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  • Misdiagnosed Rosacea

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    Articles, References and Anecdotal Reports

    There are articles on rosacea that mention misdiagnosed rosacea. While this isn't a massive problem, nevertheless, here is a list of different sources that mention the subject, including (if you scroll below) many anecdotal reports of misdiagnosis. If you want to add your experience with misdiagnosis please post your anecdotal report in this thread

    Articles and References

    "To the untrained eye, unusual skin presentations can cause confusion and alarm. They can also go misdiagnosed, often not getting the attention they require. This is because many skin conditions can seem similar in appearance to one another, says Shari Marchbein, board-certified dermatologist and clinical assistant professor of dermatology at New York University School of Medicine....Another common misdiagnosis is rosacea disguised as acne, says Estee Williams, a board-certified medical, cosmetic and surgical dermatologist and clinical professor in dermatology at Mount Sinai Medical Center in New York City." 
    4 Skin Conditions That Are Often Misdiagnosed, According to Dermatologists, BY ERIN NICOLE CELLETTI, Allure

    "Rosacea SKINsights sponsored by Galderma Laboratories [reveals] the lengths that women with rosacea would go to if they could get rid of their rosacea forever, and highlight the low awareness and complicated diagnosis path for this common condition. On average, women with rosacea waited at least seven months before receiving a correct diagnosis, and only half of respondents had ever heard of the condition upon the time of diagnosis. This reveals the high level of misunderstanding and confusion that surrounds rosacea..." Medical News Toda

    "Currently, rosacea is only diagnosed by clinical symptoms and can be confused with other dermatological diseases such as acne."
    New Treatment or Diagnosis for Rosacea with Existing Approved Drugs
    Tech ID: 19149 / UC Case 2007-047-0
    University of California, San Diego
    Technology Transfer Office

    "Despite its apparent high incidence, the nosology of rosacea is not well established, and the term “rosacea” has been applied to patients and research subjects with a diverse set of clinical findings that may or may not be an integral part of this disorder. In addition to the diversity of clinical manifestations, the etiology and pathogenesis of rosacea are unknown, and there are no histologic or serologic markers."
    Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea

    ''Some physicians may not be aware of or recognize rosacea and may treat patients with rosacea inappropriately as if they had adult acne.''
    Dr. Jonathan Wilkin NRS Medical Advisory Board

    "Rosacea is a common dermatologic disorder. It is frequently overlooked or misdiagnosed, particularly when mild in nature."
    Rosacea: A Review of a Common Disorder by Carolyn Knox, IJAPA

    "Patients with rosacea frequently present with coexisting skin conditions, such as seborrheic dermatitis, acne, perioral dermatitis, and melasma, which may complicate diagnosis and treatment."
    Heather Roebuck, Nurse Pract. 2011 Jan 11.

    "A committee member, Dr. Mark Dahl, a dermatologist at the Mayo Clinic in Scottsdale, Ariz., said, ''This is a syndrome with lots of different elements that is easy to diagnose when all the elements are present,'' but not as easy when only one or two of the characteristics appear."
    PERSONAL HEALTH; Sometimes Rosy Cheeks Are Just Rosy Cheeks
    By JANE E. BRODY, New York Times, March 16, 2004

    "Rosacea is a complex and often misdiagnosed condition." The Rosacea Forum Moderated by Drs. Bernstein and Geronemus

    "Whereas the classical subtypes of rosacea can be recognized quite well, the variants of rosacea may be overlooked or misdiagnosed." rosacea.dermis.net

    "Rosacea is often misdiagnosed as acne or discoid or systemic lupus erythematosus (SLE)." Christiane Northup, M.D.

    "Frequently misdiagnosed as adult acne, this chronic, progressive skin disorder affects millions." Recognizing and Managing Rosacea by Thalia Swinler, JSTOR

    "The last subtype, ocular rosacea, is common but often misdiagnosed." uspharmacist.com

    "The signs and symptoms of ocular rosacea in children may be frequently underdiagnosed or misdiagnosed..." NRS Rosacea Review, Summer 2008

    “It’s a condition that is often misdiagnosed and overdiagnosed. Sometimes a rosy cheek is just a rosy cheek.” Herbert Goodheart, M.D., a dermatologist in Poughkeepsie, N.Y., and author of “Acne for Dummies,” as quoted in the New York Times article

    "Dr. Jay points to the inherent dangers of misdiagnosis and inability to handle complications because of a limited understanding of cutaneous physiology."
    IPL: Wave of the future in rosacea therapy by John Nemec, Aug 1, 2006

    "...unusual manifestations of rosacea may be overlooked or misdiagnosed...."
    Rosacea: An Update
    Stanislaw A. Buechner
    Dermatology 2005;210:100-108 (DOI: 10.1159/000082564)

    "Rosacea is a skin condition as misunderstood as sensitive skin, and as frequently misdiagnosed." Dermilogica

    "Rosacea is a very common, but often misunderstood and misdiagnosed skin condition." skinlaboratory.com

    "Rosacea is a long lasting, non-scarring skin condition of the face that is often misdiagnosed as adult acne." Paul M. Friedman, MD

    "Rosacea is quite often misdiagnosed as any number of other skin disorders including acne." methodsofhealing.com

    "Often misdiagnosed as adult acne, allergy or eczema, Rosacea, if left untreated, tends to worsen over time...." Dana Anderson Skin Care

    "This present patient clearly had facial changes typical of acne rosacea, with erythema and telangiectasias of the cheeks, forehead, and nose. He had all the typical lid changes as well, including collarattes that are pathognomonic of staphylococcal blepharitis. Unfortunately, he had been misdiagnosed for several years…" Clinical Pearls by Janice A. Gault, p. 206

    "Due to the fact that lupus can cause a red rash across the nose and face, often in a butterfly pattern it can be confused with or misdiagnosed as rosacea. .." www.rosacea-treatment.net/

    "Dr. Callender also noted that rosacea is often misdiagnosed in patients of color, as clinicians may mistake the signs and symptoms of the condition for lupus – a systemic, autoimmune condition that commonly occurs as a “butterfly rash” involving the face."
    Treating acne and rosacea in people with skin of color - ihealthbulletin.com

    "...it's often overlooked in dark-skinned patients or misdiagnosed as lupus, which is marked by a red, butterfly-shaped rash in the center of the face,..." Shape May 2009

    "...the diagnosis of demodicosis is frequently masked by other skin diseases such as papulopustular or erythematotelangiectatic rosacea, seborrhoeic dermatitis, perioral dermatitis and contact dermatitis." Br J Dermatol. 2010 Feb 25.

    A Case of Precursor B-cell Lymphoblastic Lymphoma Misdiagnosed as Rosacea.
    Han EC, Kim DY, Chung JY, Chung HJ, Chung KY.
    Korean J Dermatol. 2008 Feb;46(2):264-267

    "It is when the first diagnosis and treatment don't work that dermatologists look deeper and often discover something called demodex." Microscopic menace may be cause of skin trouble, Jennifer Van Vrancken, Reporte, FOX 8 News: WVUE Live Stream

    "Busy doctors who cannot take a detailed history will frequently miss the diagnosis, complicated further by the fact that rosacea is a great mimic of other unrelated disorders that present with a “red face”. I have often seen classical cases of rosacea mistakenly diagnosed as acne vulgaris, lupus erythematosus, seborrheic dermatitis, contact dermatitis, and other inflammatory diseases." Albert Kligman, A Personal Critique on the State of Knowledge of Rosacea

    "Ocular rosacea is frequently misdiagnosed, particularly in the pediatric population." Eur J Ophthalmol. 2012 Jan 3:0. doi: 10.5301/ejo.5000103.

    A report, About some red faces, stated: "Diagnosis is based on different data: date and mode of appearance, characteristics of the erythema, functional signs, and associated systemic manifestations. A case of red face can have an infectious origin, caused by vascular, congenital, or acquired lesions, or be caused by photodermatosis, or be the main location of inflammatory dermatosis or collagenosis, but depending on the clinical context, many other diagnoses can be suggested."

    "Butterfly rash is a red flat facial rash involving the malar region bilaterally and the bridge of the nose. The presence of a butterfly rash is generally a sign of lupus erythematosus (LE), but it can also include a plethora of conditions. The case presented here is of a female with butterfly rash along with typical bright red discoloration of gingiva. The clinical, histopathological and biochemical investigations suggested the presence of rosacea."
    Contemp Clin Dent. 2012 Jul;3(3):356-8. doi: 10.4103/0976-237X.103637.
    Butterfly rash with periodontitis: A diagnostic dilemma.
    Aggarwal M, Mittal M, Dwivedi S, Vashisth P, Jaiswal D.

    "A 28-year-old female patient presented with extensive facial and ocular eruptions. She had a history of treatment with oral prednisolone due to the clinical diagnosis of lupus erythematosus (LE)....With the clinical diagnosis of severe oculofacial rosacea, she was successfully treated with oral doxycycline, steroid eye drops, and ocular lubricants. Histopathological features of skin biopsy were consistent with rosacea in the context of infection with Demodexfolliculorum.... Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE."
    J Ophthalmic Vis Res. 2017 Oct-Dec; 12(4): 429–433.doi:  10.4103/jovr.jovr_46_16
    PMCID: PMC5644412
    Severe Rosacea: A Case Report
    Ebrahim Shirzadeh, MD, Abbas Bagheri, MD, Mojtaba Fattahi Abdizadeh, PhD, and Mozhgan Rezaei Kanavi, MD

    Q: I was diagnosed with rosacea, but my skin isn’t responding to the rosacea treatments. In fact, it’s getting worse. Is it possible that I have both rosacea and acne?

    A: In a word, yes. For some patients, it is possible to have both rosacea and acne., Sue Chung , Patient Expert, Rosacea Misdiagnoses, Skin Health, Health Central

    "Many people with skin of color who have rosacea may experience delayed diagnosis leading to inappropriate or inadequate treatment, greater morbidity, and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea."
    J Am Acad Dermatol. 2018 Sep 18;:
    Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience.
    Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Ta ylor SC


    Anecdotal Reports of Misdiagnosis

    The following is a partial list of anecdotal reports either of misdiagnosing rosacea for another skin disease or vice versa:

    1. Bob reports his rosacea was misdiagnosed for discoid lupus

    2. Elizabeth's initial diagnosis of rosacea turned out to be KP

    3. Andrea says her initial diagnosis of rosacea may have turned out to be pellegra

    4. Jason was misdiagnosed numerous times and was unfortunately given steroids which he believes aggravated the condition.

    5. Kari was initially diagnosed with rosacea and later found out it was eczema.

    6. maxigee2002 said after six months of being treated for rosacea a doctor discovered she was misdiagnosed and actually had Pityrosporum Folliculitis

    7. gdybe was misdiagnosed with Crohn's disease and after six months of steroids developed rosacea.

    8. Ladonna was misdiagnosed with rosacea and it turned out to be Graves Disease. 

    9. Susan reports that she developed "a rash above my eye (below the eyebrow - a little on the lid itself). First he said it was "orbital dermatitis" and gave me topical cortisone and anti-biotics. Not sure it helped much, it seemed to go away on its own schedule, although the steroid may have lessened the itchiness. I went back and he prescribed Metrogel and more cortisone cream. He told me it was a form of rosacea."

    10. Tom says that 6 years before he was diagnosed with rosacea and treated and now says "This doctor does not think I have rosacea, instead 
    he thinks I have erythema." Tom says he thinks he might have KP. 

    11. DC says his physician misdiagnosed his dermatitis as rosacea. 

    12. NorthNova says he was misdiagnosed by dermatologists before he found out he had rosacea. 

    13. flareface reports that a dermatologist diagnosed her condition as "physiological flushing" and later she says a PA "misdiagnosed pretty much everything, gave me 3 different steroidal creams and sent me on my way." Later another derm diagnosed "contact allergy" on her eyes and prescribed a mild dose of cortisone cream for a couple days and it all cleared up. 

    14. redKen (see post #2) says his dermatologist misdiagnosed his rosacea for dermatitis. 

    15. nk104 says two dermatologists diagnosed rosacea. A third physician said it was not rosacea but neurodermitis. 

    16. Jonesy says his GP said he didn't have rosacea and later went to another physician who diagnosed urticaria. 

    17. RedFacedRedHead says her rosacea turned out to be KP.

    18. cliopatra25 says that for ten years she was misdiagnosed with acne when all the time she had rosacea. 

    19. vicky says "both my sisters was misdiagnosised collectively 10 times... and they have lupus...similar to my brother, he even had 2 positive ANA tests and thedoctor refused to treat him for lupus...... 

    20. Deb says, "I mentioned in another post that for years I was given things that were making the Rosacea worse, like retin-A and cortisone cream. I had mild rosacea then, so was misdiagnosed. For a while they thought it was Lupus since I also maintain a low-positive ANA. Their and my mistakes only made it worse, especially in the past few years." 

    21. Lisa M says, "I suffered from cystitis for years... and had to go on daily antibiotics for it for about 2 years. I also did saw a homeopath at
    the time and changed my lifestyle to no alcohol at all. I didn't know
    it at the time but I had rosacea (sadly totally misdiagnosed by
    several derms). 

    22. Mike says, "I also developed ocular rosacea a couple of
    years ago, after having facial rosacea for quite a few years. My first
    opthamologist misdiagnosed it, and treated me for months with steroids (mainly Tobradex) which ended up raising my IOP to a dangerous level. 

    23. Aurelia reports that "A teenage girl was given an "almost certain" diagnosis of ocular rosacea....The symptoms suffered by this girl did NOT match those of ocular rosacea and specialists later came up with a diagnosis of autoimmune Urticarial Vasculitis.

    24. Kerry reports that "I have found out today that I was yet again misdiagnosed and I don't have rosacea I have Lupus." 

    25. Sarah Smart says, "I am 12 weeks pregnant and my rosecea fulmins was horribly misdiagnosed by my derm (as shingles if you can imagine) and I spent 5 days in the hospital before they figured it out."Report.

    26. Kerry says, "I was misdiagnosed for 4 yrs by my gp as I have pretty severepsorisis on 60% of my body and scalp. They gave me a really strong steroid which has made my skin worse on my face.although it kept it under control. I found out 3 weeks ago i have rossacea and they
    stopped my steroids so my face has had a major eruption." 

    27. Ellen says, "my rosacea related blepharitis was misdiagnosed as seb derm." 

    28. sand7676 says, "I was misdiagnosed with acne I believe because of my skin tone. 

    29. Francois says that three derms diagnosed he had 'vascular dilation' and the last one said he had " 'Sebore' in Turkish. I looked at internet and I think it means 'Seborrhe'." 

    30. Kevin Forest says, "I've recently been diagnosed with rosacea after being misdiagnosed for ~2.5 years (errrrrr! derm aggerssion)."

    31. Joe says, "I've been misdiagnosed by numerous dermatologists who
    were in disbelieft that I would have rosacea at such a young age and
    assumed it was merely acne."

    32. Suzi LeBaron says, "I was misdiagnosed because it looked like
    rosacea -- including occular symptoms."

    33. Mike Lester says, "they called it seborrheic dermatitis, maybe rosacea. to be honest no one knew. many blood tests for lupus or something....Ive been going to doctors and doctors for my facial redness that ive had for over a year now. Well, they seem to have diagnosed me with ROSACEA!!!....I was checked for everything, lupus's, mastocytosis, carcinoids, tumors on the kidneys, brain tumors, and much, much more, some things some doctors have never even heard of. but it turns out i was misdiagnosed by the Mayo Clinic from the start, so we didnt need to go through months and months of stress, depression(which by the way i go to a psychologist now and am on PROZAC too).

