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    • This question was asked and I am sharing my answer here as well.   Basically everyone has demodex mites and it has been thought that the mites have some sort of undisclosed symbiotic relationship, i.e., the mites eat sebum which helps the mites and helps the humans keep sebum stasis. One report states, "....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host." - See Jarmuda et al published in the Journal of Medical Microbiology (second article mentioned in this post). While this same report says that 'most human populations' have NOT been sampled for demodex mites the general belief is that demodex are common throughout humanity and pose no problem as a pathogen except in the case of demodectic rosacea as far as known.    A Russian study on the mites says, "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte."  It is comparable to bacteria which humans have a relationship with, there is good bacteria and bad bacteria. The probiotic bacteria and the pathogen bacteria. The demodex mites usually pose no problem with the vast majority of humans since they are possibly on everyone. Why they become more numerous seems to be of more importance.    For some unknown reason the mites are in higher density in rosacea patients. We don't know if the rosacea cause this increase in mites or does the increase in mites cause the rosacea, the old chicken or egg conundrum? There is evidence that reducing the mite density count improves rosacea.  It is clear that the mites like human skin since they eat sebum.     Maybe the increase of sugar/carbohydrate in the diet increases sebum which in turn increases the mite population, and voila, the inflammation of rosacea?    I don't think all rosacea is demodectic. GUT Rosacea is a different variant, but may be connected or associated.  The list of systemic comorbidities with rosacea keeps growing. The gut microbiome is obviously connected with skin microbiome (see my post on this).  
    • Related Articles Epidemiological features of rosacea in Changsha, China: A population-based, cross-sectional study. J Dermatol. 2020 Mar 24;: Authors: Li J, Wang B, Deng Y, Shi W, Jian D, Liu F, Huang Y, Tang Y, Zhao Z, Huang X, Li J, Xie H Abstract Rosacea is a common chronic skin disorder of unknown etiology. While population prevalence rates range 0.2-22% in Europe and North America, prevalence in China is currently undetermined. We conducted a large population-based case-control study to determine the present epidemiological status of rosacea in China, involving 10 095 participants aged 0-100 years (mean age, 35.5 ± 19.1; 50.5% female). A census of rosacea among 15 communities in Changsha in south central China was conducted with skin examination by board-certified dermatologists. Rosacea was observed in 3.48% (95% confidence interval, 3.13-3.85%) of the study population. Subtype distribution was erythematotelangiectatic in 47.6%, papulopustular in 35.0% and phymatous in 17.4%. Family history was noted in 37.8% and ocular symptoms in 31.3%. Associations with rosacea were observed for melasma, hypertension, hyperthyroidism and breast cancer in females (P < 0.05), and also for hyperthyroidism and peptic ulcers in males (P < 0.05). Our results provide baseline information about epidemiological aspects of rosacea in China. PMID: 32207167 [PubMed - as supplied by publisher] {url} = URL to article
    • Yes, because its all about immune system and HCQ does modulate the immune system in various ways and regulate the overactivity of immune system in some conditions. Not only does it work in getting rid of symptoms but it actually works behind the disease cause.
    • The president announced on March 19, 2020 that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19.  Virus has never been ruled out in rosacea.  CNN has a followup report on this.  There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him.  Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea?  If you do take hydroxycholoroquine and your rosacea improves, please let us know.
