A breast implant is a prosthesis used to enlarge the size of a woman's breasts (known as breast augmentation, breast enlargement, mammoplasty enlargement, augmentation mammoplasty or the common slang term boob job) for cosmetic reasons; to reconstruct the breast (e.g. after a mastectomy; or to correct genetic deformities), or as an aspect of male-to-female sex reassignment surgery. According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in the United States. In 2006, 329,000 breast augmentation procedures were performed in the U.S. There are two primary types of breast implants: saline-filled and silicone-gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel....

A breast implant is a prosthesis used to enlarge the size of a woman's breasts (known as breast augmentation, breast enlargement, mammoplasty enlargement, augmentation mammoplasty or the common slang term boob job) for cosmetic reasons; to reconstruct the breast (e.g. after a mastectomy; or to correct genetic deformities), or as an aspect of male-to-female sex reassignment surgery. According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in the United States. In 2006, 329,000 breast augmentation procedures were performed in the U.S. There are two primary types of breast implants: saline-filled and silicone-gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel. There have been several alternative types of breast implants that were developed, such as polypropylene string or soy oil, but these are no longer manufactured.

History

Implants have been used since at least 1895 to augment the size or shape of women's breasts. The earliest known implant was attempted by Vincenz Czerny, using a woman's own adipose tissue (from a lipoma, a benign growth, on her back).^[1] Gersuny tried paraffin injections in 1889, with disastrous results. Subsequently, in the early to mid-1900s, a number of other substances were tried, including ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, polyvinyl alcohol-formaldehyde polymer sponge (Ivalon), Ivalon in a polyethylene sac, polyether foam sponge (Etheron), polyethylene tape (Polystan) or strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses.^[1] In recent history, various creams and medicaments have been used in attempts to increase bust size, and Berson in 1945 and Maliniac in 1950 performed a flap-based augmentation by rotating the patient's chest wall tissue into the breast to add volume. Various synthetics were used throughout the 1950s and 1960s, including silicone injections, which an estimated 50,000 women received.^[1] Development of silicone granulomas and hardening of the breasts were in some cases so severe that women needed to have mastectomies for treatment. Women sometimes seek medical treatment for complications up to 30 years after receiving this type of injection.

Indications

Breast implants are used for:

• primary reconstruction (to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality)
• revision-reconstruction (revision surgery to correct or improve the result of an original breast reconstruction surgery)
• primary augmentation (to increase breast size for cosmetic reasons)
• revision-augmentation (revision surgery to correct or improve the result of an original breast augmentation surgery)

Patient characteristics

Patients seeking breast augmentation have been reported as being usually younger, healthier, from higher socio-economic status, and more often married with children than the population at large.^[4] Many of these patients have reported greater distress about their appearance in a variety of situations, and have endured teasing about their appearance. Studies have identified a pattern (shared by many cosmetic surgery procedures) that suggest women who undergo breast implantation are slightly more likely to have undergone psychotherapy, have low levels of self-esteem, and have higher prevalences of depression, suicide attempts, and mental illness (including body dysmorphia^[5]) as compared to the general population.^[6] Post-operative surveys on mental health and quality of life issues have reported improvement on a number of dimensions including: physical health, physical appearance, social life, self confidence, self esteem, and sexual function.^{[7][8][9][10]} Longer term follow-up suggests these improvements may be transitory, with the exception of body esteem related to sexual attractiveness.^[11] Most patients report being satisfied long-term with their implants even when they have required re-operation for complications or aesthetic reasons.^[12][7]

Procedure

The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material, and implant pocket placement.

Incision types

Breast implants for augmentation may be placed via various types of incisions:

• Inframammary - an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which don't drape over the IMF. In addition, the scar may heal thicker.
• Periareolar - an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique.
• Transaxillary - an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants may require inframammary or periareolar incisions (but not always). Transaxillary procedures can be performed with or without an endoscope.
• Transumbilical (TUBA)^[14] - a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. Transumbilical procedures may be performed bluntly or with an endoscope (tiny lighted camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell during blunt insertion.
• Transabdominoplasty (TABA)^[15] - procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.

Types of implants

Saline implants

Saline-filled breast implants were first manufactured in France in 1964, introduced by Arion^[16] with the goal of being surgically placed via smaller incisions. Current saline devices are manufactured with thicker, room temperature vulcanized (RTV) shells then earlier generations of devices. These shells are made of a silicone elastomer and the implants are filled with salt water (saline) after the implant is placed in the body. Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants (which are filled with silicone before the surgery is performed). A single manufacturer (Poly Implant Prosthesis, France) produced a model of pre-filled saline implants which has been reported to have higher failure rates in vivo.^[17] Saline-filled implants were most common implant used in the United States during the 1990s due to restrictions that existed on silicone implants, but were rarely used in other countries. Good to excellent results may be obtained, but as compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and to be noticeable to the eye or the touch. Particularly for women with very little breast tissue, or for post-mastectomy breast reconstruction, silicone gel implants are considered as superior. In patients with more breast tissue in whom submuscular implant placement is used, saline implants can look very similar to silicone gel.

Silicone gel implants

Thomas Cronin and Frank Gerow, two Houston, Texas, plastic surgeons, developed the first silicone breast prosthesis with the Dow Corning Corporation in 1961. The first woman was implanted in 1962. Silicone implants are generally described in terms of five generations which segregate common characteristics of manufacturing techniques.

• First generation

The Cronin-Gerow implants were made of a tear drop shaped silicone rubber envelope (or sac), filled with a thick, viscous silicone gel with a Dacron patch (to reduce rotation of the implant)on the posterior shell.^[18]

• Second generation

In response to surgeons' requests for softer and more lifelike implants, breast implants were redesigned in the 1970s with thinner, less cohesive gel and thinner shells. These implants had a greater tendency to rupture or "gel bleed" silicone through an intact implant shell, and complications such as capsular contracture were quite common. It was predominantly implants of this generation that were involved in the American class action-lawsuits against Dow-Corning and other manufacturers in the early 1990s. Another development in the 1970s was a '''''polyurethane foam coating''''' on the implant shell which was very effective in diminishing capsular contracture by causing an inflammatory reaction that discouraged formation of fibrous tissue around the capsule. These implants were later briefly discontinued due to concern of potential carcinogenic breakdown products from the polyurethane.^[19] A review of the risk for cancer from TDA by the FDA later concluded that the risk was so small so as not to justify recommending explantation of the devices from individual patients. Polyurethane implants are still used in Europe and South America, but no manufacturer has sought FDA approval for sale in the United States.^[1] Second-generation implants also saw the introduction of various "double lumen" designs. These implants were essentially a silicone implant inside a saline implant. The double lumen was an attempt to provide the cosmetic benefits of gel in the inside lumen, while the outside lumen contained saline and its volume could be adjusted after placement. The failure rate of these implants is higher than for single lumen implants due to their more complex design. The contemporary versions of these devices ("Becker Implants") are used primarily for breast reconstruction.

• Third & Fourth generation

Third & fourth generation implants, from the mid 1980s, represented sequential advances in manufacturing principles with elastomer-coated shells to decrease gel bleed, and are filled with thicker, more cohesive gel. The increased cohesion of the gel filler reduced potential leakage of the gel compared to earlier devices and the more substancial shell improved durability as compared to 2nd generation implants. A variety of both round and tapered anatomic shapes are available from different implants in this group. The anatomic or shaped implants are uniformly impregnated with a textured surface to reduce rotation, while round devices are available in both smooth or textured surfaces.

• Fifth generation

Evaluation of "gummy bear" or solid, high-cohesive, form-stable implants is in preliminary stages in the United States but these implants have been widely used since the mid 1990s in other countries. The semi-solid gel in these type of implants largely eliminates the possibility of silicone migration. Studies of these devices have shown significant potential improvements in safety and efficacy over the older implants with low rates of capsular contracture and rupture. ^[21][22][23]

Implant pocket placement

The placement of implants is described in relation to the pectoralis major muscle.

• Subglandular- implant between the breast tissue and the pectoralis muscle. This position closely resembles the plane of normal breast tissue and is felt by many to achieve the most aesthetic results. The subglandular position in patients with thin soft-tissue coverage is most likely to show ripples or wrinkles of the underlying implant. Capsular contracture rates are also slightly higher with this approach, and placement of implants in this pocket might be inappropriate in women who are at risk for capsule formation (smokers, multiple breast surgeries).
• Subfascial ^[24] - the implant is placed in the subglandular position, but underneath the fascia of the pectoralis muscle. The benefits of this technique are debated,^[25] but proponents believe the (sometimes thick) fascial sheet of tissue may help with coverage and sustaining positioning of the implant. Implants that undergo capsular contraction are unlikely to displace upward or toward the underarm.
• Subpectoral ("dual plane")^[26] - the implant is placed underneath the pectoralis major muscle after releasing the inferior muscular attachments. As a result, the implant is partially beneath the pectoralis in the upper pole, while the lower half of the implant is in the subglandular plane. This is the most common technique in North America and achieves maximal upper implant coverage while allowing expansion of the lower pole. Animation or movement of the implants in the subpectoral plane can be excessive to some patients.
• Submuscular - the implant is placed below the pectoralis without release of the inferior origin of the muscle. Total muscular coverage may be achieved by releasing the lateral chest wall muscles (serratus and/or pectoralis minor) and sewn to the pectoralis major. This technique is most commonly used for maximal coverage of implants used in breast reconstruction.

Recovery

Depending on the level of activity required, patients are generally able to resume normal activity in approximately one week's time. Women who have their implants placed underneath the muscle (submuscular placement) will generally have a longer recovery time and experience slightly more pain due to the muscle being cut during surgery. During initial recovery it is important not to use the arms or strain the body in any way, and to avoid cigarettes. Scars from a breast augmentation surgery will last six weeks or longer and usually begin to fade several months after surgery.

