Guide

Replies sent by email: From: Robert Brodell,MD Subject: Re: Questions for the RRDi MAC Members Date: February 12, 2010 2:49:14 AM HST To: Barrows Brady Oracea Long Term Use How long should Oracea be prescribed? Oracea is a low-dose doxycycline formulated to have a slow release component so that the level of drug in a patient's system is lopw at any given time. This insures that the doxycycline is working as an anti-inflammatory drug rather than an antibiotic which minimizes side effects including stomach upset, yeast infections, and the potential for developing bacteria that are resistant to this drug. This makes it an excellent drug for rosacea. While physicians never want patients to be on any oral drug longer than they need it, some patients with rosacea require long term treatment. I have patients who have been on Oracea for years since every time I try to stop the medication their condition flares up, despite attempts to suppress their rosacea with a variety of topical medications. So, How long should Oracea be prescribed? Ans> As long as needed to keep rosacea under control....and,.... as short as possible! Robert Brodell, MD ____________________________________________________________

Galderma after it acquired Collegenex's brand Oracea, which is described as "Capsules 40 mg are hard gelatin capsule shells filled with two types of doxycycline beads (30 mg immediate release and 10 mg delayed release) that together provide a dose of 40 mg of anhydrous doxycycline," is marketing this as a first line of treatment for rosacea and as the 'only FDA approved oral medication for rosacea." The Prescribing Information Sheet from Galderma says that "Efficacy beyond 16 weeks and safety beyond 9 months have not been established." There are numerous reports that Oracea has been prescribed well over 9 months. What do you think about prescribing Oracea beyond the safety threshold described in the sheet mentioned above? Should rosaceans expect to be prescribed Oracea long term in amount such as years?

The subject of misdiagnosed rosacea usually comes up when there is a discussion or articles about rosacea. I am curious what the MAC members think about misdiagnosed rosacea and why it occurs? What would be the most obvious reason a misdiagnosis occurs? Is it because the definition of rosacea is sometimes vague? The initial history and physical exam is cursory? Or is there another reason why this occurs? If there are several reasons what might they include? Here is list of articles and anecdotal reports of misdiagnosing rosacea.

Tanweer A. Syed (Timothy Syed Andersson) is no longer affiliated in any way with the RRDi.

This is to announce that Noah Scheinfeld, M.D. has joined our Medical Advisory Committee [MAC] as a consultant to the RRDi and you may view his photo and CV at this page. Dr. Scheinfeld has a background not only in dermatology serving on the faculty at Columbia University but also a background in law having graduated from Harvard law school. The RRDi greatly appreciates his volunteering to help us.

The following replies to this thread were sent to me by email: From: Robert Brodell, M.D. Subject: Re: Calcium, Vitamin D(3), And Retinoic Acid Date: January 23, 2010 2:16:31 AM HST To: Barrows Brady Basic science research is important because it often points up approaches to disease treatment that would not be otherwise apparent. HOWEVER, acne rosacea is a complicated process and I would not recommend any changes to the treatment of patients without clinical evidence of efficacy. Bob -------------------------------------------------------

A new PubMed article abstract by Dr. Gallo concludes: "These findings show that the expression and activity of KLK are under fine control and can be distinctly influenced by variables such as differentiation, calcium, vitamin D, and RA. Thus, these variables may further control the functions of antimicrobial peptides in the skin." Does this mean that rosaceans should increase their intake of calcium, vitamin D and RA? What comments do you have about this research?

A new study which Dr. Tseng participated in entitled, Correlation between Ocular Demodex Infestation and Serum Immunoreactivity to Bacillus Proteins in Patients with Facial Rosacea, was just announced today on PubMed. Could Dr. Tseng or any of the other MAC members interpret what the results of this study might mean for us? It is rather scientific and needs some translation into layman's tongue with your thoughts on this study, please.

Thanks Dr. Jones. From what I have been learning from the MAC members is that what the public thinks about rosacea research grants is quite different from what the medical or scientific community thinks. Do you have any comments on the current published or non published rosacea research being sponsored by the NRS or the AARS?

