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    • Abstract
      In dermatology probiotic microorganisms have primarily been used orally for the prophylaxis and treatment of atopic disorders. In contrast to the successes achieved for gastrointestinal disorders, positive effects for atopic dermatitis only have been found in a few studies. New insights could now fundamentally change the impact of probiotics on dermatology. Probiotics are - like microflora of the skin - non-pathogenic microbes, which do not induce inflammatory responses in the skin. Common pathways for probiotics, non-pathogenic microbes, and microflora are characterized, in order to facilitate their more effective therapeutic use. These microbes display a majority of their effects directly at the site of application and thereby induce natural defense mechanisms. However, promotion of immunological tolerance is just as important in producing positive effects. Tolerance of the resident flora on surface organs developed during evolution and the mechanisms of action are multifaceted. Therefore, the topical application of probiotics and non-pathogenic microbes for prophylaxis and therapy of overwhelming cutaneous pro-inflammatory immune reactions is very promising. Results of recent clinical trials already have demonstrated the efficacy of this new therapeutic concept. Hautarzt. 2009 Oct;60(10):795-801. doi: 10.1007/s00105-009-1755-8.
      Outside-in. Probiotic topical agents.
      Volz T, Biedermann T.
    • Abstract
      INTRODUCTION AND OBJECTIVE:
      Normal human skin can produce a range of antimicrobial chemicals that play an important part in eliminating potential cutaneous pathogens. Lactobacillus plantarum is a gram-positive bacteria that produces antimicrobial peptides, which when applied to the skin can act like an anti-inflammatory as well as enhance the antimicrobial properties of the skin. Clinical studies were conducted to determine the effect of lactobacillus extract on improvement of skin barrier and reduction of erythema from chemical irritant, skin microflora, and acne. Results show that lactobacillus extract was effective in reducing skin erythema, repairing skin barrier, and reducing skin microflora, thereby exhibiting an effective reduction in acne lesion size and erythema at 5%, but not at 1%.
      CONCLUSION:
      Based on the results of these studies, lactobacillus extract (5%) can be used to treat mild acne lesions. J Cosmet Sci. 2012 Nov-Dec;63(6):385-95.
      Physiological effect of a probiotic on skin.
      Muizzuddin N, Maher W, Sullivan M, Schnittger S, Mammone T.
    • Related Articles Mindfulness-Based Cognitive Hypnotherapy and Skin Disorders. Am J Clin Hypn. 2018 Jul;61(1):34-44 Authors: Shenefelt PD Abstract
      Mindfulness-based cognitive hypnotherapy integrates mindfulness, cognitive-behavioral therapy, and hypnotherapy to improve physical, emotional, mental, and/or spiritual aspects of skin disorders. Meditation, including mindfulness meditation, and hypnosis both utilize trance phenomena to help produce focalization and specific improvements in skin disorders through psycho-neuro-endocrine-immunologic mechanisms. Hypnosis, cognitive hypnotherapy, focused meditation, and mindfulness meditation are discussed with respect to improving various skin disorders including acne, acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythema nodosum, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, prurigo nodularis, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Their integration into mindfulness-based cognitive hypnotherapy is then discussed and illustrated with improvement in a patient with systemic lupus erythematosus.
