Copyright 2010 Brady Barrows

Whenever the subject of trigger avoidance comes up with rosacea usually avoiding spicy food is mentioned. This is due to a 1999 survey conducted by the NRS that is usually referred to as the source of information. How was the survey conducted?

This was not a placebo controlled, double blind controlled study. This was simply a survey of rosacea sufferers who filled out a form and is purely anecdotal. The survey concluded the following according to an article in the JCAD:

“A 1999 survey by the National Rosacea Society of 3,151 rosacea patients determined different food triggers. With regard to alcohol ingestion in rosacea patients, this survey found red wine as the most likely culprit, followed by hard liquor, then beer as the least likely to cause symptoms in patients. With regard to spices, cayenne pepper aggravated rosacea 36 percent of the time, red pepper 34 percent of the time, black pepper 18 percent of the time, white pepper 9 percent of the time, and paprika 9 percent of the time.” [1]

So whenever a physician or anyone says that spicy food is a rosacea trigger they are relying on evidence that is purely anecdotal. While the survey may prove helpful it is by no means a clinical study. Just because 36 percent of the respondents of the survey said they report cayenne pepper as a rosacea trigger doesn’t mean that cayenne pepper is a rosacea trigger. All it means is that maybe it is a rosacea trigger since there is no clinical study to prove that indeed cayenne pepper is a rosacea trigger.

What a rosacea suffer needs to remember is that any proposed trigger is simply that, a proposed trigger. What triggers rosacea is an individual thing. Trigger avoidance is not an exact science and while it may prove helpful one must realize its limitations.

Every trigger proposed on the 1999 NRS survey is just a proposed trigger that MAY trigger rosacea. There has never been found one rosacea trigger that in every case produces a rosacea flare up. Not one.

Conclusion: Spicy food may be a rosacea trigger.

Source:

[1] The Role of Diet in Acne and Rosacea
September 2008
by Jonette E. Keri, MD, PhD, and Adena E. Rosenblatt
J Clin Aesthetic Derm. 2008;1(3):22–26

Glyco Mira, LLC says the company received a “SBIR Phase I grant for the development of a treatment for rosacea.” According to Pascoe this may be an “anti-cathelicidin treatment.” We may hear more later this year.

In a related matter, Richard Gallo of cathelicidin fame, has applied for a patent on some rosacea method of treatment below along with the  Regents of UCSD:

Patent application title: METHODS AND COMPOSITIONS FOR THE TREATMENT OF SKIN DISEASES AND DISORDERS

Inventors: Richard L. Gallo Jurgen Schauber Kenshi Yamasaki
Agents: Joseph R. Baker, APC;Gavrilovich, Dodd & Lindsey LLP
Assignees: THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Origin: SAN DIEGO, CA US
IPC8 Class: AA61K4800FI
USPC Class: 514 44 A
Patent application number: 20090318534
Read more

Copyright 201o Brady Barrows

When discussing rosacea the subject of triggers always comes up. There is some confusion over what a rosacea trigger is because many misunderstand the difference between a rosacea flare up and flushing. A rosacea flare up is a pronounced erythma or redness which can be, but not always, accompanied by papules and pustules. Flushing is a when the skin, usually the face, becomes red and, or hot due to blood rushing to the face. Many confuse flushing with rosacea but actually flushing is a sign of rosacea just as papules and pustules are a sign. Not all rosacea sufferers exhibit pronounced or frequent flushing any more than exhibiting papules and pustules. Some rosacea sufferers may not exhibit any pustules and papules but simply have erythma. Erythma is the distinguishing hallmark of rosacea and flushing is usually the other distinguishing mark. But not all rosacea sufferers have pronounced flushing or flush any more than the general public just as not all rosacea sufferers exhibit papules and pustules. A rosacea sufferer may blush or flush and and the erythma or redness remains and aggravates the rosacea. Hence, rosacea triggers are broken down into two types:
Rosacea Flare Up Triggers and Flushing Triggers

For More Information on Rosacea Flare Up Triggers

For More information on Flushing Triggers

The other confusion about rosacea triggers is that when a rosacea newbie reads or hears about certain triggers should be avoided from reputable physicians and rosacea organizations they may think that these triggers are set in stone and have been clinically established as absolute triggers. This is far from the truth and actually there has been only one known clinical study on a rosacea trigger done on thermal flushing. All the other proposed rosacea triggers are purely anecdotal. What does ‘anecdotal’ mean?

anecdotal |ˌanikˈdōtl|
adjective
(of an account) not necessarily true or reliable, because based on personal accounts rather than facts or research : while there was much anecdotal evidence there was little hard fact | these claims were purely anecdotal.

When a doctor mentions rosacea triggers based upon a list compiled by the NRS or other source without explaining that triggers are anecdotal it implies to a rosacea newbie that these triggers are set in stone and surely must be true. The truth of the matter is that trigger avoidance isn’t an exact science except for the one trigger that was indeed investigated with the Wilkin report that concluded:

“It is concluded that the active agent causing flushing in coffee at 60 degrees C is heat, not caffeine.”

Oral thermal-induced flushing in erythematotelangiectatic rosacea.
Wilkin JK; J Invest Dermatol. 1981 Jan;76(1):15-8.

