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Thread: Rosacea interview with Dr. Kligman

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    Default Rosacea interview with Dr. Kligman

    Here is an article I ran across today where Dr. Kligman discusses rosacea. I thought it was interesting, since Dr. Kligman is a very well-respected derm.

    http://www.dermatologytimes.com/derm....jsp?id=119838

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    Senior Member Kelli's Avatar
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    Unfortunately, it didn't tell me a whole lot, other than to keep on the good 'ol topical/oral treatment.

    Oh boy... another round of the crap.
    *Avoiding triggers is like trying to dodge raindrops in a monsoon.*

    My Blog - http://rosaceablog.moonfruit.com/

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    Articlobo,

    Thanks for pointing us to that Derm Times article from Dr. Kligman. I'm pleased to see that he certainly seems to "get it" that we need new approaches and more research into rosacea. If he's 88, or perhaps 89 by now, we better get him on here quick while he can still help us.

    Tamara


    See below for some quotes from the Dr. Kligman article:

    It appears the answer to that question is not a simple one because rather than having a single cause, rosacea probably develops as a result of multiple interacting factors, some of which include genetic determination and perhaps the presence of demodectic mites in some individuals. The pathogenesis of rosacea is a subject that has been debated and disagreed on for many years, and I consider it a real scandal that our knowledge remains so poor. Consider that rosacea and acne vulgaris are related disorders, and while we have a good understanding about the causes of acne and how to treat it, we remain as ignorant today about rosacea as we were about acne 50 years ago...

    ...Otherwise, more basic research is needed to elucidate the pathogenesis of rosacea because only with that information will we be able to identify targeted therapies. We can continue to pick at the problem with recommendations about avoiding triggers and our current empirical approaches to drug treatment. However, we need to support some serious basic research because that will provide a foundation for developing rational therapy.

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    Quote Originally Posted by Tamara
    Tamara


    See below for some quotes from the Dr. Kligman article:

    It appears the answer to that question is not a simple one because rather than having a single cause, rosacea probably develops as a result of multiple interacting factors, some of which include genetic determination and perhaps the presence of demodectic mites in some individuals. The pathogenesis of rosacea is a subject that has been debated and disagreed on for many years, and I consider it a real scandal that our knowledge remains so poor. Consider that rosacea and acne vulgaris are related disorders, and while we have a good understanding about the causes of acne and how to treat it, we remain as ignorant today about rosacea as we were about acne 50 years ago...

    ...Otherwise, more basic research is needed to elucidate the pathogenesis of rosacea because only with that information will we be able to identify targeted therapies. We can continue to pick at the problem with recommendations about avoiding triggers and our current empirical approaches to drug treatment. However, we need to support some serious basic research because that will provide a foundation for developing rational therapy.
    That was the part I found most interesting. It seems Dr. Kligman has come to the conclusion that standard treatments really aren't that effective at getting to the true heart of rosacea, and perhaps he can push the dermatological community for more active research in the area.

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    Senior Member Kelli's Avatar
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    Q Are there situations where you would prescribe monotherapy instead of combination treatment?

    Probably 95 percent of the time, I initiate treatment with the combination of an oral antibiotic and a topical agent. I might consider topical metronidazole treatment as monotherapy for a patient presenting with very early, mild rosacea. In general, however, medical management of rosacea should be multimodal. Rosacea is a serious disease with potentially significant psychosocial consequences, and there are many patients who are finally receiving treatment after suffering for 20 years without a diagnosis.
    This is why I responded the way I did. I read the article to basically be him saying one thing (What you quoted) but then saying the exact opposite - by saying 95% of the time he does what we know doesn't work most of the time.

    Sorry if I sounded harsh, but it sounded like what we keep hearing from Dr.s. Like mine, who told me last time to "humor her" and do metrogel and minocycline so she could see what it does.
    *Avoiding triggers is like trying to dodge raindrops in a monsoon.*

    My Blog - http://rosaceablog.moonfruit.com/

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    Kelli,

    First, let me say that I always appreciate your posts. I hope you don't mind if I'm a little more hopeful? If need be, can we agree to disagree?

    I was hoping that he's just been feeling as frustrated as we have, with the treatment options that have been available. It sounds like he's hungry for new ideas and progress. Let's try to win him over and get him to work on our behalf. It sounds like he must have influence in the medical community. Let's help him use that to work for us. We want it, he wants it, we could all win, but lets get moving! We want progress now, because our lives cry out for it, and how many more years does he have to be our cheerleader?