Some of the RRDi MAC Members have replied to my question by email and here is the list: From: Latkany, MD Robert Subject: RE: Question for RRDi MAC Members Date: December 24, 2009 12:52:11 AM HST To: Barrows Brady Not all grant recipients publish their results but the majority should. A submission of a paper should be required but not all papers are guaranteed acceptance. But if you are given money a paper should be submitted. The results should not influence additional funding as this introduces conflict of interest. Robert Latkany, MD ___________________________________________________________________________________________ From: Robert Brodell Subject: Re: Question for RRDi MAC Members Date: December 24, 2009 2:38:30 AM HST To: Barrows Brady Picking a winner is as difficult in funding research as it is in horse racing. Several approaches can be taken. The most common approach is to have a committee of experts review grant applications and choose grantees that 1) have a proven track record in previous research in the area; 2) Have a solid plan that is feasible; 3) will provide important basic science information that can, hopefully, be translated into clinical treatments. However, this is by no means the only approach to funding research. The American Cancer Society saw a problem with research funding 50 years ago. Young researchers could not get their first grant to get started because it would be impossible for them to have a track record. Therefore, they began funding young researchers for their first grant...only requiring that they perform research applicable to the cancer problem. This approach has led to the initial funding of 43 investigators who have won the Nobel Prize in Science! My conclusion, develop a thoughtful system utilizing stakeholders with rosacea and noted clinicians and scientists. Stick to your guns and don’t put pressure on anyone to do anything BUT, make an effort to publish their research. Recognize that research that does not pan out is harder to get into the literature than research that identifies positive findings. Therefore, it is not the fault of the investigator if their reseach does not get published...they must, however, make a good faith effort. Robert Brodell, MD __________________________________________________________________________________________ From: raymond peat Subject: Re: Question for RRDi MAC Members Date: December 31, 2009 7:14:51 PM HST To: Barrows Brady It's good to be able to consult experts when judging the applications, but I think it's important to have some judges who aren't dermatologists. The existence of a large group of interested people communicating through the website could itself make a considerable contribution to productive research. Raymond Peat, Ph.D. ______________________________________________________________________________ From: Peter Drummond Subject: RE: update on the Journal of the RRDi Date: January 2, 2010 4:36:47 PM HST To: Barrows Brady I have thought a little bit about the questions you posted on the forum about supporting rosacea research. I agree that one of the primary criteria for supporting research grant applications should be the track record of the applicants (whether publications have arisin from previous support, number of PhD students supervised, presentations at conferences etc). Of course the ultimate aim is to advance treatments for rosacea, but as progress has to depend on insights into pathophysiology it would be important to support fundamental as well as applied research. Regards, Peter Drummond, Ph.D. _______________________________________________________________________________________________________________________________________________________________________________