    • Related Articles Rosacea is Characterized by a Profoundly Diminished Skin Barrier. J Invest Dermatol. 2020 Mar 18;: Authors: Medgyesi B, Dajnoki Z, Béke G, Gáspár K, Szabó IL, Janka EA, Póliska S, Hendrik Z, Méhes G, Törőcsik D, Bíró T, Kapitány A, Szegedi A Abstract Rosacea is a common, chronic inflammation of sebaceous gland-rich facial skin characterized by severe skin dryness, elevated pH, transepidermal water loss, and decreased hydration levels. Until now, there has been no thorough molecular analysis of permeability barrier alterations in the skin of rosacea patients. Thus, we aimed to investigate the barrier alterations in papulopustular rosacea (PPR) samples compared to healthy sebaceous gland-rich (SGR) skin, using RNASeq analysis (n=8). Pathway analyses by Cytoscape ClueGo revealed 15 significantly enriched pathways related to skin barrier formation. RT-PCR and immunohistochemistry were used to validate the pathway analyses. The results showed significant alterations in barrier components in PPR samples compared to SGR, including the cornified envelope and intercellular lipid lamellae formation, desmosome and tight junction organizations, barrier alarmins, and antimicrobial peptides. Moreover, the barrier damage in PPR was unexpectedly similar to atopic dermatitis (AD); this similarity was confirmed by immunofluorescent staining. In summary, besides the well-known dysregulation of immunological, vascular, and neurological functions, we demonstrated prominent permeability barrier alterations in PPR at the molecular level, which highlight the importance of barrier repair therapies for rosacea. PMID: 32199994 [PubMed - as supplied by publisher] {url} = URL to article
    • "Webster et al. report a multicentre, randomized, double‐masked, parallel‐group, vehicle‐controlled study to evaluate the safety and efficacy of minocycline gel 1% and 3%. Topical minocycline had insignificant systemic absorption but produced significant reductions in mean inflammatory lesion counts with both the 1% and 3% concentrations. The response rate in the vehicle group was quite high, as is often the case in diseases with fluctuating inflammation. However, the 3% concentration of minocycline showed a significantly greater proportion of patients achieving Investigator's Global Assessment success at week 12 compared with vehicle. A topical minocycline foam formulation is in development, and this may provide a further useful option for treating papulopustular rosacea. How topical minocycline compares with other topical rosacea treatments is as yet unclear." Br J Dermatol. 2020 Mar 18;: Expanding treatment options for rosacea. Hampton PJ
    • Related Articles Expanding treatment options for rosacea. Br J Dermatol. 2020 Mar 18;: Authors: Hampton PJ PMID: 32189331 [PubMed - as supplied by publisher] {url} = URL to article Full Text
    • Related Articles Value of reflectance confocal microscopy for the monitoring of rosacea during treatment with topical ivermectin. J Dermatolog Treat. 2020 Mar 19;:1-9 Authors: Logger JGM, Peppelman M, van Erp PEJ, de Jong EMGJ, Nguyen KP, Driessen RJB Abstract Background: Reflectance confocal microscopy (RCM) enables noninvasive Demodex mite detection in rosacea. Objective scoring of rosacea severity is currently lacking.Objectives: To determine the value of RCM for monitoring Demodex, inflammation and vascular parameters in rosacea during treatment.Methods: In 20 rosacea patients, clinical and RCM examination were performed before, during, and 12 weeks after a 16-week treatment course with topical ivermectin. Using RCM, number of mites and inflammatory cells, epidermal thickness, and vascular density and diameter were measured. RCM features were correlated with clinical assessment.Results: Treatment resulted in clinical reduction of inflammatory lesions. Mites were detected in 80% of patients at baseline, 30% at week 16, and 63% at week 28. The number of mites reduced significantly during treatment, but no changes in inflammatory cells, epidermal thickness or vascular parameters were observed. Correlation between number of inflammatory lesions and mites was low. None of the RCM variables were significant predictors for clinical success.Conclusions: RCM enables anti-inflammatory effect monitoring of topical ivermectin by determining mite presence. Quantifying exact mite number, and inflammatory and vascular characteristics is challenging due to device limitations. In its current form, RCM seems of limited value for noninvasive follow-up of rosacea in clinical practice. PMID: 32189533 [PubMed - as supplied by publisher] {url} = URL to article
    • The president announced today that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19. As mentioned in the initial post in this thread, virus has never been ruled out in rosacea. CNN has a followup report on this.  There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him.  Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea?  If you do take hydroxycholoroquine and your rosacea improves, please let us know.
