Management of Rosacea-Prone Skin: Evaluation of a Skincare Product Containing Ambophenol, Neurosensine, and La Roche-PosayThermal Spring Water as Monotherapy or Adjunctive Therapy

August 2013 | Volume 12 | Issue 8 | Original Article | 920 | Copyright © August 2013

Sophie Seité PhD,a Florence Benech PharmD,b Sandrine Berdah PhD,b Muriel Bayer PharmD,b Sophie Veyrat PharmD,b Evelyne Segot PharmD PhD,b Marcela Sakalikova Mgr,c Lucia Gibejova Mgr,c Hana Zelenkova MD PhDc

aLa Roche-Posay Pharmaceutical Laboratories, Asnières, France
bL’Oréal Research and Innovation, Chevilly Larue, France
cDOST Svidnik, Private Clinic of Dermatovenerology, Svidnik, Slovakia

Additionally, rosacea is incurable and requires long-term management. Key treatment goals are to alleviate symptoms and improve appearance, delay or prevent development of the more advanced stages of the condition and to sustain remission. Care must be taken to ensure against psychosomatic co-morbidities, such as anxiety and personality disorders, social phobias or depression.9,10 Recently, ROSacea International Expert (ROSIE) consensus group proposed an algorithm for the choice of treatment based on the use of signs and symptoms rather than on rosacea stage or subtype.1
The diversity in rosacea is also reflected in its pathophysiology. Potential pathogenetic roles have been postulated, for example for vascular abnormalities, dermal matrix degeneration, and implication of microorganisms, such as Demodex folliculorum and Helicobacter pylori, and environmental factors. A number of predisposing factors and stimuli, the so-called “trigger factors”, are recognized which result in initial manifestations or exacerbations of symptoms including heat, cold, alcohol, sunlight, stress, spicy foods, some cosmetic products, etc.1,11
Most experts believe that an infectious cause is unlikely and that the disease is primarily inflammatory in etiology. It is believed that pro-inflammatory substances and degradative enzymes from inflammatory cells in the facial skin lead to the angiogenesis and dermal destruction associated with rosacea.12 Recent research demonstrates an up-regulation of local inflammatory cytokines in patients with rosacea, and these mediators may play key roles in the pathophysiology of this disease.1,12 A further novel approach is the link of rosacea to a dysfunction in the innate immune system elicited by elevated levels of abnormally processed cathelicidin antimicrobial peptides.1,12,13
Rosacea therapy pursues three goals: resolve current flare-ups, avoid “trigger factors” and maintain remission and the triad of rosacea care in treatment, education and skin care.1
Rosacea management may seem standardized; topical treatments should be the mainstay of treatment for many patients. Metronidazole is the most frequently used and internationally common rosacea medicine. It is therefore a benchmark in topical rosacea therapy. But many patients are moderately satisfied with their treatment.1,2,9 The aim of treatment for rosacea is multi-factorial: to reduce symptoms such as facial flushing and telangiectasias and eruption of papules and pustules, to prevent or delay worsening from milder to more severe manifestations of the condition as well as to maintain remission.
Furthermore, in a National Rosacea Society survey of 1066 patients, 41% reported that some skincare products aggravated their condition and 27% said some cosmetics also caused rosacea flare-ups.3 Therefore, it is important that products are noted as appropriate for sensitive skin or skin with rosacea, and avoid any products that sting, burn or cause irritation. So tolerance of cosmetics is key.
We therefore set out to design a product specifically adapted for patients with erythro-couperosic and rosacea sensitive skin. Ambophenol, Neurosensine, and La Roche-Posay thermal spring water were chosen for this formula for their anti-inflammatory and soothing properties. To reduce the number of additives, a hermetic packaging was designed to protect the product.
  1. Ambophenol is a purified extract of Tambourissa trichophylla leaves (used in Madagascar as soothing and pain relief infusion), titrated in polyphenols and containing condensed tannins and flavonoids. In particular, rutin and nicotiflorin have powerful anti-oxidant properties. Furthermore, rutin is also known for anti-inflammatory potential whereas nicotiflorin is considered as anti-hemorrhagic.14-16 Ambophenol combines extensive properties to minimize skin reactivity and skin redness ie, normalization of the overexpression of cathelicidins and the related enzymes (SCTE or Stratum Corneum Tryptic Enzyme, also called kallikrein-5 and SCCE: or Stratum Corneum Chemotryptic Enzyme, also called kallikrein-7)12 leading to an improvement of the skin immune protection balance; a global anti-inflammatory activity with the modulation of key inflammatory pathways (cyclooxygenase or COX and lipooxygenase or LOX)17 and the neoangiogenesis regulation with effect on both pro-angiogenic and anti-angiogenic factors and microcirculation improvement.18 These properties are confirmed by a clinical study on skin redness / rosacea, with visible results from a one month treatment.18
  2. We previously noticed a significant reduction in the number of patients with rosacea prone skin affected by functional or physical signs of skin reactivity at the end of a 4-week treatment with a simple formula (aqueous emulsion with more than 80% of water and 5% glycerin) containing Neurosensine or [N-acetyl-Tyr-Arg-hexadecylester]19 at the same concentration as in the tested formula. We also noted a reduction in the number of patients sensitive to some “trigger factors” and of the average intensity of the skin reactivity to these “trigger factors” ie cold weather, spicy food ingestion, cosmetic product use, etc.
  3. Lastly, La Roche-Posay thermal spring water with a high concentration of Selenium, is a powerful anti-oxidant, has antiradical, immunomodulatory, and anti-inflammatory properties. At the thermal care center of La Roche-Posay, these clinical therapeutic properties have been demonstrated in chronic inflammatory diseases such as atopic dermatitis (eczema), psoriasis and also, wound healing, burn scars, pruritus, and other dermatosis like rosacea or ichthyosis.20