This is an open question to the RRDi MAC members about grant writing since we hope someday that the RRDi will be sponsoring our own grants and would like to know more about the process of grant writing and how it works. We hope the MAC members will give us some insight into what kinds of grants we should sponsor and thoughts on the following questions: There are now two non profit organizations taking the lead in sponsoring rosacea research grants: National Rosacea Society American Acne & Rosacea Society The NRS has the lead in sponsoring rosacea research by spending over the past 12 years a reported $962,696 on 45 reported grants. The AARS has spent $30,000 on three grants. My questions are the following: Of the total of 45 grants sponsored by the NRS only nine have been published. The three grants by the AARS haven't been published yet. Shouldn't the sponsors of grants look for awarding grants to those who get published, or does this matter? Secondly, of the nine grants that were published (or for that matter all the grants sponsored), shouldn't the results of new treatments be one of the criteria for judging whether or not to continue sponsoring further research on a subject? I haven't heard of any new treatments as the result of any of the grants sponsored by the NRS or the AARS. Are there any new treatments resulting from any of the sponsored research so far? Here is a breakdown of the published results of completed NRS sponsored research: (1) The role of vascular endothelial growth factor in rosacea Dr. Mina Yaar, professor of Dermatology, Boston University School of Medicine. Publication of results: Kosmadaki MG, Yaar M, Arble BL, Gilchrest BA. UV induces VEGF through a TNF-alpha independent pathway. Federation of American Societies for Experimental Biology Journal 2003;17:446-448. (2) Influence of skin temperature on bacteria in rosacea Dr. Mark V. Dahl, chairman of Dermatology, Mayo Clinic Scottsdale, and Dr. Patrick M. Schlievert, professor of Microbiology, University of Minnesota Medical School. Publication of results: Dahl MV, Ross AJ, Schlievert PM. Temperature regulates bacterial protein production: possible role in rosacea. Journal of the American Academy of Dermatology 2004;50:266-272. (3) Immune system may trigger onset of rosacea symptoms Dr. Richard Gallo, associate professor of dermatology and pediatrics at the University of California - San Diego and Dr. Masamoto Murakami, postdoctoral scientist, Veterans Medical Research Center. Publication of results: Yamasaki K, Barden A, Taylor K, Wong C, Ohtake T, Murakami M, Gallo RL. Expression and potential pathological role of cathelicidin expression in rosacea [abstract]. The Journal of Investigative Dermatology 2004;122:A51. Abstract 301. (4) The role of bacterial antigen(s) in the etiology and persistence of papulopustular bacteria. Dr. Kevin Kavanagh, Department of Biology, National University of Ireland - Maynooth, and Dr. Frank Powell, consultant dermatologist, Mater Misericordiae Hospital, Dublin. Publication of results: Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. British Journal of Dermatology 2007;157:474-481. (5) Perceptions of self in persons with rosacea. Karol Burkhart Lindow, RN, C, CNS, assistant professor of nursing; Deb Shelestak, RN, MSN; Joan Lappin, RN, MSN, Kent State University. Publication of results: Lindow KB, Shelestak D, Lappin J. Perceptions of self in persons with rosacea. Dermatology Nursing 2005;17(4):249-254,3 (6) Glycomics analyses of tear fluid for the diagnostic detection of ocular rosacea. Dr. Mark J. Mannis, Department of Ophthalmology, University of California - Davis. Publication of results: An HJ, Ninonuevo M, Aguilan J, Liu H, Lebrilla CB, Alvarenga LS, Mannis MJ. Glycomics analyses of tear fluid for the diagnostic detection of ocular rosacea. Journal of Proteomic Research 2005 Nov-Dec;4(6):1981-7. (7) Allergy-like reaction may trigger inflammation in rosacea Dr. Richard L. Gallo, associate professor of dermatology and pediatrics at the University of California - San Diego, and Dr. Kenshi Yamasaki, Veterans Medical Research Center Publication of results: Yamasaki K, DiNardo A, Bardan A, et al. Increased serine protease activity and cathelicidins promotes skin inflammation in rosacea. Nature Medicine 2007;13:975-980. (8) Cell biologic effects of ATP on endothelial cells Dr. Richard Granstein, chairman, Department of Dermatology, Cornell University. Publication of results: Seiffert K, Ding W, Wagner JA, Granstein RD. ATPγS enhances the production of inflammatory mediators by a human dermal endothelial cell line via purinergic receptor signaling. Journal of Investigative Dermatology 2006;126:1017-1027 (9) Mite-related bacteria may induce rosacea inflammation Dr. Kevin Kavanagh, Department of biology, National University of Ireland, Maynooth, and Dr. Frank Powell, Consultant Dermatologist, Mater Misericordiae Hospital, Dublin. Publication of results: Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. British Journal of Dermatology 2007;157:474-481. Source of the above published results ________________________________ Do you have any comments on any of the sponsored published rosacea research that would enlighten us on what the RRDi should be looking at to sponsor?

It is with sorrow that we just learned that Karl Rebert passed away October 9, 2009 at the age of 29. Karl joined the RRDi April 5, 2008. He had a background in pharmaceutical chemistry and was quite knowledgeable about rosacea treatment. He volunteered to help edit the new journal and I asked him if he would volunteer also to serve on the board of directors which he gladly did. He worked many hours of volunteer service to the RRDi editing and proof reading the journal. Karl will be missed.

Dr. Tseng, Could you answer a couple of questions about the following report: Study finds cause of rosacea Can you explain if you feel that the cause of rosacea has really been found as the article above suggests? What can you tell us about this study and is there an abstract available on this study with PubMed? Thanks.