    34. Stuart Clark says, "I too waited months for an appointment (on two separate occasions) and she completely misdiagnosed me." 

    35. Carol Voigt says, "I, too, was "misdiagnosed" for many years."

    36. Jeff says, "I got misdiagnosed by my previous dermatologist...So he gave me a steroid to apply twice a day, which of course, did not help. And by the time I had diagnosable rosacea..." 

    37. Eddie O'Neill says, "She said that I did NOT have bacterial conjunctivitis and had been misdiagnosed..."

    38. Chantal says, "in my early 20's (around 22-23), and was misdiagnosed for years (about 5) until the correct diagnosis of rosacea was made."

    39. Heather says, "My facial rosacea was misdiagnosed for MANY years (mainly an acne component with some redness)..."

    40. Jay Valof says, "2yrs ago i had septoplasty (deviated septum) nose surgery. soon after developed symptoms, was misdiagnosed as having asthma/allergy. 2 months ago derm. said in had rosacea..."

    41. jesseleigh says, " I just found out about a week ago I have rosacea, have been misdiagnosed with atopic dermatitis for ten years." 

    42. yoli says, "I was misdiagnosed for 2 years they thought I had dermatitis but in reality i don't itch but burn.... it took me 6 dermatologist in order to get diagnosed with Rosacea." 

    43. beecham says, "I was diagnosed in December 2007 with pustular rosacea by my new doctor, I was on oxytetracycline for about a year before with my previous doctor who had misdiagnosed me with perioral 
    dermatitis.... "

    44. LoriB says, "When I saw my general doctor while waiting for an appointment with a derm he misdiagnosed me as having acne vulgaris. He told me I don't have rosacea because my cheeks aren't red." 

    45. jodieginger says, "I was repeatedly misdiagnosed as having dermatitis and none of the derms seemed to care that I simultaneously had blepharitis simultaneously. "

    46. mineren says, "I have adult acne in addition to rosacea and
    was misdiagnosed a couple of times. "

    47. mythjedi says, "She stated that I had "contact dermatitis" and gave me doxycycline....but it wasn't long before transient, big, patchy red blotches began to form on my face and chest....I discovered that I was allergic to these pills, and I stopped taking them.... I have been
    off of the pills for six months...I went to a dermatologist and was diagnosed with rosacea..."

    48. Yvonne says, "My SD was misdiagnosed as rosacea." 

    49. Cassie Henderson says, "I was misdiagnosed by a blind derm and used hydrocotizone for three months. My rosacea went from a splotty red blotch on one cheek to an all over the face red hue very bumpy dry and ruddy looking. I then went to a derm who wasn't legally blind and started using metrogel and minocycline which helped for awhile."

    50. Keith on 07.15.09 at 12:43 pm says, "...I went to a highly accomplished and respected doctor in my area who diagnosed it as Rosacea so I guess thats what it is. Other Derms have said sundamage, Folliculitis, so it is still uncertain to me..." Scroll down to Comment # 91

    51. Lori said her acne was diagnosed as rosacea which later turned out to be also seborrhoeic dermatitis after she had taken Oracea for over a month. She was switched to Doxycycline at a higher dose and Finacea. See Comments #68, #84, #89, #93, #107, #114, #117, #123.

    52. raly says, ..."I've been "diagnosed" at different times as it being rosacea, folliculitis, sebderm or possibly just acne from both GPs and a dermatologist..." Scroll down to Post #9

    53. dan pacifik says, ".... After a second trip to the doctors, my doctor seemed to think it was rosacea so she prescribed me metro cream 0.75%....…I think! I pretty much used this for about 8 months....I went back to my doctor about this and she said it looked more like acne on my forehead....I am however skeptical over my doctors and derms diagnosis..." 

    54. kfoltz9 says, "I am a 25 year old female with what appears to be perioral dermatisis around my mouth. My family history only consists of Psoryasis and I have not had a personal experience with this. I am currently on Effexor XR. I use Aveda sensitive skin facial cleanser which does not contain any Petrolatum. I have not introduced any new cosmetic products into my regimen. The dermatologist I went to yesterday about this month-old rash (I have had one previous occurence, only less intense) did not even inspect the rash, asked me if I blushed easily or often (I do not, and told him that) and diagnosed Rosacea in about 3 seconds. 

    55. siliconmessiah says, "...I first went to the doctor on a "drop-in"-visit. One of them (a really shitty doctor actually) prescribed cortisone cream for my problems - I took it for a couple of weeks with no signs of getting better. I returned to a new doctor, a really good one I might add...she diagnosed me in one minute under the light of a lamp..." Scroll down to post #2

    56. brighteyes says, "It took me approximately 3 years (and 6 derms) to get an official diagnosis...." Scroll down to post #3

    57. Mistica says, "...So in my case, rosacea wasn't recognised immediately and even 10 and a half years on from the orginal diagnosis, the 'diagnosis' is continuing in some ways. It looks like rosacea ( no missing that!!) and it behaves like rosacea, ... but is it just Rosacea?..." Scroll down to post #8

    58. IJDVL reports, "Subsequently, the initial diagnosis of allergic conjunctivitis was revised by the ophthalmologists to ocular rosacea." *

    59. A 32-year-old woman had developed moderate swelling, erythema and papules of the central part of her face for 8 weeks. She started to apply various topical cosmetic products sold for acne that did not help. As one of her hobbies was outdoor biking she noticed that sun exposure aggravated her skin condition, also resulting in burning and stinging sensations. She consulted her general practitioner who prescribed prednicarbat cream for topical application on the affected regions. Whereas she observed a slight improvement of the skin condition during the first week, she later on suddenly developed a severe worsening with erythema, papules and many pustules. She presented to a dermatologist and was diagnosed with "steroid rosacea". She went off the steroid, started topical treatment with metronidazole 1% and oral treatment with metronidazole 500 mg twice daily for 2 weeks. After an initial worsening during the first 3 days the skin condition rapidly improved. She continued metronidazole 500 mg once daily for another 2 weeks and then stopped. The topical treatment was continued twice daily for altogether 4 weeks and then reduced to once daily for another 4 weeks. Besides, she applied sun screen whenever she was outside. She continued intermittent topical use of metronidazole 1%. She remained free of symptoms except of an intermittent slight centrofacial erythema. See case report #1 

    60. A 39-year-old woman was referred to a dermatology department because of worsening of her known rosacea. She had been suffering from rosacea for 3 years. After initial, short-term and intermittent oral therapy with tetracycline for periods of up to 3 weeks she had continued topical treatment with tretinoin without any problems for the last months. Suddenly, she developed an erythema of the face accompanied by strong burning that increased in the evening, decreased over night and was moderate at day time. She discontinued topical tretinoin therapy because she felt that the symptoms were caused by it. She presented to a dermatologist with a sharp erythema of the whole face with only solitary papules and pustules. Due to the patient's history and the clinical finding contact allergy was suspected. Patch testing revealed a sensitisation to cocamidopropyl betaine, a surfactant that is frequently added to shampoos and skin cleansing products. This substance could be identified in her skin cleanser. When she discontinued this product, the symptoms disappeared and the patient could continue her topical treatment.
    We recommend to precisely ask patients about all the topical drugs and cosmetics they use including skin cleansing products. Contact allergy can also occur in rosacea patients and may mislead patients and physicians. See Case Report #3

    61. A 56-year-old diabetic man presented erythematous papules and pustules on the neck and face who had developed since 3 months. He had been treated with topical corticosteroids for the same time period that resulted in progressive exacerbation. He additionally showed patches of hair loss in the beard area, erythema and scaling of the ears. Among various differential diagnoses the clinical picture reminded of stage II rosacea. Microscopial examination and culturing revealed Microsporum canis. He was diagnosed tinea incognito, a term that has been used to describe dermatophyte infections modified by corticosteroid treatment.
    This case report demonstrates that there is a number of other skin diseases that can mimic rosacea. (see Case Report #7)
    Gorani A, Schiera A, Oriani A: Case Report. Rosacea-like Tinea incognito. Mycoses 2002; 45: 135-137. 

    62. A Case of Precursor B-cell Lymphoblastic Lymphoma Misdiagnosed as Rosacea
    Han EC, Kim DY, Chung JY, Chung HJ, Chung KY.
    Korean J Dermatol. 2008 Feb;46(2):264-267

    63. Pete says, "...Had previously been misdiagnosed by my G.P. Had been treated with steroid creams for eczema...."

    64. shakti says, "...I had a horrible rash on my face which the Dr. (dermatologist) even took pictures of, but he said it was rosacea....Then a neurologist said I could have some sort of mild m.S..... I've recently had a "rosacea flare" swelling and redness around my eyes and upper cheeks, the tiredness has returned and so has pain in my bladder and gi tract...."

    65. belinda says, "After being misdiagnosed for 7 years, I had almost given up hope." published April 8, 2008

    66. mmee says, "...just wanted to say after many years of suffering with depression and social anxity because of a red face and not being able to get any information out of 3 dermatologists and about 5 GPs (they just said it was 'normal') . I've found out from a link on this website it must be Keratosis pilaris rubra faceii..." 

    67. Gem says, "A couple of months ago I developed a rash on my forehead and weas gicven a steroid cream for it that seemed to keep it under controlfor a while, then around 3 weeks ago it spread and looked angry, I went to the doctor who said it was acne the cream I was given just aggravated it, so I went back and was given another cream by a different doctor who still thought it was acne... this again aggravated it, so I started looking on the net for other ideas or medications that could help. I tried coconut oil and aloe vera topical and ingested, another trip to the GP I was given Tetracycline oral antibiotic but it was something like a 3 month course, ....I went to my doctor again today as my self treatment wasn't doing any good and I was told it looks like rosacea I've been given metronidazole gel and I've started the Tetracycline oral antibiotics again...." 

    68. ssaeed says, "...He diagnosed me initially with Seb Derm and prescribed Desonide cream for 3 weeks. I noticed my skin got a lot better and softer during this treatment although towards the end of the treatment I started getting small pus filled acne bumps on my nose and cheek, about the size of a pore. When I saw the doc after the 3 week Desonide treatment he told me I may have symptoms of Rosacea and started me off on a treatment of Metrogel once a day and Oracea once a day in the morning." 

    69. Ladonna says, "...my husband took me to the dermatologist and she said it was Rosacea and couldnt be anything but....So he took me to many doctors, and finally a wonderful doctor took a shot in the dark blood test and discovered my problem. Later more involved tests and scans confirmed it. I was Hyperthyroid...specifically Graves Disease..."

    70. DylanG says, "... I finally got an appointment with a dermatologist for my rosacea. After waiting about half a year, I go to the appointment. The dermatologist walks in, doesn't even look at my face and says "There's nothing I can do about redness. Some people just have red skin". Then, to top it off, he gave me cream for acne - something which I could care less about - that has the side effect of making your face red. I was out of his office in practically two minutes with about twenty tiny tubes of acne medication I had no need for. ..." Scroll to Post #22

    71. Donna says, "I got results back from labs and xray..i do NOT have sarcoidosis…but still not sure what i have …i have granulomas popping out on parts of my body and my face is still not clear. I am going to a conference of doctors on the 16th to get their opinions. I was originally diagnosed with Granulomateous rosacea so lets see what opinions i get." Post #146

    72. liangjuany says, "I saw another doctor today and was told what I had was not rosacea but pityriasis rosea instead." 

    73. huiness says, "another derms who told me I had acne, or folliculitis etc. When I finally decided to go back to Derm #2, he then diagnosed me with rosacea.....went to Derm #14809348. He agreed with the rosacea diagnosis but said that this was probably steroid induced...."

    74. mrsmoof says, "1st dermatologist thought I had dermititis.....Well, I went to a 2nd dermatologist and told her my story, symptoms.....within minutes she said it was Rosacea...." Scroll to Post #43 

    75. "My wife was diagosed by a local Dermatologist as having Rocacea. He only did a visual inspection without any actual skin testing. He was sure it was Rocacea and prescribed an expensive cream which she would have to use for who knows how many years. Luckily she had a severe reaction to the cream, and discontinued it. She visitited her home country of Russia and was treated by a specialist. He told her she didn’t have Rocacea but had Demodex. She had one treatment by the doctor and her face is still clear after 6 months. Always get a second opinion." J Noble on 01.12.10 at 7:11 am Post #215 

    76. spuggylegs says, "I think it took about 10 mins for a NHS dermatologist to tell me that I didnt have rosacea. She looked at my skin said there was no visible erythema or papules and pustules to suggest rosacea, and that I needed to stop "reading stuff on the internet". I had to actually ask for a blood test to rule out lupus etc!!!!! I asked my GP if he could send me for a second opinion but he refused. The problem is that there is a lot of inequality in the NHS...and as someone who lives in a deprived area, healthcare is usually not as good as those who live in more affluent areas. (but thats another story). Well I still carried on "reading stuff on the internet" : ) and decided the only way forward was to go private..even though i couldnt really afford it. So travelled from the north east to London, and got so stressed, as we got lost a few times, and London is not the friendliest of places. By the time I had got to see the derm I was having a major flush....so after reading my medical notes, asking about family members who may have rosacea,, symptons, and looking at my skin, he diagnosed rosacea. From what i can remember the consultation lasted about 30 mins." Scroll to Post #50

    77. Rachelle C says, "My doctor diagnosed me with rosacea, delusional paristosis. The medications for these did no good. Then another dermatolgist with an allergist diagnosed me with demodex (skin mite) allergy." Scroll to Post no. 77 on 05.04.10 at 1:00 AM

    78. Girrlock Holmes says, "…I was finally diagnosed hypothyroid, insulin resistant and PCOS, and my doctor also thinks my symptoms fit with fibromyalgia…I saw a dermatologist who said it was not Rosacea but offered no info on what it could be. Then I saw an allergist and he said the derm had no basis for saying it was not Rosacea; it looked like it to him. So you see I have no clear diagnosis. I am waiting for a different derm to see me but it will not be for another 2 months…"

    79. "Terri Flynn, a 63-year-old part-time receptionist from Texas....Two different evaluators told her she had "dry eye" and prescribed artificial tears and various eye medications, while one also suggested she have her bottom eyelids lifted to help retain the moisture in her eyes....She made an appointment with a dermatologist, who "took one look at me and said, 'Yes, it's rosacea." NRS Rosacea Review Spring 2010

    80. GNR reports, "...I was told I had Perioral dermatitis because there was an outbreak near my nose....Began to notice a swelling under my right eye and a red path beneath extending up the temple. It became hot and sensitive and flares when I workout with weights. Told "hmm don't know what that is, it's not rosacea (my fear was that it was) but try rozex cream to see if it goes." It didn't. Didn't change. Had a second opinion. Same as the first. "Don't know, looks like it might be fungul. Leave it until you see a dermatologist." Began to a sore eye, a few pains and watering. Went back to the second opinion to ge this checked was given a scrip for kenocomb ointment for fungus....out of desparation I went to another gp explained the whole story again. He checked the skin, told me it wasn't rosacea that it looked like a fungus infection try Nizoral 2%. Hmmm. Later that day I had an appointment with a new dermatologist who told me that I actually had seborrhec dermatitis...this sounded right as all the systems relate, rash on chest, dry skin in eyebrows, dandruff...funny I'd never connected these things and either had anyone else.
    He then checked the rash thing on the right side of my face and temple and told me it was rosacea. I asked about the pain in the eye, watery, and he said not connected. Gave me a print of what to expect with rosacea and out the door I went..."

