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    • In the Soolantra News post if you scroll down to Cetaphil Base, Galderma, on its Mechanism of Action page, posts : "Soolantra Cream combats inflammatory lesions of rosacea with a formulation designed for tolerability, utilizing Cetaphil® Moisturizing Cream as the basis for the vehicle." However, now this page is no longer available, but we have a screen shot of the Way Back Machine on August 21, 2018 which shows you the statement below:  Soolantra mechanism of action (MOA) (Way Back Machine url)  SOOLANTRA (ivermectin) cream, 1% is a white to pale yellow hydrophilic cream. Each gram of SOOLANTRA cream contains 10 mg of ivermectin. It is intended for topical use. SOOLANTRA cream contains the following inactive ingredients: carbomer copolymer type B, cetyl alcohol, citric acid monohydrate, dimethicone, edetate disodium, glycerin, isopropyl palmitate, methylparaben, oleyl alcohol, phenoxyethanol, polyoxyl 20 cetostearyl ether, propylene glycol, propylparaben, purified water, sodium hydroxide, sorbitan monostearate, and stearyl alcohol. Source Cetaphil Moisturizing Cream Ingredients: Water, Glycerin, Petrolatum, Dicaprylyl Ether, Dimethicone, Glyceryl Stearate, Cetyl Alcohol, Prunus Amygdalus Dulcis (Sweet Almond) Oil, PEG-30 Stearate, Tocopheryl Acetate, Acrylates/C10-30 Alkyl Acrylate Crosspolymer, Dimethiconol, Benzyl Alcohol, Phenoxyethanol, Glyceryl Acrylate/Acrylic Acid Copolymer, Propylene Glycol, Disodium EDTA, Sodium Hydroxide Source Compare Soolantra inactive ingredients to Cetaphil Moisturizing Cream Ingredients Google Sheet
    • What is interesting is that Galderma claims Soolantra's base is Cetaphil. However, we did an investigation and compared Cetaphil's ingredients with the list shown in Soolantra and discovered there is a difference. For more information:  Soolantra mechanism of action (MOA)  SOOLANTRA (ivermectin) cream, 1% is a white to pale yellow hydrophilic cream. Each gram of SOOLANTRA cream contains 10 mg of ivermectin. It is intended for topical use. SOOLANTRA cream contains the following inactive ingredients: carbomer copolymer type B, cetyl alcohol, citric acid monohydrate, dimethicone, edetate disodium, glycerin, isopropyl palmitate, methylparaben, oleyl alcohol, phenoxyethanol, polyoxyl 20 cetostearyl ether, propylene glycol, propylparaben, purified water, sodium hydroxide, sorbitan monostearate, and stearyl alcohol. Source Cetaphil Moisturizing Cream Ingredients: Water, Glycerin, Petrolatum, Dicaprylyl Ether, Dimethicone, Glyceryl Stearate, Cetyl Alcohol, Prunus Amygdalus Dulcis (Sweet Almond) Oil, PEG-30 Stearate, Tocopheryl Acetate, Acrylates/C10-30 Alkyl Acrylate Crosspolymer, Dimethiconol, Benzyl Alcohol, Phenoxyethanol, Glyceryl Acrylate/Acrylic Acid Copolymer, Propylene Glycol, Disodium EDTA, Sodium Hydroxide Source Compare Soolantra inactive ingredients to Cetaphil Moisturizing Cream Ingredients Google Sheet
    • With regard to flushing, it would be good to read this post. There are a number of drugs used to avoid flushing. There are also a number of other non prescription treatments to avoid flushing which are found here. 
    • There are so many alcohols in Soolantra's inactive ingredients which cause dryness and flakiness of skin which in turn cause itching and irritation and redness. Parabens and propylene glycol are also there which tend to penetrate the skin to help allow other ingredients to enter and this may be the reason your skin reacted and couldn't handle because everyone's skin reacts differently to chemicals.
    • Yes admin I had learned about the difference when I got rosacea sometimes It was sudden intense redness and bump and sometimes it was episodic redness so I researched about it because it happens with me with the onset of autumn. When the autumn starts I get sudden intense flare with redness and bumps and then the redness and bumps last longer and take time to go and during full autumn and winter after that flare-up, I get short episodic flushing very frequently which looks like it is blushing. but it is all unexpected and unanticipated about its timing.  
    • Apurva,  You may be interested in reading this post, Liver, Yogurt, Sour Cream, Cheese, Eggplant, and Spinach, in the research articles section of our website to get an understanding between the difference of a rosacea flareup trigger vs a flushing trigger. 
