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    • "In the recent study, Di Nardo and colleagues have found that transient receptor potential vanilloid 4 (TRPV4) activates mast cells in people with rosacea." Researchers discover rosacea treatment pathway, Healio For more information on this read the post, 
      Trigeminal sensory malfunction theory
    • "It didn't take long to be diagnosed with rosacea and told that "there is not much known about it and no known cure". All four of the dermatologists I visited (yes, four - I was determined to find one who would offer a glimmer of hope) explained that it was chronic inflammation where blood vessels dilate too easily. It occurs most commonly in women (check) with fair skin (check) who are prone to blushing (check). So, at an age when I assumed I was well beyond my "skin-issue" years, I was suddenly a textbook case. All the doctors told me to treat it with oral and topical antibiotics." Dealing With Rosacea: Under My Skin, Calgary Avansino, Vogue
    • "Lena Dunham has spoken out in the past about her mental health difficulties, her endometriosis and her battles with social-media trolls, but this time she has turned her attention to a skin issue that plagues people all over the world: rosacea." Lena Dunham Speaks Out About Rosacea, Vogue
      image courtesy Wikicommons
    • Granulomatous rosacea: a case report. J Med Case Rep. 2017 Aug 20;11(1):230 Authors: Kelati A, Mernissi FZ Abstract
      BACKGROUND: Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved.
      CASE PRESENTATION: We report a case of a 54-year-old Moroccan man with a 3-month history of erythematous, nonpruritic papules on the lateral side around the eyes. Dermoscopy and histology confirmed the diagnosis of granulomatous rosacea.
      CONCLUSIONS: We describe another clinical presentation of granulomatous rosacea with a clinical-dermoscopic-pathological correlation.
      PMID: 28822351 [PubMed - in process] {url} = URL to article
    • Originally intended for those suffering from rosacea and eczema, this redness-neutralizing cream comes in three shades and has an irritation-soothing, sensitive-skin-comforting formula made up of colloidal oatmeal, peptides, hydrolyzed collagen, aloe, and avocado to calm, smooth, and hydrate the skin. This Concealer Was Made For Rosacea, but Is Baller at Covering Acne Scars,  by MEGAN MCINTYRE, Popsugar IT Cosmetics Bye Bye Redness Neutralizing Correcting Cream
    • Tom Busby, poster extraordinair at RF, posted the following which is worth reading (post no 2 in this thread):  Hi Stephan, you're right that demodex can cause dry eye symptoms, and plugging of the meibomian glands. Your photo shows a small whitish plug inside the margins of the eyelashes, which is where the meibomian glands are located. I suggest you read as much as you can, and use google search terms like "inspissated meibomian glands," which is the medical term for plugged meibomian glands, and your description of dry eyes upon waking is called "saponification." "Meibomian Gland Dysfunction" (MGD) is the general term, and demodicosis or demodectic blepharitis would be more specific terms.

      The medical profession is obsessed with the naming of things, and you'll eventually learn more if you go through the steep learning curve of learning the medical terms. I did all this when I found I had conditions very similar to yours.

      Plus, the eyes have extremely complicated anatomy, which you will need to learn. To get you started, the function of the meibomian glands is to release a tiny bit of oil each time you blink (from the blink pressure) and the oil floats on top of the tear film, and slows down the evaporation of the aqueous component. The Glands of Moll and the Glands of Zeiss also release oil. The lack of oil is the problem, and is why eye drops don't do anything at all.

      The plug that is outside the margin of the eyelashes, in your photo, is most like a plugged up Gland of Moll. These plugs are mostly a cosmetic problem, and are the result of dead demodex decaying and causing an allergic reaction. A prominent rosacea MD refers to them as "the gravestone of a dead demodex." The crusty skin below your eyes appears to be a combination of demodex-induced and malassezia-induced reactions. Climbazole treats against malassezia, but does nothing against demodex.

      You can gently express the meibomian glands, and you'll learn a lot by examining the quality and quantity of fluid that comes out. You'll need to read a lot more about this, but in very general terms, it's easier to start with the lower lid, and roll a finger gently up. Don't do this over and over, because the amount of oil in the mebomian glands is tiny, and there's no point to emptying the glands by doing it over and over. Most likely, nothing will come out of your meibomian glands, which is not what you want to see, at all, but it will show how bad the situation is. Perhaps the fluid will be discolored, or thickened -- this is also showing the need for treatment.

