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    • MENLO PARK, Calif., July 27, 2017 /PRNewswire/ -- BioPharmX Corporation (NYSE MKT: BPMX), a specialty pharmaceutical company developing products for the dermatology market, today announced that a panel of prominent dermatologists will discuss BPX-01, a unique topical hydrophilic gel formulation of minocycline at the 2017 AAD Summer Meeting tomorrow. BPX-01 is an investigational drug for the treatment of acne and rosacea. Summer AAD Panel to Discuss BPX-01 for Acne and Rosacea, NEWS PROVIDED BY BioPharmX Corporation, Cision, PR Newswire 
    • Rosacea is considered the UK’s most common skin complaint. But what causes its red, itchy patches and how can you get rid of it? Why your diet could be causing rosacea, By Carla Challis, BT Carla doesn't mention sugar or carbohydrate as a rosacea trigger. The NRS still doesn't list sugar or carbohydrate as a rosacea trigger and articles like this one parrot the NRS trigger list. 
    • Rosacea’s red cheeks and nose aren’t caused by heavy drinking, and nor is it down to poor hygiene. We dispel the myths surrounding this common skin condition. Rosacea: the causes and triggers of the skin condition explained, By Carla Challis, BT
    • Phenotype 6 - Ocular manifestations

      Ocular rosacea is common but often not recognized by the clinician.[1] It may precede, follow, or occur simultaneously with the skin changes typical of rosacea. In the absence of accompanying skin changes, ocular rosacea can be difficult to diagnose, and there is no test that will confirm the diagnosis. Patients usually have mild, nonspecific symptoms, such as burning or stinging of the eyes. A sensation of dryness is common, and tear secretion is frequently decreased. [2] Mild-to-moderate ocular rosacea (including blepharoconjunctivitis, chalazia, and hordeola) occurs frequently, whereas serious disease with the potential for visual loss, such as that which results from keratitis, occurs rarely.

      Ocular problems occur in at least 50 percent of patients with rosacea. [3] "Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity." [14]

      One report said, "Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters." [12]

      For images of Ocular Rosacea click here:

      http://goo.gl/ESG4n

      Links to get you started [5]

      Dry Eye: Awareness, Diagnosis, and Management

      All of the ocular rosacea articles at rosacea news

      Ocular Rosacea: Dr. Eric Jones, MD

      Ocular Rosacea: Dr. Mark J. Mannis, MD

      Ocular Rosacea: Curse of the Celts and Celebs, Heather Potter, MD, University of Wisconsin, School of Medicine and Public Health

      Treatment

      Treating ocular rosacea (from the AAO)

      Topical Cyclosporine Proves Beneficial For Ocular Rosacea [6]

      Avermectin Milbemycin Eyewash for Ocular Rosacea [7]

      Might consider demodex mite treatment. [8]

      Terpinen-4-ol (T4O) Pass [11]

      One report states, "We suggest that a clinically acceptable dosage of PRP provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES [Dry eye syndrome]." [13] Cliradex [15] Optimel [16]

      Diagnostic Test 

      There may be a clinical diagnositic test now available for ocular rosacea. [4] One paper suggests, "The abundance of highly fucosylated N-glycans in the control samples and sulfated O-glycans in ocular rosacea patient samples may lead to the discovery of an objective diagnostic marker for the disease." [9] Another paper suggests, "The high abundance of oligosaccharides in the tear fluid of patients with rosacea may lead to an objective diagnostic marker for the disease." [10] "There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent." [14]

      End notes

      [1] Arch Dermatol 1997;133:89-90.[CrossRef][iSI] [Medline] 
      Ocular rosacea: current concepts and therapy.
      Kligman AM

      [2] J Am Acad Dermatol 1992;26:211-214.[iSI] [Medline]
       Schirmer testing for dry eyes in patients with rosacea.
      Gudmundsen KJ, O'Donnell BF, Powell FC. 
      [3] Rosacea: A Common, Yet Commonly Overlooked, Condition
      B. WAYNE BLOUNT, M.D., M.P.H. and ALLEN L. PELLETIER, M.D.
      Am Fam Physician. 2002 Aug 1;66(3):435-441.

