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    • Related Articles Stepwise Surgical Treatment of Gnathophyma. Dermatol Surg. 2019 01;45(1):158-160 Authors: Moiin A, Mahmood SH, Kurtovic A PMID: 29642112 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Natural Skin Care Products as Adjunctive to Prescription Therapy in Moderate to Severe Rosacea J Drugs Dermatol. 2019 Feb 01;18(2):141-146 Authors: Draelos ZD, Gunt H, Levy SB Abstract Background: Rosacea is characterized by irritation associated with erythema, telangiectasias and papules/pustules. Whole formula nature-based sensitive skin products are formulated to maintain skin barrier and appropriate hydration that can lead to soothing benefits. Objective: To evaluate the efficacy and tolerability of a regimen consisting of a cleanser containing natural oils, beeswax, and witch hazel and day and night creams containing natural oils, glycerin, and botanical anti-inflammatories (NR); and a synthetic dermatologist-recommended regimen of cetyl alcohol, sodium lauryl sulphate-containing cleanser, and glycerin, polyisobutene-containing lotion (CR) in subjects with rosacea. Methods: 80 female subjects with rosacea who received 6 weeks of 0.75% metronidazole gel, were randomized to receive NR or CR, twice daily, for 4 weeks in conjunction with the gel. Blinded investigator global assessment of rosacea, investigator-rated, and subject-rated overall skin appearance was assessed using a 5-point scale (0=none, 4=severe) at baseline, 2 weeks, and 4 weeks. Noninvasive skin assessments for skin hydration and skin barrier function were made by corneometry and TEWL, respectively. Results: NR resulted in improvement in investigator global assessment of rosacea measures at 4 weeks from baseline (erythema, 28%; telangiectasia, 26%; papules/pustules, 34%: P<0.001) and CR resulted in a 8 to 12% improvement. Differences between treatments were statistically significant. Overall skin appearance measured by the investigator was clinically and statistically improved from baseline by 32% and 12% with NR and CR, respectively. Overall skin appearance measured by subjects was improved by both NR and CR from baseline with no differences between treatments. Both regimens improved barrier function from baseline to week 4 (13%, NR; 14%, CR). NR decreased hydration by 21% from baseline at week 4 while CR increased hydration by 14% (P<0.001 from NR). No clinically significant tolerability issues were reported in either regimen at week 4. Conclusion: NR was effective, well tolerated, and superior to CR in the management of rosacea, concomitantly treated with metronidazole. National Clinical Trial Identifier: NCT03392558 J Drugs Dermatol. 2019;18(2):141-146. PMID: 30794364 [PubMed - as supplied by publisher] {url} = URL to article
    • "As you’re already aware, standard FDA-approved therapies for rosacea include topical preparations: metronidazole, clindamycin, azelaic acid, sulfur, sodium sulfacetamide and oral medications: tetracycline, doxycycline and minocycline. As all dermatologists know, these therapies sometimes do not work, so an awareness of off-label uses of other medication groups and approaches is useful to avoid treatment failure, patient frustration and dermatologist exasperation. I will focus on four groups and approaches: retinoids, anti-parasitic agents, Helicobacter pylori treatment and second-generation macrolides." When Rosacea Resists Standard Therapies, the dermatologist This is an old article, written in 2008, which doesn't even mention the gold standard of treatment for rosacea, but you may find it helpful if you haven't heard of any of these treatments. These treatments are mentioned in the category:  Forum Home > Forums >  Public Forum >  Rosacea Topics >  Prescription Treatments  There are other options or alternatives  also reported using oral ivermectin and metronidazole, other prescriptions, secondary therapy, the ZZ Cream, demodex treatments,  probiotics (probiotic therapy), or a growing list of non prescription or over the counter treatments (our affiliate store). 