      The best current medically accepted treatment is 25% Tea Tree Oil (TTO), or preferably, a derivative of it called terpinen 4-ol. These procedures and products are patented. The main problem is that these treatments can't be self-administered, because both products burn the cornea, and generally require about a weekly one-hour office visit to an ophthalmologist. Worse yet, in the US these treatments aren't covered by insurance, but I'd like to know if they are covered in Canada. Treatments would cost tens of thousands of dollars. The condition, if it is indeed and allergic reaction, is most likely recurring.  

      You could self-treat with Cliradex wipes, which are 5% TTO, or terpinen 4-ol, but the concept could also be imitated by making your own Cliradex wipes, with 5% TTO and 95% MCT oil. Use before bedtime. Demodex males move around at night, and they're easier to kill. TTO is a contact-killer.

      I never used TTO or terpinen 4-ol as a treatment, because the idea of putting any essential oil near my eyes seemed to being inviting a disaster. My eyes are too important to me, as I read a lot.  

      However, after two years of effectively treating against seb derm induced by an allergic reaction to malassezia, using climbazole as the active ingredient, I found that my eyes were becoming more dry and bloodshot, so a year and a half ago, I went through a second incredibly steep learning curve to find out how I could treat MGD and demodectic blepharitis. 

      As I had previously learned how to make an MCT lotion and an MCT shampoo/shower gel with climbazole, I decided to test other compounds -- only safe ones -- and I found that piroctone olamine suppressed or eradicated demodex. Now my meibomian glands are unblocked, and have remained unblocked for over a year.  

      I use piroctone olamine at a concentration of 0.14%, and climbazole at 0.09%. Neither of these products is applied directly to the cornea or onto an open eye, which would be ridiculously dangerous in my opinion.

      However, my method of trying something to see if it works, is generally called "foraging research" and is not considered scientifically acceptable today, but it's how most discoveries were made before medicine became so incredibly complex and expensive. Nevertheless, I was so exhausted by the expense and futility of the medical system, that I did my own research and experimentation both as to malassezia and then as to demodex.

      Expect to use daily treatment with topical piroctone olamine for 23 days to see initial results, and 120 days for about 99% treatment, and 180 days for full treatment. The process of taking a shower, lathering up with the shower off for 3-5 minutes, then rinsing off and towel drying, and then applying a lotion, is very simple, so the time involved is not oppressive because the treatment is merely ordinary, daily hygiene, using an effective ingredient.

      There's a larger list of things that either don't work, or don't treat against demodex, and they're listed here, and in many other medical articles:  http://www.reviewofophthalmology.com/content/c/36944/ 

      You can't buy piroctone olamine-based cosmetics in the US or Canada because there isn't a Final Monograph approved by the FDA, and Canada follows the FDA in these matters. However, there is a Preliminary Monograph on Octopirox, another name for piroctone olamine, and one can see that piroctone olamine has a 3000 to 1 safety ratio, which is huge. With climbazole, the EU considers a 100 to 1 safety margin acceptable, so it's clear that piroctone olamine is much safer.

      There is no reason for a manufacturer to spend the millions of dollars necessary for a Final Monograph on piroctone olamine, because there are many OTC products overseas and already on the market, making the expense unrecoverable. The same reasoning shows the futility of a patented prescription product, although it would be possible, but it would be undercut by consumers who are willing to buy OTC products from overseas web-vendors.

      You could find some of these OTC piroctone olamine products on eBay or Amazon, but I'm not certain if they would ship them to the US or Canada. It would be worth your time and effort to try to obtain these products, as they aren't very expensive.

