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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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  • Posts

    • [Idiopathic facial aseptic granuloma: A case report]. Arch Argent Pediatr. 2019 Feb 01;117(1):e56-e58 Authors: Garais JA, Bonetto VN, Frontino L, Salduna MD, Ruiz Lascano A Abstract
      Idiopathic facial aseptic granuloma is a childhood condition characterized by asymptomatic erythematous-violaceous nodules, often confused with abscesses. Its pathogenesis is unknown, but some authors have postulated its relationship with infantile rosacea. We present a case of a patient with a clinical diagnosis of idiopathic facial aseptic granuloma, with ocular involvement and a good response to oral metronidazole treatment.
      PMID: 30652457 [PubMed - in process] {url} = URL to article
    • Rosacea: Relative risk vs Absolute Risk of Malignant Comorbidities. J Am Acad Dermatol. 2019 Jan 14;: Authors: Tjahjono LA, Cline A, Huang WW, Fleischer AB, Feldman SR PMID: 30654083 [PubMed - as supplied by publisher] {url} = URL to article
    • Trigger, tripwire, flareup and flush. These are probably the four most common terms used when discussing rosacea. Because of poor communication and rosaceans not understanding what there terms actually mean much confusion results, adding to the already confusing dilemma of rosacea understanding. So to set the record: 

      Flare up according to the NRS is "a more intense outbreak of redness, bumps or pimples.."  

      Tripwire or Trigger is the same thing according to the NRS who uses these words interchangeably and states that both terms mean, "factors that may cause a rosacea sufferer to experience a flare-up—a more intense outbreak of redness, bumps or pimples. [1]

      A medical dictionary source defines flush as: flush 1. transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. See also erythema. [2]

      A blush is a flush usually caused by psychological factors. A flush can be caused by a any number of factors as noted above including psychological factors. 

      The reason this is brought up is that while most rosaceans confuse flushing with a flare up there are rosaceans who report having a flare up of rosacea and DO NOT FLUSH. These ones are admittedly fewer in number, and flushing is usually associated with a flare up, but nevertheless demonstrates that flushing is not necessarily a rosacea flare up. One could flush or blush and the skin returns to normal in a rosacea sufferer. Flushing does not NECESSARILY mean a rosacea flare up and it only means that it MAY produce a rosacea flare up. Those who think flushing is rosacea is like thinking pimples mean you have rosacea (or for that matter, believing that erythema is rosacea). There is more to a diagnosis of rosacea than simply having pimples and erythema (see Diagnosis). For example, one could have erythema and have Atopic Dermatitis, not rosacea.  Flushing is one of the signs or symptoms usually associated with rosacea, but not necessarily required. Pimples are associated with rosacea but not necessarily required, i.e., Phenotype 2. Rosacea is always associated with redness or erythema.  Hopefully, if rosaceans understand these terms, trigger, tripwire, flareup and flush better, we will all be on the same page when we discuss rosacea. 

      End Notes

      [1] Coping With Rosacea, National Rosacea Society, page 1

      [2] Dorland’s Illustrated Medical Dictionary
    • Trends in Oral Antibiotic Prescription in Dermatology, 2008 to 2016. JAMA Dermatol. 2019 Jan 16;: Authors: Barbieri JS, Bhate K, Hartnett KP, Fleming-Dutra KE, Margolis DJ Abstract
      Importance: Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and this use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events.
      Objective: To characterize the temporal trends in the diagnoses most commonly associated with oral antibiotic prescription by dermatologists, as well as the duration of this use.
      Design, Setting, and Participants: Repeated cross-sectional analysis of antibiotic prescribing by dermatologists from January 1, 2008, to December 31, 2016. The setting was Optum Clinformatics Data Mart (Eden Prairie, Minnesota) deidentified commercial claims data. Participants were dermatology clinicians identified by their National Uniform Claim Committee taxonomy codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes.
      Exposures: Claims for oral antibiotic prescriptions were consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit. Courses were stratified into those of extended duration (>28 days) and those of short duration (≤28 days).
      Main Outcomes and Measures: Frequency of antibiotic prescribing and associated diagnoses. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time.
      Results: Between 2008 and 2016 among 985 866 courses of oral antibiotics prescribed by 11 986 unique dermatologists, overall antibiotic prescribing among dermatologists decreased 36.6% (1.23 courses per 100 visits) from 3.36 (95% CI, 3.34-3.38) to 2.13 (95% CI, 2.12-2.14) courses per 100 visits with a dermatologist (prevalence rate ratio for annual change, 0.931; 95% CI, 0.930-0.932), with much of this decrease occurring among extended courses for acne and rosacea. Oral antibiotic use associated with surgical visits increased 69.6% (2.73 courses per 100 visits) from 3.92 (95% CI, 3.83-4.01) to 6.65 (95% CI, 6.57-6.74) courses per 100 visits associated with a surgical visit (prevalence rate ratio, 1.061; 95% CI, 1.059-1.063).
      Conclusions and Relevance: Continuing to develop alternatives to oral antibiotics for noninfectious conditions, such as acne, can improve antibiotic stewardship and decrease complications from antibiotic use. In addition, the rising use of postoperative antibiotics after surgical visits is concerning and may put patients at unnecessary risk of adverse events. Future studies are needed to identify the value of this practice and the risk of adverse events.
      PMID: 30649187 [PubMed - as supplied by publisher] {url} = URL to article
    • Exploring the potential for rosacea therapeutics of siRNA dispersion in topical emulsions. Exp Dermatol. 2019 Jan 16;: Authors: Colombo S, Harmankaya N, Water JJ, Bohr A Abstract
      Rosacea is a prevalent skin condition dependent on the individual genetic profile. The current pharmacological management of this condition is mostly based on small molecule drugs predominately effective in ameliorating the inflammatory condition. Emerging molecular approaches could present an opportunity for managing rosacea conditions at transcriptomic level, and in the future allow personalized approaches. RNA medicines, such as small RNA interference (siRNA), could provide a flexible and applicable tool reaching this aim. However, the topical siRNA delivery by dermatological emulsions, commonly used in the daily management of rosacea, is still largely unexplored. Consequently, RNA interference application to rosacea was defined on molecular bases by genetic expression meta-data analysis. Based on this, an siRNA directed against TLR2 was designed and validated in vitro on murine macrophages and fibroblasts. Next, siRNA was dispersed in the continuous phase of emulsions and was characterized for commonly used dermatologic bases. Finally, the potential delivery performance of the topical emulsions was tested in vivo on healthy Balb/c mice. It was found that the interaction of siRNA with combination of excipients such as urea and glycerol, is likely to favor the siRNA delivery, inducing genetic silencing of TLR2. These findings provide a foundation for the future development of topical RNA-based dispersions for topical molecular medicines, by emphasizing on the formulation and therapeutic-based opportunities with dermatological treatments. This article is protected by copyright. All rights reserved.
      PMID: 30650201 [PubMed - as supplied by publisher] {url} = URL to article
    • At CES 2019, there is a new light device mentioned by Gizmodo , the Opté’s beauty wand and all you do is watch this video below to see how it works:  If anyone purchases one of these wands, please post your results in this thread. Becky gives a review of the wand here. 
    • "Photodynamic therapy is mainly used in dermatology to treat skin tumors, precancerous lesions, and condyloma acuminatum. Due to its excellent tissue selectivity, easy operation and good cosmetic effect, it has been gradually applied to the treatment of various non-neoplastic skin diseases, such as verruca acuminata, acne, rosacea, chronic skin ulcer, fungal diseases, keloid, and so on." Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Dec 28;43(12):1380-1383. doi: 10.11817/j.issn.1672-7347.2018.12.016.
      Advancement in phodynamic therapy for non-neoplastic skin diseases.
      [Article in Chinese; Abstract available in Chinese from the publisher]
      Zhan Y, Xiao R, Zhang Z.
       
