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    • Related ArticlesStatPearls Book. 2020 01 Authors: Abstract Rosacea is a common chronic inflammatory disease that presents with recurrent flushing, erythema, telangiectasia, papules, or pustules on nose, chin, cheeks, and forehead. There are four clinical subtypes of rosacea based on the predominant signs and symptoms: erythematotelangiectatic, papulopustular, phymatous, and ocular. The subtypes are not mutually exclusive. Patients can present with features of multiple subtypes, and the predominant features and areas of involvement can change over time. Fifty to seventy-five percent of patients with rosacea have eye involvement with symptoms including dryness, redness, tearing, tingling/burning sensation, foreign-body sensation, light sensitivity, and blurred vision. In addition to the skin and eye symptoms, rosacea can cause anxiety, embarrassment, and depression and can have a significant impact on the quality of life. Although usually limited to the skin, an association of rosacea with systemic comorbidities such as neurologic diseases, inflammatory bowel disease, and cardiovascular diseases has been reported.[1][2][3][4] PMID: 32491506 {url} = URL to article
    • Related ArticlesAssessment of the abdominal fat index by ultrasonography in patients with rosacea. Australas J Dermatol. 2020 Jun 03;: Authors: Özkur E, Bülbün G, Karataş D, Kıvanç Altunay İ PMID: 32491195 [PubMed - as supplied by publisher] {url} = URL to article
    • "A variety of repurposed drugs and investigational drugs such as remdesivir, chloroquine, hydroxychloroquine, ritonavir, lopinavir, interferon‐beta, and other potential drugs have been studied for COVID19 treatment. We reviewed the potential dermatological side‐effects of these drugs." Dermatol Ther. 2020 May 22 : e13476.doi: 10.1111/dth.13476 [Epub ahead of print] Cutaneous sıde‐effects of the potential COVID‐19 drugs Ümit Türsen, Belma Türsen, Torello Lotti 
    • There are different approaches offered by the various 'authorities' on rosacea diagnosis into phenotypes. [1] However, they all agree that the phenotype classification is superior to the subtype classification that has been used since 2002 initially proposed by the NRS 'expert' panel. [2] The general consensus is "at least one diagnostic or two major phenotypes are required in order to diagnose a patient with rosacea." [3] {1} Diagnostic Cutaneous Signs (only one required) The ROSCO panel list includes persistent centrofacial erythema associated with periodic intensification by potential trigger factors as a minimum diagnostic feature of rosacea and phymatous changes are individually diagnostic of rosacea.  Fixed centrofacial erythema, papules and pustules, flushing or blushing, phymatous changes are included in the NRS panel diagnostic list.  Dr. Tan with the ROSCO panel, as well as the NRS Panel, and Dr. Del Rosso with the AARS panel both concur that facial erythema is essential to a diagnosis of rosacea. [4] OR {2} RRDi Phenotypes (two required) (1) Flushing (2) Persistent Erythema (3) Telangiectasia (4) Papulopustular (Papules/pustules Lesion Counts) (5) Phymatous (6) Ocular Manifestations Variances in Phenotype Listings The ROSCO panel has no numbering phenotype system but lists the above phenotypes.  The NRS 'expert' committee's approach has no numbering system and divides four phenotypes with three secondary phenotypes. [5] Galderma tweets four major phenotypes and four minor phenotypes.  The AAD follows the NRS expert panel recommendations.  The AARS has its own way of acknowledging the phenotype classification into six phenotypes:  "central facial erythema without papulopustular (PP) lesions;"  "central facial erythema with PP lesions;"  "the presence of phymatous changes," "ocular signs, and symptoms;"  "extensive presence of facial telangiectasias;"  "and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea)"  Medscape recognizes four major phenotypes and three secondary phenotypes following the NRS recommendations End Notes [1] ROSCOE Panel • NRS Expert Panel • Galderma • AAD • AARS • Medscape [2] Phenotype Treatment is Superior [3]  Clinical, Cosmetic and Investigational Dermatology February 2020 [4] Phenotype Classification Uses Signs and Symptoms Better [5] The four phenotypes the NRS lists are Papules and Pustules, Flushing, Telangiectasia, and  Ocular manifestations. The secondary phenotypes are  Burning or stinging, Edema, and Dry Appearance.  Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. 
    • Related ArticlesStudy of Clinical Profile of Patients Presenting with Topical Steroid-Induced Facial Dermatosis to a Tertiary Care Hospital. Indian Dermatol Online J. 2020 Mar-Apr;11(2):208-211 Authors: Jain S, Mohapatra L, Mohanty P, Jena S, Behera B Abstract Background: Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately. Aim: The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population. Materials and Methods: This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded. Results: A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form "No-Scar" preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone. Conclusion: Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse. PMID: 32477980 [PubMed] {url} = URL to article
    • Stem cell colonies that are not yet differentiated. Image courtesy of Wikimedia Commons One of the many theories on the cause of rosacea is that it is caused by sun damaged skin. A paper published by Wolters Kluwer Health according to Science Daily states, "Some plastic surgeons have been using stem cells to treat aging, sun-damaged skin. But while they've been getting good results, it's been unclear exactly how these treatments work to rejuvenate 'photoaged' facial skin. A new study finds that within a few weeks, stem cell treatment eliminates the sun-damaged elastin network and replacing them with normal, undamaged tissues and structures." [1] Controversial "Stem-cell therapy has become controversial following developments such as the ability of scientists to isolate and culture embryonic stem cells, to create stem cells using somatic cell nuclear transfer and their use of techniques to create induced pluripotent stem cells. This controversy is often related to abortion politics and to human cloning. Additionally, efforts to market treatments based on transplant of stored umbilical cord blood have been controversial." [2] Regenerative Medicine Stem-cell therapy is what is called regenerative medicine. To understand the basics of this therapy watch this short TED video: How much does it cost? That is usually what most want to know the answer about before considering this treatment. The doctor from this clinic actually gives you a range of the cost since it depends on what your chief complaint issue is and various factors.  Could 10K members of the RRDi get together and each donate a dollar to sponsor a stem cell therapy for rosacea clinical study? That would be less than  the cost of a cup of coffee at Starbucks. Why not donate now? End Notes [1] Stem cell treatments 'go deep' to regenerate sun-damaged skin, Science Daily [2] Stem-cell Therapy, Wikipedia
    • Zilxi is a minocycline topical foam that has been going through clinical trials for some time now. It has been announced recently as FDA approved for rosacea (see fifth post in this thread). Minocycline, a tetracycline drug, has been shown to be just as effective as doxycycline for rosacea. If you are using Zilxi please find the green reply button and post your experience using this new treatment for rosacea. 
