Where You Live May Affect Ocular Rosacea

The not-for-profit National Women's Health Resource Center (NWHRC) today released a list of America's 100 DRY EYE HOT SPOTS, those cities with environmental conditions most likely to contribute to dry eye, a condition which can progress and if left untreated can lead to increased risk of infection and impaired vision.

The rankings are based on an analysis of data archived by the National Oceanic and Atmospheric Administration's Climatic Data Center and the Environmental Protection Agency that considered six factors including temperature, humidity, wind, altitude, pollutants and ocular allergens.

Las Vegas tops the list, followed by four Texas cities. Other large metropolitan cities on the list include New York, Los Angeles, Washington, DC, San Francisco, Chicago, Atlanta, Philadelphia and Miami.

"Even if you live in one of the worst cities for dry eye, you don't have to live with dry eye," said Marguerite McDonald, MD, FACS, clinical professor of ophthalmology at Tulane University Hospital & Clinic. "Anyone using eye drops several times a day should see an eye care professional who can properly diagnose chronic dry eye and may recommend adding a treatment, such as a prescription eye drop that targets the underlying cause of dry eye."

Chronic dry eye occurs when changes to the health of the tear-producing glands affect the quantity and quality of tears produced. The tear film can no longer provide enough nourishment or protection to the surface of the eye, explained Dr. McDonald. Dry eye can be a progressive disease and, if left untreated, chronic dry eye can lead to more serious problems.

Dry eye is one of the most common complaints brought to eye doctors, accounting for nearly one fourth of all office visits. Nearly 40 percent of Americans suffer from dry eye symptoms, which may include itching, irritation, light sensitivity, blurred vision, dryness and foreign body sensation. Those suffering from dry eye may have trouble with reading, professional work, driving at night and using a computer.

In addition to environmental factors, such as those found in the cities on the DRY EYE HOT SPOTS rankings, certain medical factors also can aggravate dry eye, including hormonal changes due to aging and menopause, thyroid problems, vitamin deficiencies, rheumatoid arthritis, diabetes, lupus, rosacea, sarcoidosis and Sjogren's syndrome.

"Women are twice as likely as men to suffer dry eye(11) because of hormonal factors and related autoimmune disorders that disproportionately affect women," said Elizabeth Battaglino Cahill, RN, executive director of the National Women's Health Resource Center (NWHRC). "It is a growing public health issue that people need to know more about."

To help raise awareness, Sen. Mark Dayton of Minnesota is working to formally designate July as Dry Eye Awareness Month in Congress. Together with the NWHRC and the Sjogren's Syndrome Foundation, a non-profit organization dedicated to educating the public about the autoimmune disease that affects moisture producing glands, Sen. Dayton has declared July as Dry Eye Awareness Month in the Congressional Record.

As part of the effort to educate about dry eye, the NWHRC has posted on http://www.healthywomen.org the rankings of HOT SPOTS cities and a Dry Eye Quiz that people can take to their doctor to help determine whether they have chronic dry eye. Visitors to the Web site also will find information on symptoms, causes, diagnosis, long-term effects and treatment options.

Organizations involved in helping raise public awareness for dry eye include the American Academy of Ophthalmology, American College of Rheumatology, American Optometric Association, Cornea Society, Foundation for Sarcoidosis Research, Lupus Foundation of America, National Association of Nurse Practitioners in Women's Health, National Rosacea Society, Rosacea Research & Development Institute and Sjogren's Syndrome Foundation.

Choosing And Using Sunscreens Properly

The July issue of Mayo Clinic Women's HealthSource offers the following tips to select the right sunscreen:
Look for one that offers:
* Broad-spectrum protection. Find one that protects against ultraviolet A (UVA) and ultraviolet B (UVB) sun rays. Both can damage the skin.
* SPF of 15 or higher. A sun protection factor (SPF) of 15 deflects allows you to remain in the sun 15 times longer than you normally would before getting burned. Higher SPFs can protect you for longer periods but reapplication is still recommended. In theory, if you burn with no protection in 10 minutes, with SPF 15, you could be protected for up to 150 minutes.
* Water-resistant or waterproof qualities. This is especially important if you'll be swimming or perspiring heavily. Water-resistant sunscreen protects for 40 minutes; waterproof sunscreen for up to 80 minutes.
* Skin-appropriate form. If your skin is dry, choose a cream or lotion sunscreen to increase moisture. For oily skin, choose an oil-free sunscreen. If you have sensitive skin, look for a sunscreen that contains only zinc oxide or titanium dioxide. These ingredients provide a physical barrier against UV rays rather than chemically absorbing them, which may be gentler on your skin. Avoid alcohol-based sunscreen if you have rosacea or eczema.
* Early and often. Remember, no matter what sunscreen you choose, the average adult requires 1 ounce of sunscreen - 2 tablespoons' worth - for full body coverage. Apply 15 to 30 minutes before sun exposure and reapply every one to two hours while outdoors.