      PMID: 29771216 [PubMed - in process] {url} = URL to article
    • Related Articles Assessment of rosacea symptom severity by genome-wide association study and expression analysis highlights immuno-inflammatory and skin pigmentation genes. Hum Mol Genet. 2018 May 16;: Authors: Aponte JL, Chiano MN, Yerges-Armstrong LM, Hinds DA, Tian C, Gupta A, Guo C, Fraser DJ, Freudenberg JM, Rajpal DK, Ehm MG, Waterworth DM Abstract
      Rosacea is a common, chronic skin disease of variable severity with limited treatment options. The cause of rosacea is unknown, but it is believed to be due to a combination of hereditary and environmental factors. Little is known about the genetics of the disease. We performed a genome-wide association study (GWAS) of rosacea symptom severity with data from 73,265 research participants of European ancestry from the 23andMe customer base. Seven loci had variants associated with rosacea at the genome-wide significance level (p≤5 × 10-8). Further analyses highlighted likely gene regions or effector genes including IRF4 (p=1.5 × 10-17), an HLA region flanked by PSMB9 and HLA-DMB (p=2.2 × 10-15), HERC2-OCA2 (p=4.2 × 10-12), SLC45A2 (p=1.7 × 10-10), IL13 (p=2.8 × 10-09), a region flanked by NRXN3 and DIO2 (p=4.1 × 10-9), and a region flanked by OVOL1and SNX32 (p=1.2 × 10-8). All associations with rosacea were novel except for the HLA locus. Two of these loci (HERC-OCA2, SLC45A2) and another precedented variant (rs1805007 in MC1R) with an association p value just below the significance threshold (p=1.3 × 10-7) have been previously associated with skin phenotypes and pigmentation, two of these loci are linked to immuno-inflammation phenotypes (IL13, PSMB9-HLA-DMA) and one has been associated with both categories (IRF4). Genes within three loci (PSMB9-HLA-DMA, HERC-OCA2, and NRX3-DIO2) were differentially expressed in a previously published clinical rosacea transcriptomics study that compared lesional to non-lesional samples. The identified loci provide specificity of inflammatory mechanisms in rosacea, and identify potential pathways for therapeutic intervention.
      PMID: 29771307 [PubMed - as supplied by publisher] {url} = URL to article
    • TEAE percentage rate is low with oxymetazoline treatment for rosacea. For more information. 
    • A new acronym, TEAE [Treatment-Emergent Adverse Events], has been published in the June issue of the Journal of the American Academy of Dermatology,  in an article entitled, "Sustained Use of Oxymetazoline Cream Efficacious for Rosacea," according to MPR, about a study on the long-term safety (1 year) and efficacy of oxymetazoline cream 1.0% in 440 patients with rosacea spear headed by Zoe Diana Draelos, MD, who volunteers on the RRDi MAC. The study concluded: "This long-term study demonstrated sustained safety, tolerability, and efficacy of oxymetazoline for moderate-to-severe persistent erythema of rosacea." "The rate of discontinuation mostly due to application-site TEAEs was 3.2%" So the TEAE is low with oxymetazoline treatment for rosacea. 
    • Treatment for rosacea depends on the severity, but often requires some detective work to figure out your triggers as well as a carefully selected skin-care plan, including prescription and over-the-counter products. Some people may benefit from antibiotics, medications that specifically target redness, or isotretinoin (Accutane). For others, just keeping an eye on their triggers can have a profound impact.
      But the piece that tends to get overlooked in all of this is the mental health toll of dealing with a new skin condition—especially one that really has no cure. Below, we spoke with 11 people who have rosacea about how they were diagnosed, how they deal with their symptoms, and what they want others to know about the condition. 11 People Describe What It's Really Like to Have Rosacea, Sarah Jacoby, SELF
    • "For instance, at 28, I had what I thought was stubborn acne for a few years. I went all out in the drugstore aisle with harsh, drying products that ended up doing more harm than good. So when I was finally diagnosed with rosacea this past December, I was actually relieved. I assumed that having an answer would make it easier to treat."  Sarah Jacoby, Senior Health News Editor at SELF, who stated the above quote in her article, 11 People Describe What It's Really Like to Have Rosacea.  SELF Masthead • Twitter • Muck Rack • Refinery29 • Linkedin
    • image courtesy of Wikipedia Salvia hispanica, commonly known as chia, is a species of flowering plant in the mint family, Lamiaceae, native to central and southern Mexico and Guatemala. Wikipedia Comparing Essential Oils with Metronidazole and Mercury Oxide in Killing Mites (with emphasis upon Salvia Hispanic) Abstract
      Demodex belong to the smallest mites: the average length of adults is 250 μm. Up to now, two Demodex species have been described, which are specific for humans: Demodex folliculorum and Demodex brevis. A medical condition caused by presence of Demodexis called demodicosis. Gao et al. in 2005 reported good effects of tea tree oil on Demodex sp. in the in vitro and in vivo settings. Aim of this study was to check survivability of Demodex mites in various substances. Tests were made with the use of the most common substances used in demodicosis treatment, i.e. metronidazole and mercury oxide. The effects of essential oils from tea tree, sea buckthorn, aloe, salvia, peppermint, camphor tree, fennel, eucalyptus, and lavender were tested as well. For controls, Demodex were placed in saline. The mean survival time of Demodex was 64 hours for metronidazole, and 46 hours – for 2.5% mercury oxide. Much better results were obtained with 50% tea tree oil (7 minutes), peppermint oil (11 minutes) and salvia oil (7 minutes).  Research Gate, December 2014
      Effect of Metronidazol, Mercury Oxide and Essentials Oils on the in vitro survivability of Demodex mites.