      Keep in mind that I'm merely a guy that reads a lot and is willing to try to figure things out, so you'll need to form your own conclusions. Good Luck!
    • In a recent interview, Sai Pallavi clarified that it is not acne and it’s an atypical disease she is suffering with. ‘It is Rosacea. I am photo sensitive. Whenever I am exposed to camera and light, my face turns pink,’ the actress said. Fidaa Girl Sai Pallavi suffers with skin disease – Rosacea, Celebs Cinema
      Image Wikipedia Commons
    • “The Antirougeurs line is targeted as redness relief,” Malinowski said. “It is clinically proven to reduce the redness associated with rosacea.” The Antirougeurs Dermo-Cleansing fluid is a gentle, soothing formula which cleanses and comforts the skin while reducing heat sensations. The Antirougeurs Redness Relief soothing cream contains an SPF of 25. “The cream moisturizes, protects, neutralizes and alleviates existing redness with a broad spectrum UVA/UVB protection,” Malinowski said. Eterna MedSpa offers help for those battling rosacea, [Sponsored] by Eterna Medspa & Laser Vein Center, The Herald-News, Shaw Media Eau Thermale Avène Antirougeurs Fort Relief Concentrate  Eau Thermale Avène Antirougeurs Dermo Cleansing Milk Eau Thermale Avène Cicalfate Restorative Skin Cream Eau Thermale Avène Antirougeurs Day Redness Relief Soothing SPF 25 Cream
    • Related Articles Etiologies and management of cutaneous flushing: Nonmalignant causes. J Am Acad Dermatol. 2017 Sep;77(3):391-402 Authors: Sadeghian A, Rouhana H, Oswald-Stumpf B, Boh E Abstract
      The flushing phenomenon may represent a physiologic or a pathologic reaction. Although flushing is usually benign, it is prudent that the physician remains aware of potentially life-threatening conditions associated with cutaneous flushing. A thorough investigation should be performed if the flushing is atypical or not clearly associated with a benign underlying process. The diagnosis often relies on a pertinent history, review of systems, physical examination, and various laboratory and imaging modalities, all of which are discussed in the 2 articles in this continuing medical education series. This article reviews flushing associated with fever, hyperthermia, emotions, menopause, medications, alcohol, food, hypersensitivity reactions, rosacea, hyperthyroidism, dumping syndrome, superior vena cava syndrome, and neurologic etiologies.
      PMID: 28807107 [PubMed - in process] {url} = URL to article
    • Demodex Solutions, one of our sponsors, is experimenting with a new improved ZZ like cream that hopefully will help with dry skin and is seeking six (6) willing volunteers who will provide before and after photos for this trial and details of your experience. You will receive free trial samples shipped to your address at no charge to you for shipping or the samples. However, you must provide before and after photos to be selected for this trial.  If you are interested, you must follow these steps:  (1) Join the RRDi and be sure to confirm by clicking on the validation email sent to you so you are a registered member.  (2) After logging to your RRDi account, use the contact form and request an application which will be sent to you after you join the RRDi in step one.  In the contact form request to be part of the Demodex Solutions trial that you want the samples mailed to you. Remember, only six will be chosen so please follow the directions we send you. If you have dry skin that would be a plus for your being selected. Demodex Solutions will choose from among the applicants the final six trial members. You may live anywhere in the world since the samples will be mailed to your address at no cost to you. 
    • Related Articles Electrosurgery for the Treatment of Moderate or Severe Rhinophyma. Actas Dermosifiliogr. 2017 Aug 09;: Authors: González LF, Herrera H, Motta A Abstract
      Rhinophyma, a rare and progressive disfiguring condition, is thought to be the final stage of rosacea. Several surgical treatments are available, including dermabrasion, cryosurgery, scalpel excision, electrosurgery, and carbon dioxide laser. The last 2 techniques are the most effective for the management of rhinophyma. We describe a series of cases of moderate or severe rhinophyma treated with high-frequency electrosurgery in the dermatology department of Hospital Simón Bolivar and in private clinics in Bogota, Colombia, between 2012 and 2016. The cosmetic result, as assessed by both the clinicians and the patients, was satisfactory in all cases. Three patients presented hypertrophic scars that were treated with steroid injections and silicone gel sheeting. Two patients presented persistent erythema. However, there were no serious infections and none of the patients required further surgery. Electrosurgery is one of the simplest and most cost-effective techniques currently available for the treatment of rhinophyma by dermatologists.