    • Menlo Therapeutics Inc. announced that the U.S. Food and Drug Administration (FDA) has approved ZILXI™ (minocycline) topical foam, 1.5%, for the treatment of inflammatory lesions of rosacea in adults. ZILXI, developed as FMX103 by Menlo’s wholly-owned subsidiary Foamix Pharmaceuticals Ltd. (“Foamix”), is the first minocycline product of any kind to be approved by the FDA for use in rosacea. Official Announcement Zilzi is a tetracycline what has done well in clinical trials. You will need to ask your physician for a prescription.  Product Insert  
    • Update "A massive study that raised health concerns over hydroxychloroquine, the anti-malaria drug touted by President Trump as a coronavirus treatment, is coming under scrutiny from scientists who are demanding to see the data behind it." Massive hydroxychloroquine study raising health concerns about the drug under scrutiny from scientists, Tal Axelrod, The Hill, MSN "After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure." N Engl J Med DOI: 10.1056/NEJMoa2016638 A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 David R. Boulware, M.D., M.P.H., Matthew F. Pullen, M.D., Ananta S. Bangdiwala, M.S., Katelyn A. Pastick, B.Sc., Sarah M. Lofgren, M.D., Elizabeth C. Okafor, B.Sc., Caleb P. Skipper, M.D., Alanna A. Nascene, B.A., Melanie R. Nicol, Pharm.D., Ph.D., Mahsa Abassi, D.O., M.P.H., Nicole W. Engen, M.S., Matthew P. Cheng, M.D., et al.
    • Related ArticlesOut of the Blue: A Case of Blue Subungual Discoloration Associated with Prolonged Tetracycline Use. Cureus. 2020 Apr 24;12(4):e7810 Authors: Ahmad Y, Boutros H, Hanna K Abstract Tetracycline derivatives are antibiotics such as minocycline and doxycycline that have been commonly utilized for inflammatory dermatological conditions such as acne and rosacea. Hyperpigmentation of the skin, nails, thyroid, oral mucosa, teeth, and bones is a known but rare side effect of prolonged tetracycline use. The hyperpigmentation typically takes months to years to develop. There may also be residual changes to the skin after discontinuation of the medication. For this reason, the time tetracyclines are used should be minimized and patients should be monitored for the skin findings. Subungual discoloration carries a broad differential including infectious, inflammatory, metabolic, malignant or systemic diseases. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration. We report on a case of a patient who has been on long-term minocycline use for adult acne management. He was initially on minocycline for six years, but due to minocycline-induced hyperpigmentation of his ears and fingernails, he had switched to doxycycline. One year later, the skin hyperpigmentation of the ears regressed; however, the blue subungual hyperpigmentation of his hands progressively become more prominent without any other significant symptoms. PMID: 32467786 [PubMed] {url} = URL to article
    • Related ArticlesSurgical mask dermatitis caused by formaldehyde (releasers) during the COVID-19 pandemic. Contact Dermatitis. 2020 May 28;: Authors: Aerts O, Dendooven E, Foubert K, Stappers S, Ulicki M, Lambert J PMID: 32468589 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesRosacea and perioral dermatitis: a single-center retrospective analysis of the clinical presentation of 1032 patients. J Dtsch Dermatol Ges. 2020 May 29;: Authors: Hoepfner A, Marsela E, Clanner-Engelshofen BM, Horvath ON, Sardy M, French LE, Reinholz M Abstract BACKGROUND: Rosacea is a common chronic inflammatory cutaneous disorder affecting nearly 5.5 % of the adult population. Our aim was to evaluate the prevalence and epidemiology of rosacea and perioral dermatitis (POD) in an ambulatory care setting. METHODS: We retrospectively analyzed medical data of patients with a confirmed diagnosis of rosacea or perioral dermatitis (POD) presenting at our university hospital outpatient clinic during a 3-year period. RESULTS: Out of 1032 patients, 81.5 % were diagnosed with rosacea and 18.5 % with POD. Overall prevalence was 1.4 % for rosacea and 0.3 % for POD. 69.3 % of the analyzed patients were female. Overall mean age was 49.3 ± 7.7 (1-92) years; the women's average age was less than the men's. Patients with POD were younger and predominantly female, whereas patients with phymatous rosacea were older and predominantly male. The most common phenotypes were papulopustular rosacea (68.4 %), erythematotelangiectatic rosacea (22.5 %), and phymatous rosacea (8.0 %). Special forms of rosacea were diagnosed in 15.8 % of the patients; the most frequent were ocular rosacea (6.9 %) and steroid-induced rosacea (5.4 %). CONCLUSIONS: The large patient cohort analyzed in our study provides a good estimate of the frequency of the rosacea subtypes, special forms and of perioral dermatitis in a hospital-based outpatient care setting. PMID: 32469453 [PubMed - as supplied by publisher] {url} = URL to article
    • Update "In this study, a high-dosage of CQ (12 g) given for 10 days concurrently with azithromycin and oseltamivir was not sufficiently safe to warrant continuation of that study group. Age was an important confounder and might be associated with the unfavorable outcomes. We recommend that similar dosages no longer be used for the treatment of severe COVID-19, especially because treatment based on older patients with previous cardiac diseases who are receiving concomitant cardiotoxic drugs should be the rule. No apparent benefit of CQ was seen regarding lethality in our patients so far. To better understand the role of CQ or HCQ in the treatment of COVID-19, we recommend the following next steps: (1) randomized clinical trials evaluating its role as a prophylactic drug and (2) randomized clinical trials evaluating its efficacy against the progression of COVID-19 when administered to patients with mild or moderate disease. Even if we fail to generate good evidence in time to control the current pandemic, the information will affect how we deal with coronavirus outbreaks in the future." JAMA Netw Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857 Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) InfectionA Randomized Clinical Trial Mayla Gabriel, Silva Borba, MD; Fernando Fonseca Almeida Val, PhD, Vanderson Souza Sampaio, PhD
