Re: Tripwires in terminology - more

[Guest guest]

Dr. Lazoff,

I am assuming you are talking to me with the Subject, 'Tripwires in

Terminology " and addressing this comment to 'Barry' but I could be

confusing myself with someone else, so forgive me if I am wrong. Having

a copy of the email you are responding to at the bottom will help

clarify this somewhat, if 'Barry' is Brady.

Your discourse just makes my head spin since I really do not understand

the pathophysiology of rosacea unless you explain it better but I am

trying to grasp the discussion. Pathos is Greek for disease

or suffering and physiology is the functions, collectively, of an

organisim or its parts, or the branch of biology concerned with the

functions of living organisms. My dictionary does not list this word

and I do not have a medical dictionary. I am guessing from your

discussion function is the key word here?

I agree with you that a flush is not a flare and 'a flare is a

relatively quick-appearing exacerbation of rosacea.' And I think

we are on the same page with what flushing is.

I think I see what you are driving at, that the trigger is related

more to the effect even though it implies the cause MAY have something

to do with it.

Your statement and question, " I can't think of any trigger that doesn't

cause either a flush, or a skin sensitivity, or a trigger that can cause

both in a single person at a single time. Can anyone? " is probably

correct, but I fail to understand what you are pointing out.

As to food, the mechanism Dr. Nase is postulating with regard to

sugar is found on page 101 of his book, Beating cea – Vascular,

Ocular & Acne Forms, which says:

“Eating large amounts of simple sugars (i.e., chocolates, syrups and

food stuffs that contain large concentrations of fructose, sucrose, and

maltose) can cause glucose levels in the blood stream to rise quickly

and trigger skin flushing.”

It may be just one of the " factors that may cause a rosacea sufferer to

experience a flare-up " but may explain the mechanism and I can't come

up with a better mechanism than Dr. Nase describes here.

You are really on a roll with this tripwires in terminology. I appreciate

your insight into the complexity of triggers.

Brady Barrows

Message: 12

Date: Mon, 17 Jun 2002 19:41:08 -0000

Subject: Re: Tripwires in terminology

Barry, I know you brought up your definitions for a different reason,

but with your permission I'm grabbing them to use in furthering my

discourse on flares and triggers. <g>

Instead of flare you say a trigger and tripwire causes " a reaction " ,

which to me emphasizes the end product rather than what causes it,

whether identificable at the time or not. But if we aren't better

defining the reaction, and we aren't better defining the stimulus,

then isn't what we're talking about too general to be helpful? That's

where I started with all this -- it's so diffuse when we don't

distinguish among triggers and tripwires and flushes and skin

sensitivities and flares.

Here's the problem I see with saying a trigger necessarily causes a

rosacea flare -- it forces us to define *all* flushing and skin

sensitivities with identificable causes as rosacean flares, instead

of acknowledging all the simple flushes and itchings experienced by

rosaceans and non-rosaceans. Further, what do we say when a person

requires a number of triggers in unison or close proximity to elicit

a response -- flushing only when alcohol is imbibed in a hot dance

club or in front of a roaring fire or BBQ, for example.

It seems to me that there's an ill-defined, indirect link between

triggers and flares, not Deryk's straightforward metaphoric gun shot.

One definition of a trigger is whatever cause flushing or skin

sensitivity in rosaceans. Alone or in concert with other factors,

triggers might -- or might not -- be capable of exacerbating an

underlying rosacea. That focuses on the cause, and leaves the result

as a superficial description without relating it to any underlying

condition or stage.

Besides, to me, a flush is not a flare, it's a flush, even in a

person whose rosacea manifests solely as flushing. Admittedly, in

such individuals it's hard to distinguish a flush from a flare; it

may be only possible in retrospect.

The point is this: a flush or skin sensitivity from any cause --

regardless of the trigger -- might initiate or exacerbate the

pathophysiological process that results in however that person

manifests rosacea. Understanding rosacea to me is linked to the

pathophysiologic process.

Alternatively, if we concentrate on the effect, a trigger can be

defined as anything that has been found to temporarily initiate or

continually exacerbate the rosacean pathophysiology, however that

manifests on the skin -- even if it doesn't manifest as anything!

This incorporates your definition of tripwire -- a skin reaction that

may not have an identifiable cause -- and also includes a cause

without an identifiable reaction at the time. An example of the

latter: chronic sun exposure seems to advance rosacean

pathophysiology, even if a single sun exposure does not cause an

obvious change in the skin. We can still call the sun a trigger, and

talk about avoiding significant sun exposure, even if the skin

doesn't cause any triggered response -- not a flush, skin

sensitivity, or flare.

So to me, a flare is much different than either of the above

definitions of trigger suggests. To me, a flare is is a relatively

quick-appearing exacerbation of rosacea; a flare has to be obvious

AND it has involve the pathophysiology of rosacea, it can't just be a

process that dilates blood vessles or releases cytokines, both of

which are normal process. This is also distinct from more slowly

developing destablizations that may be part of the normal course of

the condition (beit ongoing chronic inflammation or vascular

instability or whatever causes the condition itself to, or reactions

to chronic physical stressor).

Incidently, I can't think of any trigger that doesn't cause either a

flush, or a skin sensitivity, or a trigger that can cause both in a

single person at a single time. Can anyone?

Regarding foods: there are foods that can cause a histamine-induced

flush (in rosaceans and non-rosaceans), and there are foods that can

cause an allergic dermatitis or other skin-related intolerance

(again, in rosaceans and non-rosaceans). I don't understand either as

rosacean flares. By what mechanism are you postulating that a food

can cause a rosacean flare?

Marjorie

Marjorie Lazoff, MD