      PMID: 28802484 [PubMed - as supplied by publisher] {url} = URL to article
    • On that note, I have something to post in the Trigeminal  sensory malfunction theory thread.
    • Related Articles The dermatology life quality index (DLQI) and the hospital anxiety and depression (HADS) in Chinese rosacea patients. Psychol Health Med. 2017 Aug 10;:1-6 Authors: Wu Y, Fu C, Zhang W, Li C, Zhang J Abstract
      The study aims to investigate the quality of life (QOL) and the psychological situation in Chinese patients with rosacea. A total of 196 healthy controls and 201 rosacea patients were involved in the final analysis. The general information, the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS) were collected. Significantly higher DLQI, anxiety and depression score were observed in the rosacea group compared to the control group (p < .01). Total DLQI score of patients was positively related with anxiety (r = .526, p < .001) and depression scores (r = .399, p < .001) in HADS. Rosacea had significant psychological impact on Chinese patients and had substantial influence on their QOL. Physicians should address the psychosocial needs of rosacea patients as much as its physical symptoms.
      PMID: 28797174 [PubMed - as supplied by publisher] {url} = URL to article
    • Mahalo Mistica for your post. The new Trigeminal sensory malfunction theory involving the TRPV4 expression I originally put in 'other theories' but it is logical to put under the Nervous System Theory. Really appreciate your posting here.   
    • I too love ZZ cream and like you, Brady, find it crucial to controlling my symptoms. In my case, I mix it with my compounded Niacinamide Gel, as the newer ZZ base didn't sit well on my face. It dried like poster paint.  Plus, I love my niacinamide gel and it offers it's own benefits. The two combined work well for me...... unless  ........ (like you), my gut function is not also under control. I have followed your posts for years and I am convinced that whilst ZZ cream helps control symptoms in our faces, our primary issues come from the gut. Yet, treating the gut alone is not enough. ZZ cream seems to help restore harmony (to a point) in the face. I am also convinced that my breakouts, when they occur have little or anything to do with demodex. Based on what you report, yours aren't either. This begs the question yet again, why do medications such as ivermectin provide relief for some type 1's? Or even type 2's?  I feel the answer lies in how the medications interact with nerve cells in addition to relieving inflammation. Menthol in the ZZ cream also interacts with one of the TRP family. From memory I think it is the TRPM8. I've no doubt ZZ provides antimicrobial effects (as well as mite control) as well, but then, so do commercial sulphur topicals and personally, I don't find them overly useful at all. ZZ is different. I also feel that the base of Soolantra, being cetaphil lotion, is a poor choice and given lotions and potions in general fire up many faces, adding oil to the inferno, whilst trying to put out the fire, doesn't seem logical. I am also not convinced that the massive outbreaks that some people report when starting ZZ cream is always due to a sudden demodex die off, as people in the ivermectin trial where I live reported no such thing. There are reports of such outbreaks of P&P's from people who have been regular users of Pot, for example, or certain antidepressants and yet again, this suggests a change of firing in the nerve cells. Perhaps ZZ also modifies them? Anyway, at the end of the day, ZZ cream seems the best topical for  your case and mine (in conjunction with the niacinamide gel) and I do hope that you can find some way to continue purchasing it. As you say, it is pricey, alas. Perhaps you could find a non oily gel with which to mix it? You are a trooper testing different products over the years and providing photographic blogs.    
    • "Due to the design of the gelator, drug release was up to 10 times faster and retention of the drug within the skin was up to 20 times more effective than that observed for commercial products."  Source We will learn more about these new 'Cationic Supramolecular Hydrogels' in the future. Kate Lawrence, Chemistry Views, writes, "Effective drug delivery using cationic supramolecular gels could be associated with intermolecular reactions as well as the lack of coulombic attraction between the gelator and the drug. A rabbit model was developed based on the decrease of erythema (redness of the skin) after inducing vasodilation (widening of blood vessels), and in vivo experiments demonstrated the efficacy of the hydrogels. This, combined with the straightforward preparation of thermoreversible supramolecular hydrogels at room temperature, provides an option for industrial-scale production of dermatological formulations to treat rosacea and other chronic skin diseases."

