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  • Misdiagnosed Rosacea

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    Articles, References and Anecdotal Reports

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

    Articles and References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


    Anecdotal Reports of Misdiagnosis

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

    1. Bob reports his rosacea was misdiagnosed for discoid lupus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    More cases of misdiagnosed rosacea (or vice versa)

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    • Thanks Apurva, and also thanks for your article on co-existence. 
    • Dear Admin, Thank you for the information of posting article. I did not know about that. Next time I will copy and paste my article in the given space.
    • Hi Apurva,  I was reluctant to download a docx file since it is an odd way of posting instead of simply copying and pasting your document into the post?  I checked to see if your file contained any viruses or malware by using VirusTotal and it passed, so I opened the file and I am copying and pasting your article here for the benefit of everyone else not having to go through this process. It might be best to simply write your posts. Here is the contents of your article below:  begin article___________ Co-existence of Rosacea, Seborrheic dermatitis and Blepharitis
      There have been a lot of reports on accounting other chronic skin conditions with rosacea and it is true that you can have multiple conditions simultaneously with rosacea.
      I have experienced rosacea, seborrheic dermatitis and blepharitis together with the combination of erythema and telangiectasia. The very first time this condition appeared as a lesion on half part of nose and cheek and then covered the other part of the face with having scaly torn skin and inflamed eyes.
      After years of my experience and dealing with these conditions, the symptoms include :
      Swollen flushed skin, visible dilated blood vessels with stinging and burning sensation on face.
      SD can cause skin scaly and flaky and can burn with itch and appears mostly on front hair line,forehead and eyebrows that if you itch the flaky and crusty skin falls off like dandruff.
      Blepharitis usually involves upper eyelid and causes inflamed eyelids, teary red eyes and the most important visual aspect is greasy dandruff like scales form on eyelashes covering half of it.
      The conditions can go beyond your cheeks and nose and affect earlobes and chin area and can cause flaky and rough chin area with small bumps.
      The flare ups can last anywhere from few minutes to one day or to one month and they again come back but when it goes you can feel the temperature decrease but it can leave red bumps that looks like acne but gradually the red appearance goes with time but it waxes and wanes.
      Co-existence :
      The occurrence of other chronic inflammatory diseases like seborrheic dermatitis and blepharitis are common in patients with rosacea and the good news is, the treatment of other condition does not aggravate the signs and symptoms of rosacea and lessen the flare ups in the meantime.
      Blepharitis is an inflammation of the eyelids in which the base of the eyelids are swollen and red and flaky greasy like crusts occur around the eyelashes with frequently mildly sticking eyelids and flaky dandruff of eyebrows sometimes called seborrheic blepharitis.(1)
      It is reported that demodex can worsen the condition of rosacea but it can also aggravate the condition of seborrheic blepharitis.(2)
      SD can typically occur as rash on the face and a sheet of lesion on back and middle chest area and middle and underneath breast lines. The underlying cause of seborrhoeic dermatitis is not clear, but a type of yeast called Malassezia furfur is involved.(3) I will emphasize these conditions thoroughly in later posts but for now I will explain the treatment I had with these three conditions :
      When my doctors diagnosed these three conditions, first they prescribed me low dose oral doxycycline capsules (100mg) daily at night.
      1.    Doxycycline is an antibiotic used for treating bacterial infections.The drug is also sold under the brand names Oracea, Doryx, Monodox, Periostat, and Vibramycin. Doxycycline is in a class of medications called tetracyclines, and it's a broad-spectrum antibiotic, it works against a wide range of bacteria.This medication is used to prevent malaria and treat a wide range of infections, including: skin infection.(4,5)
           Side effects: stomach upset, constipation, nausea, heavy head.
      2.    You can apply topical metronidazole gel 0.75% on the affected skin area.  Apply a thin layer of gel once or twice daily.I used to apply once at night daily.
      It is an antibiotic and it works by decreasing redness and inflammation by stopping the growth of certain bacteria and parasites.This antibiotic treats only certain bacterial and parasitic infections. It will not work for viral infections. (6)
            Side effects : burning and eye irritation if it gets close to the eyes.
      3.     Ketoconazole 2 % and Zinc pyrithione 1 % (Shampoo) for the fungal and yeast infections of the skin. Ketoconazole an active ingredient works by interfering and weakening with the formation of the fungal cell membrane. It better works with seborrheic dermatitis and blepharitis. Thoroughly apply on wet hair and massage and leave it for 5 minutes and then rinse it out. It does not make lather like other shampoos. Take a drop on finger, rub it and apply gently on eyelashes on tightly closed eyes and rinse it properly. With 8 weeks of proper use twice in a week completely cured me with SD and blepharitis.
            Side effects : itchy and dry scalp
      4.    If you have dermatitis on your chest and breast lines and back, you can use the composition of Boric acid and  Clotrimazole cream together. It works by reducing inflammation and inhibiting the growth of fungi.
      Apply a thin layer of this base and rub until it absorbs completely twice or thrice daily. I applied this on my front              and back area for four to five days and it worked wonder and the lesions gradually disappeared.
      Note : before taking any above medication consult your doctor or physician and alcohol should not be consumed during any medication it can worsen the condition of rosacea and if you are pregnant or on breast-feeding and any other condition like diabetes or heart problem, take this medications as directed by your doctor.
      Instead relying on oral and topical steroids my doctor prescribed me with bacterial and fungal medications because taking steroids for SD and blepharitis can exacerbate the condition of rosacea and relying on antibiotics and anti-fungal treatments can lessen the condition of SD and blepharitis and keep the rosacea at bay. References :
      https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/blepharitis.(1)
      http://eyewiki.aao.org/Blepharitis.(2)
      http://www.londoneyeunit.co.uk/services/blepharitis/.(3)
      https://www.everydayhealth.com/drugs/doxycycline.(4)
      https://www.webmd.com/drugs/2/drug-8648-7073/doxycycline-hyclate-oral/doxycycline-oral/details.(5)
      https://www.webmd.com/drugs/2/drug-6426/metro
        end article_________________  
    • article.docx   Administrator Note: Read the next post that explains the above. 
    • Association between rosacea severity and relative muscle mass: A cross-sectional study. J Dermatol. 2018 Oct 31;: Authors: Nam JH, Yang J, Park J, Seo JH, Chang Y, Ryu S, Kim WS Abstract
      Rosacea is thought to be associated with factors involved in metabolic syndrome (MetS). Muscle mass has a beneficial role in preventing MetS, but its link to rosacea remains unknown. We sought to investigate the association between rosacea severity and relative skeletal muscle mass. A cross-sectional study was conducted on subjects who attended a skin check-up program at the Kangbuk Samsung Hospital Health Screening Center between 2014 and 2016. Polarized light photographs of the face were taken and evaluated by two dermatologists. Skeletal muscle mass index (SMI, [%] = total skeletal muscle mass [kg] / bodyweight [kg] × 100) was estimated using a bioelectrical impedance analyzer. A logistic regression model was used to evaluate an association between SMI and rosacea. Of 110 rosacea subjects who were finally enrolled, 17 (15.5%) and 93 (84.5%) were classified as having papulopustular and erythematotelangiectatic rosacea, respectively. Categories of SMI comprised the following tertiles: 22.86-38.40%, 38.41-43.44% and 43.45-80.65%. In severity, compared with mild rosacea (75.5%), moderate rosacea (24.5%) incrementally increased as SMI decreased (Ptrend < 0.01). Severe rosacea was not observed. After adjustment for age and sex, odds ratios (95% confidence intervals) for moderate rosacea comparing SMI tertiles 1 and 2 to the highest tertile (reference) were 5.66 (1.22-26.20) and 4.43 (1.12-17.55), respectively (Ptrend = 0.03). This association was present in women with marginal significance (Ptrend = 0.06), but not in men. Relative muscle mass is negatively associated with an increased risk of more severe rosacea, suggesting that skeletal muscle can have a protective effect on rosacea exacerbation.
      PMID: 30379346 [PubMed - as supplied by publisher] {url} = URL to article
    • Thanks so much for your post, very detailed and informative and without a doubt will help many. 
    • Here are some treatment options for demodex skin mites.   I did the combined 2 week oral therapy with Oral Ivermectin * Oral Metronidazole. It worked after years of being misdiagnosed with acne (bacterial) and "allergic conjunctivitis" and given quite a variety of useless antibiotics, retinoids and prescription benzoyl peroxide that didn't work.  8+ months after this treatment my skin and eyes are still clear - first time in many years. This oral prescription treatment was published in the May 2013 issue of the International Journal of Infectious Diseases. The combined 2 drug treatment was more effective than oral Ivermectin alone.

