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  • Misdiagnosed Rosacea
    Articles, References and Anecdotal Reports

    misdiagnosed_rosacea.pngArticles and References

     

    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

     

    "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.

    Anecdotal & Other Reports of Misdiagnosis

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

    "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 #68

    "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 #66

    full reports, "Just diagnosed with this infuriating condition after 2 years of be wrongly diagnosed and treated for both rosacea and acne. I am really clueless about this condition and need a explanation of it.. Anyone ever permanently got rid of this? My face is only affected, mainly my cheeks.," full types in the subject of this post Pityrosporum Folliculitus

    lexflorex reports, "I just want to share with you that I didn't have Rosacea. I was first diagnosed with it and prescribed a medication that didn't help me at all. So I want back to the doctor's office the 2nd time and a different doctor said I had Dematitis. I used this topical cream that they prescribed and within a few days my face cleared up. 2 weeks into it it is almost completely gone. My point is you may want to get a 2nd opinion."

    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..."

    Bob reports his rosacea was misdiagnosed for discoid lupus

    Gem says, "A couple of months ago I developed a rash on my forehead and was given a steroid cream for it that seemed to keep it under control for 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...."

    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."

    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..."

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

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

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

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

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

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

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

    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."

    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.

    DC says his physician misdiagnosed his dermatitis as rosacea.

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

    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.

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

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

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

    RedFacedRedHead says her rosacea turned out to be KP.

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

    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......

    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."

    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).

    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.

    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.

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

    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.

    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."

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

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

    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'."

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

    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."

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

    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).

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

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

    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..."

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

    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."

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

    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..."

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

    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."

    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...."

    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."

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

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

    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..."

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

    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."

    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

    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.

    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

    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..."

    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.

    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

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

    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

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

    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

    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

    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.

    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

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

    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...."

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

    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..."

    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

    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

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

    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..."

    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

    "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

    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!!!!!

    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

    "The diagnosis of lupus flare was made by the general practioner who prescribed corticosteroids....and the patient was hospitalized....The diagnosis of erysipelas of the face was made...This coincidence is a rare condition which may lead to erroneous diagnosis and inappropriate therapy."
    A red face in a lupus patient: thinking beyond lupus rash.
    Stubbe M, Smith V, Thevissen K, Mielants H, De Keyser F.
    Acta Clin Belg. 2010 Jan-Feb;65(1):44-7.

    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

    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…"

    "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

    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..."

    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..."

    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 Accutane 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."

    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)

    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)....

    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!"

    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."

    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

    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."

    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...."

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

    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."

    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

    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...."

    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....'

    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

    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

    findingaway says, "Dermatologist: 'Hmm' he says...'I think it's Seborrheic Dermatitits, but it could be rosacea, but I doubt it and you seriously wouldn't want that' "

    pier01980 says, "The problem is that In 4 months I've seen two dermatologist and this allergist who have diagnosed me three different things: Acne, rosacea and now Seborrhoeic dermatitis."

    Gigi says, "I have seen five different dermatologists, and each came up with a different diagnosis. (Dermatologist no. 4 and no. 5 I had seen within two weeks.)

    1. Dermatologist: Seborrhoeic Dermatitis
    2. Dermatologist: Acne Vulgaris
    3. Dermatologist: Rosacea
    4. Dermatologist: Rosacea and Acne Vulgaris
    5. Dermatologist: Rosacea and Seborrhoeic Dermatitis" Post #2

    mccinnis says, "I have been posting on here for the last 2 months about my recent diagnosis of sebderm. I have rosacea and have been tyring to figure out the difference between both as my sebderm does not seem to be typical and i wasnt convinced I had it and actually stopped using my noritate/lamisel mix as I think it was making my face red and dryer. I went to a new derm yesterday and was told I do not have sebderm but KPRF."

    OCbKA says, "I have been diagnosed with Rosacea by 3 different derms (one thought it was Perioral Dermotitis" Comment #24 May 22, 2011

    Della says, "I am so relieved that i finally have the right diagnosis. I have been going to different doctors for many years and they told me i had contact dermatitis, eczema etc. The stuff they would give me would help for just a little bit and it got to the point that i would have to apply steroid cream 2x a day just to keep it from becoming really gross. I got lucky and saw another dr and finally got rosacea." #44175 Della on August 15, 2010 at 1:20 PM

    jca says, "After wasting my time w/ one Derm who said I just have “dry irritated sensitive skin….I got a 2nd opinion. Within seconds of my new derm looking @me she siad..its rosacea." #44183 jca on August 15, 2010 at 7:09 PM

    CR says, "My rosacea showed up 2 summers ago. My eyes felt itchy and irritated. Took awhile for my dermatologist to diagnose it, in fact, I led the way with what I read on the net." #59407 CR on June 8, 2011 at 5:29 AM

    Marianne says, "I suffer from what I think is a mild case of rosacea (doctors think this is it but are confused themselves) with papules/ pustules and a bit of redness on my left cheek." #39001 Marianne on June 4, 2010 at 6:12 PM

    jill says, "...Dr. gave me script for presidone, said it was contact allergy and eye doctor gave me eye drops....went to ANOTHER dermy. said i had rosacea. gave me sulfur medicine." #34440 jill on March 25, 2010 at 9:28 AM

    Drew says, "The other clinic's diagnosis was rosacea. This one proposes Postular Acne..." by Drew on Thu Apr 23, 2009 8:02 am

    kam says, "...I went to see my GP and he said that I had rosacea...On my next visit to the GP, I was advised by another doctor that I simply had over sensitized skin from using facial scrub too often, too much hot water on my face, and more recently, persistent exposure to the sun....and I was advised to use.... Efcortelan ointment 0.5% which is a brand of hydrocortisone. I tried this for 3 months...I stopped using hydrocortisone...My skin condition never improved...." by kam on Tue Jun 17, 2008 10:36 pm

    ohdarnit!987 says, "t took doctors almost 20 years to put a name to my problem - then the dermatologist today took one look at me and listened to my issues and said 'classic textbook case'." by ohdarnit!987 on Wed Jun 01, 2011 9:32 pm

    kwb says, "I went to see a doctor about some redness in my cheeks a good many years ago, but he said no, it's probably an allergy. So, recently I began to notice some cleary defined red lines under my eyes, and a burning sensation accompanied by some redness around my nose, so, I decied to go to a new doctor, this time yes, shes said it's 'classic Rosace'"." by KWB on Fri Jun 10, 2011 4:59 am

    jodie says, "Just wanted to let the people who have helped me over the last week know that it turns out i dont have rosacea after all. Last night i was in a lot of pain with my face burning and eventually after a day in tears i went to the walk in centre and was seen by another doctor who could see my face when it was at its worst. He said that it in no way looked like rosacea at all and that i had photosensitivity, literally everytime i went outside i was getting sunburned even when it was cloudy." by jodie on Mon Jun 20, 2011 1:48 pm

    shahin 25 says, "It has been 2 months since I was dignosed with seb derm (I spent 2 months prior to denying there was anything wrong with me) in total i have had this gross foreign fungus on my face for 4 months. It seems to be getting worse. I had my second consult with my derm dr & he threw more steroids at me, but when I ask him about my seb derm he never gives me straight answers."

    bizi says, "I saw the new derm and she is very good. She is at least 70 years old. She right away said that I have acne and rosacea, which the other derm said it was all rosacea." Post #19 Nov 18 at 04:30 AM

    ziggR says, "Its weird, "Rosacea" took my derm awhile to say also. I got "its just KRPF, Its just the weather or it could just be hormones". It wasn't until they started IPL and PDL on my cheeks that the derm said it looks like Rosacea." post #10 12/11/11

    lulu says, "I was diagnosed about a year ago with Rosacea but prior to that I was diagnosed with a very rare skin condition called Pyoderma Faciale. It's a condition that bizzarely only affects females, of 20 -40 and from reading your post - the symptoms your describe are very similar to the symptoms I had when I had pyoderma faciale. I am not a doctor or a skin expert, and I am not suggesting for a minute that this is what you have, but it may nevertheless be worth mentioning to your doctor. My own GP, first diagnosed it as acne. It was only when I self referred myself to a dermatologist that pyoderma faciale was diagnosed." by lulu on Tue Dec 20, 2011 9:13 pm

    freeme3 says, "My dermatologist thinks that I have rosacea. I think that he is right....The first derm thought I just had sensitive skin and prescribed me locoid steroid cream. It helped for awhile but then it stopped working...." by freeme3 on Wed Dec 21, 2011 1:33 am

    Mister88 says, "At first I was diagnosed with eczema, then after trial and error and 10 different topical creams I was sent to a different derma sinc .my derma was out of ideas. The new doctor said I have rosacea and was given finacea."