      Langmuir, American Chemistry Society, reports that "hybrid peptide hydrogels show antibacterial activity." Another design "novel supramolecular gels in ethanol-water mixtures...seem to promote the retention of the drug inside the skin....effective in vivo anti-inflammatory activity was observed, especially with the indomethacin-incorporated gel, which indicates that these supramolecular hydrogels are a good option for the delivery of poor water soluble drugs for the treatment of acute inflammation or other skin diseases." 
      Novel nanostructured supramolecular hydrogels for the topical delivery of anionic drugs.   The good news about these new supramolecular hydrogels is  "the potential opening up of alternative strategies in therapy."
      Cationic nioplexes in supramolecular hydrogels as hybrid materials to deliver nucleic acids  
    •   Related Articles Cationic Supramolecular Hydrogels for Overcoming the Skin Barrier in Drug Delivery. ChemistryOpen. 2017 Aug;6(4):585-598 Authors: Limón D, Jiménez-Newman C, Rodrigues M, González-Campo A, Amabilino DB, Calpena AC, Pérez-García L Abstract
      A cationic bis-imidazolium-based amphiphile was used to form thermoreversible nanostructured supramolecular hydrogels incorporating neutral and cationic drugs for the topical treatment of rosacea. The concentration of the gelator and the type and concentration of the drug incorporated were found to be factors that strongly influenced the gelling temperature, gel-formation period, and overall stability and morphology. The incorporation of brimonidine tartrate resulted in the formation of the most homogeneous material of the three drugs explored, whereas the incorporation of betamethasone resulted in a gel with a completely different morphology comprising linked particles. NMR spectroscopy studies proved that these gels kept the drug not only at the interstitial space but also within the fibers. Due to the design of the gelator, drug release was up to 10 times faster and retention of the drug within the skin was up to 20 times more effective than that observed for commercial products. Experiments in vivo demonstrated the rapid efficacy of these gels in reducing erythema, especially in the case of the gel with brimonidine. The lack of coulombic attraction between the gelator-host and the guest-drug seemed particularly important in highly effective release, and the intermolecular interactions operating between them were found to lie at the root of the excellent properties of the materials for topical delivery and treatment of rosacea. PMID: 28794954 [PubMed] {url} = URL to article PDF
    • “Summer heat that makes the skin feel flushed can bring out melasma, hyper-pigmentation and rosacea,” Dr. Simon Ourian adds. “And humidity, which is usually good for dry skin, can make conditions like Eczema worse." 7 Products That Will Instantly Save Dry Summer Skin, Emily Siegel, Forbes Here are seven of the products mentioned in the article above. If you purchase them through our Amazon Affiliate program the RRDi receives a small affiliate fee. Mahalo for purchasing through the RRDi.  (1) emerginC - Sun 30+ (2) Mad Hippie Facial SPF (3) S.W. Basics 4 Ingredient Oil Serum (4) One Love Vitamin D Mist (5) Ilia Cucumber Water Stick (6) Glow Recipe Watermelon Sleeping Mask (7) Osmia Organics Black Clay Facial Soap
    • People who suffer from rosacea can also develop broken capillaries. These capillaries aren't always necessarily broken, but blood vessels that have a rosacea-induced increase in production and open and close as a response to environmental and emotional factors. "This is what causes people with rosacea to feel excessively hot or flush," says Bashey. How to Get Rid of Broken Capillaries on Your Face, by Erin Lukas, InStyle, SheKnows
    • Related Articles Intense pulsed light for evaporative dry eye disease. Clin Ophthalmol. 2017;11:1167-1173 Authors: Dell SJ Abstract
      There is a clear association between dry eye disease (DED) and skin inflammatory diseases occurring in close proximity to the eyelids, such as facial skin rosacea. Intense pulsed light (IPL) is widely accepted as a treatment for skin rosacea. A number of recent studies demonstrated that, in patients suffering from meibomian gland dysfunction (MGD), IPL therapy also reduces signs and symptoms of DED. Despite these encouraging results, in the context of DED and MGD, the mechanisms of action of IPL are not well understood. The purpose of this review was to raise the potential mechanisms of action and to discuss their plausibility.
      PMID: 28790801 [PubMed] {url} = URL to article
    • Related Articles Comment on "Effects of Helicobacter pylori treatment on rosacea: A single-arm clinical trial study". J Dermatol. 2017 Aug 09;: Authors: Talebi Bezmin Abadi A PMID: 28791736 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Otophyma, Rhinophyma and Telangiectatic Rosacea - A Rare Combination in a Female Patient. Open Access Maced J Med Sci. 2017 Jul 25;5(4):531-532 Authors: Wollina U, Lotti T, Tchernev G Abstract
