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    • This question was asked and I am sharing my answer here as well.   Basically everyone has demodex mites and it has been thought that the mites have some sort of undisclosed symbiotic relationship, i.e., the mites eat sebum which helps the mites and helps the humans keep sebum stasis. One report states, "....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host." - See Jarmuda et al published in the Journal of Medical Microbiology (second article mentioned in this post). While this same report says that 'most human populations' have NOT been sampled for demodex mites the general belief is that demodex are common throughout humanity and pose no problem as a pathogen except in the case of demodectic rosacea as far as known.    A Russian study on the mites says, "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte."  It is comparable to bacteria which humans have a relationship with, there is good bacteria and bad bacteria. The probiotic bacteria and the pathogen bacteria. The demodex mites usually pose no problem with the vast majority of humans since they are possibly on everyone. Why they become more numerous seems to be of more importance.    For some unknown reason the mites are in higher density in rosacea patients. We don't know if the rosacea cause this increase in mites or does the increase in mites cause the rosacea, the old chicken or egg conundrum? There is evidence that reducing the mite density count improves rosacea.  It is clear that the mites like human skin since they eat sebum.     Maybe the increase of sugar/carbohydrate in the diet increases sebum which in turn increases the mite population, and voila, the inflammation of rosacea?    I don't think all rosacea is demodectic. GUT Rosacea is a different variant, but may be connected or associated.  The list of systemic comorbidities with rosacea keeps growing. The gut microbiome is obviously connected with skin microbiome (see my post on this).  
    • Related Articles Epidemiological features of rosacea in Changsha, China: A population-based, cross-sectional study. J Dermatol. 2020 Mar 24;: Authors: Li J, Wang B, Deng Y, Shi W, Jian D, Liu F, Huang Y, Tang Y, Zhao Z, Huang X, Li J, Xie H Abstract Rosacea is a common chronic skin disorder of unknown etiology. While population prevalence rates range 0.2-22% in Europe and North America, prevalence in China is currently undetermined. We conducted a large population-based case-control study to determine the present epidemiological status of rosacea in China, involving 10 095 participants aged 0-100 years (mean age, 35.5 ± 19.1; 50.5% female). A census of rosacea among 15 communities in Changsha in south central China was conducted with skin examination by board-certified dermatologists. Rosacea was observed in 3.48% (95% confidence interval, 3.13-3.85%) of the study population. Subtype distribution was erythematotelangiectatic in 47.6%, papulopustular in 35.0% and phymatous in 17.4%. Family history was noted in 37.8% and ocular symptoms in 31.3%. Associations with rosacea were observed for melasma, hypertension, hyperthyroidism and breast cancer in females (P < 0.05), and also for hyperthyroidism and peptic ulcers in males (P < 0.05). Our results provide baseline information about epidemiological aspects of rosacea in China. PMID: 32207167 [PubMed - as supplied by publisher] {url} = URL to article
    • Yes, because its all about immune system and HCQ does modulate the immune system in various ways and regulate the overactivity of immune system in some conditions. Not only does it work in getting rid of symptoms but it actually works behind the disease cause.
    • The president announced on March 19, 2020 that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19.  Virus has never been ruled out in rosacea.  CNN has a followup report on this.  There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him.  Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea?  If you do take hydroxycholoroquine and your rosacea improves, please let us know.
    • Related Articles Rosacea is Characterized by a Profoundly Diminished Skin Barrier. J Invest Dermatol. 2020 Mar 18;: Authors: Medgyesi B, Dajnoki Z, Béke G, Gáspár K, Szabó IL, Janka EA, Póliska S, Hendrik Z, Méhes G, Törőcsik D, Bíró T, Kapitány A, Szegedi A Abstract Rosacea is a common, chronic inflammation of sebaceous gland-rich facial skin characterized by severe skin dryness, elevated pH, transepidermal water loss, and decreased hydration levels. Until now, there has been no thorough molecular analysis of permeability barrier alterations in the skin of rosacea patients. Thus, we aimed to investigate the barrier alterations in papulopustular rosacea (PPR) samples compared to healthy sebaceous gland-rich (SGR) skin, using RNASeq analysis (n=8). Pathway analyses by Cytoscape ClueGo revealed 15 significantly enriched pathways related to skin barrier formation. RT-PCR and immunohistochemistry were used to validate the pathway analyses. The results showed significant alterations in barrier components in PPR samples compared to SGR, including the cornified envelope and intercellular lipid lamellae formation, desmosome and tight junction organizations, barrier alarmins, and antimicrobial peptides. Moreover, the barrier damage in PPR was unexpectedly similar to atopic dermatitis (AD); this similarity was confirmed by immunofluorescent staining. In summary, besides the well-known dysregulation of immunological, vascular, and neurological functions, we demonstrated prominent permeability barrier alterations in PPR at the molecular level, which highlight the importance of barrier repair therapies for rosacea. PMID: 32199994 [PubMed - as supplied by publisher] {url} = URL to article