    • "In 2016, the definition of sensitive skin (SS) was established by a special interest group from the International Forum for the Study of Itch. SS is defined as a syndrome defined by the appearance of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that would not normally cause such sensations.....To our knowledge, only 2 transcriptomic studies have been performed for SS. ...As previously done with rosacea, these two studies provide very interesting data allowing, orientating and suggesting further research. Transcriptomic studies on larger populations are needed but these studies give key data to focus on some pathogenic mechanisms." Front Med (Lausanne). 2019; 6: 115. Sensitive Skin: Lessons From Transcriptomic Studies Adeline Bataille, Christelle Le Gall-Ianotto, Emmanuelle Genin, and Laurent Misery What if a non profit organization for rosacea gathered together 10,000 members, and each member donated one dollar and everyone agreed that a study on transcriptomic research be conducted? Could that be done? It is all up to you whether you think this would be worth investigating. 
    • An article published in the Daily Mail, Nerve injection that can stop the nightmare of hot flushes, by Robert Dobson, states, "An injection in the neck might ease the symptoms of hot flushes....known as a stellate ganglion nerve block."  Many rosaceans are more concerned with avoiding flushing than with anything else. What exactly is stellate ganglion nerve block? The Cleveland Clinic answers, "A stellate ganglion block is used to diagnose or treat circulation problems or nerve injuries..." Cedars-Sinai states, "A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck." Rehabilitation & Orthopaedic Institute, University of Maryland states, "A stellate ganglion block is an injection of local anesthetic (numbing medicine) to block the sympathetic nerves located on either side of the voice box in the neck." One paper on this subject states, "Due to a high risk of side effects, for example, pneumothorax and vascular puncture, an image-guided approach is strongly suggested, even with the "safer" C6 approach." [1]  "The inputs from sympathetic ganglia have been known to be involved in the pathophysiology of various conditions like complex regional pain syndrome (CRPS)" [2] Stellate ganglion block (SGB) "Stellate ganglion, also known as the cervicothoracic ganglion,....SGB is the oldest and most common sympathetic block that is applied today....There is a broad range of case studies that report the effectiveness of SGB in many different conditions. The outcomes may look promising, but expanding the indications of SGB needs more randomized, controlled studies." [2] End Notes [1] Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Stellate Ganglion Blocks Emanuele Piraccini; Ke-Vin Chang. [2] J Pain Res. 2017; 10: 2815–2826. Ganglion blocks as a treatment of pain: current perspectives Osman Hakan Gunduz and Ozge Kenis-Coskun  
    • This article is found here. 
    • Rory,  You will probably have better results using the horse paste over Soolantra, mainly because the horse paste is stronger ivermectin 1.87% over Soolantra's 1% and also because the inactive ingredients in the horse paste are simpler than Soolantra's list of inactive ingredients. So what brand of horse paste did you order? Also please be sure to post your results of taking oral ivermectin in the oral ivermectin post here. Just look at this comparison of horse paste inactive ingredients over Soolantra's inactive ingredients to see the difference:  Eqvalan inactive ingredients: Hydrogenated Castor Oil, Titanium Dioxide (E171) 2.0% w/w., Hyprolose, Propylene Glycol Agri-Mectin inactive ingredients:  Corn Oil, Polysorbate 80, Apple Flavor, and Aerosil.  Soolantra's inactive ingredients: carbomer copolymer type B, cetyl alcohol, citric acid monohydrate, dimethicone, edetate disodium, glycerin, isopropyl palmitate, methylparaben, oleyl alcohol, phenoxyethanol, polyoxyl 20 cetostearyl ether, propylene glycol, propylparaben, purified water, sodium hydroxide, sorbitan monostearate, and stearyl alcohol. This simple comparison explains why more positive results are with horse paste because of its simple inactive ingredient list compared to the huge number of inactive ingredients in Soolantra which may explain why some like you and me may have a side effect of dryness or whatever. Probably the other horse paste brands have few inactive ingredients just as the two we did find above. The most popular horse paste, Durvet Paste doesn't list the inactive ingredients but it probably is a list of only three "Proprietary Components".  Just about everyone reports it takes 12 weeks for clearance, but so do the positive reports using Soolantra, 12 weeks.     