    • Related Articles [Advancement in phodynamic therapy for non-neoplastic skin diseases]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Dec 28;43(12):1380-1383 Authors: Zhan Y, Xiao R, Zhang Z Abstract
      Photodynamic therapy is mainly used in dermatology to treat skin tumors, precancerous lesions, and condyloma acuminatum. Due to its excellent tissue selectivity, easy operation and good cosmetic effect, it has been gradually applied to the treatment of various non-neoplastic skin diseases, such as verruca acuminata, acne, rosacea, chronic skin ulcer, fungal diseases, keloid, and so on. Here is the review on the advancement in photodynamic therapy for non-neoplastic skin diseases.
      PMID: 30643057 [PubMed - in process] {url} = URL to article
    • As you can see, Stephan_J wrote the OP November 27, 2017 and never replied to my question. You can purchase Arquebuse Water from skinsentials, a company in Australia and it is pricey. If you purchase and try it, please post your results in this thread. Wish Amazon would sell it. I haven't tried Amazon Australia. 
    • Acyclovir, an antiviral medication, has been used to treat rosacea and the results according to one paper is "a patient with rosacea who was completely symptom free during two courses of treatment with acyclovir, which was prescribed for the patient’s herpes..." [1]. Acyclovir has been used to treat Pityriasis rosea, a type of skin rash, reported in one paper that may be effective. [2] Nellukas, at RF reports taking two 200 mg tablets twice daily after meals and states, "To my surprise, rosacea started to recede a few days after I started the regimen!!" End Notes [1] American Journal of Clinical Dermatology
      December 2017, Volume 18, Issue 6, pp 845–846 • Full Text 
      Improvement of Rosacea During Acyclovir Treatment: A Case Report
      Zohreh Sadat Badieyan, Sayed Shahabuddin Hosein [2] J Am Acad Dermatol. 2006 Jan;54(1):82-5.
      Use of high-dose acyclovir in pityriasis rosea.
      Drago F, Vecchio F, Rebora A.
    • What type of Rosacea you have had Stephan_J What phenotype?  
    • Clinical effectiveness of novel rosacea therapies. Curr Opin Pharmacol. 2019 Jan 10;46:14-18 Authors: Feaster B, Cline A, Feldman SR, Taylor S Abstract
      Rosacea is a common inflammatory skin disease that is difficult to manage because of the unknown etiology and due to its variable manifestations. These facts and the few new available treatment options make it difficult to select a really effective treatment. This review aims to assess the efficacy and safety of novel treatment options for rosacea. The topical alpha adrenergic agonist oxymetazoline reduces rosacea-related erythema. Topical ivermectin improves lesion count, inflammation, and maintenance of remission of rosacea compared to topical metronidazole. Procedural therapies including pulsed dye laser, radiofrequency, and dual frequency ultrasound are promising as both monotherapies or in combination. Although there are several effective treatment modalities for rosacea management, treatments options should be tailored for the specific clinical scenario.
      PMID: 30639950 [PubMed - as supplied by publisher] {url} = URL to article
    • Classifying signs and symptoms of dry eye disease according to underlying mechanism via the Delphi method: the DIDACTIC study. Br J Ophthalmol. 2019 Jan 12;: Authors: Labetoulle M, Bourcier T, Doan S, DIDACTIC group Abstract
      BACKGROUND/AIMS: Dry eye disease (DED) is categorised by pathophysiology as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE) or mixed. Treatment should be tailored to DED pathophysiology, but this is challenging to determine. This Delphi consultation aimed to categorise and weight signs and symptoms to help identify the evaporative or aqueous deficient DED origin.
      METHODS: A panel of French DED experts created an initial list of 77 DED signs and symptoms. In a Delphi consultation, experts categorised items by DED pathophysiology. Likert scoring was used to indicate whether items were strongly or moderately indicative of ADDE or EDE. Items could also be judged non-applicable to DED, with the opportunity to suggest alternative diagnoses.
      RESULTS: Experts attributed 19 items (of which 11 were strongly indicative) to a pathophysiology of EDE and 12 items (of which four were strongly indicative) to ADDE. Items scored strongly indicative with agreement >90% for EDE were previous chalazia, rosacea/rhinophyma, telangiectasias of eyelid margin and thick non-expressible meibomian gland secretions, and for ADDE were Sjögren syndrome or associated disease, and Schirmer <5 mm after 5 min (without anaesthesia). Seventeen items indicated neither pathophysiology and 18 items were found to be suggestive of alternative diagnoses.
      CONCLUSIONS: This Delphi consultation categorised signs and symptoms, using an innovative weighting system to identify DED pathophysiology. An algorithm integrating the weighting of each sign and symptom of an individual patient would be valuable to help general ophthalmologists to classify the DED subtype and tailor treatment to DED underlying mechanism.
      PMID: 30636211 [PubMed - as supplied by publisher] {url} = URL to article
    • Lucy at RF reports taking these three oral non prescriptions that she says helps:  Viralex BePure (NZ brand) Omega 3 BePure Probiotic  Fish Oil plus vitamins 
    • Related Articles Recent advances in understanding and managing rosacea. F1000Res. 2018;7: Authors: Buddenkotte J, Steinhoff M Abstract
      Rosacea is a common chronic inflammatory skin disease of the central facial skin and is of unknown origin. Currently, two classifications of rosacea exist that are based on either "preformed" clinical subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) or patient-tailored analysis of the presented rosacea phenotype. Rosacea etiology and pathophysiology are poorly understood. However, recent findings indicate that genetic and environmental components can trigger rosacea initiation and aggravation by dysregulation of the innate and adaptive immune system. Trigger factors also lead to the release of various mediators such as keratinocytes (for example, cathelicidin, vascular endothelial growth factor, and endothelin-1), endothelial cells (nitric oxide), mast cells (cathelicidin and matrix metalloproteinases), macrophages (interferon-gamma, tumor necrosis factor, matrix metalloproteinases, and interleukin-26), and T helper type 1 (T H1) and T H17 cells. Additionally, trigger factors can directly communicate to the cutaneous nervous system and, by neurovascular and neuro-immune active neuropeptides, lead to the manifestation of rosacea lesions. Here, we aim to summarize the recent advances that preceded the new rosacea classification and address a symptom-based approach in the management of patients with rosacea.