    Blackhawk says, "'Im currently 30 year old male (symptoms started at 28 / 29), and have been to about 5-6 dermatologists in the Chicagoland area over the past year and a half.....Every dermatologist tells me something different. I've been told its different forms of dermatitis/rosacea....So my latest visit to the derm told me I had a combo or seb dermatitis / rosacea."

    bobbydazler1981 says, "I have been told by Doctors initially that i had eczema, then Seborrheic Dermatitis, now 2 days ago i was told i have Acute Dermatitis."

    adinet says, "I was originally told I had rosacea then told I didn't!" Post #42 - 1st December 2011 01:02 AM

    "I was diagnosed with Rosacea many years ago and lived with it for a long time believing my doctor even though he did nothing other than ask me a few questions and peek at my skin from 4 feet away. No blood tests, nothing like that. I was in and out of his office in less then three minutes." Scully555 Post #18 19th September 2009 • "After years of misdiagnosis from two or three "specialists" I finally did what a coworker suggested.... It turns out I was using a heavily medicated dandruff shampoo loaded with "tar"......When I stopped using the shampoo, my face cleared up 100% within a few weeks and never came back...." Scully555 Post #20

    shan says, "I was offically diagnosed with a Sulphite allergy and produce anti-histamine and an allergic response.....I was also told I had Roseacea. Let me make myself clear, this is not a mis-diagnosis, as I had originally been diagnosed with Roseacea by my GP." See post #47 March 20, 2012

    trojan10 says, "a few derm's said i have rosacea, another said i just have sensitive skin and not rosacea YET." post #1 March 28, 2012

    Boiling_Point says, "* One says that I have Seb Derm and that I should use a Ketaconazole 2% dandruff schampo on scalp and face. * One says that I definitely not have Seb derm, it is Rosacea that I have and she tells me there's not much to do for me than to accept my current state (using Metronidazole-cream)."

    cherylarose says, "...My personal experience was a misdiagnosis for over 7 years (and 4 dermatologists). Perhaps your quote above is general for the forum, or perhaps you directed the statement to me. I want to assure you that I don't intend to mislead anyone by my personal experience with rosacea; I do in fact have rosacea which was diagnosed by Dr. Soldo. Even after the diagnosis, for confirmation, I underwent a series of allergy tests complete with IgE, so eczema has already been ruled out...." Post #48 24th April 2012 01:44 AM
    "Most of the dermatologists treated the condition as adult acne and prescribed Retin-A. The tipping point came when I had perioral inflammation and the doctor prescribed Elidel and topical steroids (for eczema) and the rosacea (of course) became much worse. That drove me to seek out a new dermatologist. When I was diagnosed by Dr. Soldo, he told me that the Retin-A in particular exacerbates Rosacea which made sense because my skin had several dry patches and redness but the pustules still remained. Dr. Soldo prescribed Finacea which has done a marvelous job as an exfoliant. However, it doesn't prevent flare ups from my food triggers. I also cannot use salicylic acid as it causes inflammation of the pustules and redness." Post #52 4th May 2012

    MOLLOBHG posts in the subject, "4 different doctors, 4 different diagnoses." and then says, "I've recently been told I have rosacea...... I'm still hoping there's a chance this doctor's got it wrong (as well)..." on Sun May 06, 2012 4:40 am

    dee62 says, "I was just formally diagnosed with Rosacea on Monday. I have known that I have it for some time. 1 of my doctor's diagnosed it back in 2008, after I had shingles on my face. My most recent doctor had said it was ezcema."on Wed May 02, 2012 10:40 pm

    j88e says, "Initially, I was diagnosed with contact dermatitis because this developed shortly after I had a bad reaction to a topical benzoyl peroxide/clindamycin medication I had been prescribed for acne. When it wouldn't go away, my dermatologist clung to her initial diagnosis and prescribed stronger and stronger steroids. I was skeptical, so I went to another dermatologist who instantly diagnosed rosacea."

    Lorraine says, "I was diagnosed with seborrheic dermatitis initially, then when I started complaining of redness to my cheeks the derm diagnosed me with mild rosacea." #53893 Lorraine on April 6, 2011 at 11:18 AM

    John says, "ive been diagnosed with rosacea for a few months now but for the last 11 years i’ve had this pimply rash on my forehead that would come and go . the first derm i saw said it was a fungal infection caused by the propecia i was taking for hair loss) so he gave me antifungal cream, lotion , shampoo with sulfa face scrub pads and sulfa lotion to put on and zithromax to take. then i moved too far away to see him so i went to a different derm as the rash came back a few months after i stopped the antifungals and this guy said i was fine -everyone has pimples now and then. The third one said I had acne and gave me a prescription face wash that worked pretty good for a few months. Then I went to a 4th guy who said I had rosacea." #102973 john on June 5, 2012 at 12:21 PM

    Lpkm says, "All of the doctors I have seen or spoken to have no clue about SD and instantly diagnose Rosasea - this has happened to me 3 times and i have SD not rosacea." Post #4 June 9,2012 at 9:39 AM Luke then gives details of his experience with four different doctors at this post.

    Cdw1262 says, "I just had my appointment with my primary care doctor today. He looked at some pictures briefly but basically said it was just some sort of infection, happens all the time, and gave me a perscription for a topical cream. I said well what about rosacea, and he blew me off and said no way, that only happens to old men's noses who have been drinking their whole lives and not to worry about it. I still have a follow up with a dermatologist scheduled for a few months from now." Cdw1262 Post #7 June 13, 2012

    davem81 says, "My dermatologists wavered between treating me for 'acne vulgaris' and 'acne rosacea' for a long time." davem81 Post #14 June 18, 2012

    Opinwyd says, "I have been seen by many dermatologists and the diagnosis vary each time but nothing seems to be effective. Anything from Rosacea, which they then prescribed me with several rosacea type medicines like metronidazol cream or noritate and none of it helps. Another said it was a histamine release and said take zyrtec or benadryl, that didnt work." Opinwyd Post #6 June 24, 2012

    Joejon says, "After about 10 years (I'm now 25), 10+doctors, 3 dermatologists, $1000's of dollars, countless hours of trial and error with OTC and prescription products and medications for acne I have finally been diagnosed with possible rosacea. None of the previous doctors or derm's even hinted at rosacea and I really didn't know what it was until now." Joejon Post #1 June 28, 2012

    padie says, "One of my daughters came across your post and brought it to my attention. Her sister, my youngest daughter, suffered rosacea fulminans several years ago and I thought I would share some of her experience with you. She was incorrectly diagnosed with acne initially and the condition had time to get far worse than it might have with a proper diagnosis from the beginning. We switched doctors because we knew it was not simple acne. Both of her sisters had suffered acne and she never had, so we knew what acne was and what she had was certainly not. We were lucky to see the new doctor's physician's assistant who listened patiently to her story (how her face had been clear and then suddenly she was getting multiple cysts and green puss was coming out of some of them). He said he did not know what the condition was but would find out. He called the next day and we went back to the office to hear that she had this very rare condition: rosacea fulminans." Post #6 July 18, 2012 at 05:18 AM

    buratino29 says, "In one year two dermatologists failed to diagnose me with rosacea until I persuaded the third that it is rosacea. I basically had to diagnose myself and then prove it in front of audience." Post #130 3rd April 2013 06:28 PM