    • "Webster et al. report a multicentre, randomized, double‐masked, parallel‐group, vehicle‐controlled study to evaluate the safety and efficacy of minocycline gel 1% and 3%. Topical minocycline had insignificant systemic absorption but produced significant reductions in mean inflammatory lesion counts with both the 1% and 3% concentrations. The response rate in the vehicle group was quite high, as is often the case in diseases with fluctuating inflammation. However, the 3% concentration of minocycline showed a significantly greater proportion of patients achieving Investigator's Global Assessment success at week 12 compared with vehicle. A topical minocycline foam formulation is in development, and this may provide a further useful option for treating papulopustular rosacea. How topical minocycline compares with other topical rosacea treatments is as yet unclear." Br J Dermatol. 2020 Mar 18;: Expanding treatment options for rosacea. Hampton PJ
    • Related Articles Expanding treatment options for rosacea. Br J Dermatol. 2020 Mar 18;: Authors: Hampton PJ PMID: 32189331 [PubMed - as supplied by publisher] {url} = URL to article Full Text
    • Related Articles Value of reflectance confocal microscopy for the monitoring of rosacea during treatment with topical ivermectin. J Dermatolog Treat. 2020 Mar 19;:1-9 Authors: Logger JGM, Peppelman M, van Erp PEJ, de Jong EMGJ, Nguyen KP, Driessen RJB Abstract Background: Reflectance confocal microscopy (RCM) enables noninvasive Demodex mite detection in rosacea. Objective scoring of rosacea severity is currently lacking.Objectives: To determine the value of RCM for monitoring Demodex, inflammation and vascular parameters in rosacea during treatment.Methods: In 20 rosacea patients, clinical and RCM examination were performed before, during, and 12 weeks after a 16-week treatment course with topical ivermectin. Using RCM, number of mites and inflammatory cells, epidermal thickness, and vascular density and diameter were measured. RCM features were correlated with clinical assessment.Results: Treatment resulted in clinical reduction of inflammatory lesions. Mites were detected in 80% of patients at baseline, 30% at week 16, and 63% at week 28. The number of mites reduced significantly during treatment, but no changes in inflammatory cells, epidermal thickness or vascular parameters were observed. Correlation between number of inflammatory lesions and mites was low. None of the RCM variables were significant predictors for clinical success.Conclusions: RCM enables anti-inflammatory effect monitoring of topical ivermectin by determining mite presence. Quantifying exact mite number, and inflammatory and vascular characteristics is challenging due to device limitations. In its current form, RCM seems of limited value for noninvasive follow-up of rosacea in clinical practice. PMID: 32189533 [PubMed - as supplied by publisher] {url} = URL to article
    • The president announced today that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19. As mentioned in the initial post in this thread, virus has never been ruled out in rosacea. CNN has a followup report on this.  There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him.  Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea?  If you do take hydroxycholoroquine and your rosacea improves, please let us know.
    • "In this case report, we detail the response of a 37-year-old Caucasian man with an overlap of erythematotelangiectatic rosacea and telangiectatic photoaging to brimonidine tartrate gel. With the application of brimonidine only on half of his face, skin analysis images, clinician's and patient's assessment showed that there was significant improvement in the erythema. This case has lent insight into how brimonidine can be used to assess the extent of photoaging by eliminating the erythema of rosacea to some degree. We propose that it can be used as a non-invasive test to differentiate between the two conditions, sparing patients from skin biopsies and molecular analysis." Australas J Dermatol. 2017 Feb;58(1):63-64. doi: 10.1111/ajd.12430. Epub 2016 Jan 13. Rosacea or photodamaged skin? Use of brimonidine gel in differentiating erythema in the two conditions. Oon HH, Lim ZV.
    • Telangiectatic Photoaging  "Telangiectatic photoaging is characterized by less transient and nontransient erythema, a more lateral distribution of erythema and telangiectasia, less neurogenic mast cell activation, and less MMP-mediated matrix remodeling than ETR. These data demonstrate that TP is a distinct clinical entity from ETR that can be distinguished on the basis of clinical, histologic, and gene expression findings." JAMA Dermatol. 2015;151(8):825-836. doi:10.1001/jamadermatol.2014.4728 Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging Yolanda R. Helfrich, MD; Lisa E. Maier, MD; Yilei Cui, PhD; et al JAMA Dermatol. 2015 Aug;151(8):825-36. doi: 10.1001/jamadermatol.2014.4728. Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging. Helfrich YR, Maier LE, Cui Y, Fisher GJ, Chubb H, Fligiel S, Sachs D, Varani J, Voorhees J. JK Wilkin has a comment on the above article published in JAMA and another in the NEJM. 