      Using the more effective 2 drug combined treatment (from paper) based on body weight for the oral Ivermectin:
      1. Two doses of oral Ivermectin one week apart. Each weekly dose is 200 micrograms Ivermectin per kilogram of body weight. My doctor rounded the dose up some since they tablets are 3 mg - that avoided having to break tablets. Worked out to 12 mg per dose for me. Take on an empty stomach with a large glass of water.
      2. Oral Metronidazole, 250 mg. three times a day for two weeks. Do not drink alcohol while taking oral Metronidazole and for 72 hours after taking the last tablet.

      I didn't have any problems with either drug. Although, the first dose of Ivermectin did make me sleepy. Got a great 2 hour nap out of it.  Cost:  With insurance copay just $13.03 or about $52 full retail. Here's some links to the May 2013 Journal of Infectious Diseases article:

      Summary of results:
      https://www.ncbi.nlm.nih.gov/pubmed/23294870

      Full Journal Article:
      https://www.sciencedirect.com/scienc...0197121201315X

      It may be wiser to try the Ivermectin first instead of the Roacutane. Roacutane shuts down the oil glands which will reduce the oil eating mite population by starving some of them. But Roacutane will not kill all of the mites. A lot of people seem to have rebound problems after completing the Roacutane treatment. Roacutane also has a lot of serious side effects. Roacutane treatment takes months longer as well. Additional topical treatments effective against demodex skin mites:
      A tea tree oil facial cleanser and overnight tea tree oil moisture cream or tea tree oil ointment can also provide topical support to kill the mites, especially at night. The male mites come out on the skin surface at night to mate. Tea Tree oil can kill the mites or at the very least ruin their love life.

      Tea Tree Oil cleansers:

      1. The Body Shop Tea Tree Skin Clearing Facial Wash (liquid). Available from The Body Shop store or online, or Amazon.
      2. The Body Shop Tea Tree Clearing Foaming Cleanser. Available from The Body Shop store or online, or Amazon.
      3. Desert Essence Thoroughly Clean Face Wash - Available at Kroger, Sprouts, Amazon
      4. Tranquil Eyes 1% (or 2%) Gentle Formula Tea Tree Eyelid and Facial Cleanser by eyeEco - Available at Amazon

      Tea Tree Oil Moisturizer or Ointment - 5% Tea Tree Oil is a good minimum
      1. Desert Essence Tea Tree Oil Skin Ointment - Available at Sprouts, Amazon
      2. Derma e Tea Tree and Vitamin E Relief Cream - Available at Sprouts, Amazon
      3. The Body Shop Tea Tree Night Lotion

      Warning: Tea Tree Oil should never be used at full strength - it can burn and it can be toxic if ingested. It should be diluted with another carrier oil like grapeseed oil or castor oil to no stronger than 50% - even that may be too strong for sensitive skin. 5-10% is the strongest that most face washes or night cremes will contain.

      Hypochlorous acid sprays can also help. Hypochlorous acid is a mild acid and a natural antiseptic, the same as made by the human body in response to a cut or scrape. It kills mites especially in the nymph stage. (Heyedrate and Occusoft are 2 brands available from Amazon). Spray face and eyelids and let dry prior to putting on the nightly moisturizer/ointment. If your face feels itchy in the middle of the night, spray again.

      Borax Treatments:
      Borax DIY shampoo (1 TBSP of 20 Mule Team Borax (grocery store laundry aisle) per cup of hot water, mix in hot water and stir, cool and pour in a clean shampoo bottle) can also be used to wash hair and face. Borax shampoo is a no lather shampoos, use the same as you would any shampoo. Borax kills the mites. Demodex skin mites may also cause what appears to be body acne as well as tchy skin.  The mites can make your skin itch - this borax soak will soothe the skin by killing the mites.  Borax bath soaks can be very helpful in treating demodex that has spread to other parts of the body.  Bath body soak below is for a standard 5 foot bathtub: 1. Start filling tub with pleasantly warm bath water.  Do not make the water too hot as that can over heat you. 2. Add 1 cup 20 Mule Team Borax (available in the laundry aisle at most grocery stores about $5.50 per box). 3.  Add 1 cup Dr. Teal's Epsom Salts (Coconut Oil version is good to aid skin moisture). 4.  Swish water to dissolve the Borax and the Epsom Salts. 5.  Soak for 30 minutes.  Wash your hair and face too and let the solution stay on the face and hair while you soak. 6.  Shower after soaking, rinsing hair too, conditioning hair if needed.
       
