In 2010 the NRS reports on its web site that it spent $71,364 on research grants. However, a careful look at the Form 990 for 2010 reveals that there are only 3 grants mentioned for a total of $37,500. [3] This would mean that for every dollar donated to the NRS in 2010 only 6 cents was spent on rosacea research. How the web site says the NRS spent $71,364 on research is something you can try to figure out. I suppose it costs the NRS $33,864 to give the money to the researchers. This same form reveals that Mr. Huff received $115,583 from Glendale and Park. Glendale and Park received $398,344 of the total donations received which was $617,974. So for 2010 Glendale and Park received 64% of the total donations received. Read the Form 990 for yourself.

image courtesy of ION CHANNEL MEDIA GROUP LTD

In an article published in PLoS ONE [1] stated that “The cause of rosacea has been proposed as over-production of the cationic cathelicidin peptide LL-37.”  This statement is without a doubt  the result of the work of Gallo, et. al, at the University of San Diego that was initially published in Nature Magazine [2].

So what is cationic cathelicidin peptide LL-37?  It is an Antimicrobial peptide (AMP) which is part of our immune system that attack invading bacteria or other microbes to defend our body. There has been some evidence that rosacea may be a result of an immune system disorder. [3] Gallo, mentioned earlier, said in 2004, that rosacea may be an “abnormality in the innate immune system … caused by too much cathelicidin.”  He is also quoted as saying “if we believe that the disease is caused by too much cathelicidin, we could develop a strategy to block the effects of the cathelicidins by making molecules that mimic that protein but don’t have the same effects.” [4]

When reading these articles, one might conclude that the theory of what causes rosacea is over and that cathelicidin is the culprit. However, the article only said that the “cause of rosacea has been proposed as over-production of the cationic cathelicidin peptide LL-37.”  The jury is still out on what causes rosacea. [5]

However, it is important to note that as Dr. Gallo pointed out, “if we believe that the disease is caused by too much cathelicidin” then the treatment might be radically different.  Antibiotics are regularly used to treat rosacea and may be treating the wrong target. [6] So this new article published in PloS One by Zhang, et. al, “tested a new class of non-anticoagulant sulfated anionic polysaccharides, semi-synthetic glycosaminoglycan ethers (SAGEs)”  on mouse skin. The result:

“Topical application of a 1% (w/w) SAGE emollient to overlying injected skin also reduced erythema and PMN infiltration from intradermal LL-37.”

So we wait and see what will become of this new treatment for rosacea based on the theory that the cause is an overproduction of Cationic Cathelicidin Peptide LL-37.

End Notes

[1] Novel Sulfated Polysaccharides Disrupt Cathelicidins, Inhibit RAGE and Reduce Cutaneous Inflammation in a Mouse Model of Rosacea.
Zhang J, Xu X, Rao NV, Argyle B, McCoard L, Rusho WJ, Kennedy TP, Prestwich GD, Krueger G.
PLoS One. 2011 Feb 9;6(2):e16658.

[3] Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea
Kenshi Yamasaki¹, Anna Di Nardo¹, Antonella Bardan¹, Masamoto Murakami², Takaaki Ohtake³, Alvin Coda¹, Robert A Dorschner¹, Chrystelle Bonnart^4,5, Pascal Descargues^4,5, Alain Hovnanian^4,5,6, Vera B Morhenn¹ & Richard L Gallo¹
Nature Medicine 13, 975 – 980 (2007)
Published online: 5 August 2007 | doi:10.1038/nm1616

[3] Innate Immune Response
post by Brady Barrows, Director of the RRDi

[4] Innate immunity: Role in rosacea?
Michelle Stephenson
Dermatology Times, June 1, 2004
posted at Rosacea Support Group

[5] Cause of Rosacea Revisited

[6] Dr. Gallo is quoted as saying, “Antibiotics tend to alleviate the symptoms of rosacea in patients because some of them work to inhibit these enzymes [STCE]. Our findings may modify the therapeutic approach to treating rosacea,since bacteria aren’t the right target.”
UCSD Researchers Discover Cause of Rosacea
By Debra Kain, University of California, San Diego, August 7, 2007

Image Credit
Image of  Solution structure of the LL-37 core peptide bound to detergent micelles courtesy of ION CHANNEL MEDIA GROUP LTD.

Image courtesy of TROPILAB® INC

A new article released today on PubMed suggests 4% Quassia amara extract for Rosacea. The article concluded:

“Topical quassia extract could be a new, efficient, and safe weapon in the armamentarium for the management of rosacea.”