      [4] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
      Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan, Hao Liu,‡ Carlito B. Lebrilla, Lenio S. Alvarenga, and Mark J. Mannis
      J. Proteome Res., 2005, 4 (6), pp 1981–1987, October 6, 2005, American Chemical Society

      Trail of Tears May Lead to the First Diagnostic Test for Ocular Rosacea
      Ocular Rosacea Test
      Updated: 6/21/2006 9:16:46 AM Dental Care & Health Care Articles

      [5] Link list courtesy of David Pascoe

      [6] Topical Cyclosporine Proves Beneficial For Ocular Rosacea
      Skin and Allergy News, Medical Dermatology
      BRUCE JANCIN, Skin & Allergy News Digital Network

      [7] Patent applied for by Galderma
      David Pascoe's comment on the above patent

      [8] In vitro and in vivo killing of ocular Demodex by tea tree oil.
      Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC.
      Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA.
      Br J Ophthalmol. 2005 Nov;89(11):1468-73.

      [9] Glycomic analysis of tear and saliva in ocular rosacea patients: the search for a biomarker.
      Vieira AC, An HJ, Ozcan S, Kim JH, Lebrilla CB, Mannis MJ.
      Ocul Surf. 2012 Jul;10(3):184-92. Epub 2012 May 3.

      [10] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
      Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan,Hao Liu, Carlito B. Lebrilla, Lenio S. Alvarenga,and Mark J. Mannis
      J. Proteome Res., 2005, 4 (6), pp 1981–1987, DOI: 10.1021/pr0501620, Publication Date (Web): October 6, 2005

      [11] In clinical trials as of August 2012:
      Demodex Blepharitis Treatment Study (DBTS)

      [12] Can J Ophthalmol. 2012 Dec;47(6):504-8. doi: 10.1016/j.jcjo.2012.07.009.
      Central corneal thickness in patients with mild to moderate rosacea.
      Onaran Z, Karabulut AA, Usta G, Ornek K.

