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  1. Yesterday
  2. I would like to just start out with saying you guys are just AWESOME! I am so impressed that it kind of makes me speechless. I will check all the advise that has been offered here and see what works for me. Thank you both for taking the time to respond in such a meaningful way. I have had some substantial health issues this year and I have to say it has made me more jaded about the health care templates of today. Some is good and some is just a careless conveyor belt approach. Yes I agree completely that if you are rich you can maneuver around so much of the road blocks so many greedy types are creating. Robber Barons have been around for a very long time and we have ours too. The greed is just scary and just blatant. Before it was much more under ground. Now it is done with impunity and the acceptance of this new standard is pretty shocking. It makes me beyond sad that we haven't really pushed things to benefit all. I am very naive about so much even at 63yrs old. I have had to learn to be more proactive and cautious since I am just another number and not someone to care about. After awhile you just get weary from this approach. For years I was so appalled at the way so many of my doctors just failed to give good advice or cared or knew about how to deal with all my inflammatory expressions. We should be so further along by now. That explains why so many are becoming more proactive and not defaulting to the system as much as we used. I was friends with a young intern decades ago. One thing he said always stood out for me which was completely out of character for him. I have a terrible memory but it is odd things like that, that burns into your memory where your gut knows there maybe something to what you heard but not sure what it is but you know to memorize it for the future. He said he was so surprised at how medicine really hadn't improved much. I first thought he was being overly dramatic and jumped in giving off examples where it had. But I was healthy and young at the time and really didn't understand personally what he meant by it but it still stood out for me that maybe there is more to that than I realized. Now that I am older and having to face some bigger health issues I now get what he was trying to convey. Duhhhhh He was a pediatrician and he felt overwhelmed by the lack of treatments or cures for kids. That was 35 yrs ago. Even then the press was always talking about all the improvements in medicine but it was just fluff stuff not enough of the real important stuff. Just enough to make it look like what they are doing is credible and worth hundreds of dollars to find out. Kind of like the carrot and the mule. I don't know what the answer is but I do know that not enough research is being done due to the lack of funding with worthy researchers not researchers for hire for big pharma or university professors trying to get tenure and a big payout. I wish our politicians were not owned by corporations and would really vote based on what is best for all. Even if we have the answers I don't think they have the will to really act on it. The greed is just relentless and involved with every facet. By just experimenting on my own I found that what I put in my gut improved so many things and not one doctor even broached this topic. That made me super wary of wasting money going to them. So many times I have had asked about this or that specifically and the doctor redirects the conversation and I would come away with few answers and I am sick of that too. If you don't know then say so. I kind of realized that they don't know much and just guessing too much of the time and I am paying hundreds of dollars for this too! I avoided doctors for about 4 to 5 yrs because I lost faith in the system. Some have caused me great harm like Paxil that was handed out like candy to shut patients up and keep us out of the waiting rooms. So I am careful about just taking advice from doctors on what they think I need and make sure I am sure they are not just using me to help their bottom line. I am not alone in this thinking since I have noticed many are just fed up with their doctors and healthcare providers in the lack of real cures or help. I am also done with non profits for conditions that duplicate efforts and are not really doing much but creating jobs for people who are not really providing much in a way to get to hard answers on it all. I do think cancer is a big money maker. Many are relying on this field to bring in the big dollars which it does and I can see the conflict of interest with so much in health care. I have this amazing dentist who is finally retiring at 75 yrs old. He really cares about his patients and he has spoiled me terribly with the way he has fixed my mouth after decades of greedy dentists who didn't take the time for malocclusions. The improvements he made really had a huge impact on pain too. He says it doesn't pay dentists enough to do that work. That explains why my mouth got to such a bad state going to so many different dentists over the years. It is systemic in this sector. He is older and should have retired years ago but he loves doing what he does part time. He is master at what he does. I now understand the difference in a good dentistry and a poor approach. He has tried to mentor younger dentists but they don't listen. He is frustrated with them. He is very involved with so many helpful things also and he really is a rock star person on so many levels. Guys like him are rare and I am not looking forward to using another dentist. I think when you have experienced a healer/doctor who cares and has bothered to find better approaches and is not needing to pay for the house on the lake or ______ or paying off huge student loans. Only then can you really see the stark differences in what is and what could be. I have an adult daughter who works in healthcare in admin type of job and I try to influence her on things from a patient's stand point. On many occasions she has been shocked at how the system has failed me. To say her jaw dropped is an understatement. She didn't really understand this until she experienced it herself with me. She now makes sure she helps me when I get too weary dealing with all the B.S. this sector does to patients as much as she can. She knows it can be a mind field out there. I hope if at some time she can improve things for patients she will since she can look back at what she witnessed with me. She will know where to look for the holes in it. Plus she will know how to navigate this for herself and family in the future. Two tips I have now that I have been