The Facial Redness Picture

According to the American Academy of Dermatology, you can actually have more than one skin condition at a time! Many other skin conditions can occur at the same time as rosacea or have symptoms similar to rosacea. In some cases, treatment of one skin condition can lead to another skin condition.

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent, but can also affect adults in their 20s, 30s and 40s. While there is no permanent cure for acne, it is controllable. Often the harsher treatments used in the treatment of acne such as accutane, retinoids, Azelaic acid, and benzoyl peroxide can aggravate the sensitive facial skin leading to the occurrence of rosacea. Rosacea can occur with acne or become the result of the treatment of acne.

Psoriasis causes the skin to become inflamed, while producing red, thickened areas with silvery scales. This persistent skin disease occurs most often on the scalp, elbows, knees, and lower back. In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Psoriasis, frequently treated with topical steroids will cause thinning of the skin and blood vessels causing the tell-tale blush or flush of rosacea.

Eczema is an all inclusive term used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened, and itching skin conditions. Eczema is often treated with steroids leading to a steroid-induced rosacea condition.

Seborrheic dermatitis involves overactive sebaceous glands which cause inflammation, flaking and a red rash in the central portion of the face. If one looks closely, the flakes usually have a greasy look, smell and feel. The dryness of seborrheic dermatitis is perceived because of the flaking which consists of dried layers of accumulated oil. Seborrheic dermatitis causes yellowish scales to develop on the scalp, the hairline and the eyebrows; which is often confused with the crusting and scaling on the eyelids that occur with ocular rosacea. Topical steroids used in the treatment of dermatitis can create steroid induced rosacea. This condition typically worsens when the steroid is stopped. In an unfortunate cycle the steroid may be reapplied to diminish the redness which only worsens the condition.

Discoid (cutaneous) lupus is always limited to the skin and is identified by a rash that may appear on the face, neck and scalp. Discoid lupus accounts for approximately 10% of all cases. Skin rashes occur in approximately 74% of all lupus cases. Photosensitivity occurs in approximately 30% of lupus sufferers. 42% of lupus cases are distinguished by a butterfly-shaped rash across the cheeks and nose.

Urushiol, found in the sap of Poison Ivy, Poison Oak and Poison Sumac causes a reaction in the form of a line or streak of rash (sometimes resembling insect bites) within 12-48 hours. Redness and swelling will be followed by blisters and severe itching which can in some cases resemble rosacea. In a few days, the blisters become crusted and begin to scale. The rash will usually take about ten days to heal, sometimes leaving small spots.

Insect Bites and Stings can produce local inflammatory reactions that may vary in appearance. Acute reactions may appear as hives; more chronic reactions may appear as inflammatory papule (circumscribed, solid elevations on the skin) or may be characterized by a blister or blisters.

Molecular Receptors Play A Role In The Rosacea Redness Picture

New research funded by the National Rosacea Society has found that certain molecular receptors and their activators may play a significant role in producing the redness, visible blood vessels and inflammation of rosacea.

A receptor is a structure in human cells that binds with particular activating substances in the body to trigger certain reactions or responses. Dysfunction of receptors often leads to disease. Accordingly, identification of the mechanisms of these processes, which may then be adjusted, often leads to important therapeutic advances.

Dr. Martin Steinhoff and Dr. Thomas Luger, of the department of dermatology at the University of Muenster in Germany, examined how proteinase-activated receptor 2 (PAR-2) may affect endothelial cell function in rosacea skin. PAR-2 can serve as a receptor for several molecules, including dust mite antigens and bacterial proteases, which have a high impact on inflammatory response in the skin.

In scientific terms, PAR-2 agonists were found to cause erythema and vasodilation in human skin in in vivo studies, indicating a functional role for PAR-2 in human cutaneous blood vessel formation. Dr. Steinhoff and Dr. Luger also demonstrated that PAR-2 plays an important role in leukocyte adhesion to endothelial cells in the skin of mice. Moreover, in studying the effects of PAR-2 agonists on keratinocyte function, it was found that PAR-2 activates NFkB in humans, indicating a potential important role of this receptor in skin inflammation