    • Related Articles Nasal tip schwannoma mimicking rhinophyma. BMJ Case Rep. 2017 Dec 20;2017: Authors: Geyton T, Henderson AH, Morris J, McDonald S PMID: 29269374 [PubMed - indexed for MEDLINE] {url} = URL to article
    • [FEATURES OF ROSACEA PATHOGENESIS IN PERIMENOPAUSAL WOMEN]. Georgian Med News. 2018 Sep;(282):99-102 Authors: Tsiskarishvili T, Katsitadze A, Tsiskarishvili NV, Mgebrishvili E, Tsiskarishvili NI Abstract
      In patients with rosacea, the monitoring of blood melatonin in the menopausal period, as one of the criteria for assessing the severity of the disease, seems appropriate and pathogenetically justified. The aim of this study was determination of blood melatonin, VEGF, IL-8 concentration in perimenopausal period of women suffering by rosacea. 43 to 65 years old 15 women with various clinical manifestations of rosacea, and severe climacteric syndrome were under observation. The control group consisted of 15 female patients with rosacea but without climacteric syndrome. Melatonin, VEGF,IL-8 level in serum were determined by ELISA (IBL - international - reagent), the results were expressed in pg/ml).As the results of the study showed, the concentration of vasoactive peptides in patients with rosacea differes significantly from those in the control group. Increase the concentration of cytokinesin in the blood of patients with rosacea indicate that they are playing significant role in the pathogenesis of rosaceaAccording to the results of the study, the concentration of melatonin was reduced in all patients with rosacea (the main group). The degree of reduction was in direct correlation with the severity of climacteric syndrome (11,6÷1,5 pg/ml at a rate of ≥ 20,0 pg/ml). In the control group, the melatonin concentration was approaching to the norm (19.1 pg/ml). Statistical analysis of received data revealed the correlation in between of the severity of dermatosis and changes in lipid metabolism and concentration of melatonin (R = 0,91; p <0,05) in the main group of patients (with rosacea and climacteric period). Thus, on the basis of the obtained results it can be concluded that the inclusion of melatonin-containing preparations in prescription for rosacea patients having climacteric syndrome pathogenetically is justified.
      PMID: 30358550 [PubMed - in process] {url} = URL to article
    • Leo Pharma has announced it is purchasing Finacea, as well as other dermatological treatments from Bayer according to this news release. 
    • Nasdaq reports "Aclaris Therapeutics to Acquire Worldwide Rights to RHOFADE® from Allergan." Aclaris originally owned Rhofade and sold it to Allergan and is now buying it back. 
    • Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea In Women. JAMA Dermatol. 2018 Oct 17;: Authors: Li S, Chen ML, Drucker AM, Cho E, Geng H, Qureshi AA, Li WQ Abstract
      Importance: Caffeine is known to decrease vasodilation and have immunosuppressant effects, which may potentially decrease the risk of rosacea. However, the heat from coffee may be a trigger for rosacea flares. The relationship between the risk of rosacea and caffeine intake, including coffee consumption, is poorly understood.
      Objective: To determine the association between the risk of incident rosacea and caffeine intake, including coffee consumption.
      Design, Setting, and Participants: This cohort study included 82 737 women in the Nurses' Health Study II (NHS II), a prospective cohort established in 1989, with follow-up conducted biennially between 1991 and 2005. All analysis took place between June 2017 and June 2018.
      Exposures: Data on coffee, tea, soda, and chocolate consumption were collected every 4 years during follow-up.
      Main Outcomes and Measures: Information on history of clinician-diagnosed rosacea and year of diagnosis was collected in 2005.
      Results: A total of 82 737 women responded to the question regarding a diagnosis of rosacea in 2005 in NHS II and were included in the final analysis (mean [SD] age at study entry, 50.5 [4.6] years). During 1 120 051 person-years of follow-up, we identified 4945 incident cases of rosacea. After adjustment for other risk factors, we found an inverse association between increased caffeine intake and risk of rosacea (hazard ratio for the highest quintile of caffeine intake vs the lowest, 0.76; 95% CI, 0.69-0.84; P < .001 for trend). A significant inverse association with risk of rosacea was also observed for caffeinated coffee consumption (HR, 0.77 for those who consumed ≥4 servings/d vs those who consumed <1/mo; 95% CI, 0.69-0.87; P < .001 for trend), but not for decaffeinated coffee (HR, 0.80; 95% CI, 0.56-1.14; P = .39 for trend). Further analyses found that increased caffeine intake from foods other than coffee (tea, soda, and chocolate) was not significantly associated with decreased risk of rosacea.
      Conclusions and Relevance: Increased caffeine intake from coffee was inversely associated with the risk of incident rosacea. Our findings do not support limiting caffeine intake as a means to prevent rosacea. Further studies are required to explain the mechanisms of action of these associations, to replicate our findings in other populations, and to explore the relationship of caffeine with different rosacea subtypes.
      PMID: 30347034 [PubMed - as supplied by publisher] {url} = URL to article
    • The role of phosphodiesterase 4 in the pathophysiology of atopic dermatitis and the perspective for its inhibition. Exp Dermatol. 2018 Oct 17;: Authors: Guttman-Yassky E, Hanifin JM, Boguniewicz M, Wollenberg A, Bissonnette R, Purohit V, Kilty I, Tallman AM, Zielinski MA Abstract
      Atopic dermatitis (AD) is a highly prevalent, chronic inflammatory skin disease that affects children and adults. The pathophysiology of AD is complex and involves skin barrier and immune dysfunction. Many immune cytokine pathways are amplified in AD, including T helper (Th) 2, Th22, Th17 and Th1. Current treatment guidelines recommend topical medications as initial therapy; however, until recently, only two drug classes were available: topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs). Several limitations are associated with these agents. TCSs can cause a wide range of adverse effects, including skin atrophy, telangiectasia, rosacea and acne. TCIs can cause burning and stinging, and the prescribing information lists a boxed warning for a theoretical risk for malignancy. Novel medications with new mechanisms of action are necessary to provide better long-term control of AD. Phosphodiesterase 4 (PDE4) regulates cyclic adenosine monophosphate in cells and has been shown to be involved in the pathophysiology of AD, making it an attractive therapeutic target. Several PDE4 inhibitors are in clinical development for use in the treatment of AD, including crisaborole, which recently became the first topical PDE4 inhibitor approved for treatment of mild to moderate AD. This review will further describe the pathophysiology of AD, explain the possible role of PDE4 in AD and review PDE4 inhibitors currently approved or being investigated for use in AD. This article is protected by copyright. All rights reserved.
      PMID: 30332502 [PubMed - as supplied by publisher] {url} = URL to article
    • Besides still taking the Lutein/Zeazanthin treatment, I use the ZZ cream about four or five nights a week on some red spots, however, in addition, before I do apply the ZZ cream,  I have been applying a small amount (half teaspoon) of 3% hydrogen peroxide from Walmart (57 cents a bottle) to some red spots and let this dry before applying the ZZ cream. I have noticed when applying the 3% hydrogen peroxide it doesn't sting but after it dries and deeply penetrates the skin I get some stinging which is odd to me but indicates it is finding something down deeper in my skin to work on. The results have been good so I am updating my photos below today: 