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    • Rod102988 reports, "A year ago this time I was diagnosed with Rosacea due to heavy drinking and long bouts in the sun. I was devastated, depressed and embarrassed. I quit several jobs, tried makeup, turmeric, eating healthy, water etc. You know name it. I spent hundreds on products for up to a year. I even tried Finacea which while it helped the bumps not so much with the redness plus my insurance didn't cover it and it cost $330 a tube. Finally, I did tons of research online and found two products which I use in combination and they only cost a combined $80 on Amazon.  1) La roche Posay Rosaliac AR Intense. It's a visible redness reducing serum made by scientists in France. It's light and has no smell. You apply twice a day after washing.  2) GIGI Bioplasma Azaleic Acid 15 percent cream. This stuff is better than Finacea IMO and much much cheaper. It tackles all the same things as Finacea; redness, blemishes, acne and hyperpigmenation. Now what I do is usually is place both on at the same time but always one significantly less than the other....only on the problems spots. For example, a full dot full of one and miniscule dot full of the other. But, some may get irritated by that I wouldn't suggest starting off like that. In would initially alternate with one each day and then maybe alternate throughout the day. With that said, this cream and serum has worked wonders and its only costing me $80 bucks a month but I could really stretch both to a month and a half of I want to. After using these for 3 months I am amazed and these combination have been a complete and utter life saver."
    • Found this post at healthboard.com:  "My husband and I both have rosacea. We have used Metrogel daily for years and sometimes it would keep the rosacea under control and other times it would not.
      I researched home remedies and this is what has worked for both of us. We no longer have to go to the dermatologist for an Rx for Metrogel. Please note that this is NOT a cure. We do this daily and then we have no recurrence of the rosacea. When I stopped using it, the rosacea would return after a few weeks. I purchased a 12 ounce bottle of baby shampoo. It doesn't matter what brand as long as it is not too runny like water. Then I bought a 1 ounce bottle of 100% tea tree oil at Trader Joes. It doesn't matter where you buy your bottle of 100% tea tree oil. I poured about 1/3 of the 1 ounce bottle of tea tree oil into the 12 ounce bottle of baby shampoo. I then closed the cap of the baby shampoo and shook it really well.  In the beginning when my rosacea was prevalent, every morning I would put some of the tea tree oil infused baby shampoo on those areas. I would leave it on while I brushed my teeth. I tried to keep it on for at least 5 minutes. Then I would rinse it off. That evening I would do it again and keep it on for at least 5 minutes. Then rinse off. After a few days I saw my rosacea disappear. When I stopped this treatment, the rosacea would ultimately return. So now to keep my rosacea from returning I put on the tea tree oil infused baby shampoo every morning while I brush my teeth. I no longer need to put it on at night as the once daily application has kept my rosacea from returning. It is has been well over a year since the rosacea has resurfaced.  My husband still continues to put his application of tea tree oil infused baby shampoo on twice a day because he gets good results and he doesn't want to chance it returning as his rosacea was far worse than mine. This daily regime has worked for both my husband and I. If you choose to try this, I hope it works for you as well." This probably would help improve demodectic rosacea. 
    • Related Articles An empirically generated responder definition for rosacea treatment. Clin Cosmet Investig Dermatol. 2017;10:347-352 Authors: Staedtler G, Shakery K, Endrikat J, Nkulikiyinka R, Gerlinger C Abstract
      OBJECTIVE: The aim of this study was to empirically generate a responder definition for the treatment of papulopustular rosacea.
      METHODS: A total of 8 multicenter clinical studies on patients with papulopustular facial rosacea were analyzed. All patients were treated with azelaic acid and/or comparator treatments. The severity of rosacea was described by the Investigator Global Assessment (IGA) and the number of lesions. Patients with the IGA score of "clear/minimal" were considered as responders, and those staying in the range of IGA "mild to severe" as nonresponders. The respective number of lesions was determined.
      RESULTS: A total of 2,748 patients providing 12,410 measurements were included. After treatment, responders showed 2.23±2.48 lesions (median 2 lesions [0-3]), and nonresponders showed 13.74±10.40 lesions (median 12 lesions [6-18]). The optimal cutoff point between both groups was 5.69 lesions.
      CONCLUSION: The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea.
      PMID: 28932125 [PubMed] {url} = URL to article
    • The relationship between migraine and rosacea: Systematic review and meta-analysis. Cephalalgia. 2017 Jan 01;:333102417731777 Authors: Christensen CE, Andersen FS, Wienholtz N, Egeberg A, Thyssen JP, Ashina M Abstract
      Objective To systematically review the association between migraine and rosacea. Background Migraine is a complex disorder with episodes of headache, nausea, photo- and phonophobia. Rosacea is an inflammatory skin condition with flushing, erythema, telangiectasia, papules, and pustules. Both are chronic disorders with exacerbations of symptoms almost exclusively in areas innervated by the trigeminal nerve. Previous studies found an association between these disorders. We review these findings, provide a meta-analysis, and discuss possible pathophysiological commonalities. Methods A search through PubMed and EMBASE was undertaken for studies investigating the association between all forms of migraine and rosacea published until November 2016, and meta-analysis of eligible studies. Results Nine studies on eight populations were identified. Studies differed in methodology and diagnostic process, but all investigated co-occurrence of migraine and rosacea. Four studies were eligible for meta-analysis, resulting in a pooled odds ratio of 1.96 (95% confidence interval 1.41-2.72) for migraine in a rosacea population compared to a non-rosacea population. Conclusion Our meta-analysis confirmed an association in occurrence of migraine and rosacea. Future studies should specifically investigate possible shared pathophysiological mechanisms between the two disorders.
      PMID: 28920449 [PubMed - as supplied by publisher] {url} = URL to article
    • A recently published paper concluded, "Expert groups and evidence-based guidelines agree that topical retinoids should be considered the foundation of acne therapy." So this article explains the increased use of retinoids by physicians over antibiotics since there is concern over antibiotic resistance. This article states, "The use of retinoids plus BPO targets multiple pathways and can often eliminate the need for antibiotics, reducing the likelihood of antibiotic resistance."

      Isotretinoin is just one of the several retinoids used to treat acne. The retinoids mentioned in the article are, "adapalene 0.1% and 0.3%; tazarotene 0.1%; tretinoin 0.01%, 0.025%, 0.038%, 0.04%, 0.05%, 0.08%, and 0.1% in the USA; isotretinoin 0.05% and 0.1% in other regions of the world" and reviews "the evidence supporting why retinoids should be considered the foundation of acne therapy (with a focus on topical retinoids)." The article states, "Both dermatologists and other physicians were less likely to prescribe a retinoid for patients aged 19 or older compared to those aged 10–19." The topical retinoids mentioned in this article are a "fixed combination adapalene 0.3%-benzoyl peroxide (BPO) 2.5% (0.3 A/BPO; Epiduo Forte®, Galderma Laboratories) and topical retinoids (adapalene, tazarotene, or tretinoin) and Retinoids are also available in fixed-combination formulations with BPO [adapalene-BPO 0.1%/2.5% and 0.3%/2.5% (Epiduo® and Epiduo Forte®, Galderma Laboratories)] and clindamycin [tretinoin 0.025%/clindamycin phosphate 1.2% (Veltin, Aqua Pharmaceuticals; Ziana®, Valeant Pharmaceuticals)]."