      PMID: 30631431 [PubMed - in process] {url} = URL to article
    • Sure,   No worries mate I didn't know where to put it myself, just wanted to reach as many people as possible. If even one person try this way because he /she reads my testimony and will feel better after that would be great. Also if somebody has similiar expieriences it would be great that we can share it.  
    • RedMage,  Welcome to the RRDi forum. You have a detailed history and it appears you are coming closer to regulating your flushing better. We posted about Colin Dahl's paper here in November 2017.  I have collected together a list of treatments used for flushing avoidance, if you haven't read this page already. There a number of other posts in the following:  Forum Home >  Forums > Public Forum > Rosacea Topics > Trigger Avoidance > Blushing & Flushing Triggers There is a thread at RF with a similar theme, Warm room flush theory revisited. If you would permit me, I think your post should be in the above category rather than in Rosacea in Remission since you seem to still have rosacea not completely in remission. Let me know if that is ok with you. 
    • Hi all, This will be my first post on this forum so I will start with short version of my story as a Rosacea sufferer.                    Normally I m living in Poland and I have been living in Australia for almost a year now. I started to notice that I have problems with this condition when I was 16 (today I have 32, so this is a long-standing problem). During this time, I tried many available therapies prescribed to me by doctors, dermatologists or found on the internet. I lost a lot of money and time on creams, tablets, lasers  (I had over 20 IPLs alone). Nothing helped in the long run. In the case of creams even worsened the case because at the moment I am not able to take any even delicate creams without hugly increasing my redness. Lasers could help mildly for a while but later the cheeks returned to their initial state. The tablets helped with flushing but the side effects could be very unpleasant and the red color remained. Some of the medications were able to exacerbate my condition. And with this short intruduction behind us lets go to the main dish.                       Observing my condition over the years, I noticed that my condition is improving during the summer period and worsens during autumn and winter. I thought it must be related to the amount of sun, so whenever I could I was exposing to the sun's rays. Tan actually partially concealed my ailment, although when it came down my skin was even worse than before. Last year, I went on a work & holiday visa to Australia, I chose Brisbane as a destination because I wanted my skin to get as much sun as possible and stay tanned all the time.
      As I quickly learned, because the sun here in Australia is much more biting, it was not the right approach. And mostly I was staying red all the time.
      During that time, at the forum rosaceagroup.org, I read the article "Warm room flush theory revisited" which directed to Colin Dahl's book "HEAT REGULATION AND THE WARM ROOM FLUSH PHENOMENON"
      The author is / was also rosacea sufferer. However, he managed to overcome his illness with the help of the regime he introduced. What is important is doesn't cost money, no wonderful creams or medicines. Even a laser is an optional matter here. However, my observations and Colin's observations are very convergent.                        I also wrote to him on LinkedIn to find out more details and he was so kind that he answered my questions and meticulously answered all of them.
      I started applying the regimen from September 2018, now 4 months of testing are behind me. Unfortunately, due to my work and housing conditions, I am not able to 100% stick to the presented regime. I stopped using chemistry and replaced it with an unscented soap, the same with sunscreen. A simple cream with zinc or zinc oxiade, at least SPF 30+. I trying to make the temperature in the room in which I sleep did not fall below 22 degrees. I also avoid staying in places where there are major temperature changes. This is not easy. I would say it is actually very hard. Ithink I making the plan is about 50%. The effects, however, are visible now and it seems to me that these are the best effects I have ever had even after using the most expensive lasers were not half as good.                       First of all, flushing was practically eliminated. I remember only 2 such attacks recently, but it was due to the fact that for 2 weeks I was on a trip in Cruise Ship in the South Pacific and the temperature between the islands and the air-conditioned interior plus wind and that I did not watch too well to the regime caused that after these two weeks I had this problems.
      The skin seems calmer although Its still far from its natural color (compering with the color on forehead for instance). For this I have to reduce the infrastructure of blood vessels and reverse angiogenesis. According to the author, it took him 18 months so surely I have a long way to go. Though if I will be able after I return to Poland to sustain even this result my life would be so much better compared to that it used to be. Please let me know if any of you also were trying this approach or for any other questions.   
    • There is a clinical trial going on using PAC-14028 Cream for Atopic Dermatitis (Eczema) being done by Amorepacific Corporation. Initial results seem promising [1].  End Notes  [1] British Journal of Dermatology
      Efficacy and safety of PAC‐14028 cream – a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild‐to‐moderate atopic dermatitis: a phase IIb randomized trial
      Y.W. Lee  C.‐H. Won  K. Jung  H.‐J. Nam  G. Choi  Y.‐H. Park  M. Park  B. Kim
    • red devil at RF [Post no 55] found another treatment using TXA, DERMO PHARMA DNA CREAM TRANEXAMIC ACID + COLLAGEN, by Dermapharma (Switzerland), which we await the results. 
    • Lasers Surg Med. 2018 Oct 12. doi: 10.1002/lsm.23023. [Full Text with pictures]
      The toxic edge-A novel treatment for refractory erythema and flushing of rosacea.
      Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O.