    • The gold standard for rosacea treatment is Oracea and Soolantra, both Rx(s) from Galderma (yes, Galderma has sponsored three RRDi education grants).  If your physician (hopefully a dermatologist) hasn't treated you with the gold standard, then, your physician simply isn't keeping up with the latest information on rosacea treatment. If these two treatments don't improve your rosacea, then you obviously have some other rosacea variant, rosacea mimic, or some other possible co-existing condition. Also, if your physician diagnoses you with a subtype of rosacea, your physician hasn't been keeping up with the new phenotype classification of rosacea, so you may want to find one who is keeping up with the latest information on rosacea. Once you are on the gold standard of treatment for rosacea you should improve within thirty days. Some may take longer, say sixty to ninety days, but usually you will know whether this treatment improves your rosacea within this time period. If not, you simply go back to your physician (hopefully a dermatologist) who will prescribe a different treatment if you don't respond to the gold standard. Not everyone will respond well to the gold standard, but it is worth trying since many do improve their rosacea with this treatment.  Because the gold standard is so expensive (Oracea and Soolantra are expensive, hence the gold designation), in many social media groups, i.e., Facebook, Twitter, Reddit, there are reports that many have been trying an inexpensive horse paste and rave about the success. There are other options or alternatives  also reported using oral ivermectin and metronidazole, other prescriptions, secondary therapy, the ZZ Cream, demodex treatments,  probiotics (probiotic therapy), or when rosacea doesn't respond to standard therapies. 
    • Related Articles Occupational allergic contact dermatitis to sulfite in a seafood section worker of a supermarket. Contact Dermatitis. 2019 Feb 18;: Authors: Raison-Peyron N, Roulet A, Dereure O Abstract A 56-year-old female patient was referred for itchy face dermatitis of a few months duration (fig 1). She had had allergic contact dermatitis to cheap jewellery and to an antifungal cream (Kétoderm) and was regularly using cosmetics for vascular rosacea. This article is protected by copyright. All rights reserved. PMID: 30779161 [PubMed - as supplied by publisher] {url} = URL to article
    • At the Hilton Waikoloa Resort on the Big Island of Hawaii, the Skin Disease Education Foundation is holding its 43rd annual seminar, February 17 - 22, 2019. Linda Stein Gold, MD, RRDi MAC Member spoke on how to manage rosacea patients.
    • A June 2018 article published at Bustle adds more confusion to rosaceans who read this and believe there are '9 unexpected causes of rosacea' when such a title is very misleading and so untrue. What the article is actually discussing is common rosacea triggers which are found on many rosacea trigger lists and there has never been a rosacea trigger connected with causing rosacea. Triggers are only causing a rosacea flare up or flush. While the article starts out clearly stating that the "causes of rosacea are infuriatingly elusive," and clearly states there are "numerous unexpected factors that could be triggering your rosacea," the title suggests otherwise. The 'causes' in the title of the article should have read, 'triggers.' Ms Dixon does refer to the NHS website article on the web, Causes of Rosacea, stating "The NHS offers an exhaustive (and exhausting) list of theories surrounding the origins of rosacea." The NHS article in the first paragraph states, "The exact cause of rosacea is unknown, although a number of potential factors have been suggested." 9 Unexpected Causes Of Rosacea, Because Changing These Everyday Things Could Have A Huge Impact, Emily Dxon, Bustle By EMILY DIXON
    • "The study found that people stigmatized by rosacea: are embarrassed by their skin condition (77 per cent); have difficulty establishing new relationships (53 per cent); avoid public contact or cancel social engagements (54 per cent); get depressed (70 per cent); lose confidence (69 per cent); and feel frustrated and angry (74 per cent). Rosacea also negatively affected their sex life, family life, work life, mood and psychological condition." Study confirms the emotional pain rosacea inflicts, says Windsor dermatologist, Brian Cross, CTV Windsor  
    • Thanks for you post. That is what the RRDi is all about, a huge database of rosacea information to educate rosaceans. The treatments that don't work need to be flagged by posting a user experience. A treatment that does works needs to be shared. The RRDi has the means to contact any member by email address to confirm that the user is an actual rosacea sufferer and if the poster doesn't respond to the inquiry then the user can be banned. This isn't being done in rosacea groups on Facebook, Twitter or other social media (the posts could be spam and very little is being done to prevent spam). The RRDi has safeguards in place to prevent spammers and trollers who prey on rosacea sufferers. 
    • They need to be educated I think. Though thinking more about that. Who can say that have a solution for cure which will help for sure. I guess many of them. But when you trying there cure it mostly doing nothing for you. There also products, treatments or activities that are making our ailment worse. And again you cannot be sure if something will help you or make it worse.  
    • So going to the gym or exercising to increase muscle mass may improve your rosacea. Just about any physician will tell you that exercise and eating healthy will improve not only health but also your rosacea. 
    • Dr. Chris Steele talks about LDN. 