    81. comicraven reports, "I had been misdiagnosed for a while - everything from shingles to testing for lupus - and was finally properly diagnosed about 6 months ago..."

    82. koki says, "OK according to dermatologist # 4 , again I dont have rosacea, I explained my symptoms and he said it sounds more like an allergic reaction and when he examined my face he said it was more like eczema/seborrheic dermatitis and gave me some diflucan. ....I am glad most derms say is not rosacea..."

    83. stb09 says, "In May 2004, I developed a pimple on my nose that left a red mark on it for, what must've been a solid YEAR after it cleared up. I was thorougly convinced this was a scar, and went to several dermatologists to find proper treatment. Such begins my ongoing battle (and subsequent HATRED) for all dermatologists.

    The first one I saw told me that it was a mole....
    I sought a second opinion. This one told me it was a scar, and could only be removed by a plasic surgeon. He took my $100, and gave me the number of a plastic surgeon.

    The plastic surgeon (who was once a dermatologist) was convinced it was a pimple still, and simply lanced it and dug around in it, ultimately making it worse....

    The fourth and final dermatologist perscribed me a prescription in January of 2005 for my back acne/oily skin. He agreed with ME that whatever was on my nose was inflammed and most likely a sebacous cyst. He injected it with cortisone, and that made a tremendous difference, and today there's not a mark to be found. This is the same dermatologist that dismissed my concerns of facial redness and never spoke a word about Rosacea in spite of my ruddy complexion that I was, at the time, unaware of....I was at a new branch of my college and went to the local dermatologist to seek treatment. He told me it was probably a scar and gave me the number of a laser surgeon FOUR hours away that "might" be able to help me.

    THIS is the first time a doctor has mentioned the word "Rosacea" to me. He explained that I had a ruddy complexion, and thus, the red spot on my nose was more noticable. He went on to state that people with my complexion "could be candidates for Roscea later in life." and encouraged me to stay out of the sun......I finally decided to see a dermatologist to rule Rosacea in or out so I could get on with my life one way or the other. I went back to the local dermatologist, who had told me that someone with my complexion might be a candidate for Rosacea later in life, and was told absolutely nothing new.

    He once again told me that, maybe I'd have it one day, and maybe not. I asked him if I should try avoiding "triggers" and he said that I shouldn't bother. Because it probably wouldn't help. I asked if there was any treatment, because I've since learned Rosacea is best treated early on. He said that any creams he could give me would most likely not do anything at all for me, and would be a waste of my money. The entire visit was quite ambiguous.

    I asked him what "Pre-rosacea" was, and what the difference was between that, and a normal ruddy complexion. He told me that, in his opinion, there wasn't one. As he considers anyone with a ruddy complexion at risk for developing Rosacea, and THAT he considers to be "pre-Rosacea."

    Before I left, I asked him for a definitive answer one way or the other, and he told me NO, I do not have Rosacea.....To the point of the original thread, I'd like to determine what it is I have. The doctor seems sure it's not Rosacea, but as evidenced by my ongoing battle with Dermatologists prior, I believe if I went to 10 Dermatologists I would receive 10 different opinions. Rosacea, ruddy complexion, acne, allergic rash, facial blushing, too much Niacin, high blood pressure, lupus...

    these people don't know anything, and with no insurance I'm not going to waste $100 a visit to find out precisely nothing.

    84. Ontarian says, "I was diagnosed with seborrheic dermatitis on my face about 5 years ago. The diagnosis was made by a dermatologist. Soon after, the dermatitis completely disappeared for a loooong time. Then, I suddenly got a red patch on my right cheek five years later, more precisely in February of 2006. It has slowly spread to my entire right cheek. It got worse in the summer. This whole time I thought I had seb. dermatitis. My family dr. said my face was dermatitic and prescribed hydrocortisone. It didn’t help. In August of 2006 I went to my dermatologist. This time, he said I had rosacea. I was shocked. I was not flushing like crazy (except maybe when I played soccer in +35 C degrees outside). My symptoms started as a small red patch on my right cheek, this could not be rosacea. I went to see another dermatologist (an old dude who thinks rosacea is a proper diagnosis only when your face is swollen like a balloon and when you are covered with pustules).
    So, now I have two doctors thinking I don’t have rosacea, and one doctor thinking I do." Posted: Tue Oct 17, 2006 1:34 pm (scroll down to find the post)

    85. Jen says, "Since I have stopped the med I was diagnosed with Perioral Dermititis and now as of yesteday the derm tells me I have acne.....The derm said I have almost all the face disorders (rosacea, acne, perioral dermititis, seb derm)....

    86. jhelli1 says, "I've been to four different doctors in the past and have gotten four different diagnosis. The last one was rosacea. Yesterday, I went to a fifth doctor and was told that I have..........eczema!

    87. fedup says, "....I went to this dermatologist maybe 2-3 times a year over about a 4 year period, every appointment he seemed to have absolutely no idea what was going on, or what he had prescribed/said the last time, he took a look at my scalp, says "its folliculitus" (the way he said it, every time, was as if it was a breakthrough and he figured out some giant mystery, even though he said the same thing last time....and sent me home with a prescription for Ceftin 500mg 2x a day for 2 weeks (insanely strong antibiotic, I know now..).....Made an appointment with a new dermatologist (roughly 2 years ago), after explaining the antibiotic fiasco, he told me my old doctor probably shouldnt be practicing medicine. He took about 10 seconds to diagnose me, looked at my scalp, and simply said "you have inflammatory rosacea."

    88. mutantfrog says, "...I always grumble to myself about rosacea...but if it turns out that I never had rosacea but instead have had an autoimmune disorder...well it's scary I'd rather take rosacea. I swear to god I'll never complain about 'rosacea' again..." Post #10 22nd July 2010, 07:40 PM

    89. quixotic_pessimist says, "Anyway, I had been seeing a dermatologist during this time period for acne that I have had for about 3 years, and he never mentioned anything about the red complexion of my nose. One time I voiced my concerns, and he pretty much dismissed them, saying that he didn't think my nose looked red. During my last meeting with him, I was a bit more belligerent (in that I brought up the grievances that I have with my red nose a few times). He then nonchalantly throws out that it is possible that I have Rosacea. How is it that I had been visiting this doctor for 3 years with the same red nose, but it is not until now that he suggests that I might have Rosacea? I don't get it."

    90. CHI_GUY says, "...First doc said, sebborhea/eczema. He gave me many different things, to list a few....Second doc, new one, diagnosed perioral derm. She gave me tetracycline. 500mg x2/day for the first month. She exclaimed that the previous doctor was treating the wrong thing, because I brought all my old meds in to show her...."

    91. Natasha says, "I have just been diagnosed with Rosacea....a week ago the doctor wrongly diagnosed excema..."

    92. hesperidianblue says, " I was going to 7 dermatologist till 2 of them agreed that is rosacea other wasn`t shore what is it often they thought it was atopic dermatitis."

    93. misdiagnosed says, "During this whole ordeal, I have seen a dermatologist (in OH) 2x. THe first time she tried to convince me it was “in my head” and reluctantly prescribed an antibiotic for adult acne. 8 weeks later, she seemed a little more open to the fact that it could be demodex and prescribed metrogel. Last week, I asked for metronidozale in a pill format because the lotion only does so much. She agreed to call it in. It is helping, but I have good and bad days, depending on the “hatching” cycle." #385 misdiagnosed on 10.08.10 at 12:45 AM

    94. Maureen says, "I have had this now for about I would say 2 years when I was told I had rosacea and lupus. Now a new dermatologist tells me no it's dermographism,..."

    95. francois can says, "I just cant believe. Today I went to see a derm. She looked at my face closely with a tool like a magnifier and said I misdiagnosed myself. She said rosacea has 4 components and someone has to have at least 3 of them to be diagnosed rosacea.....She said I have a
    condition associated with neurovascular dilaiton..."

    96. LarsMM says, "...First I went to a regular doctor and even though he ran a few tests he couldn't tell me wheat the problem was. He told me I shouldn't worry since the redness was at that time "barley noticeable". At the end of the third summer (2010) I went to another doctor and got the same response. After this visit I got somewhat frustrated since I was well aware that I had not been this red a few years earlier, as a result I started reading online and came across rosacea. I got an appointment with a dermatologist and she confirmed that I had stage one rosacea...."

    97. 444 says, "...my doctor has failed on many occasions to diagnose me properly probably due to my young age at the time and has disregarded any possiblilty of rosacea since the beggining....'

    98. claire says, "...I am 34 years old and I was wrongly diagnosed 7 years ago. I have gradually seen since then my skin get progressively worse, it is now in its advanced stages. ..." #41 claire on 05.16.09 at 8:16 PM

    99. Rachelle C says, "My doctor diagnosed me with rosacea, delusional paristosis. The medications for these did no good. Then another dermatolgist with an allergist diagnosed me with demodex (skin mite) allergy. Since I have very many allergies, this was a good bet. I treat itchy and red areas with tea tree oil and have managed to reielve my problem almost completely. The dermatologist also thinks a monthly treament with Kwellada-P would help further." #76 Rachelle C. on 05.04.10 at 1:00 AM

    100. findingaway says, "So I am no further forward...I still don't really know what it is I'm dealing with... Rosacea, SD, KP. All?" 

    101. Just an update and to show the importance of knowing what you have, I saw a Rosacea specialist with 20 years of treating and research under his belt, and made the appointment saying "Trying to treat Rosacea" as the reason. The second I came in he was confused and wondered where the Rosacea patient was. He looked at me and told me I absolutely do not have Rosacea, he's seen thousands of cases over decades and it's simply not it. And it's not caused by being choked, ever. It was thinned skin due to Steroid Creams, and thankfully, he caught that because the General Practitioner who 'diagnosed' me with Rosacea prescribed steroid cream. The most alarming was that the general practitioner gave me Metrogel which I understand is meant to help Pimples, and I have absolutely zero of those. AlenaCena post no 68

    102. I've been to dermatologists in three different countries starting when I was 16, and I'm now 41. When I first started going to them, they didn't know a lot about eczema and dermatitis and the treatment course was antibiotics and cortozone creams. (Not much has changed) Even then I knew foods and hormones were triggers or the cause of the skin eruptions. I've had dermatologists tell me it's not rosacea and dermatologists tell me it is. One things for certain out of the more than 30 dermatologists I've seen in my life time, no two have had the same things to say. However last time I was at one, she did look up patronizing and say, yes we now know hormones can affect eczema...as if her telling me that made a whit of difference to what I have already known. In the UK, where they have now said it is rosacea, I have had no other tests. The dermatologists I've seen refuse to accept other countries diagnosis of food allergies. They refuse to take into consideration what I'm saying, about my upper eye lid cracking (it's been cracking there my whole life, so much so I've a deep scar) and the bubbling around my eyes, and over my brows. In the end, I think a they've learnt mo about the what some skin problems are, they seem to have bunched the rest as rosacea. Which appears to me to be a blanket term, covering a huge amount of things. Melania post no 66

    103. I had a misdiagnosed case of demodex for many years. It was misdiagnosed as bacterial acne/hormonal acne and "allergic conjunctivitis". None of the treatment my 4 dermatologists prescribed ever worked. It turned into a really bad case of ocular rosacea. Early this year, I took the 2 week Oral Ivermectin + Oral Metronidazole treatment. It worked. ElaineA post no 2 

    More cases of misdiagnosed rosacea (or vice versa)