Claims of systemic illness and disease

Since the early 1990s, a number of independent systemic comprehensive reviews have examined studies concerning links between silicone gel breast implants and systemic diseases. The consensus of these reviews is that there is no clear evidence of a causal link between the implantation of silicone breast implants and systemic disease.^{[27][28][29][30]} Thousands of women claim that they have become ill from their implants; complaints include neurological and rheumatological problems. Some studies have suggested that subjective and objective symptoms of women with implants may improve when their implants are removed.^[31] As studies have followed women with implants for a longer period of time, more data have become available on systemic diseases as well as autoimmune symptoms. Several large studies from the national health registry in Denmark found implant recipients no more likely to be diagnosed with an increased incidence of classic auto-immune symptoms as compared to women of the same age in the general population,^[32] and that musculoskeletal symptoms were generally lower among women with implants compared with women with other cosmetic surgery and women in the general population.^[33] Recent longitudinal follow-up of these patients has confirmed previously reported findings.^[34] Several studies have established that women who elect to undergo breast augmentation or other plastic surgery tend to be healthier and more affluent than the general population, prior to surgery and afterwards. For example, two large studies of plastic surgery patients found a decreased standardized mortality ratio in both breast implant and other plastic surgery patients, but an increased risk of respiratory cancer deaths in breast implant recipients compared to other forms of plastic surgery. Smoking was statistically controlled in one study and not in the other, but the authors speculated that there could potentially be differences in smoking that might contribute to the higher lung cancer deaths among women with implants.^[1][1] Another large study with long-term follow-up of nearly 25,000 Canadian women with implants reported: "Findings suggest that breast implants do not directly increase mortality in women."^[37] In 2001 a study suggested an increase in fibromyalgia among women with extracapsular silicone gel leakage, compared to women whose implants were not broken or leaking outside the capsule.^[38] This association has not been repeated in a number of related studies,^[1] and the US-FDA concluded "the weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants."^[40] While there is a general international consensus that silicone implants have not been shown to cause systemic illness, excluding the possibility that a small group of patients may become ill through (as of yet) unknown mechanisms may prove difficult. The US-FDA notes that "researchers must study a large group of women without breast implants who are of similar age, health, and social status and who are followed for a long time (such as 10-20 years) before a relationship between breast implants and these diseases can conclusively be made."^[41] , unfavorable scarring (6-7%) ^[42], interference with breast feeding, visible wrinkling, asymmetry, thinning of the breast tissue, and synmastia (disruption of the natural plane between breasts which is sometimes referred to as 'bread loafing'). Complications and reoperations related to surgeries with breast implants or tissue expanders can add signifigant long term costs to patients and health care systems. Specific complications to indwelling breast implants that have received notable attention involve surveillence and treatment for implant rupture and the phenomena of capsular contracture.

Rupture

Breast implants can potentially remain intact for decades in the body, but all such devices will fail at some point. When saline breast implants break, they often deflate quickly and can be easily removed. Prospective studies of saline-filled breast implants showed rupture/deflation rates of 3-5% at 3 years and 7-10% at 5 years for augmentation patients.^[43] The age and design of the implant are the most important factors in rupture, but estimating ruptures rates of contemporary devices has been difficult, as most previous reports^[44] mixed heterogeneous groups of devices in non-randomized populations. The only available literature with longer term available MRI data on single lumen 3rd/4th generation silicone implants comes from Europe and has reported silent rupture rates of an implant at between 8% to 15% at or around a decade (or 15-30% of patients).^[45][46][47] The first series of MRI evaluation of the highly-cohesive (5th generation) gel implants suggests improved durability, with a rupture rate reported at 1% or less at a median age of six years.^[48] Its been suggested that clinical exams alone are inadequate to evaluate suspected rupture after a study reported that only 30% of ruptures in asymptomatic patients are accurately detected by experienced plastic surgeons, compared to 86% detected by MRIs ^[49] The US-FDA has recommended that MRIs be considered to screen for silent rupture starting at three years after implantation and then every two years thereafter.^[50] Other countries have not endorsed routine MRI screening, and have taken the position that MRI should be reserved only for cases involving suspected clinical rupture or to confirm mammographic or ultrasound studies suggesting rupture.^[51] in the form of granulomas (inflammatory nodules) and axillary lymphadenopathy ^[52] (enlarged lymph glands in the armpit area).^[53] The specific risk and treatment of extracapsular silicone gel is still controversial.

Capsular contracture

See main article, Capsular contracture

Capsules of tightly-woven collagen fibers form as an immune response around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics), tending to wall it off. Capsular contracture occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be very painful and distort the appearance of the implanted breast. The exact cause of contracture is not known. However, some factors include bacterial contamination, silicone rupture or leakage, and hematoma. Capsular contracture may happen again after this additional surgery. Methods which have reduced capsular contracture include submuscular implant placement, using textured^[54][55] or polyurethane-coated implants,^[56] limiting handling of the implants and skin contact prior to insertion^[57] and irrigation with triple-antibiotic solutions.^[58] Correction of capsular contracture may require surgical removal or release of the capsule, or removal and possible replacement of the implant itself. Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can cause implant rupture. Nonsurgical methods of treating capsules include massage, external ultrasound,^[59] treatment with leukotriene pathway inhibitors (Accolate, Singulair),^[60][61]and pulsed electromagnetic field therapy.^[62]

Platinum

Platinum is a catalyst used in the making of silicone implant polymer shells and other silicone devices used in medicine. The literature indicates that small amounts of platinum leaches (leaks) from these implants and is present in the surrounding tissue. The FDA reviewed the available studies from the medical literature on platinum and breast implants in 2002 and concluded there was little evidence suggesting toxicity from platinum in implant patients.^[63] In 2006, researchers published a controversial study that claimed to identify the previously undocumented presence of toxic platinum oxidative states in vivo.^[64] A letter from the editors of the publishing journal, Analytical Chemistry, subsequently expressed concern over the research's experimental design and urged the journal's readers to "use caution in evaluating the conclusions drawn in the paper."^[1] The FDA reviewed this study and the existing literature, concluding that the body of existing research did not support their findings, and that the platinum in new implants is likely not ionized and therefore would not represent a significant risk to women.^[1]

Cancer screening

The presence of radio-opaque breast implants may interfere with the sensitivity of screening mammography. Specialized radiographic techniques where the implant is manually displaced (Eklund views) may improve this somewhat, but approximately 1/3 of the breast is still not adequately visualized with a resultant increase in false-negative mammograms.^[67] A number of studies looking at breast cancers in women with implants have found no significant difference in stage of disease at time of diagnosis, and prognosis appears to be similar in both groups with augmented patients not a higher risk for subsequent cancer recurrence or death.^[68][69] Conversely, the use of implants for reconstruction after mastectomy for breast cancer also appears not to have a negative effect on cancer-related mortality.^[70] An observation that patients with implants are more often diagnosed with palpable tumors (but not larger ones) suggest that tumors of equal size may be more easily palpated in augmented patients, and this may compensate somewhat for the potential impairment of mammography.^[56] This palpability is due to thinning of the breast by compression, innately smaller breasts a priori, and that the implant serves as a base against which the mass may be differentiated.^[72] The presence of a breast implant does not influence the ability for breast conservation (lumpectomy) surgery for women who subsequently develop breast cancer, and does not interfere with delivery of external beam radiation (XRT) treatments that may be required.^[73] Fibrosis of breast tissue after XRT is common and an increase in capsular contracture rates would be expected.

Repair or revision surgery

Regardless of the type of implant, it is likely that women with implants will need to have one or more additional surgeries (re-operations) over the course of their lives. Breast implants do not last forever. According to studies conducted by implant companies for the U.S. FDA, they sometimes only last a few years. Most common indications for re-operations have included major or minor complications, capsular contracture treatment, and replacement of ruptured/deflated implants.^[74][75] as compared with the 20 percent re-operation rate at 3 years in the most recent Food and Drug Administration study.

Controversy

Since the early 1990s, nearly a dozen comprehensive systemic reviews have been commissioned by various governments' health ministries to examine the alleged links between silicone gel breast implants and systemic diseases. A clear consensus has emerged from these independent scientific reviews that there is no clear evidence of a causal link between the implantation of silicones and connective tissue disease. The conclusions of these reviews are summarized: Thousands of women have still claimed that they have become ill from their implants. Complaints include systemic fungus, neurological and rheumatological problems. As studies have followed women with implants for a longer period of time, more information has been made available to assess these issues. A 2004 Danish study, reported that women who had breast implants for an average of 19 years were no more likely to report an excess number of rheumatic symptoms then control groups.^[32] A large study of plastic surgery patients found a decreased standardized mortality ratio in both breast implant and other plastic surgery patients, but a relatively increased risk of lung cancer deaths in breast implant recipients compared to other forms of plastic surgery. The authors attributed this to differences in smoking rates.^[77] Another large study of nearly 25,000 Canadian women with implants recently reported a 43 percent lower rate of breast cancer compared with the general population and a lower-than-average risk of developing cancer of any kind.^[37]

References

External links

General

• U.S. Food and Drug Administration (FDA) - breast implant page
• Health Canada breast implant homepage
• U.K. Medicines & Health Care Products Regulatory Agency (MHRA) - breast implant page
• Australia's Department of Health & Aging Therapeutic Goods Administration breast implant portal
• 2006 European Union International Committee for Quality Assurance, Medical Technologies and Devices in Plastic Surgery(IQUAM) Position Statement
• Basics of implant based breast reconstruction (E-medicine)
• Institute of Medicine (IOM) Report on Silicone Implants
• National Science Panel report "Silicone Breast Implants in Relation to Connective Tissue Diseases and Immunologic Dysfunction"
• Summary of Silicone Implant Safety (E-medicine)
• National Research Center for Women and Families
• Breast Implant Safety.org
• Breast Cancer.org on implant-based reconstruction