    • Related Articles Integrating the Integumentary System with the Arts: A Review of Dermatologic Findings in Artwork. J Clin Aesthet Dermatol. 2018 Sep;11(9):21-27 Authors: Om A, Om A Abstract
      The objectives of this review are to demonstrate that portraits, in their visual reflections of subjects faces and expressions, offer significant representations relevant to the field of dermatology and bring attention to an underappreciated aesthetic of dermatological conditions. The review comprises paintings that purposefully or inadvertently depict dermatological conditions. The findings were substantiated by searching PubMed using the keywords art, painting, and dermatology, as well as combinations of these terms. The "Notable Notes" section of JAMA Dermatology proved especially useful. The review is subdivided by disease category, including portraits that display infectious diseases, neoplastic conditions, genetic dermatoses, rosacea and/or acne, and autoimmune disorders. The breadth of examples of dermatology represented in art suggest that portraits might serve as an unintentional atlas of dermatological conditions. By implication, it seems that the arts might be more interconnected to the sciences than traditionally acknowledged.
      PMID: 30319727 [PubMed] {url} = URL to article
    • The toxic edge-A novel treatment for refractory erythema and flushing of rosacea. Lasers Surg Med. 2018 Oct 12;: Authors: Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O Abstract
      PURPOSE: Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. The primary objective of the study was the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system (Tixel, Novoxel, Israel) to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea.
      METHODS: A retrospective review of16 patients aged 23-45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100 U of abobotulinumtoxin. A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment. Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA), and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument.
      RESULTS: The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a P-value <0.001). DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P < 0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping.
      CONCLUSION: Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
      PMID: 30311683 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Effects of combined oral doxycycline and topical cyclosporine treatment on ocular signs, symptoms, and tear film parameters in rosacea patients. Arq Bras Oftalmol. 2018 Oct 08;: Authors: Bilgin B, Karadag AS Abstract
      PURPOSE: This study reports the effects of combined use of oral doxycycline and topical cyclosporine on ocular signs, symptoms, and tear film parameters in rosacea patients.
      METHODS: Fifty-four right eyes of 54 patients were included in this study. All patients underwent full ophthalmologic examination-including best corrected visual acuity measurement, slit-lamp anterior segment and fundus examination, tear film break-up time, and Schirmer test-before treatment and six months post-treatment. Patients were divided into two treatment groups. The first group was treated with oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. The second group received topical 0.05% cyclosporine emulsion drops twice daily for six months in addition to the oral doxycycline treatment regimen. All patients received preservati ve-free artificial tear drops, warm compress, eyelash cleaning, and topical corticosteroid drops three times daily for one month.
      RESULTS: A significant improvement in ocular signs and symptoms was recorded for all patients in groups 1 and 2 after treatment. There was not a significant difference in terms of itching, burning, meibomian gland inspissation, corneal neovascularization, and conjunctival hyperemia score changes between groups 1 and 2. The increases in Schirmer test and break-up time scores were significantly higher in group 2 than in group 1.
      CONCLUSIONS: Our results support the finding that topical cyclosporine in addition to the standard regimen improves tear function, as shown by Schirmer test and break-up time scores, in ocular rosacea patients.
      PMID: 30304088 [PubMed - as supplied by publisher] {url} = URL to article
    • smart2005ct, That is such good news you are seeing Percy Lehmann, MD, who volunteers on the RRDi MAC. Keep us posted on your progress.     
    • Hello Brady! Greetings from Wuppertal Germany! I have succeeded with God help and the CEO of my bank to land in Germany at the door of prof. dr. Percy Lehmann at Helios Clinic. Keep the fingers crossed for me. Very interesting report. I have the feeling that for the very first time they got it that we are all unique and different and we need unique treatments. Also I am so glad that they have realized how big the psyhological burden is for Rosaceans and how Rosacea can destroy your social life. I cant wait for better days and a new life and the the same thing for all of us. Keep in touch. Hugs. PS: I am glad to be connected on LinkedIn with two of the authors of this report Dr. Anthony Bewley and Prof. Dr. Uwe Gieler
    • Related Articles Trends in utilization of topical medications for treatment of rosacea in the United States (2005-2014) - a cohort analysis. J Am Acad Dermatol. 2018 Oct 01;: Authors: Lev-Tov H, Rill JS, Liu G, Kirby JS PMID: 30287319 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Acute localised exanthematous pustulosis due to metronidazole. J Eur Acad Dermatol Venereol. 2018 Oct 05;: Authors: Kostaki M, Polydorou D, Adamou E, Chasapi V, Antoniou C, Stratigos A Abstract
      Dear Editor, a 78-year-old male patient known for hypertension consulted for a pustular eruption of the face of acute onset. The patient was receiving oral metronidazole as a treatment for rosacea and reported the sudden development of multiple pustules on the face 2 days after the initiation metronidazole. Physical examination revealed the presence of multiple minuscule, non-follicular pustules of the face on an erythematous, edematous background (Fig.1). This article is protected by copyright. All rights reserved.
      PMID: 30288796 [PubMed - as supplied by publisher] {url} = URL to article
    • Brimonidine displays anti-inflammatory properties in the skin through the modulation of the vascular barrier function. Exp Dermatol. 2018 Oct 05;: Authors: Bertino B, Blanchet-Réthoré S, Thibaut de Ménonville S, Reynier P, Méhul B, Bogouch A, Gamboa B, Dugaret AS, Zugaj D, Petit L, Roquet M, Piwnica D, Vial E, Bourdès V, Voegel JJ, Nonne C Abstract
      BACKGROUND: Rosacea is a chronic inflammatory skin disease. Characteristic vascular changes in rosacea skin include enlarged, dilated vessels of the upper dermis and blood flow increase. Brimonidine is approved for symptomatic relief of the erythema of rosacea. It acts by selectively binding to α2-adrenergic receptors present on smooth muscle in the peripheral vasculature, resulting in transient local vasoconstriction.
      OBJECTIVES: To provide further evidence of the anti-inflammatory potential of brimonidine across preclinical models of skin inflammation and its ability to decrease the neutrophil infiltration in human skin after ultraviolet light exposure.
      METHODS: The anti-inflammatory properties of brimonidine through modulation of the vascular barrier function were assessed using in vivo neurogenic vasodilation and acute inflammatory models and a well-described in vitro transmigration assay. A clinical study assessed the neutrophil infiltration in human skin after exposure to UV in 37 healthy Caucasian male subjects.
      RESULTS: In vitro, brimonidine affects the transmigration of human neutrophils through the endothelial barrier by modulating adhesion molecules. In vivo, in the mouse, topical treatment with brimonidine, used at a vasoconstrictive dose, confirmed its anti-inflammatory properties and prevented leukocyte recruitment (rolling and adhesion) mediated by endothelial cells. Topical pre-treatment with brimonidine tartrate 0.33% gel once a day for four days significantly prevented neutrophil infiltration by 53.9% in human skin after exposure to UV light.