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    • A paper in 2017 continues to explain the quandary. "Many studies have shown higher density of the parasites in diseased inflammatory skin than in normal skin, but whether it is the cause or result of the inflammation remains unclear." [6]  A paper in 2018 may help to resolve this issue because for the first time it has been discovered that Demodex mites secrete bioactive molecules that reduced TLR2 expression in sebocytes. [7] So while the jury is still out on this subject, What do you think?  Which comes first, the demodex or the rosacea? Does it even matter? With your above statement I highlighted and giving my view on this topic which comes first, I am also stating the same thing that I think demodex came first well it is not experiment or evidence based but with the experience I have had. Human Permanent Ectoparasites; Recent Advances on Biology and Clinical Significance of Demodex Mites: Narrative Review Article With this journal which you quoted in your article , "Many studies have shown higher density of the parasites in diseased inflammatory skin than in normal skin, but whether it is the cause or result of the inflammation remains unclear." So I was elaborating this sentence that higher density might be the result of inflammation (inflammatory immune response) and then subsequently the cause of inflammation. So I explained this with the term “reciprocal correlation”. And let’s say if the higher density is the result of inflammation, so the altered cutaneous immune responses are the cause of persistent inflammation and that is what I was trying to state in my post but then I read the above journal in detail after your question and I found the confirmation of my  expression with these sentences of journal   “ Studies indicate increased number of D. folliculorum in immunocompromised patients”  and “It remains to be determined which kind of cellular immunity may foster mites’ proliferation” and my statement “the false immune response(altered immune response) might be the cause of increasing number of demodex”  state the same thing. Thank you for questions because what I was stating is experience based but after thoroughly reading the reference journals from your article I found the confirmation of the same thing.    
    • That is difficult to follow. In a paper by Powell, et al, it is stated that the mites "secrete bioactive molecules that reduced TLR2 expression in Sebocytes." The 'bioactive molecules' that the mites secrete keep the innate immune system from reacting to the mites when in normal numbers on normal skin, so my question is what causes the demodex to proliferate in greater numbers to what you say,  "cause inflammatory immune response and inflammatory immune response" ?   Could you better explain what you mean by "self-antigen presentation to immune cells rather than non-self which is false immune response? ?
    • In my view, normal skin also has demodex mites but less in number so they can't activate pro-inflammatory cytokines but when the number is more they activate it. so logically when the normal skin flora has demodex before rosacea has occured so demodex apparently came first and because demodex mites cause inflammatory immune response and inflammatory immune response is not just related to mites but self-antigen presentation to immune cells rather than non-self which is false immune response or we call it autoimmune response and attacks to healthy cells and so the false immune response might be the cause of increasing number of demodex .So demodex and rosacea have reciprocity with each other to increase its effects and outcomes.
    • While it has been reported that topical ivermectin has better results than topical metronidazole, there is a paper you should consider reading if you are considering taking oral ivermectin and metronidazole.  A paper published by the International Journal of Infectious Diseases that compared taking 200 micro-grams Ivermectin per Kilogram of body weight of oral ivermectin once a week in one group (1) of sixty rosacea patients with another group (2) of sixty rosacea patients who received a combined therapy of the same amount of ivermectin along with 250 mg of oral metronidazole three times a day. The results were that the second group improved better than the first group. For more information Some may concerned about taking ivermectin orally. It is interesting to note that ivermectin has been around since the late 1970s and half "of the 2015 Nobel Prize in Physiology or Medicine was awarded jointly to Campbell and Ōmura for discovering avermectin, 'the derivatives of which have radically lowered the incidence of river blindness and lymphatic filariasis, as well as showing efficacy against an expanding number of other parasitic diseases' " Wikipedia Ivermectin is "a dihydro derivative of avermectin—originating solely from a single microorganism isolated at the Kitasato Intitute, Tokyo, Japan from Japanese soil...originally introduced as a veterinary drug...has led many to describe it as a “wonder” drug....few drugs that can seriously lay claim to the title of ‘Wonder drug’, penicillin and aspirin being two that have perhaps had greatest beneficial impact on the health and wellbeing of Mankind....But ivermectin can also be considered alongside those worthy contenders, based on its versatility, safety and the beneficial impact that it has had, and continues to have, worldwide—especially on hundreds of millions of the world’s poorest people....Despite decades of searching around the world, the Japanese microorganism remains the only source of avermectin ever found. Originating from a single Japanese soil sample and the outcome of the innovative, international collaborative research partnership to find new antiparasitics, the extremely safe and more effective avermectin derivative, ivermectin, was initially introduced as a commercial product for Animal Health in 1981." [1] While there are no long term clinical studies done on ivermectin use with rosacea, there are papers showing the long term effects of oral ivermectin in school-age and pre-school children treated for helminths. [2] There are also papers written about the long term effects of treating humans with ivermectin on other parasites.  'Intriguingly, IVM has a diverse range of effects in many different organisms, far beyond the endoparasites and ectoparasites it was developed to control. For example, IVM has been shown to regulate glucose and cholesterol levels in diabetic mice, to suppress malignant cell proliferation in various cancers, to inhibit viral replication in several flaviviruses, and to reduce survival in major insect vectors of malaria and trypanosomiasis. Clearly, much remains to be learned about this versatile drug, but the promise of more sustainable strategies for current helminth-control programmes and novel applications to improve and democratise human health, are compelling arguments to pursue this cause." [3] With the craze of rosaceans using horse paste to treat rosacea topically, there is one report of oral horse paste treatment for Lyme disease in Facebook by a poster. [4] So there are a substantial number of humans globally who have taken oral ivermectin.  More information on oral ivermectin. ElaineA has a post worth reading on this subject, Oral Ivermectin, getting diagnosed and a prescription. End Notes [1] Proc Jpn Acad Ser B Phys Biol Sci. 2011 Feb 10; 87(2): 13–28. doi: 10.2183/pjab.87.13 PMCID: PMC3043740; PMID: 21321478 Ivermectin, ‘Wonder drug’ from Japan: the human use perspective Andy CRUMP and Satoshi ŌMURA [2] PLoS Negl Trop Dis. 2008 Sep; 2(9): e293. Published online 2008 Sep 10. doi: 10.1371/journal.pntd.0000293 PMCID: PMC2553482; PMID: 18820741 Impact of Long-Term Treatment with Ivermectin on the Prevalence and Intensity of Soil-Transmitted Helminth Infections Ana Lucia Moncayo,  Maritza Vaca,  Leila Amorim,  Alejandro Rodriguez,  Silvia Erazo,  Gisela Oviedo,  Isabel Quinzo,  Margarita Padilla,  Martha Chico,  Raquel Lovato,  Eduardo Gomez,  Mauricio L. Barreto,  and Philip J. Cooper   [3] Trends in Parasitology Volume 33, Issue 6, June 2017, Pages 463-472 Ivermectin – Old Drug, New Tricks? Roz Laing. Victoria Gillan. Eileen Devaney [4] Post number five in this thread
    • This post has been promoted to an article. 
    • Thanks Apurva for your research and investigation into this. Hope some substantiate your findings. 
    • Have you ever heard of tea tree plant alternative? So my new experiment is on Callistemon Viminalis or Melaleuca Viminalis, commonly known as weeping bottlebrush (1) has quite similarities with Melaleuca Alternifolia or commonly known as tea tree plant  because they both belong to the Myrtaceae family (2). I have come to know about this plant accidentally because it exactly looks like tea tree plant and  when I researched about it, I compared and found that they almost have similar chemical composition so they both have same antimicrobial and antioxidant properties. some of the main active chemical components are : 1,8 cineole, terpinen-4-ol, α-pinene, α-terpineol, p-cymene and limonene are common in both plants but These components have different concentration in both plants (3). So I decided to put it on test and see what are the effects it has on skin so I made infused oil with bottlebrush leaves. I dried the leaves and put it in a jar with coconut oil and kept it under the sun for 10-20 days. This oil has a very strong smell and I have been applying this oil to my face daily and it’s been 5 months, I have been working on it and the results are amazing.Its dry leaves contain more antioxidant properties and We all have known that the antioxidants play an essential role in oxidative stress of cells by donating electrons to free radicals and thereby reducing the inflammation. Antioxidants are like soldiers always protecting our skin cells from the damaging effects of free radicals. So this oil has surprising effects on frequent flushing and reducing the post flare-up red blotches of blood capillaries just like the tea tree oil does but before you use this oil take a patch test on your hand first and see if you have any allergy or sensitivity and if you do make it more diluted with coconut oil. This is good for type I rosacea and try it.It’s all natural.   References : 1. https://en.wikipedia.org/wiki/Melaleuca_viminalis 2. https://en.wikipedia.org/wiki/Melaleuca_alternifolia 3. https://www.sciencedirect.com/science/article/pii/S1995764517303905#bib8
    • It happens sometimes. You know I have been non-vegetarian since childhood and My skin was also flawless now it's been 4 years I have rosacea with some other co-existing conditions and how did I get I do not know so throughout this journey it has been trial and error period.first I left non-veg to see if it has any effects on rosacea and trust me it helped me in reducing my frequent flare-ups. this is just an example, other than that I have systematically managed my diet and routine. What I am trying to tell you is sometimes the things and foods which we had in past that wasn't bothering at all then, sometimes bother now. so you have to keep an eye on things which you consume to see whether it has any increasing effects on your rosacea.
    • @Apurva Tathe I am surprised,cause i took cigaretts for 6 years and drank 2-3 coffees per day, and my skin looked perfect,only this year the rosacea was worse then ever.. anyway ill not smoke anymore,and reduce coffee to one per day.
    • Yes it can, because coffee contains caffeine and cigar contains nicotine and both are chemicals which increase blood pressure. A single full-size cigar can contain nearly as much nicotine as does a pack of cigarettes but coffee is good if you are taking once a day and not more than that.because caffeine and nicotine both can prolong the frequency and period of flushing. 
    • Hi Peter,  This question comes up a lot about coffee and is a FAQ answered here. We hope you continue to post and ask questions. As for cigars, we have no data on cigars and rosacea but obviously is probably not a healthy habit to keep. As for creams for rosacea, suggest you search our non prescription forum or check out our online store. 
    • Does coffee and cigars influence rosacea? Which day cream is the best for it? 🤔😄
    • Related Articles Intense pulsed light therapy: A promising complementary treatment for dry eye disease. Arch Soc Esp Oftalmol. 2019 May 09;: Authors: Mejía LF, Gil JC, Jaramillo M Abstract OBJECTIVE: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease. MATERIAL AND METHODS: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee. RESULTS: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P<.05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P<.05, for all measurements). CONCLUSION: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease. PMID: 31079987 [PubMed - as supplied by publisher] {url} = URL to article
    • Image courtesy of Wikimedia Commons The American Academy of Dermatologists is one of the premier, most distinguished organizations that produces a medical journal and sponsors conventions for their prestigious members each year. The AAD is a 501 c 3 non profit organization that in 2015 received $33 million dollars in revenue and spent $34 million dollars in expenses. If you carefully review the total amount of research grants spent in 2015 in its Form 990 you will see it spent a little over $1 million dollars so that amounts to 3 percent of its revenue. What that means, to put this into perspective about research, is that for every dollar received by the AAD three cents is spent on research. What amount went to rosacea research is anyone's guess, but if you have the volunteer spirit you could figure that out and report what you find in this thread. If you have the heart to figure out how much was spent on actual rosacea research by the AAD in 2015 you would probably find that the amount was not very much. The AAD focuses a lot on many other skin diseases, but sometimes has articles on rosacea in its journal. 
    • The skin industry, of course, is the primary sponsor of rosacea research papers published in the medical journals, as Dr. Kligman points out and comments that such papers are "perhaps not the most credible source of unbiased research.' It takes a lot of deep investigation to find the source of funding of a clinical paper published in a medical journal but if you have the time and patience you can discover who funded the research paper published. For example if you check out this article published in the Dermatology Online Journal you can find that one of the authors, Eckert M. Mendieta works at the Department of Dermatology, Clínica Dermitek, which is part of the 'skin industry.' Dermatol Online J. 2016 Aug 15;22(8). pii: 13030/qt9ks1c48n. Treatment of rosacea with topical ivermectin cream: a series of 34 cases. Mendieta Eckert M, Landa Gundin N.  While we have reviewed who is funding rosacea research we are still grateful for ANY rosacea research funding and can glean useful information from these published papers. The status quo research papers are without a doubt funded primarily by the skin industry, included in this are the few non profit organizations for rosacea since with the exception of the RRDi, is funded primarily by the pharmaceutical skin industry. Joel T. Bamford, MD, wrote an article in the Journal of the Rosacea Research & Development Institute, Is it possible for rosaceans to do research?, which encourages his recommendation that Rosaceans should get together and sponsor their own research independent of the skin industry. What a novel idea? And that is why the RRDi was formed so that a non profit organization for rosacea should be established by Rosaceans who suffer from rosacea, and not like the other non profit organizations for rosacea who are established and run by NON rosaceans. If enough rosaceans got together, say 10,000 members, and each donated one dollar, they could sponsor their own double blind, placebo controlled, peer-reviewed rosacea research clinical papers.  
    • Positive Anecdotal Reports of Soolantra MagnificenT, the Rosacea Forum, posts, "I have been using it for 4 weeks now, and I am literally shocked how my skin improved during this time. There are no more discolorations, redness decreased by 70% (I'm pinkish now, but it looks healthy), I can take a shower without going super red, and in general I no longer feel this discomfort, tightness, and dryness. After a disastrous experience with Mirvaso, I need to pay thanks to the creators of this drug, it gave me a relief I needed so much."
    • Related Articles Antimicrobial Peptide LL-37 Facilitates Intracellular Uptake of RNA Aptamer Apt 21-2 Without Inducing an Inflammatory or Interferon Response. Front Immunol. 2019;10:857 Authors: Macleod T, Ward J, Alase AA, Bridgewood C, Wittmann M, Stonehouse NJ Abstract RNA aptamers are synthetic single stranded RNA oligonucleotides that function analogously to antibodies. Recently, they have shown promise for use in treating inflammatory skin disease as, unlike antibody-based biologics, they are able to enter the skin following topical administration. However, it is important to understand the inflammatory milieu into which aptamers are delivered, as numerous immune-modulating mediators will be present at abnormal levels. LL-37 is an important immune-modifying protein upregulated in several inflammatory skin conditions, including psoriasis, rosacea and eczema. This inflammatory antimicrobial peptide is known to complex nucleic acids and induce both inflammatory and interferon responses from keratinocytes. Given the attractive notion of using RNA aptamers in topical medication and the prevalence of LL-37 in these inflammatory skin conditions, we examined the effect of LL-37 on the efficacy and safety of the anti-IL-17A RNA aptamer, Apt 21-2. LL-37 was demonstrated to complex with the RNA aptamer by electrophoretic mobility shift and filter binding assays. In contrast to free Apt 21-2, LL-37-complexed Apt 21-2 was observed to efficiently enter both keratinocytes and fibroblasts by confocal microscopy. Despite internalization of LL-37-complexed aptamers, measurement of inflammatory mediators and interferon stimulated genes showed LL-37-complexed Apt 21-2 remained immunologically inert in keratinocytes, fibroblasts, and peripheral blood mononuclear cells including infiltrating dendritic cells and monocytes. The findings of this study suggest RNA aptamers delivered into an inflammatory milieu rich in LL-37 may become complexed and subsequently internalized by surrounding cells in the skin. Whilst the results of this study indicate delivery of RNA aptamers into tissue rich in LL-37 should not cause an unwarranted inflammatory of interferon response, these results have significant implications for the efficacy of aptamers with regards to extracellular vs. intracellular targets that should be taken into consideration when developing treatment strategies utilizing RNA aptamers in inflamed tissue. PMID: 31068939 [PubMed - in process] {url} = URL to article