    • A treatment for rosacea is being considered to treat coronavirus. "The second-generation tetracycline Dox has an anti-inflammatory and broad spectrum antimicrobial activity...It has minimal side effects and it is routinely prescribed for acne and rosacea...In ophthalmology, Dox is usually administered in patients affected by ocular rosacea and posterior blepharitis...Dox also has anti-angiogenic properties... It regulates cytokines and diminishes neutrophil chemotaxis too...Besides its well-known use in treating bacterial infections, some studies in the literature report that Dox possesses a broad activity against viral infection too...The first who described the Dox antiviral effect was Sturtz in 1998 (29), and this suggestion has been confirmed in several followed-up studies...In 2007, Suzuki et al. identified that coronavirus could be associated with anosmia,..." "In our preliminary observation, the administration of Dox 200 mg once daily seems to improve respiratory symptoms and anosmia under Dox treatment in six patients completely recover after only 2 days of treatment. From our experience, it seems reasonable to continue the treatment at least 8 days. The mean patients' age was 35.8 ± 6.8 years, and 4 (66.7%) were females. One patient reported anosmia as the only COVID-19 manifestation; instead of the other five patients who complained about the loss of smell, in which it appeared 5–7 days after mild fever, dry cough, and malaise. The average time of the recovery COVID-19-linked anosmia after the administration of Dox in these patients was 2.5 ± 0.5 days. We noticed a sudden improvement in all symptoms after the administration of Dox, but our most exciting insight is about the rapid recovery of the smell." Front Med (Lausanne). 2020; 7: 200. Doxycycline: From Ocular Rosacea to COVID-19 Anosmia. New Insight Into the Coronavirus Outbreak Chiara Bonzano, Davide Borroni, Andrea Lancia, and Elisabetta Bonzano  Virus and rosacea has never, ever been ruled out.
    • Related ArticlesTopical ivermectin-metronidazole gel therapy in the treatment of blepharitis caused by Demodex spp.: A randomized clinical trial. Cont Lens Anterior Eye. 2020 May 24;: Authors: Ávila MY, Martínez-Pulgarín DF, Rizo Madrid C Abstract PURPOSE: To evaluate the efficacy of topical ivermectin-metronidazole combined therapy in the management of Demodex-associatedblepharitis. METHODS: Sixty patients with a diagnosis of Demodex-associatedblepharitis were recruited in a randomized clinical trial. Thirty receiving topical ivermectin (0.1%)-metronidazole (1%) gel treatment on days 0, 15 and 30. Thirty additional patients were used as a control group receiving vehicle on days 0, 15 and 30. The primary efficacy measure was the number of Demodex spp. mitesin the eyelashes of patients. The secondary outcomes included clinical improvement of signs and adverse events. RESULTS: Complete eradication of Demodex spp. was found in 96.6% of patients in the treatment group. Furthermore, a significant reduction of inflammation signs were found in all treated patients versus controls. None of the patients experienced any adverse effects associated with the treatment. CONCLUSION: Demodex infection was controlled satisfactorily with the ivermectin (0.1%)-metronidazole (1%) gel, and no adverse effects were observed. Application of this gel for the treatment of different parasitic infections of the eyelids could be feasible, and this requires further exploration. PMID: 32461053 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesCutaneous Exophiala oligosperma infection presenting with multiple, rosacea-like papules on the cheek in a healthy individual. J Dermatol. 2020 May 28;: Authors: Demitsu T, Umemoto N, Maeda T, Kakurai M, Harada K PMID: 32463524 [PubMed - as supplied by publisher] {url} = URL to article
    • Coconut Oil image courtesy of Wikimedia Commons "There is anecdotal evidence to support the use of coconut oil as a home remedy to treat rosacea." [1] There are a number of anecdotal reports at RF of using coconut oil as a moisturizer after cleansing with a raw honey mask. [2] Virgin Coconut Oil (VCO) vs Refined Coconut Oil (RCO) "The two main types of coconut oil you will come across are virgin coconut oil (VCO) and refined coconut oil (RCO). To make VCO, oil is cold pressed from the meat of the coconut. VCO has both the flavor and smell of coconut, and is often creamier. RCO is a mass produced oil obtained from dried coconut and is usually chemically treated. If you open a jar of RCO it will have no coconut aroma or flavor." [3] This same source says there is no such thing as extra virgin coconut oil since there is only one cold pressed 'virgin' version processed so any product that states this on its label is actually a misleading advertisement. Wikipedia explains there are two processes used to make coconut oil, the dry and the wet process. The wet process is more costly. Wikipedia also refers to the Virgin Coconut Oil (VCO) but calls the refined oil as Refined, bleached, and deodorized (RBD) oil. [4] RBD coconut oil can be processed further into partially or fully hydrogenated oil. Some RBD coconut oil can be fractionated into different fatty acids to isolate caprylic acid and capric acid (or to remove lauric acid). Caprylic acid and capric acid are medium-chain triglycerides, thus producing MCT Oil.  The benefit of VCO  over RBD oil is further shown with its use in medicine and cosmetics. Be sure to use VCO if you are using it to treat rosacea or as a moisturizer. You may want to put a test amount on your inside wrist and wait several hours to see if you have an allergic reaction to coconut oil before putting it on your face.  Coconut Oil as Medicine "Coconut oil has been shown to be as effective and safe as mineral oil when applied as moisturizers for mild to moderate xerosis." This same paper reports that coconut oil helps atopic dermatitis, improves skin barrier function, promotes wound healing through faster epithelization, increased neovascularization, fibroblast proliferation, pepsin-soluble collagen synthesis, and turnover of collagen in wounds, increases the expression of specialized cornified envelope and protects the skin from UV radiation. Coconut oil contains monolaurin, a monoglyceride derived from lauric acid, that comprises nearly 50% of coconut’s fat content. Monolaurin displays antimicrobial activity as well as exhibits antiviral and antifungal activity. [5] Another paper reports that virgin coconut oil has anti-inflammatory, analgesic, and antipyretic activities. [6] Coconut oil is among a list of plant oils that have antimicrobial, antioxidant, anti-inflammatory, and anti-itch properties. [7] Coconut Oil is listed as one of the Biologic Treatments for Rosacea.  