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Trigeminal sensory malfunction theory


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  • Root Admin

There is a new theory on the cause of rosacea, the Trigeminal sensory malfunction. So what is this all about? It involves the nervous system so it is subcategorized in the nervous system theory

First, the trigeminal nerve "is a nerve responsible for sensation in the face and motor functions such as biting and chewing and is the largest of the cranial nerves,  Also,  understanding what the Principal sensory nucleus of trigeminal nerve is all about, which is a "is a group of second order neurons which have cell bodies in the caudal pons," that "can result in craniofacial pain, including migraine, temporomandibular joint pain, and trigeminal nerve pain." [1]  

"The Mascarenhas et al. (2017) paper is exciting because it casts a critical element of rosacea pathogenesis in a new light. The increased presence of antibacterial cathelicidin is a hallmark of rosacea facial dermatitis." [1]

The "link between chronic facial skin inflammation in rosacea, constitutive facial innervation by the trigeminal system, and possible involvement of trigeminal neuroinflammation and neural sensitization mechanisms in rosacea should prompt one to think more proactively about why the presence and severity of rosacea could act as a risk factor for Alzheimer's disease, as recently reported (Egeberg et al., 2016)." [1]

"Trigeminal sensory malfunction in humans can result in craniofacial pain, including migraine, temporomandibular joint pain, and trigeminal nerve pain. As a functional and structural system that underpins these medically relevant conditions, the trigeminal system can generate neurogenic inflammation powerfully. Bearing in mind this important feature, we should consider whether the chronic facial dermatitis of rosacea can be facilitated by neurogenic inflammation via trigeminal sensory afferents and also whether chronically inflamed skin in rosacea can sensitize trigeminal sensory afferents. From the senior author's own clinical practice (with now >1,000 cases encountered suffering from trigeminally mediated pain and sensory disorders), the clinical impression is affirmative, as he has observed worsening of facial pain in patients with poorly controlled rosacea. Clearly, this clinical impression awaits controlled assessment through clinical studies." [1]

"Mascarenhas et al. report that TRPV4 expression is upregulated in mast cells in response to the proteolytic cathelicidin fragment LL37 in a murine rosacea model and that TRPV4 loss of function attenuates mast cell degranulation. These findings render TRPV4 a translational-medical target in rosacea. However, signaling mechanisms causing increased expression of TRPV4 await elucidation. Moreover, we ask whether TRPV4-mediated Ca++-influx evokes mast cell degranulation." [1]

"" 'Although more work needs to be done, these findings suggest that potential therapies may be developed specifically to block TRPV4 as a direct means of treating or preventing inflammation in patients with rosacea,' Dr. Di Nardo said." [2]

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End Notes
[1] J Invest Dermatol. Author manuscript; available in PMC 2017 Jul 31.
J Invest Dermatol. 2017 Apr; 137(4): 801–804.doi:  10.1016/j.jid.2016.12.013 - PMCID: PMC5536341-NIHMSID: NIHMS876146
TRPV4 Moves toward Center-Fold in Rosacea Pathogenesis
Yong Chen, Carlene D. Moore, Jennifer Y. Zhang, Russell P. Hall, III, Amanda S. MacLeod, and Wolfgang Liedtke

[2] Researchers Discover Missing Links in Rosacea Inflammation, NRS
Posted: 08/14/2017



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Received this explanation of the article in this thread from Ronald P. Drucker, B.S. (M.T.A.S.C.P), D.C., who wrote the following: 

Dear Brady Barrows:   Glad you found me and thank you for your email.  The gist of the research article to which you directed me is the following:  Roseacea is a risk factor for Alzheimer's Disease (Type III Autoimmune Brain Diabetes).  This is so because (even though the research article does not mention it), both are autoimmune diseases and anyone with one autoimmune disease is more likely to develop other ones.  The next point of the article is that  Inflammation of the Trigeminal Nerve can cause or exacerbate Rosacea and visa versa.  This, of course, is due to the fact that all autoimmune diseases are accompanied by an exaggerated, defective immune response; namely chronic inflammation.  Visit my website: www.healtherootcause.com, view any of the hundreds of successful User Reports .  You can also read my book "The Code Of Life" with over 100 scientific references.

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Flavia Addor, MD. explains: 

Rosacea is a chronic skin disease with a inflammatory disfunction that leads to vascular and cutaneous changes. A new theory seeks to explain the inflammatory component, and is liked to a dysfunction of a crianial nerve called trigeminal. Inflammation of this nerve would be linked to inflammation of the skin, increasing inflammatory mediators, substances that can act worsening the inflammation. On the other hand, external sensory stimuli would excite this nerve, triggering the vascular reactions known in rosacea, such as flush and burning. 

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Edward S. Jarka, OD, MS explains: 


Thank you for this opportunity to weigh in on this topic. This is the way I would describe it to a patient:

In the eye care world we are often faced with people who have uncomfortable eyes but no apparent signs to explain their discomfort. These patients typically complain of burning, grittiness or the feeling of something in their eyes and are told they have “dry eyes”, but after many appropriate treatments these people continue to feel discomfort.

So…what’s causing this painful eye situation. Well, the sensation of pain is governed by a nerve called the Trigeminal Nerve. It has been speculated for some time that the reason for this eye pain was due to chronic inflammation of this Trigeminal Nerve. It was thought that the non-stop inflammation of this nerve changed the level of sensitivity of this nerve to be more sensitive to everyday sensations than normal.  This condition is referred to as neurogenic inflammation. A condition which is hard to diagnose and often times even harder to treat. Rosacea is also a condition that is difficult to diagnose and difficult to treat.

The Trigeminal Sensory Malfunction Theory suggests that an abnormal receptor in the skin known as TRPV4 functions abnormally. The TRPV4 receptor normally monitors an number of sensations such as vascular function and pain by regulating calcium to channel from one cell to another.  So, The Trigeminal Sensory Malfunction Theory  an initiating factor (abnormal chemical or mechanical cues) like non-stop inflammation →  abnormal TRPV4 receptor → change in the level of sensitivity in the Trigeminal Nerve → Chronic pain not responsive to typical treatments of inflammation.

The Trigeminal Sensory Malfunction Theory and the discovery of the role that the TRPV4 receptor might play in rosacea as well as certain types of dry eye may lead to early identification of the people at risk for rosacea, avoidance of the precipitating factors and treatments to modulate the function of the TRPV4 receptor.

Does this work for you Brady?


Edward S. Jarka, OD, MS


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