    • I've tried Soolantra a couple of times. Lasted at best about 2 months but my face couldn't handle it. No idea why maybe its the propylene glycol in it. Im going to try the oral route and see what happens. I've ordered the paste.  One thing i noticed each time I used Soolantra was that my face was in good condition for a while after i stopped using it. So i do think demodex has some part to play for me. 
    • In the past, the general consensus has been that more women have rosacea than men, particularly in certain variants of rosacea. We will use this post to collect papers on this subject. If you find any papers on this subject, please post in this thread.  Severity Scores  One report concluded, "Self-assessment severity scores were significantly higher in men (3.6 ± 1.3) than women (3.2 ± 1.0; P = .04).The authors conclude that rosacea is more severe in men and younger patients." [1] End Notes Dermatol Clin. 2018 Apr;36(2):97-102. doi: 10.1016/j.det.2017.11.004. Epub 2017 Dec 16. Measurement of Disease Severity in a Population of Rosacea Patients. Alinia H, Tuchayi SM, James SM, Cardwell LA, Nanda S, Bahrami N, Awosika O, Richardson I, Huang KE, Feldman SR.
    • Rory,  Soolantra is 1% ivermectin and the active ingredient. 
    • Haven't heard of this lutein stuff Brady. Havent really been around much lately. So youre still using zz, using some topical peroxide, low carb diet and lutein. Hell of a life, eh.  Topical ivermectin may be the best option but some of us cant tolerate it. Im not sure any derm would be able to answer that question. Probably better to ask a vet.
    • I have been taking the lutein/zeaxanthin which seems to dry up my skin some. Wrote a post about oral ivermectin. I would run this by my dermatologist before ingesting it. Topical ivermectin seems the best route. 
    • Related Articles Minocycline-Induced Hyperpigmentation. J Am Osteopath Assoc. 2018 Jul 01;118(7):492 Authors: Skorin L, Norberg S PMID: 29946676 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles A case series of demodicosis in children. Pediatr Dermatol. 2019 Jun 13;: Authors: Douglas A, Zaenglein AL Abstract Demodex mites are commensal inhabitants of the pilosebaceous unit that are typically absent or at low numbers in childhood. When they are present, they can cause a primary eruption or exacerbate an underlying facial dermatosis. Here we report five cases of demodicosis occurring in childhood, the clinical presentations, and responses to treatment. Papulopustular lesions predominate, prompting the advice "pustules on noses, think demodicosis!" PMID: 31197860 [PubMed - as supplied by publisher] {url} = URL to article
    • Response to 'Letter to the editor' by Wienholtz et al. entitled 'The many faces of rosacea: liberal diagnostic criteria have ramifications on disease prevalence and accuracy'. J Eur Acad Dermatol Venereol. 2019 Jun 14;: Authors: Tizek L, Schielein MC, Seifert F, Biedermann T, Böhner A, Zink A Abstract We thank Wienholtz et al.1 for their comments on our article entitled 'Skin disease are more common than we think: screening results of an unreferred population at the Munich Oktoberfest'. Rosacea is a common inflammatory skin disease with a widely ranging prevalence in different countries (less than 1% to 22%), but even within Germany (2.3% to 12.3%).There might be several reasons for these different findings: examined study population, primary or secondary data source, or as mentioned by Wienholtz et al., a lacking research-based classification system. This article is protected by copyright. All rights reserved. PMID: 31199525 [PubMed - as supplied by publisher] {url} = URL to article
    • The many faces of rosacea: liberal diagnostic criteria have ramifications on disease prevalence and accuracy. J Eur Acad Dermatol Venereol. 2019 Jun 14;: Authors: Wienholtz N, Egeberg A, Thyssen JP Abstract We read with great interest the article by Tizek et al., which suggests that certain skin diseases are more common in Germany than previously thought. We were particularly interested in the finding that 25.5% of study participants fulfilled the criteria for rosacea based on dermatologist examination. The authors rightfully suggest that the high rosacea prevalence may be explained by the effect of intense (acute or chronic) ultraviolet exposure and high age of study participants. This article is protected by copyright. All rights reserved. PMID: 31199527 [PubMed - as supplied by publisher] {url} = URL to article
    • There are a lot of comments on Amazon from people who have taken it orally for Scabies. Most of the rosacea comments are using it topically but i did see a couple who use it successfully by mouth. The problem for some people maybe propylene glycol (PG), which is an ingredient in both Soolantra and the horse paste. For some people PG can cause allergic reactions, dryness and inflammation. Taking the horse paste orally may be an alternative. But i don't recommend it.  What do you think Brady? Have you ever thought about ingesting it? I know you're an oily like me which according to studies means that we most likely harbour a lot more demodex mites than normal skin.   