Thanks for the tip mchatham. I haven't heard of this product before. Maybe we will hear more good reports like yours with this product? I can't find how to buy this stuff on the the net. What is the link?

The RRDi is please to announce that Joanne Whitehead, Ph.D., has been appointed to serve on the board of directors: http://irosacea.org/....php#jwhitehead Dr. Whitehead has written an article for the RRDi which will be published later this year by the RRDi and has been pre-published by Elsiever: http://www.ncbi.nlm....5?dopt=Abstract The RRDi is a non profit organization of volunteer rosacea sufferers who have come together to find the cure for rosacea.

Maybe this is the place? Have you found any other site for dating rosaceans?

Valerie Fox has announced her resignation from the board of directors. Valerie graciously volunteered to serve on the RRDi board of directors from the start of this organization but is too busy to serve on the board anymore. I personally what to thank Valerie for all her volunteer efforts and how she was instrumental in getting our non profit status approved by the State of Hawaii and the IRS. We will miss Valerie and wish her the best in her career.

We now allow guests to post here without registering. Guests and Inactive Members are privileged to visit some of our website which had a vast amount of information about rosacea. You must be an active member to have full access to all our information on rosacea. For more information. FAQs If you are newly diagnosed, post your question in this thread or in the FAQs that are already posted. Ask about anything. However, if you browse the FAQs, usually your question has already been asked so you might want to browse through the FAQs for a while and see if your question is posted already. Here are a couple to get you started: Simple Regimen Controlling Rosacea Will I Develop Rhinophyma? Does Rosacea Progress In Stages? Repetition Please understand and indulge us when we REPEAT over and over the same point, since when we do, we are emphasizing something we know is important and you should consider carefully, since this post is for rosacea newbies. To repeat, we repeat important points over and over again. Please indulge us. Diagnosis It would be good to get a diagnosis of what skin condition you are suffering from since you may NOT have rosacea but something else. Read this post about self diagnosis or this one on internet diagnosis. If you haven't gone to a doctor to get a diagnosis and really feel like asking 'is this rosacea?' please read this post. As for treating rosacea from the inside (oral treatment), you may want to read this post on nutritional deficiencies or this post on the gut. As for what topicals, there is not one treatment, whether oral or topical that works for every rosacean, which is what we have dubbed the rosacea x-factor. Prescription Treatments Usually, with a well informed dermatologist, the current state of the art treatment for rosacea is Oracea and Soolantra, the gold standard currently. This treatment is a combination using oral, timed release, low dose doxycycline and a topical ivermectin. A well informed dermatologist prescribes this now as a first line of treatment and asks you to return in 30 days to see the results. Old school dermatologists may prescribe a higher dose doxycycline along with topical metronidazole. In each case you need to come back to the dermatologist for an assessment if the treatment is working, usually in thirty days. If after a month or more with this treatment the skin isn't improved, there are a number of other treatments used when rosacea isn't responding to the standard treatments. Since some old school dermatologists who are not keeping up with the gold standard are prescribing topical metronidazole and an oral antibiotic, which could be a tetracycline (usually doxycycline) or minocycline. Again, the physician will ask you to try this treatment and come back in a month to review the results. Sometime this old school treatment with metronidazole and antibiotic works. However, if it works for everyone we wouldn't have this post since not everyone responds to this old school treatment approach. Data has suggested that Topical Calcineurin Inhibitors (TCIs) are more commonly prescribed for rosacea according to one paper from Korea. If your results are unsatisfactory, your dermatologist might try another treatment. You may want to review When Rosacea Resists Standard Therapies. More information on prescription treatments for rosacea. Over the Counter Treatments or Non Prescription The RRDi recommends the Cosmetic ZZ cream, one of our sponsors, Demodex Solutions, which is an over the counter topical treatment. There are a number of other demodectic treatments for rosacea, including a popular treatment using horse paste. There are others as well as Diaper Treatment and the list keeps growing. When we hear any anecdotal report on what rosaceans say improves their rosacea we try to list the treatment in our store if it is over the counter and available on Amazon. As for alternative treatments, i.e. natural, or over the counter treatments, the number has grown to such a huge array in the armamentarium treatment for rosacea which is a multi-million dollar industry for both prescription and non prescription treatments, that sorting through these can be bewildering. Our affiliate store is a huge database of over the counter, non prescription treatments, not only for rosacea treatment, but for other skin conditions and the some odds and ends. Our non profit gets a small fee if you purchase an item in our store which helps us keep our web site going. Rosaceans So, that is why the RRDi exists, since the common bond of members is we are all searching for a better way to control rosacea. You may post in our member forum by registering with an email address. You may post in our private forum by registering with an email address. Since many rosaceans now prefer private social media rosaceans groups, we have paid for a private Tapatalk forum for those who want total privacy. Our member forum is secure and has all the rosacea data so we hope you join. What is the difference between a public and a private forum? Answer. You may want to understand our policy on Anonymity, Transparency and Posting. Searching First, you need to be sure what skin condition