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Sandra Lora Cremers, MD

Angiogenesis and Rosacea, S Cremers, MD, FACS

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I am happy to be a part of RRDi and am here to answer any questions as best as I can. My area of interest is in angiogenesis in rosacea, specifically ocular rosacea.

Sincerely,

Sandra Lora Cremers, MD, FACS

Harvard Medical School

The Massachusetts Eye and Ear Infirmary

243 Charles Street

Boston, MA 02114

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Guest Jenny

Hi Dr Cremers

An article from the Dermatology Times came up recently in the Rosacea Forum:

http://www.dermatologytimes.com/dermatolog...l.jsp?id=313786

"Aldara (imiquimod, 3M) is a topical drug that inhibits angiogenesis on a molecular basis (interferons, interleukins), in cells (vascular cells) and on treated tissue (animals, humans), and clinically there is now proof of principle that Aldara effectively treats vascular diseases and skin cancers.

"We know that this drug actually induces the cells near treated tissue to produce natural angiogenesis inhibitors including interferons (alpha, beta, gamma) and interleukins (IL-12, IL-18 ). These are molecules that help keep angiogenesis in check under physiological conditions, but dermatologists using Aldara have a way of increasing their levels right at the site of a skin cancer on a topical basis," Dr. Li says.

Aldara was originally developed as an immune response modifier, to boost immune-mediated killing of cancer cells. This anti-angiogenic mechanism is now being appreciated by dermatologists and researchers.

In fact, Dr. Li explains, this is one of the reasons this drug works in the treatment of AKs and BCCs, for which it received FDA approval.

"When dosed optimally, Aldara can effectively treat AKs and BCCs without the cytotoxic inflammation and necrosis of conventional topical chemotherapy such as 5-fluorouracil," Dr. Li says.

Other topical drugs that Dr. Li has combined effectively with Aldara for use in topical anti-angiogenic cocktails include retinoids, vitamin D analogs and nonsteroidal anti-inflammatory agents. The combination of these agents has proven very effective in the treatment of invasive skin cancers, including squamous skin cancer in situ."

The above is quoted from the article but not the full article.

Question posted in the Rosacea Forum:

"...perhaps Dr. Cremers could tell us why the potent antiangiogenesis

drug mentioned in the above article - Aldara, which seems to have an oral and a topical use cannot be used to treat rosacea?"

I would be grateful if you could give some insight into this Dr Cremers.

Jenny

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That's interesting, Jenny, good question... Maybe it would be useful combined w/IPL, or just to keep pre/moderate rosacea from progressing any further.

Looking forward to Dr. Cremers' remarks.

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Hello,

That is a very good question. I asked Dr. Vincent & William Li that question a few months ago.

No one has tried these medications, or the combination of medications they usually use for skin cancers, on rosacea patients.

It also still remains to be proved that rosacea is due to angiogenesis. Surprisingly there is very little research in this area & almost none in the ocular rosacea field.

For now, the potential risks and costs of Aldara (a carefully titrated dose must be given to avoid its cytotoxic effects) likely outweighs the potential benefit.

Our group though is trying to answer some of these questions & see if such a medication would benefit our patients.

Sincerely,

S. Cremers

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