Virgin Coconut Oil (VCO) Treatments Garden of Life Virgin Coconut Oil Parachute Naturalz 100% Organic Virgin Coconut Oil Premium Virgin Organic Coconut Oil Proudly Pure Virgin Coconut Oil End Notes [1] Using Coconut Oil to Treat Rosacea, Healthline [2] Anecdotal Reports on Using Raw Honey, see first subheading, Coconut Oil Not the Focus [3] This is How Coconut Oil for Skin Saved Me Time, Cash, and Face, Liz Thompson, Organic Authority [4] Coconut Oil, Wikipedia [5] Int J Mol Sci. 2018 Jan; 19(1): 70. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils Tzu-Kai Lin, Lily Zhong,2, Juan Luis Santiago Agero A.L., Verallo-Rowell V.M. A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis. 2004;15:109–116. doi: 10.2310/6620.2004.040 ]6] Journal Pharmaceutical Biology Anti-inflammatory, analgesic, and antipyretic activities of virgin coconut oil S. Intahphuak, P. Khonsung & A. Panthong [7] Am J Clin Dermatol. 2018 Feb;19(1):103-117.  doi: 10.1007/s40257-017-0301-1. Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science Alexandra R Vaughn, Ashley K Clark, Raja K Sivamani, Vivian Y Shi 
    • <What is the butterfly effect in rosacea?>  click to read article Image courtesy of Wikimedia Commons
    • William Beaumont Hospitals is sponsoring two treatments used for rosacea, Naltrezone and Ketamine, in a clinical trial to treat coronavirus. [1] Low Dose Naltrezone is used for rosacea in this post about flushing avoidance and in other prescriptions.  Ketamine 0.5% and Amitriptyline 1% in a Lipoderm cream used for Erythomelalgia has been reported anecdotally to improve rosacea in this post.  These two treatments above are included in a growing list of rosacea treatments considered to treat coronavirus. End Notes [1] Study of Immunomodulation Using Naltrexone and Ketamine for COVID-19 (SINK COVID-19), NIH, Clinical Trials
    • Raw honey - image courtesy of Wikimedia Commons Honey has been mentioned more often than not for Seborrheic Dermatitis, but there are some reports it improves rosacea.These anecdotal reports are mostily about using raw honey as a cleanser and coconut oil as a moisturizer. Not everyone finds this treatment works, which is what we call the X-Factor in Rosacea, but many do find it works for them. The only way is to try it yourself to see if you are successful. Anecdotal reports have been used for many, many years to be helpful to find a way to improve your SD or rosacea. If you do try this treatment, why not volunteer and find the green reply button and post your comment on this treatment. That is what volunteering to help other rosaceans is all about instead of just thinking about yourself. Do you have any idea how long it takes to make a post on this subject?  Why not take a subject like this and try it sometime? Coconut Oil Not the Focus In many of the anecdotal reports about using a honey mask mention using coconut oil as a moisturizer, due to Auburn's recommendation, since honey dries the skin. Some report that the coconut oil irritates their skin, so do a test to see if you are allergic (patch test on inner wrist). Others say the coconut oil feeds the fungus in SD and advise not to use it, however, there is at least one report that coconut oil is an antifungal, just like honey. [1] Then, of course, there are others who rave about raw coconut oil as a moisturizer and simply love it. Based upon a cursory investigation of this subject, more report the coconut oil with negative reports, so we are focusing more on the honey cleansing treatment rather than using the coconut oil as a moisturizer in this post. If you really need help for Dry skin (Xeroderma) that is another issue which can be pursued in another post. Honey is the subject of this post, focusing on the healing properties (enzymes?) to cleanse your skin with anecdotal reports that it does work for some to improve not only SD but also rosacea. Think honey and don’t go coconuts. If you do want to go coconuts, see this post, Coconut Oil for Rosacea. How do I cleanse with raw honey? 1. Pour about a 1/4 teaspoon of raw honey in the palm of your hand. 2. With your other hand splash your face with non chlorinated water (if you live in the city, use bottled water for this step). 3. Rub hands together to spread the honey then massage onto skin for about 30 seconds. 4. Rinse (you may use tap water) and pat dry. The above are Auburn's instructions. If you note, heating the honey may lose all its healing properties and we are focusing on raw honey only. Positive Anecdotal Reports Using a Honey Mask Gathering positive anecdotal reports takes a lot of time and investigation. If you want negative reports, you will need to gather them yourself. judworth [post no 1] "I am having amazing results with the raw honey mask and the virgin coconut oil as a moisturiser." damien [post no 33] "My skin hasn't been this clear in years. It feels like a new layer of fresh skin is making its way through."  daminen [post no 41] "Sorry for not updating in awhile but my results have continued to be GREAT! I would recommend this treatment to anyone with SD. It works and it can make difference in your life if you do the full 4 weeks like your suppose to. And, the Coconut Oil is just as beneficial. I would say that my SD is about 85-90% better than it was before. NO BURNING, NO ITCHING, NO FLAKES." damine [post 278] "I've been doing really with the honey treatment and going on three years now." RedFaceKid [post no 44] "I'm happy to hear people getting great results. I started the treatment a couple of months ago and I would say my sed derm is about 75% better." xcvq [post no 58] "The honey and coconut oil is also working for me. My redness has gone down a lot." Auburn [post no 60] "As I was telling knightley79 the other day, when I discovered coconut oil, last year, I thought that, since it has the same properties as raw honey, it would work just as well but later I learned that it is the enzymes in the honey what really keeps the fungus at bay. The oil helps a great deal but it isn't nearly as effective on its own." BPJS (Ben) [post no 326] "I stuck with the honey and coconut oil treatment to the letter...The 3-hour face masks were a God-send. The best results came from these....Interestingly enough - the first week I was using Manuka honey on my face and raw honey on my scalp. (There is a BIG difference in the active Manuka honey than there is in raw honey - I would strongly suggest you research this for yourself). The Manuka honey cleared up my face very fast. The raw honey did not clear up my scalp. After doing research, I started to understand that the