Well a clue emerges from a recent series of in depth, state of the art papers from the Journal of Investigative Dermatology Symposium Proceedings. In the introductory item title  “Pathophysiology of Rosacea: Introduction”, Dr. Martin Steinhoff tells us that

The pathophysiology of rosacea appears to be complex, as virtually all cutaneous cells, including immune cells, appear to have roles.

Ultimately, rosacea is a good ‘‘model’’ through which investigators can learn more about the complexities of neuroimmune communication, inflammation, and immunity, as well as about chronic inflammation and the development of fibrosis. [emphasis mine].

J Investig Dermatol Symp Proc. 2011 Dec;15(1)

So there is a lot going on in rosacea. Cutaneous cells include: keratinocytes, melanocytes, leucocytes,  fibroblasts,and  endothelials.

Add in the complexities of hair follicles, sweat glands, nerve fibres, sebaceous glands, apocrine glands, lymphatic and blood vessels and you have enough to fill several text books before you even start understanding it all.

Dr. Steinhoff is known to rosacea sufferers because of his work on Neurogenic Rosacea for which he holds a related patent, and has undertaken NRS and Galderma funded rosacea related research.

Stay Tuned For More

The series of papers  that form the JID’s expose on the state of the art in rosacea research are long and complex. More summaries to follow.

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News today that Scenesse has progressed another step towards wider approval with the commencement of Phase III Trials.

About 100 people with the condition Erythropoietic Protoporphyria (EPP) will be double blinded to receive the Scenesse implant or placebo. Their ability to tolerate sunlight will then be measured.

The trials will take place in Alabama, California, Michigan, New York, North Carolina, Texas and Utah.

Normally, EPP sufferers might expect to experience pain and phototoxic reactions when exposed to direct sunlight.

The aim of these Phase III trials will be confirm the efficacy and safety of previous trials, but on a larger scale.

Clinuvel commences US Phase III trial of SCENESSE® in rare light and UV disorder

Melbourne, Australia and Baar, Switzerland, May 22 2012

Clinuvel Pharmaceuticals Limited (ASX: CUV; XETRA-DAX: UR9; ADR: CLVLY) today announced that it has commenced its confirmatory Phase III US study of the novel drug SCENESSE® (afamelanotide) in patients diagnosed with the rare light intolerance disorder erythropoietic protoporphyria (EPP). The six-month, randomised, multicentre, double-blind, placebo-controlled study (CUV039) will recruit up to 100 adult EPP patients in seven specialist centres (Alabama, California, Michigan, New York, North Carolina, Texas and Utah).

Scenesse is already available in Italy as a treatment for EPP but is yet to be approved by FDA.

Scenesse has been granted orphan drug status in order to allow a streamlined approval process. This designated has been granted because it can treat certain rare diseases that are not currently well covered by existing options.

The technology behind Scenesse, that is the photo-protective properties of afamelanotide, are of interest to rosacea sufferers, especially those for whom the sun is a major trigger. So far, though no development effort targeted at rosacea has been undertaken by Clinuvel.

Related Articles

• Scenesse One Step Closer for Erythropoietic Protoporphyria (EPP)
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Yes you read correctly, some recent research conducted in the UK has found that smoking is associated with a substantially reduced risk of developing rosacea.

The study was epidemiological which means that it used statistics to match the incidence of rosacea in smokers and non-smokers in a random grouping of individuals.

Why Are Smokers Much Less Likely to get Rosacea?

Typically an epidemiological study can’t say why such associations exist, only prove their existence. It is the task of further research to establish the reason and any subsequent implications for treatment etc.

Other Nicotine and Rosacea Research

We learnt in 2008 from some NRS funded research that “The activation of nicotine receptors appeared to be associated with a significant increase in intracellular calcium, and also stimulated two major signaling proteins that may trigger a cascade of biochemical reactions associated with rosacea.”

So there will certainly be some debate about what the statically significant reduction in rosacea is smokers in the UK really means.