Controversy

• U.S. Food and Drug Administration (FDA) - breast implant page
• Health Canada breast implant homepage
• U.K. Medicines & Health Care Products Regulatory Agency (MHRA) - breast implant page
• Australia's Department of Health & Aging Therapeutic Goods Administration breast implant portal
• 2006 European Union International Committee for Quality Assurance, Medical Technologies and Devices in Plastic Surgery(IQUAM) Position Statement
• Institute of Medicine (IOM) Report on Silicone Implants
• National Science Panel report "Silicone Breast Implants in Relation to Connective Tissue Diseases and Immunologic Dysfunction"
• Breast Implant Safety.org

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    Complications

    Surgeries involving breast implants, whether for cosmetic or reconstructive surgery, carry risk common to many types of surgery. These include adverse reactions to anesthesia, post-operative bleeding (hematoma)or fluid collection (seroma), surgical site infection or breakdown, breast pain or alterations in sensation
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51. ^ When silicone implants break they rarely deflate, and the silicone from the implant can leak out into the space around the implant. An intracapsular rupture can progress to outside of the capsule (extracapsular rupture), and both conditions are generally agreed to indicate the need for removal of the implant. Extracapsular silicone has the potential to migrate, but most clinical complications have appeared to be limited to the breast and axillae
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74. ^ Re-operation rates are predictably more frequent in breast reconstruction cases due to the dramatic changes in the soft-tissue envelope and anatomical breast borders after mastetcomy, particularly when patients have received adjuvant XRT. Breast cancer patients also frequently undergo staged procedures for reconstruction of the nipple-areola complex (NAC) and symmetry procedures on the opposite breast. It appears that re-operation rates in cosmetic cases can be improved by more carefully matching individual patients' soft-tissue characteristics to the type and size of implants used. Using appropriate device selection and proper technique, re-operation rates at up to seven years followup have been reported as low as 3%,
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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Breast implant".

"Matt Beckwith" wrote in message news:1107017050.351140.78650@f14g2000cwb.googlegroups.com... > > Public Citizen, the Ralph Nader group, indicates 181 FDA-approved > > For > > example, statin cholesterol-lowering drugs deplete the body of > coenzyme Q10 > > which can result in a mortal condition called rhabdomyolysis. > > I'd like to read the study which proves that taking Co-enzyme Q10 > prevents muscle damage from statins. If it's true, I'll prescribe it > to my patients. What I recall in the literature is that ubiquinone prevents liver changes resulting from the use of statin in the rat animal model. Research on ubiquinone has slowed since the death of Carl Folkers. Other than the cost the addition of ubiquinone, it is a very safe material. Whether all the damage by statins can be fully stopped in patients is unclear. There needs to be a CoQ-10 and Statin trial in humans. Still in patient with cardiovascular disease, the addition of CoQ-10 is warrented for other reason. It...

-------------------------------------------------------------------------------
Re: Campaign launched against dietary supplements
"Matt Beckwith" wrote in message
news:1107017050.351140.78650@f14g2000cwb.googlegroups.com...
> > Public Citizen, the Ralph Nader group, indicates 181 FDA-approved
> > For
> > example, statin cholesterol-lowering drugs deplete the body of
> coenzyme Q10
> > which can result in a mortal condition called rhabdomyolysis.
>
> I'd like to read the study which proves that taking Co-enzyme Q10
> prevents muscle damage from statins. If it's true, I'll prescribe it
> to my patients.

What I recall in the literature is that ubiquinone prevents liver
changes resulting from the use of statin in the rat animal model.
Research on ubiquinone has slowed since the death of
Carl Folkers. Other than the cost the addition of ubiquinone,
it is a very safe material. Whether all the damage by statins
can be fully stopped in patients is unclear. There needs to
be a CoQ-10 and Statin trial in humans. Still in patient
with cardiovascular disease, the addition of CoQ-10
is warrented for other reason. It modestly reduce
blood pressure (human), it helps narrow the pulse pressure
a little (human), and reduces ichemia (pig). It helps gums health
(human) as well. It also reduces the toxicity of some chemoTX.


>
> > Acetaminophen
> > (Tylenol) is toxic to the liver and acetaminophen use is the leading
> cause
> > for liver transplants. The antidote for acetaminophen poisoning is
> N-acetyl
> > cysteine, a sulfur-based dietary supplement. The FDA has resisted
> appeals to
> > combine these nutrients into the drugs or mandate that supplements be
> > prescribed as companions.
>
> Well, we use N-acetyl cysteine to treat liver damage caused by Tylenol,
> but that's usually when the patient takes too much Tylenol. What would
> be the use of taking NAC along with Tylenol? That would be like
> breathing 100% oxygen whenever you start your car because carbon
> monoxide poisoning is treated with oxygen.

Acetaminophen has a narrow therapeutic range. Adding NAC would
do much to widen the range. Just adding NAC milligram per milligram
in ratio to the drug would do it. NAC is safer than oxygen at these
dose levels. The overdose patient would still need treatment but
it would limit the upfront damage.

>



>> This is an overly simplistic statement. The statement that dietary
> supplements interfere with prescription medications most likely refers
> to those dietary supplements which are drugs, such as St. John's Wort
> and Valerian Root. These dietary supplements (and myriad others) are
> dangerous if taken inappropriately.
>
> In fact, this mistaken idea that dietary supplements are benign is at
> the root of the problem of dietary supplements not being controlled.

They don't need controls, they need drug style inserts and warning labels.
Herbs and vitamins need real ongoing research. Much of the
current research is blighted by use of the wrong forms, tiny
doses, and limited paradigms.



> High-dose vitamin D is extremely dangerous. So, in addition to the
> proof of its efficacy, I'd need to see some literature on safety at
> high doses.
>

If you define 4000 to 5000 IU per day during the darker months of
the year as a high dose, you don't know what you are talking about.
I'll suggest you you read the Vitamin D expert panel group brought
together by the NIH which is available on the web with a careful
Google search. Read the paper by research workers Vieth, Holick, and Heaney.
Try this paper published in Am J Clin Nutr 2003;77:204-11 which
is entitled "Human serum 25-hydroxycholecalciferol response to
extended oral dosing with cholecalciferoil". It has long
been known (~ 40 years) that in the tropics, people synthesise
as much as 10 000 IU per day. It was pure bias that
this fact has been ignored until rather recently. Your
attutide damns many who listen to you to weaken bones,
ectopic calicifation, prostate and Breast cancer
For a nice little review article, I suggest the British Journal
of Nutrition (2003). 89, 552-572 by Armin Zittermann.
The two articles that I mentioned are available.

I'll bet Max will just ignore this final paragraph of comments
as I provided sources.
-------------------------------------------------------------------------------
Re: Campaign launched against dietary supplements
"Matt Beckwith" wrote in message
news:1107017050.351140.78650@f14g2000cwb.googlegroups.com...
> > Public Citizen, the Ralph Nader group, indicates 181 FDA-approved
> > For
> > example, statin cholesterol-lowering drugs deplete the body of
> coenzyme Q10
> > which can result in a mortal condition called rhabdomyolysis.
>
> I'd like to read the study which proves that taking Co-enzyme Q10
> prevents muscle damage from statins. If it's true, I'll prescribe it
> to my patients.

What I recall in the literature is that ubiquinone prevents liver
changes resulting from the use of statin in the rat animal model.
Research on ubiquinone has slowed since the death of
Carl Folkers. Other than the cost the addition of ubiquinone,
it is a very safe material. Whether all the damage by statins
can be fully stopped in patients is unclear. There needs to
be a CoQ-10 and Statin trial in humans. Still in patient
with cardiovascular disease, the addition of CoQ-10
is warrented for other reason. It modestly reduce
blood pressure (human), it helps narrow the pulse pressure
a little (human), and reduces ichemia (pig). It helps gums health
(human) as well. It also reduces the toxicity of some chemoTX.


>
> > Acetaminophen
> > (Tylenol) is toxic to the liver and acetaminophen use is the leading
> cause
> > for liver transplants. The antidote for acetaminophen poisoning is
> N-acetyl
> > cysteine, a sulfur-based dietary supplement. The FDA has resisted
> appeals to
> > combine these nutrients into the drugs or mandate that supplements be
> > prescribed as companions.
>
> Well, we use N-acetyl cysteine to treat liver damage caused by Tylenol,
> but that's usually when the patient takes too much Tylenol. What would
> be the use of taking NAC along with Tylenol? That would be like
> breathing 100% oxygen whenever you start your car because carbon
> monoxide poisoning is treated with oxygen.

Acetaminophen has a narrow therapeutic range. Adding NAC would
do much to widen the range. Just adding NAC milligram per milligram
in ratio to the drug would do it. NAC is safer than oxygen at these
dose levels. The overdose patient would still need treatment but
it would limit the upfront damage.

>



>> This is an overly simplistic statement. The statement that dietary
> supplements interfere with prescription medications most likely refers
> to those dietary supplements which are drugs, such as St. John's Wort
> and Valerian Root. These dietary supplements (and myriad others) are
> dangerous if taken inappropriately.
>
> In fact, this mistaken idea that dietary supplements are benign is at
> the root of the problem of dietary supplements not being controlled.

They don't need controls, they need drug style inserts and warning labels.
Herbs and vitamins need real ongoing research. Much of the
current research is blighted by use of the wrong forms, tiny
doses, and limited paradigms.



> High-dose vitamin D is extremely dangerous. So, in addition to the
> proof of its efficacy, I'd need to see some literature on safety at
> high doses.
>

If you define 4000 to 5000 IU per day during the darker months of
the year as a high dose, you don't know what you are talking about.
I'll suggest you you read the Vitamin D expert panel group brought
together by the NIH which is available on the web with a careful
Google search. Read the paper by research workers Vieth, Holick, and Heaney.
Try this paper published in Am J Clin Nutr 2003;77:204-11 which
is entitled "Human serum 25-hydroxycholecalciferol response to
extended oral dosing with cholecalciferoil". It has long
been known (~ 40 years) that in the tropics, people synthesise
as much as 10 000 IU per day. It was pure bias that
this fact has been ignored until rather recently. Your
attutide damns many who listen to you to weaken bones,
ectopic calicifation, prostate and breast cancer
For a nice little review article, I suggest the British Journal
of Nutrition (2003). 89, 552-572 by Armin Zittermann.
The two articles that I mentioned are available.