active enzymes in the Manuka honey is what actually eats away at the bacteria - I had MUCH better results with this." robertze [post no 327] "At this moment I'm trying the Honey mask and Coconut oil combination from Auburn's closed thread. I use it now for 4 weeks and I must say that it doesn't give me any spectacular results: the redness has been reduced a bit (let's say by 20%) and my skin feels less dry. But what I do see as a big difference is that now after these 4 weeks of treatment I see spider veins on my nose which I never saw before." Birdie [post no 364] "I started with manuka as well and eventually after Many months tried local raw honey. It works very very well and is much gentler on my skin Than manuka honey. I use the manuka honey as my mask honey on my scalp and eyebrows. Everyone's skin reacts differently. The manuka honey is a great exfoliator and powerful, I would caution people to treat it like a prescription not just an organic " safe" product." SarahS [post no 370] "And I must say, while I was skeptical about it working, my skin has never felt better even after only one week." gils4 [post 396] "Hi Mlydells, I have had good results with the honey masks and I recommend them. Like Tom mentioned, DON'T use the coconut oil. I was using coconut oil to moisturize my face and lips before I knew that my condition was seb derm and it made everything a lot worse. I actually think it was a major contributor to the level my seb derm reached" pmg [post no 413] "I just finished the 4 week treatment. All I can say it's amazing. JRon2112 [post no 1] "...I did the honey treatment a couple years ago and it elimanted everything no redness at all." dan pacifik [post no 14] "Do give the honey a go though, it certainly has helped alleviate some of my symptoms." solutionquest [post no 20] "I can't tell you how well this works for me. When I wake in the morning my skin is so calm and cool." LadyBee [post no 409 SIGNATURE] "Probiotics every day and honey masks every other day." Wildscenery [post no 450] "Been trying the honeymask+coconut oil for about 4 weeks now, i see some improvement and my skin is not as easily irritated anymore..." byte [post no 468] "I've been maintaning to use auburn's honey + virgin coconut oil. about 90% effective and sometimes there are SD breakouts when I don't use coconut oil for the whole day shift." daneel.olivaw [post no 495] "I'm currently doing a honey mask weekly (after doing it every other day for about 2 months) and ketoconazol daily (even twice a day) and even though I can't say my skin looks perfect, it's been a tremendous improvement compared to what it used to be." Honey Treatments Australian Manuka Honey Kanuka Honey Steens Raw Cold Pressed Manuka Honey Steens ManukaHoney UMF 15 Steens ManukaHoney UMF 20 Three Peaks New Zealand ManukaHoney UMF 10+ Three Peaks ManukaHoney UMF 10+ Three Peaks Manuka Honey UMF 20+ End Notes [1] Tom Busby, SD expert extraordinaire on RF says [post no 395], "Don't use coconut oil, as it feeds malassezia." Medical News Today reports that coconut oil not only has antibacterial properties but also is an antifungal. Is coconut oil a good remedy for yeast infection?
    • Psychological Consequences of the Most Common Dermatoses: Data from the Objectifs Peau Study. Acta Derm Venereol. 2020 May 25;: Authors: Misery L, Taïeb C, Schollhammer M, Bertolus S, Coulibaly E, Feton-Danou N, Michel L, Seznec JC, Versapuech J, Joly P, Corgibet F, Ezzedine K, Richard MA Abstract The prevalence of psychological disorders in patients with common skin diseases was assessed in a large representative sample of the French adult population. General health, as measured by the EQ5D score, was significantly lower if patients reported having rosacea, atopic dermatitis, urticaria, fungal infections, psoriasis or acne. The proportions of participants reporting being extremely anxious or depressed were higher in those who reported having rosacea, atopic dermatitis or contact dermatitis. Difficulties in sexual or conjugal life were frequently reported by people with psoriasis, atopic dermatitis, contact dermatitis, urticaria and, in particular, acne. Sleep disorders were present in 30-50% of those who reported having acne, rosacea, eczema, psoriasis or urticaria. Sleep disorders may be related not only to pruritus, but also to disfiguring skin diseases. Anxiety and depression complications were mainly reported by those with disfiguring diseases. Sexual/conjugal dysfunctions were associated with all dermatoses (with the exception of warts). PMID: 32449783 [PubMed - as supplied by publisher] {url} = URL to article
    • Low-temperature electron micrograph of a cluster of E. coli bacteria, magnified 10,000 times. Each individual bacterium is oblong shaped. Image courtesy of Wikimedia Commons. A recent paper on this subject concluded, "An altered fecal microbial richness and composition were observed in rosacea patients. The distinct microbial composition might be related to sulfur metabolism, cobalamin and carbohydrate transport." J Formos Med Assoc. 2020 May 20;: An altered fecal microbial profiling in rosacea patients compared to matched controls. Chen YJ, Lee WH, Ho HJ, Tseng CH, Wu CY
    • An altered fecal microbial profiling in rosacea patients compared to matched controls. J Formos Med Assoc. 2020 May 20;: Authors: Chen YJ, Lee WH, Ho HJ, Tseng CH, Wu CY Abstract BACKGROUND/PURPOSE: Rosacea has been linked to inflammatory bowel disease and small bowel bacterial overgrowth. We aimed to investigate the fecal microbial profiling and the potential gene functions between rosacea and non-rosacea subjects. METHODS: A case-control study. Fecal microbiome and predicted genetic function inferred from high-throughput 16S ribosomal RNA sequencing were analyzed between rosacea (n = 11) and age-, gender- and body mass index-matched non-rosacea subjects (n=110). The correlation between altered microbiome as well as lifestyle and diet were also investigated. RESULTS: A significant reduction of fecal microbial richness was found in rosacea patients. A distinct fecal microbial community structure was demonstrated in rosacea patients. The discriminating enriched genera in rosacea patients included Rhabdochlamydia, CF231, Bifidobacterium, Sarcina, Ruminococcus, belonging to the phylum of Chlamydiae, Bacteroidetes, Actinobacteria, and Lentisphaerae. The discriminating reduced abundant genera included Lactobacillus, Megasphaerae, Acidaminococcus, Hemophilus, Roseburia, Clostridium, belong to the phylum of Firmicutes; and Citrobacter, belonging to the phylum of Proteobacteria. The distinct fecal microbial composition might be related to sulfur metabolism, cobalamin, and carbohydrate transport. CONCLUSION: An altered fecal microbial richness and composition were observed in rosacea patients. The distinct microbial composition might be related to sulfur metabolism, cobalamin and carbohydrate transport. PMID: 32446756 [PubMed - as supplied by publisher] {url} = URL to article Full Text