    • First off, if you don't know what Erythromelalgia is, it is listed as a rosacea mimic and should be ruled out in a differential diagnosis of rosacea.  Someone kindly pointed out to me that The Erythromelalgia Association website is very user friendly and was impressed with the free Guide it offers on its website indicating to me that the RRDi needs to be more 'user friendly' and offering such a guide. So I decided to investigate and contacted TEA and asked for a copy of the latest Form 990 which was emailed to me and I have given a cursory investigation and am very impressed with how this 501 c 3 non profit organization spends its donations.  First off, the board of directors are all volunteers. They have managed to bring in 3000 members, and more importantly in 2018 received over $50K in donations!  They spent $103K which breaks down to this:  $75,000 for Grants and similar amounts paid (list in Schedule O) "Gift for research directly related to erythromelalgia" $13,398 for Professional fees and other payments to independent contractors $14,230 for Printing, publications, postage, and shipping (newsletter) $884 for other expenses Total Expenses $103,512 Download Form 990 for 2018 and read it yourself: Form990Package.2018.pdf So this is definitely how a non profit organization should be run and I give the highest marks possible to TEA for how it is helping Erythromelalgia sufferers. We wish that the members of the RRDi would be interested in imitating the TEA and help make the RRDi just like how TEA is run. The RRDi is very similar in how the board of directors are volunteers. We just need volunteers to step up to plate like the TEA volunteers are doing. It would be good for members of the RRDi to ask questions about the above or comment on this post. 
    • "Better efficacy with IVM 1% cream (QD) compared to MTZ 0.75% cream (BID) contributes to an improved quality of life with significantly more patients achieving an MCID in DLQI score at week 16 and higher mean EQ-5D score. IVM 1% cream is thus a better alternative than MTZ 0.75% cream for severe papulopustular rosacea patients." Dermatol Ther (Heidelb). 2016 Sep; 6(3): 427–436. Superior Efficacy with Ivermectin 1% Cream Compared to Metronidazole 0.75% Cream Contributes to a Better Quality of Life in Patients with Severe Papulopustular Rosacea: A Subanalysis of the Randomized, Investigator-Blinded ATTRACT Study Martin Schaller, Thomas Dirschka, Lajos Kemény, Philippe Briantais, and Jean Jacovella -------------------------------------- "Ivermectin 1% cream was significantly superior to MTZ 0·75% cream and achieved high patient satisfaction." Br J Dermatol. 2015 Apr;172(4):1103-10. doi: 10.1111/bjd.13408. Epub 2015 Feb 11. Superiority of ivermectin 1% cream over metronidazole 0·75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Taieb A, Ortonne JP, Ruzicka T, Roszkiewicz J, Berth-Jones J, Peirone MH, Jacovella J; Ivermectin Phase III study group. --------------------------------------- "Topical ivermectin is an effective option in the treatment of papulopustular rosacea. Although ivermectin seems to be more effective than topical metronidazole, with both treatment options about two-thirds of patient relapsed within 36 weeks after discontinuation of treatment." Dermatol Ther (Heidelb). 2018 Sep;8(3):379-387. doi: 10.1007/s13555-018-0249-y. Epub 2018 Jun 25. Topical Ivermectin in the Treatment of Papulopustular Rosacea: A Systematic Review of Evidence and Clinical Guideline Recommendations. Ebbelaar CCF, Venema AW, Van Dijk MR. --------------------------------------- "Ivermectin 1% cream QD appears to be a more effective topical treatment than other current options for the inflammatory lesions of rosacea, with at least an equivalent safety and tolerability profile, and could provide physicians and dermatologists with an alternative first-line treatment option." Springerplus. 2016 Jul 22;5(1):1151. doi: 10.1186/s40064-016-2819-8. eCollection 2016. The efficacy, safety, and tolerability of ivermectin compared with current topical treatments for the inflammatory lesions of rosacea: a network meta-analysis. Siddiqui K, Stein Gold L, Gill J.  