thru a bad health year. I will recommend that you do not fill out any feedback forms until you are completely done with the issue and have had time to reflect on it. Too many times these entities will send out surveys BEFORE you realize how bad it really was. They act like Amazon sellers who want your review before you even had a chance to use the product! These surveys help support their crappy approaches. They must know this premature feedback is better when it is submitted before you have time to reflect. Second tip is to let the clinic managers know AND corporate know when you have been treated poorly and go into detail about it. Too many times no one speaks up enough to call them out on it all and why they are losing business with their conveyor belt approaches. If nothing else . . . the bottom line does make them pay attention. If you aren't going to have your surgery with them, that brings in a lot of money, when no one gives you your test results from your biopsy then they will care. If that young doctor breezes in and out so fast and you barely have time to talk to them find another one who is listening to you. Sad but true. If a young doctor just ignores your questions and redirects the conversation or scolds you to take the heat off of them, find an older doctor who will make time for you and be honest with you. Keep looking. My daughter says she does not have any loyalty to any health care entity. Nope she bases it on the better doctors and not where they work. Trying to find them is the trick if they even exist anymore. Buy insurance that allows you to pick your doctors since it may make a huge difference when you have serious health crisis. Corporate health care is able to do more things but there is a big trade off with them buying up all the independents and my hope is there is a way to have both down the road. Not holding my breath on that one. You can't live with them and can't live without them at this point in my life. I am actually looking forward to AI doctors since maybe we can avoid pretending they care or are allowed to care due to time constraints and bottom line. Maybe better connections will be made this way? Maybe not, like Google cars that really don't work well and are not safe. I am sure the bean counters are hoping they can use robots instead and save more money for the admins and stockholders in the future. Won't be really in my lifetime. I am so grateful for forums like this where we can connect and share what we have learned when the system continues to fail us on such a grand scale. Drug companies make more money than oil companies and that is saying a lot. If we can share and find other options maybe they will begin to realize they need to change in order to stay afloat : ) They really have a huge PR problem with folks and the stockholders will be the ones who will be holding the bag ultimately when cures really do become a common reality in so many health care conditions. Patients will have memories like an elephant and will rethink who they buy their drugs from. They will not look kindly on companies like Galderma when they recall all their abuses. The internet makes this information very findable too. The old way of dividing and conquering is a outdated approach and won't work as well. I use cannabis and am finding so many peer reviewed papers that are showing how tumor cell death is happening to many types of cancers like endometrial (Cannabinoid-induced cell death in endometrial cancer cells: involvement of TRPV1 receptors in apoptosis) and prostate (Proapoptotic effect of endocannabinoids in prostate cancer cells) cancers when cannabis is used. So the tide is turning ever so slowly. When I told one oncologist about these papers his lame response was "It is not western science." Well my dentist said I don't care where the science is from as long at it is good." Big pharma has had an easy go of it with regulations preventing research with certain drugs in order to dominate the market place with their half baked drugs. Now that patients are seeking alternatives that are working it is going to be impossible for big pharma to put the genie back into the bottle with congress et al. The states are moving the chess pieces into place for patients if nothing else in order to generate revenue. Thank you so much for responding and I hope others will find this thread of how to work around Galderma's horrible greediness with U.S. patients when it comes to Soolantra and god knows what other drugs they are over charging for. Proapoptotic effect of endocannabinoids in prostate cancer cells.pdf
  3. Related Articles Management of Rhinophyma with Radio Frequency: Case Series of Three Patients. J Cutan Aesthet Surg. 2019 Apr-Jun;12(2):136-140 Authors: Tambe SA, Nayak CS, Gala P, Zambare U, Nagargoje A Abstract Rhinophyma is the most common form of phymatous rosacea, typically seen in men. It may appear de novo (without preceding inflammatory changes) or occur in patients with preexisting papulopustular rosacea. It is characterized by slow, bulbous, reddish-purple, painless enlargement of lower two-third of nose with rugose peau d'orange surface resulting from the enlargement of the sebaceous glands and subcutaneous tissue, which does not resolve spontaneously. Though benign, it causes lot of cosmetic and psychological concern. Commonly used treatment modalities include debulking by surgical excision, electrosurgery, carbon dioxide laser ablation, cryosurgery, or dermabrasion. Here we report a case series of three patients with Grade 3 rosacea as per National Rosacea Society grading, treated by radio frequency with good improvement. PMID: 31413484 [PubMed] {url} = URL to article
  4. Last week
  5. Soolantra at drugs.com costs $389/30 grams
  6. Trillium. Soolantra is a 1% Ivermectin cream in the "soothing" Cetaphil like base according to a post by Galderma. The tricky bit with the 1% liquid solution is that adding it to the cream base will dilute it more so that the resulting mix is less than 1%. If its already 1% you may actually best use the liquid solution directly onto clean skin. Try a few drops on the palm and smooth it on the face like a thin facial serum. The 1% liquid is the right strength to be effective already. Let it dry. Optionally you could apply a moisturizer like Cetaphil or whatever you prefer after the Ivermectin solution dries. That should help eliminate the messy issues with the horse paste. As Brady says, your best bet to make a 1% mix would be to use the Ivermectin powder. I'm not sure what the Percent strength of the powder is - if its mixed with something it might be less than 100% pure. The percentage will impact how much Cetaphil cream to mix with the powder. To be a match for the strength of Soolantra the ratio should dilute the powder to 1% strength when mixed with the Cetaphil. You only have to use the Soolantra once per day at night - that is when the mites are active. So there shouldn't be any need to wear it under makeup during the day. That may help with the makeup issue. I totally agree with you about the absurd costs. Ivermectin has been a generic drug for quite some time and is not that expensive. By my rough calculations Soolantra has less than $20 worth of Ivermectin per tube. So selling it for $600+ per tube is obscene.' ElaineA