    • That has been my question for a number of years when I noticed no activity here at the RRDi, even though having over 1200 members, hardly anyone posts. I have thought during this time obviously rosaceans prefer social media over the forum style posting that has been around for twenty years, which doesn't have the user experience they are accustomed to using social media platforms. I have been browsing and posting a little at Facebook, Reddit, and Twitter and found that the level of education about rosacea is paltry and mostly these groups of rosaceans are into horse paste. They feel very comfortable showing horrible photos of their rosacea which I find really ironic since I heard so many complaints about joining the RRDi and filling out contact information (so we dropped the requirement and only require an email address). The lack of knowledge about rosacea in these social media groups and the spam posts allowed for all sorts of treatment for rosacea, not to mention the advertising, to me is a sad choice rosaceans have made instead of joining together in to a non profit organization for patient advocacy. At least I know where the rosaceans have gone. Very sad. 
    • Flugs at RF has started a thread indicating that low dose Naltrexone helps with phenotype 1 (of course Flugs calls it subtype 1). If you read the entire thread Flugs also takes propranolol (10 mg 3 times daily ), uses IPL (post no 29), however, in post no 49 Flugs writes, "I’ve also dropped all the meds I have tried in the past, none of which seemed to help much anyway... at least not enough for me to want to do something to my heart in order to help my face. So all I’m taking now is LDN and a tablesppon of apple cider vinegar every day." Flugs reports at post no 80, "On the down side though - I have to confess that i have had a few (pretty minor) flushes in the past two or three weeks. Almost always for no apparent reasons. It may still be post IPL recovery, last one was a month ago.. but IPL recoveries used to be waaaayyy worse, so if this is all I get I'm fine with that. I confess I have also been dabbling with (very mild) mandelic acid of late - I think I was overdoing it - Ive dialled back." So Flugs is still trying some other treatments along with LDN. In post 99 he mentions his 12th IPL treatment.  At post no 112 Flugs writes, "I am still prone to flushing a little when I get too warm - and also (oddly) when I am trying, and failing, not to fall asleep, such as late at night in front of the tv (that’s always made me flush.. does that happen with anyone else!?) when I say “flushing a little” I mean that my cheeks get red and feel warm, but I can take it down pretty much instantly by cooling them (fan, water spray etc) in some way. Even if I were to leave them be they would go down themselves within a few mins... compare that to the sometimes 12 hour long painful flushes I got when the rosacea arrived two years ago." Judworth who suffers from Neuropathic Rosacea (has lots of posts) reports in the same thread Flug started mentioned above about his experience taking LDN, "Since taking LDN I am cautiously happy to report that I haven't had any facial nerve pain, I still get the warm room flush, but my face is less reactive in general, even after a spell on the computer (which always gave me an element of activity even if it wasn't a full-blown flush)." At post no 117 Judworth writes, "LDN has been a god-send for me, not only calming the skin, stopping my facial nerve pain and halting the burning sensation in my mouth caused by lichen planus, I feel it is somehow re-booting my faulty immune system!" The low dose Naltrexone is usually starting out at 1 mg and gradually increasing to 4.5 mg. Flugs insists that taking more than this won't work (go through his thread which has many other users reporting success with what they call LDN).  You may want to show your doctor this pdf:  Low-dose Naltrexone (LDN) Fact Sheet 2014 LDN Research Trust LDNNow
    • image courtesy of IMDB Canadian Egyptian actress Christine Solomon has rosacea. She is reported as stating, "I purchased acne products off the shelf, and that turned out to be a big mistake! My cheeks became inflamed because of the ingredients in those products, and my condition worsened. That’s when I consulted a dermatologist for the first time, and he diagnosed me with rosacea at the age of 14 years old." Ms Solomon is the 2018 spokesperson for the Acne and Rosacea Society of Canada’s Rosacea Awareness Campaign. Canadian Egyptian Actress On Rosacea, Acne and Rosacea Society of Canada
    • Tom Busby, SD poster extraordinare at RF, mentioned in a post on this subject at RF, "an alternative source of ivermectin, on eBay" which is ivermectin powder. I asked Tom whether this would be a good idea since it seems a lot safer to use the horse paste than have to concoct a paste with grain alcohol and his comment is, "horse paste is fairly expensive for a really tiny amount of product.... I have to assume that someone who has some experience formulating hot emulsions (oil in water) could make a non-greasy cream with this ivermectin powder." I would prefer the horse paste for a trial run before purchasing a chemistry set to make this. Most rosaceans are not into a laboratory approach to treatment preferring a pill or a topical than experimenting with such treatments in a lab coat. But, of course, this is the internet, and guess what?  Horse paste for rosacea. Watch Mr. Wizard concoct a new rosacea treatment on YouTube. Maybe we will hear reports of this. If you haven't heard of the new TXA treatment, it also requires concocting a rosacea treatment yourself by purchasing powder from Amazon or your local chemical store. 