      CONCLUSION: Results from in vitro, in vivo and from a clinical study indicate that brimonidine impacts acute inflammation of the skin by interfering with neurogenic activation and/or recruitment of neutrophils. This article is protected by copyright. All rights reserved.
      PMID: 30290018 [PubMed - as supplied by publisher] {url} = URL to article
    • Comparative efficacy of short-pulsed intense pulsed light and pulsed dye laser to treat rosacea. J Cosmet Laser Ther. 2018 Oct 04;:1-6 Authors: Kim BY, Moon HR, Ryu HJ Abstract
      BACKGROUND: Laser and light-based therapies have often been used successfully to treat rosacea. Recently, short-pulsed intense pulsed light (IPL) that emitted pulse durations down to 0.5 ms was found to be effective for rosacea treatment.
      OBJECTIVE: This study evaluated the efficacy of short-pulsed IPL in the treatment of rosacea compared with pulsed dye laser (PDL) using same pulse duration and fluence.
      MATERIALS AND METHODS: Nine patients with rosacea were enrolled in a randomized, split-face trial. Each treatment consisted of four sessions at three-week intervals and followed up until three weeks after the last treatment. Efficacy was assessed by erythema, melanin index, physician's subjective evaluation, and patient's satisfaction.
      RESULTS: The mean change in erythema index was -4.93 ± 1.59 for the short-pulsed IPL group and -4.27 ± 1.23 for the PDL group. The mean change in melanin index was -2.52 ± 2.45 for the short-pulsed IPL group and -1.95 ± 1.41 for the PDL group. There was no significant difference in either melanin or erythema index between short-pulsed IPL and PDL treatments, and there were no noticeable adverse events.
      CONCLUSIONS: There was no significant difference between PDL and short-pulsed IPL treatment using the same energies and pulse. Both PDL and short-pulsed IPL were satisfactory and safe for rosacea treatment.
      PMID: 30285506 [PubMed - as supplied by publisher] {url} = URL to article
    • Galderma has released a report, Rosacea: Beyond the visible, which is an "An open letter to doctors treating rosacea," answering seven questions proposed  about treating rosacea. Galderma sponsored a 'global survey of rosacea burden' of 710 rosaceans and 554 doctors which is used as data for the report with the stated goal of achieving total clearance (IGA 0). The report acknowledges, "Although we can’t yet promise ‘clear’ to all people, current treatments are now getting more people to ‘clear’, with combined therapy or even with monotherapy. By aiming for ‘clear’ (IGA 0) we can help free more people from their rosacea burden." One statement that explains rosacea best in the report is, "Ultimately, rosacea is a subjective and entirely individual experience." While we try to categorize rosacea into phenotypes and treatment protocols, there is no one treatment that works for everyone. 
    • Related Articles Toll-like receptor signaling induces the expression of lympho-epithelial Kazal-type inhibitor in epidermal keratinocytes. J Dermatol Sci. 2018 Sep 15;: Authors: Sugimoto S, Morizane S, Nomura H, Kobashi M, Sugihara S, Iwatsuki K Abstract
      BACKGROUND: Lympho-epithelial Kazal-type inhibitor (LEKTI) tightly controls the activities of serine proteases such as kallikrein-related peptidase (KLK) 5 and KLK7 in the epidermis. LEKTI is known to be an essential molecule for the epidermal skin barrier, as demonstrated by SPINK5 nonsense mutation, which results in Netherton syndrome. Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns or damage-associated molecular patterns and produce inflammatory cytokines, chemokines, and antimicrobial peptides. However, the effect of TLR signaling on the expression of LEKTI is not clear.
      OBJECTIVE: To investigate whether TLR signaling can affect expression of LEKTI in epidermal keratinocytes.
      METHODS: We stimulated a panel of TLR ligands and investigated the expression of LEKTI in normal human epidermal keratinocytes (NHEKs). We further measured trypsin or chymotrypsin-like serine protease activity in NHEK cultured media under stimulation with TLR3 ligand, poly (I:C). Immunostaining for LEKTI was performed using skin samples from skin infectious diseases.
      RESULTS: TLR1/2, 3, 5, and 2/6 ligands induced the expression of LEKTI in NHEKs. The trypsin or chymotrypsin-like serine protease activity in NHEKs was up-regulated with the stimulation of poly (I:C). The gene expressions of KLK6, KLK10, KLK11, and KLK13 were also increased by poly (I:C). An immunohistochemical analysis demonstrated that the expression of LEKTI was up-regulated in the lesions of varicella, pyoderma, and rosacea.
      CONCLUSIONS: TLR signaling induces the expression of LEKTI in epidermal keratinocytes, which might contribute to the control of aberrant serine protease activities in inflammatory skin diseases.
      PMID: 30270115 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Unilateral Facial Telangiectasia Macularis Eruptiva Perstansmimicking as Rosacea. Indian Dermatol Online J. 2018 Sep-Oct;9(5):351-353 Authors: Sinha P, Sinha A, Raman DK, Sood A PMID: 30258811 [PubMed] {url} = URL to article
    • Related Articles Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study. Clin Exp Dermatol. 2018 Sep 26;: Authors: Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Barata AR, Castellanos-González M, Pugnaire MA, Grimalt R, Hermosa-Gelbard A, Bernárdez C, Molina-Ruiz AM, Ormaechea-Pérez N, Fernández-Crehuet P, Vaño-Galván S Abstract
      BACKGROUND: Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology.
      AIM: To identify possible environmental and hormonal factors related to FFA.
      METHODS: We conducted a multicentre case-control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease.
      RESULTS: For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06-2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06-2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11-2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05-2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07-3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11-23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11-2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7-80.9) or antiageing creams (OR = 1.84; 95% CI 1.04-3.23).
      CONCLUSIONS: FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia.
      PMID: 30259544 [PubMed - as supplied by publisher] {url} = URL to article
    • Bloomberg reports, "Nestle said Thursday it would consider new owners for its dermatological business, a unit with $2.8 billion in annual revenue that Chief Executive Officer Mark Schneider said may no longer fit with the company’s overall strategy of focusing on products such as coffee, water and pet food." [1] Nestle owns Galderma, which is part of its 'dermatological business' or 'Nestlé Skin Health.' As David Pascoe puts it, "Lets hope that a pharma with deep pockets emerges, one that sees value in the assets of Galderma and further sees a future in developing new treatments that help rosacea sufferers." [2] Rosacea sufferers usually are very much aware of Galderma's Soolantra, Oracea, Mirvaso and Metrogel (Metrocream). We shall wait and see what happens.  End Notes [1] Nestle's Step Away From Skin Health Reignites L'Oreal Sale Talk
      By Thomas Mulier  and Corinne Gretler, Bloomberg [2] Galderma for sale – why we need the right buyer, by David Pascoe, Rosacea Support Group
    • Related Articles First Report of Concomitant Tinea Faciei and Pityriasis Folliculorum: A Dermatomicrobiological Rarity. Cureus. 2018 Jul 20;10(7):e3017 Authors: Vanam HP, Mohanram K, K SRR, Poojari SS, P R A, Kandi V Abstract