I'll bet Max will just ignore this final paragraph of comments
as I provided sources.
-------------------------------------------------------------------------------
Rosacea Frequently Asked Questions v1.16
Archive-name: medicine/rosacea
Posting-Frequency: monthly
Last-modified: 2004/05/31
Version: 1.16
URL: http://rosacea.ii.net/faq.html
Maintainer: David Pascoe

CVS Version: $Id: faq.txt,v 1.16 2004/05/31 12:47:40 user Exp $

----------------------------------------------------------------------------
Disclaimer: the following information is a guide only. Self diagnosis is a
dangerous pastime without all of the information. This Frequently Asked
Questions is a simple guide to rosacea, and a pointer to more information.
This text should not be used in the place of professional advice from
registered practitioners.
----------------------------------------------------------------------------

1. What is Rosacea ?

Rosacea (said rose-ay-shah) is a potentially progressive neurovascular
disorder that generally affects the facial skin and eyes.

The most common symptoms include facial redness and inflammation across
the flushing zone - usually the nose, cheeks, chin and forehead ; visibly
dilated blood vessels, facial swelling and burning sensations, and
inflammatory papules and pustules.

Rosacea can develop gradually as mild episodes of facial blushing or
flushing which, over time, may lead to a permanently red face.

Ocular rosacea can affect both the eye surface and eyelid. Symptoms can
include redness, dry eyes, foreign body sensations, sensitivity of
the eye surface, burning sensations and eyelid symptoms such as chalazia,
styes, redness, crusting and loss of eyelashes.

A panel of experts have agreed on a standard classification system for
Rosacea. This system is a brief text that is not intended to be
exhaustive, but is a place to start.

Their classification system was published in the Journal of American
Academy of Dermatology (United States), Apr 2002, 46(4) p584-7)

"Rosacea is a chronic cutaneous disorder, primarily of the central face.
It is often characterized by remission and exacerbation and it encompasses
various combinations of such cutaneous signs as flush, erythema,
telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma.
Primary features considered as necessary for diagnosis include flushing,
erythema, papules, pustules, and telangiectasias. A variety of secondary
features are listed that may be absent or present as a single finding or
in any combination."

----------------------------------------------------------------------------

1.1 Are there different types of Rosacea ?

The panel of Rosacea experts agreed on the following broad, non exclusive
text (i.e. there are other factors and types that come into play).

"The system divides rosacea into four subtypes: erythematotelangiectatic,
papulopustular, phymatous, and ocular. As presently worded, papulopustular
rosacea is noted as often being observed following or with
erythematotelangiectatic disease and phymatous rosacea as following or
occurring together with either erythematotelangiectatic or papulopustular
rosacea. However, Dr. Wilkin emphasized that while those descriptions are
consistent with common concepts about rosacea natural history, they are
provisional and subject to change."

"In its current iteration, the classification system excludes rosacea
fulminans, steroid-induced acneiform eruptions, and perioral dermatitis
without rosacea signs from the diagnosis of rosacea."

----------------------------------------------------------------------------

1.2 How is Rosacea different to Acne Vulgaris ?

As rosacea is a neurovascular disorder it affects the flushing zone.

Is is common that Rosacea does not present with blackheads that are
seen with Acne Vulgaris. Also the age of onset, and the location of
redness is a clue. Rosacea is commonly an adult disease, and is generally
restricted to the nose, cheeks, chin and forehead. It can coexist with
acne vulgaris.

Some rosacea sufferers have a significant acne component in their symptoms
so it can be easily confused with acne vulgaris. The papules and pustules
of rosacea tend to be less follicular in origin.

Rosacea will probably have an underlying redness that is related to
flushing and thus looks different to acne vulgaris. Acne sufferers
normally do not have the accompanying redness.

Rosacea usually begins with flushing, leading to persistent redness.

As both conditions are inflammatory, the treatment for rosacea and acne
vulgaris can be somewhat similar, but some of the acne vulgaris regimes
are too harsh for rosacea affected skin and can severely aggravate the
condition.

Rosacea sufferers are cautioned against using common acne treatments such
as alpha hydroxy acids (glycolic and lactic acids), topical retinoids
(such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide,
topical azelaic acid, triclosan, acne peels, chemical peels. Additionally
the caution extends to topical exfoliants, toners, astringents and alcohol
containing products.

----------------------------------------------------------------------------

1.3 What is the difference between Rosacea and Seborrheic Dermatitis ?

Seborrheic Dermatitis and Rosacea are closely related, they both involve
inflammation of the oil glands. Rosacea also involves a vascular component
causing flushing and broken blood vessels.

Seborrheic Dermatitis may involve the presence of somewhat greasy flaking
involving the T zone, crusts, scales, itching and occasionally burning,
and may also be found on the scalp, ears and torso. It does not usually
involve red bumps as in Rosacea.

The T zone is the area shaped like a `T' composed of your forehead, nose
and around your mouth.

Just to confuse things further, the two conditions are often seen
together.

----------------------------------------------------------------------------

1.4 What causes Rosacea ?

From "Beating Rosacea, Vascular, Ocular and Acne Forms", by Geoffrey Nase
PhD, Nase Publications 2001.

"Rosacea is primarily a disorder of the facial blood vessels. Experts from
across the world agree that vascular abnormalities are central to all
stages and symptoms of rosacea".

To paraphrase: Rosacea blood vessels undergo changes in function and
become hyper-responsive to internal and external stimuli. These changes
are ultimately responsible for the progression of all rosacea symptoms.

As with many conditions, there appears to be a genetic propensity to
developing rosacea.

----------------------------------------------------------------------------

1.5 How does rosacea progress ?

"Rosacea normally progresses in the same generalised fashion, frequent
dilation of facial blood vessels leads to vascular hyper-responsiveness
and structural damage."

Rosacea experts talk about rosacea symptoms appearing in 4 stages. Over
time rosacea can progress from one stage to the next.

From Dr. J Wilkin:

"Most textbooks and literature citations characterize rosacea as a disease
that gradually evolves from early to later subtypes. However, there is not
conclusive evidence to substantiate that course and we want to know if it
really occurs. Nevertheless, the individual features within a subtype can
get worse, so early treatment is advocated, even if there is not
progression from one stage to the next,"

----------------------------------------------------------------------------

1.6 What are the stages of rosacea ?

Dr. Nase talks about 4 stages, called Pre-Rosacea, Mild Rosacea, Moderate
Rosacea and Severe Rosacea.

Pre-Rosacea: the first cardinal sign of rosacea: blood vessels dilate to
more stimuli, open wider and stay open for longer periods of time compared
to normal persons. No visible damage can normally be seen.

Mild Rosacea: begins when the facial redness induced by flushing persists
for an abnormal length of time - usually 1/2 an hour or more after a
trigger. Those who have frequent pre-rosacea flushing are highly
susceptible to progressing to mild rosacea.

Some of the common triggers for a facial flush are heat, cold, emotions,
exercise, topical irritants and allergic reactions.

Moderate Rosacea: as facial flushing becomes more frequent and intense,
vascular damage occurs. This can result in long lasting redness, swelling
and inflammatory papules and pustules. Telangiectasia (damaged micro blood
vessels, often visible on the surface of the skin) may be noticed in the
areas where flushing is worst.

Severe Rosacea: characterised by intense bouts of facial flushing, severe
inflammation, facial pain, swelling and burning sensations. Sufferers may
develop intolerance to products they were able to use before. Also
inflammatory papules, pustules and nodules may be present. Some experience
a bulbous enlargement of the nose, known as rhinophyma.

This is just a guide, you may of course experience symptoms outside these
ranges.

----------------------------------------------------------------------------

2. How can Rosacea be treated ?

The best answer is "working with the support of your registered health
professional". There are medications available that control the redness
and reduce the number of papules and pustules associated with rosacea.

Current run-of-the-mill treatment might include oral antibiotics and
topical metronidazole. One study showed that the use of topical
metronidazole alone can help some sufferers to reduce rosacea flare-ups
once the rosacea is brought under control.

For those sufferers that do not benefit from the metronidazole based
treatments, there are many other options. Quite a few treatments options
are often discussed on the rosacea-support email group. Some of their
posts can be found under the `Treatments' tree on the list highlights page
see - http://rosacea.ii.net/toc.html

Experts agree that a gentle cleansing regime is very important. Avoiding
chemicals that aggravate the rosacea, but will clean and moisturise the
skin is a step in the right direction.

As the sun is a strong trigger for many rosacea sufferers, a good
non-irritating sunscreen used daily is very important. For those who react
badly to chemical sunscreens, a physical sunscreen may be more suitable.
Physical sunscreens rely on the reflective properties of the main
ingredients (rather than the ability of some chemicals to absorb the sun's
energy). The most common physical sunscreens are based on zinc oxide or
titatinium dioxide.

The vitamin A derivative isotretinoin (known as Accutane or Roaccutane),
has been shown to be effective against severe papopustular rosacea. It
works by inhibiting sebaceous gland function and physically shrinking the
glands. It also has potent anti-inflammatory properties, making it ideal
to treat resistant rosacea. At low doses, accutane has also been shown to
reduce other symptoms such as facial burning and redness. Accutance is a
strong drug, and even at the low doses found beneficial to rosacea, should
be used under strict supervision of your doctor.

Low does accutance may be more suitable than the regular dose, as there
are less side effects and lesser chance of aggravating redness.

The mixed light pulse laser - Photoderm is showing promise as a treatment
for the vascular component of rosacea. It works by targeting facial
microvessels that are damaged.