      [13] Optometry. 2012 Mar 30;83(3):111-3.
      Dry-eye--is inflammation just the tip of the iceberg?
      Jarka ES, Kahrhoff M, Crane JB. [14] Arq Bras Oftalmol. 2012 Oct;75(5):363-9. Ocular rosacea: a review. Vieira AC, Höfling-Lima AL, Mannis MJ.   [15] One report on Cliradex is from yoegan on 5th April 2013 10:01 PM Post #467   [16] judworth says, "For those of you plagued by ocular rosacea (I have MGD) and very red and sore outer lash line, I have been using Optimel for just over 2 weeks, together with a cream cleanser Ilast and the results are very encouraging! I would say the above products have improved my issues by about 70% already (Optimel says improvement by 4 weeks)."
    • CocaCola has announced a new Coke Zero Sugar brand (a different formula from Coke Zero) today which has been marketed in other countries and will be now marketed in the USA. For you CocaCola lovers who want to avoid sugar you may want to try it out. CocaCola will be eventually drop Coke Zero from its line of products replace it with Coke Zero Sugar. Read this in the Los Angeles Times.  I have listed for your convenience the ingredients of Diet Coke, Coke Zero, and Coke Zero Sugar if you are interested in knowing:  Diet Coke 
      Ingredients: Carbonated Water, Caramel Color, Aspartame, Phosphoric Acid, Potassium Benzoate (To Protect Taste), Natural Flavors, Citric Acid, Caffeine. Coke Zero
      Ingredients: Carbonated Water, Caramel Color, Phosphoric Acid, Aspartame, Potassium Benzoate (To Protect Taste), Natural Flavors, Potassium Citrate, Acesulfame Potassium, Caffeine.  Coke Zero Sugar
      Ingredients: Water, Colour (Caramel E150d), Phosphoric Acid, Sweeteners (Aspartame, Acesulfame K), Natural Flavourings Including Caffeine, Acidity Regulator (Sodium Citrate). Contains a Source of Phenylalanine  
    • Related Articles Spotlight on brimonidine topical gel 0.33% for facial erythema of rosacea: safety, efficacy, and patient acceptability. Patient Prefer Adherence. 2017;11:1143-1150 Authors: Anderson MS, Nadkarni A, Cardwell LA, Alinia H, Feldman SR Abstract
      BACKGROUND: Brimonidine tartrate is a highly selective alpha 2 agonist that induces direct vasoconstriction of small arteries and veins, thereby reducing vasodilation and edema.
      OBJECTIVE: To review the current literature regarding the safety, efficacy, and patient acceptability of brimonidine 0.33% gel.
      METHODS: A PubMed search was performed using the terms brimonidine 0.33% gel, rosacea, safety, efficacy, and acceptability. Peer-reviewed clinical trials and case reports from 2012 to 2016 were screened for inclusion of safety, efficacy, and/or patient acceptability data.
      RESULTS: Brimonidine topical gel 0.33% is associated with mild, transient skin-related adverse reactions. Efficacy may be achieved within 30 minutes of administration with maximal reductions in erythema 3-6 hours after administration. Patient satisfaction with use of brimonidine topical gel is superior to vehicle gel for facial appearance, treatment effect, facial redness, and daily control of facial redness.
      LIMITATIONS: Studies were typically limited to 1-year follow-up. Only one study has examined the use of brimonidine topical gel in combination with other rosacea and acne medications.
      DISCUSSION: Brimonidine topical gel 0.33% is a safe, effective, and patient-accepted treatment for facial erythema of rosacea.
      PMID: 28740369 [PubMed] {url} = URL to article
    • Related Articles Late onset asymptomatic pancreatic neuroendocrine tumor - A case report on the phenotypic expansion for MEN1. Hered Cancer Clin Pract. 2017;15:10 Authors: Kaiwar C, Macklin SK, Gass JM, Jackson J, Klee EW, Hines SL, Stauffer JA, Atwal PS Abstract
      BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a hereditary cancer syndrome associated with several endocrine as well as non-endocrine tumors and is caused by mutations in the MEN1 gene. Primary hyperparathyroidism affects the majority of MEN1 individuals by age 50 years. Additionally, MEN1 mutations trigger familial isolated hyperparathyroidism. We describe a seemingly unaffected 76-year-old female who presented to our Genetics Clinic with a family history of primary hyperparathyroidism and the identification of a pathogenic MEN1 variant.
      CASE PRESENTATION: The patient was a 76 year-old woman who appeared to be unaffected. She had a family history of a known MEN1 pathogenic variant. Molecular testing for the known MEN1 mutation c.1A > G, as well as, biochemical testing, MRI of the brain and abdomen were all performed using standard methods. Molecular testing revealed our patient possessed the MEN1 pathogenic variant previously identified in her two offspring. Physical exam revealed red facial papules with onset in her seventies, involving her cheeks, nose and upper lip. Formerly, she was diagnosed with rosacea by a dermatologist and noted no improvement with treatment. Clinically, these lesions appeared to be facial angiofibromas. Brain MRI was normal. However, an MRI of her abdomen revealed a 1.5 cm lesion at the tail of the pancreas with normal adrenal glands. Glucagon was mildly elevated and pancreatic polypeptide was nearly seven times the upper limit of the normal range. The patient underwent spleen sparing distal pancreatectomy and subsequent pathology was consistent with a well-differentiated pancreatic neuroendocrine tumor (pNET).
      CONCLUSIONS: Age-related penetrance and variable expressivity are well documented in families with MEN1. It is thought that nearly all individuals with MEN1 manifest disease by age 40. We present a case of late-onset MEN1 in the absence of the most common feature, primary hyperparathyroidism, but with the presence of a pNET and cutaneous findings. This family expands the phenotype associated with the c.1A > G pathogenic variant and highlights the importance of providing comprehensive assessment of MEN1 mutation carriers in families that at first blush may appear to have isolated hyperparathyroidism.
      PMID: 28736585 [PubMed] {url} = URL to article
    • The Healthy Geezer: Red, bumpy nose is rosacea, not booze, By Fred Cicetti, Times Herald-Record
    • Related Articles Improvement of Rosacea During Acyclovir Treatment: A Case Report. Am J Clin Dermatol. 2017 Jul 21;: Authors: Badieyan ZS, Hoseini SS PMID: 28733947 [PubMed - as supplied by publisher] {url} = URL to article
    • Phymatous (Rhinophyma) [aka Subtype 3] This phenotype responds to treatment very well. Phymatous rosacea is uncommon. The most frequent phymatous manifestation is rhinophyma (known familiarly as "whiskey nose" "brandy nose" or "rum blossom"). In its severe forms, rhinophyma is a disfiguring condition of the nose resulting from hyperplasia of both the sebaceous glands and the connective tissue. Rhinophyma occurs much more often in men than in women (approximate ratio, 20:1), [1] and a number of clinicopathologic variants have been described. [2] Although rhinophyma is often referred to as "end-stage rosacea," it may occur in patients with few or no other features of rosacea. The diagnosis is usually made on a clinical basis, but a biopsy may be necessary to distinguish atypical, or nodular, rhinophyma from lupus pernio (sarcoidosis of the nose); basal-cell, squamous-cell, and sebaceous carcinomas; angiosarcoma; and even nasal lymphoma. [3] Older papers usually mention how rosacea progresses in stages and ends up in subtype 3, but recent studies indicate that this is not necessarily true. One can develop phenotype 5 without going through any 'stages.' [read this post] One report says, "It can affect nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma is the most frequent location..." [15] For images of phenotype 5 (formerly Subtype 3) click below: http://goo.gl/BI2lf;  28 Images of Rhinophyma A classic example of Subtype 3 is WC Fields (the rosacea poster boy):
      Another classic example is this painting in the Louvre, "The Old Man and His Grandson" by Ghirlandiao around the year 1480.


