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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

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    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

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    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 

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    • Related ArticlesEfficacy of non-ablative fractional 1440-nm laser therapy for treatment of facial acne scars in patients with rosacea: a prospective, interventional study. Lasers Med Sci. 2020 Jul 27;: Authors: Wang B, Deng YX, Yan S, Xie HF, Li J, Jian D Abstract Acne scarring is one of the most common facial skin disorders. The appropriate treatments for acne scars in patients with rosacea have not been studied. This study was designed to evaluate the efficacy and safety of non-ablative fractional 1440-nm laser (1440-nm NAFL) therapy for treatment of atrophic acne scars in patients with rosacea. In this prospective, interventional study, 32 patients with rosacea and acne scars underwent three sessions of 1440-nm NAFL therapy. Therapy efficacy, epidermal barrier function, and side effects were evaluated. Thirty patients completed and the median acne scar scores significantly reduced from 45 (30, 50) to 15 (15, 30) after three treatments (P < 0.001). The improvement score of acne scars was 2.7 ± 0.7; 22 (73.3%) were satisfied or highly satisfied. The rosacea erythema scores changed from 2.1 ± 0.4 to 1.9 ± 0.5 (P = 0.326), and flushing, burning, and stinging were not worse. The oil content after treatments was significantly reduced (P < 0.001), while there was no significant difference in other indicators of skin barrier function. The quality-of-life score decreased from 17.5 ± 3.8 to 14.1 ± 3.0 (P < 0.001). No serious side effects were observed. The 1440-nm NAFL therapy is effective in the treatment of acne scaring in patients with rosacea with little damage to the skin barrier. PMID: 32719961 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesPrimum non nocere; the importance to evaluate the effect of treatment and consider side-effects. Contact Dermatitis. 2020 Jul 26;: Authors: Sukakul T, Dahlin J, Svedman C PMID: 32713000 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesManagement of severe rhinophyma with electrocautery dermabrasion - A case report. Int J Surg Case Rep. 2020;72:511-514 Authors: Chellappan B, Castro J Abstract INTRODUCTION: Rhinophyma is benign hypertrophic thickening of the skin and edema of the nasal pyramid. The affected tissue enlarges slowly before reaching its permanent size. The lobulated skin surface with hundreds of pores can become cosmetically embarrassing and cause significant psychosocial stress, anxiety, and depression for patients. In addition, extensive alar thickening can obstruct the external nasal valves making treatment necessary to alleviate respiratory issues. No consensus has been reached regarding management of rhinophyma and many surgeons follow the "to each his own technique" mindset. Our objective was to present a case report to support the use of electrocautery and dermabrasion as the mainstay of treatment. PRESENTATION OF CASE: Here we describe the case of a 62-year-old Caucasian male with a long-standing history of acne rosacea who developed severe rhinophyma overtime which lead to nasal obstruction and major cosmetic deformity. Electrocautery and dermabrasion in the operating room were utilized to obtain an outstanding cosmetic result and respiratory function improvement. Loop and Colorado cautery tips were used with cutting current to remove the hypertrophic skin and create a smooth contour. The patient tolerated the procedure well without any complications. The patient's skin was scab-free with normal pigmentation by four weeks post-op. He was satisfied with the cosmetic outcome and reported substantial improvement in his breathing. DISCUSSION: There have been several case reports published which describe using different surgical methods to treat rhinophyma including lasers, electrocautery dermabrasion, surgical blade, cryosurgery, and radio excision. The main limitations of laser therapy are imprecise tissue removal, risk of scarring, dyspigmentation, and bleeding. Other therapies such as surgical excision and skin grafts may require multiple procedures before obtaining a satisfactory cosmetic outcome. CONCLUSION: This case report supports electrocautery dermabrasion as the mainstay of treatment as it is a management technique which allows for smooth contouring, efficient hemostasis, more control in the operating room, and does not require multiple procedures. PMID: 32698277 [PubMed] {url} = URL to article
    • There are a number of co-existing conditions associated with rosacea that are not uncommon. Some are uncommon. Here is the list to consider:  Acne Vulgaris   Blepharitis  Blepharokeratoconjunctivitis (BKC) Dry Skin (Xeroderma) Eczema  Frontal fibrosing alopecia  Hyperkeratosis  Lupus Melasma Periorol Dermatitis Seborrheic Dermatitis