    • A comparison of the efficacy and tolerability of topical agents used in facial Demodex treatment. J Cosmet Dermatol. 2019 May 08;: Authors: Sarac G Abstract BACKGROUND: Demodex spp. is the most common ectoparasite in humans. This parasite is believed to play a role in the etiology of many dermatological and ocular disorders. AIM: The aim of this study was to compare the efficacy and tolerability of the sulfur-sodium sulfacetamide combination, crotamiton, and permethrin, which are three topical agents commonly used in Demodex treatment. METHODS: A total of 28 patients with primary demodicosis and 44 patients with Rosacea + Demodex were included in the study. The pretreatment and post-treatment Demodex spp. counts, patient satisfaction, and erythema decrease rates were compared. RESULTS: Analysis of the efficacy of these topical agents on Demodex revealed that all three significantly decreased the number of parasites. The patient satisfaction was higher in the sodium acetamide group than the 10% crotamiton and 5% permethrin groups, and clinical evaluation (erythema/ papulopustules and white plugs) was better in the sodium acetamide group than the other groups but no statistically significant difference was found in terms of patient satisfaction and clinical evaluation. CONCLUSION: The sulfur-sodium combination, crotamiton, and permethrin are the three agents commonly used in the treatment of Demodex spp. and all significantly decreased the Demodex count. The three agents were similar in terms of tolerability. Our study needs to be supported with others on larger patient series. PMID: 31066486 [PubMed - as supplied by publisher] {url} = URL to article
    • Yes I had seborrheic dermatitis and blepharitis both with rosacea. So when  I researched about it thoroughly I found that when you have SD that causes blepharitis it is sometimes combinedly called seborrheic blepharitis.
    • Thanks for you post. Never heard of seborrheic blepharitis. I have heard of seborrheic dermatitis. When I used the search feature at Wikipedia for seborrheic blepharitis, it redirected me to 'blepharitis' and I found this quote, "Different variations of blepharitis can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic." 
    • I never used horse paste or any ivermectin during my medications. I have type I followed by type 2 rosacea but most of the time type I only with the coexisting condition of seborrheic blepharitis and antibiotics work wonder if you take it orally and apply it topically as well and it completely cured me of seborrheic blepharitis and does not exacerbate the rosacea.
    • Anecdotal Reports of Using Horse Paste for Rosacea - You Decide Positive or Negative? Found one neutral anecdotal report at Rosacea Tips and Support Group, Facebook but you will just have to find it.  The RRDi complies with requests for removal of certain published material on the internet from our website. However, for those of you who may not understand the legality of this issue, you may want to read these two answers to the following two questions:  Can You Quote or Use Someone Else’s Facebook Posting? Question: Is it illegal to quote someone without permission? It is ironic that those who have issues with quoting a neutral report of using horse paste on this website have no issues with Facebook publishing their name and medical issue for all to see in a private group. 
    • Negative Anecdotal Reports of Using Horse Paste for Rosacea There are a few negative reports at Facebook Groups, i.e., Rosacea (English), Rosacea (English), Rosacea Tips and Support Groups, as well as Reddit r/Rosacea,  but you will have to join these groups to find the negative anecdotal reports since they are few are far between. Of course, you will always find negative reports, just like you do with Soolantra and any other rosacea treatment. If there are more negative ones or a significant number of them then you should be wary. So far, with horse paste the negative ones are few.  The RRDi complies with requests for removal of certain published material on the internet from our website. However, for those of you who may not understand the legality of this issue, you may want to read these two answers to the following two questions:  Can You Quote or Use Someone Else’s Facebook Posting? Question: Is it illegal to quote someone without permission? It is ironic that those who have issues with quoting a negative report of using horse paste on this website have no issues with Facebook publishing their name and medical issue for all to see in a private group. 
    • Positive Anecdotal Reports of Using Horse Paste for Rosacea There are many, many positive reports at Facebook Groups, i.e., Rosacea (English), Rosacea (English), Rosacea Tips and Support Groups, as well as Reddit r/Rosacea,  but you will have to join these groups to read the anecdotal reports.  The RRDi complies with requests for removal of certain published material on the internet from our website. However, for those of you who may not understand the legality of this issue, you may want to read these two answers to the following two questions:  Can You Quote or Use Someone Else’s Facebook Posting? Question: Is it illegal to quote someone without permission? It is ironic that those who have issues with quoting a positive report of using horse paste on this website have no issues with Facebook publishing their name and medical issue for all to see in a private group.     
    • So, we suggest that the combined therapy works better than ivermectin alone on cases with different skin lesions and anterior blepharitis. In conclusion, the combined therapy was superior in decreasing the D. folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in blepharitis lesions, while the two regimens were comparable in reducing the mite count to the normal level in acne and peri-oral dermatitis lesions. International Journal of Infectious Diseases Volume 17, Issue 5, May 2013, Pages e343-e347 Evaluation of the efficacy of oral ivermectin in comparison with ivermectin–metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum Doaa Abdel-Badie Salema, Atef El-shazly, Nairmen Nabih, Youssef El-Bayoumy, Sameh Salehc
    • I just checked this post today, May 6, which has not been a month since I initially posted this vent I am still on, and there has been 68 views of this post totaled up today. So since Apurva Tathe is the only one who replied to this thread (just in case you don't know how to reply to this thread there is a green button at the top of the thread to the right - see below) I thought maybe some of you need some help understanding how a forum works with replying to a post? Or you can scroll all the way to the bottom of the thread and you will see 'Reply to this topic' and just start typing (in both cases you need to be registered and logged in).   Anyway, I thought I would continue my vent. I have been browsing Reddit and Facebook to see where all the rosaceans have gone and have discovered that there are some huge rosacea groups formed and how these are extremely popular to use. For example, at Reddit r/rosacea has 7.9K members (I tried posting there and one of the moderators was extremely rude and would not reason with me and denigrated the RRDi repeatedly so I simply left this group). I joined Reddit r/SkincareAddition (954K members) and am appalled that anyone can try to sort through this group for help with rosacea since it covers so many different skin conditions. Facebook Rosacea (in English) has 6.6K members, while Rosacea Tips and Support Group has 7.4K members. Facebook to me has a friendlier atmosphere over Reddit (for example, I simply recommended that in one of the many inquiries, IS THIS ROSACEA?, to see a dermatologist I was chastised and rudely told to mind my own business). So far, in Facebook the rosaceans there are more respectful and kindlier than the Reddit rosaceans. The most appalling discovery in all this is the lack of rosacea knowledge. Most rosacea newbies, of course, haven't a clue what rosacea is, and the vast majority are trying to learn about it through Reddit or Facebook and the search feature at either one is dreadful. Of course, they don't know what to search for in the first place, but the most FAQs are, Is this Rosacea?, What Moisturizer?, Should I get Laser? (or LED or IPL, etc.), What is Horse Paste?, Asking about Rosacea Triggers, especially IS COFFEE A TRIGGER?, and usually asking about a particularly over the counter treatment for rosacea or a particular prescription treatment. As you can see, the RRDi has been answering these questions since 2004 and has grouped all these questions into logical categories and areas in the member forum or in the research articles. Why rosaceans prefer Facebook and Reddit over having all these questions in a forum in categories boggles my mind. What is it about Facebook and Reddit that appeals to these rosacea newbies?  It is so difficult to find what you are looking for in either one. Total chaos yet rosaceans love it. Your thoughts on all this?   Second, is the fact that since the 1200 plus members of the RRDi simply don't want to volunteer and post or do anything, the funds are dwindling and since our non profit is so transparent you can view the financial situation that the RRDi is in. At the present rate of spending, we have enough to last a little over a year. I am hoping for a donation from Demodex Solutions, but Walter apparently hasn't had the success he used to have when the ZZ cream was one of the more popular demodectic rosacea treatment around (horse paste has taken over), so I can't count on his support. There simply isn't enough members purchasing our Amazon Affiliate items to keep the RRDi afloat. There simply are no donations to speak of in the last few years. Members don't donate. If the 1200+ members each donated a dollar that would keep us going for over a year and half.  Going through the hoops to get a Galderma Education Grant is a huge amount of volunteer time and I may try going through the hoops again but you should try it and see how difficult Galderma makes this process and they only offer the RRDi a $2K grant if you qualify. Would anyone of you want to volunteer to do this and keep half the money (the RRDi has to keep half to keep this ship afloat!!!). However, if you can get one of these education grants from Galderma through the RRDi you can keep half the money which means $1K in your pocket! We have been offering this for a long time and some volunteers have tried and given up rather quickly because you really have to be patient and meticulous to follow all the instructions from Galderma, not to mention the multiple forms and bureaucratic steps required to get the grant. All you do is contact me and I will set you on course on how to do this.  So the handwriting is on the wall. The days of the RRDi are numbered since volunteering is just not popular anymore as it was in 2004 when the RRDi started. There are no Warren Stuarts or other helpful volunteers. The other board members are busy and involved with their own responsibilities to be able to volunteer very much at all. The MAC Members are the same. Actually the MAC Members are one of the Crown Jewels of the RRDi, however, I cannot really bother them since when I do some quit and want their name removed so I have learned to not bother them unless I have something pertinent to their speciality like asking them a question I know they know the answer. It is amazing they have offered to volunteer for the RRDi and give me their personal contact information and I can ask them rosacea questions. What a resource!   Then there is the wealth of rosacea data on this website. Huge amount of rosacea data. All this will be gone unless we either (1) get volunteers to keep this going, (2) get some donations to keep this going, or, (3) you come up with another solution.  This is not to mention why the RRDi was formed in the first place, which a lot of you rosacea newbies haven't a clue about. We do have a history of the RRDi if you are interested. So since I did mention this, yes, this is still a venting session for me, you may need to understand rosacea research and get a perspective on this. First read the post, Rosacea Research in Perspective of Funding and then read Rosacea Research in Perspective of Idiopathic Diseases. Do you really want the NRS and the AARS to keep the status quo rosacea research that the pharmaceutical companies keep funding?  Do you want a non profit organization for rosacea patient advocacy to fund some novel rosacea research? Unless you form another non profit organization for rosacea that is better than the RRDi, at this point, the RRDi is the only choice. So please consider what is in this entire thread, about what I just vented about and please post a comment in this thread. Do you have any thoughts on this?     
    • I am taking ldn, prescribed by an online doctor and processed by a compound pharmacy. It helps my neurogenic rosacea, its not a cure but it works better than anything else I have tried. I have tried many other things, to no avail.
    • image courtesy of WikiMedia Commons Rosacea has been associated with other diseases and the list just keeps growing. This is referred to in medicine as systemic comorbidities. What this means for you to understand is this requires even more research needed to understand why rosacea is associated with these diseases and knowing how confounding factors are used in the investigation. For further investigation and seeing the list, put on your diving cap for a deep dive investigation and click here. 
    • This question comes up a lot since many who have dry skin want a moisturizer that doesn't exacerbate their rosacea, so which moisturizer? The RRDi has collected a number of moisturizers that have been reported to work for some and listed in our non profit store and also in:  Forum Home >  Forums >  Public Forum >  Rosacea Topics > Non Prescription > Moisturizers  Most of the one listed are those who rosaceans report works for them. We hope if you find a moisturizer that works for you that you will post this in this thread by simply clicking the green reply button and share it with fellow rosacea sufferers who are asking the same question. 
    • NOTE: The reports on using horse paste is to apply it TOPICALLY,  and NOT orally.  However there is an anecdotal report posted by woman on Facebook, Rosacea Support, who says her friend ingests horse paste for Lyme disease on the advice of her 'tropical disease consultant.'    
    • Related Articles [Neonatal lupus in an infant of a mother followed up for dermatomyositis: medical images]. Pan Afr Med J. 2018;31:117 Authors: Cisse L, Karabinta Y Abstract Neonatal lupus is rare. It is due to the transmission of maternal autoantibodies across the placenta during pregnancy. We here report the case of a 2-month old female infant treated for erythematous macular cutaneous lesions on the face and the trunk. Her mother was followed up for dermatomyositis diagnosed on the basis of clinical lesions, muscle weakness and elevation in muscle enzyme levels. However she had not underwent antinuclear antibody test (ANA). Clinical examination showed atrophic erythematous lesions distributed like butterfly wings on both sides of the nasal pyramid, satellite lesions on the front, with red hair. The remainder of the physical examination was unremarkable. Laboratory tests were not performed because infant's parents also refused the biopsy. These lesions suggested seborrheic dermatitis, rosacea or atopic dermatitis. However, rosacea is very rare in infants and usually affects fair-skinned people. In seborrheic dermatitis, lesions are not atrophic. The age of onset of atopic dermatitis is usually 3 months. Lesions regressed in 15 days under dermocorticoid therapy. PMID: 31037177 [PubMed - in process] {url} = URL to article
    • Related Articles Quality of life measurement in hidradenitis suppurativa: position statement of the European Academy of Dermatology and Venereology task forces on Quality of Life and Patient-Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol. 2019 Apr 29;: Authors: Chernyshov PV, Zouboulis CC, Tomas-Aragones L, Jemec GB, Svensson A, Manolache L, Tzellos T, Sampogna F, Pustisek N, van der Zee HH, Marron SE, Spillekom-van Koulil S, Bewley A, Linder D, Abeni D, Szepietowski JC, Augustin M, Finlay AY Abstract This paper is organized jointly by the European Academy of Dermatology and Venereology (EADV) Task Force (TF) on Quality of Life (QoL) and Patient-Oriented Outcomes and the EADV TF on acne, rosacea and hidradenitis suppurativa (ARHS). The purpose of this paper was to present current knowledge about QoL assessment in HS, including data on HS-specific health-related (HR) QoL instruments and HRQoL changes in clinical trials, and to make practical recommendations concerning the assessment of QoL in people with HS. HS results in significant quimp that is higher than in most other chronic skin diseases. HS impact in published studies was assessed predominantly (84% of studies) by the Dermatology Life Quality Index (DLQI). There is a lack of high-quality clinical trials in HS patients where HRQoL instruments have been used as outcome measures. One double-blind randomized placebo-controlled trial on infliximab with low number of participants reported significantly better HRQoL improvement in the treatment group than in the placebo group. Well-designed clinical studies in HS patients to compare different treatment methods, including surgical methods and assessing long-term effects, are needed. Because of lack of sufficient validation, the Task Forces are not at present able to recommend existing HS-specific HRQoL instruments for use in clinical studies. The EADV TFs recommend the dermatology-specific DLQI questionnaire for use in HS patients. The EADV TFs encourage the further development, validation and use of other HS-specific, dermatology-specific and generic instruments but such use should be based on the principles presented in the previous publications of the EADV TF on QoL and Patient-Oriented Outcomes. PMID: 31037773 [PubMed - as supplied by publisher] {url} = URL to article
    • Successful treatment of facial vascular skin diseases with a 577-nm pro-yellow laser. J Cosmet Dermatol. 2019 Apr 29;: Authors: Mohamed EM, Mohamed Tawfik K, Hassan Ahmad W Abstract BACKGROUND: Treatment of vascular skin diseases is one of the most important indications of the laser. AIMS: To evaluate the effectiveness of 577-nm pro-yellow laser in the treatment of some vascular skin diseases. PATIENTS/METHODS: Ninety-five patients with vascular skin diseases were included in this prospective monocentric study. They were classified into: port-wine stain birthmarks (n = 37), papulopustular rosacea (n = 20), facial telangiectasia (n = 16), and facial erythema (n = 22). All participants received a monthly session of 577-nm pro-yellow laser. Follow-up was done by comparing the photographs before and at every follow-up visit. RESULTS: At the final visit, there was a significant improvement (>50%) occurred in 24/37 (64.82%), 12/20 (60%), 10/16 (62.5%), and 19/22 (86.3%) cases and poor response occurred in 6/37 (16.2%), 2/20 (10%), 2/16 (12.5%), and 0/22 cases after a mean number of sessions 7.76 ± 2.28, 3.1 ± 1.8, 3.63 ± 1.12, and 1.8 ± 0.85 in port-wine stain, rosacea-, facial telangiectasia-, and facial erythema-treated groups, respectively. Transient irritation and erythema during the session were the only complications reported in the study. CONCLUSION: Facial port-wine stains, rosacea, telangiectasia, and erythema can be successfully treated with a single pass of 577-nm pro-yellow laser with a minimal side effect. Facial erythema showed the highest degree of success with the least number of sessions, while more sessions needed for the treatment of port-wine stain. PMID: 31033204 [PubMed - as supplied by publisher] {url} = URL to article