Other Results in This Study

• Rosacea has been diagnosed in the UK in 1.65 / 1000 person-years. By my calculation this would translate to around 13% of the population of the UK having rosacea by the time they reach the life expectancy of 80 years.
• Rosacea was diagnosed in 80% of cases after the sufferer was 30 years of age.
• Ocular Rosacea was found in 21% of cases of rosacea.
• Alcohol consumption was associated with a marginal risk increase.

As the study was funded by Galderma perhaps the incidence results would be the most interesting outcomes for them.

Latest Abstract

A Study on the Epidemiology of Rosacea in the UK.

Br J Dermatol. 2012 May 5, Spoendlin J, Voegel JJ, Jick SS, Meier CR.

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland Hospital Pharmacy, University Hospital Basel, Switzerland Galderma Research & Development, Sophia Antipolis, France Boston Collaborative Drug Surveillance Program, Boston University, Lexington, MA, USA.

Background: Rosacea is a chronic facial skin disease of unclear origin. Epidemiological data are scarce and controversial with reported prevalences ranging from 0.09% to 22%. To our knowledge, incidence rates have not been quantified before.

Objectives: In this observational study we quantified incidence rates of diagnosed rosacea in the UK and described demographic characteristics and the prevalence of ocular symptoms in rosacea patients. We compared life-style factors such as smoking and alcohol consumption between rosacea patients and controls.

Methods: Using the UK-based General Practice Research Database, we identified patients with an incident diagnosis of rosacea between 1995 and 2009 and matched them (1:1) to rosacea-free control patients. We assessed person-time of all patients at risk and assessed incidence rates of rosacea, stratified by age, sex, year of the diagnosis, and region.

Results: We identified 60,042 rosacea cases and 60,042 controls (61.5% women). The overall incidence rate for diagnosed rosacea in the UK was 1.65 / 1,000 person-years.

Rosacea was diagnosed in some 80% of cases after the age of 30 years. Ocular symptoms were recorded in 20.8% of cases at the index date. We observed a significantly reduced relative risk of developing rosacea among current smokers (odds ratio 0.64, 95% CI 0.62-0.67). Alcohol consumption was associated with a marginal risk increase.

Conclusions: We quantified incidence rates and characteristics of rosacea patients diagnosed in clinical practice in a large epidemiological study using primary care data from the UK. Smoking was associated with a substantially reduced risk of developing rosacea.

Not Time to Take up Smoking

Despite the strong result from this statistical research, I doubt whether any doctor would recommend that you take up rosacea to reduce your chances of getting rosacea.

In fact you will probably find the opposite, that the health risks associated with smoking will see doctors advising smokers to give up altogether.

Any Smokers Out There?

Have you noticed a reduction in rosacea symptoms when you were a smoker ?

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Most published abstracts are a pretty dry read. This one is about as dry as they come. How about titling it “Rosacea Sufferers Willing To Pay Less than Vitiligo, Even the Women!”. Now that makes it sound more interesting right? Well that is the gist of this paper.

Researchers have come up with the idea of quantifying the burden one feels from a disease by asking sufferers how much they would be will to spend to achieve complete healing. Apparently this sort of quantification measure is a well established method.

Rosacea sufferers were found to be willing to pay on average € 2,880 or $USD 3,700.

Vitiligo sufferers on the other hand were found to be willing to spend € 7,360 or $USD 9,400.

Surprising Result?

The suggestion that vitiligo sufferers would be willing to pay 3 times as much as rosacea sufferers to achieve a cure surprised me.

Whilst vitiligo is no doubt unsightly in the worst cases, rosacea is equally if not harder to handle psychologically. Also some forms of rosacea, for example neurogenic rosacea can be quite debilitating.

Get Your Theoretical Cheque Book Out

At your worst, what would you have been willing to expend to get rid of your rosacea ?

Willingness to pay and quality of life in patients with rosacea.

J Eur Acad Dermatol Venereol. 2012 May 14, Beikert FC, Langenbruch AK, Radtke MA, Augustin M., IVDP – Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Germany.

Background: Rosacea is a chronic inflammatory dermatosis affecting >2% of the population. Willingness to pay (WTP) is a well established method which reflects the individual burden of disease.