    • Related ArticlesImpact of COVID-19 Pandemic on Dermatologists and Dermatology Practice. Indian Dermatol Online J. 2020 May-Jun;11(3):328-332 Authors: Bhat YJ, Aslam A, Hassan I, Dogra S Abstract The COVID-19 pandemic has directly or indirectly affected every human being on this planet. It's impact on the healthcare system has been devastating. The medical fraternity across the world, including India, is facing unprecedented challenges in striving to cope up with this catastrophic outbreak. Like all other specialties, dermatology practice has been profoundly affected by this pandemic. Measures have been taken by dermatologists to control the transmission of the virus, whereas providing health care to patients in the constrained environment. Preventive measures such as social distancing and hand hygienic practices along with patient education is being prioritized. Dermatological conferences and events scheduled across the globe in the first half of year 2020 have been either cancelled or postponed to discourage gatherings. Rationalization of resources and practice of teledermatology are being encouraged in current scenario. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Many national and international dermatology societies have recently proposed recommendations and advisories on usage of biologicals and immunomodulators in present context of COVID-19 pandemic. Urticarial, erythematous, varicelliform, purpuric and livedoid rash as well as aggravation of preexisting dermatological diseases like rosacea, eczema, atopic dermatitis, and neurodermatitis rash have been reported in Covid-19 patients. Self medications and poor compliance of dermatology patients in addition to lack of proper treatment protocols and monitoring are a serious concern in the present scenario. Strategies for future course of action, including the dermatology specific guidelines need to be framed. This issue includes a special symposium on dermatology and COVID-19 having recommendations from special interest groups (SIGs) of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Academy on leprosy, dermatosurgery, lasers and dermoscopy. PMID: 32695687 [PubMed] {url} = URL to article
    • "Blepharokeratoconjunctivitis (BKC) is a chronic inflammatory disease of the lid margin with secondary conjunctival and corneal involvement..." "This is a retrospective review of 14 patients with the history of chronic red eyes with corneal involvement. All patients were diagnosed with ocular demodicosis based on the results of eyelash sampling. All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg)....Rosacea was present in only three patients." Indian J Ophthalmol. 2020 May; 68(5): 745–749. Demodex blepharokeratoconjunctivitis affecting young patients: A case series Nikunj Vinodbhai Patel, Umang Mathur, Arpan Gandhi, and Manisha Singh image courtesy of PMC
    • Related ArticlesDermoscopic Monitoring of Response to Intense Pulsed Light in Rosacea: A Case Report. Dermatol Pract Concept. 2020 Jul;10(3):e2020058 Authors: Deshapande A, Ankad BS PMID: 32685276 [PubMed] {url} = URL to article
    • Related ArticlesAssociation between Rosacea and Cardiovascular Diseases and Related Risk Factors: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:7015249 Authors: Li Y, Guo L, Hao D, Li X, Wang Y, Jiang X Abstract Background: Rosacea is a common inflammatory skin disorder. Several studies, but not all, have suggested a high prevalence of cardiovascular diseases (CVDs) in rosacea patients. This study is aimed at investigating the association between rosacea and CVDs and related risk factors. Methods: We performed a literature search through PubMed, Embase, and Web of Science databases, from their respective inception to December 21, 2019. Two reviewers independently screened the articles, extracted data, and performed analysis, following the PRISMA guidelines. Odds ratios (OR) or standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for outcomes. The included studies' quality was evaluated using the Newcastle Ottawa Scale (NOS). Results: The final meta-analysis included ten studies. The pooled analysis found no association between rosacea prevalence and the incidence of CVDs (OR 0.97; 95% CI 0.86-1.10). Rosacea was found to be significantly associated with several risk factors for CVDs (OR 1.17; 95% CI 1.05-1.31), including hypertension (OR 1.17; 95% CI 1.02-1.35), dyslipidemia (OR 1.34; 95% CI 1.00-1.79), and metabolic syndrome (OR 1.72; 95% CI 1.09-2.72). However, no association was found between rosacea and diabetes mellitus (OR 0.98; 95% CI 0.82-1.16). Among the biological parameters, a significant association was found between rosacea and total cholesterol (SMD = 0.40; 95% CI = -0.00, 0.81; p < 0.05), low-density lipoprotein cholesterol (SMD = 0.28; 95% CI = 0.01, 0.56; p < 0.05), and C-reactive protein (CRP) (SMD = 0.25; 95% CI = 0.10, 0.41; p < 0.05). We found no association between rosacea and high-density lipoprotein cholesterol (SMD = 0.00; 95% CI = -0.18, 0.18; p = 0.968) or triglycerides (SMD = 0.10; 95% CI = -0.04, 0.24; p = 0.171). Conclusions: Although no significant association was found between rosacea and CVDs, rosacea was found to be associated with several of related risk factors. Patients with rosacea should pay more attention to identifiable CVD risk factors, especially those related to inflammatory and metabolic disorders. PMID: 32685519 [PubMed - in process] {url} = URL to article
    • This post has been promoted as an article. 