      Abstract
      PURPOSE:
      Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. The primary objective of the study was the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system (Tixel, Novoxel, Israel) to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea.
      METHODS:
      A retrospective review of16 patients aged 23-45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100 U of abobotulinumtoxin. A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment. Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA), and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument.
      RESULTS:
      The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a P-value <0.001). DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P < 0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping.
      CONCLUSION:
      Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
    • Related Articles Nickel Sensitivity In Rosacea Patients: A Prospective Case Control Study. Endocr Metab Immune Disord Drug Targets. 2019 Jan 01;: Authors: Çifci N Abstract
      BACKGROUND: Rosacea is a frequently seen chronic disease that allergens, some foods and beverages are known to trigger symptoms of rosacea.
      OBJECTIVE: We aimed to assess if nickel sensivity is more common in rosacea patients than normal population.
      METHOD: Fourty patients with rosacea and 40 healthy age and sex matched volunteers were included in the study. From European standard patch test series, test units with nickel were applied on the skin of the upper back. According to the scheme of the International Contact Dermatitis Research Group (ICDRG), test results were evaluated at 48th, 72th and 96th hours. Seven days later, reevaluation was done for late reactions. Statistical analyses were done by using Statistics package for Social Sciences (SPSS) 17 package program and p<0.05 was accepted as statistically significant.
      RESULTS: Female/male ratio was 34/6 in patient group and 32/8 in control group. Mean age of patient group and the control group were 39.97±12.65 (18-65 years), 40.82±11.79 (19-68 years), respectively. Age and sex distributions were found to be statistically similar. Nickel allergy in the patient and control group was found to be 52.5%, 22.5% respectively and the difference between groups was statistically significant (p=0. 006).
      CONCLUSION: Our results showed that there may be an association between nickel sensitivity and rosacea. Nickel sensitivity may be one of the underlying pathology or a triggering factor of the rosacea. Nickel restricted diet and avoiding use of nickel containing jewellery and piercings, may extend the remission periods.
      PMID: 30621570 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Melkersson-Rosenthal syndrome: a case report of a rare disease with overlapping features. Allergy Asthma Clin Immunol. 2019;15:1 Authors: Cancian M, Giovannini S, Angelini A, Fedrigo M, Bendo R, Senter R, Sivolella S Abstract
      Background: Melkersson-Rosenthal syndrome (MRS) is a rare, neuro-mucocutaneous disease which presents as orofacial swelling, facial palsy and fissured tongue. These symptoms may occur simultaneously or, more frequently, with a oligosymptomatic or monosymptomatic pattern. Swelling, that is the most common initial finding, may mimic hereditary or acquired angioedema, a disorder caused by histamine or bradykinin-mediated plasma-leakage affecting subcutaneous and/or submucosal tissue. The differential diagnosis of MRS includes also chronic inflammatory and infective diseases characterized by granulomatous infiltration, as well as rosacea, contact dermatitis, allergic reactions and Bell's palsy.
      Case presentation: A 71-year old, non-allergic female patient with no familial and personal history of angioedema presented, a few days after a possible herpes simplex or varicella-zoster virus infection, with monolateral facial paraesthesia and lower lip edema. After temporary remission of symptoms on oral steroids and antihistamines, she showed swelling recurrence refractory to valaciclovir therapy and a subsequent course of antihistamines. The clinical picture and a previous history of non-Hodgkin lymphoma prompted us to rule out an acquired form of paraneoplastic, C1-inhibitor (C1-INH) deficiency: C1q and both antigen and functional C1-INH tested normal, whilst we found low plasma levels of C3 and C4 possibly related to the parallel detection of antiphospholipid antibodies. Thus, we hypothesized a non-histaminergic, idiopathic form of angioedema and planned further therapy with tranexamic acid and the leukotriene receptor antagonist montelukast. Treatment failure with both drugs finally suggested a Melkersson-Rosenthal syndrome, which was confirmed by histologic findings of non caseating granulomas on lip biopsy.
      Conclusion: Melkersson-Rosenthal syndrome may occur with rather non-specific symptoms and overlap with alternative conditions, including recurrent angioedema. No specific biomarkers for MRS exist and clinical diagnosis is often of exclusion. The finding of complement or immune alterations, as in our patient, may be further confounding and justify the need for skin or mucosal biopsy to establish a correct diagnosis and prescribe targeted therapy.
      PMID: 30622569 [PubMed] {url} = URL to article
    • Discovered Acne and Rosacea Society of Canada website which says on its 'about us' page:  "The Acne and Rosacea Society of Canada, a national, not for profit organization led by Canadian dermatologists, offers hope and help to sufferers by providing independent, reputable and current information on these conditions and raising awareness." On its Corporate Sponsor page it shows Galderma as a Silver Level sponsor, Bayer Cipher Pharmaceuticals as a Bronze level, and Altius Healthcare as a Friend level. We will be monitoring and reviewing this Canadian non profit and investigate what it spends its funds on and report in this thread. 
    • How is the treatment going now?
    • You've done a great job. It looks really good.