  7. Trillium, Tom Busby, SD poster extraordinare at RF, mentioned in a post on this subject at RF, "an alternative source of ivermectin, on eBay" which is ivermectin powder. I asked Tom whether this would be a good idea since it seems a lot safer to use the horse paste than have to concoct a paste with grain alcohol and his comment is, "horse paste is fairly expensive for a really tiny amount of product.... I have to assume that someone who has some experience formulating hot emulsions (oil in water) could make a non-greasy cream with this ivermectin powder." There is a formulae based upon weight how much ivermectin to use per pound of body weight. You mention using the Cetaphil base for your concoction. Have you used Cetaphil? No issues with Cetaphil? Some have reported they cannot tolerate Cetaphil, while others just love it. We have a post explaining the 'basis for vehicle' regarding the use of Cetaphil with Soolantra that should prove illuminating to you. Some prefer the smaller amount of inactive ingredients in horse paste over using the huge amount of inactive ingredients in Cetaphil based Soolantra. There are a significant number of brands of horse paste and each one has similar but different inactive ingredients which are discussed in this thread. We have found two brands that actually list the inactive ingredients, but most brands do not list the inactive ingredients since they are not required to do so. As for price of Soolantra have you contacted Galderma about the CareConnect program that you may qualify for? As for the high prices pharmaceutical companies charge in the USA which is related to the medical insurance conglomerate and the universal health insurance issue, yes, it is sad that medical treatment is for the rich, similar to the way justice is given. If you are rich you definitely have an advantage in the USA for justice and medical treatment. But there are some work arounds, where philanthropic organizations help the poor with the money donated by rich benefactors but obviously not enough is given to alleviate these issues. Our non profit organization tries to help in small ways by educating Rosaceans on alternative treatments like ElaineA has done in this thread. Hopefully, you will figure out your own ivermectin solution. Are you confident that using ivermectin actually controls your rosacea? Ivermectin doesn't work for every rosacean. Which brand of horse paste 'leaves a goopy mess on your face at night' ? Have you tried using the horse paste on at night and then washing it off in the AM? Most use Soolantra this way, only use at night. Horse paste is usually only put on at night and then washed off in the AM. Keep us posted.
  8. I have tried the ivermectin horse paste but it leaves a goopy mess on your face at night.No way to wear it under makeup either. It helps but I also use SAL3 which is a sulfur soap with salicylic acid (3%) which seems to do a better job of keeping the face clean too. I am now wanting to make my own invermectin cream that will not be such a goopy mess. I have ordered Agrimectin Ivermectin injection 50ml at 1% which is a sterile solution on Amazon for about $28.00. I also picked up some Cetaphil moisturizing cream which is also made by Galderma the same company that makes Soolantra. I plan to mix the Cetaphil cream with the Agrimectin solution and make up my own ivemectin cream since my insurance doesn't cover Soolantra for Rosacea. Soolantra is still like about $660.00 a tube which is just ridiculous and highway robbery. I was given this Soolantra about 10 yrs ago and it was $600.00 then and I had to pay a $60.00 copay for it. Now the insurance companies are not going to pay the monster's (Galderma) game anymore with over inflated prices and I don't blame them. The more you pay them the more they get away with these insane practices. I think if we have more reasonable alternatives they will have to lower the price to get any sales. I have read where others around the world are paying so much less than the $660.00 that is price fixed in the U.S. I feel like Galderma treats American patients like their own parasites the way they have no regard for how most folks can't afford this price fixing they play on us. I also have 2ml syringes and not sure how much Agrimectin Invermectin to use with how much cream to make an effective cream for Rosacea. My dermatologist did try to send me to use www.userphil.com for Soolantra for about $70.00 a tube but this San Francisco start up has horrible reviews and even the BBB has rated them an F! Apparently on the website they used all this high profile company names that wrote articles about them but when the BBB tried to get proof on this or clarification the company never responded. The arrogance of these Silicon Valley investors is just astounding. This vacuum that this price fixing has created is attracting unsavory sharks to enter into the fray. Also if the prescription gets lost in the mail then you can't get a replacement. I know these Silicon Valley investors are smacking their lips over the idea of owning a huge market share of the 300 billion dollar online pharmacy sector business. These investors have over promised and left customers in the lurch. The reviews from customers are just horrible. I think only 54% recommended them on Hiya. A common term reviewers use is liars in regards to their experiences with this online site. I would like to make small maybe weekly batches of my own ivermectin cream if this cream can stay stable for a week. I found using the horse paste helped initially when I had a horrible outbreak but then I found it created an environment where it wasn't as effective since you have this moist gel on your face that kind of gets all over your hair and pillows and also seems to make the Rosacea revert back a bit and not sure why that is. SAL3 seems to dry out the skin and helps it when the horse paste stops working as well. Thanks for any help you can provide in how to figure out the recipe for ivermectin cream using a liquid ivermectin solution.