      BACKGROUND: Rosacea is an inflammatory facial dermatosis seen more frequently in adults in their second half of life. The phymas are a particular subtype with sebaceous gland hyperplasia and progressive fibrosis.
      CASE REPORT: We report on the rare simultaneous occurrence of telangiectatic rosacea, otophyma and rhinophyma in a 50-year-old female with psoriatic arthritis, chronic lymphedema of the legs, and metabolic syndrome.
      CONCLUSION: Despite the preference of rhinophyma and otophyma to the male gender, their occurrence in females needs to be considers in the differential diagnosis of dermatoses of head and neck. Early diagnosis and appropriate medical treatment improve outcome and help to avoid surgery.
      PMID: 28785351 [PubMed] {url} = URL to article
    • Edward S. Jarka, OD, MS explains:  Brady, Thank you for this opportunity to weigh in on this topic. This is the way I would describe it to a patient: In the eye care world we are often faced with people who have uncomfortable eyes but no apparent signs to explain their discomfort. These patients typically complain of burning, grittiness or the feeling of something in their eyes and are told they have “dry eyes”, but after many appropriate treatments these people continue to feel discomfort. So…what’s causing this painful eye situation. Well, the sensation of pain is governed by a nerve called the Trigeminal Nerve. It has been speculated for some time that the reason for this eye pain was due to chronic inflammation of this Trigeminal Nerve. It was thought that the non-stop inflammation of this nerve changed the level of sensitivity of this nerve to be more sensitive to everyday sensations than normal.  This condition is referred to as neurogenic inflammation. A condition which is hard to diagnose and often times even harder to treat. Rosacea is also a condition that is difficult to diagnose and difficult to treat. The Trigeminal Sensory Malfunction Theory suggests that an abnormal receptor in the skin known as TRPV4 functions abnormally. The TRPV4 receptor normally monitors an number of sensations such as vascular function and pain by regulating calcium to channel from one cell to another.  So, The Trigeminal Sensory Malfunction Theory  an initiating factor (abnormal chemical or mechanical cues) like non-stop inflammation →  abnormal TRPV4 receptor → change in the level of sensitivity in the Trigeminal Nerve → Chronic pain not responsive to typical treatments of inflammation. The Trigeminal Sensory Malfunction Theory and the discovery of the role that the TRPV4 receptor might play in rosacea as well as certain types of dry eye may lead to early identification of the people at risk for rosacea, avoidance of the precipitating factors and treatments to modulate the function of the TRPV4 receptor. Does this work for you Brady? Thanks, Edward S. Jarka, OD, MS  
    • Related Articles Treatment of Ocular Rosacea. Surv Ophthalmol. 2017 Aug 03;: Authors: Wladis EJ, Adam AP Abstract
      While rosacea is a common entity with significant cosmetic, socioeconomic, and vision-threatening impacts, this disorder remains incurable. Furthermore, until quite recently, many of the therapeutic options for rosacea had not been assessed through rigorous clinical testing with meaningful outcome measures. Nonetheless, new medical and surgical interventions that have been validated in well-designed trials hold the promise of treating rosacea more effectively. Furthermore, recent enhancements in our understanding of the cellular and molecular biology offer highly translational insights that will hopefully lead to the development of new treatment options for rosacea. We review the evidence for these therapies and discusses new scientific findings that can be exploited for new therapeutic interventions.
      PMID: 28782548 [PubMed - as supplied by publisher] {url} = URL to article
    • "NYC-based dermatologist Dr. Dennis Gross sums it up like this: “Heavy metals (iron, copper, zinc, magnesium, and lead) are free radicals found in tap water, perspiration, and in an unbound form in skin. The heavy metals found in tap water are actually free radicals themselves. They also generate other free radicals (like a chain reaction) that destroy collagen.” The result, says Gross, is pandemonium for your skin — breaking down collagen, causing wrinkles and fine lines, inducing inflammation, and causing and aggravating conditions like acne and rosacea." Tap Water Could Be to Blame for Your Beauty Woes
      I mean, probably not all of them.
