rosacea blog

How Rosacea and Autism Can Be Linked

Wednesday, March 11th, 2009 | rosacea | 8 Comments

As both rosacea and autism affect my family, I was wondering if a link between the two conditions existed. Chronic inflammation is one of the hallmarks of both rosacea and autism and research has suggested that processes triggered by our innate immunity are to blame for such inflammation. Innate immunity is how our body reacts to foreign microorganisms by activating specialized “killer” cells such as macrophages without the involvement of antibodies, which are part of our adaptive immune system.

Besides the inflammatory processes that play a role in the etiology of autism and rosacea, both conditions appear to have key trigger factors such as environmental factors, dietary factors and stress.

With the discovery in 2007 of a link between rosacea and antimicrobial peptides (specifically cathelicidins) that are aberrantly processed and overly abundant in rosacea skin, I wanted to find out if there were any studies done that looked at antimicrobial peptides such as cathelicidins and autism.

Cathelicidins

Cathelicidins belong to a group of antimicrobial peptides that are found in the skin and in certain white blood cells (neutrophils) and contribute to the body’s early host defense against infection. Cathelicidins are produced as inactive precursor proteins and when cleaved into activated antimicrobial peptides, destroy bacteria by disrupting the integrity of their membranes (just as most antibiotics do).

Cathelicidins are not just activated by skin injuries and invading microorganisms. The cathelicidin response is also dependent on the steroid hormone vitamin D. In addition to its effect on calcium homeostasis and bone formation, vitamin D is an important regulator of the innate immune response. Studies have shown that the cathelicidin genes are controlled by a vitamin D response element (a molecular switch if you will): when activated vitamin D levels are low (such as in the winter), in theory there will be less production of cathelicidins.

How Does Vitamin D work?

We get some of our vitamin D through our food, but the majority of active vitamin D is produced in the skin: UVB radiation from the sun is required to produce pre-vitamin D3 (calciol) from 7-hydroxycholesterol. Pre-vitamin D3 needs to be modified by 2 additional enzymes (found in skin, liver and kidneys) to generate active vitamin D3 (calcitriol).

So how does vitamin D fit in with autism?

Some people believe that since vitamin D plays such an important role in innate immunity and early brain development, that vitamin D deficiency during gestation or early childhood may contribute to the development of autism. The theory behind this is, that the increase in the number of autism cases over the last 20 years does not follow classic Mendelian inheritance. While autism has a strong genetic basis with many different genes playing a role, it is fair to say that the role these genes play in the etiology of autism could not have changed much over the last 20 years.

It may be possible that environmentally responsive genes play a much larger role in the development of conditions such as autism and that something in the environment, before or after birth, is influencing the outcome of our genotype. The rise in autism incidence over the last 20 years corresponds with increasing medical advice to stay out of the sun and use high SPF sunscreens, which may have resulted in a severe vitamin D deficiency in many people (especially during the winter months).

In addition, a strikingly high male-to-female ratio in autism can be explained by the stimulating effect estrogen has on vitamin D levels in the brain: estrogen protects female brains from calcitriol deficiencies whereas testosterone does not. Note that in rosacea there seems to be a high female-to-male ratio.

If vitamin D deficiency plays any role in autism, then symptoms should improve during the summer. Also, autism prevalence would be higher in (more) Northern latitudes. Some studies (see Cannell 2008) found an association between prevalence of autism and latitude, including recent CDC data that looked at autism prevalence in 14 states.

How can sun avoidance in the summer lead to vitamin D deficiency?

When a fair skinned adult stays in the sun for 20 minutes (full body), approximately 20,000 units of vitamin D enters their circulation. You would have to drink 200 glasses of milk or take 50 multivitamins to receive a similar amount of vitamin D.

Patients suffering from Rickets, a condition in which vitamin D deficiency is caused by a genetically defective production of the enzyme that activates vitamin D, share some of the symptoms of autism such as hypotonia and developmental delay. Children with Williams’s Syndrome, who have very high levels of vitamin D in early infancy, often show signs that are the complete opposite of autism such as overfriendliness, empathy and increased sociability.

A number of drugs can interfere with vitamin D metabolism. One of them is sodium valproate (a.k.a. Depakote), a drug that is frequently used to treat epilepsy, seizures and convulsions. Numerous animal studies have shown that sodium valproate (or valproic acid) given during pregnancy can lead to abnormal brain development and symptoms of autism in offspring. It has been shown that sodium valproate interferes with vitamin D’s actions. Sodium valproate or valproic acid is often used to generate mice that show the classic symptoms of autism.

Vitamin D and rosacea

While the available data from studies suggests a possible risk factor for autism and vitamin D deficiency, it is unclear at the present time whether vitamin D has a positive or negative effect on the outcome of rosacea.

