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    • Melasma, (aka, chloasma faciei) can co-exist with rosacea. "The symptoms of melasma are dark, irregular well demarcated hyperpigmented macules to patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Melasma is also common in pre-menopausal women. It is thought to be enhanced by surges in certain hormones." Wikipedia Mistca who suffers from rosacea and melasma responded to a post here about what she has done for both conditions which may help you in your quest to find a solution and here are her remarks:  Hi,
      I developed melasma due to taking the progesterone only pill. Attempts to treat the melasma with Retin A irritated the hell out of my skin, and led to rosacea, and later on, severe flushing, due to being given ventolin (which I did not need). I also had gut issues and a bunch of other stuff going on at the same time.
      Lots of disasters happened to me along the way leading to my current state.

      That aside. Melasma. Did you know it is not just a pigment disorder? It actually has a vascular component.
      Here is one article which speaks about it.

      I battled the hideous mess for years and it ruined my life. Trying to treat Rosacea on a background of melasma is a nightmare.

      Later on in years, I discovered I was iodine deficient and supplementation finally rid me of the remnants of the pigmentation issue. I do realise it could still be lurking beneath the skin.

      In addition, pigment issues are often connected to thyroid dysfunction. I went on to develop Hashimoto's disease during the time I was iodine deficient, but hashi's is a complex disease and has many other contributing factors. 

      Currently I am completely free of melasma, but struggle to completely rid myself of rosacea and flushing, although for a couple of years, I was in a pretty decent state. 

      Oral and topical niacinamide (which I take/use), are also beneficial for alleviating melasma. Melasma has an oxidative stress factor which the above help alleviate. I take oral vitamin C, but don't use it topically due to irritation.

      I also use ZZ cream, which I mix with my niacinamide gel and that helps calm and control my subtype 1 rosacea/flushing. I expect it helps with controlling pigment too.

      High dose oral vitamin C, moderate zinc and gut antimicrobials have brought about a reduction of melasma in a number of other women. A quick google should lead you to them. 

      Another thing you might consider is elevating your glutathione levels with NAC. Around 200mg. Any more might cause flushing. 
      Glutathione is considered a master antioxidant and could help relieve both your melasma and rosacea.

      Of course, the above treatments take a fairly long time to work, but I do believe they have merit. I have spent decades researching the subject and applying different methods.

      IPL can make melasma much worse and progressive. Been there, done that.

      Based on what you say, I suspect you do have a form of rosacea/flushing. ----end post 
    • A biopsy is not required to take a demodex density count. All is needed is dermoscopy: 

      Scroll down to this article and look for Dermoscopy for more details. What are the numbers of demodex on normal skin compared to those who have demodectic rosacea? They are reports that the numbers are higher in rosacea sufferers who suffer from demodectic rosacea. One report says, "Instead of 1 or 2 per square centimetre of skin, the number rises to 10 to 20." Another report says, "The mean mite count was 49.8 (range 2 to 158) in patients with rosacea and 10.8 (range up to 97) in control subjects (p < 0.001); the highest density of mites was found on the cheeks. A statistically significant increase in mites was found in all subgroups of rosacea, being most marked in those with steroid-induced rosacea."

      There are reports in RF of simply a taking cellophane tape scraping of the cheek and examining under a simple microscope you can by at Amazon and do it yourself, for example this post. 

      There is evidence that decreasing the demodex density count improves rosacea.  

      Physicians rarely take demodex density counts. In his authoritative book on rosacea, Frank Powell, MD, wrote on the last paragraph of page 82 in his book:

      “There is no laboratory test or investigation that will confirm the diagnosis of PPR. Specific investigations may be required to rule out similar appearing conditions (many of which will be identified by listening carefully to the patient’s medical history and examining the skin lesions). These include skin swabs for bacterial culture, skin scrapings for the presence of demodex mites, scrapings for fungal KOH and fungal culture, skin biopsy for histologic examination, (and rarely culture) skin surface biopsy for demodex mite quantification, patch tests, photopatch tests, and very rarely systemic workup wih appropriate blood tests and radiological examinations.”