    • Thank you very much for your analysis. It's very useful.
    • The RRDi has established a LinkedIn company page. 
    • Related Articles Dermoscopy of Common Inflammatory Disorders. Dermatol Clin. 2018 Oct;36(4):359-368 Authors: Sgouros D, Apalla Z, Ioannides D, Katoulis A, Rigopoulos D, Sotiriou E, Stratigos A, Vakirlis E, Lallas A Abstract
      In addition to its "traditional" application for the early diagnosis of melanoma and nonmelanoma skin cancers, dermoscopy gains appreciation in fields beyond dermato-oncology. Nowadays, dermoscopy has been established as a reliable adjunctive tool to the everyday clinical practice of general dermatology. Morphology and distribution of vascular structures, background colors, follicular abnormalities, and the presence of scales are important features that should be evaluated. Clinical examination remains the undoubted mainstay of diagnosis in inflammatory and infectious diseases.
      PMID: 30201145 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Microneedling with Biologicals: Advantages and Limitations. Facial Plast Surg Clin North Am. 2018 Nov;26(4):447-454 Authors: Duncan DI Abstract
      Microneedling is a popular and cost-effective treatment with little down time. The application of topical agents to enhance outcomes is common practice. Microchannels created with nonthermal needling close at 4 hours to 6 hours due to fibrin plugs. Channels created with thermal needling or fractional laser stay open longer and enhance drug or biological uptake more due to the dermal sponge injury pattern that is created. Nonthermal microneedling devices may need Food and Drug Administration clearance, which also notes that dermaceuticals should be considered drugs in many cases.
      PMID: 30213426 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Morbihan disease: treatment difficulties and diagnosis: a case report. Pan Afr Med J. 2018;30:226 Authors: Aboutaam A, Hali F, Baline K, Regragui M, Marnissi F, Chiheb S Abstract
      Morbihan disease (MD) is a rare entity. Its nosography is unclear and its therapeutic management is difficult. We report a new case of MD. We report a case of a 51-year-old patient consulted in our department for a one year facial edema, erythema and papules reported by him, for which the patient was treated with cyclins, local and general corticotherapy, without improvement. The clinical examination found an important edema of the front and eyelids with an erythema of the cheeks covered with a few telangiectasias. The clinical, biological and histological findings lead to a diagnosis of Morbihan disease after excluding other diseases. Due to previous therapeutic failures, the patient was put on isotretinoin and furosemide with slight improvement. The particularity of our observation lies in the rarity and especially in the therapeutic difficulties encountered during this disease.
      PMID: 30574244 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Apparently the club feature allows you to setup your own 'club' or blog and totally control it yourself. You have to be a member of the RRDi to do this but you can make it totally public and allow anyone to comment a reply, so that means anyone could put whatever they want, which may mean I will change this later to RRDi members only can comment. So let's see what happens. 
    • Gallo et al whose research published in Nature Medicine in 2007 that suggested "an explanation for the pathogenesis of rosacea by demonstrating that an exacerbated innate immune response can reproduce elements of this disease" involving cathelicidin (particularly Peptide LL-37), Vitamin D3, and Alarmins has applied for a patent (United States Patent Application 20160030386), PREVENTION OF ROSACEA INFLAMMATION. [1] The patent is a long read and not for the timid or shy to read through. The nutshell version is a patent for treating rosacea inflammation with mast cell stabilizers, (ie., lodoxamide, nedocromil, cromolyn, pemirolast, pharmaceutical salts), as well as, neuropetide antagonists, a serine protease inhibitor,  a vitamin D3 antagonist, including combinations of these treatments.  End Notes [1] Images and tables/graphs with results
      http://www.freepatentsonline.com/20160030386.pdf
    • Of course, not all skin care trends are bad news, said Dhaval Bhanusali, a dermatologist in New York. "I don't think people should ignore trends, but they should always proceed with caution," he told INSIDER. "Just because something worked for one person, doesn't mean it will work for another. You have to be careful." 10 popular skin-care trends dermatologists say you should avoid
      Maddy Sims, Business Insider
    • There is a new cheap treatment using tranexamic acid solution (Transamin inj/sol 500 mg/5 mL) infused wet dressing for erythematotelangiectatic rosacea. The results of an unblinded study of 20 patients resulted with "All patients were improved in the end of the therapy....The improvement lasted more than four months." [1] Another clinical paper on TXA says, "Finally, TXA repressed the angiogenesis by reducing the number of CD31+ cell and downregulating the expression levels of VEGF in rosacea. In conclusion, our finding defines a treatment mechanism by which TXA ameliorates rosacea symptoms by regulating the immune response and angiogenesis." [2] Microneedling with tranexamic acid solution was an effective treatment for women with erythematotelangiectatic rosacea, according to late-breaking research presented at the American Academy of Dermatology Annual Meeting. [3] "Topical tranexamic acid could improve the epidermal permeability barrier function and clinical signs of rosacea, likely resulting from inhibition of PAR-2 activation and consequent calcium influx. Thus, tranexamic acid could serve as an adjuvant therapy for rosacea." [4] "Taken together, we report that TA solution soaking is an easy, safe and non-costly approach to improve skin rosacea rapidly, although further randomized controlled trials should be conducted." [5] "Also, recent studies demonstrated that tranexamic acid inhibits epidermal PAR-2 expression