      Aleksandra Sedzikowska,Maciej Oseka, B. Grytner-Zięcina, Emilia Jaremko ---------------------------------------------------------------- Abstract
      Demodicosis is a medical condition caused by presence of Demodex mites. Mites may cause ocular demodicosis with symptoms such as burning and itching of eyelids. Currently, several drugs are available for the treatment of demodicosis. However, their use carries a risk of serious side effects. According to recent studies, substances contained in some plant-derived essential oils kill Demodex mites. Good efficacy of tea tree oil against Demodex sp. has been reported. However, some patients develop allergic reactions and ocular irritation in the course of tea tree oil treatment. Tests with essential oils showed that salvia and peppermint oils rapidly kill Demodex-in 7 and 11 minutes, respectively. Salvia is known as a valuable herb and is used to treat eye disease. Therefore, salvia essential oil could be an alternative treatment for demodicosis. J Bacteriol Parasitol, 2015, Volume 6. Issue 3.
      Impact of Salvia and Peppermint Oil on the In Vitro Survival of Demodex Mites (PDF)
      Aleksandra Sędzikowska, Maciej Osęka , Beata Roman3and Emilia Jaremko.
      Department of General Biology and Parasitology, Medical University of Warsaw, Poland. Ofta Ltd., ul. Mleczna 8, 03-667 Warsaw, Poland, Verco Sp. z o.o., Warsaw, Poland.
    • We learned about the Rositta Method in June 2012 at this thread at RF and it was a mystery how she treated rosacea patients for a long time. However, Conf posted [post no 109 11th May 2018 07:10 PM] an article published March 14, 2018 in Beauty Journaal (translated from Dutch) that describes her method of extracting demodex mite eggs and her complete treatment. You may watch this video below if you understand Dutch: 
    • Related Articles A case report of granulomatous rosacea of the face. Singapore Med J. 2018 Apr;59(4):228-229 Authors: Kok WL, Oon HH, Giam YC PMID: 29748691 [PubMed - in process] {url} = URL to article
    • What Dr. Kluk and I both thought interesting was your comment about rosacea. It’s very possible that you don’t have it, but as Dr Kluk told me: "Rosacea is very misunderstood as a condition, and it’s very common. If you google it, you’re going to get quite graphic photos of people with extreme redness, rough and broken skin, that sort of thing, but that is a very advanced kind of rosacea. There are much subtler, less pervasive forms of rosacea, and just because you have a less aggressive kind of rosacea now, it doesn’t mean it will become more like that at all. It’s possible to have rosacea without any textural changes to the skin." Dear Daniela: What Can I Do About My Red, Blotchy Skin?
      DANIELA MOROSINI, Refinery29
    • Here is a very interesting article about vitamins and supplements and Rosacea https://rosadyn.com/rosacea/suppliments-vitamin/vitamins-supplements-rosacea-triggers/ It seems that in some case not the vitamin is the problem but the quantity. From it I have learned how many mistakes I have made in my case treating my Rosacea over time. I have been treated by neurologyst with Ginko Biloba and by psychiatrist with Vinpocetine(Cavinton Forte). I have been diagnosed recently with Vertebro Basilar Circulatory Insufficiency and Cavinton Forte 3x10mg per day for 3 months were prescribed to me. In less than a week my face was melted, hard to touch and with pain and acid sensations. My God are pysicians so ignorant when it comes to Rosacea???