    • Related Articles Identification of Long Noncoding RNA Associated ceRNA Networks in Rosacea. Biomed Res Int. 2020;2020:9705950 Authors: Wang L, Lu R, Wang Y, Wang X, Hao D, Wen X, Li Y, Zeng M, Jiang X Abstract Rosacea is a chronic and relapsing inflammatory cutaneous disorder with highly variable prevalence worldwide that adversely affects the health of patients and their quality of life. However, the molecular characterization of each rosacea subtype is still unclear. Furthermore, little is known about the role of long noncoding RNAs (lncRNAs) in the pathogenesis or regulatory processes of this disorder. In the current study, we established lncRNA-mRNA coexpression networks for three rosacea subtypes (erythematotelangiectatic, papulopustular, and phymatous) and performed their functional enrichment analyses using Gene Onotology, KEGG, GSEA, and WGCNA. Compared to the control group, 13 differentially expressed lncRNAs and 525 differentially expressed mRNAs were identified in the three rosacea subtypes. The differentially expressed genes identified were enriched in four signaling pathways and the GO terms found were associated with leukocyte migration. In addition, we found nine differentially expressed lncRNAs in all three rosacea subtype-related networks, including NEAT1 and HOTAIR, which may play important roles in the pathology of rosacea. Our study provided novel insights into lncRNA-mRNA coexpression networks to discover the molecular mechanisms involved in rosacea development that can be used as future targets of rosacea diagnosis, prevention, and treatment. PMID: 32185228 [PubMed - in process] {url} = URL to article Full Article (if anyone can make heads or tails of this article it would be much appreciated if someone could translate this paper into layman's language)  Please comment on this by clicking the green REPLY button.  In the abstract paragraph above it mentions 'NEAT1 and HOTAIR, which may play important roles in the pathology of rosacea.' If you look at the diagram above at the top of the post you can find NEAT1 near the center of the diagram in red and HOTAIR just below NEAT1 to the right in blue. That probably helped you out a lot, didn't it? Just trying to helpful. 
    • image courtesy of Wikimedia Commons                             Related Articles Distinguishing rosacea from sensitive skin by reflectance confocal microscopy. Skin Res Technol. 2020 Mar 16;: Authors: Ma Y, Li L, Chen J, Chen T, Yuan C Abstract BACKGROUND: The updated standard classification and pathophysiology of rosacea have provided clear and meaningful evaluation parameters; however, differentiating rosacea from sensitive skin (SS) remained an obstacle for dermatologists around the world, especially in China. Herein, we aimed to find a better characteristic to distinguish rosacea from SS by using reflectance confocal microscopy (RCM). METHOD: Forty rosacea patients and 143 healthy subjects were recruited in this study. Firstly, a SS questionnaire and a lactic acid sting test were conducted among healthy subjects. Next, two major groups were divided out, including a SS group (40 subjects) and a normal skin control group (NS, 60 subjects). The cutaneous structures of face and fossa cubitalia were imaged by RCM. RESULTS: We found that more parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae (P < .05) in rosacea patients than that of the NS group, whereas there were no significant differences, were found in rosacea patients and the SS group. Strikingly, we found that rosacea patients have a larger depth of honeycomb pattern than that of SS subjects (P < .05). But, the epidermal thickness of rosacea did not differ from that of SS groups. There was also no significant difference of epidermal thickness and honeycomb structure depth between rosacea patients and NS group. CONCLUSION: From the RCM images of parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae, we found that RCM might be a faithful tool to distinguish rosacea from NS group. The depth of honeycomb structure of SS was more superficial than rosacea patients, whereas no significant difference between rosacea patients and NS group. RCM may provide a new method for evaluating the development of rosacea although it failed to distinguish rosacea and SS effectively. PMID: 32180258 [PubMed - as supplied by publisher] {url} = URL to article What is reflectance confocal microscopy?
    • Rosa canina image courtesy of Wikimedia Commons Related Articles Molecular mechanism of the anti-diabetic activity of an identified oligosaccharide from Rosa canina. Res Pharm Sci. 2020 Feb;15(1):36-47 Authors: Bahrami G, Miraghaee SS, Mohammadi B, Bahrami MT, Taheripak G, Keshavarzi S, Babaei A, Sajadimajd S, Hatami R Abstract Background and purpose: Because of the high prevalence, diabetes is considered a global health threat. Hence, the need for effective, cheap, and comfortable therapies are highly felt. In previous study, a novel oligosaccharide with strong anti-diabetic activity in the crude extract of Rosa canina fruits, from the rosacea family, was identified. The present study was designed to ensure its efficacy using in vivo and in vitro studies. Experimental approach: Crude extract and its purified oligosaccharide were prepared from corresponding herb. Adult male Wistar rats were randomly divided into four groups of 10 each, as follows: group 1, healthy control rats given only sterile normal saline; group 2, diabetic control rats received sterile normal saline; group 3, diabetic rats treated with crude extract of Rosa canina (40% w/v) by oral gavage for 8 weeks; group 4, diabetic rats treated with purified oligosaccharide of Rosa canina (2 mg/kg) by oral gavage for 8 weeks. After treatment, body weight, fasting blood glucose, serum insulin levels and islet beta-cell repair and proliferation were investigated. The possible cytoprotective action of oligosaccharide was evaluated in vitro. The effect of oligosaccharide on apoptosis and insulin secretion in cell culture media were examined. Real-time PCR was used to determine the expression level of some glucose metabolism-related regulator genes. Findings / Results: In the animal model of diabetes, the insulin levels were increased significantly due to the regeneration of beta-cells in the islands of langerhans by the purified oligosaccharide. In vitro cell apoptosis examination showed that high concentration of oligosaccharide increased cell death, while at low concentration protected cells from streptozotocin-induced apoptosis. Molecular study showed that the expression of Ins1 and Pdx1 insulin production genes were increased, leading to increased expression of insulin-dependent genes such as Gck and Ptp1b. On the other hand, the expression of the Slc2a2 gene, which is related to the glucose transporter 2, was significantly reduced due to insulin concentrations. Conclusion and implications: The purified oligosaccharide from Rosa canina was a reliable anti-diabetic agent, which acted by increasing insulin production in beta-cells of the islands of Langerhans. PMID: 32180815 [PubMed] {url} = URL to article
    • "Using isotretinoin for 1-2mg/kg/day for 3-4 months produces 60%-95% clearance of inflammatory lesions in patients with acne. Doses as low as 0.1mg/kg/day have also proven successful in the clearance of lesions. Encouraging results have also been seen in small numbers of patients with rosacea, Side effects affecting the mucocutaneous system and raised serum triglyceride levels occur in most patients receiving isotretinoin." Profiles Drug Subst Excip Relat Methodol. 2020;45:119-157 Isotretinoin. Khalil NY, Darwish IA, Al-Qahtani AA
    • Related Articles Isotretinoin. Profiles Drug Subst Excip Relat Methodol. 2020;45:119-157 Authors: Khalil NY, Darwish IA, Al-Qahtani AA Abstract Isotretinoin is chemically named as: (2Z, 4E, 6E, 8E)-3,7-Dimethyl-9-(2,6,6-trimethylcyclohex-1-enyl)nona-2,4,6,8-tetraenoic acid. It is an orally active retinoic acid derivative for the treatment of severe refractory nodulocystic acne. It acts primarily by reducing sebaceous gland size and sebum production, and as a result alters skin surface lipid composition. Using isotretinoin for 1-2mg/kg/day for 3-4 months produces 60%-95% clearance of inflammatory lesions in patients with acne. Doses as low as 0.1mg/kg/day have also proven successful in the clearance of lesions. Encouraging results have also been seen in small numbers of patients with rosacea, Side effects affecting the mucocutaneous system and raised serum triglyceride levels occur in most patients receiving isotretinoin. Isotretinoin is strictly contraindicated in women of childbearing potential. This profile discusses and explains names of isotretinoin, its physical and chemical characteristics. It also includes methods of preparation, thermal and spectral behavior, methods of analysis, and pharmacology. PMID: 32164966 [PubMed - in process] {url} = URL to article
    • Staphylococcus epidermidis image courtesy of Wikimedia Commons Bacteria has been implicated and investigated as the leading microbe associated with rosacea for over sixty years. Antibiotics have been prescribed for rosacea, particularly tetracycline and more recently with doxycycline, along with many other antibiotics, which leads to the bacteria theory on the cause of rosacea. There has been a bias in most, if not all, the clinical papers investigating the skin microbiome in rosacea patients ignoring other microbes, i.e., virus, archea, fungus, protozoa.  Demodex mites have been the other most investigated microbe of the skin microbiome with a vast number of clinical papers. A typical paper indicating this bias towards chiefly investigating bacteria and demodex is the following conclusion on this subject: "Although we were not able to pinpoint a causative microbiota, our study provides a glimpse into the skin microbiota in rosacea and its modulation by systemic antibiotics.'  J Clin Med. 2020 Jan; 9(1): 185. Published online 2020 Jan 9. doi: 10.3390/jcm9010185 PMCID: PMC7019287 PMID: 31936625 Characterization and Analysis of the Skin Microbiota in Rosacea: Impact of Systemic Antibiotics Yu Ri Woo, Se Hoon Lee, Sang Hyun Cho, Jeong Deuk Lee, and Hei Sung Kim The above paper only investigated bacteria and mentions demodex and ignores all other microbes of the skin microbiota.  Microorganisms of the Human Microbiome
    • image courtesy of Pinterest Odd that a rosacea plant would have natural antibacterial properties. The photo above is one of Pyrus glabra while the one below is Pyrus syriaca: image courtesy of Wikimedia commons
    • Topical ivermectin has been found effective in the treatment of T‐cell‐mediated skin inflammatory diseases. For more information. 