    • Another study showing the superiority of ivermectin over metronidazole has been published by NEJH Journal Watch. 399 rosacea patients enrolled in a study who were judged clear after receiving 16 weeks of ivermectin treatment and stopped the ivermectin treatment. Those that had a greater IGA score of ≤2 (which means some pimples/redness returned) "resumed their original topical treatment until remission was again obtained" whether it was ivermectin or metronidazole. The study showed that the relapse rate of rosacea was more days than those using the metronidazole treatment, in other words, the number of days to the relapse of rosacea was higher in the ivermectin group than the metronidazole group. The study concluded, "The relapse rate by study end at 36 weeks was lower for IVER recipients (62.7%) than MET recipients (68.4%)." Metronidazole vs. Ivermectin Mark V. Dahl, MD reviewing Taieb A et al. J Eur Acad Dermatol Venereol 2015 Dec 21 Which drug for remission of rosacea? ------------------------------------------------ "The results of this relapse study showed that an initial successful treatment with ivermectin 1% cream QD significantly extended remission of rosacea compared with initial treatment with metronidazole 0.75% cream BID following treatment cessation." J Eur Acad Dermatol Venereol. 2016 May;30(5):829-36. doi: 10.1111/jdv.13537. Epub 2015 Dec 21. Maintenance of remission following successful treatment of papulopustular rosacea with ivermectin 1% cream vs. metronidazole 0.75% cream: 36-week extension of the ATTRACT randomized study. Taieb A, Khemis A, Ruzicka T, Barańska-Rybak W, Berth-Jones J, Schauber J, Briantais P, Jacovella J, Passeron T; Ivermectin Phase III Study Group -----------------------------------------------
    • Image courtesy of Wikimedia Commons Acyclovir Amytriptyline Antibiotics Anti-Flushing Drugs Apple Cider Vinegar Histame Lutein with Zeaxanthin Low Dose Naltrexone Mastic Gum and HCL Supplements MSM and Grapefruit Seed Extract Niacinamide Oil of Oregano Oral Ivermectin for Rosacea Plaquenil (Hydroxychloroquine) Probiotics  Prednisone (not a long term solution)  Retinaldehyde Retinoids (low dose has become quite popular)  Rosadyn Spironolactone Supplements (Vitamins/minerals) The list just keeps growing.... (prescription)
    • Related Articles Vascular endothelial growth factor gene polymorphisms in patients with rosacea: A case-control study. J Am Acad Dermatol. 2019 Jun 07;: Authors: Hayran Y, Lay I, Mocan MC, Bozduman T, Ersoy-Evans S Abstract BACKGROUND: Rosacea is a chronic disease that is characterized by facial skin inflammation and vascular abnormality. Vascular endothelial growth factor (VEGF) is a potent mediator of vascular permeability and inflammation that might play a role in the pathogenesis of rosacea. OBJECTIVE: This study aimed to determine the association between VEGF gene polymorphisms and rosacea. METHODS: A case-control study design was used to compare 100 patients with rosacea and 100 age- and gender-matched control subjects in terms of VEGF polymorphisms based on polymerase chain reaction and the serum level of VEGF and VEGF receptors based on enzyme-linked immunosorbent assay. RESULTS: Heterozygous and homozygous +405C/G polymorphism of the VEGF gene was observed to increase the risk of rosacea 1.7-fold (95% confidence interval 1.2-4.2) and 2.3-fold (95% confidence interval 1.2-4.2), respectively. There was a significant positive correlation between the severity of rosacea and +405C/G polymorphism of the VEGF gene in patients with erythematotelangiectatic rosacea. LIMITATIONS: Serum VEGF and VEGF receptor levels were measured in the limited number of patients. CONCLUSION: The present findings indicate that +405C/G polymorphism of the VEGF gene increases the risk of rosacea. PMID: 31182382 [PubMed - as supplied by publisher] {url} = URL to article
    • 3.6. OS and Angiogenesis Associated with Rosacea Rosacea is a common chronic inflammatory dermatosis, clinically characterized by erythema of the central face, episodic flushing, papules, and pustules. Skin care and pharmacologic treatments are the pillars of effective management of rosacea. Apart from existing topical agents (sodium sulfacetamide, azelaic acid, metronidazole, and the alpha-adrenergic agonist brimonidine) and systemic medications (tetracyclines, beta-blockers and isotretinoin), new therapies including serine protease inhibitors and mast cell stabilizers may ameliorate rosacea symptoms. However, some of these approaches have not been approved by the Food and Drug Administration. Though the exact pathogenesis of rosacea needs to be clarified, OS and oxidation of lipids are considered as crucial factors to trigger and aggravate the inflammatory processes of rosacea. Increased OS and decreased antioxidants are determined in systemic circulation of rosacea. OS, in addition, is complicated in vascular changes, inflammation, and oxidative tissue damage in rosacea. Therefore, antioxidants may be a potential strategy for treating rosacea. As an essential process in chronic inflammatory dermatoses, angiogenesis also contributes to the development of rosacea. Amal et al. reported that VEGF expression elevated in cutaneous lesions of rosacea and was consistent with vascular histological changes which clinically presented as erythema and telangiectasia. VEGF, indeed, has an important impact on the angiogenesis process, responsible for telangiectasia and increased vascular permeability, leading to cutaneous inflammation and the presence of papules, pustules, and nodules in rosacea. Thus, attenuation of OS and VEGF may be relevant approaches for the therapy of rosacea. However, more research should be carried out to clarify the relationship of OS and angiogenesis and provide a novel therapeutic way for rosacea. Oxid Med Cell Longev. 