      How many dermatologists do you know do such a detailed history and examination? When you were diagnosed with rosacea, did your physician come close to what is mentioned in the above paragraph? So be sure to read HunkeyMonkey's post on Cheap and easy home test for Demodex
    • Just ran a nine day course of Prednisone and thought it appropriate to post this here to see the results. 
    • Just ran a nine day course of Prednisone and thought it appropriate to post this here to see the results. 
    • ElaineA Home Made Ivermectin Cream (Cheaper than Soolantra or Permethrin Creams) How to blend your own Ivermectin Cream for treating Rosacea and possibly Occular Rosacea (eye lids and face only, do NOT put this stuff in your eyes!) Soolantra (1% Ivermectin cream) costs your insurance company or uninsured patients about $455 per 45 gram tube.
      A competing product, Permethrin cream which contains 5% Permethrin is available for as low as $41.21 for a 60 gram tube(GoodRx price quoted today at Walmart). Permethrin is used to treat scabies and lice and is sometimes prescribed for demodex mites as well. Soolantra Ingredients:
      1. Galderma states that Soolantra is 1% Ivermectin in their Cetaphil Moisturizing Cream. Cetaphil is noted for making high quality moisturizers.
      - Cetaphil Moisturizing Cream - 20 Oz available from Amazon for $16.69 (- Amazon rating is 4.5 stars) OR a travel size container may be found for about $2-$3 in the drugstore travel section. 2. Ivermectin - available in inexpensive generic prescription form. The Ivermectin drug has been available since 1975 and is off patent.
      - Amazon sells the Duramectin Ivermectin Paste 1.87% For Horses, 0.21 oz for $5.37 or a 3-pack for $11.24 I wonder if you could make your own Ivermectin Cream? The horse paste is for horses but is edible at least by horses. If there is nothing irritating in it, it might work OK for humans when applied topically. Dilution equation from Wikipedia:
      C1 * V1 = C2 * V2 To dilute the 1.87% horse paste with the cream down to a 1% solution would then work out to:
      0.0187 * 0.21 = 0.01 * V2 V2 = (0.0187/0.01) * 0.21 = 0.3927 oz Total Volume of completed mix. Amount of Moisterizer to Add is 0.3927 - 0.21 = 0.1827 oz. (5.18 grams) of cream per tube of horse paste. That will dilute it to the same 1% solution in Soolantra. One tube of Duramectin paste mixed with a good moisturizing cream would yield about 11.13 grams of ivermectin cream.
      The full 3 pack of Duramectin + 0.5481 oz of Cetaphil moisturizing cream would yield 1.18 oz or about 33.45 grams of ivermectin cream. I don't know if this would be useful or not. The Duramectin paste might be irritating in some way to humans. But it would certainly be cheaper with about $20 or less cost vs. $455 per tube of Soolantra.
    • Marcello, a lawyer, says, "Ten days ago, I bought Lutein-Z with zeaxanthin (10 mg) from Jamieson brand and started to take it with Canola oil (to improve lutein's absorption). That, of course, was to protect my eyes and nothing else. Then a couple of days later I noticed that I had no more new pustules on my face. Not a single new one !!! I was honestly wondering what was happening, then I realized that the only thing that could explain it was my new intake of lutein. It's been 10 days now since I took my first pill and my face is still completely clear." [post no. 1] Also see post no 20 in this thread]
      "Lutein from Latin luteus meaning "yellow" is a xanthophyll and one of 600 known naturally occurring carotenoids." Wikipedia
      "Zeaxanthin is one of the most common carotenoid alcohols found in nature. It is important in the xanthophyll cycle." Wikipedia "Dr Lange also likes to add 6 mg of astaxanthin along with some lutein and zeaxanthin in moderate to marked cases of blepharitis for the additional anti inflammatory properties when used together with omega 3." Natural Treatment for Blepharitis by Dr Michael Lange  If you decide to try Lutein with Zeaxanthin please use our Amazon Affiliate store (we get a small fee if you purchase through our store and you will helping our non profit organization). Please post your experience in this thread. Mahalo. 
    • Related Articles Psychosocial aspects of rosacea with a focus on anxiety and depression. Clin Cosmet Investig Dermatol. 2018;11:103-107 Authors: Heisig M, Reich A Abstract
      Background: Rosacea is a common, chronic skin condition characterized by facial redness and inflammatory lesions. The disease can lead to social stigmatization and may significantly reduce the quality of life of patients. Psychosocial impact of rosacea can be severe and debilitating; however, it is still underestimated.
      Objective: This paper provides a literature review focused on depression and anxiety in patients with rosacea.
      Conclusion: Rosacea patients have an increased risk of developing depression and anxiety and tend to avoid social situations. However, there are still limited data on this condition. Effective treatment of clinical symptoms brings significant improvement in psychological symptoms. Further studies should be conducted to investigate in more detail the psychological impact of rosacea. In addition, improvement of the efficacy of rosacea treatment is still needed.
      PMID: 29551906 [PubMed] {url} = URL to article
    • Related Articles Genome-Wide Analysis Characterization and Evolution of SBP Genes in Fragaria vesca, Pyrus bretschneideri, Prunus persica and Prunus mume. Front Genet. 2018;9:64 Authors: Abdullah M, Cao Y, Cheng X, Shakoor A, Su X, Gao J, Cai Y Abstract