      Tinea faciei (TF) is a common dermatomicrobiological condition caused by dermatophytes involving the skin of the face but not the mustache and beard (Tinea barbae). It poses a diagnostic dilemma with its atypical clinical presentation. Pityriasis folliculorum (PF) is a dermatological condition that results in rosacea-like skin eruptions. It was previously associated with a human ectoparasitic infestation. Demodex mites (Demodex folliculorum) is a group of obligate parasites that live on the skin of mammals. These mites have been associated with various dermatological disorders, clinically termed as demodicosis. Insects have been described as potential vectors that can carry various microorganisms and especially spores of fungi. Hence, infestation by such insects may aggravate the already present skin condition, leading to secondary infections. There has been a change in the trend of dermatophytosis worldwide and infections caused by Trichophyton mentagrophytesvar.interdigitale (T. interdigitale) are increasing. Hence, there is an urgent need for a thorough investigation of an infectious etiology among various skin disorders. This is the first report of concomitant Tinea faciei and Pityriasis folliculorum involving facial skin.
      PMID: 30254806 [PubMed] {url} = URL to article
    • Morbihan Disease Treatment: Two Case Reports and a Systematic Literature Review. Ophthalmic Plast Reconstr Surg. 2018 Sep 24;: Authors: Boparai RS, Levin AM, Lelli GJ Abstract
      PURPOSE: To assess the effectiveness of treatments for Morbihan disease.
      METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was performed on April 1, 2018, using PubMed, Google Scholar, and Excerpta Medica dataBASE with terms used to describe Morbihan disease, including "Morbihan Disease," "Morbihan Syndrome," "lymphedema rosacea," and "lymphedematous rosacea". Case reports or case series were included if they fulfilled the following criteria: published in English, peer-reviewed, and reported Morbihan disease.
      RESULTS: A total of 89 patients-87 patients from 49 articles and 2 cases from the authors' institution-were included in the final analysis. The median age of patients was 51 years (range: 14-79), and 66 of 89 (74%) patients were men. Male gender correlated with lack of complete response to treatment (odds ratio: 0.25; 95% confidence interval: 0.06-0.97; p = 0.02), while presence of papules or pustules correlated with complete response to treatment (odds ratio: 4.07; 95% confidence interval: 1.04-17.68; p = 0.03). Longer antibiotic duration correlated with response to treatment (p = 0.03), favoring complete over partial response (p= 0.02). Mean antibiotic duration in patients who responded was 4.43 months (standard deviation: 3.49), with complete responders requiring 6.50 months (standard deviation: 4.57). Oral corticosteroids, isotretinoins, and combination therapies did not correlate with treatment response.
      CONCLUSIONS: The presence of papules and pustules correlates with a complete response to treatment, while male gender correlates with a partial response. Patients may benefit from 4- to 6-month duration of tetracycline-based antibiotics. Prospective studies are needed to assess the impact of antibiotic and isotretinoin dose and duration on treatment response.
      PMID: 30252748 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Role of serum 25-hydroxyvitamin D levels and vitamin D receptor gene polymorphisms in patients with rosacea: a case-control study. Clin Exp Dermatol. 2018 Sep 23;: Authors: Akdogan N, Alli N, Incel Uysal P, Candar T Abstract
      BACKGROUND: Vitamin D has significant effects on the immune system and thereby on the pathogenesis of rosacea. However, there is a lack of information on the vitamin D status and vitamin D receptors (VDRs) of patients with rosacea.
      AIM: To evaluate the role of vitamin D in rosacea susceptibility.
      METHODS: A case-control study was conducted, enrolling patients with rosacea and healthy controls (HCs). Five VDR gene single nucleotide polymorphisms (SNPs) (Cdx2, FokI, ApaI, BsmI and TaqI) and serum 25-hydroxyvitamin D3 [25(OH)D3 ] levels were compared between patients and HCs.
      RESULTS: The study enrolled 60 patients (M/F: 14/46) and 60 age- and sex-matched HCs (M/F: 14/46). Age (mean ± SD) was 48 ± 11 years for both groups. The serum 25(OH)D3 levels (median ± interquartile range) were higher in patients with rosacea (12.9 ± 6.8 ng/mL) than in HCs (10.5 ± 3.7 ng/mL) (P < 0.001). Subjects with high serum 25(OH)D3 levels had a 1.36-fold increased risk of rosacea (95% CI 1.17-1.58). Heterozygous and mutant ApaI polymorphisms increased rosacea risk by 5.26-fold (95% CI 1.51-18.35) and 3.69-fold (95% CI 1.19-11.48), respectively, whereas mutant TaqI polymorphisms decreased the risk by 4.69 times (95% CI 1.37-16.67). Heterozygosity for Cdx2 alleles increased rosacea risk, whereas wildtype ApaI and mutant TaqI alleles decreased it.
      CONCLUSIONS: The present study suggests that an increase in vitamin D levels may contribute to the development of rosacea. ApaI and TaqI polymorphisms, and heterozygous Cdx2, wildtype ApaI and mutant TaqI alleles were significantly associated with rosacea. These results indicate a possible role of vitamin D and VDR pathways in the pathogenesis of rosacea, although causality could not be assessed.
      PMID: 30246390 [PubMed - as supplied by publisher] {url} = URL to article
    • Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience. J Am Acad Dermatol. 2018 Sep 18;: Authors: Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC Abstract
      Among individuals with skin of color, rosacea has been reported less frequently than in those with white skin, but it is not a rare disease. In fact, rosacea may be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin, as well as underestimation of the susceptibility of more highly pigmented skin to dermatologic conditions like rosacea whose triggers include sun exposure. Many people with skin of color who have rosacea may experience delayed diagnosis leading to inappropriate or inadequate treatment, greater morbidity, and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. This paper reviews the epidemiology of rosacea in skin of color and highlights variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. It presents strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.
      PMID: 30240779 [PubMed - as supplied by publisher] {url} = URL to article
    • Full Text The four components of this treatment are: (1) Dextran sulfate is an anionic polymer of sulfated glucose [1] Dextran sulfate contains approximately 17% sulfur which is equivalent to approximately 2.3 sulfate groups per glucosyl residue. [2]  (2) 4-t-butylcyclohexanol  [BCH; TRP-regulin ®] [3] (3) pongamia oil [4] (4) hesperidin methyl chalcone [HMC] [5] Some of the products mentioned in the above post, "Avène redness-relief cosmetic products for sensitive skin prone to redness" are:  
      Eau Thermale Avène Antirougeurs Clean Redness-Relief Refreshing Cleansing Lotion
      Eau Thermale Avène Tolérance Extrême Emulsion
      Eau Thermale Avène Antirougeurs Calm Soothing Repair Mask
      Eau Thermale Avène Xeracalm A.D Lipid-Replenishing Cleansing Oil
      Eau Thermale Avène Skin Recovery Cream
      Eau Thermale Avène Cicalfate Restorative Skin Cream
      Eau Thermale Avène Extremely Gentle Cleanser Lotion
      Eau Thermale Avène Antirougeurs Dermo Cleansing Milk
      Eau Thermale Avène Antirougeurs Day Redness Relief Soothing SPF 25 Cream
      Eau Thermale Avène Antirougeurs Fort Relief Concentrate End Notes  [1] Dextran Sulfate, Sodium Salt (CAS 9011-18-1), Santa Cruz Biotechnology [2] Dextran Sulfate, Sigma Aldrich, Millipore Sigma [3] PubChem, Sigma Aldrich, ChemSpider, Paula's Choice, Safety Data Sheet, Effective treatment for sensitive skin: 4-t-butylcyclohexanol and licochalcone A [4] derived from the seeds of the Millettia pinnata tree [5] Paula's Choice, Truth in Aging, Douglas Laboratories, 
    • Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea. Clin Cosmet Investig Dermatol. 2018;11:421-429 Authors: Hernandez-Pigeon H, Garidou L, Galliano MF, Delga H, Aries MF, Duplan H, Bessou-Touya S, Castex-Rizzi N Abstract
      Background: Rosacea is a chronic facial skin disorder characterized by inflammation and vascular abnormalities. The pathophysiology of rosacea involves increased activation of the capsaicin receptor, TRPV1, the vascular endothelial growth factor (VEGF) pathway, and cathelicidin LL-37, MMP-9, and KLKs. We evaluated the activity of four compounds (dextran sulfate, 4-t-butylcyclohexanol [BCH; TRP-regulin®], pongamia oil, and hesperidin methyl chalcone [HMC]) on inflammatory and vascular responses implicated in rosacea.
      Materials and methods: The anti-inflammatory activity of dextran sulfate was evaluated on PGE2 production after PMA stimulation of NCTC-2544 keratinocytes, and on normal human epidermal keratinocytes (NHEKs) after proinflammatory stimulation to mimic a rosacea environment. The anti-angiogenic activity of dextran sulfate was measured by analyzing pseudotube formation in co-cultured human microvascular endothelial cells/normal human dermal fibroblasts. HMC modulation of vascular responses and IL-8 cytokine production after SP stimulation was evaluated in human skin explants. We also assessed the effect of BCH on TRPV1 activation, and the effect of combined BCH and pongamia oil on the inflammatory response of NHEKs.
      Results: Dextran sulfate strongly and significantly inhibited PMA-induced PGE2 production, inhibited KLK5 and MMP-9 mRNA expression, and IL-8, IL-1α and VEGF production, and displayed a highly significant inhibitory effect on VEGF-induced pseudotube formation. In SP-stimulated human skin explants, HMC significantly decreased the proportion of dilated vessels, total vessel area, and IL-8 production. BCH significantly and dose-dependently inhibited TRPV1 activation, and BCH and pongamia oil inhibited CXCL1 and CXCL6 mRNA expression and IL-8 production in NHEKs. Combined BCH/pongamia oil inhibited IL-8 production synergistically.
      Conclusion: These in vitro results showed that dextran sulfate, BCH, pongamia oil and HMC, possess complementary soothing and anti-redness properties, supporting their combination in Avène redness-relief cosmetic products for sensitive skin prone to redness, and for topical adjunctive rosacea treatment.
      PMID: 30233225 [PubMed] {url} = URL to article
    • One paper links Fungal keratitis associated with ocular rosacea
    • Related Articles Procedural management of rhinophyma: A comprehensive review. J Cosmet Dermatol. 2018 Sep 17;: Authors: Krausz AE, Goldberg DJ, Ciocon DH, Tinklepaugh AJ Abstract
      BACKGROUND: Rhinophyma is a cosmetically deforming disease characterized by nodular overgrowth of the lower 2/3 of the nose and is considered the end stage of acne rosacea.
      AIMS: Review the spectrum of procedural techniques for treatment of rhinophyma with a focus on the advantages and disadvantages of each modality.
      METHODS: A comprehensive literature search was conducted using the search terms "rhinophyma," "treatment," and "surgery" in PubMed. Case reports, case series, and small retrospective trials using procedural techniques for management of rhinophyma were included for review. Animal studies, non-English articles, and reports of medical treatment of rhinophyma were excluded.
      RESULTS: There are currently no prospective, randomized controlled studies evaluating procedural management of rhinophyma. The most commonly employed treatments include scalpel excision, resection with heated knives, dermabrasion, electrosurgery and lasers, specifically carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG). The main complication associated with complete excision of rhinophymatous tissue is excessive scarring. To correct for this adverse effect, partial or tangential excision with preservation of underlying adnexal structures is now the accepted technique, irrespective of the chosen modality.
      CONCLUSION: There is no accepted gold standard for management of rhinophyma, and each modality succeeds in maintaining hemostasis, reducing scarring and achieving satisfactory cosmesis to different degrees. There is a conflicting data on the theoretical risk of recurrence with partial excision due to incomplete removal of tissue. Further studies evaluating this risk and alternate methods of prevention are required.
      PMID: 30225926 [PubMed - as supplied by publisher] {url} = URL to article
    • Diagnostic Indicators of Rosacea and Demodicosis. Acta Derm Venereol. 2018 Sep 18;: Authors: Forton FMN, De Maertelaer V Abstract
      Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic importance of clinical signs and symptoms that are poorly recognized as being associated with these conditions. In addition to well-known signs (vascular signs (present in 80% of patients), papules (39%), pustules (22%) and ocular involvement (21%)), other signs and symptoms (discreet follicular scales (93%), scalp symptoms (pruritus, dandruff or folliculitis; 38%) and pruritus (15%)) may also suggest a diagnosis not only of demodicosis, but also of papulopustular rosacea. Facial Demodex densities (measured by 2 consecutive standardized skin biopsies) were higher when ocular or scalp involvement was present, suggesting more advanced disease, but further investigations are needed to confirm this hypothesis. Recognition of these clinical signs and symptoms should encourage dermatologists to perform a Demodex density test, thus enabling appropriate diagnosis to be made.
      PMID: 30226528 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles FINACEA™ (Azelaic Acid) Foam, 15. Skinmed. 2016;14(6):445-447 Authors: Gupta AK, Foley KA, Abramovits W PMID: 28031132 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Treatment of rhinophyma with the Versajet™ Hydrosurgery System and autologous cell suspension (ReCELL®): A case report. J Cosmet Laser Ther. 2018 Apr;20(2):114-116 Authors: K Y, B R K, T D, E G Abstract
      This is a case report of a 63-year-old male patient who presented with rhinophyma of 17 years duration. Several medical treatments were applied previously, with no response or poor improvement. We present our experience by combining the Versajet™ Hydrosurgery System and ReCELL® in a heavy smoker patient, which led to a good aesthetic outcome. With the combined technique, we did not encounter any difficulties either within the operation or in the follow-up period. We obtained less complications and faster wound healing, which in return led to higher patient satisfaction.
      PMID: 28872937 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Subtyping, phenotyping or endotyping rosacea: how can we improve disease understanding and patient care? Br J Dermatol. 2018 Sep;179(3):551-552 Authors: Thyssen JP PMID: 30222873 [PubMed - in process] {url} = URL to article
    • ElaineA [post no 3] reports trying this treatment and posts on September 14, 2018, "I am still clear at 7 months post oral treatment."
    • Related Articles Demodex blepharitis: clinical perspectives. Clin Optom (Auckl). 2018;10:57-63 Authors: Fromstein SR, Harthan JS, Patel J, Opitz DL Abstract
      Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. Demodex mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.
      PMID: 30214343 [PubMed] {url} = URL to article
    • Oxymetazoline Hydrochloride 1% Cream (Rhofade) for Persistent Facial Erythema Associated with Rosacea. Am Fam Physician. 2018 Jun 15;97(12):808-810 Authors: Garcia C, Birch M PMID: 30216014 [PubMed - in process] {url} = URL to article
    • Topical Steroid Damaged/Dependent Face (TSDF): A Study from a Tertiary Care Hospital in Eastern India. Indian J Dermatol. 2018 Sep-Oct;63(5):375-379 Authors: Pal D, Biswas P, Das S, De A, Sharma N, Ansari A Abstract