    • A case of Demodex-induced Lupus miliaris disseminatus faciei was treated with "ornidazole tablets (500 mg twice a day) and recombinant bovine basic fibroblast growth factor gel (0.2 g/cm twice a day) for an 8-week period" and the results showed "the facial erythematous papules were improved, and no new skin lesions were observed. The patient showed no signs of recurrence during the 6-month follow-up." Medicine (Baltimore). 2020 Jul 02;99(27):e21112 Demodex-induced Lupus miliaris disseminatus faciei: A case report. Luo Y, Wu LX, Zhang JH, Zhou N, Luan XL
    • Related ArticlesDemodex-induced Lupus miliaris disseminatus faciei: A case report. Medicine (Baltimore). 2020 Jul 02;99(27):e21112 Authors: Luo Y, Wu LX, Zhang JH, Zhou N, Luan XL Abstract RATIONALE: Lupus miliaris disseminatus faciei (LMDF) is an inflammatory granulomatous skin disease without a clear etiology that frequently involves the middle area of the face and the upper eyelids. Pathological features of the disease include caseation necrosis and epithelioid granuloma. Consensus treatment for LMDF is currently unavailable. PATIENT CONCERNS: A 47-year-old Chinese female patient who presented with facial pruritic, erythematous papules 8 months before this study. She was diagnosed with skin tuberculosis at another hospital and given antituberculosis medication. However, the treatment was not efficacious. DIAGNOSES: In this study, the diagnosis of Demodex-induced LMDF was made by a dermatologist according to physical examination, skin biopsy pathology, and microscopic examination. INTERVENTIONS: The patient was given ornidazole tablets (500 mg twice a day) and recombinant bovine basic fibroblast growth factor gel (0.2 g/cm twice a day) for an 8-week period. OUTCOMES: Eight weeks after the treatment, the facial erythematous papules were improved, and no new skin lesions were observed. The patient showed no signs of recurrence during the 6-month follow-up. LESSONS SUBSECTIONS: This case showed that ornidazole combined with recombinant bovine basic fibroblast growth factor gel might be useful in treatment of Demodex-induced LMDF. In addition, the results suggested that pathological caseation necrosis was caused by a series of inflammatory and immune responses to Demodex infection. PMID: 32629745 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related ArticlesClinical and biological impact of the exposome on the skin. J Eur Acad Dermatol Venereol. 2020 Jul;34 Suppl 4:4-25 Authors: Passeron T, Krutmann J, Andersen ML, Katta R, Zouboulis CC Abstract The skin exposome is defined as the totality of environmental exposures over the life course that can induce or modify various skin conditions. Here, we review the impact on the skin of solar exposure, air pollution, hormones, nutrition and psychological factors. Photoageing, photocarcinogenesis and pigmentary changes are well-established consequences of chronic exposure of the skin to solar radiation. Exposure to traffic-related air pollution contributes to skin ageing. Particulate matter and nitrogen dioxide cause skin pigmentation/lentigines, while ozone causes wrinkles and has an impact on atopic eczema. Human skin is a major target of hormones, and they exhibit a wide range of biological activities on the skin. Hormones decline with advancing age influencing skin ageing. Nutrition has an impact on numerous biochemical processes, including oxidation, inflammation and glycation, which may result in clinical effects, including modification of the course of skin ageing and photoageing. Stress and lack of sleep are known to contribute to a pro-inflammatory state, which, in turn, affects the integrity of extracellular matrix proteins, in particular collagen. Hormone dysregulation, malnutrition and stress may contribute to inflammatory skin disorders, such as atopic dermatitis, psoriasis, acne and rosacea. PMID: 32677068 [PubMed - in process] {url} = URL to article
    • AARS 2018 Form 990 Review Total Contributions from public support (99.25%) in the amount of $304,583.Total Expenses were $207,657.At the end of the 2016 the AARS reports 'net assets or fund balances' totaling $462,175. The AARS spent most of the expenses on 'conferences, meetings and conventions' in the amount of $148,728 for its prestigious members who are comprised mostly of dermatologists. The next largest expense was on 'management' in the amount of $48,000. The third largest expense was on its website which amounted to $4,473.  In 2018 the AARS didn't spend any of its donations on research grants. Schedule B, page 2 reveals the top contributors:  Galderma $50,000 L'oreal $35,000 Cutanea Life Sciences $15,000 Ortho Dermatologics $35,000 Bayer Healthcare $20,000 Allergan USA $35,000 Total $190,000 The six skin care industry corporations above contributed 62% of the total donations.  You can read the Form 990 yourself:  2018_AARS Form 990 signed by JHarper 8.6.19.pdf You can read for yourself the mission of the AARS and what they did in 2018 in the screenshot below of Form 990 Part III: 