      The SQUAMOSA promoter binding protein (SBP)-box proteins are plant-specific transcriptional factors in plants. SBP TFs are known to play important functions in a diverse development process and also related in the process of evolutionary novelties. SBP gene family has been characterized in several plant species, but little is known about molecular evolution, functional divergence and comprehensive study of SBP gene family in Rosacea. We carried out genome-wide investigations and identified 14, 32, 17, and 17 SBP genes from four Rosacea species (Fragaria vesca, Pyrus bretschneideri, Prunus persica and Prunus mume, respectively). According to phylogenetic analysis arranged the SBP protein sequences in seven groups. Localization of SBP genes presented an uneven distribution on corresponding chromosomes of Rosacea species. Our analyses designated that the SBP genes duplication events (segmental and tandem) and divergence. In addition, due to highly conserved structure pattern of SBP genes, recommended that highly conserved region of microsyneteny in the Rosacea species. Type I and II functional divergence was detected among various amino acids in SBP proteins, while there was no positive selection according to substitutional model analysis using PMAL software. These results recommended that the purifying selection might be leading force during the evolution process and dominate conservation of SBP genes in Rosacea species according to environmental selection pressure analysis. Our results will provide basic understanding and foundation for future research insights on the evolution of the SBP genes in Rosacea.
      PMID: 29552026 [PubMed] {url} = URL to article
    • Related Articles Quality of Life in Individuals with Erythematotelangiectatic and Papulopustular Rosacea: Findings From a Web-based Survey. J Clin Aesthet Dermatol. 2018 Feb;11(2):47-52 Authors: Zeichner JA, Eichenfield LF, Feldman SR, Kasteler JS, Ferrusi IL Abstract
      OBJECTIVE: The objective of the study was to evaluate the impact of rosacea on self-perception, emotional, social, and overall well-being and quality of life in individuals with erythematotelangiectatic rosacea (ETR) and papulopustular rosacea (PPR). DESIGN: We distributed a cross-sectional email invitation for participants in the United States to fill out a web-based survey. PARTICIPANTS: We included adults who reported having previously received a diagnosis of erythematotelangiectatic rosacea or papulopustular rosacea. MEASUREMENTS: Questionnaires measured the psychosocial aspects of rosacea, including the Satisfaction With Appearance Scale and modified Satisfaction With Appearance Scale questionnaires, Impact Assessment for Rosacea Facial Redness, Rosacea-Specific Quality-of-Life questionnaire, and RAND 36-Item Short Form Health Survey. The Impact Assessment for Rosacea Facial Bumps or Pimples was administered to the papulopustular rosacea cohort. RESULTS: Six hundred participants enrolled and completed the survey, with most rating their rosacea as mild or moderate (ETR: 95.6%; PPR: 93.7%). In the erythematotelangiectatic rosacea and papulopustular rosacea cohorts, respectively, 45 and 53 percent disagreed/strongly disagreed that they were satisfied with their appearance due to rosacea; 42 and 27 percent agreed/strongly agreed that they "worry how people will react when they see my rosacea"; and 43 and 59 percent agreed/strongly agreed that they feel their rosacea is unattractive to others. Rosacea-Specific Quality-of-Life total and domain scores indicated negative impact of rosacea for both cohorts. Both cohorts reported worse 36-item Short Form Health Survey overall and domain scores than population norms in the United States. CONCLUSION: Rosacea had wide-ranging, negative effects on self-perceptions and emotional, social, and overall well-being as well as rosacea-specific quality of life. Overall, both erythematotelangiectatic rosacea and papulopustular rosacea cohorts reported a substantial negative impact of rosacea on quality of life on a range of instruments.
      PMID: 29552276 [PubMed] {url} = URL to article
    • "Acne rosacea, or more commonly called just rosacea, affects 14 million people in the U.S., or five percent of the population, and is sometimes said to be an adult version of acne vulgaris." Rosacea affects 5 percent of population, Richard P. Holm, Medical Doctor, Argus Leader, Part of the USA Network, Dec 11, 2017
    • Martin Schaller, MD, from the Department of Dermatology, Eberhard Karls University Tuebingen in Germany has co-wrote a paper that proposes using topical Ivermectin (Soolantra) to treat ocular rosacea. Dr. Schaller is a member of the RRDi MAC.  Br J Dermatol. 2018 Mar 12. doi: 10.1111/bjd.16534. 
      Successful therapy of ocular rosacea with topical ivermectin.
      Schaller M, Pietschke K. This was first announced by David Pascoe at RSG. 
    • A number of reports from patients who have used photo dynamic therapy [PDT] complain of hair loss, particularly males. Here is a list:  samoht  timo  [more will be added if anyone posts in this thread] The main point is that you should be aware that PDT has a risk of hair loss. Apparently PDT can be used to stimulate hair growth or eliminate hair growth, depending on the desired treatment.  "Several new devices (in-office procedures and at-home devices) are being touted to reverse hair loss and restore hair growth..." [1] "Our results suggest that PDT can damage the nonpigmented hair matrix, but not stem cells or dermal papillae. Repeated PDT may impair the hair-regeneration capacity via a bystander effect on bulge stem cells or dermal papillae. In this study, we found it was possible to remove nonpigmented hair using PDT" [2] "Low power CW He:Ne laser and methylene blue (MB) offered a successful PDT system in selectively damaging hair follicles, leaving an intact epidermis. The current PDT system provides better outcome than hair destruction through laser heat transfer procedures and laser-mediated hair removal, due to complete destruction of hair follicles." [3] "Here at WellMedica we treat hair loss and alopecia through Low Level Laser Therapy."  "An experimental method combining chemicals and radiation to induce controlled hair loss or reduction" Hair Facts, Photodynamic therapy hair removal End Notes [1] New generation of laser and light therapies could provide future treatment options for skin, hair and nail conditions