which is elevated in rosacea patients (Zhong et al., 2015). Taken together, these results suggest that combination treatment of minocycline, propranolol, and tranexamic acid may be a possible strategy for treatment of rosacea, especially that involving severe flushing, refractory erythema, and sen- sitive skin." [6] We have started a list of TXA over the counter products available through our Amazon Affiliate program if you scroll down to the second comment in this post. A thread at RF discusses this subject. Any new information will be posted in this thread. If you have something to add please reply to this thread. In this thread, jrlhamcat2 [post no 47] reports, "I've soaked one side of my face about 6 times over around 10 days now. My skin has been getting less red and the flushing has been less frequent and less intense, but on both sides of my face, not just the one I've been treating." DERMO PHARMA DNA CREAM TRANEXAMIC ACID + COLLAGEN, by Dermapharma (Switzerland) [7] End Notes [1] J Cosmet Dermatol. 2018 Aug 11;:
      The new therapeutic choice of tranexamic acid solution in treatment of erythematotelangiectatic rosacea.
      Bageorgou F, Vasalou V, Tzanetakou V, Kontochristopoulos G [2] Int Immunopharmacol. 2018 Dec 19;67:326-334
      Tranexamic acid ameliorates rosacea symptoms through regulating immune response and angiogenesis.
      Li Y, Xie H, Deng Z, Wang B, Tang Y, Zhao Z, Yuan X, Zuo Z, Xu S, Zhang Y, Li J [3] Microneedling with tranexamic acid solution
      By Admin, March 8, 2017 in Rosacea in the News, RRDi Forum [4] DERMATOLOGICA SINICA 33 (2015) 112e117
      Topical tranexamic acid improves the permeability barrier in rosacea
      Shaomin Zhong, Nan Sun, Huixian Liu, Yueqing Niu, Can Chen, Yan Wu [5] Letters to the Editor, 40 (1), Pages 70-71, (2012) The Journal of Dermatology, Japanese Dermatological Association 
      Tranexamic acid solution soaking is an excellent approach for rosacea patients: A preliminary observation in six patients
      Myoung Shin KIM, Sung Eun CHANG, Sik HAW, Hana BAK, Youn Jin KIM, Mi Woo LEE [6] Dermatologic Therapy, 30(3), e12439. doi:10.1111/dth.12439. August 2016
      Combination treatment of propranolol, minocycline, and tranexamic acid for effective control of rosacea
      Kwon, H. J., Suh, J. H., Ko, E. J., & Kim, B. J.  [7] See fourth post in this thread
    • Wouldn't be surprised that the one of the 'online forums' was RF since this has been discussed frequently as an alternative to Soolantra. 
    • Misuse of veterinary wormers in self-medication of rosacea and scabies. Br J Dermatol. 2018 Dec 30;: Authors: Hellen R, Ní Raghallaigh S Abstract
      Dermatology patients are increasingly well informed about chronic skin conditions such as rosacea. Online forums are a popular way for patients to discuss treatments ranging from prescription drugs to alternative medicines. The introduction of topical ivermectin 1% has recently gained traction in these forums. We report a patient with papulopustular rosacea who had an excellent response to topical ivermectin 1% cream. This article is protected by copyright. All rights reserved.
      PMID: 30597520 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Interventions for rosacea based on the phenotype approach: An updated systematic review including GRADE assessments. Br J Dermatol. 2018 Dec 26;: Authors: van Zuuren EJ, Fedorowicz Z, Tan J, van der Linden MMD, Arents BWM, Carter B, Charland L Abstract
      BACKGROUND: Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping.
      OBJECTIVES: Updating our systematic review on interventions for rosacea.
      METHODS: We searched: CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index, and ongoing trials registers (March 2018) for randomised controlled trials. Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. GRADE was used to assess certainty of evidence.
      RESULTS: We included 152 studies (46 were new), comprising 20,944 participants. Topical interventions included: brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included: oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light-based treatment. We present the most current evidence for rosacea management based on a phenotype-led approach.
      CONCLUSIONS: For reducing temporarily persistent erythema: there was high certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia: low to moderate certainty evidence for laser and intense pulsed light therapy. This article is protected by copyright. All rights reserved.
      PMID: 30585305 [PubMed - as supplied by publisher] {url} = URL to article
    • Insights into the Role of ER Stress in Skin Function and Associated Diseases. FEBS J. 2018 Dec 26;: Authors: Park K, Lee SE, Shin KO, Uchida Y Abstract
      Endoplasmic reticulum (ER) stress is a mechanism that allows to protect normal cellular functions in response to both internal perturbations, such as accumulation of unfolded proteins, and external perturbations, for example redox stress, UVB irradiation, and infection. A hallmark of ER stress is the accumulation of misfolded and unfolded proteins. Physiological levels of ER stress trigger the unfolded protein response (UPR) which is required to restore normal ER functions. However, the UPR can also initiate a cell death program/apoptosis pathway in response to excessive or persistent ER stress. Recently, it has become evident that chronic ER stress occurs in several diseases, including skin diseases like Darier's disease, rosacea, vitiligo, and melanoma; furthermore, it is suggested that ER stress is directly involved in the pathogenesis of these disorders. Here, we review the role of ER stress in skin function, and discuss its significance in skin diseases. This article is protected by copyright. All rights reserved.
      PMID: 30586218 [PubMed - as supplied by publisher] {url} = URL to article
    • Epidemiology of benign essential blepharospasm: A nationwide population-based retrospective study in Taiwan. PLoS One. 2018;13(12):e0209558 Authors: Sun Y, Tsai PJ, Chu CL, Huang WC, Bee YS Abstract
