced by nerves or
cells in the skin may play a role in the flushing, telangiectasia
and inflammation associated with rosacea. In their initial research,
the researchers discovered that ultraviolet B (UVB) radiation found
in sunlight may induce expression of VEGF as well as increase a
cytokine that is associated with inflammation. Conversely, they
found that a neuropeptide known as somatostatin appears to reduce
production of VEGF. In the coming year, they will define how certain
neuropeptides and hormones, alone or in combination with UVB
irradiation, may affect the endothelial cells that line the blood
vessels. This grant will also fund the study of UVB-irradiated
keratinocytes (cells that produce keratin, a constituent of outer
skin, hair and nails) and their effects on vascular endothelial
cells, combined with the characterization of the effects of a number
of neuropeptides on keratinocyte and endothelial activation.



1. Wilkin, J.K. Why is flushing limited to a mostly facial
cutaneous distribution? J Am Acad Dermatol 19: 309-313, 1988.

2. National Rosacea Society. "Rosacea Review". Winter. 1999.
Drake,L.

3. Panconesi, E. Psychosomatic dermatology. Clin Dermatol 2: 94-
179, 1984.

4. Wilkin, J.K. "The red face: Flushing disorders". Clin Dermatol
11: 211-223, 1993.

5. Wilkin, J.K. Flushing reactions: consequences and mechanisms.
Ann Intern Med 95: 468-476, 1981.