      American Academy of Dermatology’s 70th Annual Meeting by Molly Wanner, MD, FAAD, instructor at Harvard Medical School and dermatologist at Massachusetts General Hospital in Boston.  [2] Lasers Surg Med. 2016 Oct;48(8):748-762. doi: 10.1002/lsm.22570. Epub 2016 Aug 9.
      Nonpigmented hair removal using photodynamic therapy in animal model.
      Shin H, Yoon JS2,, Koh W, Kim JY2,, Kim CH, Han KM, Kim EJ, Kwon  [3] Photodynamic therapy for hair removal
      Mohamed H.M. Ali, Mohamed M. Hashem, Amr Zaher, Soheir Korraa, Farouk Hamouda, Carmen M. Ali, Khalid A. Al-Saad
      QScience Connect 2013:16
    • Out of 103 female patients 34 percent of the study group show signs of hair loss [frontal fibrosing alopecia] (FFA). J Am Acad Dermatol. 2018 Mar;78(3):596-597.e1. doi: 10.1016/j.jaad.2017.09.004.
      Frontal fibrosing alopecia and cutaneous comorbidities: A potential relationship with rosacea.
      Pindado-Ortega C, Saceda-Corralo D, Buendía-Castaño D, Fernández-González P, Monero-Arrones ÓM, Fonda-Pascual P, Rodrigues-Barata AR, Jaén-Olasolo P, Vañó-Galván S.
    • In this study, we aimed to determine if low doses of isotretinoin were effective in patients with treatment-resistant rosacea. Efficacy of Low-Dose Isotretinoin in Patients With Treatment-Resistant Rosacea
      (Arch Dermatol. 1998;134:884-885)  This report of cases describes the safe and successful use of therapeutic-dose oral isotretinoin in 3 patients with a history of pseudotumor cerebri. Drugs common in the treatment of acne vulgaris, such as minocycline and isotretinoin, have been reported in association with pseudotumor cerebri (PTC), which can lead to severe, irreversible symptoms, including vision loss. There is a paucity of data on isotretinoin use in patients with prior PTC. Safe Use of Therapeutic-Dose Oral Isotretinoin in Patients With a History of Pseudotumor Cerebri
      JAMA Dermatol.2015 Nov 18. doi: 10.1001/jamadermatol.2015.3447. [Epub ahead of print]]
      Suzanne J. Tintle, MD, MPH; Julie C. Harper, MD; Guy F.Webster, MD, PhD; Grace K. Kim, DO; Diane M. Thiboutot,MD;
    • In this article, the authors discuss the use of oral isotretinoin in the management of rosacea, exploring dosage, comparable efficacy, safety, and cost. J Clin Aesthet Dermatol. 2011 Sep; 4(9): 54–61.
      PMCID: PMC3175801
      Use of Oral Isotretinoin in the Management of Rosacea
      Hyunhee Park, DO and James Q. Del Rosso, DO, FAOCD
    • To get members involved in posting in our forum, we are giving away free copies of the Journal of the RRDi (as long as funds permit) to members who will post at least 10 posts in our forum. To qualify for a free copy use the contact form stating that from todays date, March 18, 2018, you have posted at least ten posts. We will need to then confirm you are the member who actually did the ten posts and send the copy of the journal to you. 
    • ag2001 says, "The second saving grace for me has been alevicyn gel. It is a prescription and not a steroid or an antibiotic. It’s safe for long term use and I lather it on at night - spot treat anything with it during the day. It’s clear and leaves a little flaky look, but almost like a concealer." [post no 2] Alevicyn contains hypochlorous acid which is "a weak acid that forms when chlorine dissolves in water, and itself partially dissociates, forming ClO-. HClO and ClO- are oxidizers, and the primary disinfection agents of chlorine solutions." Wikipedia "ALEVICYNTM Antimicrobial Dermal Spray cleanses, irrigates and moistens, and removes foreign material, including microoganisms." "ALEVICYNTM Antipruritic Gel relieves the itch and pain associated with skin irritations and wounds, such as sores, injuries and ulcers of skin tissue." "ALEVICYNTM Antipruritic SG sprays like a liquid and adheres like a gel to relieve the burning, itching and pain from atopic dermatitis. It’s ideal for larger or harder-to-reach skin surfaces." Alevicyn Official Website by  IntraDermTM Pharmaceuticals, a division of Sonoma Pharmaceuticals, Inc. 
    • Recent studies confirm that a bacteria in the mites (Bacillus oleronius, Staphylococcus epidermidis, Bartonella quintana, Bacillus pumilus or Bacillus cereus) may be associated with rosacea. For more information. 
    • Ivermectin 1% (CD5024) for the treatment of rosacea. Expert Opin Pharmacother. 2018 Mar 16;:1-6 Authors: Sahni DR, Feldman SR, Taylor SL Abstract
      INTRODUCTION: Rosacea is a chronic and recurrent disease with a variety of cutaneous manifestations. The disorder is a centrofacial inflammatory dermatosis with significant financial, physical and psychological impacts. There are a number of topical, oral and systemic treatments available. Yet, treatment for rosacea remains difficult. The multifactorial nature of the disease combined with an incomplete understanding of the pathophysiology is challenging for providers and patients. Areas covered: This article provides an in-depth review of rosacea treatment and emerging use of ivermectin 1% cream for papulopustular rosacea based on multiple clinical trials. The PubMed database was searched using the combination of keywords "ivermectin, rosacea, and papulopustular." Expert opinion: Topical ivermectin 1% cream has emerged as a novel agent for treatment of papulopustular rosacea. The drug targets the Demodex mite which is increased in patients with rosacea. Though ivermectin 1% is a clinically efficacious medication, poor adherence continues to remain an issue due to topical application. Ultimately, the agent has the potential to be an effective drug when used as a single or combination agent. With the move to limit chronic antibiotic use, topical agents such as ivermectin 1% will continue to thrive as a specialized niche in the rosacea market.