    • Dual-Frequency Ultrasound as a New Treatment Modality for Refractory Rosacea: A Retrospective Study. Dermatol Surg. 2018 May 09;: Authors: Park JY, Ahn MK, Cho EB, Park EJ, Kim KH Abstract
      BACKGROUND: Dual-frequency ultrasound (DFU) has emerged as a new treatment modality for improving inflammatory skin disorders. Although there have been few pilot studies, there are a limited number of studies that investigated efficacy of DFU on refractory rosacea.
      OBJECTIVE: This study investigated the effect of DFU on patients with refractory rosacea.
      MATERIALS AND METHODS: The authors retrospectively analyzed medical records of 42 patients with refractory rosacea (erythematotelangiectatic rosacea [ETR], n = 26; papulopustular rosacea [PPR], n = 14, mixed, n = 2). The patients were treated with DFU twice per week for the 1st week, and then once per week thereafter. Efficacy was assessed using erythema index (EI), transepithelial water loss (TEWL), and patient self-assessment (PSA).
      RESULTS: Treatment with DFU resulted in significant decrease in EI, TEWL, and PSA. No significant difference was noted between ETR and PPR.
      CONCLUSION: Application of DFU in patients with refractory rosacea resulted in improvement in persistent erythema, barrier dysfunction, and patient-reported symptoms. Dual-frequency ultrasound may be an additional treatment option for rosacea that is resistant to other treatments.
      PMID: 29746429 [PubMed - as supplied by publisher] {url} = URL to article
    • Thanks for sharing the article. In my case no Micellar water worked, not even the Bioderma Sensibio H2O Solution Micellaire. They were making my skin drier and drier. I would be willing to give a try to Biossance 100% Squalane Oil(I did not know such a thing exist and I am speaking about Squalane Oil not Squalane).
    • Treating any specific skin issue is always about trial, error, and adaptation: What worked well one month might be fully ineffectual the next. But through all my experimentation — the countless serums, creams, toners, and treatments I’ve tried — these are the six essentials that consistently keep my skin calm all season long. 6 Beauty Essentials That Keep My Rosacea-Ridden Skin Under Control, Kelsey Haywood, Brit + CO 
    • According to Dr. Fishman, anyone with rosacea or especially sensitive skin would experience noticeable, positive differences with fewer products, fewer chemicals, and a decrease in skin irritants. "That includes exposure to cold, wind, low humidity, and extreme heat as well as products," she said. While it can be a bummer if you love product, she said, rosacea sufferers were not meant to constantly experiment with several new skin care formulations. "If you find products and ingredients that work for your skin, stick with them!" How To Navigate Beauty Products With Rosacea, by Lindsay Kellner, mbglifestyle  
    • The investigators concluded that the results of this study imply that the use of CD-doxycycline may have an impact on the previously reported association between rosacea and GID. This may be due in part to a dose-dependent effect, but it might also be linked to the inherent characteristics of the SD (modified-release) formulation of doxycycline. Longitudinal studies are warranted in order to further define this association. Fewer Gastrointestinal Issues in Rosacea Treated With Subantimicrobial vs Conventional Doxycycline, by Sheila Jacobs, Dermatology Advisor