Click here for a copyrighted photo of Quassia.

Wikipedia says quassia amara is “used for the bitterwood or quassia, its heartwood, used as a febrifuge; this contains quassin, a bitter-tasting substance (it is, in fact, the bitterest substance found in nature). Extracts of Q. amara bark containing quassinoids are used as insecticides, being particularly useful against aphids on crop plants [1]. It is also used to flavor aperitifs and bitters which are added to cocktails.”

We will await anecdotal evidence in the online rosacea groups to confirm the effectiveness of quassia extract for rosacea.

More rosacea news:
http://www.rosaceans.com/news.php

PubMed source of article

A Spanish public research organisation has developed a monoclonal antibody that detects a protein of Candida famata. The antibody detects candidiasis and retinopathies in samples from blood, urine, aqueous humour, vitreous humour, and cerebral spinal fluid without interference from other species of Candida. The antibody is also useful for monitorization of antifungal treatments efficacy. Pharma and biotech companies are sought for exploitation under a patent license agreement.

Candidiasis has been reported to be linked to rosacea in at least one clinical paper. [1] There are some anecdotal reports that have been collected about this which you may be interested in reading. [2] There obviously needs to be more research on this subject. More info on this image is available at note number 3. Candidiasis is another rosacea mimic. [4]

[1] Candida Albicans and rosacea

[2] Anecdotal Reports

[3] Image courtesy of European Technologies

[4] http://rosaceans.com/rosacea_mimics.php

The National Rosacea Society has reported the required Form 990 for 2009 which is late this year. The report stated that “additional time is required to compile all data necessary to file a complete and accurate return.”  This is understandable when you review the Form 990 for 2009 and compare it with previous returns, especially the one for 2008.  More information is included in the Form 990 for 2009, such as, the salaries for Glendale and Park Employees are included in the report for 2009 which amounted to a total of $183,491 while these salaries were not reported in Form 990 for 2008 by comparison.  What do the salaries of Glendale and Park have to do with the NRS?  These are private corporations that are reported on Form 990 used by the NRS as independent contractors which three of the board of directors of the NRS are employees of. [1] The Form 990 reports for 2005, 2006, and 2007 also reported these salaries, while reports previous to 2005 never mention these salaries (the report for 2008 also omits these salaries). The Internal Revenue Service obviously wants the NRS to report these salaries so the public can know how a non profit spends its donated funds.

The economy may have affected the NRS as the rest of us since revenues are down 20% from the previous year. The total revenue received by the NRS for 2009 is reported to be $633,576.  Of this total received the NRS spent $69,725 on rosacea research grants. This means that for every dollar donated to the NRS eleven cents was spent on rosacea research grants. Where did the rest of the donated funds go?  $449,824 of the total funds received which amounts to 74% went to the two independent contractors, Glendale and Park, both of which are owned by the director of the NRS (three of the board members of the NRS are also employees of Glendale and Park including the director of the NRS).  [1]

I have been following the NRS reports to the IRS by reading their Form 990 reports since 1998.  Over this period the NRS has received $9,177,103 in revenue and of this revenue $942,971 has been spent on rosacea research which is a twelve year run.  That means over the past twelve years for every dollar donated to the NRS a little over ten cents is spent on rosacea research. Where did all the rest go?  Basically over this same period 62.5% went to independent contractors that are owned by Sam Huff, Director of the NRS.  [2]

The NRS reports on Form 990 for 2009 that 22.73% of the donated funds are from public support, meaning not from private corporations, i.e., pharmaceutical companies. In 2008 this public support is reported to be 35.1% which shows that in 2009 this public support has dropped probably due to the economy. [3] The NRS web site reports $88,150 in ‘individual donations.’ [4] Rosaceans continue to support the NRS with substantial donations and usually have no clue about what the NRS reports on Form 990 which is public knowledge. If those who donate from the public would see how the NRS spends its funds for themselves and actually take a look at what the NRS reports to the Internal Revenue Service each year on Form 990, they might have some questions about how these donated funds are spent. It takes about ten minutes to take a cursory look at Form 990 to get an overall review of revenues and expenses but if you want a nut shell version of how the NRS has been doing for a twelve year period you can click here for a report.

If you want to do something about this click here.

References

[1] Sam Huff, Glendale & the NRS

[2] For a complete breakdown of revenue and expenses of the NRS from 1998 thru 2009 click here.