      PMID: 29544355 [PubMed - as supplied by publisher] {url} = URL to article
    • Pivotal Trial of the Efficacy and Safety of Oxymetazoline Cream 1.0% for the Treatment of Persistent Facial Erythema Associated With Rosacea: Findings from the Second REVEAL Trial. J Drugs Dermatol. 2018 Mar 01;17(3):290-298 Authors: Baumann L, Goldberg DJ, Stein Gold L, Tanghetti EA, Lain E, Kaufman J, Weng E, Berk DR, Ahluwalia G Abstract
      Rosacea is a chronic dermatologic condition with limited treatment options, particularly for persistent erythema. This pivotal phase 3 study evaluated oxymetazoline, an a1A-adrenoceptor agonist, for the treatment of moderate to severe persistent erythema of rosacea. Eligible patients were randomly assigned 1:1 to receive oxymetazoline cream 1.0% or vehicle applied topically to the face once daily for 29 days. The primary efficacy outcome was ≥2-grade improvement from baseline on both Clinician Erythema Assessment (CEA) and Subject Self-Assessment for rosacea facial redness (SSA) (composite success) at 3, 6, 9, and 12 hours postdose on day 29. Digital image analysis of rosacea facial erythema was evaluated as a secondary efficacy outcome measure. Safety assessments included treatment-emergent adverse events (TEAEs) and dermal tolerability. Patients were followed for 28 days posttreatment to assess worsening of erythema (1-grade increase in severity from baseline on composite CEA/SSA in patients with moderate erythema at baseline; rebound effect). The study included 445 patients (mean age: 50.3 years; 78.7% female); most had moderate erythema at baseline (84.0% on CEA; 91.5% on SSA). The proportion of patients achieving the primary efficacy outcome was significantly greater with oxymetazoline versus vehicle (P=0.001). Similar results favoring oxymetazoline over vehicle were observed for the individual CEA and SSA scores (P less than 0.001 and P=0.011, respectively). Median reduction in rosacea facial erythema on day 29 as assessed by digital image analysis also favored oxymetazoline over vehicle (P less than 0.001). Safety results were similar between oxymetazoline and vehicle; discontinuations due to TEAEs were low (2.7% vs 0.5%). Following cessation of treatment, 2 (1.2%) patients in the oxymetazoline group and no patient in the vehicle group had rebound effect compared with their day 1 baseline score. Topical oxymetazoline applied to the face once daily for 29 days was effective, safe, and well tolerated in the treatment of moderate to severe persistent facial erythema of rosacea. <p><em>J Drugs Dermatol. 2018;17(3):290-298.</em></p>.
      PMID: 29537447 [PubMed - in process] {url} = URL to article
    • Phase 2 Randomized, Dose-Ranging Study of Oxymetazoline Cream for Treatment of Persistent Facial Erythema Associated With Rosacea. J Drugs Dermatol. 2018 Mar 01;17(3):308-316 Authors: DuBois J, Dover JS, Jones TM, Weiss RA, Berk DR, Ahluwalia G Abstract
      BACKGROUND: Rosacea is a chronic dermatologic condition with limited treatment options.
      OBJECTIVE: This phase 2 study evaluated the optimal oxymetazoline dosing regimen in patients with moderate to severe persistent facial erythema of rosacea.
      METHODS: Patients were randomly assigned to oxymetazoline cream, 0.5%, 1.0%, or 1.5%, or vehicle, administered once daily (QD) or twice daily (BID) for 28 consecutive days. The primary efficacy endpoint was the proportion of patients with ≥2-grade improvement from baseline on the Clinician Erythema Assessment (CEA) and the Subject Self-Assessment of erythema (SSA-1) on day 28. Safety assessments included treatment-emergent adverse events and dermal tolerability.
      RESULTS: A total of 356 patients were treated (mean age, 50.0 years; 80.1% female). The proportions of patients achieving the primary endpoint were significantly higher with oxymetazoline 0.5% QD (P=0.049), 1.0% QD (P=0.006), 1.5% QD (P=0.012), 1.0% BID (P=0.021), and 1.5% BID (P=0.006) versus their respective vehicles. For both QD and BID dosing, the efficacy of oxymetazoline 1.0% was greater than the 0.5% dose and comparable to the 1.5% dose. Safety and application-site tolerability were similar across groups.
      LIMITATIONS: Short-term treatment period.
      CONCLUSION: Oxymetazoline 1.0% QD provided the optimal dosing regimen and was selected for evaluation in phase 3 clinical studies. J Drugs Dermatol. 2018;17(3):308-316.
      PMID: 29537449 [PubMed - in process] {url} = URL to article
    • Johns Hopkins University is sponsoring a clinical trial of using Timolol for the Treatment of Acne and Rosacea which started in March 2016, with an Estimated Primary Completion Date of March 2019 and an Estimated Study Completion Date of March 2021. Timolol eye drops or gel is usually used to treat increased pressure inside the eye such as in ocular hypertension and glaucoma while oral Timolol is used for high blood pressure, chest pain due to insufficient blood flow to the heart, to prevent further complications after a heart attack, and to prevent migraines. Wikipedia  Timolol is marketed under a number of brand names but is available in generic prescriptions.  There are some anecdotal reports of using the gel on rosacea at RF which you may be interested in reviewing:  Timoptol-LA 0.5% stops my cheeks flushing Topical Timolol to erase Telangiectasia? Search Timolol at RF - the results show Timolol highlighted in a number of threads which will take you a while to sort through.  Brands
