rosacea blog

Stress and Depression Influence the Outcome of Rosacea

Monday, May 18th, 2009 | rosacea | 5 Comments

When stress takes over our lives, it can be damaging to our health. Stress not only weakens our immune system, but it also affects our skin’s barrier function. The skin’s barrier function is important for regulating the balance of water and temperature of our skin as well as blocking the entry of microorganisms.

Chronic stress activates the so-called HPA axis, which is the connection between the hypothalamus and pituitary gland in the brain and the adrenal glands on the kidneys. Activation of the HPA axis by stress leads to higher levels of the stress hormones corticotropin-releasing hormone (CRH) and cortisol, which have a profound effect on our health, skin and brain. The HPA axis is kept balanced by neurotransmitters such as serotonin, adrenaline and dopamine. However, if the HPA axis gets chronically stimulated by stress, a major imbalance in neurotransmitters can result and may lead to the development of anxiety and depression.

Research suggests that the breakdown of the skin’s barrier function (or matrix degeneration) in combination with excessive exposure to the sun, forms a central part of rosacea development. A breakdown of the collagen fibers is thought to play a major part in the degeneration of the skin’s matrix. Poor connective tissue support for blood vessels just underneath the skin can therefore result in the pooling of serum, metabolic waste and immune mediators, which over time leads to more flushing, edema, chronic erythema and telangiestacias. The involvement of a matrix breakdown in rosacea is likely, because blood vessels in rosacea are still able to respond to vasoactive substances.

An out-of-balance HPA axis (particularly prominent in depression and anxiety), results in high levels of corticotropin-releasing hormone (CRH). CRH has been shown to increase the permeability of peripheral blood vessels through the stimulation of mast cells, which in turn release immune mediators such as histamine and nitric oxide. Anti-depressant drugs are thought to “calm” an over-active HPA axis by increasing the availability of neurotransmitters such as serotonin, dopamine and adrenaline. Therefore, the use of antidepressants for a prolonged period of time may reduce the severity of rosacea symptoms. Reducing stress levels in our lives could have a significant impact on the progression and stabilization of rosacea symptoms.

Fimmel S. et al. (2008) New aspects of the pathogenesis of rosacea. Drug Discovery Today: Disease Mechanisms 5: 103-111.

More on Stress and Depression

• comment on mental health in the workplace: food for thought by … – a very well written article. unfortunately mental health isn’t openly discussed as much as it should be. maybe one day it will be.

Tags: depression rosacea, stress

Rosacea and Gluten

Thursday, April 9th, 2009 | rosacea | 4 Comments

I couldn’t find any scientific publication on the topic of gluten sensitivity and rosacea, but if you do a search online, then you’ll find plenty of information on the topic (mostly in forums and message boards).

As it turns out, many people with rosacea wonder if their rosacea symptoms are caused by a gluten sensitivity. Some have been successful in reducing their rosacea symptoms by following a gluten-free diet. As I and others have written before, there seems to be a digestive component to rosacea.

Gluten is a protein that’s abundant in certain grains, mostly wheat, barley and rye. The gluten itself is a protein made up of two protein parts, gliadin and glutenin. The gliadin part is responsible for the abnormal immune reaction that causes gluten sensitivity and celiac disease. Between 0.5 and 1% of the world’s population suffers from gluten-sensitivity. Gluten sensitivity is not the same as a gluten allergy. The gluten proteins of corn and rice lack the gliadin part and do therefore not cause any sensitivity.

The immune system’s overreaction to wheat’s gluten causes celiac disease, in which the lining of the small intestine becomes chronically inflamed. Symptoms of celiac disease include chronic diarrhea, cramps, bloating, fatigue and malabsorption of essential nutrients, which could result in secondary symptoms such as psychological and neurological problems.

The gluten sensitivity makes it difficult for the body to absorb vitamins, in particular vitamin D. This could explain the possible involvement of vitamin D in rosacea and autism that I described recently. Many children with autism have seen their symptoms improve after staring a gluten-free diet.

Whether a potential gluten sensitivity is involved in the development of rosacea symptoms, it is possible that the inflammation of the intestines contributes to an overall stronger inflammatory response in the facial skin of rosacea patients. While there are many rosacea trigger factors, pizza (loaded with gluten and histamine) is one food that probably should be limited in your diet if you have rosacea.

Tags: rosacea and gluten

Rosacea Induced by Erectile Dysfunction Drugs?

Monday, March 30th, 2009 | rosacea | 1 Comment

Rosacea is associated with many different trigger factors. Recently, another potential trigger factor for rosacea was described. It appeared that men who had been taking drugs for erectile dysfunction, were developing rosacea symptoms.

The erectile dysfunction (ED) drugs these men were taking belong to a class of drugs called Phosphodiesterase 5 Inhibitors (PDE5i). Phosphodiesterase 5 inhibitors are not just used to treat ED, but also conditions such as pulmonary hypertension and Raynaud’s phenomenon.

Phosphodiesterase enzymes play an important role in regulating certain signaling pathways inside the cell. The PDE5 enzymes are associated with regulating the Nitric Oxide (NO) signaling pathway. NO, generated from the amino acid L-Arginine, is released from nerves and endothelium and causes smooth muscle cells lining the blood vessels to relax, which increases blood flow. Inhibitors of PDE5 prolong the NO signal, thereby increasing the widening of blood vessels and blood flow.

The men in this study were of an average age of 53.6 years and the majority of them reportedly never complained of any (facial) skin problems prior to taking these ED drugs. The men took the PDE5i ED drugs for as little as 7.5 months to 21 months. The average ED tablet intake was 3.4 tablets per week.

The men met all criteria for rosacea and other conditions that could cause a red facial appearance were ruled out. To find out if the erectile dysfunction drugs were able to induce rosacea symptoms, the men were asked to discontinue their use of ED drugs. While off the ED drugs, the men were treated with topical metronidizole for a period of 8 weeks and their rosacea cleared up except for the telangiectasias.

Three months after stopping the ED drugs, the men were asked to continue their ED treatments. A relapse of rosacea with the associated symptoms of erythema, inflammation and papules was reported for all men who re-initiated their ED treatment.

The findings reported in this study suggest a possible correlation between the use of Phosphodiesterase 5 Inhibitor drugs and the induction of rosacea. The increased production of NO following administration of PDE5 inhibitor drugs, could lead to changes in blood vessels and the development of rosacea in genetically predisposed patients. It is currently unclear whether nitric oxide is the key agent in this scenario. Previously, no association of increased amounts of NO in rosacea skin could be found by other studies.

Ioannides, D. et al. (2009) Phosphodiesterase-5 inhibitors and rosacea: report of 10 cases. Br. J. Dermatol. 160: 719-20.

Tags: rosacea ED drugs