      The article does address the concern of "retinoid irritation" and offers "Strategies to minimize tolerability issues" in Table 1 but does not mention anything about long term risks of 'accutane induced rosacea' which many in RF and other anecdotal reports have confirmed happens to some.  Dermatol Ther (Heidelb). 2017 Sep; 7(3): 293–304.
      Published online 2017 Jun 5. doi:  10.1007/s13555-017-0185-2
      PMCID: PMC5574737
      Why Topical Retinoids Are Mainstay of Therapy for Acne
      James Leyden, Linda Stein-Gold, and Jonathan Weiss
    • sepi takes "half teaspoon fine chili powder and I mix it with about 15g face cream" and reports it works for rosacea. Read her report. 
    • "...the results of a pooled analysis of four Galderma-sponsored studies evaluating the use of topical therapies for the treatment of inflammatory papules and pustules of rosacea were presented at the 26th European Academy of Dermatology and Venereology Congress in Geneva, Switzerland. The success of rosacea treatment is usually defined as a score of 1 ('almost clear') or 0 ('clear') on the 5-point Investigator Global Assessment (IGA) scale. The new analysis reports that rosacea patients who achieve 'clear' (IGA 0), not only experience a more complete reduction in inflammatory lesions compared with patients who achieve 'almost clear' (IGA 1), but also an extended time to relapse that is associated with improved quality of life." ‘CLEAR’ (IGA 0) ROSACEA PATIENTS EXPERIENCE A DELAYED TIME TO RELAPSE, Lausanne, Switzerland – September 16, 2017 Galderma: 'Clear' (IGA 0) Rosacea Patients Experience a Delayed Time to Relapse
      PR Newswire
       Sep. 16, 2017
    • Is Sugar Addictive? There are reputable sources who say it is and those who say it is is not. I have collected the sources who say it is along with the those who say sugar is not addictive (scroll down). You be the judge.  Sources Who Say Sugar is Addictive "Our findings clearly demonstrate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals. We speculate that the addictive potential of intense sweetness results from an inborn hypersensitivity to sweet tastants. In most mammals, including rats and humans, sweet receptors evolved in ancestral environments poor in sugars and are thus not adapted to high concentrations of sweet tastants. The supranormal stimulation of these receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus to lead to addiction." Intense Sweetness Surpasses Cocaine Reward
      Magalie Lenoi , Fuschia Serre, Lauriane Cantin, Serge H. Ahmed 
      Plos One "Sugar is addictive. And we don’t mean addictive in that way that people talk about delicious foods. We mean addictive, literally, in the same way as drugs. And the food industry is doing everything it can to keep us hooked." Sugar Season. It’s Everywhere, and Addictive.
      By JAMES J. DiNICOLANTONIO and SEAN C. LUCANDEC. 22, 2014, New York Times "Withdrawal from a “sugar-rich” diet is associated with behavior suggestive of “withdrawal” symptoms." Diabetes 2016 Jul; 65(7): 1797-1799.
      Is Sugar Addictive?
      George A. Bray "Sugar addiction happens due to intense cravings for sweet food. It is triggered by the brain by sending signals to the receptors in our tongue that were not able to develop from the low-sugar diets of our ancestors" The Truth About Sugar Addiction
      By Dr. Mercola,  "The biological robustness in the neural substrates of sugar and sweet reward may be sufficient to explain why many people can have difficultly to control the consumption of foods high in sugar when continuously exposed to them." Curr Opin Clin Nutr Metab Care. 2013 Jul;16(4):434-9. doi: 10.1097/MCO.0b013e328361c8b8.
      Sugar addiction: pushing the drug-sugar analogy to the limit.
      Ahmed SH, Guillem K, Vandaele Y. "In animals, it’s a “no-brainer.” Dr. Nicole Avena of Columbia University exposes rats to sugar water in an excess-deprivation paradigm for three weeks, and they demonstrate all the criteria needed to diagnose addiction: binging, withdrawal, craving, and addiction transfer (when you’re addicted to one substance, you’re addicted to others as well)." The Sugar-Addiction Taboo
      When can you call a food addictive?
      ROBERT H. LUSTIG, The Atlantic  "In animal studies, sugar has been found to produce more symptoms than is required to be considered an addictive substance. Animal data has shown significant overlap between the consumption of added sugars and drug-like effects, including bingeing, craving, tolerance, withdrawal, cross-sensitisation, cross-tolerance, cross-dependence, reward and opioid effects. Sugar addiction seems to be dependence to the natural endogenous opioids that get released upon sugar intake. In both animals and humans, the evidence in the literature shows substantial parallels and overlap between drugs of abuse and sugar, from the standpoint of brain neurochemistry as well as behaviour." Sugar addiction: is it real? A narrative review
      James J DiNicolantonio, James H O'Keefe, William L Wilson
      British Journal of Sports Medicine  "In an interview with Lisa Mullins from Here & Now, Dr. DiNicolantonio further stated that some studies on rats show that sugar is potentially more addictive that cocaine because even after being hooked on cocaine, they invariably switch to sugar when it is introduced to them." Sugar Addiction: Facts And Figures
      AddictionResource "Your brain also sees sugar as a reward, which makes you keep wanting more of it. If you often eat a lot of sugar, you're reinforcing that reward, which can make it tough to break the habit." Slideshow: The Truth About Sugar Addiction
      WebMD "So drugs and sugar both activate the same reward system in the brain, causing the release of dopamine." Fact or fiction – is sugar addictive?
      TheConversation "The link between sugar and addictive behavior is tied to the fact that, when we eat sugar, opioids and dopamine are released." Experts Agree: Sugar Might Be as Addictive as Cocaine
      Written by Anna Schaefer and Kareem Yasin, healthline "Scientists have found that sugar is addictive and stimulates the same pleasure centers of the brain as cocaine or heroin. Just like those hard-core drugs, getting off sugar leads to withdrawal and cravings, requiring an actual detox process to wean off." Are You Addicted to Sugar? Here’s How to Break the Cycle, by Sarah Elizabeth Richards, Daily Burn, Life "While it is true that sugary foods can stimulate the same part of the brain responsible for pleasure and reward, as do many illicit substances, there are reasons other than addiction that eating could be linked with the reward area of the brain." Is sugar addictive?
      CSU External Relations Staff "Despite the anecdotal reports of people who claim to be addicted to sugar, and seemingly endless Web sites devoted to sugar addiction," says Cynthia Bartok, associate director for the Center for Childhood Obesity Research in Penn State's College of Health and Human Development, "modern science has not yet validated that idea." "However, 'yet' may be the key word," Bartok adds. "It was once thought of as pseudoscience, but a whole field of research has sprung out of the idea that food components such as sugar or fat may have some similarities to addictive drugs." Probing Question: Is sugar addictive?
      Lisa Duchene, Penn State "But the study inadvertently highlights an important truth: Anything that provides pleasure (or relieves stress) can be the focus of an addiction, the strength of which depends not on the inherent power of the stimulus but on the individual's relationship with it, which in turn depends on various factors, including his personality, circumstances, values, tastes, and preferences. As Peele and other critics of neurological reductionism have been pointing out for many years, the reality of addiction lies not in patterns of brain activity but in the lived experience of the addict." Research Shows Cocaine And Heroin Are Less Addictive Than Oreos, Jacob Sullum, Forbes "The evidence supports the hypothesis that under certain circumstances rats can become sugar dependent. This may translate to some human conditions as suggested by the literature on eating disorders and obesity." Neuroscience & Biobehavioral Reviews
      Volume 32, Issue 1, 2008, Pages 20-39
      Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake
      Nicole M. Avena, Pedro Rada, Bartley G. Hoebel "For many years, studies have demonstrated that sugar triggers the brain’s pleasure and reward centers—areas in the emotional centers of the brain responsible for the release of “feel good” neurotransmitters called dopamine. These are the same brain areas stimulated by cocaine, nicotine, opiates (such as heroin and morphine), and alcohol. This addiction is not an imaginary thing in the minds of millions of sugar junkies—it’s associated with real physiological changes in the brain. And, perhaps because the brain’s pleasure areas are also very close to the pain centers, withdrawal from sugar has been described by many patients as being painful—like romantic pain or eliminating nicotine or caffeine." Sugar Addiction: Is It Real?
      By Dr. Phil Maffetone
      April 9, 2015, Fat-Burning Journal, Nutrition, MAF "According to Avena, when we eat sugar a signal is sent from the tongue to the cerebral cortex that activates a “rewards system.” This in turn encourages us to eat more. A huge part of the rewards system is the release of dopamine in our brain, which, when put into overdrive, can be pretty addictive." This Is Why You’re ‘Addicted’ To Sugar
      There’s a reason it feels so darn good.
      By Cate Matthews, Healthy Living, Huffpost "Speaking to the Guardian, DiNicolantonio said that the consumption of sugar was a grave concern. “In animals, it is actually more addictive than even cocaine, so sugar is pretty much probably the most consumed addictive substance around the world and it is wreaking havoc on our health.”  Is sugar really as addictive as cocaine? Scientists row over effect on body and brain, by Nicola Davis, theguardian "Studies show that sugar lights up the same exact area of our brain that is stimulated by drugs. For some people, the highs, lows and withdrawal from sugar can be just as powerful and dramatic as what a drug addict experiences." Sugar and Your Brain: Why Sugar Is So Very Addictive, 
      By: Rachel Gargano MS, RD, LDN, CSSD, Reboot with Joe "Sugar addiction should be treated like drug abuse, new research has revealed."
      Sugar addiction like drug abuse, study reveals, by  Nicola Harley, Telegraph "It is widely thought to affect the brain in a similar way to cocaine, and now a new study has suggested people addicted to sugar should be treated in the same way as other drug abusers." Sugar addiction 'should be treated as a form of drug abuse'
      by Matt Payton, Independent "Taubes surveys the admittedly sparse research on sugar's psychoactive effects. For example, researchers have found that eating sugar stimulates the release of dopamine, a neurotransmitter that is also released when consuming nicotine, cocaine, heroin, or alcohol. Researchers are still debating the question of whether or not sugar is, in some sense, addictive." Is Sugar an Addictive Poison?
      Hypothesis: More sugar causes both more diabetes and more obesity
      Ronald Bailey | January 6, 2017, reason.com "Research published in the Public Library of Science highlights a strange lab rat experiment involving sugar and cocaine. The rats were given cocaine until they became dependent on it. Then, researchers provided them a choice – the rats could continue to have the cocaine or they could switch to sugar. Guess which one the rodents chose? Yup, the sugar. 94% chose to make the switch. Even when they had to work hard to access the sugar, the rats were more interested in it than they were in the cocaine." Study Shows Sugar is More Addictive Than Cocaine!, David Wolfe Sources Who Say Sugar is Not Addictive "That is definitely a problem, but is not necessarily an addiction."