One treatment that has been shown to help some is Rosacea-LTD III. It is
the third generation of topical mineral salt based treatment. The minerals
shrink facial vessels as well as reduce papules and pustules. More
information is available at http://www.rosacea-ltd.com

For those wanting to treat the flushing side of their rosacea, 2 drugs are
worth investigating. Monoxidine and Clonodine are 2 anti-hypertensives
that you could look at with your doctor.

From a subjective view of the rosacea-support list members it would appear
that one person's treatment does not necessarily suit another, so your
mileage may vary with any recommended treatment. Experiment a little and
find what helps you. Depending on the stage of your rosacea, some
treatments may be aggravating, while for others the same treatment may not
cause problems. Every rosacea patient is unique and needs individual
treatment.

Whatever path you choose, the support of a doctor or dermatologist that is
willing to work with you will be very important, so shop around until you
are happy with your health professional.

Dr. Nase's book will serve as a valuable resource - it contains detailed
and proven current rosacea treatment information.

----------------------------------------------------------------------------

2.1 What about steroids ?

Steroids have long been prescribed for rosacea because of their perceived
quick relief. Milder (1% hydrocortisone) over the counter preparations are
also popular as they are thought to be safer than the prescription
strength treatment.

Sufferers should be aware of the following warnings:

"Topical steroids can worsen all rosacea symptoms by dilating facial blood
vessels, thinning the protective skin barrier, and thinning the dermis by
breaking down the collagen and elastin support structures".

"Medical experts stress that rosacea sufferers should not use topical
steroids (of any strength) to treat their symptoms".

These quotes are from Dr. Nase's book. They are backed up by several pages
of studies and comments. Topical steroids can induce rosacea and worsen
pre-existing rosacea. It must be avoided in patients with rosacea.

----------------------------------------------------------------------------

2.2 Can you be cured of Rosacea ?

Perhaps not cured in the sense of cured of a cold, but you can reduced
your symptoms to a manageable level. There are plenty of treatment options
out there, you may just need to experiment with a few.

If you want to feel encouraged that Rosacea really can be practically
cured, check out Geoffrey Nase's before and after photographs at
http://rosacea.ii.net/gnase.html

----------------------------------------------------------------------------

3. What information is available on the Internet about Rosacea ?

There are some pages that are worth visiting. You can find a list of
reviewed Internet resources relating to Rosacea as part of the Open
Directory at
http://dmoz.org/Health/Conditions_and_Diseases/Skin_Disorders/Rosacea/
There you will find sections on companies offering treatment products,
research results as well as medical texts on rosacea.

----------------------------------------------------------------------------

3.1 Are there any email mailing lists relating to Rosacea ?

Yes, see http://rosacea.ii.net/ml.html or
go straight to the email group hosting page at
http://groups.yahoo.com/group/rosacea-support/

Many interesting and useful discussions have taken place on the mailing
list since it was created in October 1998. There are 2 Doctors on the list
who have hugely contributed to the group and posted great articles. You
can see the list highlights categorised by treatment, symptoms and more at
http://rosacea.ii.net/toc.html

There is a Rosacea forum for those who use AOL as their internet company.
The address is aol://5863:126/mB:144806

Another place to try is http://www.esfbchannel.com/forum/ , the
Blushing/Flushing and Sweating forum. This forum deals more with issues of
hyperhidrosis, facial blushing and flushing as well as ETS issues.

----------------------------------------------------------------------------

3.2 Are there any Usenet Newsgroups relating to Rosacea ?

Not exclusively for Rosacea. Perhaps the best 2 to try are
alt.skincare.acne and alt.support.skin-diseases. You can read and post to
these forums using the Google Groups facility at http://groups.google.com

http://groups.google.com/groups?group=alt.support.skin-diseases
http://groups.google.com/groups?group=alt.skincare.acne

You could also try your local feed of these newsgroups if your browser is
configured: news:alt.support.skin-diseases news:alt.skincare.acne

----------------------------------------------------------------------------

3.3 Are there any Books about Rosacea I should read ?

There are very few books about Rosacea. In the last year of so there has
been a couple of `self help' books written about rosacea. You can find a
review of a couple of these at http://rosacea.ii.net/reviews.html

A recently published book by Dr. Geoffrey Nase is destined (we believe) to
become a seminal text on Rosacea. You can read a detailed discussion of
the contents of the book at http://www.drnase.com The book is titled
"Beating Rosacea, Vascular, Ocular and Acne Forms". It is only available
from his web site.

----------------------------------------------------------------------------

3.4 Is this Frequently Asked Question list on the Internet ?

Yes, you may find a more up to date listing if you check
http://rosacea.ii.net/faq.html

You can find the official html'ised archived version of this FAQ at
http://www.faqs.org/faqs/medicine/rosacea

Also, you can get this FAQ via email. The address of the faq server is
mail-server@rtfm.mit.edu

First, get the directory listing with the `index' command, and then fetch
the latest version of the FAQ with the `send' command. You should include
the commands in the _body_ of the message, the subject will be ignored.
All messages to the mail server should be on one line only, if your email
program inserts carriage returns because the line is too long, you may
find retrieving the FAQ difficult.

For example, to get version 1.12 of the FAQ you would send the following
texts in the body of 2 emails (first one to get directory and second, once
you know the filename you want).

index usenet-by-group/alt.support.skin-diseases

send
usenet-by-group/alt.support.skin-diseases/Rosacea_Frequently_Asked_Questions_v1.14

----------------------------------------------------------------------------

4. Are there any support groups related to Rosacea ?

You may want to check out The National Rosacea Society and the
rosacea-support email list.

The National Rosacea Society is a non profit organisation set up to
provide information about Rosacea. You can find them at
http://www.rosacea.org/home.html They publish newsletters online as well
as conduct surveys about rosacea sufferers. Also they make published
information available to sufferers via regular mail. The National Rosacea
Society are an introductory organisation that are a good first point of
contact for information. The depth and breadth of information that they
make available is something that we hope that they will be able to devote
some resources to.

There is an email support group that you can subscribe to. This email
group is free and unmoderated. Currently there are about 1800 users and
about 10-40 messages per day. Digest versions are available. To find out
more information about the list, visit http://rosacea.ii.net/ml.html or go
straight to the email hosting page at
http://groups.yahoo.com/group/rosacea-support/

An alternative list archive on the web is also located at
http://www.escribe.com/health/rosacea-support/ this site has a slightly
more traditional feel to it, you may prefer to read from this archive.

Rosacea Reading Glossary
----------------------------------------------------------------------------

As you read more about Rosacea, you might come across lots of terms that
are new to you. Below is a short list of some of the terms you might come
across.

accutane: a powerful vitman A derivate that was originally prescribed for
severe acne vulgaris. Has been used effectively for rosacea as well. Also
known as roaccutane.
for more info http://www.rocheusa.com/products/accutane/

blepharitis: inflamation and crusting of the eyelid.

cutaneous: pertaining to the skin.

demodex mites: (demodex folliculorum and demodex brevis): microscopic
mites that lives in the skin. Some have suggested that this is the cause
of rosacea, but most experts discount this theory. According to Dr Nase,
"This theory has now been disproved. Rosacea experts all agree that this
mite plays no real role in the development or progression of rosacea
(except for the odd pustule).", pg. 110 in Beating Rosacea.

chalazion: a lump on the eyelid that is caused by a clogged duct of one or
more of the meibomian glands on the eyelid.

conjunctivitis: inflammation of the conjunctiva (the thin transparent
lining in the front of the eyeballs and eyelids).

dry eye: a condition brought about by abnormal production in the quantity
or quality of tears.

edema: presence of abnormally large amounts of fluid in the intercellular
tissue spaces of the body, especially wrt subcutaneous tissues.

epifacial: another term referring to a full face treatment using
photoderm.

epilight: a treatment very similar to photoderm, originally intended for
hair removal. differs by using different filters to photoderm. For more
information see http://www.skinandhealth.com

erythema: inflammatory redness of the skin.

erythematotelangiectatic: having symptoms of both erythema and
telangiectasias

ESB: Endoscopic Sympathetic Block, clamps used to block the transmission
of the neural impulses in the sympathetic chain. Is considered a
reversible procedure. See http://privatix.magenta.net

ETS: Endoscopic Transthoracic Sympathectomy (or endoscopic transthoracic
sympathicotomy) a procedure where a surgeon excises the major sympathetic
nerves that supply the hands, neck and face. Main indications for ETS are
blushing and hyperhidrosis. One place for more information:
http://www.sweaty-palms.com/ets.htm

fotofacial: a treatment regime using photoderm pioneered by Dr. Patrick
Bitter Jnr., for more information, see http://www.fotofacial.com

Helicobacter pylori: bacteria that live in the cell lining of the stomach.
According to Dr. Nase, "Most rosacea specialists now conclude that H.
Pylori only play a small role in a minor number of rosacea patients." pg.
109 in "Beating Rosacea".

hypertrophy: the enlargement or overgrowth of an organ or part due to an
increase in size of its constituent cells.

hyperemia: abnormally increased blood flow

IPL: Intense Pulse Light, a description of the technology used in the
family of machines made by ESC. For more information, see
http://www.skinandhealth.com

isotretinoin: the a vitamin-A derivative that is the active ingredient in
accutane (also known as roaccutane).

keratitis: infection or inflammation of the cornea of the eye.

ketoconozole: the active antifungal ingredient in nizoral, helpful for
seborrheic dermatitis and dandruff.

lupus: an auto-immune disease that causes inflammation in various parts of
the body such as the skin, joints and kidneys. Skin flushing is an
important symptom of lupus.

metrogel: a 0.75% metranidazole treatment. For more information
http://www.metrogel.com/aboutmetrogel/index.html

metronidazole: a topical treatment for rosacea. Has been found by some to
effective against rosacea. Has a yet to be understood anti-inflammatory
action. Is the active ingredient in metrogel, metrocream, metrolotion,
rozex and noritate.

meibomitis: inflammation of the oil producing meibomian glands of the
eye.

