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    • 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
    • Soolantra at drugs.com costs $389/30 grams    
    • 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
    • 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.   
    • 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.   
    • 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.
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
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