      Is Sugar Addiction?
      by Susan J. SMith, Ph.D, CDE, Visalia Medical Clinic "Most of the research they found on sugar addiction was done using mice or rats, and it’s not clear that these findings will translate perfectly to people." Everyone Calm Down for a Minute About ‘Sugar Addiction,’ Neuroscientists Plead
      By Melissa Dahl, Science of Us, NYMag "Given the lack of evidence supporting it, we argue against a premature incorporation of sugar addiction into the scientific literature and public policy recommendations." European Journal of Nutrition
      November 2016, Volume 55, Supplement 2, pp 55–69
      Sugar addiction: the state of the science
      Margaret L. WestwaterPaul C. FletcherHisham Ziauddeen "Prof Suzanne Dickson, of Gothenburg University and co-ordinator of the NeuroFAST project, said: "There has been a major debate over whether sugar is addictive.
      "There is currently very little evidence to support the idea that any ingredient, food item, additive or combination of ingredients has addictive properties." Sugar 'not addictive' says Edinburgh University study, 
      9 September 2014
      From the section Edinburgh, Fife & East Scotland, BBC "Sugary and high-fat food have both been shown to increase the expression of ΔFosB, an addiction biomarker, in the D1-type medium spiny neurons of the nucleus accumbens; however, there is very little research on the synaptic plasticity from compulsive food consumption, a phenomenon which is known to be caused by ΔFosB overexpression." Food Addiction, Wikipedia
    • asmaa,  Thanks for posting, which is the best thing you can do. Public relations is a great place to post. What is your background? PR?  Tell us about your rosacea? 
    • hi all, hi brady  barrows as you know i am already member in the rosacea forum, and i would like to be an active member in this forum (RRDi) too, i received your e-mail and i am happy to participate. i need more details  to know how can i help thanks to all
    • Related Articles Painful subcutaneous nodules in a patch of livedo reticularis. Int J Dermatol. 2017 Mar;56(3):e44-e46 Authors: Barnes P, Chapman C, Fett N PMID: 27496315 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Treatment of Rosacea With Concomitant Use of Topical Ivermectin 1% Cream and Brimonidine 0.33% Gel: A Randomized, Vehicle-controlled Study. J Drugs Dermatol. 2017 Sep 01;16(9):909-916 Authors: Gold LS, Papp K, Lynde C, Lain E, Gooderham M, Johnson S, Kerrouche N Abstract
      BACKGROUND: There is currently a lack of data on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream and brimonidine 0.33% (BR) gel have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively.
      OBJECTIVE: To evaluate the efficacy, safety, patient satisfaction, and optimal timing of administration of IVM associated with BR (IVM+BR) versus their vehicles in rosacea (investigator global assessment [IGA] ≥3).
      METHODS: Multicenter, randomized, double-blind study including subjects with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks.
      RESULTS: The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared to vehicle (55.8% vs. 36.8%, P=0.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. Subjects reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles.
      CONCLUSION: Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease. Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability. <p><em>J Drugs Dermatol. 2017;16(9):909-916.</em></p>.
      PMID: 28915286 [PubMed - in process] {url} = URL to article
    • Related Articles Painful subcutaneous nodules in a patch of livedo reticularis. Int J Dermatol. 2017 Mar;56(3):e44-e46 Authors: Barnes P, Chapman C, Fett N PMID: 27496315 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Treatment of Rosacea With Concomitant Use of Topical Ivermectin 1% Cream and Brimonidine 0.33% Gel: A Randomized, Vehicle-controlled Study. J Drugs Dermatol. 2017 Sep 01;16(9):909-916 Authors: Gold LS, Papp K, Lynde C, Lain E, Gooderham M, Johnson S, Kerrouche N Abstract
      BACKGROUND: There is currently a lack of data on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream and brimonidine 0.33% (BR) gel have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively.
      OBJECTIVE: To evaluate the efficacy, safety, patient satisfaction, and optimal timing of administration of IVM associated with BR (IVM+BR) versus their vehicles in rosacea (investigator global assessment [IGA] ≥3).
      METHODS: Multicenter, randomized, double-blind study including subjects with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks.
      RESULTS: The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared to vehicle (55.8% vs. 36.8%, P=0.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. Subjects reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles.
      CONCLUSION: Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease. Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability. <p><em>J Drugs Dermatol. 2017;16(9):909-916.</em></p>.
      PMID: 28915286 [PubMed - in process] {url} = URL to article
    • Is Sugar Addictive? This post has moved  
    • Chemical Peels: Indications and Special Considerations for the Male Patient. Dermatol Surg. 2017 Sep 04;: Authors: Reserva J, Champlain A, Soon SL, Tung R Abstract
      BACKGROUND: Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic procedure performed in men.
      OBJECTIVE: To review the indications for chemical peels with an emphasis on performing this procedure in male patients.
      MATERIALS AND METHODS: Review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men.
      RESULTS: Conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Male patients may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density.
      CONCLUSION: Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should have an understanding of chemical peel applications and techniques to address the concerns of male patients.
      PMID: 28902026 [PubMed - as supplied by publisher] {url} = URL to article
    • The Association Between Low Grade Systemic Inflammation and Skin Diseases: A Cross-sectional Survey in the Northern Finland Birth Cohort 1966. Acta Derm Venereol. 2017 Sep 13;: Authors: Sinikumpu SP, Huilaja L, Auvinen J, Jokelainen J, Puukka K, Ruokonen A, Timonen M, Tasanen K Abstract
      Low grade inflammation is associated with many noncommunicable diseases. The association between skin diseases in general and systemic inflammation has not previously been studied at the population level. A whole-body investigation on 1,930 adults belonging to Northern Finland Birth Cohort 1966 was performed and high sensitive C-reactive protein (CRP) level was measured as a marker of low grade inflammation in order to determine the association between low grade inflammation and skin diseases in an unselected adult population. After adjustment for confounding factors the following skin disorders were associated with low grade inflammation in multinomial logistic regression analysis: atopic eczema (OR 2.2, 95% CI 1.2-3.9), onychomycosis (OR 2.0, 1.2-3.2) and rosacea (OR 1.7, 1.1-2.5). After additionally adjusting for body mass index and systemic diseases, the risks for atopic eczema (OR 2.4, 1.3-4.6) and onychomycosis (OR 1.9, 1.1-3.1) remained statistically significant. In conclusion, low grade inflammation is present in several skin diseases.
      PMID: 28902946 [PubMed - as supplied by publisher] {url} = URL to article
    • A new article was released by DovePress regarding, "a responder definition for the treatment of papulopustular rosacea."  So what is a 'responder'?   According the authors of this paper, "patients with treatment success, i.e., improvement in IGA to “clear” or “minimal” were called “responders,” and those with treatment failure, i.e., staying in the range of IGA “mild” to “severe” were called “nonresponders”." The paper further stated that, "The goal of our study was to empirically generate a responder definition based on the number of facial rosacea lesions." The authors concluded, "The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea. As this is the first publication providing a responder definition based on the number of lesions, we suggest utilizing both end points – IGA and number of lesions – in clinical research programs for the near future." Clinical, Cosmetic and Investigational Dermatology, September 8, 2017, Dovepress
      An empirically generated responder definition for rosacea treatment • Full Text 
      Staedtler G, Shakery K, Endrikat J, Nkulikiyinka R, Gerlinger C
    • Quality of Life Measurement in Acne. Position Paper of the European Academy of Dermatology and Venereology (EADV) Task Forces on Quality of Life and Patient Oriented Outcomes (QoL and PO) and Acne, Rosacea and Hidradenitis Suppurativa (ARHS). J Eur Acad Dermatol Venereol. 2017 Sep 12;: Authors: Chernyshov PV, Zouboulis CC, Tomas-Aragones L, Jemec GB, Manolache L, Tzellos T, Sampogna F, Evers AWM, Dessinioti C, Marron SE, Bettoli V, van Cranenburgh OD, Svensson A, Liakou AI, Poot F, Szepietowski JC, Salek, Finlay AY Abstract
      Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health-related QoL assessment in acne and because of the high impact of acne on patients' lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations. This article is protected by copyright. All rights reserved.
      PMID: 28898474 [PubMed - as supplied by publisher] {url} = URL to article
    • Of the 15 subjects that have completed 12 weeks of treatment in the study, 100% have IGA scores of clear (0) or almost clear (1), compared to their baseline scores of moderate (3) or severe (4). Investigators also observed a 93% reduction in total inflammatory lesions from baseline to week 12 in the same subjects who have completed the 12-week study.....BPX-011 is a hydrophilic (non-oil-based) topical gel with fully solubilized minocycline that has been shown to penetrate the skin to deliver the antibiotic to its target. Following positive results from its previously announced phase 2b study of BPX-01 in acne, BioPharmX continues with phase 3 clinical study plans for BPX-01 for the treatment of acne. BioPharmX Announces Preliminary Data from Rosacea Feasibility Study, by BioPharmX Corporation, PharmPro
    • "LAUSANNE, Switzerland, Sept. 11, 2017 /PRNewswire/ -- Today, the results of a study evaluating the combined use of topical rosacea treatments ivermectin 1% cream and brimonidine 0.33% gel were published in the Journal of Drugs in Dermatology." Galderma: Combined Use of Rosacea Therapies Ivermectin 1% Cream and Brimonidine 0.33% Gel Evaluated in MOSAIC Study, PRNewswire, MarketsInsider, BusinessInsider
    • "Following fourteen years of follow-up analysis, this study showed that increased alcohol intake was associated with a significantly higher risk of rosacea when compared to individuals who never consumed alcohol. Of the individual types of alcohol beverages, the consumption of white wine or liquor showed an even higher association with rosacea risk. Interestingly, white wine and liquor are the only two types of alcoholic beverages that lack anti-inflammatory components such as flavonoids which are present in red wine. Importantly, this study adds to the growing body of evidence in implicating alcohol consumption as a factor in the development of rosacea." Does Alcohol Intake Lead to an Increased Rate of Rosacea?, Written by Neeti Vashi, BSc, Medical News Bulletin
    • Treatment of erythemato-telangiectatic rosacea with brimonidine alone or combined with vascular laser based on preliminary instrumental evaluation of the vascular component. Lasers Med Sci. 2017 Sep 09;: Authors: Micali G, Dall'Oglio F, Verzì AE, Luppino I, Bhatt K, Lacarrubba F Abstract