      Timoptol LA 0.25% and 0.5% wv Gel-Forming Eye Drops Solution is available in the UK
    • This statement gives some clearer understanding on the pathogenesis of demodectic rosacea:  "High numbers of Demodex induced pro-inflammatory cytokine secretion whereas lower numbers did not. Demodex mites have the capacity to modulate the TLR signalling pathway of an immortalised human sebocyte line. Mites have the capacity to secrete bioactive molecules that affect the immune reactivity of sebocytes. Increasing mite numbers influenced IL8 secretion by these cells."  Note these links: 
      Demodectic Rosacea (Variant)
      Demodex Density Count - What are the Numbers? What is the Immortalized Human Sebaceous Gland Cell Line?
      The human sebocyte culture model was first introduced in 1989. Cultured human sebocytes have been shown to preserve important sebocytic characteristics, although they undergo an incomplete terminal differentiation in vitro. Over the years, modifications of the technique have improved the culture of human sebocytes in vitro, but the primary cultured sebocytes can still be maintained for no more than six passages in vitro. The immortalized human sebaceous gland cell lines SZ95, SEB-1 and Seb-E6E7 have been developed in recent years, which make it possible to get a large number of sebocytes from the same donor culture. 
      Dermatoendocrinol. 2009 Mar-Apr; 1(2): 92–95.
      PMCID: PMC2835897
      Culture of human sebocytes in vitro
      Longqing Xia, Christos C Zouboulis, and Qiang Ju
      Human facial sebaceous gland cells were transfected with a PBR-322-based plasmid containing the coding region for the Simian virus-40 large T antigen. The resulting proliferating cell cultures have been pas-saged over 50 times to date, have been cloned, and show no signs of senescence after 4&DF;1 2 y in vitro, whereas normal human sebocytes can only be grown for three to six passages.
      Establishment and Characterization of an Immortalized Human Sebaceous Gland Cell Line (SZ95)
      Christos C. Zouboulis, Holger Seltmann, Constantin E.Orfanos, Heidemarie Neitzel
    • Demodex mites modulate sebocyte immune reaction: Possible role in the pathogenesis of rosacea. Br J Dermatol. 2018 Mar 12;: Authors: Lacey N, Russell-Hallinan A, Zouboulis CC, Powell FC Abstract
      Rosacea is a common facial skin disorder affecting middle-aged adults. Its aetiology is unknown and pathogenesis uncertain. Activation of the host innate immune response has been identified as important. The Demodex mite population in the skin of these patients is significantly higher than in subjects with normal skin suggesting they may be of etiological importance in this disorder. Little is known of the role of these mites in human skin and their potential to interact with the host immune system has not been elucidated. Live Demodex mites were extracted from normal facial skin of control subjects and used in cell stimulation experiments with the immortalised SZ95 sebocyte line. Time and mite dose dependent experiments were performed. Direct Demodex effects and the effects of medium in which Demodex had been cultured were evaluated on the TLR-signalling pathway on both a gene and protein expression level. Mites modulated TLR signalling events on both mRNA and protein levels in SZ95 sebocytes. An initial trend towards down modulation of genes in this pathway was observed. A subsequent switch to positive gene up-regulation was recorded after 48 hours of co-culture. Demodex secreted bioactive molecules that affected TLR2 receptor expression by sebocytes. High numbers of Demodex induced pro-inflammatory cytokine secretion whereas lower numbers did not. Demodex mites have the capacity to modulate the TLR signalling pathway of an immortalised human sebocyte line. Mites have the capacity to secrete bioactive molecules that affect the immune reactivity of sebocytes. Increasing mite numbers influenced IL8 secretion by these cells. This article is protected by copyright. All rights reserved.
      PMID: 29532463 [PubMed - as supplied by publisher] {url} = URL to article
    • Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction. Ocul Immunol Inflamm. 2018 Mar 13;:1-4 Authors: Ozek D, Evren Kemer Ö, Artüz F Abstract
      PURPOSE: To evaluate the results of tear functions in acne rosacea.
      METHODS: This prospective study includes 64 eyes of 32 acne rosacea patients without blepharitis and meibomian gland dysfunction and 90 eyes of 45 patients as control group. Tear functions of all were evaluated with ocular surface disease index (OSDI) questionnaire, and measurements of tear osmolarity were performed by using TearLab, Schirmer I tests without anesthesia and fluorescein tear break-up time (TBUT).
      RESULTS: The mean Schirmer test result was 12.53 ± 6.54 in study group and 16.21 + 7.52 mm/5 min in control group (p = 0.28). The mean TBUT in study group was 8.21 ± 4.01 and in control group was 18.03 ± 6.45 s (p = 0.02). Mean tear osmolarity in study group was 304.77 ± 15.59and in control group was 275.23 + 28.52 mOsms/L (p = 0.03). Mean OSDI score in study group was 27.51 ± 16.73 and was 18.15 ± 7.05 in control group (p = 0.38).
      CONCLUSIONS: Our study demonstrated lower dry eye tests before the appearance of clinical signs of meibomian gland disease in acne rosacea.
      PMID: 29533687 [PubMed - as supplied by publisher] {url} = URL to article
    • David Leonhardt, New York Times, wrote an interesting article, Big Sugar Versus Your Body, mentioning going sugarless for thirty days, which would also help your rosacea and makes this point about going sugarless for a month:

