Research has shed new light on the cause of rosacea symptoms. At the same time, clinical testing has been abandoned on one oral medication that showed promise as an effective therapy.
A recent study led by Richard L. Gallo, M.D., Ph.D., professor and chief, division of dermatology, University of California, San Diego School of Medicine, found that overproduction of two interactive inflammatory proteins may result in excessive levels of a third protein that causes rosacea symptoms.
The study results were published in an August online edition of the journal Nature Medicine.
In the statement, he says his team's research "may modify the therapeutic approach to treating rosacea, since bacteria aren't the right target."
"There are many theories about triggers and causes of rosacea, but our study is the first to show a specific molecular pathway and demonstrate that this can cause similar skin changes in an experimental model," Dr. Gallo says.
"While we stand by the conclusions made in the paper based on our study's results, we also know that more research is needed to expand, refine and further nail down how our findings relate to the population at large. We hope one way this will happen is to use the data to develop more effective treatments."
What some hoped would be a soon-to-be-approved treatment for rosacea - and one that appeared to be tailor-made in terms of the Gallo-led study, because the drug's antibiotic elements were removed - has suffered a setback.
In September, CollaGenix Pharmaceuticals announced that it was halting research on incyclinide for rosacea indications. In a Sept. 26 CollaGenix press release, chief medical officer Klaus Theobald, M.D., Ph.D., says, "We are surprised and disappointed that the results of this large, well-controlled phase 2 study did not support the findings of an earlier, much smaller pilot study in rosacea patients. On the basis of these results, we will not be pursuing further clinical development of incyclinide in rosacea patients."
"Oracea is consistent with the new research, which I think is breakthrough research," he says. "Oracea looks like a treatment that may become a standard for some forms of rosacea."
In addition to the accepted pharmaceutical treatments and therapies such as Metrogel (Galderma), sulphur-containing creams and topical antibiotics, laser therapy is highly effective for most forms of rosacea, Dr. Werschler says.
"Lasers are used principally to reduce redness in erythematotelangiectatic rosacea, and to minimize the effects of phymatous and also for the ocular form," he says. "This therapy, of course, helps to fix damage that's already been done."
In terms of treatment, Dr. Werschler says that from the patient's point of view, knowing the factors that exacerbate rosacea - and avoiding those factors - is important.
"We should educate rosacea patients about avoiding hot showers, alcohol, spicy food and overexposure to the sun, because rosacea tends to flare with too much exposure," he says.
As for treatments that may come along down the road, Bellingham, Wash., dermatologist Elizabeth M. Vennos, M.D., agrees with Dr. Werschler's assessment of the Gallo study as being breakthrough research that could revise therapy standards for the disorder. However, she's not in total agreement about avoidance as an effective therapy.
"I don't think the common recommendation to avoid the so-called exacerbating factors, such as heat, cold, red wine and so forth, will improve already established rosacea," she says.