  9. One cross-sectional study including 99 women with Frontal fibrosing alopecia presented a higher prevalence of rosacea than did controls. [1] "Frontal Fibrosing Alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline. It is considered to be a clinical variant of lichen planopilaris. Frontal Fibrosing Alopecia has been most often reported in post-menopausal women with higher levels of affluence and a negative smoking history. Autoimmune disease is found in 30% of patients." Wikipedia Frontal fibrosing alopecia may be a co-existing condition with rosacea. Genetic and Rare Diseases Information Center (GARD) End notes [1] A Cross-sectional Study of Rosacea and Risk Factors in Women with Frontal Fibrosing Alopecia.
  10. Related Articles The Role of IL-17 in Papulopustular Rosacea and Future Directions. J Cutan Med Surg. 2019 Aug 12;:1203475419867611 Authors: Amir Ali A, Vender R, Vender R Abstract Rosacea is a chronic, progressive, inflammatory condition phenotypically subtyped into diagnostic features, major features, and minor/secondary features. There is currently no cure for rosacea, and it carries a significant negative psychosocial burden for afflicted patients. While there are a number of treatment modalities at the disposal of the clinician, clinical experience has suggested a need for updated treatments. The pathogenesis of rosacea is multifactorial; however, this paper will focus on the pivotal role of interleukin 17 (IL-17) in the development and progression of the disease. Furthermore, this paper will explore the mechanism of action of standard rosacea treatments and their effect on different stages of the IL-17 pathway. The standard treatments for rosacea are usually effective in controlling the symptoms of the disease in its mild-to-moderate form; however, their efficacy is diminished in the setting of severe and treatment-resistant rosacea. We hypothesize that IL-17 inhibitors, currently used successfully in psoriasis and psoriatic arthritis, could perhaps be used to treat severe and treatment-resistant papulopustular rosacea in the future; however, clinical trials and case reports will be needed to dictate expanded indications of IL-17 inhibitors. Furthermore, the high cost of IL-17 inhibitors presently prevents their use in disease states other than psoriasis or psoriatic arthritis. PMID: 31402691 [PubMed - as supplied by publisher] {url} = URL to article
  11. A Cross-sectional Study of Rosacea and Risk Factors in Women with Frontal Fibrosing Alopecia. Acta Derm Venereol. 2019 Aug 13;: Authors: Porriño-Bustamante ML, Fernández-Pugnaire MA, Arias-Santiago S Abstract Frontal fibrosing alopecia has been related to some autoimmune diseases, but the association with rosacea is not clear. The objective of this study was to analyse the prevalence of rosacea in a group of patients with frontal fibrosing alopecia. A cross-sectional study, including 99 women with frontal fibrosing alopecia and 40 controls, was performed, in which clinical, dermoscopic and hormonal data were analysed. Women with frontal fibrosing alopecia presented a higher prevalence of rosacea than did controls (61.6% vs. 30%, p = 0.001), especially those with severe grades of alopecia (77.8% in grade V vs. 33.3% in grade I, p = 0.02). Binary logistic multivariate analysis showed that perifollicular erythema (odds ratio (OR) 8.5; 95% confidence interval (95% CI) 1.73-42.30), higher body mass index (OR 1.16; 95% CI 1.01-1.34) and lower progesterone levels (OR 0.15; 95% CI 0.028-0.89) were associated with a higher risk of rosacea in patients with frontal fibrosing alopecia. In conclusion, patients with frontal fibrosing alopecia presented a higher prevalence of rosacea than did controls. Perifollicular erythema, higher body mass index and lower progesterone levels were associated with a higher risk of rosacea in the group with frontal fibrosing alopecia. PMID: 31408181 [PubMed - as supplied by publisher] {url} = URL to article
  12. Earlier