    • image courtesy of Nutrients A report concluded, "Overall, probiotics and prebiotics are promising in protecting the skin against UVR-induced skin damage." Nutrients. 2020 Jun; 12(6): 1795. Published online 2020 Jun 17. doi: 10.3390/nu12061795 PMCID: PMC7353315 PMID: 32560310 Potential of Skin Microbiome, Pro- and/or Pre-Biotics to Affect Local Cutaneous Responses to UV Exposure VijayKumar Patra,1,2 Irène Gallais Sérézal,3,4 and Peter Wolf2,*
    • UPDATE "Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19."  Annals of Internal Medicine, 16 Jul 2020 Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 A Randomized Trial Caleb P. Skipper, MD et al "Hydroxychloroquine did not lead to faster symptom improvement among patients who had Covid-19 symptoms and were not hospitalized, according to a new study published Thursday in the Annals of Internal Medicine."  New Covid-19 study, despite flaws, adds to case against hydroxychloroquine By MATTHEW HERPER, STAT "Hydroxychloroquine does not appear to keep people from getting the disease after they’ve been exposed to someone who has it. It does not change how many people hospitalized with Covid-19 die of the disease. It does not reduce symptoms for people with milder cases who aren’t in the hospital." Hydroxychloroquine Still Doesn’t Do Anything, New Data Shows, Wired "The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized." Hydroxychloroquine studies show drug is not effective for early treatment of mild covid-19 Laurie McGinley, The Washington Post, MSN 
    • 3D medical animation still of Cytokines that are important in cell signaling. Image courtesy of Wikimedia Commons Another cytokine is emerging as a possible link to rosacea, interleukin 17A (IL17A), with a report of using a biologic treatment for rosacea, secukinumab. [1] For several years the cytokine, cathlecidin, has been considered linked to rosacea because it is found in high levels with rosacea patients. [2]  Cytokines "Cytokines are a broad and loose category of small proteins (~5–20 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrine, paracrine and endocrine signaling as immunomodulating agents." [3]  "Their definite distinction from hormones is still part of ongoing research." [3] Therefore, cytokines are important in health and in disease prevention and when working properly everything is fine. However, just like the hormone insulin, when in proper amount secreted it works like a charm. If you are too low on insulin or too high things get a bit tricky when it comes to health. The same is true with cytokines. Cytokines in the right amount, everything is hunky dory, but when too many are present it can create quite a storm, or if not enough, things can get worse. The theory is that cytokines need to be be investigated more in what role they play in rosacea inflammation.  Cytokines and the Rosacea Immune System Disorder Theory Cytokines are related to the theory that rosacea is an immune system disorder. [4] Mast cells have important effects on the pathogenesis of rosacea and produce cytokines.   What is interesting is that "Cytokines also play a role in anti-inflammatory pathways and are a possible therapeutic treatment for pathological pain from inflammation or peripheral nerve injury. There are both pro-inflammatory and anti-inflammatory cytokines that regulate this pathway." [3] The first cytokine discovered was Interferon-alpha, an interferon type I, identified in 1957 as a protein that interfered with viral replication. [5] Both interleukin 17A and cathlecidin are cytokines that are related to inflammation in disease.  Topical ivermectin has been found effective in the treatment of T‐cell‐mediated skin inflammatory diseases. [6] Could it be possible that the cytokine response in rosacea sufferers is somehow related to virus? [7] For over sixty years the focus has been on bacteria or demodex. Could it be that the investigation should focus more on virus as the culprit why the cytokines are reacting? Virus are so tiny that the bacteria or demodex may carry a pathogen virus that is triggering the cytokine response. Has anyone even looked into this?  Have you seen any paper that has ruled out virus in rosacea? Magnesium decreases inflammatory cytokine production by modulation of the immune system. [8] A Cytokine storm is associated with Covid 19 deaths as well as with the 1918 Spanish Flu epidemic.  