[3] Form 990 Report - Schedule A, page 2, Section C, 14, 15

[4] http://www.rosacea.org/about/financial.php

A new study confirms antibiotics mess with the gut.  The study, published in the Proceedings of the National Academy of Sciences, supports the common wisdom that antibiotics can damage the ‘good’ germs living in the body. [1]

Another article suggests five ways to kill bugs in your gut and one of these suggestions is to stop eating sugar which I have been saying for over eleven years will help your rosacea. Dr. Hyman, the writer of the article suggests that what is in your gut may be the problem for a number of health problems including skin diseases. [2]

Clearing up any unhealthy bugs and getting a healthy flora may improve not only the skin but also a number of other health issues and “relief from allergies, acne, arthritis, headaches, autoimmune disease, depression, attention deficit, and more–often after years or decades of suffering.”

Bacteria has been one of the theories postulated as the cause of rosacea but this has never been proven. If bacteria isn’t involved the question is always asked, then, why do antibiotics clear rosacea? The usual response is the anti-inflammatory role of antibiotics is what treats rosacea. There is now a very low dose antibiotic like Oracea used to treat rosacea. However, the long term risks of antibiotic treatment is something to consider which may include an upset stomach, antibiotic resistance and bacterial overgrowth.

But the question is whether do you have a gut feeling about rosacea?  And antibiotics without a doubt plays a role in the gut.  Do you feel that rosacea is somehow related to something going wrong in your gut?

Most rosaceans use  trigger avoidance in their treatment of rosacea and the subject of diet triggers ALWAYS comes up.  Rosaceans have a gut feeling that what they are eating and drinking may have something to do with their rosacea but can’t seem to get a handle on it.  While most rosaceans on the internet know that sugar is a potential rosacea trigger, the NRS still hasn’t added sugar to their ‘official trigger list.’

For more than eleven years my Rosacea Diet has been published explaining why sugar is a rosacea trigger and more rosaceans have confirmed that reducing sugar in the diet does indeed help control their rosacea. Sugar is feeding your rosacea which makes it warm, red, and glowing.

There has been some discussion of how treating IBS, SIBO and H Pylori has helped rosacea. You might want to read this interesting post by Nanobugs, especially the last part of the post. So maybe you have a gut feeling that your rosacea is related to what you are eating and drinking.  Maybe your gut is trying to tell you something.

For more information:

[1] Study confirms antibiotics mess with gut
ABC Science, Maggie Fox, Reuters, Tuesday, 14 September 2010
Original Article

[2] 5 Steps to Kill Hidden Bugs in Your Gut That Make You Sick
Mark Hyman, MD
The Huffington Post . September 30, 2010

More Info:

Rosacea 101: Includes the Rosacea Diet

H Pylori Controversy

SIBO and Rosacea

A new report says, “Because Demodex mites are ubiquitous, their potential as human pathogens has often been ignored. This contribution focuses on the growing body of evidence linking Demodex mites with various skin disorders. Histologically, spongiosis and lymphoid inflammation are regularly seen in follicles containing Demodex mites. In animals, they are well established as a cause of mange, and a human counterpart-demodectic alopecia-appears to exist. There is also a statistical association between Demodex mite density and rosacea, facial itching, and chronic blepharitis. Papulovesicular rosacealike lesions and spiny blepharitis often respond to agents that reduce Demodex numbers. Although these observations are not sufficient to fulfill Koch’s postulates, Koch’s postulates are also not fulfilled for the association between brown recluse spiders and dermal necrosis or the association between streptococci and guttate psoriasis. The evidence linking Demodex mites to human disease has implications regarding treatment.”  [1]

Demodex and its connection with rosacea is probably the most researched and reported topic other than reports on metronidazole. [2] Yet demodex remains a hot topic that is debated and discussed not only by rosaceans but also in the medical community. For example, a couple of noted rosacea online gurus have dismissed the role of demodex in rosacea. One such rosacea guru said, “Rosacea experts all agree that this mite plays no real role in the development of progression of rosacea (except for the odd pustule).”  [3] The other rosacea guru says, “I have always pushed the line that demodex mites have thus far only been proven to be innocent bystanders in rosacea symptoms.” [4]

While demodectic rosacea remains a controversy, it will continue to play a significant role in more research and discussion and the list of articles written on this subject by researchers all over the world will continue to grow.  [5]

Sources

Accutane is being prescribed for rosacea more than ever according to anecdotal reports. More reports of accutane treatment for rosacea in low dose prescriptions seem to be the current popular treatment without much discussion on the risks and side effects.  Accutane was initially used to treat acne but has become quite common to hear of physicians prescribing it for rosacea. Particularly pregnant women should be warned clearly of the risks associated with accutane. A rosacean should ask his doctor what are the risks associated with taking accuatane, including the side effects and determine if the risks are worth the benefits. This what is called the risk-benefit analysis. If you decide to accept risks of this treatment,  you will discover later what these risks are for yourself but at least you were warned. Taking Accutane without considering the risks is like jumping into a dark deep hole blind folded. What you land on could hurt later.