    • "Altogether, our results show that IVM is endowed with topical anti‐inflammatory properties that could have important applications for the treatment of T‐cell‐mediated skin inflammatory diseases." Topical ivermectin improves allergic skin inflammation E. Ventre  A. Rozières  V. Lenief  F. Albert  P. Rossio  L. Laoubi  D. Dombrowicz  B. Staels  L. Ulmann  V. Julia  E. Vial  A. Jomard  F. Hacini‐Rachinel  J.‐F. Nicolas  M. Vocanson
    • Related Articles Fatty acid profile and in vitro biological properties of two Rosacea species (Pyrus glabra and Pyrus syriaca), grown as wild in Iran. Food Sci Nutr. 2020 Feb;8(2):841-848 Authors: Hazrati S, Govahi M, Mollaei S Abstract The high demands for the consumption of edible oils have caused scientists to struggle in assessing wild plants as a new source of seed oils. Therefore, in this study, the oil yield, fatty acid and tocopherol compositions, antioxidant and antibacterial activities of the oils obtained from Iran's two endemic plants (Pyrus glabra and Pyrus syriaca) were investigated. The obtained oil yields from the P. glabra and P. syriaca seeds were 33 ± 0.51 and 26 ± 0.28 w/w%, respectively. Oleic acid (C18:1) with the amount of 49.51 ± 1.05% was the major fatty acid in the P. glabra oil, while the main fatty acids in the P. syriaca seed oil belonged to linoleic acid (C18:2) and oleic acid (C18:1) with the amounts of 46.99 ± 0.37 and 41.43 ± 0.23%, respectively. The analysis of tocopherols was done by HPLC, and the results indicated that the P. glabra and P. syriaca seed oils were rich in α-tocopherol (69.80 ± 1.91 and 45.50 ± 1.86 mg/100 g oil, respectively), constituting 86.24 and 89.01% of total detected tocopherols, respectively. The study on the reducing capacity of the oils indicated that the P. glabra oil had more reducing capacity than the P. syriaca oil. Moreover, the antioxidant activity of the P. glabra seed oil (43.4 ± 0.7 µg/ml) was higher than the P. syriaca seed oil (46.3 ± 1.2 µg/ml). Also, the investigation of the antibacterial activities indicated that the P. glabra and P. syriaca oils have an inhibitory effect on the studied bacteria. The results indicate that the oils of these plants can be appropriate sources of plant oils which can act as natural antibacterial agents. PMID: 32148793 [PubMed] {url} = URL to article
    • For a long time microorganisms of the skin microbiome have been suggested as a cause of rosacea. The list includes, bacteria, virus, and demodex mites. Further, there are some papers that suggest that the gut microbiome may be involved in rosacea. Microorganisms of the Human Microbiome "Antiparasitics are a class of medications which are indicated for the treatment of parasitic diseases, such as those caused by helminths, amoeba, ectoparasites, parasitic fungi, and protozoa, among others." Wikipedia "Broad-Spectrum antiparasitics, analogous to broad-spectrum antibiotics for bacteria, are antiparasitic drugs with efficacy in treating a wide range of parasitic infections caused by parasites from different classes." Wikipedia Prescription Antinematodes include ivermectin.  Prescription Antiprotozoals include metronidazole (also used for its anti-inflammatory effect),  mepacrine, artemisinin, chloroquine, hydroxychloroquine, tinidazole, ornidazole, and secnidazole.  Other prescription anti-parasitic drug therapies are Anticestodes, Antitrematodes, Antiamoebics, AntiFungals, and new drug therapies such as "triazolopyrimidines and their metal complexes have been looked at as an alternative drug to the existing commercial antimonials.' Wikipedia
    • Oshea Herbals is one of the topmost skincare companies, which produces effective and skin-friendly D-Tan Face Packs. However, if you are facing skin-problems then do buy this face pack and treat your problems.
    • Does anyone have any experience of doing chemical exfoliation on rosacea skin? Chemical exfoliation is very good for skin once in a while but what about rosacea skin?      
    • Thanks BlackMamba24 for the update and so happy for you!
    • Related Articles Severe rosacea in a child. J Fr Ophtalmol. 2020 Mar 02;: Authors: Tijani M, Albaroudi N, Boutimzine N, Cherkaoui O PMID: 32139082 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Granulosis rubra nasi seen through the dermatoscope. JAAD Case Rep. 2020 Mar;6(3):234-236 Authors: Palit A, Sethy M, Nayak AK, Ayyanar P, Behera B PMID: 32140525 [PubMed] {url} = URL to article
    • Related Articles Pulsed Dye Laser Alone Versus Its Combination With Topical Ivermectin 1% In Treatment of Rosacea: A Randomized Comparative Study. J Dermatolog Treat. 