Multilight: a member of the Intense Pulsed Light family, along with the
photoderm machine. For more information see http://www.skinandhealth.com
Can also be used for hair removal.

noritate: a 1% metronidazole treatment. for more info
http://www.dermik.com/prod/noritate/Noritate.jsp

ocular: of the eye.

papulopustular: having symptoms of both papules and pustules.

papule: a small, solid, elevated skin lesion, less than 0.5cm in diameter.

perioral dermatitis: perioral refers to the area around the mouth, and
dermatitis indicates redness of the skin. In addition to redness, there
are usually small red bumps or even pus bumps and mild peeling.

photoderm: an intense light source, fired at the facial skin to reduce
flushing associated with rosacea. a new treatment for rosacea that
is producing some exciting results. For more information see
http://www.skinandhealth.com

photofacial: a treatment regime using photoderm, pioneered by Dr. Patrick
Bitter Snr., for more information, see http://www.photofacial.com

photorejuvenation: a broad term used describe Intense Pulsed Light
treatments. photorejuvenation treatments are aimed at stimulating
collagen formulation.

phymatous: having symptoms of abnormal growth, as found in rhinophyma.

pustule: a vesicle filled with cloudy fluid, such as pus, often associated
with a hair follicle but can exist independently.

Quantam SR: a member of the Intense Pulsed Light family, along with the
photoderm machine. For more information see http://www.skinandhealth.com

rhinophyma: abnormal growth of the soft tissue of nose, caused by sebaceous
gland hypertrophy and hyperplasia (increased growth and number of
sebaceous glands).

roaccutane: a powerful vitman A derivate that was originally prescribed for
severe acne vulgaris. Has been used effectively for rosacea as well. Also
known as accutane. for more info
http://www.roaccutane.com.au

rosacea fulminans: a rare form of rosacea that appears very quickly.

rozex: 0.75% metronidazole based treatment also known as metrogel. for
more info http://www.medsafe.govt.nz/consumers/cmi/r/rozexgel.htm

rosacea-ltd: a non-prescription topical treatment for rosacea, see
http://www.rosacea-ltd.com

seborrheic dermatitis: an inflamatory skin condition, associated with
itchy flaking skin.

sebaceous gland: a gland often associated with a hair follicle, that
produces sebum.

stye: inflammation of an eyelash follicle on the edge of the eyelid.

subcutaneous: under the skin.

telangiectasias: damaged micro blood vessels, often visible on the surface
of the skin.

tetracycline: an antibiotic often prescribed for rosacea.

V-beam: the fifth generation (hence roman 5=V) of the pulse dye laser. for
more information, see http://www.vbeamlaser.com

vascular: of the blood vessels.

vasculight: a IPL+laser machine that can be used to give mixed wavelength
and fixed wavelength treatments. Can target large and deep blood vessels.
For more information see http://www.skinandhealth.com

versapulse: a type of laser, for more information, see
http://www.coherentinc.com

" vim:tw=74:et

--
David Pascoe, pascoedj+usenet@spamcop.net, Western Australia
-------------------------------------------------------------------------------
Rosacea Frequently Asked Questions v1.16
Archive-name: medicine/rosacea
Posting-Frequency: monthly
Last-modified: 2004/05/31
Version: 1.16
URL: http://rosacea.ii.net/faq.html
Maintainer: David Pascoe

CVS Version: $Id: faq.txt,v 1.16 2004/05/31 12:47:40 user Exp $

----------------------------------------------------------------------------
Disclaimer: the following information is a guide only. Self diagnosis is a
dangerous pastime without all of the information. This Frequently Asked
Questions is a simple guide to rosacea, and a pointer to more information.
This text should not be used in the place of professional advice from
registered practitioners.
----------------------------------------------------------------------------

1. What is Rosacea ?

Rosacea (said rose-ay-shah) is a potentially progressive neurovascular
disorder that generally affects the facial skin and eyes.

The most common symptoms include facial redness and inflammation across
the flushing zone - usually the nose, cheeks, chin and forehead ; visibly
dilated blood vessels, facial swelling and burning sensations, and
inflammatory papules and pustules.

Rosacea can develop gradually as mild episodes of facial blushing or
flushing which, over time, may lead to a permanently red face.

Ocular rosacea can affect both the eye surface and eyelid. Symptoms can
include redness, dry eyes, foreign body sensations, sensitivity of
the eye surface, burning sensations and eyelid symptoms such as chalazia,
styes, redness, crusting and loss of eyelashes.

A panel of experts have agreed on a standard classification system for
Rosacea. This system is a brief text that is not intended to be
exhaustive, but is a place to start.

Their classification system was published in the Journal of American
Academy of Dermatology (United States), Apr 2002, 46(4) p584-7)

"Rosacea is a chronic cutaneous disorder, primarily of the central face.
It is often characterized by remission and exacerbation and it encompasses
various combinations of such cutaneous signs as flush, erythema,
telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma.
Primary features considered as necessary for diagnosis include flushing,
erythema, papules, pustules, and telangiectasias. A variety of secondary
features are listed that may be absent or present as a single finding or
in any combination."

----------------------------------------------------------------------------

1.1 Are there different types of Rosacea ?

The panel of Rosacea experts agreed on the following broad, non exclusive
text (i.e. there are other factors and types that come into play).

"The system divides rosacea into four subtypes: erythematotelangiectatic,
papulopustular, phymatous, and ocular. As presently worded, papulopustular
rosacea is noted as often being observed following or with
erythematotelangiectatic disease and phymatous rosacea as following or
occurring together with either erythematotelangiectatic or papulopustular
rosacea. However, Dr. Wilkin emphasized that while those descriptions are
consistent with common concepts about rosacea natural history, they are
provisional and subject to change."

"In its current iteration, the classification system excludes rosacea
fulminans, steroid-induced acneiform eruptions, and perioral dermatitis
without rosacea signs from the diagnosis of rosacea."

----------------------------------------------------------------------------

1.2 How is Rosacea different to Acne Vulgaris ?

As rosacea is a neurovascular disorder it affects the flushing zone.

Is is common that Rosacea does not present with blackheads that are
seen with Acne Vulgaris. Also the age of onset, and the location of
redness is a clue. Rosacea is commonly an adult disease, and is generally
restricted to the nose, cheeks, chin and forehead. It can coexist with
acne vulgaris.

Some rosacea sufferers have a significant acne component in their symptoms
so it can be easily confused with acne vulgaris. The papules and pustules
of rosacea tend to be less follicular in origin.

Rosacea will probably have an underlying redness that is related to
flushing and thus looks different to acne vulgaris. Acne sufferers
normally do not have the accompanying redness.

Rosacea usually begins with flushing, leading to persistent redness.

As both conditions are inflammatory, the treatment for rosacea and acne
vulgaris can be somewhat similar, but some of the acne vulgaris regimes
are too harsh for rosacea affected skin and can severely aggravate the
condition.

Rosacea sufferers are cautioned against using common acne treatments such
as alpha hydroxy acids (glycolic and lactic acids), topical retinoids
(such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide,
topical azelaic acid, triclosan, acne peels, chemical peels. Additionally
the caution extends to topical exfoliants, toners, astringents and alcohol
containing products.

----------------------------------------------------------------------------

1.3 What is the difference between Rosacea and Seborrheic Dermatitis ?

Seborrheic Dermatitis and Rosacea are closely related, they both involve
inflammation of the oil glands. Rosacea also involves a vascular component
causing flushing and broken blood vessels.

Seborrheic Dermatitis may involve the presence of somewhat greasy flaking
involving the T zone, crusts, scales, itching and occasionally burning,
and may also be found on the scalp, ears and torso. It does not usually
involve red bumps as in Rosacea.

The T zone is the area shaped like a `T' composed of your forehead, nose
and around your mouth.

Just to confuse things further, the two conditions are often seen
together.

----------------------------------------------------------------------------

1.4 What causes Rosacea ?

From "Beating Rosacea, Vascular, Ocular and Acne Forms", by Geoffrey Nase
PhD, Nase Publications 2001.

"Rosacea is primarily a disorder of the facial blood vessels. Experts from
across the world agree that vascular abnormalities are central to all
stages and symptoms of rosacea".

To paraphrase: Rosacea blood vessels undergo changes in function and
become hyper-responsive to internal and external stimuli. These changes
are ultimately responsible for the progression of all rosacea symptoms.

As with many conditions, there appears to be a genetic propensity to
developing rosacea.

----------------------------------------------------------------------------

1.5 How does rosacea progress ?

"Rosacea normally progresses in the same generalised fashion, frequent
dilation of facial blood vessels leads to vascular hyper-responsiveness
and structural damage."

Rosacea experts talk about rosacea symptoms appearing in 4 stages. Over
time rosacea can progress from one stage to the next.

From Dr. J Wilkin:

"Most textbooks and literature citations characterize rosacea as a disease
that gradually evolves from early to later subtypes. However, there is not
conclusive evidence to substantiate that course and we want to know if it
really occurs. Nevertheless, the individual features within a subtype can
get worse, so early treatment is advocated, even if there is not
progression from one stage to the next,"

----------------------------------------------------------------------------

1.6 What are the stages of rosacea ?

Dr. Nase talks about 4 stages, called Pre-Rosacea, Mild Rosacea, Moderate
Rosacea and Severe Rosacea.

Pre-Rosacea: the first cardinal sign of rosacea: blood vessels dilate to
more stimuli, open wider and stay open for longer periods of time compared
to normal persons. No visible damage can normally be seen.

Mild Rosacea: begins when the facial redness induced by flushing persists
for an abnormal length of time - usually 1/2 an hour or more after a
trigger. Those who have frequent pre-rosacea flushing are highly
susceptible to progressing to mild rosacea.

Some of the common triggers for a facial flush are heat, cold, emotions,
exercise, topical irritants and allergic reactions.

Moderate Rosacea: as facial flushing becomes more frequent and intense,
vascular damage occurs. This can result in long lasting redness, swelling
and inflammatory papules and pustules. Telangiectasia (damaged micro blood
vessels, often visible on the surface of the skin) may be noticed in the
areas where flushing is worst.

