Reactions to ingredients (Was Re: Giving Gold Bond a try..)

April 30, 2002

> cea induces cytokine production, anything which

> causes a flare does, in fact, and cytokines significantly influence

> comedone formation. Cunliff goes over cytokine induced comedones

> in his book. This has been deomonstrated via cultured ducts in

> vitro experimentally. It appears that rosacea and acne are more

> closely linked that realized.

I wouldn't think the relationship is closer than we think, 007.

Cytokines play a role in all inflammation. As I understand it, in

rosacea the inflammation causes acne, perhaps as Cunliff describes,

but in vulgaris the abnormal keratinization lining the pores sets the

stage for comedone formation and inflammation, through a number of

mechanisms.

> In the case of one type of pustule, a rosacea mediated pustule

> caused by immune system reaction, and an acne related pustule (like

> a rosacea mediated pustule with the addition of p. acne

> involvement), it would make sense to use either full dose zithromax

> or minocyline because they work for either type of pustular

> etiology. Whereas,

> tetracyline, doxycycline, clindamycin, and erythromycin, generally

> are ineffective for acne pustules due to high p. acne resistance.

But why start off treating for two conditions when the patient only

has one condition? It's one thing if someone doesn't respond as

expected, but most rosaceans do fine with first-line antibiotics. And

why be overconcerned about P. acne in rosacea, when at best it's a

concern in only a minority of rosaceans? I think the goal is to

isolate that subset of rosaceans where bacteria contributes to a

pathogenic process, if that's true -- not to assume that even if it's

relevant for a group of rosaceans then it's relevant for everyone.

> Additionally, isn't it ironic that retin a cream vehicle is

> comedogenic?

I don't know. Not really. Sorry 007, it may be my ignorance but I'm

not convinced.

When the new Austin Powers film comes out, are you going to change

your moniker from 007 to Goldmember?

Marjorie

Marjorie Lazoff, MD

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