Richard Odom, MD, Professor of Clinical Dermatology at the University of California-San Francisco, Former President of the American Academy of Dermatology, and member of the expert committee of National Rosacea Society, talks about dermatologists’ growing role in providing care and counsel for today’s rosacea patients.
What do we know about rosacea and its link to systemic comorbidities?
“This becomes more and more interesting every day. Many countries around the world have found associations between rosacea and increased risk for a variety of potentially serious systemic disorders including cardiovascular disease, certain cancers and gastrointestinal diseases. This is a similar to what we have seen in other skin diseases such as psoriasis and atopic dermatitis, and inflammation is the most likely common denominator. It’s not that rosacea causes liver cancer or liver cancer causes rosacea, per se. It’s a reflection of what is going on in the entire body. The inflammatory cascade is affecting many different organs. That’s the big picture.”
What causes rosacea?
“We are not 100 percent clear on that yet. We know that rosacea is an innate immune response. We also know that there is a strong genetic predisposition and that there are things that cause neurovascular dysregylation in fair skinned individuals. There are also many environmental triggers. Most recently, a study found that white wine and alcohol, but not red wine, might cause flares in women with rosacea . No doubt, red wines act as a trigger as well since they are 13-14 percent alcohol content and many patients who drink red wines primarily report flushing, blushing and exacerbation of rosacea. We still don’t have a definitive single cause that we can point to and say ‘this causes rosacea.’ It is a multifactorial disease.”
Are there any rosacea treatment gaps, and if so, how can we shore them up?
“We are pretty much able to control all of the inflammatory components of the disease—the pimples, pustles, and systemic manifestations, if they occur. The main problem is the flushing and the persistent redness that is due to neurovascular dysregulation. This is very hard to control. We have masking agents, topical alpha-adrenergic agonists and some studies show that anti-hypertensives may play a role. More recently, we have seen lasers and lights that help with the redness, and there was a study that suggested botulinum toxin injections might also be effective. This is all interesting, but it remains very hard to change the neuroregulation of blood vessels.”
What role can and should dermatologist play in taking care of the whole rosacea patient?
“Rosacea needs to be taken very seriously. Dermatologists are on the front lines of care for these patients. The onus falls on us to ask about overall medical history and general health. If there is any suggestion of a systemic condition, we need to make sure they see their primary care doctor. We didn’t do that before.”
Rosacea’s Impact on Patients
Recent National Rosacea Society surveys found 90 percent of rosacea patients said rosacea’s effect on personal appearance had lowered their self-esteem and self-confidence, and 52 percent said they had avoided face-to-face contact because of the disorder. Among those with severe symptoms, 51 percent reported they had even missed work because of their condition.