      The purpose of this study is to evaluate the outcome of a series of patients with erythematotelangiectatic rosacea (ETR) affected by persistent erythema and varying degree of telangiectasias being treated with brimonidine alone or combined with a vascular laser based on the type of vascular components preliminarily evaluated by clinical and instrumental observation. Ten patients affected by ETR were enrolled in a pilot, open study. Instrumental evaluation included erythema-directed digital photography by VISIA-CR™ system and X10 dermoscopy. Those patients showing marked background erythema and minimal telangiectasias (group A) were treated with a single application of brimonidine 0.33% gel, while patients showing both marked background erythema and marked telangiectasias (group B) were treated with a session of Nd:YAG laser and reevaluated 1 month later after a single application of brimonidine. An Investigator Global Assessment (IGA) of treatment outcome was performed at the end of treatment in both groups. In group A, 6 h after brimonidine application, a marked reduction of the background erythema was observed in all patients, and IGA was rated as excellent. In group B, 6 h following the application of brimonidine, a marked reduction of the background erythema was observed in all cases, while telangiectasias remained unchanged. A further treatment with brimonidine 1 month after the Nd:YAG laser session determined complete clearing of facial erythema, and IGA was rated as excellent. In conclusion, a preliminary evaluation of the vascular component by erythema-directed digital photography and dermoscopy in ETR may be helpful to select the most appropriate therapeutic strategy.
      PMID: 28889348 [PubMed - as supplied by publisher] {url} = URL to article
    • Vitamin B Derivative (Nicotinamide)Appears to Reduce Skin Cancer Risk. Skin Therapy Lett. 2017 Sep;22(5):1-4 Authors: Nazarali S, Kuzel P Abstract
      Nicotinamide, an amide form of vitamin B3, has shown the potential to treat a variety of dermatological conditions, including acne, rosacea, and atopic dermatitis. Recent studies have demonstrated the role of nicotinamide, in both topical and oral forms, as a chemopreventive agent against skin cancer. Its anti-carcinogenic role may be due to its ability to enhance DNA repair and prevent ultraviolet (UV)-induced immunosuppression, which is known to contribute to the progression of pre-malignant lesions. Furthermore, nicotinamide is a precursor of essential coenzymes for many important reactions in the body, including the production of nicotinamide adenine dinucleotide (NAD). NAD is a key coenzyme in the synthesis of adenosine triphosphate (ATP), which transports chemical energy within cells. Therefore, nicotinamide plays a significant role in supporting energy-dependent cellular processes, including DNA repair.
      PMID: 28888216 [PubMed - in process] {url} = URL to article
    • A photoconverter gel-assisted blue light therapy for the treatment of rosacea. Int J Dermatol. 2017 Sep 07;: Authors: Braun SA, Gerber PA PMID: 28884800 [PubMed - as supplied by publisher] {url} = URL to article
    • "New research shows that keeping these microorganisms in balance may help to protect skin from certain conditions. For example, acne, eczema, and rosacea are now attributed to a lack of diversity in the skin microbiome, Dr. Levin explains. Eczema patients, for instance, were found to have a microbiome that's different from the microbiomes of those who do not suffer from the telltale inflammation and skin rashes. Often, skin conditions occur because the microorganisms found on the skin have changed significantly from optimal levels, she adds." Everything You Need to Know About Your Skin Microbiome, By Alina Dizik, Shape For more information on this subject
    • Can Hematologic Parameters be an Indicator of Metabolic Disorders Accompanying Rosacea? Acta Dermatovenerol Croat. 2017 Jul;25(2):145-150 Authors: Akin Belli A, Kara A, Ozbas Gok S Abstract
      Recently, diverse hematologic parameters have been used as an indicator of the presence or severity of inflammatory and cardiovascular diseases. Our aim was to investigate the ratios of neutrophils to lymphocytes (NL), monocytes to high-density lipoprotein (HDL) cholesterol (MHC), and platelets to lymphocytes (PL) in patients with rosacea in comparison with the control group and determine whether there was a correlation between these ratios and metabolic disorders in patients with rosacea. We conducted a case-control study on 61 patients with rosacea and 60 healthy controls between January 2015 and January 2016 at the Dermatology Outpatient Clinic, Mugla, Turkey. Demographic data, biochemical parameters, hematologic parameters and ratios, the presence of metabolic syndrome (MS), and the presence of insulin resistance (IR) in the participants were recorded. Sixty one patients with rosacea (16 men, 45 women) and 60 controls (13 men, 47 women) were included in the study. The NL ratio, mean levels of low-density lipoprotein (LDL) and total cholesterol, triglyceride, C-reactive protein (CRP), systolic and diastolic blood pressures, and the presence of IR were significantly higher in patients with rosacea than in controls. In the rosacea group, the MHC ratio was significantly higher in patients with rosacea with IR and MS. Moreover, only the MHC ratio was an independent predictor of MS according to univariate logistic regression analysis. The cutoff value of MHC on admission for predicting MS in patients with rosacea was 0.013.The higher levels of NL ratio and IR in the rosacea group corroborate the previous studies demonstrating a high level of cardiovascular risk factors in patients with rosacea. The MHC ratio may be used as a simple and inexpensive method to predict metabolic disorders in patients with rosacea.
      PMID: 28871930 [PubMed - in process] {url} = URL to article
    • Rosacea treatment schema: an update. Cutis. 2017 Jul;100(1):11-13 Authors: Rosamilia LL PMID: 28873101 [PubMed - in process] {url} = URL to article
    • Lack of significant anti-inflammatory activity with clindamycin in the treatment of rosacea: results of 2 randomized, vehicle-controlled trials. Cutis. 2017 Jul;100(1):53-58 Authors: Martel P, Jarratt M, Weiss J, Carlavan I Abstract
      Rosacea is a chronic inflammatory skin disease of the face. The objective of the studies described here was to evaluate the efficacy of clindamycin in the treatment of rosacea. Two multicenter, randomized, vehicle-controlled, phase 2 studies were conducted in participants with moderate to severe rosacea. Study A was a 12-week dose-comparison, 5-arm, parallel group comparison of clindamycin cream 1% or vehicle once or twice daily and clindamycin cream 0.3% once daily. Study B was a 2-arm comparison of twice daily clindamycin gel 1% versus vehicle gel. A total of 629 participants (study A, N=416; study B, N=213) were randomized. The results of these studies indicated that clindamycin cream 0.3% and 1% and clindamycin gel 1% were no more effective than the vehicle in the treatment of moderate to severe rosacea, suggesting clindamycin has no intrinsic anti-inflammatory activity in rosacea.
      PMID: 28873109 [PubMed - in process] {url} = URL to article
    • "Rosacea has always been a subtle, yet outwardly facing part of my identity—one I've never truly come to terms with. Growing up I would always be asked, "Why are your cheeks so red?" Or "Why are you blushing so much? Are you embarrassed?" No Karen, I have rosacea, my skin is overly sensitive to the sun. Of course I never said that—I simply shrugged it off." What It's Really Like Living with Rosacea, by RACHEL EPSTEIN, marie claire
    • LENA DUNHAM REVEALS BATTLE WITH ROSACEA
      10:51 AM PDT 8/22/2017 by Stephanie Chan, Hollywood Reporter
    • Related Articles Diffuse Papular Eruption of the Face and Eyelids. Skinmed. 2017;15(4):291-292 Authors: Frisch S, Kozel J, Jensen S, Vidal CI Abstract
      A 68-year-old Caucasian woman presented with a 1-month history of a facial and neck eruption (Figure 1A). Her face was covered with 3-mm monomorphic, pink, shiny, papules and rare pustules on an erythematous background. The eruption extended down the neck, her conjunctivae were injected, and her lid margins were inflamed. She had no history of rosacea.
      PMID: 28859742 [PubMed - in process] {url} = URL to article
    • The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organ J. 2017;10(1):29 Authors: Prescott SL, Larcombe DL, Logan AC, West C, Burks W, Caraballo L, Levin M, Etten EV, Horwitz P, Kozyrskyj A, Campbell DE Abstract
      Skin barrier structure and function is essential to human health. Hitherto unrecognized functions of epidermal keratinocytes show that the skin plays an important role in adapting whole-body physiology to changing environments, including the capacity to produce a wide variety of hormones, neurotransmitters and cytokine that can potentially influence whole-body states, and quite possibly, even emotions. Skin microbiota play an integral role in the maturation and homeostatic regulation of keratinocytes and host immune networks with systemic implications. As our primary interface with the external environment, the biodiversity of skin habitats is heavily influenced by the biodiversity of the ecosystems in which we reside. Thus, factors which alter the establishment and health of the skin microbiome have the potential to predispose to not only cutaneous disease, but also other inflammatory non-communicable diseases (NCDs). Indeed, disturbances of the stratum corneum have been noted in allergic diseases (eczema and food allergy), psoriasis, rosacea, acne vulgaris and with the skin aging process. The built environment, global biodiversity losses and declining nature relatedness are contributing to erosion of diversity at a micro-ecological level, including our own microbial habitats. This emphasises the importance of ecological perspectives in overcoming the factors that drive dysbiosis and the risk of inflammatory diseases across the life course.
      PMID: 28855974 [PubMed] {url} = URL to article
    • You may want to print the following published paper and bring this with you to your dermatologist to give him a copy.  Forum for Nord Derm Ven 2017, Vol. 22, No. 1
      Rosacea: Time for a New Approach • Rosacea-Time-for-a-New-Approach.pdf
      CARSTEN SAUER MIKKELSEN, PETER BJERRING, MARGARETA LIRVALL, MARGARETA SVENSSON, HELENE RINGE HOLMGREN, ALEXANDER SALAVA AND THEIS HULDT-NYSTRØM  
    • "We report a unique case of facial erythema of rosacea that responded to brimonidine gel with effective blanching for two years until the patient developed a paradoxical erythema reaction. This is an adverse reaction physicians should be aware of with continued prescription of brimonidine gel for their rosacea patients." Paradoxical Erythema Reaction of Long-term Topical Brimonidine Gel for the Treatment of Facial Erythema of Rosacea
      June 2016 | Volume 15 | Issue 6 | Case Report | 763 | Copyright © 2016 • PubMed
      Erin Lowe MSIV and Scott Lim DO
    • Stanford Secukinumab Clinical Trial (posted by David Pascoe)
    • "Considering the significant improvement in the patient’s condition after appropriate diet and appropriate use of herbal medicines, it seems that traditional medicinal therapies have great results in the treatment of rosacea." Treatment
      Measures to Protect Health and Nutrition:
      Health and nutrition regimes were recommended at first because of gastrointestinal problems are, prohibited concentrated foods and due to the type of skin lesions that is a sign of increased virulent yellow bile the prohibition of bile stimulating and producing foods.
      Pharmaceutical Measures:
      Aftimoni whey protein with Sisymbrium irio should be consumed hot at fasting, Liver capsule (coriander seed, fumaria, lettuce seed, chicory seed, Jujube, Rhubarb root, cassia leaf, thyme), sekanjabin (fennel, chicory seed, celery seed, Tribulus terrestris, cumin, Khyarin seed, chicory root bark, fennel root bark, capparis root bark), and local mask containing mallow, mallow flowers, and chamomile flowers were administered along with milk and two drops of lemon juice.
      Conclusion
      Owing to the significant improvement in our patient’s condition, it seems that temperament reform through recommendations and regimens, as well as herbal medicines prescribed according to sources of Iranian traditional medicine, play an important role in the development of rosacea symptoms. This study should be a useful guide for future clinical studies of this disease. Asian Journal of Clinical Case Reports for Traditional and Alternative Medicine 