    • We are seeking a resident of Hawaii volunteer to be the registered agent for the RRDi to continue our non profit organization corporation status in the State of Hawaii. If you are able to volunteer for this, please contact us if you have a Hawaii mailing address. 
    • What are the biologic treatments for rosacea?  First, what are we referring to? Biologic treatments are those derived from biological sources rather than from totally synthesized pharmaceuticals sources. [1] This post will divide those that are biologic specifically for rosacea and those that might be considered helpful for rosacea but are not specifically for rosacea, instead these treatments might be used for rosacea or other diseases. The vast majority of treatments for rosacea are derived from synthesized pharmaceutical sources and are found in this category. Very few treatments for rosacea are biologic. If you know of any others not listed below find the green reply button and be a RRDi volunteer! Biologic Treatments for Rosacea Antibiotics  Artemisinin Botox Probiotics Other Biologic Treatments to Consider Aloe Vera Bees & Snails Coconut Oil APOSEC Diatomaceous Earth Dupilumab Honey Nonpathogenic E. coli strain Nissle 1917 Rose Petals Rose Water Stem Cells End Notes [1] "A biopharmaceutical, also known as a biologic(al) medical product, or biologic, is any pharmaceutical drug product manufactured in, extracted from, or semisynthesized from biological sources. Different from totally synthesized pharmaceuticals, they include vaccines, blood, blood components, allergenics, somatic cells, gene therapies, tissues, recombinant therapeutic protein, and living medicines used in cell therapy. Biologics can be composed of sugars, proteins, or nucleic acids or complex combinations of these substances, or may be living cells or tissues. They (or their precursors or components) are isolated from living sources—human, animal, plant, fungal, or microbial." Wikipedia
    • Related Articles Efficacy and safety of hydroxychloroquine for treatment of patients with rosacea: a multi-center, randomized, double-blind, double-dummy, pilot study. J Am Acad Dermatol. 2020 May 18;: Authors: Wang B, Yuan X, Huang X, Tang Y, Zhao Z, Yang B, Yang B, Zheng Y, Yuan C, Xie H, Li J PMID: 32439466 [PubMed - as supplied by publisher] {url} = URL to article More info on hdroxychloroquine and rosacea
    • Related ArticlesRole of ferritin in pathogenesis of rosacea and its value in efficacy of 595 nm pulsed dye laser in treatment of different variants of rosacea: a clinical and immunohistochemical study. J Cosmet Laser Ther. 2020 May 22;:1-7 Authors: Elwan NM, Salah SM, Abdelsalam SF, Elfar NN Abstract BACKGROUND: Current rosacea treatment focused on symptom suppression to improve patient's quality of life, prevent progression, and sustain remission. The progress of laser therapy has brought about a paradigm shift in the world of treating erythema and telangiectasia. We appraised role of ferritin in pathogenesis of rosacea and consider its value in efficacy of 595 nm pulsed dye laser (PDL) in treatment of rosacea. MATERIALS/METHODS: 20 patients had rosacea were treated with PDL; received 4 sessions, 4 weeks apart. They were assessed before and after treatment by rosacea grading scale and skin biopsies were taken to detect changes in ferritin expression before and after treatment. RESULTS: Ferritin expression in lesional skin was positively expressed in all patients proportional to severity of rosacea that showed statistically significant reduction of ferritin expression after PDL. There was a statistically significant reduction in rosacea grading scale after PDL (p value = .005*); the highest efficacy was in phymatous then papulopustular and erythrotelangiectatic types. CONCLUSIONS: The reduction of ferritin expression after PDL opens a new era for antioxidant agents to be added as a relevant approach for the therapy of rosacea via attenuation of oxidative stress. PMID: 32441163 [PubMed - as supplied by publisher] {url} = URL to article
    • In summary, this multinational, observational, real-world study of patients with COVID-19 requiring hospitalisation found that the use of a regimen containing hydroxychloroquine or chloroquine (with or without a macrolide) was associated with no evidence of benefit, but instead was associated with an increase in the risk of ventricular arrhythmias and a greater hazard for in-hospital death with COVID-19. These findings suggest that these drug regimens should not be used outside of clinical trials and urgent confirmation from randomised clinical trials is needed. The Lancet Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis Prof Mandeep R Mehra, MD  Sapan S Desai, MD Prof Frank Ruschitzka, MD Amit N Patel, MD
    • In summary, this multinational, observational, real-world study of patients with COVID-19 requiring hospitalisation found that the use of a regimen containing hydroxychloroquine or chloroquine (with or without a macrolide) was associated with no evidence of benefit, but instead was associated with an increase in the risk of ventricular arrhythmias and a greater hazard for in-hospital death with COVID-19. These findings suggest that these drug regimens should not be used outside of clinical trials and urgent confirmation from randomised clinical trials is needed. The Lancet Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis Prof Mandeep R Mehra, MD  Sapan S Desai, MD Prof Frank Ruschitzka, MD Amit N Patel, MD