2019; 2019: 2304018. Emerging Roles of Redox-Mediated Angiogenesis and Oxidative Stress in Dermatoses Dehai Xian, Jing Song, Lingyu Yang,  Xia Xiong,  Rui Lai,  and Jianqiao Zhong
    • Related Articles Rosacea Fulminans: two case reports and review of the literature. J Dermatolog Treat. 2019 Jun 06;:1-11 Authors: Angileri L, Veraldi S, Barbareschi M Abstract Rosacea Fulminans is a rare and severe inflammatory dermatosis which affects predominantly childbearing women. It is characterized by sudden onset and it usually localizes exclusively on the centrofacial areas, presenting with numerous fluctuant inflammatory nodules and papules which may coalesce. Treatment with isotretinoin in combination with topical and systemic corticosteroids is successful. Clearance of lesions may be obtained under systemic treatment with no or minimal scarring outcomes. Due to rare incidence its pathophysiological mechanisms, diagnosis and management remain controversial. We report two cases of Rosacea Fulminans arised in otherwise healthy people and completely healed after treatment. Our aim is to share our experience about this disease in order to increase knowledge about its diagnosis, management and its treatment. We also make a review of the literature of this peculiar dermatosis. PMID: 31169436 [PubMed - as supplied by publisher] {url} = URL to article
    • Yes, I had also mentioned this in my previous post quoting someone's question about tobacco and cigar causing him rosacea and I had said that you have to figure it out which food or item is triggering your rosacea and I had given my example of leaving non-veg (pointing out meat) which was causing me flare-ups and then recently I read about red meat causes skin inflammation. So the point is if any food items or drinks or smoke are triggering your rosacea and are not listed anywhere but you have to keep an eye on your diet because everyone's body reacts differently to what  they eat.
    • Diffuse lissamine green staining in a person with severe dry eye.  Image Wikimedia Commons A paper published in the Journal of Women's Health addresses the prevalence of DED in women and highlights a significant opportunity for action if earlier diagnosis and treatment of this common but burdensome condition is obtained that could significantly improve a woman's quality of life. As the Mayo Clinic observes, "Ocular rosacea may affect the surface of your eye (cornea), particularly when you have dry eyes from a deficiency of tears." The comprehensive paper concludes, "Women are diagnosed with DED at earlier ages, and progression to severe forms of the disease is more prevalent in women than men. Thus, earlier diagnosis of DED in women may result in a significant improvement in their quality of life." If you have rosacea and DED it would be prudent to see your dermatologist as soon as possible.  J Womens Health (Larchmt). 2019 Apr 1; 28(4): 502–514. Dry Eye Disease: Consideration for Women's Health Cynthia Matossian, MD, FACS, Marguerite McDonald, MD, FACS, Kendall E. Donaldson, MD, MS, Kelly K. Nichols, OD, MPH, PhD, Sarah MacIver, OD, and Preeya K. Gupta, MD
    • image Wikimedia Commons Someone at RF posted a subject, 'Random flareup from steak alleviated with propranolol?' and here was my response:  beherenow, glad the propranolol helped your flareup.  It is important to eliminate what actual food is triggering your flareup, as well as defining the flareup, whether you mean a rosacea flareup or a flushing flareup, since flareup means different things to Rosaceans. For example, while you mention celery juice and a lot of water, understanding what an elimination diet is all about will help, since not everyone agrees what an elimination diet is. For example, there are a number of lists proposed what food/drink triggers rosacea, the most known list is the NRS list. Steak/hambuger is not on the list, and you would be hard pressed to find any rosacea trigger list or anecdotal report with steak/hamburger mentioned, but I urge you to find some to substantiate your suggestion. However, LIVER is at the top of the the NRS list. Trigger factors that are listed are all anecdotal or taken from patient histories and therefore possibly helpful, but extremely subjective. There has never been one rosacea diet trigger factor that produces a rosacea flareup in every rosacean, not one. Any proposed rosacea diet trigger is just that, a proposed factor. It may be helpful to others to