    • Flavia Addor, MD. explains:  Rosacea is a chronic skin disease with a inflammatory disfunction that leads to vascular and cutaneous changes. A new theory seeks to explain the inflammatory component, and is liked to a dysfunction of a crianial nerve called trigeminal. Inflammation of this nerve would be linked to inflammation of the skin, increasing inflammatory mediators, substances that can act worsening the inflammation. On the other hand, external sensory stimuli would excite this nerve, triggering the vascular reactions known in rosacea, such as flush and burning. 
    • Leonard Weinstock, MD wrote:  Interesting
      This might explain why we have seen some patients get better with low dose naltrexone ... decreases inflammation 
    • Received this explanation of the article in this thread from Ronald P. Drucker, B.S. (M.T.A.S.C.P), D.C., who wrote the following:  Dear Brady Barrows:   Glad you found me and thank you for your email.  The gist of the research article to which you directed me is the following:  Roseacea is a risk factor for Alzheimer's Disease (Type III Autoimmune Brain Diabetes).  This is so because (even though the research article does not mention it), both are autoimmune diseases and anyone with one autoimmune disease is more likely to develop other ones.  The next point of the article is that  Inflammation of the Trigeminal Nerve can cause or exacerbate Rosacea and visa versa.  This, of course, is due to the fact that all autoimmune diseases are accompanied by an exaggerated, defective immune response; namely chronic inflammation.  Visit my website: www.healtherootcause.com, view any of the hundreds of successful User Reports .  You can also read my book "The Code Of Life" with over 100 scientific references.
    • There is a new theory on the cause of rosacea, the Trigeminal sensory malfunction. So what is this all about? It involves the nervous system so it is subcategorized in the nervous system theory.  First, the trigeminal nerve is "is a nerve responsible for sensation in the face and motor functions such as biting and chewing and is the largest of the cranial nerves,  Also,  understanding what the Principal sensory nucleus of trigeminal nerve is all about, which is a "is a group of second order neurons which have cell bodies in the caudal pons," that "can result in craniofacial pain, including migraine, temporomandibular joint pain, and trigeminal nerve pain." [1]   "The Mascarenhas et al. (2017) paper is exciting because it casts a critical element of rosacea pathogenesis in a new light. The increased presence of antibacterial cathelicidin is a hallmark of rosacea facial dermatitis." [1] The "link between chronic facial skin inflammation in rosacea, constitutive facial innervation by the trigeminal system, and possible involvement of trigeminal neuroinflammation and neural sensitization mechanisms in rosacea should prompt one to think more proactively about why the presence and severity of rosacea could act as a risk factor for Alzheimer's disease, as recently reported (Egeberg et al., 2016)." [1] "Trigeminal sensory malfunction in humans can result in craniofacial pain, including migraine, temporomandibular joint pain, and trigeminal nerve pain. As a functional and structural system that underpins these medically relevant conditions, the trigeminal system can generate neurogenic inflammation powerfully. Bearing in mind this important feature, we should consider whether the chronic facial dermatitis of rosacea can be facilitated by neurogenic inflammation via trigeminal sensory afferents and also whether chronically inflamed skin in rosacea can sensitize trigeminal sensory afferents. From the senior author's own clinical practice (with now >1,000 cases encountered suffering from trigeminally mediated pain and sensory disorders), the clinical impression is affirmative, as he has observed worsening of facial pain in patients with poorly controlled rosacea. Clearly, this clinical impression awaits controlled assessment through clinical studies." [1] TRPV4
      "Mascarenhas et al. report that TRPV4 expression is upregulated in mast cells in response to the proteolytic cathelicidin fragment LL37 in a murine rosacea model and that TRPV4 loss of function attenuates mast cell degranulation. These findings render TRPV4 a translational-medical target in rosacea. However, signaling mechanisms causing increased expression of TRPV4 await elucidation. Moreover, we ask whether TRPV4-mediated Ca++-influx evokes mast cell degranulation." [1] "" 'Although more work needs to be done, these findings suggest that potential therapies may be developed specifically to block TRPV4 as a direct means of treating or preventing inflammation in patients with rosacea,' Dr. Di Nardo said." [2] End Notes
      [1] J Invest Dermatol. Author manuscript; available in PMC 2017 Jul 31.