      “The sugarless month is just a means to an end, and there are other means. Working with experts and colleagues, I’ve now put together an online guide to cutting back on sugar without spending more money or losing the pleasure of eating. That last part is important. Done right, a less sweet diet can be more enjoyable than a sugar-packed one.”

      Big Sugar Versus Your Body
    • Successful therapy of ocular rosacea with topical ivermectin. Br J Dermatol. 2018 Mar 12;: Authors: Schaller M, Pietschke K Abstract
      Approximately 75% of cutaneous rosacea patients also suffer from an ocular involvement with blepharitis and meibomian gland dysfunction often presented as chalazia. Clinical symptoms are foreign body sensation, light sensitivity, burning and tearing. This article is protected by copyright. All rights reserved.
      PMID: 29527668 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Contact hypersensitivity in rosacea - a report on 143 cases. J Eur Acad Dermatol Venereol. 2018 Mar 10;: Authors: Diczig B, Németh I, Pónyai G, Sárdy M Abstract
      Rosacea is a chronic skin disease characterized by inflammatory processes affecting mainly the center of the face. The pathophysiology is complex, environmental factors seem to play an important role in the exacerbation and worsening of the lesions. The barrier-dysfunction theory in atopic dermatitis has been well described in the literature. This article is protected by copyright. All rights reserved.
      PMID: 29524258 [PubMed - as supplied by publisher] {url} = URL to article
    • She had seen various doctors over the past two years. Most of them had told her she had eczema and prescribed steroid-based creams that did help, but not for long. When she stopped applying them, the flushing returned with a vengeance. There was nothing wrong with the creams - it was the diagnosis that was incorrect. Once, a doctor told her she had acne. The topical medication that was given to her made her redness and sensitivity worse. This is the classic history of a person who is suffering from rosacea, which is often mistaken for other skin diseases. A rosacea patient may be misdiagnosed and wrongly treated for years.
      Don't be red-faced over rosacea, Lynn Teo, The Strait Times, Singapore In one year two dermatologists failed to diagnose me with rosacea until I persuaded the third that it is rosacea. I basically had to diagnose myself and then prove it in front of audience. buratino29 Post #130 3rd April 2013 06:28 PM One of my daughters came across your post and brought it to my attention. Her sister, my youngest daughter, suffered rosacea fulminans several years ago and I thought I would share some of her experience with you. She was incorrectly diagnosed with acne initially and the condition had time to get far worse than it might have with a proper diagnosis from the beginning. We switched doctors because we knew it was not simple acne. Both of her sisters had suffered acne and she never had, so we knew what acne was and what she had was certainly not. We were lucky to see the new doctor's physician's assistant who listened patiently to her story (how her face had been clear and then suddenly she was getting multiple cysts and green puss was coming out of some of them). He said he did not know what the condition was but would find out. He called the next day and we went back to the office to hear that she had this very rare condition: rosacea fulminans. padie Post #6 July 18, 2012 at 05:18 AM I was told I had Perioral dermatitis because there was an outbreak near my nose....Began to notice a swelling under my right eye and a red path beneath extending up the temple. It became hot and sensitive and flares when I workout with weights. Told "hmm don't know what that is, it's not rosacea (my fear was that it was) but try rozex cream to see if it goes." It didn't. Didn't change. Had a second opinion. Same as the first. "Don't know, looks like it might be fungul. Leave it until you see a dermatologist." Began to a sore eye, a few pains and watering. Went back to the second opinion to ge this checked was given a scrip for kenocomb ointment for fungus....out of desparation I went to another gp explained the whole story again. He checked the skin, told me it wasn't rosacea that it looked like a fungus infection try Nizoral 2%. Hmmm. Later that day I had an appointment with a new dermatologist who told me that I actually had seborrhec dermatitis...this sounded right as all the systems relate, rash on chest, dry skin in eyebrows, dandruff...funny I'd never connected these things and either had anyone else. He then checked the rash thing on the right side of my face and temple and told me it was rosacea. I asked about the pain in the eye, watery, and he said not connected. Gave me a print of what to expect with rosacea and out the door I went...  GNR post no 1
    • "Dapsone, also known as diaminodiphenyl sulfone (DDS), is an antibiotic..." Wikipedia "Dapsone gel was as effective as metronidazole gel in the treatment of papulopustular rosacea." [1] "Topical dapsone is a sulfone antibacterial with anti-inflammatory actions. It was recently approved for acne in Australia, but in the USA it is approved for rosacea. Dapsone 7.5% gel is applied once daily for up to 12 weeks. It should be avoided in those with known glucose-6-phosphate dehydrogenase deficiency." [2] End Notes  [1] J Drugs Dermatol. 2015 Jun;14(6):602-6.
      Dapsone Gel in the Treatment of Papulopustular Rosacea: A Double-Blind Randomized Clinical Trial.
      Faghihi G, Khosravani P, Nilforoushzadeh MA, Hosseini SM, Assaf F, Zeinali N, Smiley A. [2] Aust Prescr. 2018 Feb; 41(1): 20–24.
      Published online 2018 Feb 1. doi:  10.18773/austprescr.2018.004
      PMCID: PMC5828925
      An update on the treatment of rosacea
      Alexis Lara Rivero, Margot Whitfeld,   
    • Related Articles Topical Ivermectin: Data Supporting Dual Modes of Action in Rosacea. J Clin Aesthet Dermatol. 2017 Sep;10(9):39-42 Authors: Del Rosso JQ Abstract
      Until recently, the potential modes of action of topical ivermectin in rosacea have been speculated but not studied. Short-term studies (12 week), long-term studies (up to 52 weeks), and case report series have now been completed, and topical ivermectin (IVM), formulated as a 1% cream that is applied once daily, has been shown to be effective, well-tolerated, and safe for the treatment of rosacea. This article reviews outcomes from studies that support dual modes of action, including both anti-inflammatory and anti-parasitic effects.
      PMID: 29515751 [PubMed] {url} = URL to article
    • Generally steroid treatment for rosacea is not recommended. Read this article about Steroid Rosacea. However, sometimes you read in clinical papers that certain skin cases are treated with steroids. For example, in treating rosacea fulminans (aka, Pyoderma Faciale), "Corticosteroids and isotretinoin are regarded as the two main therapeutic agents." [1] There are many other examples where steroids are used to treat skin conditions including rosacea.  In the short term, steroid treatment may improve rosacea. For example, read this post about using Prednisone for an allergic reaction and how rosacea improved.  Long term steroid treatment for rosacea is not recommended and will make rosacea worse.  End Notes [1] Rosacea fulminans in pregnancy.
      Lewis VJ, Holme SA, Wright A, Anstey AV.
      Br J Dermatol. 2004 Oct;151(4):917-9.
    • "However, following injury or inflammatory skin diseases such as psoriasis and rosacea, expression of the cathelicidin antimicrobial peptide LL37 breaks tolerance to self-nucleic acids and triggers inflammation." Cathelicidin promotes inflammation by enabling binding of self-RNA to cell surface scavenger receptors.
      Sci Rep. 2018 Mar 05;8(1):4032
      Takahashi T, Kulkarni NN, Lee EY, Zhang LJ, Wong GCL, Gallo RL
    • Related Articles Cathelicidin promotes inflammation by enabling binding of self-RNA to cell surface scavenger receptors. Sci Rep. 2018 Mar 05;8(1):4032 Authors: Takahashi T, Kulkarni NN, Lee EY, Zhang LJ, Wong GCL, Gallo RL Abstract
      Under homeostatic conditions the release of self-RNA from dying cells does not promote inflammation. However, following injury or inflammatory skin diseases such as psoriasis and rosacea, expression of the cathelicidin antimicrobial peptide LL37 breaks tolerance to self-nucleic acids and triggers inflammation. Here we report that LL37 enables keratinocytes and macrophages to recognize self-non-coding U1 RNA by facilitating binding to cell surface scavenger receptors that enable recognition by nucleic acid pattern recognition receptors within the cell. The interaction of LL37 with scavenger receptors was confirmed in human psoriatic skin, and the ability of LL37 to stimulate expression of interleukin-6 and interferon-β1 was dependent on a 3-way binding interaction with scavenger receptors and subsequent clathrin-mediated endocytosis. These results demonstrate that the inflammatory activity of LL37 is mediated by a cell-surface-dependent interaction and provides important new insight into mechanisms that drive auto-inflammatory responses in the skin.
      PMID: 29507358 [PubMed - in process] {url} = URL to article
    • Related Articles An update on the treatment of rosacea. Aust Prescr. 2018 Feb;41(1):20-24 Authors: Rivero AL, Whitfeld M PMID: 29507456 [PubMed] {url} = URL to article
    • The ROSCO panel who created the new phenotype classification are from all over the world (by last name, first name initial, country): 