Objectives: Evaluation of WTP and quality of life (QoL) in patients with rosacea.

Methods: Nationwide postal survey on adult patients with rosacea affiliated with the German rosacea patient advocacy group. WTP was evaluated by three standardized items and compared to historical data on vitiligo (n = 1023). QoL was assessed using the Dermatology Life Quality Index (DLQI).

Results: Data from n = 475 rosacea patients (79.9% women, mean age 56.3, range 26-90) were analysed. On average, patients were willing to pay € 2880 (median € 500) for complete healing compared with € 7360 (median € 3000) in vitiligo.

Relative WTP was higher in women; the highest sums were registered for the age group 21-30 years.

The extent of facial involvement predicted a higher relative WTP, whereas WTP decreased with the duration of symptoms and age.

Mean DLQI total score was 4.3 compared to 7.0 in vitiligo.

In rosacea, the highest values were observed in patients < 30 years. Severe QoL reductions (DLQI>10) were less frequent (11%) than in vitiligo (24.6%).

The correlation between WTP and DLQI was significant (e.g. r = 0.249, P = 0.000 for relative WTP).

Conclusion: Rosacea patients show a moderate WTP and average QoL reduction is mild. WTP proved to be a valid tool to assess patients’ burden of disease. Patient education and the development of effective treatment options might still improve patients’ satisfaction.

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The Daily Mail continues to show itself as the premier newspaper for rosacea related news stories.

This last weekend the paper has a great article highlighting a new corrective surgical treatment for rhinophyma.

Typically rhinophyma surgery is risky and can lead to complicates with bleeding and scarring.

The new technique highlighted by The Daily Mail is called Coblation.

What is Coblation?

Coblation uses a wand that utilises a tip with a focused `beam of energy’.

The tip uses radio frequency energy to excite (i.e. vibrate) the salt molecules in a saline solution.

The amount of energy focused in the plasma tip is enough to excise and even dissolve skin. Thus the wand becomes a bit like a three dimensional scalpel, allowing the surgeon to reshape the nose tissue.

The temperature of the wand is relatively low compared to other techniques which helps with controlling the resulting bleeding as well as reducing any burn related scarring.

How salt-blasting surgery cured my disfiguring condition called ‘drinker’s red nose’

By ROGER DOBSON

PUBLISHED: 21:07 GMT, 12 May 2012 | UPDATED: 22:23 GMT, 12 May 2012

A team of British surgeons reported major improvements in patients’ appearance, with the size of noses shrinking by a third or more, and disappearance of the red colouring.

One of the first patients to have the procedure, known as coblation, is John Clough, 64, who developed rhinophyma about 15 years ago. The semi-retired marketing consultant says having the treatment has changed his life.

…

John, who lives in Blackburn, Lancashire, with his partner Angela, 58, an accountant, eventually was referred to surgeon Michael Timms at The Royal Blackburn Hospital, who was about to begin trialling the coblation treatment.

‘They jokingly described it as being like sandblasting with salt, and warned me that I wouldn’t want to go out for a few weeks afterwards because it would  look bad,’ says John.

…

During the procedure the patient  is put under general anaesthetic. A hand-held coblation ‘wand’ emits a slow stream of saline solution – sterilised salt water – from the end that comes into contact with the nose.

At the same time, it emits waves of radiofrequency energy to excite the molecules in the solution which ‘sands’ down the tissue. It also uses a low  heat to cauterise (clot) any bleeding blood vessels.

John says: ‘I had a general anaesthetic and the whole thing took about  20 minutes. It was day surgery – I went home in the late afternoon, with a cream that had be applied everyday.

‘It looked pretty awful. Essentially, I’d had hundreds of layers of skin filed away leaving a raw wound, which scabbed over. But after the first day  I didn’t need painkillers and it looked far worse than it felt.

‘I’d say my nose has reduced by about one third in size, back to what it was when I was younger. It is much smoother, and has lost the red colouring. In fact, it is slightly paler than my other skin now. It’s an absolutely brilliant result.’