2020 Mar 06;:1-22 Authors: Osman MA, Shokeir HA, Hassan AM, Kahlifa MA Abstract Background While the aetiology of rosacea is multifactorial, it is not surprising that treatment has been controversial. Pulsed dye laser (PDL) has been successfully used to treat vascular components of rosacea. Ivermectin 1% cream is an emerging treatment of rosacea.Objective To provide a comprehensive clinical and dermatoscopic comparative study between the efficacy and safety of pulsed dye laser alone versus its combination with topical ivermectin 1% in the treatment of rosacea.Materials and methods Thirty Patients were randomly divided into two groups. Group A (n = 15) treated with 585 nm PDL, and group B (n = 15) treated with 585 nm PDL and topical ivermectin 1% cream. All patients received four laser treatments with a 4-week interval. The efficacy of treatment was assessed by photographs and dermoscopic photomicrographs at baseline and 3 months after the final treatment. The patient's level of satisfaction was also recorded.Results At the 3-month follow-up, group B induced better clinical improvement than group A. However, this difference was not significant. No serious adverse events were observed in either treatment group.Conclusion This study supports the efficacy of PDL treatment for patients with rosacea. PDL could be more effective when combined with ivermectin 1% cream. PMID: 32141785 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles [THE ROLE OF HELICOBACTER PYLORI IN ROSACEA AND PATHOGENETIC TREATMENT]. Georgian Med News. 2020 Jan;(298):109-112 Authors: Beridze L, Ebanoidze T, Katsitadze T, Korsantia N, Zosidze N, Grdzelidze N Abstract Rosacea is a chronic, recurrent skin disease. It may be aggravated by various factors. An increased incidence of rosacea has been reported in those who carry the stomach bacterium Helicobacter pylori. The purpose of this study was determination of the relationship of this infection with rosacea and to investigate effectiveness of eradication therapy of H. pylori. As our results showed, 80.9% of study patients were infected with H. pillory. There was correlation between infection rates and rosacea severity. In most cases the positive test results for H. Pylori was found in patients with moderate to severe form of disease. The results of the treatment of different forms of rosacea confirmed the effectiveness of the eradication therapy of H. Pylori, regarding as one of the pathogenic cause of rosacea and the way in the choice of treatment. More wide studies of pathophysiological aspects of causes of rosacea will be promising and help in treating rosacea. These data indicate the important role of H.Pylori in the development of rosacea and recommend taking into account in the therapy of this dermatosis. PMID: 32141861 [PubMed - as supplied by publisher] {url} = URL to article
    • Hi Brady, I wanted to check back in with an update. I have to tell you, things have improved over the last week. I credit the improvement to ZZ Cream. It's really starting to make a significant difference and I'm grateful to you as this is where I learned about it. I started with ZZ Cream (the gold original bottle) in late January that I ordered on Amazon UK. It wasn't immediately successful. In fact, there were some very depressing days. In mid-February, I had a dermatolgist appointment. You were right, my doctor wasn't overly supportive, however, he is kind and he understood why I was searching forums and ordering things from China. He recommended at that appointment that I take his advice and start using Accutane (he had already recommended this course). This was not what I wanted, but in mid-February my skin was not good, despite having used ZZ Cream for about three weeks. I strongly considered stopping the ZZ Cream and starting Accutane. I decided to give it another week to finish the first bottle. I was really at a crossroads - planning which day I was going to get bloodwork to start the Accutane. The first bottle lasted me about one month and nothing really changed. My doctor said he thought using Accutane, which is highly regulated by the FDA, might actually be safer than ZZ cream, which comes from out of the country without regulations. It was a fair point and since it wasn't working, I nearly stopped. But on Feb. 24, one week after my appointment, I received a second order of ZZ Cream that I had ordered in early February when I was worried the first little bottle wouldn't last. That order was made on eBay. The weekend before the 24th, I was contemplating when I would get my bloodwork. After some sleepless nights, I decided that since I had already bought the second ZZ cream, I would keep going. I had read on a different forum that it can take as long as one year to fully work, so I figured Accutane would be there if this second bottle didn't work. Anyway, long story short, the second black bottle seemed to make an immediate difference. I noticed last weekend (about six days after starting bottle No. 2) things had improved. I woke up today (12 days after starting the second bottle) and my skin looked better than it had since I used Bactrim back in November! Like my pre-Rosacea days almost!  I did notice tonight I have a little bump in between my eyebrows, which is a place I never use the ZZ cream. But my skin is so much better. I just wanted to share how it's going and thank you. I know it's long way from over and I have to just keep using the cream. I've already ordered a third bottle. I was a little concerned that with coronavirus they might not allow shipments, or something might be off with the production. But fingers crossed this good fortune will continue and my next shipment will arrive! I will say, I cut back on sugar dramatically, and tried to minimize carbohydrates as much as possible, especially later in the day. But I never fully cut sugar and went to 30g of carbs. Hoping I won't have to go that route as that is extremely difficult, but all options still under consideration as I battle this ugly disease! Thanks again for your wisdom. I do appreciate what I learned on the forum.