      Background: Awareness against abuse of topical corticosteroids (TC), especially over the face, has been going on for last 5 years in India. In spite of that we are getting lots of cases in our hospitals.
      Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face among the dermatology outpatient department (OPD) attendees and to analyze its causes.
      Methods: This study was conducted in a tertiary care medical center of eastern India. Patients with relevant facial dermatoses were asked about their current use of topical formulations and confirmed to be TSDF were included in the study.
      Results: A total of 748 patients with facial dermatoses were screened, of which 271 (36.22%) were using TC. Of them mostly young adults between 20 and 29 years (37.10%) were using TC. Average duration between starting of use of medication and the onset of symptoms was 5 months. Ninety-eight (36.16%) patients were using topical corticosteroid for the treatment of acne and 74 (27.30%) were using as depigmenting cream. About 108 (39.85%) patients bought medicine over the counter being recommended by pharmacist/shop owner. Rosacea like features with photosensitivity was the most common adverse effect found in 79 (29.15%) patients whereas comedonal acne/acne exacerbation were found in 68 (25.09%) patients. Most of them (227, 83.76%) were unaware about the side effects of steroids.
      Conclusions: TC misuse in patients with facial dermatoses is still quite common even after efforts to grow the awareness among population.
      PMID: 30210157 [PubMed] {url} = URL to article
    • Thanks Vestpocket for your post on this subject and pointing out how tiny the population of only 24 people in the study was. Wouldn't it be a novel idea for a group of rosaceans to get together and fund their own research. For example, let's get 10,000 rosacea sufferers together in a non profit organization dedicated to find the cure for rosacea and each rosacean donates $1 to this non profit organization who when funds a rosacea double blind, placebo controlled, clinical study on a rosacea trigger, such as coffee, or for that matter, whatever the 10,000 rosacea sufferers deemed to be a clinical subject worth investigating. Certainly one of the RRDi MAC members might be interested in receiving $10,000 to conduct such a clinical study that rosaceans would like to fund rather than the current status quo studies being done now by the other two non profit rosacea organizations.  As mentioned in the initial post, there is a difference between a flushing trigger and a rosacea flareup trigger. When you drink coffee (or for that matter ingest caffeine from green tea or whatever) after you flush, and eventually recover from the flush, does the flush exacerbate your rosacea seriously, or after the flush subsides, is your rosacea unchanged?
    • Related Articles Dermatoscopy of Granulomatous Disorders. Dermatol Clin. 2018 Oct;36(4):369-375 Authors: Errichetti E, Stinco G Abstract
      Although diagnosis of cutaneous granulomatous disorders (CGDs) is usually suspected based on morphologic findings, localization, and anamnestic data, clinical differentiation from each other and from similar dermatoses may be challenging. Recently, dermatoscopy has been demonstrated to be a useful tool for assisting the recognition of several CGDs. This article provides a current overview of the dermatoscopic features of the main noninfectious and infectious CGDs, including sarcoidosis, necrobiosis lipoidica, granuloma annulare, rheumatoid nodules, and leishmaniasis. Other, less common, CGDs are briefly addressed, including granulomatous rosacea, acne agminata, and leprosy.
      PMID: 30201146 [PubMed - in process] {url} = URL to article
    • Related Articles A Prunus persica genome-wide RNA-seq approach uncovers major differences in the transcriptome among chilling injury sensitive and non-sensitive varieties. Physiol Plant. 2018 Sep 11;: Authors: Nilo-Poyanco R, Vizoso P, Sanhueza D, Balic I, Meneses C, Orellana LA, Campos-Vargas R Abstract
      Chilling injury represents a major constrain for crops productivity. Prunus persica, one of the most relevant rosacea crops, have early season varieties that are resistant to chilling injury, in contrast to late season varieties, which display chilling symptoms such as mealiness (dry, sandy fruit mesocarp) after prolonged storage at chilling temperatures. To uncover the molecular processes related to the ability of early varieties to withstand mealiness, postharvest and genome-wide RNA-seq assessments were performed in two early and two late varieties. Differences in juice content and ethylene biosynthesis were detected among early and late season fruits that became mealy after exposed to prolonged chilling. Principal Component and Data Distribution Analysis revealed that cold stored late variety fruit displayed an exacerbated and unique transcriptome profile when compared to any other postharvest condition. A differential expression analysis performed using an empirical Bayes mixture modeling approach followed by co-expression and functional enrichment analysis uncover processes related to ethylene, lipids, cell wall, carotenoids and DNA metabolism, light response, and plastid homeostasis associated to the susceptibility or resistance of P. persica varieties to chilling stress. Several of the genes related to these processes are in QTLs associated to mealiness in P. persica. Together, these analyses exemplify how P. persica can be used as a model for studying chilling stress in plants. This article is protected by copyright. All rights reserved.
      PMID: 30203620 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Efficient isolation and observation of the most complex human commensal, Demodex spp. Exp Appl Acarol. 2018 Sep 06;: Authors: Clanner-Engelshofen BM, Ruzicka T, Reinholz M Abstract
      Demodex spp. mites are an often neglected member of the human skin microbiome. Mostly they are commensals, although their pathophysiological role in rosacea, spinulosis folliculorum, and other skin diseases is recognized. Little is known about their life cycle, biology, and physiology. Demodex mites cannot be cultivated in vitro, thereby complicating research immensely. The manual extraction from human sebum is laborious and death can only be detected by surrogate markers like ceased movement or loss of fluorescence. Here we present a new approach for the extraction of larger mite numbers and the hitherto most precise way to detect death. The extraction of mites from sebum and debris by hand can be accelerated by a factor 10 using sucrose gradient centrifugation, which is well tolerated by the mites. Staining with propidium iodide allows for easy identification of dead mites, excluding frail mites that stopped moving, and has no negative effect on overall mite survival. We anticipate our methods to be a starting point for more sophisticated research and ultimately in vitro cultivation of Demodex spp. mites.
      PMID: 30191497 [PubMed - as supplied by publisher] {url} = URL to article
    • Advances in Acne and Rosacea Therapy. Semin Cutan Med Surg. 2018 Jun;37(3S):S63-S66 Authors: Stein Gold LF, Alexis AF, Harper JC, Tan JKL Abstract
      New topical therapies have demonstrated efficacy in patients with moderate or severe acne who might otherwise have required therapy with systemic antibiotics or isotretinoin. Increasing knowledge about the pathogenesis of acne has facilitated the development of therapies with novel modes of action. New and investigational therapies also are available or in development for the treatment of both the papulopustular and erythematous manifestations of rosacea. Semin Cutan Med Surg 37(supp3):S63-S66 © 2018 published by Frontline Medical Communications.
      PMID: 30192344 [PubMed - in process] {url} = URL to article
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