In the last year, two new advances in our treatment and understanding of rosacea have occurred that I am excited to share. For those of us who have spent our professional lifetime treating rosacea, it’s really satisfying to see pieces of the enigmatic rosacea puzzle come together.
The first exciting rosacea puzzle piece is in genetics and is thanks to the new frontier of genetic mapping. Dermatologists and rosacea patients have long observed that rosacea-prone skin runs in families. Now, researchers at Stanford, working with the genetics company called 23andMe have substantiated that observation. The research shows specific similarities in the genes of people with papulopustular rosacea. This is exciting and important for two reasons. First of all, as we learn more, it will certainly help us better predict which rosacea patients will respond best to certain treatments. Secondly, it will also allow us to make connections between rosacea (a highly viable skin problem) and other more subtle health issues seen in people who have these same genetic characteristics. Already it's starting to look like rosacea is not "just" skin deep!
The study specifically notes:
All of these HLA allele associations have links to other autoimmune diseases. The DRB1*03:01-DQB1*02:01-DQA1*05:01 haplotype has been associated with type I diabetes (Erlich et al., 2008), and HLA-DRB1*03:01 is associated with retinopathy in type I diabetics (Kastelan et al., 2013), a vascular proliferative disorder of the eye. Rosacea also exhibits abnormal proliferation of blood vessels including on the ocular conjunctiva. HLA-DQB1*02:01 has been associated with celiac disease in humans (Krini et al., 2012), a condition that can have skin manifestations. Celiac disease involves the small intestine, and rosacea has been associated with conditions located in the small intestine, namely small intestinal bacterial overgrowth (Weinstock and Steinhoff, 2013). Together, these data strongly suggest a role for antigen presentation by class II HLA in the etiology of rosacea.
But, don't get lost in the scientific details. Instead, look at the big picture - rosacea connected to diabetes and celiac disease with some puzzle pieces between the conditions is also becoming clear. We know that rosacea is actually less of a problem for diabetics being treated for their diabetes. Could it be that the control of diabetes positively impacts a person's rosacea? This is potentially some serious dot connecting and is extremely exciting!
Gain a better understanding of what rosacea is and how it can be treated by downloading our rosacea guide!
As a doctor, the genetic revolution is an exciting wonder to behold. This dot connecting for mysteries we have long pondered is soul satisfying and scratches the intellectual itch big time. I’ve said to my rosacea patients for years, “I hope before I die, we figure this out because I feel like we are just tinkering in the dark, and I know there is a fascinating explanation just out of sight for rosacea.”
Well, the puzzle pieces are coming into focus and it's a good thing since my body tried to fail me recently and this rosacea mystery has really vexed me.
The second advance is the release of a new medicine for rosacea that kills mites. The mite/rosacea story is fascinating, and my patients know how much I love to kill skin mites. The situation is that rosacea-prone skin often has more mites in the pores. Understand that mites in the pores is a part of being human, so don't get too disgusted! It’s not the mites that are the problem, it’s a protein on the bacteria in the tummy of the mites that’s the problem. This protein tweaks the skin in rosacea. Population control on the mites will lower the amount of the protein in the skin and help the rosacea. I like to aim for that therapeutically.
This new medicine, an ivermectin cream called Soolantra, gives us a tool and instructions for the anti-mite mission for years to come. No more having to be a cowboy (or cowgirl, ladies!) out improvising, which is what I've been doing ever since hearing a very intriguing talk at the Annual Meeting of the American Academy of Dermatology years ago. The speaker had some compelling electron micrographic photos of mites in rosacea pores. That’s all it took for this gardener to start an all-out war on mites – channeling frustrated anti-crab grass crusading Caddy-Shack gopher hunting “issues” into the demodex/rosacea challenge!
But now, we have a medicine specifically tested on mites and rosacea. Wow, I’ve lived long enough! Once daily application of this medicine helps many people with moderate to severe papulopustular rosacea. In my opinion, this is the first real new advance in the treatment of rosacea since I started my dermatology residency in 1987. It’s been a good year. Let's celebrate!
Along with adding these new developments to my rosacea management, what else is in my out-of-the-box toolkit for rosacea?
Rosacea sufferers should also take advantage of the following products:
My Redness Relief Kit which includes:
- A gentle soap that delivers pyrithione zinc to the skin - this ingredient is known to help control a skin yeast that is also more present in rosacea-prone skin.
- Pharmaceutical-grade green tea polyphenols and caffeine in a cream that has very much been proven in my patients to help control facial redness and inflammation from a variety of causes, including rosacea.
- This kit combined with a daily application of a mineral-based sunscreen since sun triggers rosacea is highly recommended.
- Only non-irritating skin care products are also recommended since rosacea-prone skin has damaged skin barrier strength and flare ups are often triggered by skin irritation. The most popular facial moisturizer for my patients is my Daily Face Cream. It is hypoallergenic and enriched with ceramids to help heal the delicate barrier problems that make rosacea-prone complexions so temperamental. Mineral makeup powders are the products best suited for rosacea-prone complexions because they are gentle and don't contain complex ingredients that can be irritating.
- Diet and lifestyle changes are also very important in treating rosacea. Now that researchers are finding rosacea genetic characteristics in common with diabetes and celiac, I’m over the moon and can’t wait for more of this story to develop!
Yes, it’s been a good year, and I’m forever grateful for many reasons, rosacea advances included!!
Learn more about what you can do about rosacea in our guide or my rosacea advice pages.
Assessment of the Genetic Basis of Rosacea by Genome-Wide Association Study Anne Lynn S Chang et. al., Journal of Investigative Dermatology (2015) 135, 1548–1555; doi:10.1038/jid.2015.53; published online 12 March 2015
Efficacy and Safety of Ivermectin 1% Cream in Treatment of Papulopustular Rosacea: Results of Two Randomized, Double-Blind, Vehicle-Controlled Pivotal Studies
Linda Stein Gold MD et. al., J Drugs Dermatol. 2014;13(3):316-323.