    • image courtesy of the CDC Sugar is just as much a valid rosacea trigger as any of the other proposed rosacea triggers since Sugar = Rosacea Fire. You will not learn that sugar is a rosacea trigger from any other rosacea non profit organization because the RRDi is the only one that lists sugar as a rosacea trigger. This post will help you understand how you can figure out better what added sugar is in the processed food or drink you might consume to see how much sugar you are allowing in your diet.  We reported in 2015 how the FDA was considering make a a change on the nutrition facts label about how many grams of added sugar is in a food or drink (the eighth post in this thread dated Posted July 25, 2015). The FDA did change the Nutrition Facts Label to show added sugar with this announcement in October 2018 that allows certain manufacturers until 2021 to comply with the change. While there are six new differences in the label, item number 3 is about added sugar and note what the FDA states about this: "3. Added sugars are now listed to help you know how much you are consuming. The 2015-2020 Dietary Guidelines for Americans recommends you consume less than 10 percent of calories per day from added sugars. That is because it is difficult to get the nutrients you need for good health while staying within calorie limits if you consume more than 10 percent of your total daily calories from added sugar." October 2018 announcement Healthline had this to say about the above label change: "Before this label change, different types of sugars were lumped into a total sugars category on the Nutrition Facts label. For example, many fruit yogurts contain sugars from three sources: lactose from milk, natural sugars from fruit, and added sugars. All of these were tallied as one figure under total sugars. The new labels will distinguish added sugars to help people understand exactly how much they’re eating, which shouldn’t be more than 10 percent of their daily calories, according to the FDA’s dietary guidelines." New Nutrition Labels Reveal How Much Added Sugar You’re Eating, Healthline, November 2, 2018 WebMD had this to say about the label change: "It can be tough to recognize added sugars by looking at the list of ingredients on a label, the U.S. Centers for Disease Control and Prevention says. Brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, molasses, raw sugar and sucrose are just some of the many different ingredients that contribute added sugars to food, the CDC notes. To make things simpler for consumers, the FDA proposed a new line on the Nutrition Facts label that totals up all these sources of added sugar." 'Added Sugars' Label on Foods May Save Many Lives, Dennis Thompson, WebMD Later, the FDA allows manufacturers of certain "single-ingredient sugars and syrups and certain cranberry products' that "allow for the use of a “†” symbol immediately following the percent Daily Value declaration for Added Sugars, which leads consumers to a statement that provides information about the gram amount of Added Sugars, as well as information about how that amount of sugar contributes to the percent Daily Value." Statement on new guidance for the declaration of added sugars on food labels for single-ingredient sugars and syrups and certain cranberry products, Susan T. Mayne Ph.D., Director - Center for Food Safety and Applied Nutrition (CFSAN) The CDC has this to say about the amount of added sugar you should consume each day:  "Americans should keep their intake of added sugars to less than 10% of their total daily calories as part of a healthy diet. For example, in a 2,000 daily calorie diet no more than 200 calories should come from added sugars." Know Your Limit for Added Sugars To convert calories to grams you should remember that there are 4 calories in one gram of carbohydrate. So the above recommendation from the CDC which is based upon the new FDA recommendation means that 10% of added sugar amounts to 50 grams of carbohydrate. Sugar is carbohydrate. Further, the added sugar is just what the label is pointing out to you besides the natural sugar or carbohydrate in the food or drink your are consuming. So if you look at the new label at the top of this post the TOTAL carbohydrate (sugar) contained in the item is 37 grams. Of that 37 grams there is included 10 grams of added sugar. In other words, if the product didn't add the 10 grams of sugar the food item still has 27 grams of carbohydrate (sugar).  If you want to learn for your self whether reducing sugar (carbohydrate) in your diet improves your rosacea, looking at the Nutrition Facts Label can be an eye opener for many who are not aware how much carbohydrate (sugar) is in the diet. A simple test to discover that sugar (carbohydrate) is a rosacea trigger for you, reduce the amount of sugar (carbohydrate) in your diet to no more than 30 grams a day for 30 days. During this test you should see some improvement in your rosacea within the thirty days. After the thirty days, gorge yourself with all the sugar and carbohydrate you want and see if your rosacea comes back? That is the basic nutshell version of the Rosacea Diet. This post on the new label requirements for added sugar makes it easier for you to spot added sugar.  The New York Times had this to say about added sugar: "While you might think you’re not eating much sugar, chances are you’re eating a lot more than you realize. Added sugar lurks in nearly 70 percent of packaged foods and is found in breads, health foods, snacks, yogurts, most breakfast foods and sauces. The average American eats about 17 teaspoons of added sugar a day (not counting the sugars that occur naturally in foods like fruit or dairy products). That’s about double the recommended limit for men (nine teaspoons) and triple the limit for women (six teaspoons). For children, the limit should be about three teaspoons of added sugar and no more than six, depending on age and caloric needs." Make 2020 the Year of Less Sugar, Tara Parker-Pope, The New York Times, December 31, 2019 The above article also included a seven day challenge.  There was a follow up article on the above article which added:  "As an example, take a look at the label on whole milk, which shows 11 grams of sugar in a one-cup serving. That sounds like a lot, but the new label will make it clear that all that sugar occurs naturally as lactose and that the same cup of milk has zero grams of added sugar. A chocolate milk label will show 26 grams of total sugar, which includes 11 grams of lactose, and the extra information that a serving has 15 grams of added sugar."  Dried Fruit, Oats and Coffee: Answers to Your Sugar Questions Our 7-Day Sugar Challenge prompted a number of questions about cutting added sugar from our daily diet. Tara Parker-Pope, The New York Times, Jan. 8, 2020    
    • Related Articles Skincare Habits and Rosacea in 3,439 Chinese Adolescents: A University-based Cross-sectional Study. Acta Derm Venereol. 2020 Mar 04;: Authors: Zuo Z, Wang B, Shen M, Xie H, Li J, Chen X, Zhang Y Abstract The pathogenesis of rosacea remains unclear but has been reported to correlate with skin barrier function. The objective of this study was to elucidate the skincare habits of Chinese adolescents and determine the relationship between skincare habits and rosacea. A university-based cross-sectional investigation included 310 rosacea cases and 3,129 healthy controls who underwent health examinations and completed a questionnaire about daily skincare habits. Fitzpatrick skin phototype IV is a protective factor against rosacea (adjusted adds ratio (aOR) 0.40; 95% confidence interval (CI) 0.22-0.72). Long bath duration (≥ 11 min, aOR 2.60; 95% CI 1.01-6.72) and frequent use of facial cleansers (≥ 2 times/day, aOR 1.70; 95% CI 1.17-2.36) were positively associated with rosacea, but bath frequency (p = 0.22), water temperature (p = 0.53), and sun protection (p = 0.65) were not associated with rosacea. Inappropriate skincare habits, including extended bath durations and frequent use of facial cleansers, significantly increase the risk of rosacea in Chinese adolescents. PMID: 32128599 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Thumbnail-squeezing method: an effective method for assessing Demodex density in rosacea. J Eur Acad Dermatol Venereol. 2020 Mar 03;: Authors: Huang HP, Hsu CK, Yu-Yun Lee J Abstract D. folliculorum, and D. brevis are human ectoparasites living in hair follicles and sebaceous glands of the skin, respectively, and most commonly on the face. They are normal flora, but D. folliculorum can cause disease when it proliferates excessively or penetrates the dermis. Increased densities of Demodex have been reported in rosacea-by reflectance confocal microscopy (RCM), two consecutive SSSB (2-SSSB)7 and a superficial needle-scraping method. PMID: 32124497 [PubMed - as supplied by publisher] {url} = URL to article Demodex Density Count - What are the Numbers?