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Rhinophyma: Erbium YAG + CO2 Laser

In 2010 La Roche Posay  took the opportunity of the rosacea awareness month and their support of the National Rosacea Society to promote their product – Rosaliac UV Fortifying Anti-Redness Moisturizer with SPF 15.

This year La Roche Posay are again using the Rosacea Awareness Month to promote a new product, this time with a product called Rosaliac AR Intense.

In the past their rosacea targeted products such as `Skin Perfecting Anti-Redness Moisturizer’ and `UV Fortifying Anti-Redness Moisturizer’ have only received a few modest reviews online.

Maybe it will be third time lucky for La Roche-Posay.

What is Rosaliac AR Intense?

Rosaliac AR Intense is called a `localized redness intensive serum’ and cites 3 key ingredients:

• Ambophenol a “powerful vegetal extract rich in polyphenols to reduce the size of blood vessels and strengthen their walls.” The extract is from the Tambourissa Trichophylla plant found in Madagascar
• Neurosensine, a “soothing active ingredient to reduce appearance of redness.”
• La Roche-Posay Thermal Spring Water, an “Anti-irritant and decongestant “

Related Patent: Tambourissa Plant Extracts

Thanks to  downbythebay for pointing out a possibly related patent application to this product.

Compositions for skin diseases or disorders

United States Patent Application 20120009290

Medicaments or cosmetic compositions for the treatment or alleviation of skin or mucous membrane diseases or disorders related to an enhanced level of anti-microbial peptides or proteins comprising Tambourissa plant extracts, which may comprise polyphenols.

This invention relates to medicaments and cosmetic compositions comprising Tambourissa plant extracts that in turn comprise polyphenols for the treatment or alleviation of skin or mucous membrane diseases or disorders related to an enhanced level of anti-microbial peptides or proteins. This invention also relates to processes for preparing a Tambourissa plant extract, the extract itself, and uses of the extract.

The Tambourissa genus belongs to the Monimiaceae family and comprises about 43 species found throughout the western islands of the Indian Ocean, such as Madagascar, Comoros and the Mascarenes islands (Mauritius and Reunion). The various Tambourissa species tend to show endemic specificity as most of them are localized in only one island and in only one habitat.

Tambourissa trichophylla is known to contain polyphenols and flavonoids, including epicatechin, nicotiflorin and rutin.

Rosaliac AR Intense Ingredients

Cited Key Ingredients: Ambophenol , Neurosensine, La Roche-Posay Thermal Spring Water.

Other Ingredients: water, glycerin, isotearyl neopentandate, butylene gluycol, pentylene glycol, polysorbate 20, tambourissa trichophylla leaf extract, glyceryl acrylate/acrylic acid copolymer, dimethicone, dimethiconol, ammonium polyacryldimethyltauramide/ammonium polyacryloyldimethyl taurate, disodium EDTA, acetyl dipeptide-1 cetyl ester.

Related Product

Rosaliac AR Intense is available from SkinCareRx and also from SkinStore.com.

Your Thoughts

Are La Roche-Posay getting traction with their rosacea-targeted products ? What do you think of their latest offering of Rosaliac AR Intense ?

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• Rosaliac UV Fortifying Anti-Redness Moisturizer with SPF 15
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News today that the giant pharmaceutical company Novartis International is buying Fougera Pharmaceuticals.

Fougera is known to rosacea sufferers through the availability of generic metronidazole 0.75%. Fougera will brings its specialty in generics to Sandoz, the generics division of Novartis.

Who is Novartis?

Novartis was previously the manufacturer of Elidel (Pimecrolimus cream 1%).

Novartis are also trialling BFH772 for the redness of rosacea (NCT01449591). BFH772 is also being trialled for Psoriasis (NCT00987870).

BFH772 appears to be a metrondizaole variant of some sort, perhaps a genuine competitor to Metrogel 1%.

Hopefully this further signals Novartis as a company willing to invest in treatments for rosacea.