      There are Five Variants of Rhinophyma:
      Glandular
      Fibrous
      FibroangiomatousActinic
      Rhinophymous
      leishmaniasis  This is a great thread to read about Subtype 3. Treatment There are a number of different treatments for rhinophyma, including surgery, but it is better to treat the rosacea before it reaches the advance stage of rhinophyma. However, once rhinophyma has developed it can usually be corrected by surgery using either laser, scapel, or dermabrasion. The good thing about rhinophyma is that though this condition is generally regarded as a severe form of rosacea it is a relatively rare disorder involving thickening of the skin on the nose and the presence of many oil glands and this condition can usually can be corrected. Accutane is usually the drug of choice, but your physician may use other prescription drugs such as antibiotics if you have this skin disorder. Other treatment may involve cryosurgery, dermashaving and electrosurgery. "Coblation of rhinophyma is an effective treatment with few side effects." [4] ""...Initially, the mass was thought to be rhinophyma, but biopsy of the mass revealed noncaseating granulomata consistent with sarcoidosis. The mass resolved following several steroid injections..." [5] Radiofrequency is used to treat rhinophyma. [6]Rhinophyma treated with kilovoltage photons {7]Treatment of rhinophyma with ultrasonic scalpel: case report [8] Radiosurgical excision of rhinophyma. [9] "Surgery is indisputably the treatment of choice for rhinophyma." [10] This report said, "Despite many advances in fundamental understanding, surgical techniques, and related technologies, no single method has been universally embraced and employed as the "gold standard." " [11] Smoothbeam laser [13] Surgical Management [14] Another report says, "Both tangential excision and carbon dioxide laser are well-established, reliable procedures for rhinophymaplasty that preserve the underlying sebaceous gland fundi allowing spontaneous re-epithelialization without scarring with similar outcomes and high patient satisfaction. The original nose shape and nearly normal skin surface texture are preserved by quickly removal of the hypertrophic tissue sparing the pilosebaceous tissue. The CO(2) laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs." [16] Another report, which says, "a surgical "gold standard" for treating the distorting phymatous skin alterations has not yet been established," it goes on to state, "the combination of a bovine collagen-elastin with simultaneous autologous non-meshed split-thickness skin grafting" was used in a surgery, and "may ultimately avoid the recurrence of rhinophyma and contribute to a full skin repair leading to satisfactory functional and aesthetic outcome." [17] "This report describes a simple, safe, efficient, and cost-effective approach to the treatment of severe rhinophyma using a scalpel and the electroscalpel, instruments readily available in every operating room." [18] Scalpel Excision and Wire Loop Tip Electrosurgery [19] One reports says, "The CO2 laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs." [20] Salicylic acid 30% • Jojoba oil • Glycolic acid 70% • Baking Soda • Dawn Ultra Low Dose Isotretinoin Another treatment has been reported, coblation. The report says, "A hand-held coblation ‘wand’ emits a slow stream of saline solution – sterilised salt water – from the end that comes into contact with the nose. At the same time, it emits waves of radiofrequency energy to excite the molecules in the solution which ‘sands’ down the tissue. It also uses a low heat to cauterise (clot) any bleeding blood vessels." [12] Anecdotal Reports  Nose Swelling, big pores, phymous tissue--please post! End Notes [1] Roberts JO, Ward CM. Rhinophyma. J R Soc Med 1985;78:678-681.[iSI] [Medline] [2] Aloi F, Tomasini C, Soro E, Pippione M.
      The clinicopathologic spectrum of rhinophyma.
      J Am Acad Dermatol 2000;42:468-472.[CrossRef][iSI] [Medline] [3] Murphy A, O'Keane JC, Blayney A, Powell FC.
      Cutaneous presentation of nasal lymphoma: a report of two cases.
      J Am Acad Dermatol 1998;38:310-313.[iSI] [Medline]

