Hello Group,

I just submitted a Special Discussion Letter to the Editor of
Clinical Therapeutics. It was accepted for publication – I will be
told which issue it will be placed in by the end of the month. I
thought it was important to submit this to an International Medical
Journal that reaches the UK, Australia, NZ, the Netherlands, etc.
This, article, in addition to the Dermatology Times article on
Neuropathic Rosacea should finally open up the eyes of
dermatologists.


Just as important, it finally gives rosacea a medical status and not
just a cosmetic status. The next logical step is to publish an
article showing that laser treatment is one of the best treatments
for Neuropathic Rosacea – then we get full insurance coverage under
medical necessity.


Clinical Therapeutics: The International Peer-Reviewed Journal of
Drug Therapy


Letter to the Editor: Special Discussion by Dr. Geoffrey Nase



Rosacea and Neuropathic Burning: A Disabling Combination that
Affects Quality of Life


Rosacea is an inflammatory skin disorder that affects the face and
eyes of approximately 45 million people world wide. It is a
perplexing disorder that has been misdiagnosed, under treated, and
under studied for decades. Recently, a general classification
system has been devised to help physicians understand and treat
rosacea. Briefly, rosacea has been divided into four subtypes:
Subtype I, which refers to those patients with chronic redness,
frequent flushing and broken blood vessels; Subtype 2, which refers
to those patients with inflammatory papules and pustules; Subtype 3,
which refers to those sufferers with bulbous noses, facial fibrosis
and nodules and; Subtype 4, which refers to rosacea sufferers with
eye symptoms such as blepharitis, ocular inflammation, blurred
vision and meibomian gland dysfunction.


This classification system has proven helpful to many general
dermatologists. However, a gaping hole has been left in the system
setup. This system has excluded one of the most important rosacea
subtypes. It's important that all dermatologists become aware that
a new clinical subtype has recently been identified. Though not
officially recognized yet, Neuropathic Rosacea (Subtype 5) is
believed to be the most debilitating form of the disorder.
Hallmarks of Neuropathic Rosacea include bouts of centrofacial
burning and pain sensations following exposure to triggers. Such
bouts usually last longer than 30 minutes. More serious cases can
become semi-permanent if dermal inflammation or various inflammatory
cytokines damage or permanently activate sensory nociceptors. In
severe cases, underlying facial inflammation may trigger these
sensory nociceptors in the absence of external triggers.


It must be stressed that this subtype can cause physical disability
comparable to diabetic neuropathy and other painful peripheral
neuropathies.


Rosacea sufferers with Neuropathic Rosacea are best treated by a
collaborative effort between dermatologists, neurologists with
peripheral nerve treatment training and pain specialists.


Dr. Geoffrey Nase, Ph.D.
Rosacea Research Specialist & Treatment Analyst
Indiana University School of Medicine, IN USA