Acne Rosacea: [rosacea] Re: No evidence that rosacea is primarily a vascular disorder

Wednesday, December 13, 2006

[rosacea] Re: No evidence that rosacea is primarily a vascular disorder

Hi Brady & Artist,

Drs Plewig and Jansen were definitely ahead of their time, and I
believe we owe them a huge amount of thanks. Unfortunately this
study is now @ 10 years old, however. Some more recent studies have
layered on additional details, and I think this sequence of events,
presented by Collagenex Pharmaceuticals, explains very well some of
the latest details in the pathologic sequence of events in rosacea:

"Sequence of Events

While the evolution of the inflammatory response in rosacea has not
been precisely elucidated, investigators suspect a sequence of events
similar to the following:

* Vasodilation of dermal capillaries, possibly mediated by
histamine, prostacyclin, prostaglandin E2, nitric oxide, or other
vasoactive compounds, causes initial erythema
* Prolonged dilation weakens capillary walls, allowing neutrophils
and proinflammatory cytokines such as TNF-α, IL-1, and IL-6 to leak
into the surrounding dermis
* Extravascular fluid builds up, overwhelming lymphatic vessels,
and results in edema
* Additional neutrophils are recruited by chemotactic factors
released from inflamed dermal tissues
* Activated neutrophils release degradative compounds, including
matrix metalloproteinases (collagenases and gelatinases), reactive
oxygen species, and nitric oxide—that exacerbate the inflammatory
response and lead to tissue damage5,6,7"

The full page can be found at the following link (notice they quote
Drs Plewig and Jansen's study on this page):

http://www.rosaceatoday.com/RoleofInflammation.asp

What's really interesting was that I was "chatting" online with a
microbiologist recently, and this person mentioned that rosacea seems
to share a very similar pathology to other inflammatory disorders such
as MS, Crohn's Disease and Interstitial Cystitis, whereby chronic
inflammation allows for the degradative compounds of the inflammatory
infiltrates to cause tissue damage in localized tissues (the brain in
MS, the intestine in Crohn's Disease, the bladder in Interstitial
Cystitis, and of course the dermal tissues in rosacea).

It's unfortunate that medicine is so specialized. Sharing of
knowledge across the specialties of neurology, gastroenterology,
urology, dermatology, etc might really help us out...

Dan

--- In rosacea-support@yahoogroups.com, "nurse_artist"
<nurse_artist@...> wrote:
>
> Wow. Interesting! "the vessels do not seem abnormally fragile so
> the main abnormality is probably in the dermis surrounding blood
> vessels rather than in vessel walls." Maybe it's with the collagen.
> Collagen supports vessels. Over time, RLT enlarges the collagen
> fibers. Maybe that's part of why it helps, along with the anti-
> inflammatory effects.
>
> Cheers!
>
> Artist
>
> --- In rosacea-support@yahoogroups.com, "Brady Barrows" <brady@>
> wrote:
> >
> > According to Thomas Jansen, MD and Gerd Plewig, MD, "there is no
> direct
> > evidence that rosacea is primarily a vascular disorder." This to me
> is news
> > since I have been hearing for so long that rosacea is primarily a
> vascular
> > disorder.
> >
> > Here is part of what the article says:
> >
> > "The pathogenesis of rosacea thus remains obscure. What is certain,
> however,
> > is that rosacea patients are constitutionally predisposed to
> blushing and
> > flushing. The basic abnormality seems to be a microcirculatory
> disturbance
> > of the function of the facial angular veins. Statistical
> associations between
> > rosacea-related flushing and migraine suggest a shared disorder of
> vascular
> > regulation but there is no direct evidence that rosacea is primarily
> a vascular
> > disorder. The response of the facial vessels to adrenaline,
> histamine and
> > acetylcholine is normal, and the vessels do not seem abnormally
> fragile so
> > the main abnormality is probably in the dermis surrounding blood
> vessels
> > rather than in vessel walls. In addition, the distribution of
> rosacea is not
> > identical with the flush area. A very important background feature
> is
> > sun damage. Rosacea is always associated with solar elastosis and
> often with
> > heliodermatosis. Fair-skinned patients with rosacea type I will
> often give a
> > history of sun sensitivity. " > Rosacea: classification and
> treatment,
> > Thomas Jansen, MD and Gerd Plewig, MD
> >
> > source >
> >
> > http://www.pubmedcentral.nih.gov/picrender.fcgi?
> artid=1296179&blobtype=pdf
> >
> > html version >
> >
> > http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1296179
> >
> > For more information on the cause of rosacea go to this url >
> >
> > http://www.rosaceans.com/html/cause.html
> >
> > Dr. Plewig is a member of the Medical Advisory Committee for the
> RRDi >
> >
> > http://www.irosacea.org/mac.php
> >
>