      [4] Coblation of rhinophyma.
      Timms M, Roper A, Patrick C.J Laryngol Otol. 2011 Apr 27:1-5.

      [5] Sarcoidosis of the external nose mimicking rhinophyma. Case report and review of the literature.
      Goldenberg JD, Kotler HS, Shamsai R, Gruber B.Ann Otol Rhinol Laryngol. 1998 Jun;107(6):514-8.

      [6] Management of mild to moderate rhinophyma with a radiofrequency.
      Erisir F, Isildak H, Haciyev Y.J Craniofac Surg. 2009 Mar;20(2):455-6. [7] Rhinophyma treated with kilovoltage photons.
      Skala M, Delaney G, Towell V, Vladica N.Australas J Dermatol. 2005 May;46(2):88-9. [8] Treatment of rhinophyma with ultrasonic scalpel: case report.
      Tenna S, Gigliofiorito P, Langella M, Carusi C, Persichetti P.J Plast Reconstr Aesthet Surg. 2009 Jun;62(6):e164-5. Epub 2008 Dec 12. [9] Radiosurgical excision of rhinophyma.
      Somogyvári K, Battyáni Z, Móricz P, Gerlinger I.Dermatol Surg. 2011 May;37(5):684-7.
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    • Related Articles [Rosacea: New data for better care]. Ann Dermatol Venereol. 2017 Jul 17;: Authors: Cribier B Abstract
      In the last 10 years, numerous studies have been published that throw new light on rosacea, in all areas of the disease. This overview summarises all the key developments, based on the indexed bibliography appearing in Medline between 2007 and 2017. Recent epidemiological data show that the prevalence of the disease is doubtless greater than estimated hitherto (more than 10% of adults in some countries) and that we should not overlook rosacea in subjects with skin phototypes V or VI, a condition that exists on all continents. A new classification of rosacea by phenotype comprising major and minor signs has been put forward; it provides a more rational approach to suitable management based upon symptoms, the severity of which may be graded into 5 classes. The treatments with the best-demonstrated efficacy (updated Cochrane study) are topical metronidazole, azelaic acid and ivermectin, and oral doxycycline; isotretinoin is effective against resistant forms but is off-label. In ocular rosacea, the reference treatment is doxycycline in combination with topical therapy of the eyelids. The physiopathology is complex and involves several factors: vascular (vasodilatation, vascular growth factors), neurovascular (hypersensitivity, neuropathic pain, neuropeptides), infectious (Demodex folliculorum and its microbiota) and inflammatory (abnormal production of pro-inflammatory peptides of the innate immune system). In addition, there is a genetic predisposition as demonstrated by the weight of familial history and comparison of homozygous and heterozygous twins. There is also activation of several genes involved in immunity, inflammation and lipid metabolism; the theory of hydrolipid film anomalies has been posited once more. There has thus been a tremendous leap forward in the field of rosacea research, with therapeutic progress and improved understanding of the underlying mechanisms, which should enable the future development of more targeted treatments as well as global management of this disease, which has major social and emotional consequences on the life of patients.
      PMID: 28728857 [PubMed - as supplied by publisher] {url} = URL to article
    • Face flushing? You might want to look at what you’re drinking: Alcohol can raise your risk of a skin condition called rosacea, a new study published in the Journal of the American Academy of Dermatology suggests. In the study, researchers quizzed nearly 83,000 people on their alcohol intake every four years. They discovered that the more total alcohol they drank, the more likely they were to develop rosacea over the 14-year follow up. How Booze Can Make Your Face Red, Flushed, and Swollen, BY CHRISTA SGOBBA, Men's Health
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