  13. Related Articles Photodynamic Therapy Assay. Methods Mol Biol. 2019 Aug 08;: Authors: Varol M Abstract Photodynamic therapy is a promising, minimally invasive, and clinically approved treatment strategy that destroys the cell components by oxidizing the biological molecules such as nucleic acids, carbohydrates, proteins, and lipids, and leads apoptosis in the cells of the target tissue through the generation of singlet oxygen and reactive oxygen species (ROS) owing to the synergic interactions of a nontoxic photosensitizer, a non-thermal light source, and tissue oxygen. This innovative method has drawn the attention of many scientists and been employed in a wide range of medical fields that covers the treatment of cancer diseases and precancerous dermatological disorders, and the aesthetic and cosmetic practices, including photorejuvenation and treatment of photoaging, hirsutism, facial flat warts, rosacea, acne vulgaris, and sebaceous gland hyperplasia. It was therefore intended to provide an in vitro photodynamic therapy assay protocol on human healthy keratinocytes and epidermoid carcinomas to investigate comparatively the therapeutic and destructive activities of the potent light-sensitive medications. PMID: 31392587 [PubMed - as supplied by publisher] {url} = URL to article
  14. Related Articles Recommendations for rosacea diagnosis, classification and management: Update from the global ROSacea COnsensus (ROSCO) 2019 panel. Br J Dermatol. 2019 Aug 07;: Authors: Schaller M, Almeida LMC, Bewley A, Cribier B, Del Rosso J, Dlova NC, Gallo RL, Granstein RD, Kautz G, Mannis MJ, Micali G, Oon HH, Rajagopalan M, Steinhoff M, Tanghetti E, Thiboutot D, Troielli P, Webster G, Zierhut M, van Zuuren EJ, Tan J Abstract BACKGROUND: A transition from subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorisation by pre-defined subtypes. The ROSCO 2017 recommendations further supported this transition and align with guidance from other working groups. OBJECTIVES: To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development. METHODS: Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded. RESULTS: Delphi statements on which the panel achieved consensus of ≥75% voting 'Agree' or 'Strongly agree' are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, due to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximise outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements. CONCLUSIONS: The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. This article is protected by copyright. All rights reserved. PMID: 31392722 [PubMed - as supplied by publisher] {url} = URL to article
  15. Improved clinical outcome and biomarkers in adults with papulopustular rosacea treated with doxycycline modified-release capsules in a randomized trial. J Am Acad Dermatol. 2019 Aug 05;: Authors: Friedman A PMID: 31394131 [PubMed - as supplied by publisher] {url} = URL to article
  16. Related Articles Artemisinin, a potential option to inhibit inflammation and angiogenesis in rosacea. Biomed Pharmacother. 2019 Sep;117:109181 Authors: Yuan X, Li J, Li Y, Deng Z, Zhou L, Long J, Tang Y, Zuo Z, Zhang Y, Xie H Abstract BACKGROUND: Rosacea is a facial chronic inflammatory skin disease with dysfunction of immune and vascular system. Artemisinin (ART), an anti-malaria drug, was reported to have several effects including anti-inflammation and anti-angiogenesis activities. However, the role of ART on rosacea remains unclear. OBJECTIVES: To investigate the effects and molecular mechanism of ART on rosacea. METHOD: In rosacea-like mouse model, the phenotype of rosacea lesions was evaluated by redness score, the inflammatory biomarkers were analyzed by qPCR, and the infiltration of inflammatory cells were assessed by IHC analysis and immunofluorescence. In vitro, LL37-induced expression of inflammatory factors in HaCaT cells was detected by qPCR, potential signaling pathways were detected by Western blotting or immunofluorescence. Migration ability of human umbilical vein endothelial cells (HUVECs) was evaluated by cell scratch and transwell assays. RESULT: The skin erythema and histopathological alteration, as well as the elevated pro-inflammatory factors (IL-1β, IL6, TNFα) and TLR2 were significantly ameliorated by ART treatment in LL37-induced rosacea-like mice. In addition, ART reduced the infiltration of CD4+ T cells, macrophages and neutrophils, and repressed the expression of immune cells related chemokines (CXCL10, CCL20, CCL2 and CXCL2) in mouse lesions. In HaCaT cells, ART significantly decreased the LL37-induced expression of inflammatory biomarkers. Moreover, we found that ART inhibited rosacea-like inflammation via NF-kB signaling pathways in HaCaT cells. Finally, for vascular dysregulation, ART repressed the angiogenesis in mouse model and inhibited the LL37-induced HUVECs migration in vitro. CONCLUSION: ART ameliorated rosacea-like dermatitis by regulating immune response and angiogenesis, indicating that it could represent an effective therapeutic option for patients with rosacea. PMID: 31387196 [PubMed - in process] {url} = URL to article