      Improvement of Rosacea Symptoms in a 62-year-old Man with the Treatment of Iranian Traditional Medicine
      Article 4, Volume 1, Issue 1, Winter 2017, Page 29-36 • Abstract •
      Akramosadat Atyabi (M.D., Ph.D. Candidate), Fatemeh Eghbalian (M.D., Ph.D. Candidate) , Mehrdad Karimi (M.D., Ph.D.)   
    • Related Articles The many faces of interleukin-17 in inflammatory skin diseases. Br J Dermatol. 2016 Nov;175(5):892-901 Authors: Speeckaert R, Lambert J, Grine L, Van Gele M, De Schepper S, van Geel N Abstract
      Interleukin (IL)-17 is an emerging target for inflammatory skin disorders. Given the remarkable success of its therapeutic inhibition in psoriasis, the pathogenic role of this cytokine is being explored in other immune-mediated diseases. Interestingly, IL-17 is linked to particular skin conditions where its activation coincides with disease flares. The leading hypothesis for its contribution to proinflammatory signalling cascades is driving inflammasome activation. However, IL-17 stimulation also releases a range of noninflammasome-related cytokines from human skin. Furthermore, a role in cytotoxic responses and an important interplay with the microbiome is hypothesized. While treatment failure would be surprising in neutrophilic dermatoses, the picture might be more complex in lymphocyte-mediated conditions. Nonetheless, increasing insights into the pathogenesis suggest that beneficial responses are also probable in the latter conditions. Study of this pathway in the skin reveals some intriguing aspects of the IL-17-related immunological network.
      PMID: 27117954 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Rosacea and Helicobacter pylori: links and risks. Clin Cosmet Investig Dermatol. 2017;10:305-310 Authors: Lazaridou E, Korfitis C, Kemanetzi C, Sotiriou E, Apalla Z, Vakirlis E, Fotiadou C, Lallas A, Ioannides D Abstract
      Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms "rosacea", "H.pylori", "gastrointestinal disorders and H.pylori", "microorganisms and rosacea", "pathogenesis and treatment of rosacea", and "risk factors of rosacea", and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea.
      PMID: 28848358 [PubMed] {url} = URL to article
    • "The researchers also noted that a very low intake of saturated fats (below 3 percent of daily diet) was associated with a higher risk of death in the study, compared to diets containing up to 13 percent daily. At the same time, high-carb diets -- containing an average 77 percent carbohydrates -- were associated with a 28 percent increased risk of death versus low-carb diets, Dehghan said. "The study showed that contrary to popular belief, increased consumption of dietary fats is associated with a lower risk of death," Dehghan said. "We found no evidence that below 10 percent of energy by saturated fat is beneficial, and going below 7 percent may even be harmful. Moderate amounts, particularly when accompanied with lower carbohydrate intake, are probably optimal," she said. These results suggest that leading health organizations might need to reconsider their dietary guidelines, Dehghan noted." Large diet study suggests it's carbs, not fats, that are bad for your health, By DENNIS THOMPSON HEALTHDAY, CBS News
    • This post has been promoted to an article: 
      Do You Have A Gut Feeling About Your Rosacea?
    • Immune deficiency and rosacea. J Eur Acad Dermatol Venereol. 2017 Aug 28;: Authors: Second J, Lipsker D Abstract
      They wonder whether the patients that we reported definitely had demodicidosis associated to rosacea, and above all provide, they their own interesting findings in 60 patients with rosacea, findings that we will not comment here.We agree that skin scraping with a D. folliculorum count is certainly the less unreliable way to support a diagnosis of demodicidosis. We did not perform this test, since in our experience, strong itching in papulo-pustular rosacea in individuals with immune deficiency is always associated with D. folliculorum proliferation. This article is protected by copyright. All rights reserved.
      PMID: 28846159 [PubMed - as supplied by publisher] {url} = URL to article
    • The usefulness of investigating the possible underlying conditions in rosacea. J Eur Acad Dermatol Venereol. 2017 Aug 28;: Authors: Ciccarese G, Parodi A, Rebora A, Drago F Abstract
      The paper entitled "Rosacea and demodicidosis with gain of function mutation in STAT1″ by Second et al.(1) is of indubitable interest and prompted us to make some observations. The Authors described a patient with cutaneous and ocular rosacea that they related to demodicidosis since oral ivermectin improved the cutaneous lesions(1) . However, the Authors did not demonstrate by skin scraping nor by standardized skin surface biopsy (SSSB) an excessive number of Demodex folliculorum (DF) mites in the pilosebaceous units to justify an oral antiparasitic treatment as a drug of first choice(1) . This article is protected by copyright. All rights reserved.
      PMID: 28846817 [PubMed - as supplied by publisher] {url} = URL to article
    • "While assessment of available clinical trial data indicates that the medication is as effective as other available treatment for controlling rosacea-associated erythema with minimal risk of adverse effects, studies of long-term duration and direct comparison will be necessary to establish its place in treatment guidelines and clinical practice." Oxymetazoline hydrochloride cream for facial erythema associated with rosacea. Expert Rev Clin Pharmacol. 2017 Aug 24;:1-6 Authors: Patel NU, Shukla S, Zaki J, Feldman SR
    • Oxymetazoline hydrochloride cream for facial erythema associated with rosacea. Expert Rev Clin Pharmacol. 2017 Aug 24;:1-6 Authors: Patel NU, Shukla S, Zaki J, Feldman SR Abstract
      INTRODUCTION: Rosacea is a chronic skin condition characterized by transient and persistent erythema of the central face. The symptom of persistent erythema can be particularly frustrating for both patients and physicians as it is difficult to treat. Areas covered: Current treatment options for the treatment of rosacea include metronidazole, azelaic acid, sodium sulfacetamide-sulfur, and brimonidine. Until recently, brimonidine gel was the only option approved specifically for the treatment of facial erythema. However, oxymetazoline hydrochloride 1% cream is a newly FDA approved topical medication for adult rosacea patients. A primarily alpha-1a agonist, oxymetazoline hydrochloride (HCl) is thought to diminish erythema through vasoconstriction. Our paper seeks to evaluate evidence for topical oxymetazoline HCl with respect to its efficacy and safety for its approved indication of treating the persistent erythema associated with rosacea. Expert commentary: While assessment of available clinical trial data indicates that the medication is as effective as other available treatment for controlling rosacea-associated erythema with minimal risk of adverse effects, studies of long-term duration and direct comparison will be necessary to establish its place in treatment guidelines and clinical practice. As further evidence becomes available, the real-world clinical potential of topical oxymetazoline cream will become clearer.
      PMID: 28837365 [PubMed - as supplied by publisher] {url} = URL to article
    • "Patients with rosacea were significantly more likely than controls to have Demodex mite infestation, according to findings from a literature review and meta-analysis." Demodex mite infestation present in patients with rosacea, Healio Dermatology What are the numbers?
    • Swiss S1 guideline for the treatment of rosacea. J Eur Acad Dermatol Venereol. 2017 Aug 21;: Authors: Anzengruber F, Czernielewski J, Conrad C, Feldmeyer L, Yawalkar N, Häusermann P, Cozzio A, Mainetti C, Goldblum D, Läuchli S, Imhof L, Brand C, Laffitte E, Navarini AA Abstract
      Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.
      PMID: 28833645 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Laser treatment of medical skin disease in women. Int J Womens Dermatol. 2017 Sep;3(3):131-139 Authors: LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J Abstract
      Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
      PMID: 28831422 [PubMed] {url} = URL to article
    • Q&As What Can I Do for My Rosacea?
      The Short Answer from a dermatologist —Dermatologist  Christine Poblete-Lopez, MD
      healthessentials, Cleveland Clinic
    • "In the recent study, Di Nardo and colleagues have found that transient receptor potential vanilloid 4 (TRPV4) activates mast cells in people with rosacea." Researchers discover rosacea treatment pathway, Healio For more information on this read the post, 
      Trigeminal sensory malfunction theory
    • "It didn't take long to be diagnosed with rosacea and told that "there is not much known about it and no known cure". All four of the dermatologists I visited (yes, four - I was determined to find one who would offer a glimmer of hope) explained that it was chronic inflammation where blood vessels dilate too easily. It occurs most commonly in women (check) with fair skin (check) who are prone to blushing (check). So, at an age when I assumed I was well beyond my "skin-issue" years, I was suddenly a textbook case. All the doctors told me to treat it with oral and topical antibiotics." Dealing With Rosacea: Under My Skin, Calgary Avansino, Vogue
    • "Lena Dunham has spoken out in the past about her mental health difficulties, her endometriosis and her battles with social-media trolls, but this time she has turned her attention to a skin issue that plagues people all over the world: rosacea." Lena Dunham Speaks Out About Rosacea, Vogue
      image courtesy Wikicommons Lena Dunham Reveals Her Struggle With Rosacea, And For A Great Reason, Huff Post LENA DUNHAM REVEALS A SUDDEN STRUGGLE WITH ROSACEA HAS "RUINED" HER SKIN, Harpers Bazaar Lena Dunham Is Not Happy That She Suddenly Has Rosacea, Self Lena Dunham Reveals How Rosacea Ruined Her 'Perfect ****** Skin', Allure Lena Dunham Is Seriously Bummed She Suddenly Has Rosacea at 31. Here's Why That Happens, Health
    • Granulomatous rosacea: a case report. J Med Case Rep. 2017 Aug 20;11(1):230 Authors: Kelati A, Mernissi FZ Abstract
      BACKGROUND: Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved.
      CASE PRESENTATION: We report a case of a 54-year-old Moroccan man with a 3-month history of erythematous, nonpruritic papules on the lateral side around the eyes. Dermoscopy and histology confirmed the diagnosis of granulomatous rosacea.
      CONCLUSIONS: We describe another clinical presentation of granulomatous rosacea with a clinical-dermoscopic-pathological correlation.
      PMID: 28822351 [PubMed - in process] {url} = URL to article
    • Originally intended for those suffering from rosacea and eczema, this redness-neutralizing cream comes in three shades and has an irritation-soothing, sensitive-skin-comforting formula made up of colloidal oatmeal, peptides, hydrolyzed collagen, aloe, and avocado to calm, smooth, and hydrate the skin. This Concealer Was Made For Rosacea, but Is Baller at Covering Acne Scars,  by MEGAN MCINTYRE, Popsugar IT Cosmetics Bye Bye Redness Neutralizing Correcting Cream
    • Tom Busby, poster extraordinair at RF, posted the following which is worth reading (post no 2 in this thread):  Hi Stephan, you're right that demodex can cause dry eye symptoms, and plugging of the meibomian glands. Your photo shows a small whitish plug inside the margins of the eyelashes, which is where the meibomian glands are located. I suggest you read as much as you can, and use google search terms like "inspissated meibomian glands," which is the medical term for plugged meibomian glands, and your description of dry eyes upon waking is called "saponification." "Meibomian Gland Dysfunction" (MGD) is the general term, and demodicosis or demodectic blepharitis would be more specific terms.

