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    No one really knows the cause of rosacea but there are many theories. "Rosacea is a skin disease with an obscure and complicated pathogenesis." [1]

    The current most popular theory is that rosacea is a disorder of the innate immune system. For over twenty years the vascular theory was held as the most promising. What is interesting is at the heart of the innate immune system theory is that this includes an overproduction of cathelicidin (a killer of microscopic organisms that is at the cellular level found in white blood cells and also found in cells on the skin) which is transported in the vascular system, so we have come full circle. Some consider the nervous system as the root cause of rosacea, and the list goes on with many other theories worth considering (the latest theory is the Trigeminal sensory malfunction theory) but a good place to start your research is our post on Theories Revisited

    End Notes

    [1] Dovepress
    Rosacea and Helicobacter pylori: links and risks
    Elizabeth Lazaridou, Chrysovalantis Korfitis, Christina Kemanetzi, Elena Sotiriou, Zoe Apalla, Efstratios Vakirlis, Christina Fotiadou, Aimilios Lallas, Demetrios Ioannides

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    • Rod102988 reports, "A year ago this time I was diagnosed with Rosacea due to heavy drinking and long bouts in the sun. I was devastated, depressed and embarrassed. I quit several jobs, tried makeup, turmeric, eating healthy, water etc. You know name it. I spent hundreds on products for up to a year. I even tried Finacea which while it helped the bumps not so much with the redness plus my insurance didn't cover it and it cost $330 a tube. Finally, I did tons of research online and found two products which I use in combination and they only cost a combined $80 on Amazon.  1) La roche Posay Rosaliac AR Intense. It's a visible redness reducing serum made by scientists in France. It's light and has no smell. You apply twice a day after washing.  2) GIGI Bioplasma Azaleic Acid 15 percent cream. This stuff is better than Finacea IMO and much much cheaper. It tackles all the same things as Finacea; redness, blemishes, acne and hyperpigmenation. Now what I do is usually is place both on at the same time but always one significantly less than the other....only on the problems spots. For example, a full dot full of one and miniscule dot full of the other. But, some may get irritated by that I wouldn't suggest starting off like that. In would initially alternate with one each day and then maybe alternate throughout the day. With that said, this cream and serum has worked wonders and its only costing me $80 bucks a month but I could really stretch both to a month and a half of I want to. After using these for 3 months I am amazed and these combination have been a complete and utter life saver."
    • Found this post at healthboard.com:  "My husband and I both have rosacea. We have used Metrogel daily for years and sometimes it would keep the rosacea under control and other times it would not.
      I researched home remedies and this is what has worked for both of us. We no longer have to go to the dermatologist for an Rx for Metrogel. Please note that this is NOT a cure. We do this daily and then we have no recurrence of the rosacea. When I stopped using it, the rosacea would return after a few weeks. I purchased a 12 ounce bottle of baby shampoo. It doesn't matter what brand as long as it is not too runny like water. Then I bought a 1 ounce bottle of 100% tea tree oil at Trader Joes. It doesn't matter where you buy your bottle of 100% tea tree oil. I poured about 1/3 of the 1 ounce bottle of tea tree oil into the 12 ounce bottle of baby shampoo. I then closed the cap of the baby shampoo and shook it really well.  In the beginning when my rosacea was prevalent, every morning I would put some of the tea tree oil infused baby shampoo on those areas. I would leave it on while I brushed my teeth. I tried to keep it on for at least 5 minutes. Then I would rinse it off. That evening I would do it again and keep it on for at least 5 minutes. Then rinse off. After a few days I saw my rosacea disappear. When I stopped this treatment, the rosacea would ultimately return. So now to keep my rosacea from returning I put on the tea tree oil infused baby shampoo every morning while I brush my teeth. I no longer need to put it on at night as the once daily application has kept my rosacea from returning. It is has been well over a year since the rosacea has resurfaced.  My husband still continues to put his application of tea tree oil infused baby shampoo on twice a day because he gets good results and he doesn't want to chance it returning as his rosacea was far worse than mine. This daily regime has worked for both my husband and I. If you choose to try this, I hope it works for you as well." This probably would help improve demodectic rosacea. 
    • Related Articles An empirically generated responder definition for rosacea treatment. Clin Cosmet Investig Dermatol. 2017;10:347-352 Authors: Staedtler G, Shakery K, Endrikat J, Nkulikiyinka R, Gerlinger C Abstract
      OBJECTIVE: The aim of this study was to empirically generate a responder definition for the treatment of papulopustular rosacea.
      METHODS: A total of 8 multicenter clinical studies on patients with papulopustular facial rosacea were analyzed. All patients were treated with azelaic acid and/or comparator treatments. The severity of rosacea was described by the Investigator Global Assessment (IGA) and the number of lesions. Patients with the IGA score of "clear/minimal" were considered as responders, and those staying in the range of IGA "mild to severe" as nonresponders. The respective number of lesions was determined.
      RESULTS: A total of 2,748 patients providing 12,410 measurements were included. After treatment, responders showed 2.23±2.48 lesions (median 2 lesions [0-3]), and nonresponders showed 13.74±10.40 lesions (median 12 lesions [6-18]). The optimal cutoff point between both groups was 5.69 lesions.
      CONCLUSION: The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea.
      PMID: 28932125 [PubMed] {url} = URL to article
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