  17. Admin

    Phenotypes Updates

    Medscape has recognized the phenotype classification of rosacea with the following: In 2016, the global rosacea consensus panel recommended a new classification: at least one diagnostic or two major phenotypes are required for the diagnosis of rosacea. Diagnostic phenotypes A diagnosis of rosacea may be considered in the presence of one of the following diagnostic cutaneous signs: Fixed centrofacial erythema in a characteristic pattern that may periodically intensify Phymatous changes: Patulous follicles, skin thickening or fibrosis, glandular hyperplasia, and bulbous appearance of the nose (rhinophyma is the most common form) Major phenotypes Without a diagnostic phenotype, the presence of two or more of the following major features may be considered diagnostic: Papules and pustules Flushing: Frequent and typically prolonged Telangiectasia: Predominantly centrofacial in phenotypes I-IV, rarely seen in darker phenotypes Ocular manifestations Secondary phenotypes The following secondary signs and symptoms may appear with one or more diagnostic or major phenotypes: Burning and stinging Edema: Facial edema Dry appearance: Central facial skin may be rough and scaly Ocular rosacea Major features of ocular rosacea are as follows: Lid margin telangiectasia Interpalpebral conjunctival injection Spade-shaped infiltrates in the cornea Scleritis and sclerokeratitis Secondary features of ocular rosacea are as follows: "Honey crust" and collarette accumulation at the base of the lashes Irregularity of the lid margin Evaporative tear dysfunction (rapid tear breakup time) Although ocular manifestations may precede the cutaneous signs by years, in many cases they develop concurrently with dermatologic manifestations. The diagnosis of rosacea is made clinically, based on the 2016 global rosacea consensus that one diagnostic or two major phenotypes are required for the diagnosis of rosacea. A skin biopsy is sometimes performed to exclude other cutaneous diseases, such as lupus or sarcoidosis. Agnieszka Kupiec Banasikowska, MD Consulting Staff, Georgetown Dermatology, PLLC Medscape > Drugs & Diseases > Dermatology > Rosacea
  18. A recent paper on the subject of probiotics for skin conditions states, "Unfortunately, very few studies have looked how probiotic supplementation influence inflammatory skin disorders. The results of probiotic use, although beneficial, are difficult to implement into clinical practice due to the heterogeneity of the applied supplemental regimen. In this Viewpoint we aim to encourage the conduction of more research in that direction to explore unambiguously the therapeutic potential of oral probiotics in dermatology." [1] Wouldn't it be incredible if a non profit for rosacea got 10K members each to donate one dollar to fund a peer reviewed, double blind, placebo controlled clinical study on probiotics and rosacea? Could that be possible? Only you can be a part of such a miracle. End Notes [1] Exp Dermatol. 2019 Aug 06;: Targeting the gut-skin axis - probiotics as new tools for skin disorder management? Szántó M, Dózsa A, Antal D, Szabó K, Kemény L, Bai P
  19. Actually is isn't as off topic about rosacea as it should be, because there are many published peer reviewed papers on rosacea, but I thought it important enough to have this article mentioned in a post to be able to refer to it later, since it points out some of the negative aspects of those who rely on peer reviewed papers. The article, Why we shouldn’t take peer review as the ‘gold standard’, by Paul D. Thacker and Jon Tennant, August 1, 2019, The Washington Post, has this subtitle, 'It’s too easy for bad actors to exploit the process and mislead the public.'