If every trigger was investigated as coffee was the list might be reduced. The first three on the NRS list, liver, yogurt and sour cream are an example of how anecdotal this list is:

http://www.rosacea.org/patients/materials/triggers.php

Another survey, which is anecdotal said the the most common triggers were:

Sun exposure
Emotional stress
Hot weather
Wind
Heavy exercise
Alcohol consumption
Hot baths
Cold weather
Spicy foods

http://www.rosacea.org/patients/materials/triggersgraph.php

The above survey listed this as ‘the most common factors’ by percentages and ‘spicy foods’ was the eighth most common. Maybe a clinical study will be done on spicy foods eventually.

Follow the Money by Tony Karp

Copyright 201o Brady Barrows

Non Prescription (Over the Counter [OTC])

How much money is being spent on rosacea? According to a NY Times article, “Sales of anti-redness facial care products grew by 35 percent from 2002 to 2007, an increase of $300 million, according to Kline’s 2007 global cosmetics and toiletries report. That figure, Ms. Wang said, doesn’t include products designed for sensitive skin or uneven complexions, which also purport to quell rosacea.”

This gives you an idea of the market for anti-redness OTC products.

Prescription Treatments

A Market Watch report says “the current size of the U.S. rosacea products market is around $500 million.”

Note this 2004 Business Wire report stated:

“With 85% of people worldwide suffering from acne at some point in their lives, leading to more than 103 million affected by acne and another 45 million by rosacea, the global market for prescription dermatological therapeutics continues to be substantial. Current drugs include a variety of topical and systemic medications such as antibiotics, anti-infectives, anti-inflammatory, hormone therapies, keratolytics, and retinoids–many of which are indicated for both diseases.

The worldwide acne and rosacea therapeutics market is estimated at over $2.16B in 2004 and is expected to grow at a compound annual rate of 1.4% to reach more than $2.31B worldwide by 2009. Although market growth is stabilizing, there is still a pressing demand for new products since most current therapies are associated with adverse side effects including skin irritation, depression, and birth defects.”

There are actual figures provided about this from Mindbranch with their report The Dermatology Market Outlook to 2011 which covers the ’5 Major dermatological indications,’ rosacea being one of these and says about this report:

“The Dermatology Market Outlook to 2011 provides detailed analysis on 5 indications within the dermatology market, identifying high growth brands, future market leaders and key drug classes. The in-depth 6-year epidemiology and product sales forecasts in this report will enable you to plan effectively, evaluate changes in the competitive positions of leading companies and accurately benchmark your position.”

If you can get this report it would be a great benefit to know what it says the market share is for rosacea. But I can’t afford to buy this report but if you can let us know what you find out? If you live in the UK you can buy this report by clicking here. pharmalicensing.com also sells this report. The abstract of this report says the following:

“Forecast sales of the acne market are estimated at $2.7bn in 2011.”

There is no forecast figures for rosacea but it may be similar. And remember, these are prescription drugs only.

Another outlook report for 2013.

Sources:

“The revenue of dermatological market in 2006 was $16bn”
The World Dermatological Market Analysis & Forecasts 2007-2022

“Research and Markets: Acne & Rosacea Therapeutics: Ten Emerging Acne and Rosacea Therapies in Phase and Clinical Development Expected to launch by 2009″. Business Wire

Oracea is now being promoted by Galderma as a first line treatment of rosacea along with its metronidazole brand name topical treatments for rosacea. Galderma bought Collegenex who originated the brand name Oracea prescription only oral treatment for rosacea that is FDA approved. Oracea is enteric coated with 10 mg of ‘delayed released beads’ and 30 mg of immediate release doxycycline and is advertised as anti-inflammatory and ‘submicrobial’ rather than antibiotic. This is supposed to reduce the chances of developing antibiotic resistance in long term use. The majority of rosacea users report success in using Oracea but some negative reports have been found.

According to a University of California Davis School of Medicine, report, “Recently, subantimicrobial-dose doxycycline was demonstrated to be an effective treatment for rosacea, due to its inherent anti-inflammatory properties. Furthermore, subantimicrobial-dose doxycycline has a more preferable tolerability profile and a lower occurrence of bacterial resistance than traditional-dose doxycycline. To further elucidate the role of tetracycline agents in rosacea, clinical trials that compare these agents with each other as well as with other effective rosacea treatments are called for.”

It will be good to see if clinical studies will be done on the effectiveness of Oracea compared with low dose doxycycline or tetracycline. For more information and a collection of reports of users of Oracea click here.

Copyright 201o Brady Barrows

While misdiagnosis of rosacea is not a massive problem, it comes up quite often in articles and clinical studies on rosacea. This is because sometimes the definition of rosacea is vague. The most common misdiagnosis is acne vulgaris. However because of the number of rosacea mimics misdiagnosis does indeed occur. The next most common ones are Seborrheic Dermatitis, Perioral Dermatitis, and Pityrosporum Folliculitis. You may view some photos of rosacea mimics to see how confusing this may seem. However, if your dermatologist takes the time to get a history and physical exam, usually your diagnosis will be correct. For some anecdotal and other reports of misdiagnosed rosacea click here. To understand better how a rosacea diagnosis is obtained click here.