you are suffering from, since you need to rule out a number of rosacea mimics or other skin conditions. The RRDi recognizes thirteen rosacea variants, so it would be important to get a proper diagnosis. We can't over emphasize this, and we are redundant in recommending this. Differentiating Rosacea from Other Skin Conditions. So the question is whether you have been properly diagnosed with rosacea and what phenotype? Can you get a diagnosis on the internet? It has been stated in some papers on rosacea when treatment for acne exacerbates the condition that a diagnosis of rosacea may be a consideration (more info on diagnosing rosacea). Rosacea skin is usually described as sensitive so sometimes it is best to be careful not to use too many treatments at the same time since you may be making it worse. Sometimes you may need to let your skin heal on its own for a few days to allow your skin some time to recover from the treatments which may have done more harm than good. There isn't one treatment for rosacea since what condition you may have could result in a different diagnosis later, such as a rosacea mimic or a rosacea variant. The RRDi recognizes thirteen variants of rosacea. Yes, we repeat information to emphasize points. Since there isn't one treatment that works for every rosacean we have dubbed this the Rosacea X-Factor. Rosacea has been described by one doctor as "probably a collection of many different diseases that are lumped together inappropriately." There has been a controversy on the subtype classification of rosacea since it was announced in 2002. The RRDi has endorsed the Phenotype Classification of rosacea which is a superior classification than subtypes. So if your physician says you have a subtype, your physician isn't keeping up with the latest state of the art diagnosis of rosacea. Most rosacea sufferers follow the advice of a physician. You should at the very least be sure to get a proper diagnosis of what your skin condition is. Some who have followed the advice of their physician are successfully treated and remain happy campers. Usually these patients never post in forums like this one, since they have moved on in life and follow the advice of their physician and have their rosacea controlled with prescription treatment. If you have never been diagnosed and decide to see a dermatologist you may want to know what to ask your physician. Others, who join this forum, usually are frustrated with the treatment offered and find rosacea confusing and a bewilderment. Some others claim that this isn't the case at all and have rosacea all under control. There are a significant number of rosaceans who have been misdiagnosed and you should be aware, this may happen to you. There are a significant number of rosaceans who use the various light therapy devices, whether offered by a physician or simply purchase their own light devices. However, even these, after some time find these light devices wanting. There are a significant number of rosaceans in this forum who have tried all the various treatments offered by dermatologists and the pharmaceutical prescription treatments and found them wanting and use various over the counter or non prescription or natural treatments to control their rosacea. The number of treatments stagger the imagination and the list keeps growing. Our store offers a mere fraction of these treatments (our non profit organization receives a small fee if you purchase an item through our affiliate store). One recommendation is to just take a few days to let your skin heal on its own and only apply cool water to your skin. You may find that you have simply used too many treatments on your rosacea sensitive skin and you just need your skin to heal on its own. Then, apply one rosacea treatment at a time to see what happens rather than multiple treatments since you have no idea what may be exacerbating your skin if you are using multiple treatments. Browse and read the posts in this forum to educate yourself on what others are doing to control their rosacea. You will quickly discover that what works for one rosacea sufferer does not necessarily work for another. There are a number of alternative and non prescription (over the counter) treatments for rosacea that some report work for them. Try using one (or two) treatments at a time since it is difficult to know what is working and not working for your skin if you are using three or more treatments on your skin. Using more than one treatment, especially three or more will be extremely difficult to decide what treatment is actually working. If you decide to take oral treatments (prescription or non prescription) for rosacea, you may want to try them one at a time, slowly increasing another oral treatment to see what is working or what is not working. Others have tried trigger avoidance, which is an accepted medical treatment for rosacea, and is usually always mentioned by physicians. Probiotic treatment for rosacea is now an acceptable medical treatment for rosacea. The gold standard state of the art treatment is usually what a well informed dermatologist will prescribe to rule out demodectic rosacea. If your rosacea isn't responding to standard treatments, you may want to consider When Rosacea Resists Standard Therapies. Finally, post questions in the different threads and also post what results you are experiencing. Others with similar experiences may help you. Be positive and try to remain calm, you will get your rosacea under control, as many in this forum have reported. If you are concerned about joining the RRDi all you need to join and post is an email address and you can hide behind a cryptic display name of your choosing so no one knows who you are. Read this post if you still have concerns about your privacy. Or join our private Tapatalk forum. Newbies Should Post We encourage you to post and become actively involved with the RRDi forum. We really need rosaceans who want to volunteer. Of course, you don't have to volunteer, which is what the word means, "a person who freely offers to take part in an enterprise or undertake a task." You should volunteer because you want to volunteer. The RRDi can improve if you simply post your concerns and questions or what you have found to improve your rosacea. Get your RRDi Tee Shirt Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