Based on the findings of Yamasaki and colleagues, vitamin D would increase cathelicidin production, which in rosacea would lead to a higher level of (disease causing) antimicrobial peptides. However, some studies have looked at the seasonal effect of rosacea and reported that for the majority of rosacea patients, symptoms did improve during the summer months. Also, other studies have found that vitamin D deficiency is associated with increased levels of the matrix metalloproteinases (MMP 2 and 9), which are related to the serine proteases involved in rosacea. If higher levels of vitamin D could lower the levels of the serine proteases in the skin that are causing the inflammation-causing splicing of cathelicidin, then higher levels of circulating vitamin D could therefore be beneficial to the management of rosacea symptoms.

Additional Reading

Zanetti, M. (2005) The role of cathelicidins in the innate host defenses of mammals. Curr. Issues Mol. Biol. 7: 179-196.

Schauber, J. and Gallo, R.L. (2008) The vitamin D pathway: a new target for control of the skin’s immune response? Exp. Dermatol. 17: 633-39.

Cannell, J.J. (2008) Autism and vitamin D. Med. Hypotheses 70: 750-59.

Yamasaki, K. et al. (2007) Increased serine protease activity and cathelicidin promote skin inflammation in rosacea. Nat. Med. 13: 975-80.

Tags: autism, rosacea, vitamin D

Why Rhinophyma Affects more Men than Women?

Tuesday, December 23rd, 2008 | rosacea | No Comments

Rosacea affects about three times as many women than men. Rhinophyma, seen in late-stage rosacea, is characterized by a bulbous overgrowth of the nose, and occurs in approximately 4% of all rosacea sufferers. It affects about twelve times as many men than women and is usually seen in white males of English or Irish descent. Rhinophyma causes a lot of embarrassment and distress to people who have it.

Traditionally, rhinopyma was thought to be associated with alcoholism, but this turned out not to be the case. Rhinophyma is associated with late-stage rosacea and is characterized by fast growing sebaceous tissue and inflammation. Rhinophyma is worsened by anything that dilates blood vessels.

The fact that rhinophyma affects more men than women, could be explained by the fact that male hormones stimulate sebaceous gland growth and secretion of sebum. The sebum is secreted around hair follicles, where it mixes with common skin bacteria, which secrete the enzyme lipase. The lipase interacts with the sebum to produce free fatty acids which stimulates inflammation. Fast growing tissue forces the skin pores to open up, allowing more bacteria to enter.

Rhinophyma cannot be controlled satisfactory with traditional rosacea medications and topical treatments. The treatment of the early stages of rosacea with topical treatments can delay the onset or the severity of the condition. Rhinophyma can be surgically treated. This has to be arranged through a dermatologist. Tissue can be surgically removed or the rhinophyma can be treated with a laser.

Tags: rhinophyma

Choosing Shampoos that don’t contain Sodium Lauryl Sulfate

Wednesday, December 10th, 2008 | skin care | 17 Comments

Finding a shampoo you’ll like is never easy. Finding a shampoo that is gentle to your skin, is even harder. If you have rosacea, you probably are already preventing shampoo suds to get onto your face when washing your hair, in order not to aggravate your condition.

Many shampoos on the market today contain ingredients that can be considered “toxic”. One of the shampoo ingredients that can be hurting your scalp and skin, is sodium lauryl sulfate. Sodium lauryl sulfate, which in the scientific community is known as sodium dodecyl sulfate (SDS), is a powerful detergent that is able to strip your skin of important oils and proteins. Sodium lauryl sulfate is used in science to denature proteins (disrupting the protein’s native shape), so that biologic samples with many different proteins can be separated according to size by gel electrophoresis.

Sodium lauryl sulfate is used in many personal care products (shampoos, liquid soaps and shower gels), because it is cheap and produces a rich thick lather. However, if you are using shampoo that contains sodium lauryl sulfate, you may be damaging your skin, especially if you have sensitive skin.

Sodium lauryl sulfate has a slightly less reactive cousin, sodium laureth sulfate. Sodium myreth sulfate is related to sodium lauryl sulfate and sodium laureth sulfate, but would be the better choice if you had to pick between the three.

Walking down to my local drugstore, I wasn’t able to find any shampoo on the shelf without sodium lauryl sulfate. Looking at a shampoo’s ingredient list, sodium lauryl sulfate and sodium laureth sulfate are usually the second or third ingredient mentioned.

After doing some research online and at my local organic food store, I have compiled the following list of shampoos that are free of sodium lauryl sulfate or sodium laureth sulfate, and may be safer to use if you have sensitive skin:

• Alba
• Alaffia
• Avalon Organics
• Aubrey Organics
• Beauty Without Cruelty
• Burt’s Bees
• Dessert Essence
• Elave (UK & Ireland and online)
  
• EO
  
• Jason
• John Masters
• Kiss My Face
• Pureology
  
• Shikai
  
• Whole Foods Market (Premium Body only)

This list will probably change over time as more and more beauty brands are eliminating harsh chemicals from their products. Feel free to let us know about your favorite shampoo (without sodium lauryl sulfate).

Tags: shampoo, sodium lauryl sulfate