    • Evidence for a genetic component to rosacea has been hypothesized, with a retrospective study showing that rosacea patients have a greater than fourfold increased odds of having a family member with rosacea (Abram et al., 2010; Steinhoff et al., 2013), but the genes leading to this association are not known....A genome-wide association study was conducted in 22,952 individuals whose genomes showed >97% European ancestry. Because of the sample size needed for this study, cases and controls were identified by an online questionnaire in which participants responded to a survey item on whether a healthcare professional had ever diagnosed them with rosacea. Participants who answered “yes” were defined as “cases” (n=2,618), and those who answered “no” (n=20,334) were defined as “controls”.... Together, these data strongly suggest a role for antigen presentation by class II HLA in the etiology of rosacea. The data presented from this large discovery and replication group provide evidence for a genetic component of rosacea.  J Invest Dermatol. 2015 Jun; 135(6): 1548–1555. Assessment of the Genetic Basis of Rosacea by Genome-Wide Association Study Anne Lynn S Chang, Inbar Raber, Jin Xu, Rui Li, Robert Spitale, Julia Chen, Amy K Kiefer, Chao Tian, Nicholas K Eriksson, David A Hinds, and Joyce Y Tung
    • Rosacea is associated with a number of other diseases, referred to as ‘systemic comorbidities’, which one study reports, “Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.” [1] The following is a growing list: Autoimmune conditions [2] Allergies (airborne, food, etc.) Anxiety Disorder [3] Alzheimer's Disease Cancer Chronic rhinosinusitis (CRS) [4] CKD Cardiovascular diseases [3] Depression/anxiety disorders [3] Dementia Diabetes [3] Dyslipidemia [3] Female hormone imbalance [5] [10] Gastroesophageal Reflux Disease (GERD) and other GI disorders [1] Glioma Hair loss Helicobacter pylori infection [3] Hepatobiliary system disorders [1] Hyperlipidemia [3] Hypertension [6] Inflammatory bowel disease (IBD) HLA-DRA Locus [7] Kidney Disease [8] Low-grade inflammation Mental Health Disorders [9] Metabolic diseases [1] MetS Migraine [31] Multiple sclerosis Obesity [25] Parkinson's disease Psychiatric diseases [3] Respiratory diseases [1] Rheumatoid Arthritis [3] SIBO Ulcerative Colitis [3] Urogenital diseases [10] The above list keeps growing. This complicates the theories on the cause of rosacea increasing the call for further research. However, in one study it was stated, "In this large study of patients with rosacea, atopic dermatitis, and psoriasis, we did not detect an increased 1-year risk of cardiovascular disease after adjusting for confounders." [18] Therefore, papers stating an association of rosacea with other diseases should all be taken with a grain of salt due to 'confounders' since another paper states, "Limitations included the accuracy of the published data, potential patient selection, and possible confounding factors. The true nature of the drawn correlations is uncertain, and causality cannot be established." [26] "In statistics, a confounder (also confounding variable, confounding factor or lurking variable) is a variable that influences both the dependent variable and independent variable causing a spurious association." Wikipedia End Notes [1] Int J Dermatol. 2018 Dec 21;: Systemic comorbidities associated with rosacea: a multicentric retrospective observational study. Aksoy B, Ekiz Ö, Unal E, Ozaydin Yavuz G, Gonul M, Kulcu Cakmak S, Polat M, Bilgic Ö, Baykal Selcuk L, Unal I, Karadag AS, Kilic A, Balta I, Kutlu Ö, Uzuncakmak TK, Gunduz K [2] Dermatol Clin. 2018 Apr;36(2):115-122. doi: 10.1016/j.det.2017.11.006. Epub 2017 Nov 29. Rosacea Comorbidities. Vera N1, Patel NU2, Seminario-Vidal L3. [3] J Am Acad Dermatol. 2018 Apr;78(4):786-792.e8. doi: 10.1016/j.jaad.2017.09.016. Epub 2017 Oct 26. Comorbidities in rosacea: A systematic review and update. Haber R1, El Gemayel M2. [4] There may be a relationship between rosacea and chronic rhinosinusitis (CRS) as the following quote concludes:  "Patients with rosacea and CRS manifested severe erythematotelangiectatic rosacea. There was enough evidence to suggest an association between rosacea and CRS. Clinical and radiological assessments of the paranasal sinuses are recommended." Med Princ Pract 2014;23:511-516 (DOI:10.1159/000364905) Rosacea and Chronic Rhinosinusitis: A Case-Controlled Study Al-Balbeesi A.O.  Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia [5] "There is no research regarding hormones and their effect on rosacea," Dr. Bergfeld said. "However, it has been widely observed that rosacea is often aggravated at menopause and sometimes during mid-cycle." Women May Need Added Therapy, Rosacea Review, NRS [6] Cardiovascular Diseases and Rosacea [7] "The HLA-DRA locus is associated with rosacea as well as with other inflammation-associated disorders, such as inflammatory bowel diseases including ulcerative colitis, Crohn’s disease, and celiac disease....Moreover, Spoendlin et al. found that an increased risk of rosacea was observed particularly during the period of increased gastrointestinal tract inflammation. Thus, the overlap in the genetic relevance of HLA-DRA between rosacea and inflammatory bowel diseases might imply a potential link between these disorders...Patients with rosacea have a higher risk of cardiovascular comorbidities including hypertension, dyslipidemia, and coronary artery disease than that seen in controls. Rosacea severity was also found to be dependent on the presence of cardiovascular comorbidities....In addition, the association between cardiovascular diseases and rosacea might also be explained by enhanced expression of the cathelicidin, which has been observed both in the course of atherosclerosis and rosacea. The GWAS by Chang et al. [20] also revealed that patients with rosacea shared a genetic locus with type 1 diabetes mellitus; this association was further confirmed by a population-based study as well....Patients with rosacea have a significantly increased risk of neurologic disorders such as migraine, depression, complex regional pain syndrome, and glioma...Recently, an increased interest has been shown in the potential associations between neurodegenerative diseases and rosacea....For example,...Parkinson’s disease...dementia, especially Alzheimer disease..." Int J Mol Sci. 2016 Sep; 17(9): 1562. Published online 2016 Sep 15. doi:  10.3390/ijms17091562, PMCID: PMC5037831 Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition Yu Ri Woo, Ji Hong Lim, Dae Ho Cho, and Hyun Jeong Park, Chris Jackson, Academic Editor [8] Study Finds Possible Link Between Kidney Disease and Rosacea, NRS [9] Clin Exp Dermatol. 2019 Jan 31;: The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample. Singam V, Rastogi S, Patel KR, Lee HH, Silverberg JI [10] J Am Acad Dermatol. 2015 Aug 6; Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: Results of a case-control study. Rainer BM, Fischer AH, Luz Felipe da Silva D, Kang S, Chien AL      
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    • The above report was done with 'questionnaires' and was not done with placebo controlled double blind studies. Again, the above study on diet and rosacea is simply anecdotal reports.  Another point to question is, does the tea consumed by the respondents to the 'questionnaire' have sugar? 
    • "We found that high-frequency intake of fatty food and tea presented a positive correlation with rosacea, while high-frequency dairy product intake showed significant negative correlation with rosacea. Sweet food, coffee and spicy food appeared to be independent of any subset of rosacea in our study. However, high-frequency dairy product intake showed a borderline beneficial effect on rosacea severity. We further analyzed the correlation between diet and the subtype of rosacea. We found that high-frequency fatty intake was associated with erythematotelangiectatic rosacea (ETR) and phymatous rosacea, while high-frequency tea intake was only associated with ETR. In addition, high-frequency dairy product intake showed negative correlations with ETR and papulopustular rosacea. Rosacea is associated with some dietary factors, and our study is valuable in establishing dietary guidelines to prevent and improve rosacea." J Dermatol. 2019 Jan 18. doi: 10.1111/1346-8138.14771.  Relationship between rosacea and dietary factors: A multicenter retrospective case-control survey. Yuan X, Huang X, Wang B, Huang YX, Zhang YY, Tang Y, Yang JY, Chen Q, Jian D, Xie HF, Shi W, Li J.