    Would people with awesome laser/IPL results be willing to put together something that would win him, and other doctors, over to the successes of IPL/laser treatment? That's something we could use help on right away, because we need insurance companies to be willing to pay for those treatments that we so desperately need. He could be another champion for us in the medical community--if we could help him understand how he could help us help ourselves.

    Let's get him on FIRST, NEXT WEEK and be VERY nice and gracious to him!

    Tamara

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    Senior Member Kelli's Avatar
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    I have no problems with agreeing to disagree. I also don't have a problem with Dr. Kligman being part of the rosacea Q&A that Dr. Nase and Warren are putting together.

    My problem is that I read that he "wants" to do something, but he's not trying anything different.

    Yes, I'm jaded. I think we all are. I was diagnosed at the age of eleven. I have the permanent emotional scars that go with it. (Getting sung the Clearasil commercial in a crowded hallway in 6th grade is not one of my high points of my life.) So, when I see that there could be progress, but then I read that one of the main people isn't pushing as hard as I'd like to think he could, it's rather discouraging.

    I sincerely hope I'm wrong.

    We'll have to see about the IPL thing. $1500 later and I'm still waiting on my results. I have 5th and final treatment tomorrow.
    *Avoiding triggers is like trying to dodge raindrops in a monsoon.*

    My Blog - http://rosaceablog.moonfruit.com/

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    Hi Kelli,

    I'm sorry to hear you got rosacea so young; it sounds awful. Kids can be rude. Sometimes adults are too. I guess I'm lucky that mine didn't arrive until I was a "middle-aged white woman". I guess I should count my blessings, when all I do is grumble about the agonies of having rosacea.

    I'd like to think he doesn't know what to do and Dr. Nase is about to teach him.

    Are you doing the pretreatment flush with your IPL and the double/triple passes etc.? Gawd, I hope it works for you! We're rooting for you.

    Tamara

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    Honestly, I think the only way that we will get successful treatments is for pharmaceautical companies to start an extensive marketing campaign much like the recent onslaught of depression and ADD commercials. I am really surprised since there is so much $$ to be made off of us sufferers. This is a relatively common skin disorder with great marketing possibilies. Whenever I go on pubmed.org or dermatology times I get so frustrated because a majority of these medications only count reduction in papules/pustules and not the psychological aspect of treatment. I release that these drug studies need to have a control(only one thing being tested at a time), but sadly there is hardly any studies on blushing, flushing, or depression related to rosacea. I try to be optimistic, but I get discouraged at statements like this from the Klingman article,

    "Q Do you foresee any new developments in treatment occurring over the next five to 10 years?

    We have begun to do some research on the use of topical retinoids, and I think as we collect more information, they will emerge as a first order treatment. There is a good rationale for using topical retinoids recognizing that patients with rosacea have severely photodamaged skin even at the time of disease onset. Therefore, I think topical retinoids are indicated and effective because of their benefits for restoring the dermal matrix."

    Please, please, please, I hope he is not talking about retin-A, maybe Retinaldehyde which is a precursor to retinoic acid. It is a much gentler than retin A and may thicken the epidermis. Still, he is probably more open to this disorder than my parents, lol.

    Ray
    23 yo male
    Sub-type 2: Papulopustular rosacea
    4 v-beam and 2 smoothbeam treatments last Summer through Winter of 2004-05

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    Senior Member irishgenes's Avatar
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    Oh, I hope he isn't talking about Retin-A, too. I "fought through" Retin-A for acne 20 years ago (didn't know I had rosacea back then) and didn't leave the house for 3 months because my skin looked so much worse during treatment. I kept hearing that it was going to "cure" me, but I got scars instead. How can he call topical retinoids a "new development"?!!! And I have never been a sun-worshipper. My face does not have severely photodamaged skin.

    I think this is a case of the doctor NOT LISTENING to his rosacea patients. Doctors talking among themselves have remained ignorant about rosacea for 50 years, when all they have to do is ASK US! No, we are not researchers, but you first have to understand the problem in order to do the research. For example, counting decreases in papules from visit to visit as a way of knowing if the treatment is working shows a lack of basic understanding of the disease. I can be horribly broken out within hours after a doctor visit. Then I can be clear again within 2 days. It is totally unpredictable. The flushing has to stop for the disease to stop, and topicals currently available are never going to stop the flushing.

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