  20. Targeting the gut-skin axis - probiotics as new tools for skin disorder management? Exp Dermatol. 2019 Aug 06;: Authors: Szántó M, Dózsa A, Antal D, Szabó K, Kemény L, Bai P Abstract The existence of a gut-skin axis is supported by increasing evidence, but its translational potential is not widely recognized. Studies linked inflammatory skin diseases to an imbalanced gut microbiome, hence, the modulation of the gut microbiota to improve skin condition seems to be a promising approach. Today there is a growing interest in natural products as alternatives to synthetic drugs. In this respect, oral probiotics could be a simple, safe and cheap modality in the therapeutic management of skin inflammation. Unfortunately, very few studies have looked how probiotic supplementation influence inflammatory skin disorders. The results of probiotic use, although beneficial, are difficult to implement into clinical practice due to the heterogeneity of the applied supplemental regimen. In this Viewpoint we aim to encourage the conduction of more research in that direction to explore unambiguously the therapeutic potential of oral probiotics in dermatology. We focus on the most common inflammatory skin diseases (atopic dermatitis, psoriasis, rosacea, acne vulgaris) with gut dysbiosis, but we also discuss some less common and very serious skin pathologies (e.g. erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa) that are possibly linked to an imbalanced gut microbiome. We dissect the possible mechanisms along the gut-skin axis and highlight novel points where probiotics could interfere in this communication in the diseased state. This article is protected by copyright. All rights reserved. PMID: 31386766 [PubMed - as supplied by publisher] {url} = URL to article
  21. Related Articles Itch in Elderly People: A Cross-sectional Study. Acta Derm Venereol. 2019 Aug 06;: Authors: Reszke R, Białynicki-Birula R, Lindner K, Sobieszczańska M, Szepietowski JC Abstract Ageing is associated with numerous medical afflictions, including dermatological symptoms and diseases. Chronic itch (CI) in elderly people is a frequent symptom of diverse aetiology. This study assessed the prevalence and detailed clinical features of CI among 153 elderly patients hospitalized in the geriatric ward, including associations with comorbidities and pharmacotherapy. CI affected 35.3% of subjects, most commonly due to cutaneous conditions, mixed aetiology and neurological disorders (53.7%, 25.9% and 11.1% of pruritic subjects, respectively). The mean itch intensity assessed with the 4-Item Itch Questionnaire (4IIQ) was 6.6 ± 2.8 points. Viral hepatitis (p = 0.02), higher serum creatinine concentration (p = 0.02) and coexistent purpuric lesions (p = 0.002) were associated with higher 4IIQ scores. In logistic regression analysis CI correlated positively with female sex, atopic dermatitis, immobility, rheumatoid arthritis and ischaemic neurological diseases, while low-molecular-weight heparins, antipruritic drugs, allergy, rosacea and higher haemoglobin concentration had the contrary effect. CI is a frequent and interdisciplinary problem among elderly subjects, which requires a holistic clinical approach. PMID: 31384955 [PubMed - as supplied by publisher] {url} = URL to article
  22. Related Articles Manifestations of ocular rosacea in females with dark skin types. Saudi J Ophthalmol. 2019 Apr-Jun;33(2):135-141 Authors: Al-Balbeesi AO, Almukhadeb EA, Halawani MR, Bin Saif GA, Al Mansouri SM Abstract Background: Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. Objective: To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. Method: Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. Result: Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. Conclusion: Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other. PMID: 31384155 [PubMed] {url} = URL to article
  23. Credit: INSTAGRAM / JO HOARE The writer, Jo Hoare, states clearly, "I was diagnosed in 2016" with rosacea in an article in The Sun, SEEING RED Writer dares to bare the truth about living with rosacea and how to manage its symptoms. Jo Hoare is a journalist based in London, UK. Linkedin • Jo Hoare has made the RRDi official list of famous rosaceans. That is what you do, get a diagnosis from a physician, preferably a dermatologist like Jo Hoare did. She complains of flushing so she may have Phenotype 1 and Phenotype 2 (you can have more than one phenotype of rosacea, there are actually six phenotypes). While Tom Busby makes a point that "Rosacea is so badly defined" it is important that anyone that presents with a red face should get a correct diagnosis since there are also at least thirteen variants of rosacea and a huge number of rosacea mimics, so a differential diagnosis is prudent. Just because one presents with a red face doesn't necessarily mean one has rosacea. I refer to Dr. Draelos statement about all this which is pertinent to this post, "Rosacea is probably a collection of many different diseases that are lumped together inappropriately." So while there is some confusion about presenting one self to a physician with a red face, there is a lot of information dermatologists have to find a correct diagnosis by taking a patient history, examination, and possibly some tests to rule out certain skin conditions that present with a red face. What everyone wants is to find the best dermatologist who does just that (finds the correct diagnosis), because misdiagnosis is not uncommon. Sometimes, the path to a correct diagnosis can get complicated.