read about such diet triggers to see if avoiding 'steak/hamburger' or whatever improves their rosacea flareups or it may not. For example, on the NRS list rosaceans have reported that Liver, Yogurt, Sour Cream, Cheese, Eggplant, and Spinach are "Factors That May Trigger Rosacea Flare-Ups," however, you will be hard pressed to find any clinical study indicating scientific proof, and the key word is MAY. Another factor to consider is that rosacea diet triggers may be cumulative over a certain number of days. You have to consider what you have been eating/drinking cumulatively over the last three to five days. For example, let's say you have been eating/drinking fruit smoothies as well as celery juice over the past three to five days and have accumulated a huge amount of fructose (which is converted to glucose) in your blood. Fructose, as well as any other sugar is also a rosacea diet trigger proposed by the RRDi which the NRS totally ignores. So there is a lot to consider in determining what is actually triggering your flareup when it comes to rosacea diet triggers. Drugs, and as you mentioned the environment, stress, and a lot other factors are proposed to be rosacea trigger factors.
    • Ivermectin treatment for rosacea was first announced by Galderma in its February 2015 release of Soolantra. Since then this prescription topical treatment for rosacea has had much success. Sometime around 2017 the first reports of using horse paste topically for rosacea containing 1.87% ivermectin began circulating in rosacea social media groups and this has spread further so that thousands have reported success in treating their rosacea. There are some reports of using oral ivermectin to treat rosacea. There are reports that oral ivermectin along with oral metronidazole is more effective than oral ivermectin alone. The RRDi recommends that if you decide to treat your rosacea with ivermectin to discuss this with your physician, preferably a dermatologist, since not only is ivermectin prescribed as a prescription medication for rosacea, it is easily available online without a prescription.   
    • Found this discussion pertinent to this thread. If anyone has anything to post about using any of the Kiss products for rosacea other than mchatham, please share. 
    • Related Articles A randomized phase 3b/4 study to evaluate concomitant use of topical ivermectin 1% cream and doxycycline 40 mg modified-release capsules versus topical ivermectin 1% cream and placebo in the treatment of severe rosacea. J Am Acad Dermatol. 2019 May 28;: Authors: Schaller M, Kemeny L, Havlickova B, Jackson JM, Ambroziak M, Lynde C, Gooderham M, Remenyik E, Del Rosso J, Weglowska J, Chavda R, Kerrouche N, Dirschka T, Johnson S Abstract BACKGROUND: Randomized controlled studies of combination therapies in rosacea are limited. OBJECTIVE: Evaluate efficacy and safety of combining ivermectin 1% cream (IVM) and doxycycline 40 mg modified-release capsules∗ (DMR) versus IVM and placebo (PBO) for treatment of severe rosacea. METHODS: This 12-week, multicenter, randomized, investigator-blinded, parallel-group comparative study randomized adult subjects with severe rosacea (Investigator's Global Assessment [IGA]=4) to either IVM and DMR (combination arm) or IVM and PBO (monotherapy). RESULTS: A total of 273 subjects participated. IVM and DMR displayed superior efficacy in reduction of inflammatory lesions (-80.3% vs. -73.6% for monotherapy, p=0.032) and IGA score (p=0.032). Combination therapy had a faster onset of action as of week 4; it significantly increased the number of subjects achieving IGA 0 (11.9% vs. 5.1%, p=0.043)† and 100% lesion reduction (17.8% vs. 7.2%, p=0.006) at week 12. Both treatments reduced the Clinician's Erythema Assessment score, stinging/burning, flushing episodes, Dermatology Life Quality Index and ocular signs/symptoms, and were well-tolerated. LIMITATIONS: The duration of study prevented evaluation of potential recurrences or further improvements. CONCLUSION: Combining IVM and DMR can produce faster responses, improve response rates, and increase patient satisfaction in severe rosacea. PMID: 31150711 [PubMed - as supplied by publisher] {url} = URL to article
    • Autosensitization dermatitis when it appears on the face can be indistinguishable from rosacea, hence a rosacea mimic.  "Autosensitization dermatitis presents with the development of widespread dermatitis or dermatitis distant from a local inflammatory focus, a process referred to as autoeczematization." Wikipedia "The term autosensitization dermatitis was coined in 1921 by Whitfield to describe reaction patterns ranging from a generalized, erythematous, morbilliform, and urticarial eruption after blunt trauma to a generalized, petechial, papulovesicular dermatitis after the acute irritation of chronic stasis dermatitis." Chapter 17. Autosensitization Dermatitis, Fitzpatrick's Dermatology in General Medicine, Donald V. Belsito A case in point is recorded in the Journal of the American Academy of Dermatology  about a 46 year old woman who was initially diagnosed with rosacea and later diagnosed with Autosensitization dermatitis. 
