Rosacea Review - Newsletter of the National Rosacea SocietyRosacea Review - Newsletter of the National Rosacea Society

Research Grants Awarded to Study Causes of Little-Known Disorder

The National Rosacea Society announced that five new studies have been awarded funding as part of its research grants program to advance scientific knowledge of this widespread but poorly understood disorder that affects an estimated 14 million Americans.

"We are pleased to be receiving a growing number of high-quality grant applications for important studies relating to potential causes and other key aspects of rosacea," said Dr. Jonathan Wilkin, chairman of the Society's medical advisory board, which reviews and selects the research proposals for funding. "The newly awarded grants include promising new areas of scientific investigation as well as research that builds upon significant previous findings."

Dr. Youwen Zhou, assistant professor of dermatology and director of the Chieng Genomics Center at the University of British Columbia in Canada, was awarded $25,000 for the study, "Molecular disease markers: gene expression profile of rosacea." Dr. Zhou and his colleagues hypothesize that rosacea-affected skin may have characteristic gene expression profiles -- that is, patients with rosacea may express different levels of certain genes involved in new blood vessel formation, inflammation and other signs and symptoms of rosacea.

The researchers will first identify the gene expression profiles of normal skin and of skin from patients with subtype 1 rosacea (redness, sometimes visible blood vessels) and subtype 2 rosacea (redness, bumps and pimples), respectively, by studying the genetic codes from biopsy samples. They will then attempt to determine which metabolic pathways may be implicated in the disease process (pathogenesis) of rosacea.

The Society awarded $25,000 to Dr. Martin Steinhoff and Dr. T. Luger, department of dermatology, University of Muenster, Germany, for their study, "Role of proteinase-activated receptor-2 in the pathophysiology of cutaneous inflammation." Dr. Steinhoff noted that proteinase, a natural substance capable of combining with a receptor on a cell to initiate an inflammatory reaction or activity, may induce signs of rosacea including redness (erythema), visible blood vessels (telangiectasia) and inflammation such as bumps (papules), pimples (pustules) or swelling (edema).

They will investigate whether there is an increase in proteinase-activated receptor-2 (PAR-2) and its activators in progressively severe phases of rosacea; whether activators of PAR-2 modulate vascular endothelial growth factor (VEGF), which has been linked in earlier research to the development of telangiectasia, often seen in subtype 1 rosacea; and whether PAR-2 activators have an effect on the release of nitric oxide, a substance present in all cells that may be associated with erythema as well as inflammation.

Dr. Richard Granstein, chairman of dermatology at Cornell University, was awarded $23,283 to continue research on how neuropeptides and hormones, produced by nerves or cells in the skin, may play a role in the flushing, telangiectasia and inflammation associated with rosacea.

In their initial research sponsored by the Society, Dr. Granstein and colleagues discovered that ultraviolet B (UVB) radiation found in sunlight may induce expression of VEGF as well as increase a cytokine that is associated with inflammation. Conversely, they found that a neuropeptide known as somatostatin appears to reduce production of VEGF.

In the coming year, the researchers will define how certain neuropeptides and hormones, alone or in combination with UVB irradiation, may affect the endothelial cells that line the blood vessels. This will also include the study of UVB-irradiated keratinocytes (cells that produce keratin, a constituent of outer skin, hair and nails) and their effects on vascular endothelial cells, combined with the characterization of the effects of a number of neuropeptides on keratinocyte and endothelial activation.

Dr. Richard Gallo, director of dermatology research, and researcher Dr. Masamoto Murakami at the Veterans Medical Research Foundation in San Diego will receive $25,000 for their study, "Role of the innate immune system in rosacea." In earlier Society funded research, they discovered that patients with rosacea have abnormally high levels of cathelicidins, proteins made by the skin in response to injury or infection that may induce rosacea like histopathological changes, including telangiectasia and dermatitis.

They concluded these findings strongly suggest that an understanding of cathelicidins may be critical to understanding rosacea, and plan to further investigate the abnormal production of cathelicidins in rosacea patients. The researchers will also investigate peptides (natural proteins) that may help inhibit the disease process.

Dr. YaXian Zhen and Dr. Albert Kligman, professor of dermatology at the University of Pennsylvania, were awarded $25,000 for their research, "Experimental studies in the pathogenesis of rosacea." The researchers noted that acne (acne vulgaris) and rosacea may coexist more commonly than is widely recognized, and they hypothesize that rosacea and acne may have certain features in common that may underlie their pathogenesis.

They observed that the faces of rosacea patients may produce more oil (sebum) and may have tiny blackheads (microcomedones), enlarged oil glands and an increased number of the bacteria Propionibacterium acnes. They will study the facial skin of rosacea patients to determine sebum output, microcomedones and various microscopic organisms that may be associated with the disease process.

The standard classification of rosacea, developed by a consensus committee and review panel of 17 medical experts worldwide, identifies four subtypes of rosacea, defined as common patterns or groupings of signs and symptoms. These include subtype 1 (erythematotelangiectatic rosacea), characterized by flushing and persistent erythema, and which may also include telangiectasia; subtype 2 (papulopustular rosacea), characterized by persistent erythema with transient papules and pustules; subtype 3 (phymatous rosacea), characterized by skin thickening, most often resulting in enlargement of the nose; and subtype 4 (ocular rosacea), characterized by ocular manifestations such as dry eye, tearing and burning, swollen eyelids and recurrent styes. Many experience characteristics of more than one subtype at the same time.