    • Naltrexone, a prescription drug, is "sold under the brand names ReVia and Vivitrol among others, is a medication primarily used to manage alcohol or opioid dependence." Wikipedia There is a thread at RF that some are taking this for rosacea in low dose tablets, which you may want to follow. If you discovered this here at the RRDi and find low dose naltrexone helps your rosacea, can you please post in this thread this is where you learned about it and post your results here? 
    • Image courtesy of Wikimedia Commons Demodetic Rosacea has a long history. For example, note the following quote in a paper written in 1886: "From these and other statements it is seen that in suggesting the thought that these minute forms of life are etiological factors in even some of the phases of acneform diseases, I shall be but little in accord with the highest authorities. In antagonism to these views, I may say that the results of my observations appear to indicate a close relationship of the parasites with the diseased condition." Demodex Folliculorum in Diseased Conditions of the Human Face Proceedings of the American Society of Microscopists, Vol. 8, 1886, page 123, Published by: Wiley-Blackwell According to Google Scholar a paper, Simon 1842, is cited by at least 38 articles that mention demodex foliculorum.  Simon G (1842), Ueber eine in den kranken und normalen haarsacken des menschen lebende milbe. Arch Anat, Physiol u Wissensch Med 11: 218–237. "D. folliculorum and D. brevis are typically found on humans. D. folliculorum was first described in 1842 by Simon; D. brevis was identified as separate in 1963 by Akbulatova. D. folliculorum is found in hair follicles, while D. brevis lives in sebaceous glands connected to hair follicles." Wikipedia For more information on demodectic rosacea 
    • Crotamiton is used mainly to treat scabies which is caused by the Sarcoptes scabiei mite and there are a few articles showing Crotamiton improves rosacea. For more information click here. 
    • Crotamiton is used mainly to treat scabies which is caused by the Sarcoptes scabiei mite and there are a few articles showing Crotamiton improves rosacea. If you are using crotamiton or know of any other articles like the ones below, please post in this thread. That is what volunteering is all about. Share your rosacea knowledge with other rosaceans.  "After clinical manifestations, the mites may be temporarily eradicated with topical insecticides, especially crotamiton cream, permethrin cream, and also with topical or systemic metronidazole. In severe cases, such as those with HIV infection, oral ivermectin may be recommended." [1] "When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole." [2] "The skin lesions resolved after treatment including systemic metronidazole, topical metronidazole, crotamiton, or gamma benzene hexachloride." [3] "Patients with these skin conditions markedly improved with the use of topical crotamiton twice daily, regardless of results from a KOH test for the presence of Demodex mites. Crotamiton also possesses antipruritic properties, which may be helpful in cases associated with pruritis. Based on these findings, we recommend the use of topical crotamiton twice daily in patients with a chronic history of, or who present with, facial erythema, dryness, scaling, and roughness with or without papules/pustules." [4] "A random sample of 16 female patients suffering from papulopustular rosacea (PPR) as well as (16) normal female healthy subjects as control group were adopted in this study to assess of Demodex folliculorum pathogenesis. It was done through determination of mite density using a standard skin surface biopsy 10.5 cm2 from different designated 6 areas on the face, and scanning electron microscopic study (SEM) as well as total IgE estimation. A trial of treatment using Crotamiton 10% cream with special program was also attempted. All subjects ranged between 35-55 years old. All patients with rosacea and 15 of the control group i.e. 75.93% were found to harbour mites. The mean mite counts by site distribution were 28.6 & 6.9 on the cheeks, followed by 14.5 & 3.0 on the forehead and lastly 6.8 & 0.8 on the chin in PPR and control groups respectively. The total mean mite count in patients was 49.9 initially and 7.9 after treatment. In the control group it was 10.7 & 10.6 respectively. The mean total IgE was 169.4 & 168.4 and 96.3 & 98.4 in PPR and control groups respectively Light and scanning electron microscopy revealed that all mites were pointing in one direction. Some of them were containing bacteria inside their gut and on their skin. After treatment 3 cases (18.75%) were completely cured, 10 cases (62.5%) gave moderate response while 3 cases (18.75) have no response. In conclusion, this study supports the pathogenic role of D. folliculorum in rosacea." [5] End Notes [2] Indian J Dermatol. 2014 Jan-Feb; 59(1): 60–66.doi:  10.4103/0019-5154.123498PMCID: PMC3884930Human Demodex Mite: The Versatile Mite of Dermatological ImportanceParvaiz Anwar Rather and Iffat Hassan [2] Ann Dermatol Venereol. 2011 Nov;138 Suppl 3:S211-4 Treatment of rosacea. Parodi A, Drago F, Paolino S, Cozzani E, Gallo R [3] J Am Acad Dermatol. 2009 Mar;60(3):453-62 Demodicosis: A clinicopathological study. Hsu CK, Hsu MM, Lee JY [4] J Clin Aesthet Dermatol. 2009 January; 2(1): 20–25. Demodex Dermatitis, A Retrospective Analysis of Clinical Diagnosis and Successful Treatment with Topical Crotamiton Joseph B. Bikowski and James Q. Del Rosso [5] J Egypt Soc Parasitol. 1997 Apr;27(1):183-95.  A study on Demodex folliculorum in rosacea.Abd-El-Al AM, Bayoumy AM, Abou Salem EA.  
    • image courtesy of WikiMedia Commons The National Institutes of Health (NIH) spent $31.3 billion in 2016 according to this report. You may see the list of diseases that the NIH funds research on and rosacea is not on the list.  Dr. Kligman in a paper he wrote in 2003 mentions the "indifference of the National Institutes of Health, which with an annual budget of nearly 30 billion dollars, has not seen fit to fund a single grant for the investigation of rosacea." Dr. Kligman also says that most research done on rosacea is by the skin industry which is "voluminous literature, mainly focused on treatments sponsored by commercial interests; perhaps not the most credible source of unbiased research.'” A Personal Critique on the State of Knowledge of Rosacea32.48 kB · 2 downloads , Albert M. Kligman, M.D., Ph.D.Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A. For example, this paper states, "Of the 106 studies, 66 reported that they received funding, mainly by pharmaceutical companies. We were confident funding did not affect the results in 56 of these studies but had concerns about the remaining 10." [1] The National Rosacea Society, who is heavily funded by pharmaceutical companies or skin industries, i.e., Galderma, Allergan, Bayer HealthCare, Rodan+Fields, Cutanea, has funded over $1.6 million on rosacea papers over a twenty year period. The AARS has funded a little research.  One paper on demodex was funded by the Irish Health Research Board.  You have to do some investigative digging on who is funding a research paper on rosacea. Are you into this?  That is what volunteering is all about.  End Notes [1] Cochrane Database Syst Rev. 2015 Apr; 2015(4): CD003262. Published online 2015 Apr 28. doi: 10.1002/14651858.CD003262.pub5 PMCID: PMC6481562 PMID: 25919144 Interventions for rosacea Zbys Fedorowicz, Ben Carter, Mireille MD van der Linden, Lyn Charland, and Esther J van Zuuren
    • One report from Megan Tolliver‎, Rosacea Tips and Support Group, Facebook, posts, "I will also note that about a month ago I was also prescribed Spironolactone."   When asked, "How much credence do you attribute Spironolactone as improving your skin? Are you still taking Spironolactone and, if so, how much do you take each day?"  Megan replied, "my skin had cleared before I started the spironolactone. But it has helped with the two-three major pimples I would get just before my period. I am on the lowest dose. 25mg I believe. I mentioned it because some have asked about flaring with their cycle and I feel like it might could help them too." In the same thread, Ashley Mitzenmacher posted a link to this article, THIS PILL (NOT *THE* PILL) HELPS TO BANISH HORMONAL ACNE—HERE’S WHAT TO KNOW, which is how spironolactone helps acne.  Spironolactone is a potent antimineralocorticoid according to Wikipedia, and you need a prescription from your doctor. If you have experience with this drug, please post in this thread. 
    • Image courtesy of Wikimedia Commons There is a huge number of articles on demodex and rosacea (the RRDi started a list sometime back and abandoned this project so if you are interested here is the link). If a volunteer wants to take on this project and update it contact us. It would be better to use Google Sheets for this project and you need a lot of time to gather all the demodex articles onto one Google Sheet. This is not for the faint of heart.  We have browsed some of the most interesting articles on demodex since our last investigation and here are some interesting thoughts on this subject that has been gleaned and the highlights are shown below:  ------------------- Under the lash "Because all adult mites have a limited life cycle, their ability to expand in numbers in a human host depends on successful copulation by adult male and female mites in the opening of the hair follicle (near the skin surface). Afterwards, the gravid female moves to the sebaceous gland to deposit eggs, each of which gives rise to a larva and then a protonymph in the sebaceous canal. A protonymph is brought to the opening of the hair follicle and matures into a deutonymph, which crawls on to the skin surface, then re-enters a hair follicle to become an adult. Therefore, during a life cycle, if adults can successfully copulate and produce the next generation, the extent of Demodex infestation will gradually increase in the host over time. Scanning electron microscopy reveals the special piercing mouthparts of D. folliculorum as a sharp offensive weapon capable of destroying adipose tissue. Although it has also been proposed that mites feed on follicular and glandular epithelial cells, sebum is thought to be the mite’s main food source. As a result, both Demodex species often coexist at the same skin area and gather in the face, cheeks, forehead, nose and external ear tract, where active sebum excretion creates favourable habitats and breeding conditions. Because these mites are susceptible to desiccation, their lifespan is limited outside the living body, and direct contact is required for transmission of mites from one individual to another. Consequently, an effective regimen in eradicating Demodex infestation should include killing as well as prevention of their copulation and transmission..... ......To quantify the extent of Demodex infestation in the skin, a surface biopsy has been standardized as the main method4. After cleaning the patient’s skin and a glass slide with ether to improve adherence, a spot of cyanoacrylate adhesive (superglue) is applied on the skin surface of interest before being overlaid with a slide. After approximately 1 minute on the skin, the slide is gently removed and covered by one drop of immersion oil before being mounted with a coverslip. The density of D. folliculorum is measured by counting the number of mites on the slide in a pre-marked surface area of 1 cm2 at a magnification of ×40 and ×100 under a microscope...... ......It has been proposed that the pathogenic potential increases if a mite density is higher than five per cm2 1. Several studies have shown a higher mite density on the faces of rosacea patients than on those of age- and sex-matched non-rosacea controls. It is intriguing that Demodex numbers increase when the outside temperature elevates in spring and summer, coinciding with the time when rosacea is exacerbated...... .....Contiguous to the skin, the eye can also be infested by Demodex mites....As a matter of fact, the first disorder that was associated with Demodex, dated as early as 1899, was blepharitis (inflammation of the lid), a disease that has continued to be a subject of investigation ever since....Hence, we believe that one way of determining the pathogenic potential of Demodex infestation in blepharitis and other ocular diseases is to identify a treatment that can kill Demodex with a good safety profile..... .....Nevertheless, one cannot rule out the pathogenic role of microbial agents that may be associated with Demodex infestation. The notion that microbes are involved in pathogenesis of mite-infested diseases has long been suggested because the skin inflammation in rosacea can be markedly improved by topical metronidazole or oral antibiotics including tetracycline, i.e. treatments that do not kill mites...... .....In short, the co-morbidity based on a symbiotic relationship of B. oleronius in Demodex mites also justifies the consideration of a therapeutic strategy directed to killing the symbiotic bacterium via oral antibiotics such as tetracycline and to killing and preventing mating/reinfestation of Demodex mites, e.g. lid scrub with TTO and general hygiene at the same time...." Biochem (Lond). 2009;31(4):2-6 Under the lash Demodex mites in human diseases Noreen Lacey, Kevin Kavanagh, and Scheffer C.G. Tseng --------------------------------- The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea. ".....Over a significant period of time, there have been numerous attempts to connect the etiopathogenesis of rosacea with the presence of some micro-organisms on or within the skin (Lazaridou et al., 2011), including Demodex mites and bacteria. It is well established that there is a higher density of Demodex mites in the skin of rosacea patients than control patients but the significance of this has been disputed (Vance, 1986; Bonnar et al., 1993; Erbağci & Ozgöztaşi, 1998). This review will explore the current understanding of the role of these organisms in the induction of rosacea.... .....Demodex mites use the chelicerae to cut the epithelial cells of the host skin, secrete lytic enzymes for pre-oral digestion and evacuate liquid cytoplasm components (Desch & Nutting, 1972). In the process of destroying the epithelial cells, the epithelial barrier is often disturbed and the mite penetrates into the dermis stimulating Toll-like receptors (TLR) (Schauber et al., 2007). Proteolytic enzymes (proteases) are among the digestive enzymes secreted by Demodex mites. Concrements of serum immunoglobulin IgD and two inhibitors of serum proteases (α-1-antitrypsin and α-1-antichymotrypsin), which might be a specific defensive reaction of the host against mites, have been detected on the surface of Demodex mites (Tsutsumi, 2004). In atopic dermatitis, proteases produced by house dust mites have been identified as the factor responsible for local skin irritation (Deleuran et al., 1998)...... ....In all phases of their life cycle, Demodex mites avoid sunlight. They emerge from the pilosebaceous units at night and migrate across the surface of the skin to find a mating partner, travelling at a speed of about 16 mm h−1 (Lacey et al., 2011). The life cycle of Demodex mites consists of five phases of development and lasts from 14 to 18 days. The copulation takes place near the entry of the hair follicle. Afterwards, the gravid female moves to the inside of the sebaceous gland, where she deposits eggs, from which the larvae will emerge about 60 h later. Protonymphs and nymphs are the next phases of the Demodex life cycle (Lacey et al., 2009; Spickett, 1961) Due to the fact that Demodex mites are obligate parasites of the pilosebaceous units and highly susceptible to desiccation, they are not capable of surviving for long periods outside the host. Routes of transmission are not fully known but it may occur by direct contact as well as through dust. While the skin of new-borns is free of Demodex folliculorum, colonization of the skin in humans takes place in childhood or early adulthood. Demodex mites are found in representatives of all human races and in all geographical areas (Lacey et al., 2009)..... ....