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Introduction - Lance Christiansen


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Rosacea is a common condition and therefore it must have a common cause. Various rheumatoid diseases such as lupus erythematosis and dermatomyositis have erythema of the face as one of their signs. I have found that patients with rosacea have palmar erythema, that is redness of the palms and plantar erythema, that is relative redness of their palms and soles. The coloration is secondary to a phenomenon in dermatology termed physical dermatitis wherein physical trauma, in this case ultraviolet from the sun striking the face and the "V" of the neck and compression and abrassion of the hands during grasping and the feet due to weight bearing causes an increased inflammatory reaction. Other triggering factors in physical dermatitis are infection, chemical, heat, and cold. If a person with rosacea takes a hot shower, for instance and then quickly looks in the mirror their whole bdoy appears reddened and it fades somewhat quickly on cooling. Some people have the underlying condition so severely that they have erythroderma, that is thier whole body appears reddened all the time. Many people with MS exhibit erythroderma.

One of the problems with medical research in the modern day, which means for the last sixty years, is that medicine as a science has become fragmented into specialties. This fragmentation creates problems, for instance, since the problem in rosacea is that the blood vessels are inflamed, but there are no vasculologists, so there is no one out there to "figure out" what causes blood vessel inflamation. Dermatologists deal with skin diseases, but then again most skin diseases are idiopathic, that is, there is no known cause for them, so there is a trite saying in dermatology, if it is wet, "dry it"; if it is dry, "wet it", if it is colored or protrudes "cut it off", and if all esle fails, "use steroids". Generally, since medical science became so fragmented there has been very few breakthroughs of a meaningful nature in sixty years. There have been extensions of prior breakthroughs, for instance x-rays, which were developed in the 1890's and now they have been computerized as cat scans. In addition, aftger physical chemists understood the inherent polarity of the water molecule and electromagnets were developed by physicists it was eventually realized that placing a human whose tissues contain a variable amount of water and create, with computers, an MRI scan. When one really thinks about it, the last great breakthrough in medicine was in 1933 with the development of the antibiotic theory and the development of sulfa drugs in 1933. Salk developed the poliovaccine in the 1950's, but the vaccine theory or the insight that led to the first one, that is of small pox, was determined by some unknown farmer hundreds of years ago and formalized by Jenner in the 1800's, I believe. Even though hundreds of billions have been funneled into academic research to determine the cause of many diseases, there have been no breakthroughs. The specialty arrangement of medicine including that of PhD's doing research, when they never see patients, has formed the organization which hs been very unproductive, but very expensive for the worlds population.

I determined the cause of rosacea, not because I was looking for it. Often when one question is asked and when one works to find the answer to the question advanced, the answers to collateral questions appear. That is how I determined the cause of rosacea. My question was "what causes low back pain with neuropathy to the lower extremity and shoulder and neck pain and neuropathy to the upper extremity? I learned it was from an inflammatory autoimmune disease process and nerves being highly vascular were affected by the vascular inflammation and compression and abrassion of the sacral plexus and the brachial plexes caused the inflammation and pain to be worse. Many minor accidents became workers' compensation claims. This same group of patients frequently had reddened cheeks, chins, nose and "V" of the neck. It also depended on how much sun they were exposed to. Ultraviolet caused the blood vessels to become more inflammed and become abnormal and form spider nevi, telangectasias, and petechiae. This is part of the physical dermatitis I mentioned above. All people also exhibit high-grade dermographism, which is a manifestation of physical dermatitis when the skin, for instance of the inside of the forearm, which is more light appearing than the outside of the arm where sun strikes and where nevi and seborrheic keratosis develop. Since the same group of patients exhibited high-grade rosacea it probably was caused by the same thing as the neurological pain.

Eventually I learned that the vascular inflammation was caused by an inflammatory autoimmune disease process and after two and one-half years of searching, 12-14 hours a day I determined that the auotimmune response was caused by a common bacterial pathogen, Streptococcus pyogenes. The nick-name is Strep A, the same bacteria that causes strep throat, ear infections, sinusitis, bronchitis, scarlet fever, rheumatic fever, erysepilas, peurperal fever, etc. The organism is ubiquitous to all vertebrates and at least in humans and domestic animals (Russian literature). One we get a Streptococcus pyogenes infection, like at one month old with the sniffles, a person will have the autoimmune disease for life. The more frequently we have infection and the more serious the more meaningful the inflammatory autoimmune disease will become. Many "disease entities" are caused by this disease process, a systemic disease process, and so I am writing a book about it and it is in the editing phase now. The title will be "Rheumatism, Enigma Unraveled", and yes, rosacea is part of the old fashioned rheumatism concept.