    • A post by johny at RF recommends a trial diet using the principles of the 'carnivore diet' and states, " if you have decades long skin problems, you probably have issues with plant material. The best evidence is to trial the diet and see for yourself, if you give it an honest effort and don't like it no harm done."   A thirty to ninety day trial diet cannot do any permanent damage no matter what proof you come up with, you can always go back to the way you were eating before the trial, and as johny points out, 'no harm done.'  There is a huge number of links in a google search on 'carnivore diet' and after reading several articles on this subject, I liked the one by Dave Asprey, Carnivore Diet Results: Why It Works for Some People But Didn’t for Me, who tried eating the carnivore diet for three months, and did notice some improvement which is noted in his article (no mention of rosacea, his improvements included "felt great for the first month") and then explains why modifying the carnivore diet with some tweaks to improve it.  Sugar and Carbohydrate are rosacea triggers and any diet that reduces these two items will improve rosacea. Maybe the carnivore diet is something you can at least try and report in this thread your results. 
    • Related Articles A Decade Retrospective Study of Light/Laser Devices in Treating Nasal Rosacea. J Dermatolog Treat. 2019 Feb 07;:1-24 Authors: Zhang Y, Jiang S, Lu Y, Wu Y, Yan H, Xu Y, Xu T, Li Y, Geng L, Gao XH, Chen HD Abstract BACKGROUND: Large-scale retrospective studies of light/laser in treating nasal rosacea were lacking. OBJECTIVE: The study was aimed to perform a decade retrospection of the patients with nasal rosacea who were treated with light/laser devices. METHODS: Methods: A study between 2008 and 2017 was performed retrospectively. Categorization of rosacea type (erythema/telangiectasia, ET; papules/pustules, PP; rhinophyma, RP) was made according to the photographs. Device settings, treatment regimens and treatment sessions of light/laser facilities were summarized. Efficacy was evaluated using a grading scale. RESULTS: In all, 807 patients received light/laser treatments. The subtypes of nasal rosacea were ET (n = 196), PP (n = 95), RP (n = 42), ET + PP (n = 334), ET + RP (n = 15), PP + RP (n = 88), and ET + PP + RP (n = 37). The lesions of ET or PP were mainly treated with non-invasive devices (Intense pulsed light, IPL; Dye pulse light, DPL; Dual wavelength laser system, DW) and those of RP were treated with the Fractional carbon dioxide (FCO2) laser. For the mixed subtypes, the general disposal orders of lesions were ET, PP and later RP. And the fundamental orders of devices application were IPL, DPL, DW and FCO2 laser. For all types of rosacea except for RP (2-4 sessions), most of the patients received 4-6 sessions of treatments. Of all subtypes of ET, PP, RP, ET + PP, ET + RP, PP + RP, ET + PP + RP, the patients who achieved more than 50% improvement accounted for 74.5%, 58.3%, 83.3%, 69.2%, 73.3%, 61.4%, 51.4%, respectively. CONCLUSION: The multiple, sequential light/laser devices can be safely used in nasal rosacea with various degrees efficacies based on different types. PMID: 30732485 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Metronidazole loaded nanostructured lipid carriers to improve skin deposition and retention in the treatment of rosacea. Drug Dev Ind Pharm. 2019 Feb 06;:1-30 Authors: Shinde UA, Parmar SJ, Easwaran S Abstract The objective of the present investigation was to improve the skin deposition and retention of metronidazole (MTZ) in rosacea therapy, by incorporating it into nanostructured lipid carriers (NLCs). The main challenge in this endeavour was the partial hydrophilicity of MTZ, which mandated careful selection of excipients, including solid and liquid lipids, surfactants, and their ratios in combination. NLCs were produced by the phase inversion temperature method and finally converted into a gel for topical application. The prepared nanoparticles were evaluated for their particle size, zeta potential, entrapment efficiency, solid state characteristics, surface morphology, in vitro drug release, and permeation through excised skin. The gel was additionally characterized for its pH, drug content, viscosity and spreadability. The prepared nanoparticles were spherical and of size below 300nm. Incorporation of judiciously chosen excipients made possible a relatively high entrapment efficiency of almost 40%. The drug release was found to be biphasic, with an initial burst release followed by sustained release up to 8 hours. In comparison to the plain drug gel, which had a tissue deposition of 11.23%, the NLC gel showed a much superior and desirable deposition of 26.41%. The lipophilic nature of the carrier, its size and property of occlusion enabled greater amounts of drug to enter and be retained