    • After my two weeks were up, my takeaway was pretty clear: Changing my diet helped clear up and prevent rosacea flare-ups, but it didn't eliminate them completely. I still had redness and new bumps pop up over the course of the two weeks, despite adhering to my "rosacea diet." To be fair, this type of diet probably produces best results over the long term, and I will continue to follow some of the recommendations because they were actually helpful. Can the "Rosacea Diet" Actually Clear Your Skin?, By Julia Malacoff, Shape
    • A new photo series is rejecting a culture of ‘perfect’ pictures and airbrushing by celebrating women with common skin conditions such as acne, rosacea and eczema. Sophie Harris-Taylor’s project Epidermis is inspired by her own experience of being a young woman with severe acne, which left her struggling with self-confidence and acceptance. In Epidermis, twelve women are shown barefaced in unretouched images, some of who had never left the house before without their make-up on. Harris-Taylor says she deliberately shot it in the style of a beauty editorial shoot: “I wanted it to be seen as a beauty shoot first and an exploration of skin second.” With Epidermis, she hopes to make our perception of beauty less homogenised. Here, Harris-Taylor speaks to i about her series.  This make-up free photo series is celebrating women with acne, rosacea and other skin condition, by Healther Saul, iNews  
    • The investigators concluded that the results of this study demonstrate the wide-ranging, negative impact of rosacea on self-perception: and emotional, social, overall well-being; rosacea-specific QoL. Effective treatments that address the underlying etiology of the disease and its troublesome symptoms — along with appropriate education — are necessary in order to achieve optimal aesthetic and psychosocial outcomes in individuals with rosacea. Rosacea Has Significant Effects on Emotional, Social Well-Being, by Sheila Jacobs, Dermatology Advisor
    • "Rosacea is characterized by a red face or neck with broken blood vessels, with or without acne, and can run in families,” says dermatologist Jeanine Downie, M.D., founder of Image Dermatology. “You see it in light-skinned patients more, but you can see it in all races," she says. The good news: There’s a lot you can do to calm this Santa situation down. The Best Rosacea Treatments, Ranked, By Grace Gold, Women's Health
    • Thanks D-Mac,  Welcome aboard the RRDi member forum. Keep posting and mucho mahalo for your donation. 
    • Related Articles Rhinophyma: A Treatment Review. Dermatol Surg. 2018 Feb;44(2):275-282 Authors: Fink C, Lackey J, Grande DJ Abstract
      BACKGROUND: Rhinophyma is the overgrowth of sebaceous glands in nasal tissue and its etiology unclear. Without treatment, rhinophyma can be progressive and cause concern both with respect to function and cosmesis.
      OBJECTIVE: The objective of this work is to describe treatment options for rhinophyma and their respective risks and benefits.
      MATERIALS AND METHODS: A PubMed search was performed to include the terms "rhinophyma" and "treatment."
      RESULTS: Numerous physically destructive modalities exist for treatment of rhinophyma, falling primarily into 3 categories: mechanical destruction, directed electrical energy/radiofrequency, and directed laser energy.
      CONCLUSION: There are multiple treatment modalities available to dermatologists for the treatment of rhinophyma. To the best of our knowledge, there are no randomized, prospective, control studies for any treatment, which makes it difficult to recommend a single treatment over another. Nonetheless, it is important to recognize that scarring and hypopigmentation most often occur on or near the nasal ala. Moreover, risks may increase if tissue destruction extends to the papillary dermis or pilosebaceous units are ablated.