      IMPORTANCE: This study provides a nationwide, population-based data on the incidence of benign essential blepharospasm in Asian adults.
      BACKGROUND: To describe the incidence, patient demographics, and risk factors associated with benign essential blepharospasm.
      DESIGN: Population-based retrospective study.
      PARTICIPANTS AND SAMPLES: A total of 1325 patients with benign essential blepharospasm were identified.
      METHODS: Patients with diagnosis of blepharopsasm between January 2000 and December 2013 were sampled using the Longitudinal Health Insurance Database 2000. Secondary blepharospasm that may be related to neurological, trauma, and ocular surface disease were excluded.
      MAIN OUTCOME MEASURED: Multivariate conditional logistic regression was used to estimate the odds ratios for potential risk factors of benign essential blepharospasm.
      RESULTS: The mean annual incidence was 0.10‰ (0.07‰ for males, and 0.12‰ for females). The peak incidence was in the 50 to 59-year-old age group (0.19‰). People living in urban regions have more risk of developing blepharospasm comparing to people living in less urban regions (p <0.01). White-collar workers also have higher chance of having blepharospasm (p<0.001). Significant difference between control group and case group in hyperlipidemia (p <0.001), sleep disorders (p <0.001), mental disorders (depression, anxiety, obsessive compulsive disorder) (p <0.001), dry eye-related diseases (dry eye, Sjögren's syndrome) (p <0.001), Parkinson's disease (p <0.004), and rosacea (p <0.021) were also identified.
      CONCLUSIONS AND RELEVANCE: Higher level of urbanization, white-collar work, sleep disorders, mental health diseases, dry eye-related diseases, Parkinsonism, and rosacea are possible risk factors for benign essential blepharospasm.
      PMID: 30586395 [PubMed - in process] {url} = URL to article
    • What an oddity, since the study concluded, "In summary, based on a large, well-established cohort, we provide evidence in US women that past smoking is associated with an increased risk of rosacea, while current smoking is associated with a decreased risk of rosacea."  
    • "A paste made from TXA tablets offers similar hemostatic benefits of topical IV TXA administration and provides another option for drug delivery. Pastes may be easier to apply to, and/or remain on, certain anatomic locations." Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis, ALiEM For more info about using TXA read this post.  jrlhamcat2 writes about the TXA paste mentioned above, "They're crushing pills to make a paste to stop bleeding in emergency situations. That's a much stronger concentration that has been used topically for rosacea and seems potentially risky. A 3% or 5% solution will be a clear liquid."  
    • Related Articles Tranexamic acid ameliorates rosacea symptoms through regulating immune response and angiogenesis. Int Immunopharmacol. 2018 Dec 19;67:326-334 Authors: Li Y, Xie H, Deng Z, Wang B, Tang Y, Zhao Z, Yuan X, Zuo Z, Xu S, Zhang Y, Li J Abstract
      Rosacea is a chronic inflammatory cutaneous disease characterized by immune system anomalies and vascular hyperreactivity. Recently, therapy of rosacea has improved substantially with the approval of Tranexamic acid (TXA), an antifibrinolytic agent. However, we know little about the underlying mechanism. In this study, we evaluated the effects of TXA and its molecular mechanism on rosacea by using LL37-induced mouse model and HaCaT cell model. Rosacea-like symptoms including skin erythema and histopathological alterations, as well as the elevated pro-inflammatory cytokines (IL-6 and TNFα) and MMP9 expression were significantly ameliorated by TXA treatment. In addition, TXA reduced the expression levels of innate immune gene (TLR2, KLK5 and Camp) and neutrophils relative gene in rosacea-like lesion. For adaptive immune, CD4+ T cell infiltration and the gene expression of Th cytokines and chemokines were regulated by TXA in skin lesion. Furthermore, the anti-inflammatory effects of TXA were associated with the inhibition of TLR2, pro-inflammatory cytokines (IL-6 and TNFα) and chemokines (CCL10) expression in LL37-activated HaCaT cells. Finally, TXA repressed the angiogenesis by reducing the number of CD31+ cell and downregulating the expression levels of VEGF in rosacea. In conclusion, our finding defines a treatment mechanism by which TXA ameliorates rosacea symptoms by regulating the immune response and angiogenesis.
      PMID: 30578968 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Systemic comorbidities associated with rosacea: a multicentric retrospective observational study. Int J Dermatol. 2018 Dec 21;: Authors: Aksoy B, Ekiz Ö, Unal E, Ozaydin Yavuz G, Gonul M, Kulcu Cakmak S, Polat M, Bilgic Ö, Baykal Selcuk L, Unal I, Karadag AS, Kilic A, Balta I, Kutlu Ö, Uzuncakmak TK, Gunduz K Abstract
      BACKGROUND: Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities.
      METHODS: This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities.
      RESULTS: The study included 1,195 rosacea patients and 621 controls without rosacea aged 18-85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity- and duration-dependent manner.
      CONCLUSION: Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.
      PMID: 30575019 [PubMed - as supplied by publisher] {url} = URL to article
    • "Rosacea is probably a collection of many different diseases that are lumped together inappropriately." Zoe Diana Draelos, MD.  So there are a number of skin diseases that look like rosacea, which may be actually a catch-all diagnosis for any skin condition that is present in a patient with any of the rosacea phenotypes. However, if you are diagnosed with one of the rosacea variants or mimics you may find a more appropriate treatment since having a correct diagnosis certainly goes a long way to finding relief. It would be good to rule out any of the rosacea mimics listed in a differential diagnosis list (which is even a much longer list). But the list below is the 'official rosacea mimic list' (14): 

