Rosacea-What Causes It

[Cali]

I have facial and ocular rosacea. Interesting, the dermatologist who diagnosed me 30 years ago and many since, never asked if I had dry or gritty eyes (indicators of ocular rosacea). None of the six cornea specialists I saw over the last 8 months ever asked me if I had facial rosacea (indicator of ocular rosacea). Up to 50% of those with facial rosacea have ocular rosacea (numbers vary online). Had I known 30 years ago about ocular rosacea, perhaps not ALL of my lower meibomian glands would have atrophied. Caught early the glands can be managed.

In summary, rosacea is the over-production of two interactive inflammatory proteins that result in excessive levels of a third protein. These proteins are anti-microbial peptides, small proteins in the body’s defense systems. Rosacea patients have far more peptides than is normal. The precursor form of these peptides is calls cathelicidin which “normally” protects the skin from infection. Rosacea patients have too much cathelicidin in their skin and it’s in a different form that is “normal.” And rosacea patients have greatly elevated levels of enzymes called stratum corneum tryptic enzymes (SCTE) These enzymes turn the precursor into the disease-causing peptide. So basically, we as rosacea sufferers have too much cathelicidin plus SCTE which leads to rosacea. Antibiotics sometimes work because they inhibit some of these enzymes.

The cause was discovered by Dr. Richard L. Gallo at the University of California, San Diego. Here is the link: http://ucsdnews.ucsd.edu/newsrel/hea...RosaceaDK-.asp

He runs his own lab in La Jolla so maybe he's working on a cure: http://dermatology.ucsd.edu/research/gallo-lab.shtml Possible hope for the future

I was able to see a colleague of Dr. Gallo’s today and was told nobody really specializes in “ocular rosacea.” It would be a niche study by a cornea specialist. Apparently there is one at the University of California, Davis, Dr. Mark J. Mannis, MD, who specializes in ocular rosacea.

I’ve been researching the heck out of facial/ocular rosacea, trying to come up with a diet plan. Lot’s of contradictory information out there but I’m making my way through it. It’s a *%$&%% for sure! Nothing really new on the market – no real new information. Just thought people might want to know what causes rosacea - it's our biology, how we're built.

What we can do is avoid known triggers (stress, extreme heat, cold, spicy foods, histamine causing foods, etc.) which cause the body to overact and become “inflamed” which ultimately effects our eyes. Rosacea is all about inflammation. We don't want to activate these two interactive inflammatory proteins with a known rosacea trigger. That we can control. We can't control our biology, how we are built, but we can avoid the known triggers to help alleviate painful ocular rosacea.

[littlemermaid]

Hello Cali ~ this is about where we are too. Another dermatologist's thoughts I like is James Del Rosso. Do you have other symptoms of sensitivity or inflammation?

We have bowel cramps after food triggers, allergic contact rashes as red patches, even dermatographism on some meds, intracranial hypertension triggered by oral meds and stress, p&p periorificial dermatitis/rosacea controlled by topical antibacterials and moisturisers and tea tree mixes. Immune response is obviously more active around eyes, nose, mouth. The literature reports some children with 'rosacea' response round the anus. This is why rosacea needs a rethink.

I think ours was started by prescription Clotrimazole with hydrocortisone (now discontinued formulation) for Tinea Versicolor on the hairline and back 28 days at adrenarche (puberty), but it seems there can be various eg oral meds and autoimmune responses setting up what looks like ocular rosacea. And it can be an immune response, like allergy or sensitivity, without classic 'rosacea' skin signs. Interestingly, 'rosacea' doesn't always start immediately and it looks like an intervention might set up a preponderance for later in susceptible (eg genetic HLA B27) people on a 'have you ever used...?'-type basis. The pathway seems to be in the steroid-hormone-lipid metabolism too.

We have alpha-1 antitrypsin deficiency in the gene pool, which is a protease inhibitor controlling inflammation, but she has tested negative for that twice. Still not convinced.

Unfortunately dermatologists don't seem to keep up with their literature (and the immunology is difficult) or know anything about the immune system or systemic affects of the topical meds they prescribe, so some patients have been made worse with rosacea by eg topical steroids. 'Rosacea' can also be started by inhaled steroids for asthma http://dermatology.cdlib.org/1604/le...084/kumar.html Derms we've seen have been non-starters on thinking about autoimmune conditions and we've done better in Rheumatology and even Neurology for that.

Rosacea does seem like an inflammatory immune response - type 4 hypersensitivity, it's described as too.

I love James Del Rosso's good advice to support the skin with ceramide moisturisers before blitzing with harsh antibacterials (PubMed, Medscape). This is our experience. She is sensitive to mineral base products and we do best on bee products without additives. Sunblock essential.

Spmcc has helped us very much with good experience dealing with this. Good dermatologist advice has been to rotate maybe 3 products like shampoo or moisturiser to avoid sensitivity developing.

Do your eyes feel better in different houses and using eg different tap waters? Anything that helps support your skin? Is there anything you know you are sensitised to?

Really excited to hear that you have accessed Richard Gallo's experience! All our docs think best results come from a 'what makes it better, what makes it worse' 'keep well, have fun, reduce stress' approach but some doc interest and guidance would be nice.