Press Release

Novartis to Buy Fougera Pharmaceuticals for $1.5 Billion

BY MICHAEL J. DE LA MERCED

Novartis International agreed on Wednesday to buy Fougera Pharmaceuticals, a maker of generic skin care medicine, for $1.525 billion in cash. The move would make the company the biggest manufacturer in the field.

It is the latest round of consolidation in the health care industry, a sector that has had a number of deals over recent weeks.

Under the terms of the deal, Fougera will be folded into Sandoz, the generics division of Novartis. The acquisition would give Novartis a leading position in generic treatments for ailments like acne, eczema and rosacea. The combined business will have an estimated $620 million in annual global sales, mostly in the United States.

Related Articles

• Generic Metrogel soon – Fougera
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Researchers in Ireland were able to show that demodex bacteria Bacillus oleronius proteins induced an “aberrant wound healing response” in  the cells irritated by scratch in a cornea.

The aberration appeared as an elevated immune response and an chagnes in cells’ inability to move like normally expected.

A Quick Revision

Previously we have learnt from NRS sponsored research from Dr. K. Kavanagh – “Dr. Kevin Kavanagh and colleagues at the National University of Ireland-Maynooth found that the bacterium Bacillus oleronius stimulated an immune system response, inducing high levels of T-cell proliferation, in 79 percent of patients with subtype 2 rosacea, compared with only 29 percent of patients without the disorder. T-cell proliferation induces an inflammatory response, evident as papules and pustules.”

Further, we also know that “two antigenic proteins of size 62 and 83 kDa” isolated in Bacillus oleronius have the potential to stimulate an inflammatory response in patients with papulopustular rosacea.

Correlation between ocular demodex and ocular symptoms tells us that those with rosacea linked to demodex bacteria, ocular symptoms may also be exacerbated by a reaction to the bacterial proteins.

Latest Research

Demodex-associated Bacillus proteins induce an aberrant wound healing response in a corneal epithelial cell line (hTCEpi).

Invest Ophthalmol Vis Sci., 2012 Apr 24

O’Reilly N, Gallagher C, Katikireddy K, Clynes M, O’Sullivan F, Kavanagh K.

Department of Biology, NUI Maynooth, Maynooth, Co. Kildare, ABC 127, Ireland.

Purpose: The aim of the work presented here was to establish the response of a corneal epithelial cell line (hTCEpi) to protein extracted from a bacterium (Bacillus oleronius) previously isolated from a Demodex mite from a rosacea patient.

Methods: The response of the corneal epithelial cell line to Bacillus proteins was measured in terms of alterations in cell migration and invasiveness. Changes in the expression of metalloproteinase genes and proteins were also assessed.

Results: The results indicated increased cell migration (14.5 fold, p = 0.001) as measured using 8 µm PET inserts (BD Falcon) in a transwell assay and invasiveness (1.7 fold, p = 0.003) as measured using 8 µm Matrigel (BD Biocoat) invasion inserts in a 24 well plate assay format, following exposure to the Bacillus proteins.

Cells exposed to the Bacillus protein showed a dose dependent increased in expression of genes coding for matrix metalloprotease-3 (MMP-3) (61 fold) and matrix metalloprotease-9 (MPP-9) (301 fold).

This dose dependent increase in gene expression was also reflected in elevated levels of MMP-9 protein (1.34 fold, p = 0.033) and increased matrix metalloprotease activity (1.96 fold, p = 0.043) being present in the culture supernatent.

Cells also displayed reduced levels of β-integrin (1.25 fold, p = 0.01), indicative of increased motility, and elevated levels of vinculin (2.7 fold, p = 0.0009), suggesting altered motility.

Conclusion: The results indicate that exposure of corneal epithelial cells to Bacillus proteins results in an aberrant wound healing response as visualized using a scratch wound assay.

Related Articles

• We’ve all been exposed to Demodex Bacteria Proteins ?
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Cetaphil has launched 2 new products that are targeted at oily or acne-prone skin. The products are called, take a breath; Cetaphil DermaControl Oil Control Moisturiser SPF 30 and Cetaphil DermaControl Oil Control Foam Wash.

