Follow up on Dermatology Times Article -- More indepth

[drnase]

For my Dermatology Times article I interviewed Dr. Theobald, the Chief Medical Officer at Collagenex (they make Periostat and Oracea).

They have found ways to take oral antibiotics and chemically modify them. With Periostat and Oracea, they had to stay to low doses. But with newer generation antibiotics they can remove the antibacterial actions and enhance the anti-inflammatory actions at high doses.

What they are finding in pre-clinical and clinical studies on skin cancer and inflammatory skin disorders is that the anti-inflammatory actions are now enhanced enough to normalize vascular dilation (which feeds skin cancer and our disorders) and skin inflammation. More specifically, in these disorders, nitric oxide (inducible) is greatly elevated, VEGF is greatly elevated, inflammatory cytokines are greatly elevated and neutrophils are found in the skin in outlandish numbers.

These new chemically modified anti-inflammatory antibiotics normalize nitric oxide which greatly reduces blood flow. It blocks VEGF production considerably (but not totally) which attenuates new blood vessel growth, normalizes cell adhesion molecules which helps stop the vicious inflammatory cycle, and stops the penetration of neutrophils through the blood vessel walls and chemotaxis up to the epidermis (e.g. blocks papule formation).

I could not gather much else, but it seems as if they are doing this with several classes of antibiotics and seeing which ones have the greatest effect and least side efffects. The only side effect noticed was increased sun sensitivity when not wearing sunblock, so I hope they figure that one out.

[Tricia]

Dr. Nase, I really appreciate all the information on the new stuff coming out. I think it goes without saying how inspiring and hopeful those messages are.

Do you think these are things that dermatologists are going to become aware of and reccomend for rosacea tx as they become available? Or do you think we are still going to have to claw and plead for prescriptions because they at first will be for other diseases?

There is still so much difficulty for folks getting Accutane or even Biaxin which have both been around for awhile that I can only imagine the looks we'll get when we ask for the latest Nitric Oxide inhibitor.

Course I'm certainly used to strange looks from doctors, but I'm just curious if you think derms are being better educated about rosacea.

Tricia

[IowaDavid]

Course I'm certainly used to strange looks from doctors, but I'm just curious if you think derms are being better educated about rosacea.

Probably not...and this sounds very on the fringe of research regarding inflammatory skin disorders. Nice to know something might be coming down the line, though.

Would this mean, given this next generation of macrolides comes to market in the next couple of years, we wouldn't have to worry about killing GI bacteria? Is this, in a sense, making these not antibiotics, but anti-inflammatories that act on the skin?

Thanks,

David

[drnase]

Dr. Nase, I really appreciate all the information on the new stuff coming out. I think it goes without saying how inspiring and hopeful those messages are.

Do you think these are things that dermatologists are going to become aware of and reccomend for rosacea tx as they become available? Or do you think we are still going to have to claw and plead for prescriptions because they at first will be for other diseases?

There is still so much difficulty for folks getting Accutane or even Biaxin which have both been around for awhile that I can only imagine the looks we'll get when we ask for the latest Nitric Oxide inhibitor.

Course I'm certainly used to strange looks from doctors, but I'm just curious if you think derms are being better educated about rosacea.

Tricia

Tricia,

We are going to be clawing all the way. I dont know how else to put it. The most respected dermatolgist I know at IU and a close friend did not know what Noritate was 7 months after it was on the market. I love the guy, but they are overwhelmed and rosacea is a backseat disorder.

Sorry. Truth time. They are becoming much more receptive to information being brought in and read. So theres something.

[drnase]

Course I'm certainly used to strange looks from doctors, but I'm just curious if you think derms are being better educated about rosacea.

Probably not...and this sounds very on the fringe of research regarding inflammatory skin disorders. Nice to know something might be coming down the line, though.

Would this mean, given this next generation of macrolides comes to market in the next couple of years, we wouldn't have to worry about killing GI bacteria? Is this, in a sense, making these not antibiotics, but anti-inflammatories that act on the skin?

Thanks,

David

Hi David,

Yes, fringe of skin disorders, but well into trials on skin cancer. So, off label will be here much sooner.

I believe they are already taking the macrolides and playing mad scientist with it. That would save the GI bacteria, but just as important, they are pumping it up with steroids to boost the anti-inflammatory actions (kidding about steroids as that is a no no, but they are feeding them something -- maybe free range macrolides).