Research Reveals New Findings ...Or The Same Old Findings?

Medical scientists from around the world heard updated reports on advances in the understanding of the potential causes and other key aspects of rosacea at the National Rosacea Society (NRS) research workshop held in conjunction with the annual meeting of the Society for Investigative Dermatology in St. Louis. The NRS conducts the annual workshop to promote interest in rosacea research and to share new information from ongoing studies.
In a recently completed clinical study, Dr. Joel Bamford, associate professor of family practice, University of Minnesota-Duluth, and colleagues found that individuals who had styes as children were significantly more likely to have rosacea as adults.
In the study, 5.5 percent of those who had had styes as children developed rosacea as adults, while just 1.5 percent of those who had not had styes later developed the skin disorder. Styes are an inflamed swelling of the sebaceous gland, called the Meibomian gland, at the margin of the eyelid.
"These findings suggest new avenues for investigation of the causes of rosacea, as well as an informal diagnostic marker to consider in patient histories," Dr. Bamford said.
Dr. Richard Gallo, chief of the division of dermatology, University of California-San Diego, reported that new research by his group shows that a particular antimicrobial peptide that acts as a natural antibiotic could be the cause of certain signs of rosacea.
"Biopsy samples from all rosacea patients in the study showed increased levels of cathelicidins, one of the tools the body uses to protect itself against infection," Dr. Gallo said. He noted that cathelicidins are vasoactive (expand blood vessels) and inflammatory (cause irritation), potentially producing the telangiectasia (visible blood vessels) as well as the papules (bumps) and pustules (pimples) often associated with rosacea. They also observed that certain microorganisms like Helicobacter pylori, which have been linked to rosacea, are better able to stimulate an increase in cathelicidins than other skin organisms.
Dr. Richard Granstein, chairman of dermatology at Cornell University, reported on his group's research into the role of neurochemicals in the development of rosacea. They found that adenosine triphosphate (ATP), a neurotransmitter and carrier of chemical energy that is widespread throughout the body, induced the release of a variety of substances linked to inflammation, and hypothesize that rosacea triggers such as stress, alcohol and sunlight may initiate a cascade of events that contribute to producing the bumps and pimples of rosacea.
Tracy Stoudemayer reported results of an NRS-funded study conducted by Dr. YaXian Zhen and Dr. Albert Kligman, professor, University of Pennsylvania, exploring similarities between acne vulgaris and rosacea. The researchers noted that in studies of more than 100 women with rosacea, about 40 percent reported having adolescent acne. Moreover, about 30 percent to 40 percent of the women who experienced acne during adolescence exhibited moderate flushing responses to common rosacea triggers.
In a further investigation of 15 female rosacea patients and five women without rosacea as controls, the researchers found that the rosacea patients had more characteristics common to acne than the control subjects. Facial oil production was about 40 percent greater; microcomedones, precursor to visible comedones (blackheads), were twice as numerous and larger in the rosacea patients than in the controls; and the density of the acne bacterium, Propionibacterium acnes, was nearly twice that of controls.

Dr. Nase Refutes the Benefits of the New Research Grant

If one emotionally detaches from everything that has been going on these last three months and examines the grant funded with your money, I feel that this grant is my fault. I have placed too much pressure on the RRF to either fund a grant or give rosacea sufferers their money back. This resulted in a hasty, non-helpful grant. In any academician's eyes this grant would not have passed any peer-reviewed process. On a scale of 0 to 10 -- with 0 being "poor" and "10" being excellent the rating would probably be a "1" based on known evaluation protocols. Even if everyone was on best of terms, this would be my same critique. This grant does nothing to help rosacea sufferers: 1. It is not novel 2. It shows us nothing about the underlying causes of rosacea 3. This study has already been performed in large part 4. This study gives us no new insight into better laser treatments, protocols, flushing methodologies, how to treat triggers, how to stop the regrowth of blood vessels, etc. 5. The number of patients is the lowest number that can be used to find a statistical significance. This number should at least be doubled or tripled. 10 patients in one group does not cover the spectrum of rosacea symptoms and inflammatory factors in one subtype. This grant is analagous to studying the effects of oral tetracycline on rosacea. Nothing new at all or nothing presented to build on. For example, in order: 1. We already know that blood vessel number is decreased after laser treatment, and that new blood vessels that are formed are smaller and thicker walled. 2. We already know that laser treatment of any form downregulates I-CAM, VEGF, INOS, inflammatory cytokines and helps restructure the dermal architecture to help the lymphatic vessels work better to remove fluids and metabolic waste products. 3. The primary features already have been visualized with basic microscopic techniques. This is nothing new for any rosacea symptoms. 4. We already know that in many rosacea sufferers, the increased blood flow, fibroblast activity and DHT stimulation increases the size and number of sebaceous glands and subsequently makes for a better habitat for demodex. 5. Is there anything postitive at all that we will learn from this grant and be able to build on -- NO. Absolutely nothing. How could this money have been spent more wisely: 1. Spending all the money on renting the best in vivo confocal microscope and detailing the rosacea sufferer's vascular network to the exact micron. Elucidate the sizes, angles and shapes of all blood vessels going down to the adipose cells. That would have been an awesome study. This then allows for better treatment because laser physicians know that at certain depths in the skin, blood flow is a certain amount, blood vessels are a particular size, vessels are oriented a special way, and how deep they would have to go. This would have advanced their ability to better treat rosacea by 10-fold and finally treat resistant cases by knowing the exact vascular pathology so that laser physicians would know exact protocols to use. 2. Determining how to get better results -- evaluating different pre-flushing mechanisms (topical, oral or neural), measure blood vessel responses to find the best flushers and then evaluating the results; conversely, treatment with angiogenesis inhibitors post laser (topical or oral) by itself would open up a new world of treatment. Also the use of clotting factors (either injections or oral factors) to enhance the death of blood vessels not fully treated could have lead to remarkable strides. This study could have utilized new "blood dyes" to be delivered IV into the patient so that we would only need to use a very specific wavelength to successfully treat the blood vessels as the "blood dye" only reacts to a particular wavelength -- this takes out the entire guessing game and almost ensures immediate results that are vastly improved. How else could the RRF have spent their money to induce the greatest change in rosacea treatment and perception: 1. A couple people on the RRF, most notably, Schelly Scheen, spent months designing the most incredible one page flyer and two page brochure (in color and very professional) to re-educate all physicians, dermatologists and pharmaceutical companies on rosacea and the need for better treatments and better studies. These brochures are just a few hours away from being completed, but no one has put in the few hours in 5 months now to get these finished and mail them to every single dermatology office and pharmaceutical company -- we already have all the addresses piled up and ready to be printed out for mailing. The brochures were our biggest achievement as they would instantaneously replace the overloaded Galderma pamphlets at every doctors office. Just a few hours to fine tune everything and these brochures would have made more difference than any 10 rosacea grants that they could fund. I just cannot believe they could not find the time to finish these brochures by setting aside one night to polish them off in 5 months. I have re-read my message several times before posting to make sure that it was fair, pointed out the flaws of the grant with an academician's logical perspective, and detail how the money would have been much better spent. I certainly hope this post comes across as intended. Please do not re-invent the wheel for us. Teach us how to make shock absorbers for our wheels.