    • "In this case report, we detail the response of a 37-year-old Caucasian man with an overlap of erythematotelangiectatic rosacea and telangiectatic photoaging to brimonidine tartrate gel. With the application of brimonidine only on half of his face, skin analysis images, clinician's and patient's assessment showed that there was significant improvement in the erythema. This case has lent insight into how brimonidine can be used to assess the extent of photoaging by eliminating the erythema of rosacea to some degree. We propose that it can be used as a non-invasive test to differentiate between the two conditions, sparing patients from skin biopsies and molecular analysis." Australas J Dermatol. 2017 Feb;58(1):63-64. doi: 10.1111/ajd.12430. Epub 2016 Jan 13. Rosacea or photodamaged skin? Use of brimonidine gel in differentiating erythema in the two conditions. Oon HH, Lim ZV.
    • Telangiectatic Photoaging  "Telangiectatic photoaging is characterized by less transient and nontransient erythema, a more lateral distribution of erythema and telangiectasia, less neurogenic mast cell activation, and less MMP-mediated matrix remodeling than ETR. These data demonstrate that TP is a distinct clinical entity from ETR that can be distinguished on the basis of clinical, histologic, and gene expression findings." JAMA Dermatol. 2015;151(8):825-836. doi:10.1001/jamadermatol.2014.4728 Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging Yolanda R. Helfrich, MD; Lisa E. Maier, MD; Yilei Cui, PhD; et al JAMA Dermatol. 2015 Aug;151(8):825-36. doi: 10.1001/jamadermatol.2014.4728. Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging. Helfrich YR, Maier LE, Cui Y, Fisher GJ, Chubb H, Fligiel S, Sachs D, Varani J, Voorhees J. JK Wilkin has a comment on the above article published in JAMA and another in the NEJM. 
    • Related Articles Identification of Long Noncoding RNA Associated ceRNA Networks in Rosacea. Biomed Res Int. 2020;2020:9705950 Authors: Wang L, Lu R, Wang Y, Wang X, Hao D, Wen X, Li Y, Zeng M, Jiang X Abstract Rosacea is a chronic and relapsing inflammatory cutaneous disorder with highly variable prevalence worldwide that adversely affects the health of patients and their quality of life. However, the molecular characterization of each rosacea subtype is still unclear. Furthermore, little is known about the role of long noncoding RNAs (lncRNAs) in the pathogenesis or regulatory processes of this disorder. In the current study, we established lncRNA-mRNA coexpression networks for three rosacea subtypes (erythematotelangiectatic, papulopustular, and phymatous) and performed their functional enrichment analyses using Gene Onotology, KEGG, GSEA, and WGCNA. Compared to the control group, 13 differentially expressed lncRNAs and 525 differentially expressed mRNAs were identified in the three rosacea subtypes. The differentially expressed genes identified were enriched in four signaling pathways and the GO terms found were associated with leukocyte migration. In addition, we found nine differentially expressed lncRNAs in all three rosacea subtype-related networks, including NEAT1 and HOTAIR, which may play important roles in the pathology of rosacea. Our study provided novel insights into lncRNA-mRNA coexpression networks to discover the molecular mechanisms involved in rosacea development that can be used as future targets of rosacea diagnosis, prevention, and treatment. PMID: 32185228 [PubMed - in process] {url} = URL to article Full Article (if anyone can make heads or tails of this article it would be much appreciated if someone could translate this paper into layman's language)  Please comment on this by clicking the green REPLY button.  In the abstract paragraph above it mentions 'NEAT1 and HOTAIR, which may play important roles in the pathology of rosacea.' If you look at the diagram above at the top of the post you can find NEAT1 near the center of the diagram in red and HOTAIR just below NEAT1 to the right in blue. That probably helped you out a lot, didn't it? Just trying to helpful. 
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