    • Sunny Beach Treatment Increases RF Irradiation in Rosacea A paper about RF irradiation may explain why short term sun can improve rosacea when you are on a vacation on a sun filled beach. When you are exposed short term on a vacation by the sun you are receiving more RF radiation in the form of radio waves along with the visible light as you are on the beach. [1] This exposure may actually accentuate* your rosacea. Of course, over exposure to sun light and radio waves will trigger your rosacea, so you have to be careful to not get sun burned, which would exacerbate your rosacea. Balance is the key. A little sun can help your rosacea, not to mention reducing your stress level.    "Notably, blood vessel densities in the skins of UVB-treated mice and rosacea patients were significantly decreased by RF irradiation. These results provide experimental and molecular evidence regarding the effectiveness of RF irradiation for the treatment of rosacea." [2] End Notes [1] "All of the energy from the Sun that reaches the Earth arrives as solar radiation, part of a large collection of energy called the electromagnetic radiation spectrum. Solar radiation includes visible light, ultraviolet light, infrared, radio waves, X-rays, and gamma rays." Lab Activity: Heat Transfer by Radiation, NOAA Earth System Research Laboratories (ESRL) [2] Exp Dermatol. 2020 May 20;: Radiofrequency irradiation attenuates angiogenesis and inflammation in UVB-induced rosacea in mouse skin. Son M, Park J, Oh S, Choi J, Shim M, Kang D, Byun K * "Attenuate is a verb that means to make or become weaker. The effects of aging may be attenuated by exercise — or by drinking from the fountain of youth. The versatile word attenuate denotes a weakening in amount, intensity, or value." vocabulary.com
    • Related ArticlesLupus miliaris disseminatus faciei in a young male. G Ital Dermatol Venereol. 2019 Dec;154(6):714-716 Authors: Manganoni AM, Farisoglio C, Pavoni L, Chiudinelli M, Stillitano G, Ungari M, Calzavara-Pinton P Abstract We report a case of a healthy 26-year-old male with multiple asymptomatic reddish papules and papule-nodules on the central area of the face, persisting from more than 2 months and gradually increasing in number. An incisional skin biopsy revealed a confluent dense granulomatous infiltrate centred by large areas of eosinophilic necrosis consistent with the diagnosis of lupus miliaris disseminatus faciei (LMDF). This is a rare dermatosis first described in 1878 by Fox, that often poses a clinical challenge as it is a disease process which is difficult to diagnose. In fact, in our case, a diagnosis of LMDF was made on skin biopsy. We think that collaboration among dermatologists and General Practitioners is very important for diagnosis of rare dermatosis and especially for management of it, in order to prevent the development of depressed scars. PMID: 26349925 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients. BMJ Open. 2020 May 18;10(5):e032829 Authors: Thomas M, Wong CC, Anderson P, Grills N Abstract INTRODUCTION: Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients' perception of skin disease. METHODS: A mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome. RESULTS: Out of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days' wages of a labourer). CONCLUSION: Steroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek 'quick fixes' from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and prescription of irrational TS combinations. PMID: 32430446 [PubMed - in process] {url} = URL to article
    • Expressions of glutathione S-transferases alpha, mu, pi and theta in the skin samples of patients with acne rosacea. J Cosmet Dermatol. 2020 May 20;: Authors: Takci Z, Bilgili SG, Kilic M, Oguztuzun S, Moran B, Simsek GG, Akbayrak A, Seckin HY, Karadag AS Abstract BACKGROUND: Data point to the importance of oxidative stress in rosacea. Glutathione S-transferases (GSTs) have substantial roles in a wide variety of oxidative stress-related conditions. AIM: To evaluate the immunohistochemical staining characteristics of GST alpha (GSTA), mu (GSTM), pi (GSTP), and theta (GSTT) in patients with rosacea. PATIENTS/METHODS: The study included 23 women and 7 men with rosacea (mean ± SD age 49 ± 11 yr) and 15 healthy control subjects (10 women, 5 men; mean ± SD age 47.86 ± 10.88 yr). For each patient, the average disease duration, disease subtype, ocular involvement, and severity score were recorded. A 3-mm punch biopsy was taken from the facial skin of each patient and control. Expression of GST isoenzymes was analyzed immunohistochemically. RESULTS: Expressions of GSTM1, GSTP1, and GSTT1 were significantly elevated in patients with rosacea compared to those in the control group (p = 0.0001, p = 0.0002, p < 0.0001, respectively). In the rosacea group, GSTT1 expression was significantly stronger than GSTP1 and GSTA1 expressions (p = 0.019, p < 0.0001, respectively). There were no significant associations between expressions of GST isoenzymes and gender, age, average duration of illness, disease subtype, ocular involvement, or severity score in the patient group (all p > 0.05). CONCLUSIONS: In rosacea, the significant increase of GSTT1, GSTP1, and GSTM1 expressions might result from activation of GST as an outcome of extreme free radical generation from triggered neutrophils or ultraviolet vulnerability. These findings support the relevance of oxidant stress in the pathogenesis of rosacea. PMID: 32433803 [PubMed - as supplied by publisher] {url} = URL to article
    • Radiofrequency irradiation attenuates angiogenesis and inflammation in UVB-induced rosacea in mouse skin. Exp Dermatol. 2020 May 20;: Authors: Son M, Park J, Oh S, Choi J, Shim M, Kang D, Byun K Abstract Rosacea is a skin inflammatory condition accompanied by cutaneous signs such as edema, flushing, erythema, telangiectasia, and pustules. Generally, rosacea is triggered by ultraviolet B (UVB) exposure. When exposed to UVB, skin epidermis thickens and produces elevated levels of pro-inflammatory cytokines, especially keratinocyte-related VEGF, a potent angiogenic factor. The upregulations of VEGF expression and its secretion promote the formation of new blood vessels and exacerbates rosacea. In this study, radiofrequency (RF) irradiation reduced keratinocyte proliferation in the epidermal layer, the expressions of pro-inflammatory cytokines, angiogenesis-related inflammatory factors, and VEGF in our UVB-induced model of rosacea in vitro and in vivo. RF irradiation attenuated VEGF-induced angiogenesis-associated-processes such as tube formation, cell migration, and endothelial cell proliferation. Notably, blood vessel densities in the skins of UVB-treated mice and rosacea patients were significantly decreased by RF irradiation. These results provide experimental and molecular evidence regarding the effectiveness of RF irradiation for the treatment of rosacea. PMID: 32434270 [PubMed - as supplied by publisher] {url} = URL to article Sunny Beach Treatment Increases RF Irradiation in Rosacea Does a vacation to the South Pacific which includes snorkeling improve rosacea?