      PMID: 29140869 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Regional Dermabrasion of Nasal Surgical Scars and Rhinophyma Using Electrocautery Scratch Pads. Dermatol Surg. 2018 Feb;44(2):300-302 Authors: Chuang GS, Alfaresi F PMID: 29401164 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Skin mites in mice (Mus musculus): high prevalence of Myobia sp. (Acari, Arachnida) in Robertsonian mice. Parasitol Res. 2018 May 04;: Authors: Sastre N, Calvete O, Martínez-Vargas J, Medarde N, Casellas J, Altet L, Sánchez A, Francino O, Ventura J Abstract
      Myobia sp. and Demodex sp. are two skin mites that infest mice, particularly immunodeficient or transgenic lab mice. In the present study, wild house mice from five localities from the Barcelona Roberstonian system were analysed in order to detect skin mites and compare their prevalence between standard (2n = 40) and Robertsonian mice (2n > 40). We found and identified skin mites through real-time qPCR by comparing sequences from the mitochondrial 16S rRNA and the nuclear 18S rRNA genes since no sequences are available so far using the mitochondrial gene. Fourteen positive samples were identified as Myobia musculi except for a deletion of 296 bp out to 465 bp sequenced, and one sample was identified as Demodex canis. Sampling one body site, the mite prevalence in standard and Robertsonian mice was 0 and 26%, respectively. The malfunction of the immune system elicits an overgrowth of skin mites and consequently leads to diseases such as canine demodicosis in dogs or rosacea in humans. In immunosuppressed mice, the probability of developing demodicosis is higher than in healthy mice. Since six murine toll-like receptors (TLRs) are located in four chromosomes affected by Robertsonian fusions, we cannot dismiss that differences in mite prevalence could be the consequence of the interruption of TLR function. Although ecological and/or morphological factors cannot be disregarded to explain differences in mite prevalence, the detection of translocation breakpoints in TLR genes or the analysis of TLR gene expression are needed to elucidate how Robertsonian fusions affect the immune system in mice.
      PMID: 29728826 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Which acne treatment has the best influence on health-related quality of life? Literature review by the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes. J Eur Acad Dermatol Venereol. 2018 May 05;: Authors: Chernyshov PV, Tomas-Aragones L, Manolache L, Svensson A, Marron SE, Evers AWM, Bettoli V, Jemec GB, Szepietowski JC Abstract
      According to results of a recent literature search performed by the European Academy of Dermatology and Venereology (EADV) Task Forces (TF) on Quality of Life and Patient Oriented Outcomes (QoL and PO) and Acne, Rosacea and Hidradenitis Suppurativa (ARHS) most of publications where health-related (HR) QoL of acne patients was studied were clinical trials. Members of the EADV TF on QoL and PO decided to detect which acne treatment has the best influence on HRQoL of acne patients. A new literature search was organized to find publications on acne treatment where the HRQoL of patients was assessed as an outcome measure. From 186 papers with HRQoL assessment 37 papers were included for further analysis. Our results revealed that oral isotretinoin had the best influence on HRQoL of acne patients. Several other treatment methods also showed good effects on the HRQoL of acne patients. Oral isotretinoin and norethindrone acetate/ethinyl estradiol, topical clindamycin phosphate/benzoyl peroxide and adapalene/benzoyl peroxide showed significantly better effect on HRQoL than placebo. There is limited number of the high-quality studies on acne treatment where HRQoL were assessed. Dermatology-specific and acne-specific instruments showed much better sensitivity to successful therapeutic intervention than generic HRQoL instruments. The most frequently used HRQoL instrument was the DLQI questionnaire. This article is protected by copyright. All rights reserved.
      PMID: 29729107 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles A report and follow up of a patient with disseminated superficial actinic porokeratosis (DSAP) undergoing novel systemic treatment with palifermin (a keratinocyte growth factor) during chemotherapy. Dermatol Online J. 2018 Feb 15;24(2): Authors: Howard M, Hall A Abstract
      Disseminated superficial actinic porokeratosis (DSAP) is an inherited dermatosis triggered by chronic ultraviolet light exposure. Cosmetic improvement has been noted with topical therapies or laser treatment. Lesions of DSAP are precancerous, having been reported to develop into squamous cell carcinomas (SCCs) or basal cell carcinomas (BCCs) occasionally. We describe a patient with longstanding DSAP who developed a primary CNS lymphoma. Palifermin (a keratinocyte growth factor analogue) was used as an adjuvant for his chemotherapy to minimize mucositis. Our patient noted marked clinical improvement of his DSAP following his chemotherapy for lymphoma. Follow-up has shown a sustained improvement of his DSAP with no development of any SCCs. Palifermin may be safe for use in individuals at high risk of developing SCCs and further research into keratinocyte growth factors and risk of development of SCC is warranted. Systemic chemotherapy appears to improve DSAP lesions.