Severe Rosacea: characterised by intense bouts of facial flushing, severe
inflammation, facial pain, swelling and burning sensations. Sufferers may
develop intolerance to products they were able to use before. Also
inflammatory papules, pustules and nodules may be present. Some experience
a bulbous enlargement of the nose, known as rhinophyma.

This is just a guide, you may of course experience symptoms outside these
ranges.

----------------------------------------------------------------------------

2. How can Rosacea be treated ?

The best answer is "working with the support of your registered health
professional". There are medications available that control the redness
and reduce the number of papules and pustules associated with rosacea.

Current run-of-the-mill treatment might include oral antibiotics and
topical metronidazole. One study showed that the use of topical
metronidazole alone can help some sufferers to reduce rosacea flare-ups
once the rosacea is brought under control.

For those sufferers that do not benefit from the metronidazole based
treatments, there are many other options. Quite a few treatments options
are often discussed on the rosacea-support email group. Some of their
posts can be found under the `Treatments' tree on the list highlights page
see - http://rosacea.ii.net/toc.html

Experts agree that a gentle cleansing regime is very important. Avoiding
chemicals that aggravate the rosacea, but will clean and moisturise the
skin is a step in the right direction.

As the sun is a strong trigger for many rosacea sufferers, a good
non-irritating sunscreen used daily is very important. For those who react
badly to chemical sunscreens, a physical sunscreen may be more suitable.
Physical sunscreens rely on the reflective properties of the main
ingredients (rather than the ability of some chemicals to absorb the sun's
energy). The most common physical sunscreens are based on zinc oxide or
titatinium dioxide.

The vitamin A derivative isotretinoin (known as Accutane or Roaccutane),
has been shown to be effective against severe papopustular rosacea. It
works by inhibiting sebaceous gland function and physically shrinking the
glands. It also has potent anti-inflammatory properties, making it ideal
to treat resistant rosacea. At low doses, accutane has also been shown to
reduce other symptoms such as facial burning and redness. Accutance is a
strong drug, and even at the low doses found beneficial to rosacea, should
be used under strict supervision of your doctor.

Low does accutance may be more suitable than the regular dose, as there
are less side effects and lesser chance of aggravating redness.

The mixed light pulse laser - Photoderm is showing promise as a treatment
for the vascular component of rosacea. It works by targeting facial
microvessels that are damaged.

One treatment that has been shown to help some is Rosacea-LTD III. It is
the third generation of topical mineral salt based treatment. The minerals
shrink facial vessels as well as reduce papules and pustules. More
information is available at http://www.rosacea-ltd.com

For those wanting to treat the flushing side of their rosacea, 2 drugs are
worth investigating. Monoxidine and Clonodine are 2 anti-hypertensives
that you could look at with your doctor.

From a subjective view of the rosacea-support list members it would appear
that one person's treatment does not necessarily suit another, so your
mileage may vary with any recommended treatment. Experiment a little and
find what helps you. Depending on the stage of your rosacea, some
treatments may be aggravating, while for others the same treatment may not
cause problems. Every rosacea patient is unique and needs individual
treatment.

Whatever path you choose, the support of a doctor or dermatologist that is
willing to work with you will be very important, so shop around until you
are happy with your health professional.

Dr. Nase's book will serve as a valuable resource - it contains detailed
and proven current rosacea treatment information.

----------------------------------------------------------------------------

2.1 What about steroids ?

Steroids have long been prescribed for rosacea because of their perceived
quick relief. Milder (1% hydrocortisone) over the counter preparations are
also popular as they are thought to be safer than the prescription
strength treatment.

Sufferers should be aware of the following warnings:

"Topical steroids can worsen all rosacea symptoms by dilating facial blood
vessels, thinning the protective skin barrier, and thinning the dermis by
breaking down the collagen and elastin support structures".

"Medical experts stress that rosacea sufferers should not use topical
steroids (of any strength) to treat their symptoms".

These quotes are from Dr. Nase's book. They are backed up by several pages
of studies and comments. Topical steroids can induce rosacea and worsen
pre-existing rosacea. It must be avoided in patients with rosacea.

----------------------------------------------------------------------------

2.2 Can you be cured of Rosacea ?

Perhaps not cured in the sense of cured of a cold, but you can reduced
your symptoms to a manageable level. There are plenty of treatment options
out there, you may just need to experiment with a few.

If you want to feel encouraged that Rosacea really can be practically
cured, check out Geoffrey Nase's before and after photographs at
http://rosacea.ii.net/gnase.html

----------------------------------------------------------------------------

3. What information is available on the Internet about Rosacea ?

There are some pages that are worth visiting. You can find a list of
reviewed Internet resources relating to Rosacea as part of the Open
Directory at
http://dmoz.org/Health/Conditions_and_Diseases/Skin_Disorders/Rosacea/
There you will find sections on companies offering treatment products,
research results as well as medical texts on rosacea.

----------------------------------------------------------------------------

3.1 Are there any email mailing lists relating to Rosacea ?

Yes, see http://rosacea.ii.net/ml.html or
go straight to the email group hosting page at
http://groups.yahoo.com/group/rosacea-support/

Many interesting and useful discussions have taken place on the mailing
list since it was created in October 1998. There are 2 Doctors on the list
who have hugely contributed to the group and posted great articles. You
can see the list highlights categorised by treatment, symptoms and more at
http://rosacea.ii.net/toc.html

There is a Rosacea forum for those who use AOL as their internet company.
The address is aol://5863:126/mB:144806

Another place to try is http://www.esfbchannel.com/forum/ , the
Blushing/Flushing and Sweating forum. This forum deals more with issues of
hyperhidrosis, facial blushing and flushing as well as ETS issues.

----------------------------------------------------------------------------

3.2 Are there any Usenet Newsgroups relating to Rosacea ?

Not exclusively for Rosacea. Perhaps the best 2 to try are
alt.skincare.acne and alt.support.skin-diseases. You can read and post to
these forums using the Google Groups facility at http://groups.google.com

http://groups.google.com/groups?group=alt.support.skin-diseases
http://groups.google.com/groups?group=alt.skincare.acne

You could also try your local feed of these newsgroups if your browser is
configured: news:alt.support.skin-diseases news:alt.skincare.acne

----------------------------------------------------------------------------

3.3 Are there any Books about Rosacea I should read ?

There are very few books about Rosacea. In the last year of so there has
been a couple of `self help' books written about rosacea. You can find a
review of a couple of these at http://rosacea.ii.net/reviews.html

A recently published book by Dr. Geoffrey Nase is destined (we believe) to
become a seminal text on Rosacea. You can read a detailed discussion of
the contents of the book at http://www.drnase.com The book is titled
"Beating Rosacea, Vascular, Ocular and Acne Forms". It is only available
from his web site.

----------------------------------------------------------------------------

3.4 Is this Frequently Asked Question list on the Internet ?

Yes, you may find a more up to date listing if you check
http://rosacea.ii.net/faq.html

You can find the official html'ised archived version of this FAQ at
http://www.faqs.org/faqs/medicine/rosacea

Also, you can get this FAQ via email. The address of the faq server is
mail-server@rtfm.mit.edu

First, get the directory listing with the `index' command, and then fetch
the latest version of the FAQ with the `send' command. You should include
the commands in the _body_ of the message, the subject will be ignored.
All messages to the mail server should be on one line only, if your email
program inserts carriage returns because the line is too long, you may
find retrieving the FAQ difficult.

For example, to get version 1.12 of the FAQ you would send the following
texts in the body of 2 emails (first one to get directory and second, once
you know the filename you want).

index usenet-by-group/alt.support.skin-diseases

send
usenet-by-group/alt.support.skin-diseases/Rosacea_Frequently_Asked_Questions_v1.14

----------------------------------------------------------------------------

4. Are there any support groups related to Rosacea ?

You may want to check out The National Rosacea Society and the
rosacea-support email list.

The National Rosacea Society is a non profit organisation set up to
provide information about Rosacea. You can find them at
http://www.rosacea.org/home.html They publish newsletters online as well
as conduct surveys about rosacea sufferers. Also they make published
information available to sufferers via regular mail. The National Rosacea
Society are an introductory organisation that are a good first point of
contact for information. The depth and breadth of information that they
make available is something that we hope that they will be able to devote
some resources to.

There is an email support group that you can subscribe to. This email
group is free and unmoderated. Currently there are about 1800 users and
about 10-40 messages per day. Digest versions are available. To find out
more information about the list, visit http://rosacea.ii.net/ml.html or go
straight to the email hosting page at
http://groups.yahoo.com/group/rosacea-support/

An alternative list archive on the web is also located at
http://www.escribe.com/health/rosacea-support/ this site has a slightly
more traditional feel to it, you may prefer to read from this archive.

