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    • Melasma, (aka, chloasma faciei) can co-exist with rosacea. "The symptoms of melasma are dark, irregular well demarcated hyperpigmented macules to patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Melasma is also common in pre-menopausal women. It is thought to be enhanced by surges in certain hormones." Wikipedia Mistca who suffers from rosacea and melasma responded to a post here about what she has done for both conditions which may help you in your quest to find a solution and here are her remarks:  Hi,
      I developed melasma due to taking the progesterone only pill. Attempts to treat the melasma with Retin A irritated the hell out of my skin, and led to rosacea, and later on, severe flushing, due to being given ventolin (which I did not need). I also had gut issues and a bunch of other stuff going on at the same time.
      Lots of disasters happened to me along the way leading to my current state.

      That aside. Melasma. Did you know it is not just a pigment disorder? It actually has a vascular component.
      Here is one article which speaks about it.

      I battled the hideous mess for years and it ruined my life. Trying to treat Rosacea on a background of melasma is a nightmare.

      Later on in years, I discovered I was iodine deficient and supplementation finally rid me of the remnants of the pigmentation issue. I do realise it could still be lurking beneath the skin.

      In addition, pigment issues are often connected to thyroid dysfunction. I went on to develop Hashimoto's disease during the time I was iodine deficient, but hashi's is a complex disease and has many other contributing factors. 

      Currently I am completely free of melasma, but struggle to completely rid myself of rosacea and flushing, although for a couple of years, I was in a pretty decent state. 

      Oral and topical niacinamide (which I take/use), are also beneficial for alleviating melasma. Melasma has an oxidative stress factor which the above help alleviate. I take oral vitamin C, but don't use it topically due to irritation.

      I also use ZZ cream, which I mix with my niacinamide gel and that helps calm and control my subtype 1 rosacea/flushing. I expect it helps with controlling pigment too.

      High dose oral vitamin C, moderate zinc and gut antimicrobials have brought about a reduction of melasma in a number of other women. A quick google should lead you to them. 

      Another thing you might consider is elevating your glutathione levels with NAC. Around 200mg. Any more might cause flushing. 
      Glutathione is considered a master antioxidant and could help relieve both your melasma and rosacea.

      Of course, the above treatments take a fairly long time to work, but I do believe they have merit. I have spent decades researching the subject and applying different methods.

      IPL can make melasma much worse and progressive. Been there, done that.

      Based on what you say, I suspect you do have a form of rosacea/flushing. ----end post 
    • A biopsy is not required to take a demodex density count. All is needed is dermoscopy: 

      Scroll down to this article and look for Dermoscopy for more details. What are the numbers of demodex on normal skin compared to those who have demodectic rosacea? They are reports that the numbers are higher in rosacea sufferers who suffer from demodectic rosacea. One report says, "Instead of 1 or 2 per square centimetre of skin, the number rises to 10 to 20." Another report says, "The mean mite count was 49.8 (range 2 to 158) in patients with rosacea and 10.8 (range up to 97) in control subjects (p < 0.001); the highest density of mites was found on the cheeks. A statistically significant increase in mites was found in all subgroups of rosacea, being most marked in those with steroid-induced rosacea."

      There are reports in RF of simply a taking cellophane tape scraping of the cheek and examining under a simple microscope you can by at Amazon and do it yourself, for example this post. 

      There is evidence that decreasing the demodex density count improves rosacea.  

      Physicians rarely take demodex density counts. In his authoritative book on rosacea, Frank Powell, MD, wrote on the last paragraph of page 82 in his book:

      “There is no laboratory test or investigation that will confirm the diagnosis of PPR. Specific investigations may be required to rule out similar appearing conditions (many of which will be identified by listening carefully to the patient’s medical history and examining the skin lesions). These include skin swabs for bacterial culture, skin scrapings for the presence of demodex mites, scrapings for fungal KOH and fungal culture, skin biopsy for histologic examination, (and rarely culture) skin surface biopsy for demodex mite quantification, patch tests, photopatch tests, and very rarely systemic workup wih appropriate blood tests and radiological examinations.”

      How many dermatologists do you know do such a detailed history and examination? When you were diagnosed with rosacea, did your physician come close to what is mentioned in the above paragraph? So be sure to read HunkeyMonkey's post on Cheap and easy home test for Demodex
    • Just ran a nine day course of Prednisone and thought it appropriate to post this here to see the results.