Use this forum for FAQs about rosacea. You may find the list of the most frequently VIEWED questions since probably your questions may be the same of others. Browse through the questions before you ask, since it probably has already been asked. Spend at least a half hour in our FAQs and you will probably learn more in a half hour than you spend at the social media platforms for hours. However, if you do have a question not listed in this category, please feel free to post your question by clicking on START NEW TOPIC button at the top level of FAQs. Or you may search the entire forum for a topic that interests you by typing in the search box top right corner your inquiry or look at all the categories of rosacea topics. If you have a complaint, a good category for complaints is this one. Hopefully a fellow rosacea sufferer will read about your complaint and have empathy. If you think you may have rosacea and are curious whether or not you do have it, we recommend you read this post.

The RRDi is sponsoring a new publication, RRDi Report, Volume 1, No. 1, which will be released in 2008. We are asking for the MAC members to volunteer to write an article on rosacea and conribute for this project as a volunteer. We will publish this as a print on demand book and the profit for the sale of this book will be used to put in the general fund to use for rosacea research. If you would like to volunteer for this project let me know in this topic whether you could help in either of these two ways: (1) Work on the editorial staff (let me know your skills) (2) Write an article for this publication So far I have received a few replies from the MAC members: (1) From: Neil Shear, MD Subject: RE: volunteering to write an article for a book Date: September 6, 2007 2:14:24 AM HST I would be very interested to provide a chapter on the place of camouflage makeup. I have over 20 years experience in the area, and run a camouflage clinic at our University Hospital. I know this is of great value to our rosacea patients. Neil Shear _____________________________________________ (2) Edit out _____________________________________________ (3) From: Peter Drummond, Ph.D. Subject: RE: volunteering to write an article for a book Date: September 6, 2007 6:12:50 PM HST Hello Brady, My student, Daphne Su, and I would be interested in writing a chapter on psychological aspects of rosacea for the book. Best wishes, Peter Drummond _____________________________________________ (4) From: Raymond Peat, Ph.D Subject: Re: volunteering to write an article for a book Date: September 13, 2007 9:12:23 AM HST I'll send you a draft of an article in a few days. _____________________________________________ (5) From: Kosta Y. Mumcuoglu, PhD Subject: RE: Volunteering to write an article Date: September 22, 2007 3:38:15 AM HST Dear Mr. Barrows, Dr. Akilov and myself would be interested in writing a chapter in the future book on the role of Demodex mites in Rosacea and other dermatoses. However, we would need 3-4 months to deliver the manuscript. Best Regards †Kosta Y. Mumcuoglu, PhD _____________________________________________ Helen Cooper RRDi Corporate Member Submitted an article: THE EFFECT OF DIETARY SALT ON ROSACEA _____________________________________________ The following MAC members are too busy and replied that they could not contribute an article: Marianne Boes, PhD Robert T. Brodell, MD Sandra Creamers, MD Robert Latkany, MD Michelle Pelle, MD Gerd Plewig, MD _____________________________________________ We have yet to hear from 15 MAC members, so based on the replies so far, it will be a long project before we are finished. But I am confident that the first publication the RRDi sponsors will be important and increase respect for this non profit organization of volunteers and increase membership. Let me know if you want to be a part of this project?