    • A new rosacea mimic has emerged called Autosensitization dermatitis which is indistinguishable from rosacea when it appears on the face. It is now added to the list of skin conditions that need to be differentiated from rosacea, which list keeps growing. So what is it? "Autosensitization dermatitis, or id reaction, is a cutaneous phenomenon in which an acute secondary dermatitis develops at a location distant from a primary inflammatory focus." [1]  The case of a 46-year-old woman (with photos) published in the Journal of the American Academy of Dermatology was initially diagnosed as papulopustular rosacea but resistant to all usual treatments for this disease which included topical and oral metronidazole, several oral tetracyclines, isotretinoin, ivermectin, topical dapsone with oral metronidazole. Later, she was found to have a rosacea-like id reaction in response to an oral infection after treatment with amoxicillin-clavulanate. This case indicates that there are difficult cases to treat due to not obtaining a correct diagnosis initially.  End Notes  [1] JAAD Case Rep. 2019 May; 5(5): 410–412.Autosensitization dermatitis: A case of rosacea-like id reactionSarah D. Ferree, BA, Connie Yang, BA, and Arianne Shadi Kourosh, MD, MPH
    • "Our results demonstrate that in eyelashes with CD, the prevalence of Demodex brevis is higher than that of Demodex folliculorum. We also found that the number of Demodex spp. increases with age and that females are attacked more easily than males by Demodex spp. In patients with CD eyelashes, the severity of eyelid congestion was exacerbated by the prevalence and number of Demodex spp." J Ophthalmol. 2019; 2019: 8949683. The Prevalence of Demodex folliculorum and Demodex brevis in Cylindrical Dandruff Patients Jing Zhong, Yiwei Tan, Saiqun Li, Lulu Peng, Bowen Wang, Yuqing Deng, and Jin Yuan  
    • "Sarecycline (trade name Seysara; development code WC-3035) is a tetracycline-derived antibiotic. In the United States, it was approved by the FDA in October 2018 for the treatment of moderate to severe acne vulgaris". Wikipedia "There are currently no clinical trials underway assessing sarecycline in rosacea.....For moderate to severe and inflammatory acne vulgaris, oral antibacterials are standard care components, with tetracyclines and macrolides usually preferred. However, these agents have certain limitations, among which are photosensitivity (tetracyclines), adverse vestibular effects (minocycline), gastrointestinal disturbances (particularly with macrolides and doxycycline), dysbiosis and microbial resistance concerns."  Drugs. 2019; 79(3): 325–329.Sarecycline: First Global ApprovalEmma D. Deeks
    • "Concurrent improvement of ocular surface conditions observed in patients treated for rosacea of their face, led to the potential implementation of intense pulsed light (IPL) for the treatment of MGD (meibomian gland dysfunction). IPL has been widely used in dermatology to treat various conditions such as rosacea, benign vascular lesions, and pigmented lesions....Patients with low meibum expressibility and tear film instability experienced greater improvement in symptoms after IPL treatment. The improvement in meibum expressibility was also associated with a decrease in tear inflammatory cytokine levels. Therefore, meibum expressibility improvement might be a good therapeutic target of IPL treatment in patients with MGD and DED, and could be an indicator of ocular surface inflammation during IPL treatment." Sci Rep. 2019; 9: 7648. Meibum Expressibility Improvement as a Therapeutic Target of Intense Pulsed Light Treatment in Meibomian Gland Dysfunction and Its Association with Tear Inflammatory Cytokines Moonjung Choi, Soo Jung Han, Yong Woo Ji, Young Joon Choi, Ikhyun Jun, Mutlaq Hamad Alotaibi, Byung Yi Ko, Eung Kweon Kim, Tae-im Kim, Sang Min Nam, and Kyoung Yul Seo
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