in the skin, simultaneously minimizing permeation through the skin, i.e., systemic exposure. The results of the study suggest that NLCs of anti-rosacea drugs have the potential to be of use in the therapy of rosacea. PMID: 30727789 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Assessment of Skin Physiology Change and Safety After Intradermal Injections With Botulinum Toxin: A Randomized, Double-Blind, Placebo-Controlled, Split-Face Pilot Study in Rosacea Patients With Facial Erythema. Dermatol Surg. 2019 Feb 01;: Authors: Kim MJ, Kim JH, Cheon HI, Hur MS, Han SH, Lee YW, Choe YB, Ahn KJ Abstract BACKGROUND: Botulinum toxin (BTX) has been used cosmetically with good clinical efficacy and tolerable safety. OBJECTIVE: This randomized, double-blind, split-face clinical study aimed to investigate the efficacy and safety of intradermal BTX in patients with rosacea. MATERIALS AND METHODS: Twenty-four participants were enrolled and randomly given intradermal injections of BTX and normal saline in both cheeks. Clinician Erythema Assessment (CEA) score, Global Aesthetic Improvement Scale (GAIS) score, skin hydration, transepidermal water loss (TEWL), melanin content, erythema index, elasticity, and sebum secretions were evaluated at baseline and 2, 4, 8, and 12 weeks. RESULTS: On the BTX-treated side, the CEA score significantly decreased and the GAIS score significantly increased. The erythema index decreased at Weeks 4 and 8. Skin elasticity was improved at Weeks 2 and 4 and skin hydration, at Weeks 2, 4, and 8. However, TEWL and sebum secretion did not show significant differences. CONCLUSION: Intradermal BTX injections significantly reduced the erythema on both cheeks and improved skin elasticity and hydration, but not TEWL and sebum secretion. Intradermal BTX injections reduced erythema and rejuvenated the skin effectively and safely in patients with rosacea. PMID: 30730346 [PubMed - as supplied by publisher] {url} = URL to article
    • Medical News Today has an article by Christian Nordqvist on rosacea [1] that is fairly comprehensive and takes about five minutes to read but isn't keeping up with the phenotype classification of rosacea, refers to 14 million Americans having rosacea (current estimates are 16 million Americans or 415 million worldwide), doesn't get into the many theories on the cause of rosacea, instead discusses five 'factors' that are thought to contribute to rosacea. The article should be updated and I give it a grade C for reporting and keeping up with rosacea.    End Notes  What is rosacea? Last updated    Fri 15 December 2017 By Christian Nordqvist, Reviewed by Cynthia Cobb, APRN, Medical News Today
    • Steroid Rosacea  image credit: Corinna Kennedy own work 2017 https://upload.wikimedia.org/wikipedia/commons/d/d9/Steroid_Rosacea.jpg
    • Dr. Eric Berg explains why MSM and Grapefruit Seed Extract Oil are beneficial for rosacea. 
    • "Rosacea appears to be the first human skin disease to be treated with a veterinary medication....Doctors and researchers have growing concerns about the widespread use of this homegrown treatment." [1] A typical example is a post by Lori Durham, a poster at the Facebook Rosacea Tips and Support Group,  who writes, "I did a full 12 week course of horse paste and yes if you don't dilute it with moisturizer, some do experience headaches. I did not. I also took it by the recommendation of my primary care and dermatologist. My dermatologist recommends it to all of his patients that can not afford Soolantra or have health insurance. He has had many patients that have had success stories with it. And says that horse paste and Soolantra are basically the same thing except hp is a tad stronger and the base ingredients are not as toxic as Soolantra. If you want to try it, I suggest doing a test spot first for a couple days." You can read about all this in a Reddit group r/rosacea or in the Facebook Group Rosacea (English) and this is spreading in other groups. Therefore, the rosaceans who are trying this over-the-counter treatment for horses on their rosacea while reporting success will be the first guinea pigs in this group who have valiantly gone where no rosaceans have gone before and will eventually in the future report back any of the side effects and long term results or risks associated with using a veterinary medication for horses on their rosacea. It would be ironic that using a horse paste for rosacea that costs a few dollars is just as valid as using Soolantra which has cost millions of dollars for Galderma to go through the hoops to get FDA approval. End Notes [1] People are turning to medication made for horses to treat rosacea, and dermatologists are concerned, J.K. Trotter, Insider Br J Dermatol. 2018 Dec 30. doi: 10.1111/bjd.17540. Misuse of veterinary wormers in self-medication of rosacea and scabies. Hellen R, Ní Raghallaigh S.