      PMID: 29630163 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Keep up the good work Brady. I read a lot of your posts and appreciate the effort you put it.  Rosacea is tough, but  it helps me immensely to read the stories of others. I will be donating to the rrdi very soon.  I encourage other rosaceans to do the same. 
    • Related Articles Skin neurogenic inflammation. Semin Immunopathol. 2018 Apr 30;: Authors: Choi JE, Di Nardo A Abstract
      The epidermis closely interacts with nerve endings, and both epidermis and nerves produce substances for mutual sustenance. Neuropeptides, like substance P (SP) and calcitonin gene-related protein (CGRP), are produced by sensory nerves in the dermis; they induce mast cells to release vasoactive amines that facilitate infiltration of neutrophils and T cells. Some receptors are more important than others in the generation of itch. The Mas-related G protein-coupled receptors (Mrgpr) family as well as transient receptor potential ankyrin 1 (TRPA1) and protease activated receptor 2(Par2) have important roles in itch and inflammation. The activation of MrgprX1 degranulates mast cells to communicate with sensory nerve and cutaneous cells for developing neurogenic inflammation. Mrgprs and transient receptor potential vanilloid 4 (TRPV4) are crucial for the generation of skin diseases like rosacea, while SP, CGRP, somatostatin, β-endorphin, vasoactive intestinal peptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP) can modulate the immune system during psoriasis development. The increased level of SP, in atopic dermatitis, induces the release of interferon (IFN)-γ, interleukin (IL)-4, tumor necrosis factor (TNF)-α, and IL-10 from the peripheral blood mononuclear leukocytes. We are finally starting to understand the intricate connections between the skin neurons and resident skin cells and how their interaction can be key to controlling inflammation and from there the pathogenesis of diseases like atopic dermatitis, psoriasis, and rosacea.
      PMID: 29713744 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles [Time to limit the use of antibiotics in rosacea!] Lakartidningen. 2018 Apr 24;115: Authors: Mobacken H, Berg M, Angesjö E, Dunér K, Svensson M, Synnerstad I Abstract
      Rosacea is a chronic inflammatory disease with facial erythema and papulopustules. It is common in middle-aged/elderly persons and often affects self-perception and social well-being. It is generally classified into four subtypes. Improved understanding of pathophysiology has resulted in novel treatment approaches, but routine management in health care usually follows old trails. Most patients are managed in primary care. Greater attention to the reduced skin barrier, avoidance of exacerbating factors, better topicals and encouragement to topical maintenance treatment should reduce the use of oral tetracyclines. Low-dose isotretinoin is reserved for treatment-resistant patients, but relapses are frequent unlike its use in acne. In order to reduce antibiotic use, we propose that patients should be referred to a dermatologist for optimization of therapy including consideration of isotretinoin following tetracycline treatment of a maximum of 4-6 months.
      PMID: 29714807 [PubMed - in process] {url} = URL to article
    • Related Articles Oral Azithromycin: A Treatment Option for Papulopustular Rosacea. Actas Dermosifiliogr. 2018 Apr 25;: Authors: Blanes M PMID: 29705016 [PubMed - as supplied by publisher] {url} = URL to article
    • Frank Bures: The mystery of rosacea, a disease with no known cause or cure
      Frank A. Bures For the Winona Daily News
    • ‘A diet high in sugar and high-glycemic index (GI) carbohydrates such as white rice, pasta, bread, and sweets have now been shown to cause inflammation in the body that can make the skin age much quicker,’ Dr Williams said.  One study, from the Leiden University Medical Centre in the Netherlands, made the first direct link between the amount of sugar circulating in the blood, and how old a person looks.
      It found the higher the amount of sugar and high GI carbs a person ate, the older they looked. Here’s what’s happening. When blood sugar levels are constantly on the high-low cycle that comes from a high sugar and high carb diet, (eating too often between meals has the same effect), sugar molecules permanently bond to proteins, including the collagen in your skin.  This is a process known as glycation, and produces aptly named compounds called AGES, or Advanced Glycation End Products (AGES), that cross-link with proteins, Dr Williams said.