      The medical profession is obsessed with the naming of things, and you'll eventually learn more if you go through the steep learning curve of learning the medical terms. I did all this when I found I had conditions very similar to yours.

      Plus, the eyes have extremely complicated anatomy, which you will need to learn. To get you started, the function of the meibomian glands is to release a tiny bit of oil each time you blink (from the blink pressure) and the oil floats on top of the tear film, and slows down the evaporation of the aqueous component. The Glands of Moll and the Glands of Zeiss also release oil. The lack of oil is the problem, and is why eye drops don't do anything at all.

      The plug that is outside the margin of the eyelashes, in your photo, is most like a plugged up Gland of Moll. These plugs are mostly a cosmetic problem, and are the result of dead demodex decaying and causing an allergic reaction. A prominent rosacea MD refers to them as "the gravestone of a dead demodex." The crusty skin below your eyes appears to be a combination of demodex-induced and malassezia-induced reactions. Climbazole treats against malassezia, but does nothing against demodex.

      You can gently express the meibomian glands, and you'll learn a lot by examining the quality and quantity of fluid that comes out. You'll need to read a lot more about this, but in very general terms, it's easier to start with the lower lid, and roll a finger gently up. Don't do this over and over, because the amount of oil in the mebomian glands is tiny, and there's no point to emptying the glands by doing it over and over. Most likely, nothing will come out of your meibomian glands, which is not what you want to see, at all, but it will show how bad the situation is. Perhaps the fluid will be discolored, or thickened -- this is also showing the need for treatment.

      The best current medically accepted treatment is 25% Tea Tree Oil (TTO), or preferably, a derivative of it called terpinen 4-ol. These procedures and products are patented. The main problem is that these treatments can't be self-administered, because both products burn the cornea, and generally require about a weekly one-hour office visit to an ophthalmologist. Worse yet, in the US these treatments aren't covered by insurance, but I'd like to know if they are covered in Canada. Treatments would cost tens of thousands of dollars. The condition, if it is indeed and allergic reaction, is most likely recurring.  

      You could self-treat with Cliradex wipes, which are 5% TTO, or terpinen 4-ol, but the concept could also be imitated by making your own Cliradex wipes, with 5% TTO and 95% MCT oil. Use before bedtime. Demodex males move around at night, and they're easier to kill. TTO is a contact-killer.

      I never used TTO or terpinen 4-ol as a treatment, because the idea of putting any essential oil near my eyes seemed to being inviting a disaster. My eyes are too important to me, as I read a lot.  

      However, after two years of effectively treating against seb derm induced by an allergic reaction to malassezia, using climbazole as the active ingredient, I found that my eyes were becoming more dry and bloodshot, so a year and a half ago, I went through a second incredibly steep learning curve to find out how I could treat MGD and demodectic blepharitis. 

      As I had previously learned how to make an MCT lotion and an MCT shampoo/shower gel with climbazole, I decided to test other compounds -- only safe ones -- and I found that piroctone olamine suppressed or eradicated demodex. Now my meibomian glands are unblocked, and have remained unblocked for over a year.  

      I use piroctone olamine at a concentration of 0.14%, and climbazole at 0.09%. Neither of these products is applied directly to the cornea or onto an open eye, which would be ridiculously dangerous in my opinion.

      However, my method of trying something to see if it works, is generally called "foraging research" and is not considered scientifically acceptable today, but it's how most discoveries were made before medicine became so incredibly complex and expensive. Nevertheless, I was so exhausted by the expense and futility of the medical system, that I did my own research and experimentation both as to malassezia and then as to demodex.

      Expect to use daily treatment with topical piroctone olamine for 23 days to see initial results, and 120 days for about 99% treatment, and 180 days for full treatment. The process of taking a shower, lathering up with the shower off for 3-5 minutes, then rinsing off and towel drying, and then applying a lotion, is very simple, so the time involved is not oppressive because the treatment is merely ordinary, daily hygiene, using an effective ingredient.

      There's a larger list of things that either don't work, or don't treat against demodex, and they're listed here, and in many other medical articles:  http://www.reviewofophthalmology.com/content/c/36944/ 

      You can't buy piroctone olamine-based cosmetics in the US or Canada because there isn't a Final Monograph approved by the FDA, and Canada follows the FDA in these matters. However, there is a Preliminary Monograph on Octopirox, another name for piroctone olamine, and one can see that piroctone olamine has a 3000 to 1 safety ratio, which is huge. With climbazole, the EU considers a 100 to 1 safety margin acceptable, so it's clear that piroctone olamine is much safer.

      There is no reason for a manufacturer to spend the millions of dollars necessary for a Final Monograph on piroctone olamine, because there are many OTC products overseas and already on the market, making the expense unrecoverable. The same reasoning shows the futility of a patented prescription product, although it would be possible, but it would be undercut by consumers who are willing to buy OTC products from overseas web-vendors.

      You could find some of these OTC piroctone olamine products on eBay or Amazon, but I'm not certain if they would ship them to the US or Canada. It would be worth your time and effort to try to obtain these products, as they aren't very expensive.

      Keep in mind that I'm merely a guy that reads a lot and is willing to try to figure things out, so you'll need to form your own conclusions. Good Luck!
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