Since rosacea is a manifestation of an autoimmune, systemic vascular disease one has to use systemic treatments. Naturally, topical steroid creams may help to some degree, but systemic treatments are the best. Some systemic treatments are: Aspirin, 325mg, coated, one three times a day. Indocin SR 75mg one in the pm and 25mg in the AM, both after meals. Since this is an autoimmune disease methotrexate can be used in the same dose used for rheumatoid arthritis, 2.5mg, 4 tabs one time a week. Zyrtec 10 mg, one in the AM and Benadryl, 25 mg, one in the PM are appropriate because anti-histamines are also anti-inflammatories of a certain type. Allergies and asthma are caused by this disease process, I will say. It may be that Omega-3 caplets will help since perhaps the omega-3 oil may coat the endothelium, or vascular lining. I am not sure about it, but there have been some studies that indicate that it helps other syndromes caused by the blood vessel inflammation I have mentioned.

All medical texts indicate that if a person has a high-grade autoimmune response that is "labled" rheumatic fever, that a person whould be one penicillin every day to limit Strep A colonization and disease from its invasion. So, Penicillin VK, 500 mg, two times a day and four times a day in crowded areas especially airplanes and overland busses. The facial vasculitic sign of this disease, rosacea will appear more meaningful in areas with more sunlight, but ultraviolet will pass through clouds easily, so escaping to Seattle, will not help much.

There are antibody tests for Streptococcus pyogenes: ASO titer, Anti-DNAse B titer, and Anti-hyaluronidase titer. it would be interesting to have one hundred patients with severe rosacea take those tests. It would be interesting to see how frequently severe or mild neuropathies appear in patients with rosacea. It would be interesting to see how frequently patients with rosacea have MS.

Frequently, I believe, patients with erythroderma (red skin all over) or rosacea are high-functioning individuals. I think it affects the brain in a way that makes it "mildly supercharged". For instance, JFK was ruddy; Elvis featured erythroderma, Bush is quite red in the face, Marilyn Monroe had erythema, but often women in the limelite use make up to tone it down. Often times people are agressive in their natures, and often they have Agsberger's syndrome, a shy personality when young, but idosyncratic in their behavior, and Elvis was like that.

I have seen 230,000 patient visits as a general practitioner and I treated all diseases, for males and fremales of all ages. I had a chance to put the "puzzle together". I will say, though, that I had hundreds of patients with painful neuropathies on workers compensation in Washington State through the years. Many received pensions and disabilities. After nearly thirty years of practice, 6 of which were as a Navy physician, the workers compensation department transfered one of their bureaucrats to the "Department of Health, and he managed to use his power to suspend my license temporarily claiming I overdosed patients with pain medicine. It was not true, but the state is very powerful and they had the ability to stop me from practicing for a number of months. Since I had 14 employees, three clinics, and 80,000 overhead a month I just decided I would retire since I was 65 years old and had earned a US Marine Corps/Navy Medical Corps retirement and I was getting social security soon. It was a tragedy, in a way, but in other ways I was "burned out" and practicing with no help for over twenty-three years in a small town, it was time for a change. The above information comes from a physician with no license to practice medicine and so you must take that into consideration. If any person wants to use indocin, methotrexate, or penicillin they will have to get the cooperation of their doctor. The same for the use of prophylactic penicillin. A great study could be done by taking 200 patients with severe rosacea and do the serology tests I have mentioned above and include inflammatory marker tests: RA Factor, Sedimentation Rate, and C-reactive protein and C-ractive protein high sensitivity. I bet that there will be a meningful percentage of patients with elevated test results and it is my idea that many have at least minor findings of one of the rheumatoid diseases.

Thanks for the opportunity to write this note on the cause of rosacea.

Yours, Lance W. Christiansen, DO. (Commander, USNR, ret.)

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