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host. However the opinion about the role of Demodex in pathogenesis of many diseases, including rosacea has been changing (Lacey et al., 2009). In some specific conditions in the host system, Demodex mites may become potential pathogens. This may happen when the immunological conditions of the host change and new environmental conditions on the skin facilitate the development of Demodex mites (Dahl et al., 2004; Whitfeld et al., 2011)..... .....The extent of Demodex colonization in the human population is high (20–80%), reaching 100% in elderly people (Elston, 2010). Mite density starts to rise in the sixth decade of life and stays at the same level until the eight decade of life. Mite density is very low in young adults, even though their levels of sebum production, a potential source of food for mites, are very high (Ozdemir et al., 2005; Aylesworth & Vance, 1982). Patients with papulopustular rosacea produce sebum with an altered fatty acid profile, suggesting that the nature of the sebum, rather than its quantity, may favour the development of Demodex mites (Ní Raghallaigh et al., 2012). This finding raises the possibility that non-antibiotic therapies to restore the normal fatty acid composition of sebum may improve skin integrity and inhibit the proliferation of Demodex mites Due to the fact that Demodex mites are commonly found in healthy individuals and the density of mites is generally low, the presence of mites on the skin is not enough to determine pathogenicity. An increase in mite density on facial skin is observed in perioral dermatitis, caused by long-term use of local steroids or other immunomodulating drugs (Fujiwara et al., 2010). Higher numbers of Demodex mites have been noted in patients undergoing immunosuppressive therapy, for example children receiving chemotherapy for leukaemia (Ivy et al., 1995), patients with HIV-infection or AIDS (Aquilina et al., 2002; Dominey et al., 1989) and chronic dialysis patients (Karincaoglu et al., 2005)..... ....Most probably, when Demodex mites breach the epithelial barrier, their antigens influence the immune system of the host and induce a type IV hypersensitivity reaction. Demodex mites may then be attacked by giant cells giving rise to dermal granulomas, which are most often observed in granulomatous acne rosacea. Granulomas are also found in skin biopsies of patients with papulopustular rosacea and even in patients with erythematous rosacea (Hsu et al., 2009). The causal relationship of Demodex mites in skin lesions has been suspected to occur through several mechanisms. They may mechanically block the follicles, leading to distension and causing intra-follicular hyperkeratosis. The presence of mite’s chitinous external skeleton may act like a foreign body and contribute to the formation of granulomas. The waste products of Demodex mites and/or associated bacteria may activate the elements of innate immune system or stimulate the immune system through the mechanism of delayed hypersensitivity reaction (Bevins & Liu, 2007)..... ....One hypothesis concerning the role of Demodex mites in the induction of rosacea assumes that Demodex are vectors for micro-organisms that causes and exacerbates skin lesions (Hsu et al., 2009). The theory has its roots in the fact that clinical improvement was noted in patients with rosacea who were administered tetracycline antibiotics, although these antibiotics neither demonstrate activity against D. folliculorum nor reduce their numbers on the skin. It has been suggested that the beneficial activity of antibiotics was due to their anti-inflammatory properties; however, other anti-inflammatory agents, such as steroids or tacrolimus, intensify the symptoms of rosacea or even induce its development (Antille et al., 2004). The fact that only some drugs proved to be effective in the treatment of rosacea suggested that that an unknown bacterium may have a role in the pathogenesis of the disease..... .....Bacillus oleronius was isolated from a Demodex mite, obtained from a patient with papulopustular rosacea (Lacey et al., 2007)...... ....Staphylococcus epidermidis has been isolated from the pustules of 9 out of 15 patients with papulopustular rosacea, whereas this bacterium was not detected on unaffected areas of the skin (Whitfeld et al., 2011). S. epidermidis was also isolated from the eyelid margins of 4 out of 15 patients with papulopustular rosacea, whereas no pure growth was isolated from the eyelids of age- and sex-matched control subjects. The same study also found that this bacterium was susceptible to antibiotics commonly used to treat rosacea..... .....It is believed that B. oleronius forms a symbiotic relationship with Demodex, as it does in the termite (Kuhnigk et al., 1995). On the skin of humans, this bacterium may occur in the endospore form, which enters the digestive tract of Demodex mites when they consume epithelial cells. The dead mites then decompose inside the hair follicles, where they release significant numbers of bacterial antigens, which have the potential to stimulate a strong immune response (O’Reilly et al., 2012). Thus, the intensification of blepharitis and rosacea, especially the papulopustular variant, may not be induced so much by the presence of the mites alone but by the presence of Demodex mites that carry B. oleronius in their digestive tract. Empirically confirmed sensitivity of B. oleronius to different antibiotics, especially doxycycline, (Lacey et al., 2007) might explain the favourable therapeutic effect of the drug in diseases such as rosacea and blepharitis..... ....The pathogenic role of Demodex mites, as well as B. oleronius and S. epidermidis, in the induction and persistence of rosacea remains an unresolved issue..... Journal of Medical Microbiology, 61 (11 ). pp. 1504-1510. ISSN 0022-2615 The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea.   Jarmuda, Stanislaw and O’Reilly, Niamh and Zaba, Ryszard and Jakubowicz, Oliwia and Szkaradkiewicz, Andrzej and Kavanagh, Kevin (2012)  ---------------------------------- Ubiquity and Diversity of Human-Associated Demodex Mites "Here we use a new molecular method to assess the occurrence of Demodex mites on humans.....A phylogenetic analysis of 18S rDNA reveals intraspecific structure within one of the two named human-associated Demodex species, D. brevis....While these mites are well known to dermatologists, ophthalmologists, and veterinarians and have been the subject of study for 172 years, their ubiquity, diversity and evolution are poorly understood.... ....Methods used to collect Demodex mites from humans include biopsy, the cellophane tape method (placing tape on the face to stick to the mites), scraping areas where mites are likely to reside, and plucking eyelash and eyebrow hairs. Based on the visual observation of mites collected from healthy individuals by these methods, it appears that approximately 3–55% of humans harbor Demodex, with most studies falling in the range of 10–20%. However, because these mites may occur in patches around the body, as in dogs, and all existing collection methods sample just small patches of skin (and even incompletely sample those patches), it is difficult to know to what extent the absence of mites in a sample equates to the absence of mites on the body. Intriguingly, in postmortem studies, mites appear to be present on all adult cadavers. The ubiquity of mites on cadavers might indicate they are universally present on living, adult humans but missed by current sampling methods. Alternately, conditions in which cadavers are found might facilitate colonization by mites and, in doing so, artificially inflate estimates of their incidence...... .....Only recently have molecular studies begun to consider Demodex mites. Existing phylogenies and estimates of molecular divergence include very limited sampling of Demodex species, are based on few genetic markers, and include only minimal geographic representation...... .....Here we test a new molecular approach to detect the presence of mites on human bodies and assess the proportion of individuals in one population colonized by mites. We then use phylogenetic reconstruction based on the nuclear 18S rRNA gene (18S rDNA) to better understand the diversity of these mites..... ....All sample collections were performed in Raleigh, NC at either the North Carolina Museum of Natural Sciences or North Carolina State University. Each participant was gently scraped with a metal laboratory spatula along the creases of the nose and over the surrounding cheek area. The facial habitats were chosen based on their high levels of sebum production and ease of pore expression. In addition, Bonnar et al. (1993) found the greatest abundance of mites in the cheek area among rosacea patients..... ....DNA was extracted from the sebum of individual participants, regardless of the presence or absence of an observed mite,... ....The 16S rDNA PCR products were separated on 2% agarose gels to assess presence or absence of mite DNA within a sample..... ....The 18S rDNA PCR products were sequenced from four individuals and used for phylogenetic analyses..... ....Phylogenetic analyses were conducted using maximum likelihood (ML) and Bayesian inference (BI). Under both methods, gaps in the alignment were treated as missing data..... .....Molecular evidence suggests Demodex prevalence is much higher than recognized through visual observation alone. Our results are in line with postmortem studies that find Demodex mites present on all adult cadavers.... .....Here we tested 29 people for the presence of Demodex mites and found that mites were much more common than expected in comparison to methods that rely solely on the visual confirmation of whole mite specimens taken from living humans. When we sampled individuals using traditional approaches, our results were similar to those of the many previous morphologically based studies.... .....Little is known about the transmission of mites among humans. Recent studies find that many symbiotic microbes are passed directly from mother to offspring during breast-feeding or during birth (especially if birth is vaginal), and dogs acquire their Demodex mites as nursing pups. In light of this, the same means of mite transmission seems possible in humans, supported by the fact that in one study, Demodex mites were found in 77% of nipple tissue from mastectomies..... .....Mites could be more ubiquitous on children than noted in postmortem studies or herein but at levels or in locations that make the mites difficult to detect even with the use of molecular approaches. One study of Demodex mites on Tokelau islanders found that mites were present on a greater number of children than on adults. These conflicting findings highlight our limited understanding of how and when mites move onto and among human bodies.... ....The evolutionary history of the two human-associated Demodex species is, at best, poorly understood. D. folliculorum was described by Simon in 1842, and as late as 1933, all human Demodex were regarded as one, albeit variable, species. It was only in 1963 that D. brevis was distinguished from D. folliculorum and described as a separate, but closely related, species. Yet de Rojas et al. (2012) have demonstrated that interpreting variation in the morphology of the two human-associated Demodex mite species is problematic, even when interpreted in light of molecular (16S rDNA) sequence data. The closest relatives for both human-associated species, D. folliculorum and D. brevis, remain unknown and are likely to remain unknown until these mites are much better sampled from other primates and mammalian hosts in general. Of the described Demodex species, only 13 have been sampled for molecular data and included in phylogenetic analyses.... .....Demodex are generally considered to be species specific, which would suggest there might be as many as 10,000 Demodex species on living mammals if there are two host specific mites per mammal species..... .....Our phylogeny indicates that the two human-associated mite lineages do not share a recent common ancestor and likely have separate evolutionary histories of transmission to humans. The 18S rDNA sequence does not resolve the sister group to D. folliculorum, but places a paraphyletic group of dog-associated mites as the closest relative to D. brevis..... .....Phylogenetic estimates based on 16S rDNA also find that dog-hosted Demodex mites share a recent common ancestor with a human-associated species, though in this case D. folliculorum and D. brevis are both more closely related to goat-associated mites,.... Plos | One Ubiquity and Diversity of Human-Associated Demodex Mites Megan S. Thoemmes , Daniel J. Fergus, Julie Urban, Michelle Trautwein, Robert R. Dunn -----------------------------------    
    • image courtesy of Wikimedia Commons An article recommends that ‘rosacea‐like demodicosis’, the disease term, should be not used at all, and the rosacea subtype II, Papulopustular (PPR), should be ‘reconsidered and simplified to include all patients with central face papulopustules–with or without persistent erythema’. This article, authored by F.M.N. Forton and V. De Maertelaer, published by the Journal of the European Academy of Dermatology and Venereology in February 2018, was several months after the NRS endorsed the phenotype classification in October 2017* but does mention the ‘global ROSacea COnsensus (ROSCO) panel [that] recently suggested a more phenotype‐based approach’ [1] which the RRDi endorsed in November 2016. The RRDi is the only non profit for rosacea organization that recognizes demodectic rosacea as a rosacea variant. The article recommends two phenotypes, one for PPR and another 'rosacea‐like demodicosis.'  The RRDi recognizes and recommends that PPR be considered Phenotype 4 and that 'rosacea‐like demodicosis'  be classified as Demodectic Rosacea and be considered a rosacea variant. This will allow clinicians to diagnose Phenotype 4 and Demodectic Rosacea in the same individual if the diagnosis warrants or separate if treatment for demodex is unresponsive (or little evidence of demodex) allowing for a diagnosis of just Phenotype 4.  Below are some of the highlights of this paper that confirms demodectic rosacea as a valid concern.  “Our findings therefore demonstrate that a disease usually considered as not being caused by Demodex (PPR) has similar (and perhaps even slightly higher) Dds than a disease in which the role of the mite is accepted (rosacea with papulopustules without persistent erythema). It is difficult to understand how the presence of mites at similar density in these two clinically similar diseases can be considered to have a causative role in one condition, but to be only an epiphenomenon in the other. A more probable hypothesis is that the numerous mites are responsible for both conditions and that these two ‘entities’ should therefore be considered as two phenotypes of a single disease.” “All our observations therefore highlight the nosological confusion that persists between PPR and rosacea‐like demodicosis and the need to update the consensus concerning the definition and classification of rosacea. Moreover, they suggest that PPR and rosacea‐like demodicosis may be phenotypes of the same disease.” “In conclusion, while our observations do not prove a causative role of Demodex in rosacea, they nevertheless support the idea that PPR and rosacea‐like demodicosis should no longer be considered as two separate entities, but rather as two phenotypes of the same disease. As such, the definition of rosacea subtype II (PPR) should be reconsidered and simplified to include all patients with central face papulopustules–with or without persistent erythema –and thus also patients with ‘rosacea‐like demodicosis’, which is a term that should therefore disappear.” Journal of the European Academy of Dermatology and Venereology Papulopustular rosacea and rosacea‐like demodicosis: two phenotypes of the same disease? F.M.N. Forton and V. De Maertelaer https://dx.doi.org/10.1111/jdv.14885 *An article published in the Journal of the American Academy of Dermatology published in January 2018 [Epub 2017 Oct 28] Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee End Notes [1] The ROSCO panel published its recommendation for a phenotype classification of rosacea in October 2016 in the British Journal of Dermatology ROSCO Panel Recommends New Approach on Rosacea Diagnosis by Phenotype
    • Image courtesy of Wily Online Library A paper by Frank Powell, MD, The Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland, and three other authors*, Demodex mites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea, concludes, “Our results also show for the first time that Demodex mites secrete bioactive molecules that reduced TLR2 expression in sebocytes.”  So let’s break this down since this is demodectic rosacea news and you want to understand what all this means for those who want to dive deeper into rosacea investigative research. First off, what are sebocytes?  Answer Any of the cells that make up the sebaceous glands, and secrete sebum. Wiktionary What is TLR2? Answer One of a class of proteins that are single, membrane-spanning, non-catalytic receptors that identify structurally preserved molecules acquired from microbes known as Toll-Like Receptor 2 that play a key role in the innate immune system. What does this mean? If you look at the image above which shows on the left normal skin and how only a normal amount of demodex are able to regulate a TLR2 response so that the innate immune system doesn’t go into overdrive and respond to the demodex. For some unknown reason, in the image on the right with rosacea, when the demodex are increased the demodex can’t regulate the TLR2 response which initiates a cascade of molecular innate immune system activity.  Why do the mites increase? This has been one of the long time questions that the jury is still out on. More information.  Conclusion The paper written by Lacey, et. al, about understanding this activity of the mites regulating a TLR2 response at the molecular level may help in treating rosacea and understanding that demodex may be the cause of the innate immune system response.  * British Journal of Dermatology Demodex mites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea N. Lacey, A. Russell‐Hallinan, C.C. Zouboulis, F.C. Powell
    • A recent report states this about consumers using health apps on Android or iOS mobile devices:  "Clinicians should be conscious about the choices they make in relation to their app use and, when recommending apps to consumers, explain the potential for loss of personal privacy as part of informed consent. Privacy regulators should consider that loss of privacy is not a fair cost for the use of digital health services." BMJ. 2019; 364: l920. Published online 2019 Mar 20. doi: 10.1136/bmj.l920 PMCID: PMC6425456 PMID: 30894349 Data sharing practices of medicines related apps and the mobile ecosystem: traffic, content, and network analysis Quinn Grundy, assistant professor and honorary senior lecturer, Kellia Chiu, PhD candidate, Fabian Held, senior research fellow, Andrea Continella, postdoctoral fellow, Lisa Bero, professor, and Ralph Holz, lecturer in networks and security
    • A topical nanocrystal Azelaic acid (AZA)-loaded hydrogels composed of Pluronic® F127 and hyaluronic acid mixture that are able to deliver AZA into the stratum corneum and deeper skin layers was considered in a study and we await further outcome of this research. For More Information
    • Intense pulsed light therapy (IPL ) along with a topical skin care regimen "produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement."  For more information
    • Evaluation of the efficacy and tolerance of artemether emulsion for the treatment of papulopustular rosacea: A randomized pilot study. J Dermatolog Treat. 2019 Apr 24;:1-16 Authors: Wang GJ, Gao XY, Wu Y, He HQ, Yu Y, Qin HH, Shen WT Abstract OBJECTIVE: To assess the efficacy and safety of artemether emulsion in patients with papulopustular rosacea. METHODS: A total of 130 (randomized 1:1) were externally administered either artemether emulsion (1%) or metronidazole emulsion (3%) twice daily for 4 weeks with an open-label 8-week follow-up. The primary endpoints included the proportion of patients who achieved clinical effective responses, as well as erythema and papule and pustule score at week 4. RESULTS: Numerically more patients achieved an effective response at week 4 with artemether emulsion (87.1%) than metronidazole emulsion (80.0%) (P > 0.05). Patients with artemether emulsion had comparable baseline erythema score (2.45 ± 0.67 vs 2.42 ± 0.70, P = 0.809) and papule and pustule score (2.11 ± 0.96 vs 2.32 ± 0.83, P = 0.264), but significantly lower papule and pustule score (0.21 ± 0.52 vs 0.42 ± 0.83, P = 0.001) and comparable erythema score (0.53 ± 0.88 vs 0.62 ± 0.88, P = 0.999) compared to patients with metronidazole emulsion at week 4. There was a significantly higher proportion of patients with metronidazole emulsion relapse compared to metronidazole emulsion during the open-label 8-week follow-up period (21.6% vs 2.4%, P < 0.01). CONCLUSIONS: Artemether emulsion improved papulopustular rosacea in the metronidazole emulsion group as early as 4 weeks, but its beneficial effect was maintained through the 8-week follow-up period compared to metronidazole emulsion. PMID: 31017492 [PubMed - as supplied by publisher] {url} = URL to article
