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New Study Finds Allergy-Like Reaction May Trigger Rosacea Bumps and Pimples

The bumps (papules) and pimples (pustules) of rosacea, a poorly-understood facial disorder affecting an estimated 14 million Americans, may be the result of an allergy-like reaction to environmental and emotional triggers, according to new study results presented at the National Rosacea Society (NRS) research workshop during the annual meeting of the Society for Investigative Dermatology and reported in Rosacea Review.

"We are very excited about these findings because they may provide the basis for improving the treatment and management of this condition," said Dr. Richard Gallo, chief of the division of dermatology at the University of California-San Diego and lead investigator of the NRS-funded study. "By defining the process leading to the inflammation, new medications might be developed to block these effects."

Dr. Gallo explained that when the normal immune system is faced with any of a broad range of potential dangers—such as sun exposure, emotional stress, heat and spicy foods, among many others—receptors recognize potential threats and protect the body by prompting the production of protective substances that isolate and neutralize any harmful effects. With rosacea, however, these protective substances turn the body on itself like overzealous guards, leading to inflammation.

Using advanced mass spectrometry technology to analyze the biochemical composition of proteins in rosacea patients, the researchers discovered an abnormality in the production of protective molecules known as cathelicidins, Dr. Gallo said. In normal patients, the cathelicidins are found in a form that is inactive and would not lead to bumps and pimples. In rosacea patients, the forms of cathelicidins are different and lead to skin inflammation. The cause of this abnormality in cathelicidins seems to be due to an equally important problem in rosacea—an overabundance of yet another substance, called kallikrein, which can spur dormant cathelicidins into action.

"It appears that the combination of these two substances at abnormally high levels is a double whammy for rosacea patients," Dr. Gallo noted.

The researchers recently completed the picture when they were able to demonstrate that this process is linked to the actual formation of rosacea signs and symptoms. The skin of mice injected with the cathelicidins found in rosacea patients showed a dramatic inflammatory response—including bumps and pimples—while mice injected with normal cathelicidins showed no inflammation, either visually or under a microscope.

"The next step is to test these findings in human subjects through various therapeutic interventions," Dr. Gallo said. "As we gain a thorough understanding in humans, we can look for new medications that block this process in order to treat or prevent the inflammation associated with rosacea."

Rosacea is a chronic disorder that primarily affects the cheeks, nose, chin or forehead, and is often characterized by flare-ups and remissions. It typically begins as a flushing or redness that comes and goes, and visible blood vessels may also appear. Inflammatory bumps and pimples often develop, and in severe cases, the nose may become swollen and enlarged from excess tissue.

In addition to long-term medical therapy to bring the condition under control and maintain remission, patients are advised to keep a diary to identify and avoid lifestyle and environmental factors that may affect their individual cases. Some of the most common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, hot baths and spicy foods.

Ethnic Skin Care

By: Heather Woolery-Lloyd, MD

Discover the unique skin care challenges of various ethnic skin types and about some treatment options.

Drug-resistant Acne Runs in the Family

An antibiotic-resistant acne germ can spread among family members, Swedish researchers find.

The germ is Propionibacterium acnes. Skin colonized by P. acnes tends to erupt into the blotches and pustules of acne. Since the 1960s, doctors have fought P. acnes with antibiotics. The bug fought back. It's now common to find P. acnes strains resistant to several common antibiotics.

Doctors hoped that the only people carrying the drug-resistant acne bugs would be patients on long-term antibiotic therapy. That isn't the case, find Carl Eric Nord, MD, PhD, and colleagues at Karolinska Institute in Stockholm, Sweden.

Nord and colleagues took skin samples from 10 acne patients, all on antibiotic therapy, and from two close family contacts of each patient. Twelve healthy, acne-free volunteers -- who were not taking antibiotics and did not have family members with acne -- served as a comparison group.

Nord and colleagues found that nearly half of the family members carried drug-resistant acne bacteria on their skin. Genetic analysis showed that these family members carried the same strain of P. acnes as the acne patient among them.

The good news is that the family members fought off the drug-resistant germs -- but only after the acne patient in their family stopped using antibiotics.