The Oil Control Moisturizer is promoted as a lightweight 3-in-1 moisturizer for acne-prone skin. It is said to provide broad spectrum sun protection, control shine without over-drying. The SPF 30 protection is provided via the combination of 3 chemical sunscreens – avobenzone, octisalate and octocyrlene.

The Oil Control Foam Wash is promoted as being able to remove excess oil and impurities and contribute to soothing acne treatment effects like dryness and irritation.

Suitable for Rosacea?

It will be interesting to see how rosacea sufferers compare the Oil Control Foam to the popular Cetaphil Gentle Skin Cleanser.

I really like the combination of the Cetaphil Gentle Cleanser and Skin Moisturizing Lotion. Being a typical male I barely used any skincare products years ago. Now I have a simple but I think quite effective regime based on Cetaphil and Tinted ZincO.

If you have very oily skin then it might be worth trying these 2 new products and see if they might fit into your regime.

Do be aware though, that the moisturizer uses chemical sunscreens to give you SPF30. This might be an issue for extra sensitive skin.

The Ever Expanding Cetaphil Range

Cetaphil is now also making 2 products that are targeted at extra dry skin and may be suitable for rosacea sufferers who struggle with very dry sky skin – see Cetaphil RestoraDERM for comments.

You can see Galderma is trying to build on the success of the Cetaphil brand for problem skin. So far I think they are doing pretty well. offering a few choices for rosacea sufferers.

Cetaphil DERMACONTROL Oil Control Moisturizer SPF 30 Ingredients

Active ingredients: avobenzone 3%, octisalate 5%, octocrylene 7%

Inactive ingredients: water, isopropyl lauroyl sarcosinate, glycerin, dimethicone, diisopropyl sebacate, silica, polymethyl methacrylate, aluminum starch octenylsuccinate, sucrose tristearate, dimethiconol, pentylene glycol, polysorbate 61, sodium stearoyl glutamate, phenoxyethanol, caprylyl glycol, tocopheryl acetate, glycyrrhetinic acid, panthenol, triethanolamine, allantoin, carbomer, potassium sorabte, zine gluconate, xanthan gum, disodium EDTA, hydroxypalmitoyl sphinganine

Cetaphil DermaControl Oil Control Foam Wash Ingredients

water, zinc coceth sulfate, glycerin, PEG-75, dipotassium glycyrrhizate, zinc gluconate, PEG-200 hydrogenated glyceryl palmate, PEG-40 hydrogenated castor oil, PEG-7 glyceryl cocoate, sodium benzoate, masking fragrance, disodium EDTA

Featured Products

The Cetaphil DermaControl range is available online from Walgreens, drugstore.com and CVS.

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Live in the UK? Interesting in being a part in the My Naked Secret 2 series? The producers of this Channel 4 programme, who are based in London are looking to feature someone who suffers from rosacea.

The Assistant Producer says “The show is very positive and offers people psychological help with their underlying issue and treatment from top surgeons and specialists in the UK. It would be very interesting to feature someone with rosacea in the series, and put them in touch with specialist who could potentially treat their condition.”

Good publicity for and the promotion of the best practices for treating rosacea can only be a good thing. I’d love to see someone who was brave enough to show their rosacea face to the country.

Actually, if you have watched many episodes of My Naked Secret you will meet people with really quite embarrassing problems that can give perspective to rosacea sufferers.

What a great way to raise the profile of rosacea, especially in the UK. Contact details for the programme are below.

Is there something you hate about your body that you want to change?

Is it affecting your confidence and you want to do something about it?

Maverick Television, the Producers of Embarrassing Bodies are making the next series of ‘My Naked Secret’ and we want
to help. We are looking for men and women who might have conditions such as:

• Vitiligo
• Keloid Scarring
• Rosacea
• Psoriasis
• Excess Hair
• Acne Scarring

If you want help with any of the above or any other secret body issue please get in touch.
E-mail: mynakedsecret@mavericktv.co.uk or call 0207 874 6692 for more information.

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