Image Courtesy of Alternative Media Initiative

In recent years oral antibiotics are now given by dermatologists as a first line treatment for rosacea along with topical metronidazole.  Oracea has become the most recent popular antibiotic because it is low dose and touted as an anti-inflammatory rather than antibiotic, but nevertheless, is still an antibiotic. Generally speaking, taking these antibiotics for rosacea is long term since after short term use rosacea comes right back. Why is long term use of antibiotics the treatment?  According to Dr. James Del Rosso, professor of dermatology at the University of Nevada, says, ”We know that it’s best, in an ideal world, that patients are not on long-term antibiotic therapy. The reality is that patients are there for treatment, and part of the effective treatment that we have to date is giving them antibiotics. And so we’re caught in the middle until we have some better, definitive ways to solve the problem.” [1]  So what doctors are trying to do is reduce the dosage to a minimal amount that still treats the rosacea effectively, hence low dose tetracycline, Oracea. We have no idea what the long term effects of taking Oracea are since the safety of using Oracea hasn’t been established beyond nine months. All we do know is the long term effects of antibiotics since they have been used for a long time. What are the long term risks and side effects of antibiotic use?

Long Term Risks

There are many risks associated with long term antibiotic treatment and probably the foremost concern is antibiotic resistance which is is a type of drug resistance where a microorganism is able to survive exposure to an antibiotic. This problem is aggravated when “the greater the duration of exposure the greater the risk of the development of resistance irrespective of the severity of the need for antibiotics.” [2] There are, of course, other risks associated with long term antibiotic resistance including bacterial overgrowth, digestive problems usually due to changes in gut microflora, lower levels of phytoestrogens and compromising the immune system. [3] This doesn’t even take into account the many side effects of antibiotic treatment which are too many to list here. [4]

So a rosacean should ask his doctor what are the long term risks associated with taking an antibiotic, including Oracea, including the side effects and determine if the risks are worth the benefits.  This what is called the risk-benefit analysis. If you decide to accept long term antibiotic treatment, including Oracea, you will discover later what these risks are for yourself but at least you were warned.

For more information on this subject CLICK HERE.

Sources

[1] NPR
Doubts Raised Over Antibiotic Use for Acne by Allison Aubrey

[2] Wikipedia

[3] The Long-Term Effects of Antibiotics on Health and Immunity

[4] Antibiotics
The Merck Manuals

Copyright 2010 • All Rights Reserved • July 2010 by Brady Barrows

Artist Depiction of H Pylori

H Pylori (Helicobacter Pylori) has been a controversy with rosacea for some time now.  Some experts dismiss H Pylori’s role in rosacea and yet it remains a controversy since other rosacea experts continue to discuss H Pylori as a possible factor in rosacea. A report in January 2010 states that “Helicobacter pylori infection is implicated in the pathogenesis of extradigestive diseases such as acne rosacea…” A report by Mc Leer, Lacey and Powell in 2009 listed H Pylori as a possible factor in the pathophysiology in rosacea. One report in 2003 suggests “some form of relationship between rosacea and H. pylori infection.” Two reports in 1996 suggested H Pylori’s role in rosacea with titles such as “Eradication of Helicobacter pylori as the only successful treatment in rosacea” and “Acne rosacea and Helicobacter pylori betrothed.” Rebora suggested in 1995 that the “role of H. pylori is more probable in erythrotic rosacea than in its papulopustular and granulomatous stages.” [1] These are just a few reports suggesting H Pylori as a factor in rosacea.

When you consider the fact that H Pylori was ‘officially’ discovered in 1986 by Drs Marshall and Warren in Australia who both won the Nobel Prize in 2005 for this discovery and changed the textbooks about how bacteria can survive in the human stomach and its relation to ulcers and other gastric problems and the fact that this gram negative bacteria is considered an infection that half the world’s population is carrying with most being totally asymptomatic it is a wonder that anyone can even connect H Pylori with rosacea at all.  Yet the reports on H Pylori and rosacea keep coming out despite the fact that many reports negate H Pylori’s role in rosacea.