      Atopic Dermatitis (Eczema) Dermatomyositis

      Erysipelas Erythromelalgia Erythromelanosis follicularis faciei et colli (EFF) Gram-Negative Folliculitis Keratosis Pilaris Rubra Faceii Lupus Lupoid Rosacea Perioral Dermatitis PF Pityriasis rosea [PR]

      Seborrheic Dermatitis

      Telangiectatic Photoaging (TP) Note: If you have another skin condition that is a rosacea mimic that we don't have on this official list, please reply in this thread and we will consider whether to add it. 
    • The RRDi recognizes Rosacea Lymphedema  (Morbihan Disease) as a rosacea variant. [1] Also known as rosacea lymphoedematousn or persistent solid facial edema [2], Persistent edema of rosacea or Chronic upper facial erythematous edema. [3] "Morbihan disease (MD) is a rare entity. Its nosography is unclear and its therapeutic management is difficult....the patient was put on isotretinoin and furosemide with slight improvement. The particularity of our observation lies in the rarity and especially in the therapeutic difficulties encountered during this disease.  [4] Notes  [1] "Morbihan syndrome is a rare entity that more commonly affects women in the third or fourth decade of life. It is considered a special form of rosacea and its pathogenesis is not fully known..." An Bras Dermatol. 2016 Sep-Oct; 91(5 Suppl 1): 157–159.
      doi:  10.1590/abd1806-4841.20164291
      PMCID: PMC5325027
      Morbihan syndrome: a case report and literature review
      Rossana Cantanhede Farias de Vasconcelos, Natália Trefiglio Eid, Renata Trefiglio Eid, Fabíolla Sih Moriya, Bruna Backsmann Braga, and Alexandre Ozores Michalany "Morbihan disease, also known as rosacea lymphedema, is a rare persistent form of lymphedema that is associated with the disease of rosacea." Phys Ther. 2018 Dec 18;
      Complete Decongestive Therapy Is an Option for the Treatment of Rosacea Lymphedema (Morbihan Disease): Two Cases.
      Kutlay S, Ozdemir EC, Pala Z, Ozen S, Sanli H [2] "Morbihan disease is a rare entity. Its place in the nosography is uncertain. Sometimes called persistent solid facial edema, sometimes rosacea lymphoedematous. It may correspond to a particular clinico-pathological form of lymphoedema or rosacea." Pan Afr Med J. 2018; 30: 226.
      Published online 2018 Jul 26. doi: 10.11604/pamj.2018.30.226.14440
      PMCID: PMC6295304; PMID: 30574244
      Morbihan disease: treatment difficulties and diagnosis: a case report
      Alaa Aboutaam,& Fouzia Hali, Kenza Baline, Meryem Regragui, Farida Marnissi, and Soumiya Chiheb [3] Persistent edema of rosacea, Wikpedia [4] Pan Afr Med J. 2018 Jul 26;30:226. doi: 10.11604/pamj.2018.30.226.14440. eCollection 2018.
      Morbihan disease: treatment difficulties and diagnosis: a case report.
      Aboutaam A, Hali F, Baline K, Regragui M, Marnissi F, Chiheb S.
    • Clinical Case Reports, states, "Kleresca® biophotonic platform utilizing fluorescent  light energy effectively decreased the inflammatory and erythematous reaction common in rosacea subtypes 1, 2, and 3.  Kleresca® may be considered as a single treatment for rosacea, targeting multiple features, or combined with invasive methods for an enhanced normalizing and healing profile of the skin." [1] End Notes [1] Clin Case Rep. 2018 Dec;6(12):2385-2390
      Fluorescent light energy: Treating rosacea subtypes 1, 2, and 3.
      Sannino M, Lodi G, Dethlefsen MW, Nisticò SP, Cannarozzo G, Nielsen MCE
    • This is an unusual treatment for rosacea, since we hear complaints from rosaceans about fluorescent lights, there is now a treatment for rosacea using fluorescent light, Klereska®, reported in Clinical Case Reports, that states, "Kleresca® biophotonic platform  utilizing fluorescent  light energy effectively decreased the inflammatory and erythematous reaction common in rosacea subtypes 1, 2, and 3.  Kleresca® may be considered as a single treatment for rosacea, targeting multiple features, or combined with invasive methods for an enhanced normalizing and healing profile of the skin." [1] End Notes [1] Clin Case Rep. 2018 Dec;6(12):2385-2390
      Fluorescent light energy: Treating rosacea subtypes 1, 2, and 3.
      Sannino M, Lodi G, Dethlefsen MW, Nisticò SP, Cannarozzo G, Nielsen MCE    
    • Related Articles Fluorescent light energy: Treating rosacea subtypes 1, 2, and 3. Clin Case Rep. 2018 Dec;6(12):2385-2390 Authors: Sannino M, Lodi G, Dethlefsen MW, Nisticò SP, Cannarozzo G, Nielsen MCE Abstract
      Kleresca® biophotonic platform utilizing fluorescent light energy effectively decreased the inflammatory and erythematous reaction common in rosacea subtypes 1, 2, and 3. Kleresca® may be considered as a single treatment for rosacea, targeting multiple features, or combined with invasive methods for an enhanced normalizing and healing profile of the skin.
      PMID: 30564333 [PubMed] {url} = URL to article
    • Complete Decongestive Therapy Is an Option for the Treatment of Rosacea Lymphedema (Morbihan Disease): Two Cases. Phys Ther. 2018 Dec 18;: Authors: Kutlay S, Ozdemir EC, Pala Z, Ozen S, Sanli H Abstract
      Background and Purpose: Morbihan disease, also known as rosacea lymphedema, is a rare persistent form of lymphedema that is associated with the disease of rosacea. Even though acne rosacea responds well to standard medical treatment, the lymphedema component of the disease is resistant to both medical and surgical therapy. Complete decongestive therapy (CDT) may be considered as a conservative alternative option for treatment of rosacea lymphedema. To date, there is no report on the use of CDT in treating facial lymphedema secondary to acne rosacea.
      Case Description: Here, we present two cases of women with a diagnosis of Morbihan disease and chronic facial lymphedema which remained resistant to drug treatment for many years before CDT was offered. The treatment program included 4 components: manual lymphatic drainage (MLD), compression bandaging, exercises to enhance lymphatic drainage, and patient education.
      Outcomes: Following 10 to 15 sessions of CDT, the first patient's facial edema had almost completely resolved, and she remained edema-free one month after treatment. The second patient's response to treatment was assessed as moderate.
      Discussion: To the best of our knowledge, these two cases of Morbihan disease treated with CDT are the first of their kind to be presented in the literature. As the treatment options for Morbihan disease remain inadequate, we believe that CDT should be considered as a treatment option in those patients who do not benefit from or refuse drug treatment, before moving on to more invasive procedures. Prospective studies should be designed to demonstrate the efficacy of CDT and provide management details.
      PMID: 30561675 [PubMed - as supplied by publisher] {url} = URL to article
    • NRS Review of Form 990 for 2017 In December 2018, the NRS published its Form 990 for 2017. This year marks the fourth highest banner year in donations, the first highest banner year was in 1998 which the donations totaled over $1 million dollars ($1,148,375). In 2017, the NRS received in donations $929,730.00, just $216,645 short of its 1998 banner year. So let's review what the NRS spent its donations on. First off, let's be clear that Samuel B Huff, Director, signed off on page one of the 2017 Form 990, and on page 7, under the heading, Part VII, Compensation, it shows that Samuel B Huff, President, was paid $119,100 under the column, Reported compensation from related organizations. Also Mary F Erhard, Secretary, was paid $27,963 making a grand total here of $147,063. Grants spent this year on rosacea totaled $74,443. So if you do the math, the total spent on rosacea research grants in 2017 amounts to 8% of the total revenue donated to the NRS. Putting this into something you can understand a little clearer, for every dollar donated to the NRS 8 cents was spent on rosacea research grants.  What did the NRS spend the rest of the money on?  On page 10, Part IX, Expenses, it shows a list totalying $763,980.  Of that total, $105,494 was spent on Information Technology. You can read the rest yourself.  Scrolling down to Schedule R (Form 990) Part V, you will note there are two corporations listed under TRANSACTIONS WITH RELATED ORGANIZATIONS, which are the following:  Glendale Communications Group, Inc. $498,910. Park Mailing and Fulfillment, Inc. $70,194.00 The above two corporations is where a total of $569,104 was spent which are the related organizations the NRS used and this amounts to 61% of its total donations received. These two private corporations are owned by Samuel B Huff, the Director/President of the NRS. For proof, read this post.  Read the NRS Form 990 for 2017:
      nrs_990_2017.pdf        
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