Rosacea: Exciting Breakthroughs in Understanding and Treatment
Published Sep 3, 2013
Rosacea is a common skin disease causing a range of eye and facial skin symptoms ranging from facial flushing to pus filled acne like bumps. There are in fact four types of rosacea:
- Erythematotelangiectatic – Also known as ETR, those with this type have very sensitive red skin, easily irritated with dryness, wetness or even skin care creams and lotions.
- Papulopustular – Burning or itchy acne like bumps on the skin occur in this form
- Phymatous – Over time, rosacea-affected skin on the chin, eyes, eyelids, cheeks, nose or ears may get thickened, deformed, and bumpy.
- Ocular: Eye redness, dryness, and burning can occur in this subtype
(It’s is unclear whether the four subtypes of rosacea are distinct, or represent a “march” from one stage to the next.)
The Emotional Toll of Rosacea
An estimated 16 million Americans have rosacea, yet we still don’t completely understand why it happens and therefore our ability to treat is has been somewhat limited. The disease may not life-threatening, but those who suffer from even the mildest form of rosacea report that it imparts a major toll on their social and emotional well-being. One of the most common complaints among rosacea sufferers is that certain foods or drinks can trigger a flare-up, visual symptoms that can generate negative comments or stares causing effected individuals to cancel social events because of self-consciousness regarding their appearance. Triggers can vary broadly, including but not limited to spicy foods, alcohol, emotional stress, sun exposure, and hot baths. This impact on quality of life highlights the importance of gaining a better understanding of the biological underpinnings of the disease, and by doing so, develop more effective treatments
Fortunately, research conducted over the past few years has made major headway allowing us to hone in on the underlying mechanisms that cause rosacea. Researchers at UCSD have found that in rosacea, there is an overproduction of small peptides called Cathelicidins and overexpression of its activator, Kallikrein 5, which are very important for fighting off invading infections and helping with wound healing. However, too much of a good thing is a bad thing, and this group was able to replicate the signs of rosacea by injecting increased amounts of the peptide/activator into animals. Interestingly, it seems that many of the current rosacea medication we have now, such as finacea and oracea, work by impacting these components.
Other research is finding that miscommunication between the vascular system, the immune and the nervous system can play a big role in rosacea. Researchers found that one neuro-signal, pituitary adenylate cyclase activating polypeptide (PACAP), a potent blood vessel dilator in humans, is 20 to 30 times upregulated in rosacea, possibly explaining that characteristic redness. Investigations into the role of inflammation, inability to quench free radicals, and even a mite that is found in our hair follicles called the Demodex mite, are being explored as potential treatment targets
A Big Treatment Breakthrough
One of the biggest breakthroughs of late has been the recent FDA approval last month of a first-in-class medication that targets the frustrating uncomfortable erythema of rosacea. As mentioned above, the erythema of the central face that characterizes rosacea is thought to result from abnormal skin blood vessel activity, an issue the majority of rosacea medications does not address outside of laser treatment and cover up cosmetics. A new formulation of Brimonidine tartrate (BT), trade name Mirvaso, a highly selective alpha2-adrenergic agonist that has been used for about 10 years as an ophthalmic solution for the treatment of glaucoma, was found to be successful as a once a day dosing treatment for facial redness. The approval of Mirvaso was based on data collected from two phase 3 clinical and a long-term study in 276 subjects who used Mirvaso for up to 12-months was also conducted. Given the paucity of rosacea treatments, it is very exciting to get a new drug on the market place, one which is a new chemical entity in dermatology, not just a repackaged precursor. Have hope rosacea sufferers, help is coming.
What You Can Do to Control Rosacea Symptoms
Because rosacea is a chronic condition which gets worse it left unchecked, here are some useful tips you can do starting right now to help control your rosacea:
- Use sunscreen effectively
- Sun exposure is the number 1 trigger for rosacea. Make sure to use a sunscreen that is spf 30 + broad spectrum 20 minutes before going outside (reapply every 2 hours if outside for long periods of time), and use sun protective clothing including hats and sunglasses. Avoid peak hours in the sun from 10 AM- 2PM
- Because rosacea suffers often have sensitive skin, using sunscreens with mineral sunblocking ingredients like zinc oxide or titantium dioxide may be less irritating.
- Know your triggers
- Keep a diary of exposures (foods, drinks, medications, weather, exercise, cosmetics, etc) that cause flares.
- Cleanse with a soft touch
- Hot water, harsh soaps, and rough scrubbing can make rosacea worse. Tame these triggers: Gently wash your face with a nonabrasive cleanser, and rinse with lukewarm water. Blot dry with a soft cotton towel.
- Don’t irritate your irritable skin
- Some skin-care products and cosmetics contain ingredients that can irritate the skin and worsen rosacea.
- Avoid ingredients that cause burning, stinging, or increase facial redness. Common troublemakers include alcohol, witch hazel, menthol, peppermint, eucalyptus oil, clove oil, and fragrances.
Don’t do it alone – If you think you have rosacea, see your dermatologist to get the help you need and deserve. The sooner the better, as the longer your rosacea is active, the harder it is to control.