    • Open-label study assessing the efficacy and tolerability of topical skin care and sun protection alone and in combination with intense pulsed light therapy. J Cosmet Dermatol. 2019 Apr 24;: Authors: Deaver Peterson J, Katz TM Abstract BACKGROUND: Intense pulsed light therapy (IPL) decreases facial erythema and telangiectasias associated with rosacea. Topical skin care products decrease facial erythema by the action of active ingredients and masking effects. OBJECTIVES: To assess the efficacy and tolerability of combining a topical skin care regimen (TSCR) comprised of a multifunctional three-in-one facial cream and a mineral-based brush-on SPF50 powder sunscreen with a single IPL treatment for treating mild-to-severe facial redness associated with rosacea. METHODS: Twenty female subjects with Fitzpatrick skin types I-III received TSCR monotherapy for 12 weeks. At that time, subjects received a single IPL treatment and continued TSCR for 6 additional weeks. Subjects were evaluated at Baseline and at Weeks 4, 8, 12, and 18. RESULTS: Using a 7-point redness scale, the overall mean (SD) redness score significantly improved from 3.05 (0.97) at baseline to 2.05 (0.76) at Week 18 (P < 0.01). There was a decrease in investigator-rated erythema from baseline (bare skin) to Week 12 (bare skin, before IPL) when TSCR was used as monotherapy which did not achieve significance (P = 0.12). Most subjects (80%) were satisfied or Very satisfied with the TSCR at Week 18. All subjects (100%) agreed that it improved their baseline skin redness and most (85%) would recommend TSCR to others. TSCR was well-tolerated with no significant changes in skin dryness, scaling, or itching. Mild burning occurred immediately following the IPL treatment at Week 12. CONCLUSION: TSCR in combination with a single IPL treatment produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement. PMID: 31017734 [PubMed - as supplied by publisher] {url} = URL to article
    • Warning Concerning Brands of Horse Paste/Gel There are a number of horse paste/gel brands that also contain praziquentel (PZQ), an anthelmintic, which Wikipedia reports "is a medication used to treat a number of types of parasitic worm infections." Some brands are Pfizer Equimax Horse Wormer, Merial Zimecterin Gold, Bimeda Equimax and others. Praziquantel as far as we know has never been used to treat rosacea. Another horse paste, UltraCruz Equine Bio-Absorb Paste contains dioctahedral smectite (dio) which is used to treat acute diarrhoea. There may be other horse pastes that contain other active ingredients that you should carefully read the label on the horse paste and know what you are buying. Using treatments for horses or other animals which have not been FDA approved for humans may have some serious risks.  The horse paste that everyone is reporting using is horse paste that only contains 1.87% ivermectin as the active ingredient. Read the label of the brand you are buying and if the active ingredient includes ivermectin and ANYTHING else, you may be in serious health risk applying this topically. Stick to the brands that ONLY have 1.87% ivermectin as the active ingredient. 
    • A study on 54 patients  who met eligibility criteria with azelaic acid reports, "The biggest concern was cost (11.1%), with a mean importance score (IS) on a 10-point scale of 9.3."  Other than this the report concludes, "Patient-reported side effects were rare. Minor patient-reported side effects and concerns do not appear to affect rosacea-related QoL and medication satisfaction. Compared to a previously conducted study of similar design with patients using metronidazole gel and metronidazole cream, more patients in the current study reported no concerns with their treatment, while the number of patients reporting no side effects, as well as mean SATMED-Q and DLQI scores, were similar."  For more information
    • Concerns and Treatment Satisfaction in Patients Being Treated With Azelaic Acid Foam for Rosacea J Drugs Dermatol. 2019 Apr 01;18(4):381-386 Authors: Williamson T, Cameron J, McLeod K, Turner B, Quillen A, LaRose A, Lott J, Gaiser A Abstract Objective: To describe patient characteristics, concerns, side effects, treatment satisfaction, and quality of life (QoL) of rosacea patients currently being treated with monotherapy azelaic acid foam based on patient-reported data. Methods: The study utilized a non-interventional, prospective, observational design. Patients were recruited in the United States and were eligible if the following criteria were met: diagnosed with rosacea by a medical professional, ≥18 years of age, currently receiving monotherapy with azelaic acid foam, and able to provide informed consent. Patients using other topical treatments for rosacea during enrollment were excluded. An online tool administered a survey of 3 questionnaires including the Rosacea Treatment Preference Questionnaire, Treatment Satisfaction with Medicines Questionnaire (SATMED-Q), and Dermatology Life Quality Index (DLQI). The survey collected demographics, clinical characteristics, treatment history, adverse events, and patient-reported outcomes related to treatment with azelaic acid foam and QoL with rosacea. Results: 54 patients met eligibility criteria. Participants were primarily female (90.7%), ranging from 26 to 63 years of age. The most common subtypes reported were erythematotelangiectatic and papulopustular (74.1% each) with 59.3% of participants reporting mild symptoms (16.7% “absent”; 24.1% “moderate”) in the 4 weeks before enrollment. The majority reported no concerns (74.1%) with their treatment. The biggest concern was cost (11.1%), with a mean importance score (IS) on a 10-point scale of 9.3. A majority (77.8%) of patients reported no side effects. Side effects reported included dryness (13%; IS: 5.3), stinging (7.4%, IS: 2.5), itching (5.6%; IS: 4.7), or burning (3.7%; IS: 7.0). Global satisfaction (SATMED-Q) mean score was 79.0 and treatment effectiveness mean score was 70.8. QoL impact of rosacea was minimal (mean DLQI score: 2.35). In regression models, increasing dryness was significantly associated with worsening outcomes in SATMED-Q and DLQI. Conclusions: Patient characteristics of the study population closely mirror the distribution of rosacea by gender and subtype as in previous estimates. Findings indicate minimal patient concerns with azelaic acid foam and primarily pertained to cost. Patient-reported side effects were rare. Minor patient-reported side effects and concerns do not appear to affect rosacea-related QoL and medication satisfaction. Compared to a previously conducted study of similar design with patients using metronidazole gel and metronidazole cream, more patients in the current study reported no concerns with their treatment, while the number of patients reporting no side effects, as well as mean SATMED-Q and DLQI scores, were similar. Further research is necessary to directly compare the results of these 2 studies. J Drugs Dermatol. 2019;18(4):381-386. PMID: 31013011 [PubMed - as supplied by publisher] {url} = URL to article
    • Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites. Dermatol Reports. 2019 Jan 23;11(1):7675 Authors: Kubanov A, Gallyamova Y, Kravchenko A Abstract The article analyzes the clinical picture and course of rosacea in patients with Demodex mites. It presents the advantages of using the method of confocal laser scanning microscopy over the method of light microscopy of facial skin scrapes. The aimes were to study the influence of Demodex mites on the clinical picture and course of rosacea; to compare laboratory and instrumental diagnostic methods for detecting Demodex mites; to evaluate the effectiveness of external therapy aimed at eliminating Demodex mites. 212 people were examined. The study included healthy patients, patients with a diagnosis of rosacea with the presence and absence of Demodex. The presence of Demodex mites was confirmed by two methods of study (light microscopy of skin scrapes and confocal laser scanning in vivo microscopy). Demodex mites promote the development of acute-inflammatory morphological elements, increase the duration of the condition (more than 5 years, P<0.01) and the probability of recurrence (from 1 to 3 relapses in 39.5% of patients, P<0.05), resulting in a decrease in the quality of life of patients (dermatology life quality index is 12.5±4.5, P<0.05). Antiparasitic drug ivermectin, in the form of an external form, at a concentration of 1% has a high therapeutic efficacy (in 93.3% of cases). Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte. The severity of the condition does not depend on the quantitative load of the mites in the scrape. As an antiparasitic drug, it is recommended to use 1% ivertmectin. PMID: 31007879 [PubMed] {url} = URL to article URL to Review and to full article
    • The Russian Ministry of Health conducted a detailed study of demodex mites and rosacea on 212 men and women which is illuminating and confirms the effectiveness of using 1% ivermectin in treating rosacea is just as effective as using metronidazole combined therapy. Further, some new information about detecting a demodex mite density count is revealed that is significant news. While the paper is difficult to read, probably due to the translation, here are some of the jewels found in the report:  (1) Light Microscopy Skin Scraping Not Reliable According to the report,  if you use a skin scraping with a light microscope, there may be no reliable data on demodex density counts, which says, "The severity of the condition does not depend on the quantitative load of the mites in the scrape." The report states that "in the light microscopy of scrapes of Demodex mites in the number of 5 individuals per 1 cm2, only 6 healthy persons (n=6; 2.8%); in the remaining 66 healthy people (31.2%), the light microscopy of the scrapes was negative." "As a result of the study, we found that it is difficult to detect the mite by light microscopy of scrape per 1 cm2 of skin." However when using a 'Confocal laser scanning in vivo microscopy', there is a significantly more reliable data to count on, which this same report concludes, "Confocal laser scanning in vivo microscopy is an effective diagnostic method to detect Demodex mites that does not require preliminary preparation for analysis and allows detecting Demodex mites at the level of the spiky epidermis layer, which is not accessible for scarification, to identify the species belonging to the size of Demodex mites (from 100 up to 200 μm - Demodex brevis, 200 to 400 μm – Demodex folliculorum)." "Comparing the results obtained by light microscopy and confocal laser scanning in vivo microscopy in patients with rosacea and healthy people, in more cases Demodex mites are detected by confocal laser scanning in vivo microscopy, whereas scrape in these patients were negative." (2) The report confirms the size and movement of demodex  "Using a confocal laser scanning in vivo microscope allowed determining the average size of Demodex mites. When determining the size of mites from 100 to 200 μm, it was believed that in this case Demodex brevis was observed, while the average length of the mite was 125 μm; from 200 to 400 μm – Demodex folliculorum with an average length of 293 μm. The average size of the width of Demodex mites was 24 μm." More information on the size of demodex. "In the examination of healthy people by light microscopy, Demodex mites were detected in 6 cases (2.8%). Given the ability of the mites to move over the surface of the skin at a speed of 8-16 mm/h, as well as random selection of the study site, this fact does not prove the absence of mites." The method of scattered light intensity (SLI) is used as a new quantitative method of evaluating the viability of Demodex mites.  (3) Topical 1% Ivermectin Just as Effective as Metronidazole "Antiparasitic drug ivermectin, in the form of an external form (cream), at a concentration of 1% (1 time per day, the general course of 30 days) has a high therapeutic efficacy in patients with associated with Demodex mites (in 93.3% of cases). The effectiveness of external therapy with a drug containing 1% ivermectin (course of 30 days) is comparable to the combined treatment with the systemic drug metronidazole 250 mg per os 2 times a day and the external application of 1% metronidazole (gel) 1 time per day for 30 days." "Thus, clinical observations demonstrated a lack of superiority in combined antiparasitic therapy using a systemic drug compared to external therapy using a preparation containing 1% ivertmectin as a cream, as confirmed by statistical analysis. Stein et al. showed that after 12 weeks of ivermectin treatment, the skin of patients was defined as clean or almost clean. There was a significant reduction in the percentage of inflammatory lesions in the ivermectin treatment group. The results of the study showed that 1% ivermectin is an effective and safe treatment for inflammatory lesions in patients with rosacea." (4) No Demodex Mites Detected in Some Patients This paper reveals that in some humans there are no demodex detected. The report states, "the fact that in 55-100% of cases, mites are detected, both in patients with face dermatosis and with patients having no clinical signs of dermatological illnesses......II group is a comparison group, which was composed of patients with a diagnosis of rosacea with no Demodex mites. In Group II patients, two methods of study of Demodex mites were not found." What this means is the second comparison group demodex mites were not detected by two methods, light microscope by skin scraping and Confocal laser scanning in vivo microscopy. The study concluded that those in group two had no demodex mites. If this is true, then this is illuminating and definitely  news since most literature says demodex mites are on all humans except new born babies.  "In 80 patients with rosacea (37.8%) with Demodex mites were detected in an amount of less than 5 individuals per 1 cm2 or were absent altogether with a developed clinical picture of the condition." However, because of the ability of the mites to move, the report adds this caution:  "In the examination of healthy people by light microscopy, Demodex mites were detected in 6 cases (2.8%). Given the ability of the mites to move over the surface of the skin at a speed of 8-16 mm/h, as well as random selection of the study site, this fact does not prove the absence of mites." (5) Role of Demodex on Humans "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte." Most papers state that the role of demodex is not known. This is illuminating and definitely news.  (6) Demodex Mites are Significantly Higher in Rosacea "Our findings confirm the hypothesis of Turgut Erdemir et al., that the Demodex mites affect the severity of the disease and contribute to the progression of the pathological process. In addition, the authors have proved that the density of mites increases depending on the severity of the disease." "The detection of Demodex mites is not only statistically more significant in patients with rosacea than in the rest of the population, but also as can be seen from the Table 2, Demodex mites were more often found in patients with more severe clinical forms of rosacea (pustulous, infiltrative- productive forms)." (7) Demodex brevis not as significant as Demodex Folliculorum "In patients with severe manifestations of the condition (pustulous and infiltrative- productive forms of rosacea), the species of the mites Demodex folliculorum (P<0.01) is more often detected. Demodex brevis is found in mild forms of the condition and in healthy people, without showing signs of parasitism." "When Demodex brevis is found, given its weak possibility of parasitism, treatment with antiparasitic drugs is not indicated." (8) After 30 days of Ivermectin Treatment there is an INCREASE of demodex mites "Patients enrolled in subgroup A received only external therapy with a drug containing 1% ivermectin in the form of a cream 1 time per day for 30 days. Patients enrolled in subgroup B received a drug containing 250 mg of metronidazole systemically 2 times a day, externally 1% metronidazole in the form of a gel 1 time per day for 30 days. A repeat visit of the patients took place after 30 days of continuous therapy. Subjectively, treatment regimens of patients were well tolerated, no side effects were noted, no patient was excluded from the study. When comparing the efficacy of the therapy, it was found that statistically significantly more Demodex mites were found after treatment with confocal laser scanning in vivo microscopy (P≤0.05) (Table 7).  The above is significant news. However, the patients nevertheless improved their rosacea in 30 days and the report concluded:  "Analysis of the clinical picture showed a positive dynamics of therapy, which manifested itself in a significant decrease in the number of morphological elements characterizing the severity of inflammation (P≤0.05). The effectiveness of the therapy was confirmed by a reduction in subjective complaints of patients after the treatment, and patients who received only external therapy had no complaints of a feeling of lusters of skin and the appearance of greasy lusters, which is an additional advantage." You can read the entire Russian paper yourself here:  Dermatol Reports. 2019 Jan 23; 11(1): 7675.Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mitesAlexey Kubanov, Yuliya Gallyamova, and Anzhela Kravchenko
    • The gold standard treatment for rosacea includes Soolantra (1% ivermectin) along with Oracea. Learn more. 
    • Nanoemulsion strategy of pioglitazone for the treatment of skin inflammatory diseases. Nanomedicine. 2019 Apr 17;: Authors: Espinoza LC, Silva-Abreu M, Calpena AC, Rodríguez-Lagunas MJ, Fábrega MJ, Garduño-Ramírez ML, Clares B Abstract Pioglitazone (PGZ) is a peroxisome proliferator-activated receptor agonist. Its role in the inflammatory response modulation opens the door for additional therapeutic applications. The purpose of this study was to develop a pioglitazone nanoemulsion (PGZ-NE) to investigate its anti-inflammatory efficacy on the skin. For that a NE vehicle aimed for skin delivery was optimized and characterized. The resulting PGZ-NE showed a good anti-inflammatory efficacy by decreasing the expression of adipose inflammatory cytokines IL-6, IL-1β and TNF-α. The properties of the developed nanocarrier allowed achieving a high permeation flux of PGZ through the skin as well as high retained amount in the skin, probably due to the depot effect of ingredients, which assured a prolonged local action, with good skin tolerability among participating individuals. Consequently, these results suggest that PGZ-NE may be used as an alternative treatment for inflammatory skin diseases such as rosacea, atopic dermatitis or psoriasis. PMID: 31004811 [PubMed - as supplied by publisher] {url} = URL to article
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