      ‘Consequently, tissues become stiff and inflexible, skin becomes tougher, saggier, and wrinkles form often prematurely,’ she added. ‘ Where once we as dermatologists dismissed the idea of diet and pimples, there is now good evidence of a link between unrefined sugars, sweets, milk chocolate, and unrefined carbohydrates with increased incidence of acne breakout,’ she said.
      When he puts patients with inflammatory skin conditions, such as acne, psoriasis, and eczema, on diets reducing their intake of refined sugars and dairy products, Dr Lowe explained, their conditions often get better. ‘Changing their diets can reduce the severity of their conditions,’ he said. Want great skin? Dermatologists reveal which foods they swear by for a healthy glow - and those that never pass their lips, By ANNA MAGEE FOR HEALTHISTA, Daily Mail Watch the Video  
    • Related Articles Regional Dermabrasion of Nasal Surgical Scars and Rhinophyma Using Electrocautery Scratch Pads. Dermatol Surg. 2018 02;44(2):303 Authors: Monheit G PMID: 29360653 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Papulopustular Rosacea: Response to Treatment with Oral Azithromycin. Actas Dermosifiliogr. 2018 Apr 23;: Authors: Lova Navarro M, Sánchez-Pedreño Guillen P, Victoria Martínez AM, Martínez Menchón T, Corbalán Vélez R, Frías Iniesta J Abstract
      INTRODUCTION: Oral tetracyclines and topical antibiotics have been used to treat papulopustular rosacea (PPR) for years, but it is not uncommon to find patients who do not respond to this standard treatment. In such refractory cases, oral azithromycin has proven to be an effective option.
      MATERIAL AND METHOD: We conducted a prospective pilot study of 16 patients with PPR who were treated with oral azithromycin after a lack of response to oral doxycycline and metronidazole gel. At the first visit, the patients were assessed for baseline severity of PPR on a 4-point clinical scale and started on oral azithromycin. At the second visit, response to treatment in terms of improvement from baseline was evaluated on a 3-point scale. Patients were then scheduled for follow-up visits every 12 weeks to assess long-term effectiveness.
      RESULTS: All 16 patients experienced an improvement in their PPR following treatment with oral azithromycin. Eight weeks after completion of treatment, 14 patients (87.5%) showed complete or almost complete recovery (slight or no residual redness and complete clearance of papules and pustules). Only 2 patients experienced a new episode of inflammatory PPR lesions during follow-up.
      CONCLUSIONS: The findings of this pilot study suggest that oral azithromycin could be a very effective short-term and long-term treatment for RPP resistant to conventional treatment.
      PMID: 29699769 [PubMed - as supplied by publisher] {url} = URL to article
    • "A patient with severe papulopustular rosacea (PPR) and severe background erythema responded well to a treatment regimen consisting of a short course of antibiotics in combination with a corticosteroid, followed by monotherapy with isotretinoin. In patients with very severe, inflamed disease, it is necessary to achieve a rapid response with a fast-acting combinatorial treatment regimen to reduce the inflammation. Patients with severe PPR and an inflammatory component can respond rapidly when treated using a multimodal, tailored approach."  Martin Schaller, who volunteers on the RRDi MAC, and Lena Gonser wrote a paper with above information of treating a female patient with severe Phenoytype 2 and Phenotype 4 (click here for photos) with antibiotics, prednisolone, topical brimonidine, topical metronidazole, and isotretinoin.   Drugs R D. 2016 Sep; 16(3): 279–283.
      Published online 2016 Sep 13. doi:  10.1007/s40268-016-0141-0
      PMCID: PMC5045832
      PMID: 27623792
      A Tailored Approach to the Treatment of a Patient with a Severe Dynamic Manifestation of Rosacea: A Case Report
      Martin Schaller and Lena Gonser
    • Skin specialist Joanne Frances outlines tips and treatments for rosacea.  Tips and treatment options for rosacea, WPTV, West Palm Beach
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