    • While the above study admitted the limit of a small sample size, as well as, 'The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation,' it doesn't mention that Light Microscopy Skin Scraping is Not as Reliable as 'Confocal laser scanning in vivo microscopy' which is more reliable. See item one in this post. What it does conclude is demodex mites are indeed in higher density in rosacea patients over the control group.  Demodex Density Count - What are the Numbers?  
    • Related Articles Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis. An Bras Dermatol. 2020 Feb 12;: Authors: Aktaş Karabay E, Aksu Çerman A Abstract BACKGROUND: Demodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. OBJECTIVE: To investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. METHODS: This prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. RESULTS: In terms of gender and age, no significant difference was found between the patients and controls (p>0.05). Demodex infestation rates were significantly higher in patients than in controls (p=0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p=0.001; p=0.024; p=0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p=0.001 and p=0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p=0.294). STUDY LIMITATIONS: Small sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. CONCLUSION: The findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation. PMID: 32113677 [PubMed - as supplied by publisher] {url} = URL to article
    • "Oral ivermectin (200 micrograms/kg/day) is also a treatment alternative for PPR although it is supported with level D evidence. In patients with treatment resistant rosacea, combination of oral ivermectin and permethrin 5% cream can be considered since this combination was found to be effective in decreasing demodex density in immunocompromised patients as well." Clin Cosmet Investig Dermatol. 2020; 13: 179–186. Published online 2020 Feb 20. doi: 10.2147/CCID.S194074 PMCID: PMC7039055 PMID: 32110082 Conventional and Novel Treatment Modalities in Rosacea Burhan Engin, Defne Özkoca, Zekayi Kutlubay, and Server Serdaroğlu
    • The February 2020 issue of the Clinical, Cosmetic and Investigational Dermatology reports, "Therefore, in 2017, there was a shift from subtypes to phenotypes in the diagnosis of rosacea and at least one diagnostic or two major phenotypes are required in order to diagnose a patient with rosacea."
    • I have been noticing the fact that how all the factors come together in an interplay to cause any condition and how paying attention to the factors and working with them would relieve you from the symptoms. My yeast overgrowth was aggravating my flushing, my blood vessels had become very dilated and at one point my skin was a full dry land and I coincidentally conversed with Dr. O’Desky our MAC member and she understood the condition and asked me to do gut cleaning. I was already a little bit resolved with the condition but did gut cleaning and not only gut cleaning but I have had such foods which kept my gut pH alkaline and I was already washing my face and scalp with ketoconazole with zinc pyrithione lotion and now my skin is in good condition not only yeast overgrowth was reduced but my intense prolonged flushing is at bay, meaning very mild flushing and one more thing I have considered, the environmental factor. My skin has withstood the extremities of temperature frequency  this season. So I was on with my internal and external cure meanwhile when the favorable temperature stability came it automatically helped to get my skin breathe and respond to the cure. So I observed how gut microbiota and skin microbiota are in close connection with each other and not only skin microbiota but gut microbiota also reacts and responds to the environmental factors. So I concluded how skin microbiota overgrowth and then its stability was responding to gut and temperature changes and how in turn that yeast growth was controlling the already existing inflammation of the skin.
    • Related Articles Conventional and Novel Treatment Modalities in Rosacea. Clin Cosmet Investig Dermatol. 2020;13:179-186 Authors: Engin B, Özkoca D, Kutlubay Z, Serdaroğlu S Abstract Rosacea is a common skin disease that is troublesome for both the patients and the dermatologists. Erythema, telengiectasia, papulopustular changes and phymatous changes are the main problems faced by the patients and dermatologists in everyday practice. Due to the chronic and relapsing nature of the disease, patients are usually unsatisfied with conventional treatment methods. This article aims at redefining rosacea according to the 2017 consensus and reviewing the different treatment modalities for different manifestations of the disease in depth. PMID: 32110082 [PubMed - as supplied by publisher] {url} = URL to article [abstract] Full Article
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