    • You may be concerned with how to protect your skin as well as the mucous membrane, especially if you have issues with a mask irritating your rosacea sensitive skin. One paper on this subject states, "Insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier." [1] Another paper calls this 'Surgical Mask Dermatitis." [2] Personal Protective Equipment (PPE) includes among other items a facial mask, gloves, etc.   It has been recommended that, "using moisturizing products is highly recommended to achieve better protection." [1]. If you are concerned about wearing a mask, there are masks that may reduce skin irritation, i.e,, Anti-fog Full Face Shield, Anti-fog Adjustable Full Face Shield, Safety Face Shield.  In using googles, one source states, "Over‐tight using cannot enhance the protective effect but damage the skin and generate fogs instead." [1] Treatment for Skin Irritation Resulting from Using Protection "Therapeutic measures for redness and swelling include hydropathic compress with three to four layers of gauze soaked by cold water or normal saline for about 20 minutes each time every 2 to 3 hours and then applying moisturizers. Avoid washing with over‐heated water, ethanol or other irritative products." [1] The paper recommends other therapeutic treatments if you are suffering from further damage to your skin.  End Notes [1] Dermatol Ther. 2020 Mar 29 : e13310. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health‐care workers fighting against coronavirus disease 2019 Yicen Yan,  Hui Chen,  Liuqing Chen,  Bo Cheng,  Ping Diao,  Liyun Dong [2] Contact Dermatitis. 2020 May 28.  doi: 10.1111/cod.13626.  Online ahead of print. Surgical Mask Dermatitis Caused by Formaldehyde (Releasers) During the COVID-19 Pandemic Olivier Aerts, Ella Dendooven, Kenn Foubert, Sofie Stappers, Michal Ulicki, Julien Lambert   
    • Benzyl Benzoate, a treatment for scabies, not available in the USA but is available in the UK, Australia and China, has been reported to be "a useful alternative treatment for rosacea as well as for demodicosis" according to a paper published in the May issue of the J Dermatolog Treat.  J Dermatolog Treat. 2020 May 19;:1-28 Effectiveness of benzyl benzoate treatment on clinical symptoms and Demodex density over time in patients with rosacea and demodicosis: a real life retrospective follow-up study comparing low- and high-dose regimens. Forton FMN, De Maertelaer V Benzyl Benzoate is listed with Anti-parasitic Prescription Agents For Rosacea
    • Effectiveness of benzyl benzoate treatment on clinical symptoms and Demodex density over time in patients with rosacea and demodicosis: a real life retrospective follow-up study comparing low- and high-dose regimens. J Dermatolog Treat. 2020 May 19;:1-28 Authors: Forton FMN, De Maertelaer V Abstract Background: Patients with rosacea and demodicosis have high facial skin Demodex densities (Dds), which decrease with benzyl benzoate (BB) treatment.Objectives: To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms during prolonged follow-up and to compare low (12% once daily) and high (12% twice daily or 20-24% once daily) BB dose regimens.Methods: This retrospective study included 344 patients (103 rosacea, 241 demodicosis) observed for 7.1 ± 0.5 months. Dds were measured on two consecutive standardized skin surface biopsies and symptoms evaluated using investigator global assessment. Compliance was considered good if patients correctly followed treatment instructions.Results: At final follow-up, in the 248 patients with good compliance, Demodex density had normalized in 217 (88%) and symptoms cleared in 204 (82%). The high dose was associated with better compliance and faster results than the low-dose. The higher the initial Dd, the longer it took to normalize. In the 96 poorly compliant patients, treatment was less effective and slower.Conclusion: These findings indirectly support a key role of the mite in rosacea and suggest that topical treatment with BB (+crotamiton), especially the higher dose, may be a useful alternative treatment for rosacea as well as for demodicosis. PMID: 32427504 [PubMed - as supplied by publisher] {url} = URL to article Crotamiton for Demodectic Rosacea According to Wikipedia, benzyl benzoate "is not available for medical use in the United States." It is available in the UK, Australia, China and other countries.   Treatment of Rosacea and Demodicosis With Benzyl Benzoate: Effects of Different Doses on Demodex Density and Clinical Symptoms
    • October 2, 2019 Galderma to become the world’s largest independent global dermatology company after completion of CHF 10.2 billion carve-out of Nestlé Skin Health
    • UPDATE  "President Donald Trump announced he was taking hydroxychloroquine, a drug he's repeatedly touted as a treatment for coronavirus, despite warnings about its effectiveness and safety." Coronavirus live updates, Ryan W. Miller, USA TODAY President Trump suffers from rosacea. 
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