Rosacea Reading Glossary
----------------------------------------------------------------------------

As you read more about Rosacea, you might come across lots of terms that
are new to you. Below is a short list of some of the terms you might come
across.

accutane: a powerful vitman A derivate that was originally prescribed for
severe acne vulgaris. Has been used effectively for rosacea as well. Also
known as roaccutane.
for more info http://www.rocheusa.com/products/accutane/

blepharitis: inflamation and crusting of the eyelid.

cutaneous: pertaining to the skin.

demodex mites: (demodex folliculorum and demodex brevis): microscopic
mites that lives in the skin. Some have suggested that this is the cause
of rosacea, but most experts discount this theory. According to Dr Nase,
"This theory has now been disproved. Rosacea experts all agree that this
mite plays no real role in the development or progression of rosacea
(except for the odd pustule).", pg. 110 in Beating Rosacea.

chalazion: a lump on the eyelid that is caused by a clogged duct of one or
more of the meibomian glands on the eyelid.

conjunctivitis: inflammation of the conjunctiva (the thin transparent
lining in the front of the eyeballs and eyelids).

dry eye: a condition brought about by abnormal production in the quantity
or quality of tears.

edema: presence of abnormally large amounts of fluid in the intercellular
tissue spaces of the body, especially wrt subcutaneous tissues.

epifacial: another term referring to a full face treatment using
photoderm.

epilight: a treatment very similar to photoderm, originally intended for
hair removal. differs by using different filters to photoderm. For more
information see http://www.skinandhealth.com

erythema: inflammatory redness of the skin.

erythematotelangiectatic: having symptoms of both erythema and
telangiectasias

ESB: Endoscopic Sympathetic Block, clamps used to block the transmission
of the neural impulses in the sympathetic chain. Is considered a
reversible procedure. See http://privatix.magenta.net

ETS: Endoscopic Transthoracic Sympathectomy (or endoscopic transthoracic
sympathicotomy) a procedure where a surgeon excises the major sympathetic
nerves that supply the hands, neck and face. Main indications for ETS are
blushing and hyperhidrosis. One place for more information:
http://www.sweaty-palms.com/ets.htm

fotofacial: a treatment regime using photoderm pioneered by Dr. Patrick
Bitter Jnr., for more information, see http://www.fotofacial.com

Helicobacter pylori: bacteria that live in the cell lining of the stomach.
According to Dr. Nase, "Most rosacea specialists now conclude that H.
Pylori only play a small role in a minor number of rosacea patients." pg.
109 in "Beating Rosacea".

hypertrophy: the enlargement or overgrowth of an organ or part due to an
increase in size of its constituent cells.

hyperemia: abnormally increased blood flow

IPL: Intense Pulse Light, a description of the technology used in the
family of machines made by ESC. For more information, see
http://www.skinandhealth.com

isotretinoin: the a vitamin-A derivative that is the active ingredient in
accutane (also known as roaccutane).

keratitis: infection or inflammation of the cornea of the eye.

ketoconozole: the active antifungal ingredient in nizoral, helpful for
seborrheic dermatitis and dandruff.

lupus: an auto-immune disease that causes inflammation in various parts of
the body such as the skin, joints and kidneys. Skin flushing is an
important symptom of lupus.

metrogel: a 0.75% metranidazole treatment. For more information
http://www.metrogel.com/aboutmetrogel/index.html

metronidazole: a topical treatment for rosacea. Has been found by some to
effective against rosacea. Has a yet to be understood anti-inflammatory
action. Is the active ingredient in metrogel, metrocream, metrolotion,
rozex and noritate.

meibomitis: inflammation of the oil producing meibomian glands of the
eye.

Multilight: a member of the Intense Pulsed Light family, along with the
photoderm machine. For more information see http://www.skinandhealth.com
Can also be used for hair removal.

noritate: a 1% metronidazole treatment. for more info
http://www.dermik.com/prod/noritate/Noritate.jsp

ocular: of the eye.

papulopustular: having symptoms of both papules and pustules.

papule: a small, solid, elevated skin lesion, less than 0.5cm in diameter.

perioral dermatitis: perioral refers to the area around the mouth, and
dermatitis indicates redness of the skin. In addition to redness, there
are usually small red bumps or even pus bumps and mild peeling.

photoderm: an intense light source, fired at the facial skin to reduce
flushing associated with rosacea. a new treatment for rosacea that
is producing some exciting results. For more information see
http://www.skinandhealth.com

photofacial: a treatment regime using photoderm, pioneered by Dr. Patrick
Bitter Snr., for more information, see http://www.photofacial.com

photorejuvenation: a broad term used describe Intense Pulsed Light
treatments. photorejuvenation treatments are aimed at stimulating
collagen formulation.

phymatous: having symptoms of abnormal growth, as found in rhinophyma.

pustule: a vesicle filled with cloudy fluid, such as pus, often associated
with a hair follicle but can exist independently.

Quantam SR: a member of the Intense Pulsed Light family, along with the
photoderm machine. For more information see http://www.skinandhealth.com

rhinophyma: abnormal growth of the soft tissue of nose, caused by sebaceous
gland hypertrophy and hyperplasia (increased growth and number of
sebaceous glands).

roaccutane: a powerful vitman A derivate that was originally prescribed for
severe acne vulgaris. Has been used effectively for rosacea as well. Also
known as accutane. for more info
http://www.roaccutane.com.au

rosacea fulminans: a rare form of rosacea that appears very quickly.

rozex: 0.75% metronidazole based treatment also known as metrogel. for
more info http://www.medsafe.govt.nz/consumers/cmi/r/rozexgel.htm

rosacea-ltd: a non-prescription topical treatment for rosacea, see
http://www.rosacea-ltd.com

seborrheic dermatitis: an inflamatory skin condition, associated with
itchy flaking skin.

sebaceous gland: a gland often associated with a hair follicle, that
produces sebum.

stye: inflammation of an eyelash follicle on the edge of the eyelid.

subcutaneous: under the skin.

telangiectasias: damaged micro blood vessels, often visible on the surface
of the skin.

tetracycline: an antibiotic often prescribed for rosacea.

V-beam: the fifth generation (hence roman 5=V) of the pulse dye laser. for
more information, see http://www.vbeamlaser.com

vascular: of the blood vessels.

vasculight: a IPL+laser machine that can be used to give mixed wavelength
and fixed wavelength treatments. Can target large and deep blood vessels.
For more information see http://www.skinandhealth.com

versapulse: a type of laser, for more information, see
http://www.coherentinc.com

" vim:tw=74:et

--
David Pascoe, pascoedj+usenet@spamcop.net, Western Australia
-------------------------------------------------------------------------------
Rosacea Frequently Asked Questions v1.16
Archive-name: medicine/rosacea
Posting-Frequency: monthly
Last-modified: 2004/05/31
Version: 1.16
URL: http://rosacea.ii.net/faq.html
Maintainer: David Pascoe

CVS Version: $Id: faq.txt,v 1.16 2004/05/31 12:47:40 user Exp $

----------------------------------------------------------------------------
Disclaimer: the following information is a guide only. Self diagnosis is a
dangerous pastime without all of the information. This Frequently Asked
Questions is a simple guide to rosacea, and a pointer to more information.
This text should not be used in the place of professional advice from
registered practitioners.
----------------------------------------------------------------------------

1. What is Rosacea ?

Rosacea (said rose-ay-shah) is a potentially progressive neurovascular
disorder that generally affects the facial skin and eyes.

The most common symptoms include facial redness and inflammation across
the flushing zone - usually the nose, cheeks, chin and forehead ; visibly
dilated blood vessels, facial swelling and burning sensations, and
inflammatory papules and pustules.

Rosacea can develop gradually as mild episodes of facial blushing or
flushing which, over time, may lead to a permanently red face.

Ocular rosacea can affect both the eye surface and eyelid. Symptoms can
include redness, dry eyes, foreign body sensations, sensitivity of
the eye surface, burning sensations and eyelid symptoms such as chalazia,
styes, redness, crusting and loss of eyelashes.

A panel of experts have agreed on a standard classification system for
Rosacea. This system is a brief text that is not intended to be
exhaustive, but is a place to start.

Their classification system was published in the Journal of American
Academy of Dermatology (United States), Apr 2002, 46(4) p584-7)

"Rosacea is a chronic cutaneous disorder, primarily of the central face.
It is often characterized by remission and exacerbation and it encompasses
various combinations of such cutaneous signs as flush, erythema,
telangiectasias, edema, papules, pustules, ocular lesions, and rhinophyma.
Primary features considered as necessary for diagnosis include flushing,
erythema, papules, pustules, and telangiectasias. A variety of secondary
features are listed that may be absent or present as a single finding or
in any combination."

----------------------------------------------------------------------------

1.1 Are there different types of Rosacea ?

The panel of Rosacea experts agreed on the following broad, non exclusive
text (i.e. there are other factors and types that come into play).

"The system divides rosacea into four subtypes: erythematotelangiectatic,
papulopustular, phymatous, and ocular. As presently worded, papulopustular
rosacea is noted as often being observed following or with
erythematotelangiectatic disease and phymatous rosacea as following or
occurring together with either erythematotelangiectatic or papulopustular
rosacea. However, Dr. Wilkin emphasized that while those descriptions are
consistent with common concepts about rosacea natural history, they are
provisional and subject to change."

"In its current iteration, the classification system excludes rosacea
fulminans, steroid-induced acneiform eruptions, and perioral dermatitis
without rosacea signs from the diagnosis of rosacea."

----------------------------------------------------------------------------

1.2 How is Rosacea different to Acne Vulgaris ?

As rosacea is a neurovascular disorder it affects the flushing zone.

Is is common that Rosacea does not present with blackheads that are
seen with Acne Vulgaris. Also the age of onset, and the location of
redness is a clue. Rosacea is commonly an adult disease, and is generally
restricted to the nose, cheeks, chin and forehead. It can coexist with
acne vulgaris.

Some rosacea sufferers have a significant acne component in their symptoms
so it can be easily confused with acne vulgaris. The papules and pustules
of rosacea tend to be less follicular in origin.

Rosacea will probably have an underlying redness that is related to
flushing and thus looks different to acne vulgaris. Acne sufferers
normally do not have the accompanying redness.

Rosacea usually begins with flushing, leading to persistent redness.

As both conditions are inflammatory, the treatment for rosacea and acne
vulgaris can be somewhat similar, but some of the acne vulgaris regimes
are too harsh for rosacea affected skin and can severely aggravate the
condition.

Rosacea sufferers are cautioned against using common acne treatments such
as alpha hydroxy acids (glycolic and lactic acids), topical retinoids
(such as tretinoin, Retin-A Micro, Avita, Differin), benzoyl peroxide,
topical azelaic acid, triclosan, acne peels, chemical peels. Additionally
the caution extends to topical exfoliants, toners, astringents and alcohol
containing products.

----------------------------------------------------------------------------

1.3 What is the difference between Rosacea and Seborrheic Dermatitis ?

Seborrheic Dermatitis and Rosacea are closely related, they b