      Almeida LM, Brazil
      Bewley A, United Kingdom
      Cribier B, France
      Dlova NC, South Africa
      Gallo R, USA
      Kautz G, Germany
      Mannis M, USA
      Oon HH, Singapore
      Rajagopalan M, India
      Schaller M. Germany
      Steinhoff M, Ireland
      Tan J, Canada
      Thiboutot D, USA
      Troielli P, Argentina.
      Webster G, USA
      Wu Y, China
      van Zuuren EJ, Netherlands

      Why is the Phenotype Classification superior to the subtype classification? Answer. 

      What is the difference between the phenotype classification and the subtype classification? Answer.

      Phenotype Classification Uses Signs and Symptoms Better, by Dr. Jerry Tan

      Shortcomings in rosacea diagnosis and classification, Tan, J., et al
    • Topical Oxymetazoline: A Novel Approach to Treat Rosacea, Border Compounding Pharmacy
    • I just broke out with a poison ivy rash about five days (which I suffered with in New England, very sensitive to poison ivy) and went to the dermatologist who taking one look at the blisters on my elbows and back of my head said, "You have been eating mangoes?" I said, "How did you know?" First off, mangoes are not in season here in Hawaii yet, so I had purchased them at Costco imported from who knows where? My derm explained that the mango tree is related to the poison oak/sumac family and the tree has a sap that is oily and gets on the skin of the mangoes. The fruit itself doesn't cause the rash but the oily sap on the skin does. I had got it on my hands and then scratched the back of my head and once the rash starts it is systemic and broke out on both elbows with little blisters that oozes and spreads the rash further. He said it will continue to break out, which I certainly know does indeed spread all over. The doc recommended a Rx for Prednisone, a nine day course which he says will clean up the blisters and rash, otherwise it will continue a month or more. I opted to take the treatment even though I am not a steroid fan. The itching with this rash is incredible and drives me batty.  Why did I bring this up? I am on my fifth day taking Prednisone (60 mg/day X 3 days, 30 mg/day for two days) and my skin on my face has cleared up dramatically! Way better than Mirvaso or Rhofade, believe me. If you really need to get a quick clearance of rosacea, ask your physician for Prednisone. Not a recommended long term solution for rosacea, but if you have a special event such as a wedding or interview, it might be the trick to get a total clearance. Takes just a few days to get clearance.  Who knows what the rebound might be? I will surely find out, but, in the meantime, WOW!   Sent from my iPad using Tapatalk