  24. New Insight in Noninvasive Rejuvenation: The Role of a Rhodamine-Intense Pulsed Light System. Photobiomodul Photomed Laser Surg. 2019 Aug 05;: Authors: Cannarozzo G, Bonciani D, Tamburi F, Mazzilli S, Garofalo V, Del Duca E, Sannino M, Zingoni T, Nisticò SP Abstract Background: Rhodamine-intense pulsed light (r-IPL) is a noncoherent, noncollimated, polychromatic light energy optimized for a double-peak wavelength emission, ranging between 550-680 and 850-1200 nm. Traditional IPL works within visible and infrared spectra, targeting hemoglobin and melanin, are effective to treat rosacea and pigmentary disorders. r-IPL, a new technology in dermatology, emits high-intensity light with a wavelength peak similar to the one of the pulsed dye lasers, showing a good safety and efficacy profile in nonablative photorejuvenation. Objective: Assess efficacy and safety of r-IPL on photodamaged facial skin showing hyperpigmentation, telangiectasias, fine lines, and textural changes. Methods: Five sessions of r-IPL treatment (fluence ranged between 13.5 and 14 J/cm2) have been performed on one 75-year-old lady affected by facial photodamaged skin. Efficacy of treatment was evaluated using the Fitzpatrick Elastosis and Wrinkles Scale (FEWS) and the Global Aesthetic Improvement (GAI) Scale assessed by an investigator, compared with baseline. Treatment safety and tolerance were also evaluated using the Visual Analog Scale (VAS). Results: Photographic and multispectral evaluation demonstrated relevant improvement (vascular, pigment, and texture) of photodamaged facial skin. One month after the last treatment, significant improvement in facial wrinkle and texture was noted. FEWS scores decreased significantly from 7 to 2. According to the GAI scale, the patient had an improvement in skin texture. Immediate response included mild-to-moderate erythema and only trace-mild edema in the treatment area. Pain during the treatment was minimal with a mean VAS pain score of 3/10. No other adverse events were reported. No post-treatment downtime was recorded. Conclusions: r-IPL may represent a valid therapeutic approach in noninvasive photorejuvenation. PMID: 31381488 [PubMed - as supplied by publisher] {url} = URL to article
  25. image courtesy of Wikimedia Commons Another rosacea mimic to rule out is Perioral Demodex folliculitis from Rosacea Perioral Dermatitis. See the following article: JAAD Case Rep. 2019 Jul; 5(7): 639–641.Perioral Demodex folliculitis masquerading as perioral dermatitis in the peripartum periodDema T. Alniemi, MD and David L. Chen, MD
  26. Admin

    Phenotypes Updates

    The AARS in June 2019 has now officially at the very least, started to recognize the phenotype classification of rosacea with its published paper stating, "The classification of rosacea in both clinical practice and research previously utilized subtype designations as described by Wilkin et al in 2002 from the National Rosacea Society. However, the current recommendations from multiple organizations with interest in the diagnosis and treatment of rosacea suggest characterizing patients with rosacea by individual clinical manifestations and symptoms that are present at the time of examination. As rosacea is a phenotypically heterogeneous disease, this might include central facial erythema without papulopustular (PP) lesions; central facial erythema with PP lesions; the presence of phymatous changes, ocular signs, and symptoms; extensive presence of facial telangiectasias; and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea). Manifestations at various time points in a single patient might differ depending on whether the rosacea is flared or quiescent, the age of the patient, the duration of his or her disease, the frequency and magnitude of rosacea flares, and associated symptomatology." J Clin Aesthet Dermatol. 2019 Jun; 12(6): 17–24. Update on the Management of Rosacea from the American Acne & Rosacea Society (AARS) James Q. Del Rosso, DO, FAOCD, FAAD, Emil Tanghetti, MD, FAAD, Guy Webster, MD, PhD, FAAD, Linda Stein Gold, MD, FAAD, Diane Thiboutot, MD, FAAD, and Richard L. Gallo, MD, PhD, FAAD While this isn't exactly endorsing the phenotype classification 'officially' and it is odd that the AARS paper on the management of rosacea has such a cursory reference to phenotypes since the ROSCO panel, RRDi, NRS, and Galderma have endorsed the phenotype classification of rosacea. But notice the 'phenotypically' list quoted above how it follows the phenotype classification: "central facial erythema without papulopustular (PP) lesions;" (Phenotype 2) "central facial erythema with PP lesions;" (Phenotype 4) "the presence of phymatous changes," (Phenotype 5) "ocular signs, and symptoms;" (Phenotype 6) "extensive presence of facial telangiectasias;" (Phenotype 3) "and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea)" (Phenotype 1) The AARS is recognizing the phenotypes in its own way. This is typical of how rosacea non profit medical organizations have to be different yet basically say the same thing, just list in a different order with lots of words. You can probably see that the six phenotypes are an easier way to refer to these 'manifestations' especially in writing down a diagnosis on a patient's chart.
  27. Quite right. There hasn't been any dog mites shown to be on human skin. Weird isn't it? Yet, dog mites can travel on human skin. But for some reason we never find dog mites on human skin. I haven't really done any serious investigation on this because all the papers say humans only have demodex folliculorum and brevis mites. The dog mites are indeed different mites as you have pointed out. Sorry to cause any confusion.
  28. Brady I read that dogs have a different type of mite on them. One that does not/can not live on human skin. Are you saying this is inaccurate? Or dated information? Could you please link me to some info. I cannot find anything about humans getting mites from dogs. Also should I be at all concerned about spreading mites to my dog? I realize I'm being a bit neurotic about all this. But I believe in being thorough.
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