Due to time constraints Dr. Clark has resigned from volunteering from the MAC. We are sorry to see her go and wish the best for Dr. Clark and an open invitation is always there for her.

MAC Members, Please comment on this news item that was just released. In major newspapers across the country they are saying scientists have found the cause of rosacea. For instance the Los Angeles Times, US News and World Report, the Washington Post, UCSD News and Medical News Today. The abstract is already published on PubMed. Here is the Abstract Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea Kenshi Yamasaki, Anna Di Nardo, Antonella Bardan, Masamoto Murakami, Takaaki Ohtake, Alvin Coda1, Robert A Dorschner1, Chrystelle Bonnart, Pascal Descargues, Alain Hovnanian, Vera B Morhenn & Richard L Gallo Nature Medicine, 5 August 2007 | doi:10.1038/nm1616; http://www.nature.com [type in rosacea in the search box] Acne rosacea is an inflammatory skin disease that affects 3% of the US population over 30 years of age and is characterized by erythema, papulopustules and telangiectasia1, 2, 3. The etiology of this disorder is unknown, although symptoms are exacerbated by factors that trigger innate immune responses, such as the release of cathelicidin antimicrobial peptides4. Here we show that individuals with rosacea express abnormally high levels of cathelicidin in their facial skin and that the proteolytically processed forms of cathelicidin peptides found in rosacea are different from those present in normal individuals. These cathelicidin peptides are a result of a post-translational processing abnormality associated with an increase in stratum corneum tryptic enzyme (SCTE) in the epidermis. In mice, injection of the cathelicidin peptides found in rosacea, addition of SCTE, and increasing protease activity by targeted deletion of the serine protease inhibitor gene Spink5 each increases inflammation in mouse skin. The role of cathelicidin in enabling SCTE-mediated inflammation is verified in mice with a targeted deletion of Camp, the gene encoding cathelicidin. These findings confirm the role of cathelicidin in skin inflammatory responses and suggest an explanation for the pathogenesis of rosacea by demonstrating that an exacerbated innate immune response can reproduce elements of this disease. 1. Division of Dermatology, University of California, San Diego, and VA San Diego Health Care System, 3350 2. La Jolla Village Drive, San Diego, California 92161, USA. 3. Department of Dermatology, Asahikawa Medical College, Asahikawa 078-8510, Japan. 4. Department of Medicine, Asahikawa Medical College, 2-1-1-1 Midorigacka Hidashi, Asahikawa 078-8510, Japan. 5. INSERM, U563, Toulouse F-31000, France. UniversitÈ Paul-Sabatier, Toulouse F-31000, France. 6. CHU Toulouse, Department of Genetics, Place du Dr. Baylac, Toulouse F-31000, France.

This section is for you to post whatever questions you may have to fellow corporate members about rosacea.

I have been troubled to understand what the criteria is in determining when physicians choose to use laser, IPL, LED, or other light devices to treat rosacea? Could you help understand when laser would be appropriate, when IPL would be the choice, when LED treatment would be used, or any other light devices?

I just ran across something that was new to me, that rosacea is a condition, not a disease (like acne is a condition and acne vulgaris is the disease). The source of this new thought to me was in an article entitled, The Proposed Inflammatory Pathophysiology of Rosacea, by Medscape from WebMD. However I have seen in many articles that rosacea is a disease, such as this recent quote in an article just released, "Rosacea is a common and chronic disorder characterized by flushing, erythema, papules, pustules, and telangiectasia on the central part of the face. Because the facial skin of individuals with rosacea is particularly sensitive, irritants can trigger a worsening of the signs and symptoms of the disease," written by Laquieze, et al, . If rosacea is considered a condition rather than a disease, what would the correct term be for the disease?