While there are many older reports suggesting H Pylori having some role in rosacea, newer reports dismiss this role. For instance, the late Dr. Kligman noted H Pylori’s controversial role in rosacea in his 2003 report. [2]

A report released in 2002 mentions ‘promising recent reports of beneficial H. pylori eradication’ in many cutaneous skin diseases except rosacea. [3]

A study published in May 2010 concluded, “There is no association between Helicobacter pylori infection and rosacea in current study.” [4]

Nevertheless, there are reports of H Pylori associated with rosacea indicating that eradicating H Pylori clears rosacea and discuss the possible cutaneous pathology of H Pylori to an autoimmune mechanism. A report in 2009 says, a “few case reports have documented associations between Helicobacter pylori infection and rosacea.” [5]

What is H Pylori and how does it relate to rosacea?

H Pylori is a gram negative bacteria that is considered an infection and harmful to humans.

According to one report, “more than 50% of the human population have long-term Helicobacter pylori infection.” [3] Wikipedia says that the diagnosis of H Pylori is done with different tests that are not failsafe and sometimes results in false positives.  How anyone can know for sure that 50% of the human population is infected with H Pylori is quite suspect. The percentage of ‘infection’ of H Pylori, if indeed it is an infection, may be more or less than 50% .

According to Wikipedia, “Helicobacter pylori is a Gram-negative, microaerophilic bacterium that can inhabit various areas of the stomach, particularly the antrum. It causes a chronic low-level inflammation of the stomach lining and is strongly linked to the development of duodenal and gastric ulcers and stomach cancer. Over 80% of individuals infected with the bacterium are asymptomatic.”

So, if 80% of individuals are asymptomatic and they only discovered H Pylori in 1986 how do they know that H Pylori is a human pathogen?  There is an amusing article, “So, What’s Your Problem with Gram-Negative Bacteria??,” that gets you thinking. Do you really think that medical science knows everything about H Pylori in a little over twenty years?  Obviously sometimes H Pylori is a human pathogen and runs amuck causing us problems. But in 80% of individuals H Pylori is asymptomatic and obviously is in the stomach for some reason, possibly for some nefarious purpose such as an ulcer, but it is quite possible for some beneficial purpose as well.  Could it be possible that a gram negative bacteria serves some useful purpose that as yet hasn’t been discovered? For instance, E. coli can help people and animals to digest food and help in providing vitamins but sometimes runs amuck causing some serious food poisoning. Could H Pylori have some beneficial yet undiscovered function for humans yet sometimes cause issues like E. coli does?

Could H Pylori be asymptomatic because it is helping us for some reason yet undiscovered, and sometimes for some yet undiscovered reason turns into a monster that causes problems like ulcers and rosacea?

Helicobacter pylori and rosacea.
Zandi S, Shamsadini S, Zahedi MJ, Hyatbaksh M
East Mediterr Health J. 2003 Jan-Mar;9(1-2):167-71.

Eradication of Helicobacter pylori as the only successful treatment in rosacea
Kolibásová K, Tóthová I, Baumgartner J, Filo V.
Arch Dermatol. 1996 Nov;132(11):1393.

Acne rosacea and Helicobacter pylori betrothed
Wolf R.
Int J Dermatol. 1996 Apr;35(4):302-3

May Helicobacter pylori be important for dermatologists?
Rebora A, Drago F, Parodi A.
Dermatology. 1995;191(1):6-8

[2] A Personal Critique on the State of Knowledge of Rosacea
Albert M. Kligman, M.D., Ph.D.

[3] Helicobacter pylori infection in skin diseases: a critical appraisal.
Wedi B, Kapp A.
Am J Clin Dermatol. 2002;3(4):273-82.

[4] Risk factors associated with rosacea.
Abram K, Silm H, Maaroos HI, Oona M.
J Eur Acad Dermatol Venereol. 2010 May;24(5):565-71. Epub 2009 Oct 23.

[5] Helicobacter pylori infection and dermatologic diseases.
HERNANDO-HARDER AC, BOOKEN N, GOERDT S, SINGER MV, HARDER H.
Eur J Dermatol. 2009 Sep-Oct;19(5):431-44. Epub 2009 Jun 15.

[6] Small Intestinal Bacterial Overgrowth: A Comprehensive Review
Andrew C. Dukowicz, MD, Brian E. Lacy, PhD, MD, and Gary M. Levine, MD
Gastroenterology & Hepatology Volume 3, Issue 2 February 2007

[7] ice2meetyu’s report July 4, 2010

[8] Rosacea and digestive problems