On the other hand, you apparently can't avoid drug-resistant acne germs by avoiding people with acne. A third of the healthy comparison group also carried drug-resistant P. acnes on their skin.

Nord reported the findings at last week's 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, held Sept. 27-30 in San Francisco.

SOURCES: 46th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, Sept. 27-30, 2006.

By Daniel DeNoon, WebMD, October 2, 2006

The Latest Advances in Nonsurgical Facial Restoration

By Nicholas Daniello, MD

Estheticians must familiarize themselves with the most recent nonsurgical techniques in order to better advise and retain clients.

Botox Reduces Facial Scarring

Botox injections can help facial wounds heal with less scarring, a small study finds.

"This is the first medication found to minimize scarring," senior author Dr. David Sherris, professor and chair of the department of otolaryngology at the University at Buffalo, said in a prepared statement.

His team published the study in the August issue of Mayo Clinic Proceedings.

The study included 31 patients who suffered wounds to the forehead or had surgery to remove skin cancers from the forehead, an area that's particularly susceptible to scarring. The patients received either an injection of Botox or saline within 24 hours after wound closure.

Photographs were taken at the time the patients received the injections and again six months later. The photographs were reviewed by two facial plastic surgeons who weren't involved in the study. They rated the patients' wound healing on a scale of zero to 10, with 10 representing the best result. The two surgeons' scores were averaged to reach a final score for each patient.

The median scores for wounds injected with Botox were 8.9, compared to 7.1 for wounds injected with saline.

"The result is of substantial interest in the field of scar treatment. When a wound occurs, especially on the face, people are always worried about the scar. We can now try to improve scars with these injections," Sherris said.

The study was funded by a clinical research grant from the Mayo Clinic.

HealthDay News, August 24, 2006

The Botox-like Facial

By Kellie K. Speed

Extra Wrinkles a Bad Sign for Smokers

British scientists have discovered a tantalizing new wrinkle in our understanding of smoking's unhealthy effects.

Middle-aged smokers whose faces were heavily wrinkled were five times as likely to have chronic obstructive pulmonary disease (COPD) than smokers whose faces were relatively smooth, the study found.

The authors speculated that both COPD and wrinkling may be linked by a common mechanism and that facial wrinkling might indicate susceptibility to the potentially deadly lung disease.

It's unclear, however, what kind of clinical relevance the findings hold.

"It's certainly biologically plausible," said Dr. Norman Edelman, chief medical officer for the American Lung Association. "This may be of use in educating patients but, in terms of detection of lung disease, we [already] have a simple breathing test. We don't have to look for wrinkles."

The research appears in the June 14 online edition of Thorax, which is published by the British Medical Journal.

COPD refers to a group of progressive chronic lung diseases, including emphysema and bronchitis, that block the airways and restrict oxygen flow.

Some 13.5 million Americans suffer from COPD, and the World Health Organization predicts that the condition will become the third leading cause of death worldwide by 2020.

Smoking is the biggest risk factor for COPD, and dermatologist have long noted that smoking causes premature aging of the skin.

However, not all smokers go on to develop COPD. "Obviously, people vary in their response to what's in the smoke," Edelman said.

In the study, the team wanted to see if genetic factors that predispose smokers to COPD might also predispose them to wrinkles.

The researchers, based at Royal Devon and Exeter NHS Foundation Trust, analyzed data on 149 current and former middle-aged smokers, 68 of whom (45.6 percent) had COPD. The participants came from 78 families.

Eighty-three percent had no facial wrinkling or only minor lines, but close to 17 percent had considerable wrinkling.

Lung strength and function, measured in all participants, turned out to be significantly lower in those with extensive wrinkling than in those with smoother faces.

People with heavy wrinkles were also five times more likely to have COPD than those without wrinkles. People with facial wrinkling also had triple the risk of suffering from more severe emphysema.

The authors theorized that smoking-linked changes in cells' collagen and elastin may be important for the development of both lung disease and wrinkles.

The findings are more likely to be helpful in spurring new research than in providing any direct benefit to patients, Edelman said.

"I think this will be of use to basic biologists," he explained. "Maybe you can start doing experiments on the skin, maybe that's an easier model to use than the lung to figure out what the mechanisms are."

HealthDay News, June 14, 2006