Thank you Matija. Subtype directed approaches are the current
trend. But, I just want to point out a couple things this doctor
said that really are not right or potentially harmful. I am not
perfect and I have never claimed to know the specific genes involved
in rosacea, but I can and will put up a halt or yield sign when bad
advice is given out. Acutally, it is a well written and researched
article for the most part. Some comments below.



> Hi,
>
> I found an article from the January '05 edition of Dermatology
Times
> (our favorite publication for obvious reasons!) that seems to
tailor
> treatment via subtype.
>
> Take care,
> Matija
>
> URL that will break:
>
http://www.dermatologytimes.com/dermatologytimes/article/articleDetai
l
> .jsp?id=140940&sk=&date=&%0A%09%09%09&pageID=2
>
> Shortcut to above URL:
> http://tinyurl.com/4y2jn
>
>
> 'Subtype-directed' approach targets rosacea
>
>
> Jan 1, 2005
> By: Andrew Bowser
> Dermatology Times
>
>
>
> New York — The four recently defined subtypes of rosacea are
likely
> caused by different pathogenic factors, and thus respond to
different
> therapeutic regimens, according to Michelle T. Pelle, M.D.
>
> Consequently, dermatologists should employ a "subtype-directed
> approach" when treating rosacea — incorporating the available
> topical, oral, laser and light therapies, says Dr. Pelle, who
spoke
> here at an American Academy of Dermatology (AAD) press conference
> held in support of National Healthy Skin Month.
>
> "Characterizing the subtype of rosacea provides a clearer approach
to
> therapy for that patient," Dr. Pelle says.
>
> The new classification system for rosacea, published in 2002 by
the
> AAD (Wilkin et al., J Am Acad Dermatol. 46: 584-587), defines the
> four main subtypes of rosacea as erythematotelangiectatic,
> papulopustular, phymatous and ocular, each characterized by
presence
> of specific signs and symptoms in a central face distribution.
>
> "I call it 'redefining,' because we used to think of rosacea in a
> staged type of progression, where one stage moved to the other,
but
> in fact, that doesn't happen," Dr. Pelle says.





This is 100% wrong. Most, if not all rosacea sufferers have the
underlying Subtype I at the heart of the disorder. The
dermatologist just dismisses the more frequent flushers as part of
this subtype. In true rosacea, most flushers and red faces progress
in a standard manner to include papules and pustules after enough
dermal inflammation has gathered over the years. Then the derm
decides which is worse -- the papules or the redness. Then
classification starts.












>
> Topical retinoids
> Topical retinoids have clearly demonstrated benefit in rosacea.
>
> "Some dermatologists choose to avoid them, because they are more
> difficult to use, but over the long term, they really do make a
> difference for these patients," Dr. Pelle says. "In my experience,
at
> one month you get an improved skin texture, at four months
flushing
> is much less frequent, and at one year there is a normal flush
> response, substantially decreased redness and few to no flares
> requiring tetracyclines."
>
> "I tell almost every patient I see that we are going to eventually
> transition them to tretinoin," Dr. Pelle adds. "Whether they have
> started with a combination therapy that's medical, or whether they
> have had laser or light therapy, they always finish up with a
gentle
> sunscreen and a topical retinoid. That's the best way, in my
opinion,
> to maintain them."




WOW. Good luck. Absolutely not even close to agreement with the
specialists in the area. My face was bleeding upon application of
retinoids and tretinoin. Please please please please dont follow
this route. Please. Those are the most horrific emails that I
get. Tretinoin or wrinkle reducing retinoids have turned my face
into a bloody burning mess. I continued to fight through it upon
doctors orders for 3, 6, 9 months. Trust me you are playing a
dangeous game with that approach.

Regards,

Geoffrey
______________________________

Dr. Geoffrey Nase
Ph.D. Neurovascular Physiologist
http://www.drnase.com
______________________________






















>
> Vascular laser therapy is useful in treating the telangiectasia
and
> erythema associated with rosacea. Choices include standard and
long
> pulsed-dye laser (PDL), potassium-titanyl-phosphate (KTP) lasers,
> diode frequency-doubled lasers and the Nd-YAG lasers.
>
> Dr. Pelle says she most recently has used the variable-pulsed PDL
(10
> mm, 10 ms, 7.5 J/cm2): "With a longer pulse duration, we can
deliver
> enough energy to vaporize the blood vessel, but over a longer
> duration to decrease purpura," she explains. "We damage the tissue
> less, and deliver the same amount of energy over a longer period
of
> time."
>
> One to three treatments are typically necessary for "good to
> excellent" reduction of erythema and small red vessels, and in
> general, the side effects are minimal. Disadvantages include
> temporary bruising, especially when larger vessels are eliminated.
As
> with any rosacea treatment, patients must afterward continue to
> practice proper preventative precautions, such as avoiding the sun
> and using sunscreen.
>
> Intense pulsed light (IPL) products such as the Photoderm VL
> (Lumenis) are available for the treatment of vascular lesions.
> Multiple wavelengths are emitted during IPL therapy, allowing for
> treatment of multiple depths, and thus larger vessels. While
outcomes
> can be lasting, the procedure takes longer to perform than PDL,
and
> it can be painful for some patients. Other potential adverse
effects
> include bruising, redness or scale, and rarely, reversible skin
> lightening.
>
> In one investigation of IPL, more than 90 percent of patients
treated
> had 75 percent to 100 percent clearance of facial vascular
lesions,
> most after only one treatment (Angermeier et al., J Cutan Laser
Ther.
> 1999; 1: 95-100). "I usually tell patients to expect up to three
and
> sometimes up to five treatments," Dr. Pelle says.
>
> Dr. Pelle and colleagues recently published a comprehensive review
of
> the available topical, oral, laser and light therapies in the
context
> of these cutaneous subtypes. The article reviews the evidence
> supporting their use in specific phenotypes, and outlines some
other
> clinical approaches that have worked anecdotally (J Am Acad
Dermatol.
> 2004; 51: 499-512).