    • Beauty blogger Stephanie Lange has a YouTube channel with a lot of followers has rosacea. She posted on Facebook, "I had a bad flare up of rosacea so I thought instead of hiding - what better way to test out the new @deciem The Ordinary Coverage Foundation!" She has a video, How to Cover Redness / Rosecea / Acne / Inflammation with Makeup you can watch below: 
    • Beauty blogger Casey Holmes has rosacea according to Devon Abelman, allure, in an article, Casey Holmes Shares the Inside Scoop on Her Smashbox Spotlight Palettes, where Casey is quoted as saying, "Since I have a lot of texture and pretty big pores because I have rosacea, I wanted a formula that was very smooth...."  Casey has a lot of followers in her YouTube channel and she has a Vlog. 
    • Cæcilie Johansen, MD, who has rosacea explains in details makeup and medicine for rosacea. Zoe Draelos, MD, volunteers for the RRDi MAC, is also the editor of Cosmetic Dermatology and has advice on cosmetics for rosacea. Dr. Sherry Shieh has some advice on what should be in your cosmetic medicine cabinet.  Jamie Kern Lima, the co-founder and CEO of IT Cosmetics has rosacea. Beauty bloggers Casey Holmes and Stephanie Lange both have rosacea. There are a number of cosmetic posts for rosacea for your consideration that may prove helpful to you, not to mention our affiliate store has a whole cosmetic category (our non profit organization for rosacea receives a small fee if you purchase a cosmetic for your rosacea which keeps our web site going). We have a informative article about cosmetics and rosacea. Green is the color concealer of choice for rosacea. 
    • Related Articles Noninvasive assessment of subclinical atherosclerosis in patients with rosacea. G Ital Dermatol Venereol. 2019 Feb 04;: Authors: Gürel G, Turan Y Abstract BACKGROUND: Rosacea is a chronic, inflammatory cutaneous disorder that is characterized by remissions and relapses that commonly occur in patients over the age of 30 years. There have been many studies in literature evaluating the relationship between cardiovascular disease and psoriasis, which is a chronic inflammatory disease, however, there have been very few studies to date evaluating the relationship between rosacea and cardiovascular disease risk. METHODS: The study included 52 consecutive rosacea patients and 52 healthy controls matched for age, gender and body mass index. Demographic data, anthropometric measurements, lipid parameters, C-reactive protein (CRP), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) were recorded. RESULTS: The main finding of the present study is the significantly higher EFT (p˂0.001) and CIMT (p˂0.001) values identified in patients with rosacea than in the control group and CRP (p=0.004), total cholesterol (p=0.003) and low-density lipoprotein (p=0.004) levels were also significantly higher in the rosacea group. EFT was significantly correlated with CIMT in the rosacea group (p=0.041). Total cholesterol (OR = 1.032, p=0.017), CIMT (OR = 7.391, p˂0.001) and EFT (OR = 3.959, p=0.036) were independently associated with rosacea. CONCLUSIONS: Clinicians should be aware of the risk of cardiovascular disease when presenting with conditions involving persistent subclinical inflammation, as in the case of rosacea. EFT and CIMT measurements, which are noninvasive, easily accessible and cheap, can be useful to determine cardiovascular risk in rosacea patients. PMID: 30717569 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Claudin reduction may relate to an impaired skin barrier in rosacea. J Dermatol. 2019 Feb 04;: Authors: Deng Z, Chen M, Xie H, Jian D, Xu S, Peng Q, Sha K, Liu Y, Zhang Y, Shi W, Li J Abstract Rosacea is a chronic inflammatory skin disorder whose pathophysiological mechanism remains largely unknown. Although recent studies have revealed the hypersensitivity of the skin towards chemical, thermal and biological stimuli, there is no direct molecular evidence suggesting the skin barrier is impaired in rosacea. In this study, we demonstrated that the mRNA levels of most claudins (CLDN), the main components of tight junctions determining the major barrier of the paracellular pathway between epithelial cells, were lowered in lesional skin of rosacea patients, especially with erythematotelangiectatic (ETR) and papulopustular (PPR) subtypes. Immunohistochemical analysis showed a significant decrease in the expression of CLDN1, CLDN3, CLDN4 and CLDN5 in the epidermis of ETR and PPR patients. However, the expression of other skin barrier genes, such as filaggrin, loricrin and keratin 10, was not altered. In vitro, various rosacea trigger factors reduced the protein levels of CLDN1, CLDN3 and CLDN5 in keratinocytes. Taken together, our results demonstrate a significant decrease in the expression of CLDN rather than other skin barrier genes, which may be associated with an impaired skin barrier responsible for the development of rosacea. PMID: 30714633 [PubMed - as supplied by publisher] {url} = URL to article
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