      J Invest Dermatol. 2017 Apr; 137(4): 801–804.doi:  10.1016/j.jid.2016.12.013 - PMCID: PMC5536341-NIHMSID: NIHMS876146
      TRPV4 Moves toward Center-Fold in Rosacea Pathogenesis
      Yong Chen, Carlene D. Moore, Jennifer Y. Zhang, Russell P. Hall, III, Amanda S. MacLeod, and Wolfgang Liedtke [2] Researchers Discover Missing Links in Rosacea Inflammation, NRS
      Posted: 08/14/2017    
    • Arlene,  Are you still around?   Brady
    • Related Articles « Malignant » Rosacea as a sign of systemic marginal zone lymphoma. J Eur Acad Dermatol Venereol. 2017 Aug 03;: Authors: Lamoureux A, Vergier B, Fidelin-Ferrati G, Hans P, Milpied N, Beylot-Barry M Abstract
      Rosacea is a common facial dermatosis for which differential diagnoses have to be considered in the case of atypical features or treatment failure. We report 3 cases of systemic marginal zone lymphomas (MZL), with skin involvement simulating rosacea. A 76-year-old man presented a rhinophyma for one year (Fig 1). This article is protected by copyright. All rights reserved.
      PMID: 28776782 [PubMed - as supplied by publisher] {url} = URL to article
    • I have now gone back to my tried and true favorite treatment, the ZZ cream which you can follow my photos and review here. 
    • I have been using the ZZ cream for years. I stopped for a while to try Soolantra which I reviewed here. However, I have returned using the ZZ cream for about three weeks now and my face is doing much better using the ZZ cream which is my favorite treatment for rosacea along with my Rosacea Diet. So I thought I would post today my photos for your review. I haven't found anything as good as the ZZ cream to treat my rosacea/SD. Demodex Solutions is one of our affiliate sponsors. 
    • We have written on this subject with several articles:  Do You Have a Gut Feeling About Your Rosacea? Microbiome-based therapeutic strategies Probiotics The Huff Post has recently mentioned rosacea in a similar article, The Gut-Skin Axis: The Importance of Gut Health for Radiant Skin, by 
      Deanna Minich, Ph.D., which is worthy of your consideration. 
    • "Inflammatory bowel disease (IBD) is also associated with a higher risk of developing an inflammatory skin condition, such as psoriasis, atopic dermatitis, and rosacea. In one population-based cross-sectional study, the researchers found a significant association between IBD disorders, including both ulcerative colitis and Crohn’s disease, and inflammatory skin conditions. The same association was not found for autoimmune skin conditions, such as alopecia and vitiligo. In another study, the incident of IBD was higher in patients with rosacea compared to those without, with an adjusted hazard ratio of 1.94(95% CI 1.04 - 3.63 p= .04)." The Gut-Skin Axis: The Importance of Gut Health for Radiant Skin, Deanna Minich, Ph.D., Contributor, Huff Post Is inflammatory bowel disease (IBD) the same thing as Irritable Bowel Syndrome (IBS)? Answer
    • The Rosacea Pipeline Insight, 2017 report covers the dormant and discontinued pipeline projects related to the Rosacea. The Rosacea Pipeline market Insight, 2017 report provides a complete understanding of the pipeline activities covering all clinical, pre-clinical and discovery stage products. Rosacea Pipeline Global Market Outlook, Product Description, Assessment by route of administration and Forecast Report, medGadget
    • Related Articles Three Cases of Autoimmune Progesterone Dermatitis. Ann Dermatol. 2017 Aug;29(4):479-482 Authors: You HR, Yun SJ, Kim SJ, Lee SC, Won YH, Lee JB Abstract
      Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to progesterone produced during the luteal phase of the menstrual cycle. The clinical symptoms of autoimmune progesterone dermatitis overlap with other forms of dermatosis such as erythema multiforme, eczema, fixed drug eruption, urticaria, and angioedema. We experienced 3 cases of autoimmune progesterone dermatitis. All patients had a recurrent history of monthly skin eruptions. Skin lesions normally began a few days before menstruation and resolved a few days later. Patients were confirmed to have autoimmune progesterone dermatitis by the results of the progesterone intradermal test. All three patients had different clinical findings such as erythema annulare centrifugum, urticaria, contact dermatitis, and rosacea. Because patients presented with variable clinical manifestations, they could have been easily misdiagnosed. The patients were treated with oral contraceptive, antihistamine and steroids for symptom control. We propose that dermatologists should consider autoimmune progesterone dermatitis in cases of recurrent cyclic skin eruptions in female patients. Further, if this condition is suspected, thorough history taking including that on menstrual cycle and intradermal progesterone test should be performed.
      PMID: 28761298 [PubMed] {url} = URL to article