Interleukin 17A is an inflammatory cytokine. "Inflammatory cytokines are predominantly produced by and involved in the upregulation of inflammatory reactions.Excessive chronic production of inflammatory cytokines contribute to inflammatory diseases, that have been linked to different diseases...A balance between proinflammatory and anti-inflammatory cytokines is necessary to maintain health. Aging and exercise also play a role in the amount of inflammation from the release of proinflammatory cytokines." [9] "Cathelicidin antimicrobial peptides (CAMP) LL-37 and FALL-39 are polypeptides...serve a critical role in mammalian innate immune defense against invasive bacterial infection..." [2] "These peptides are potent, broad spectrum antibiotics which demonstrate potential as novel therapeutic agents.  Antimicrobial peptides have been demonstrated to kill Gram negative and Gram positive bacteria, enveloped viruses, fungi and even transformed or cancerous cells." [10] Dr. Gallo, et al, has applied for a patent, PREVENTION OF ROSACEA INFLAMMATION, United States Patent Application 20160030386, related to this. [11] Without a doubt we will be learning more on further research with interleukin 17A (IL17A) and possible other cytokines that are involved in the inflammation of rosacea.  Independent Rosacea Research Could a group of rosacea sufferers in a non profit organization like the RRDi collectively get together and sponsor their own research on rosacea? For example, if 10K members each donated a dollar, could it be possible that this money could be used to sponsor their own independent rosacea research on a cytokine?  What do you think? If you want to do something about this read this post.  End Notes [1] Secukinumab (Cosentyx) [2] Cathelicidin [3] Cytokine, Wikipedia [4] Innate Immune Response Disorder [5] Proc R Soc Lond B Biol Sci. 1957 Sep 12;147(927):258-67.  doi: 10.1098/rspb.1957.0048. Virus interference. I. The interferon A ISAACS, J LINDENMANN [6] Ivermectin Anti-Inflammatory Properties [7] Virus and Rosacea [8] J Immunol. 2012 Jun 15;188(12):6338-46.  doi: 10.4049/jimmunol.1101765.  Epub 2012 May 18. Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism Jun Sugimoto, Andrea M Romani, Alice M Valentin-Torres, Angel A Luciano, Christina M Ramirez Kitchen, Nicholas Funderburg, Sam Mesiano, Helene B Bernstein J Inflamm Res. 2018 Jan 18;11:25-34.  doi: 10.2147/JIR.S136742.  eCollection 2018. Magnesium deficiency and increased inflammation: current perspectives Forrest H Nielsen  [9] Inflammatory cytokine, Wikipedia [10] Antimicrobial peptides (AMPs), Wikipedia [11] Gallo Patent for the 'Prevention of Rosacea Inflammation'
    • Related Articles Erythematous Papules Involving the Eyebrows in a Patient with a History of Rosacea and Hair Loss. Skin Appendage Disord. 2020 Jun;6(3):190-193 Authors: Kłosowicz A, Thompson C, Tosti A PMID: 32656245 [PubMed] {url} = URL to article Source of image above Etcetera Sickening started a thread about eyebrow hair loss
    • Related ArticlesFacial dermatoses in general population due to personal protective masks: first observations after lockdown. Clin Exp Dermatol. 2020 Jul 13;: Authors: Giacalone S, Minuti A, Spigariolo CB, Passoni E, Nazzaro G Abstract Since SARS-COV-2 pandemic began, frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE). PMID: 32658350 [PubMed - as supplied by publisher] {url} = URL to article
    • A rare condition involving SD is eyebrow hairloss. Sickening started an interesting thread on this subject if you are suffering from this disorder. A similar thread was started by angelstar. Sometimes it can be confused with Frontal Fibrosis Alopecia.
    • StatPearls Book. 2020 01 Authors: Abstract Lupus miliaris disseminatus faciei (LMDF) is an idiopathic granulomatous disease affecting facial skin primarily. Nosologically, it is on a spectrum of facial granulomatous dermatoses and shares overlapping features with rosacea and sarcoidosis. In most cases, this disorder resolves spontaneously within several years but can leave potentially disfiguring scarring. The name derives from a historic putative association with tuberculosis, as discussed below. More recent authors have proposed adopting the term facial idiopathic granulomas with regressive evolution (FIGURE) instead of the entrenched LMDF. However, it does not appear that a name change has been widely accepted.[1] Older terms for a similar facial granulomatous dermatosis include micropapular tuberculid, Lewandowsky’s eruption, and lupoid rosacea.[2] Acne agminata has been used to refer to similar lesions in the axilla. PMID: 32644491 {url} = URL to article
    • The RRDi has been around for quite a while and we publish on our website for free what rosacea sufferers all over the world have said works to control their rosacea. A significant number of rosaceans say this simple method to control rosacea using this two step regimen does indeed work. Will it work for you?  The only way to know is to try it. There is no rosacea treatment regimen that works for every rosacea sufferer, not one. We have dubbed this the Rosacea X-Factor. However, this is what we recommend you try and we hope you will reply in this thread your results.  (1) Diet First, keep in mind this recommendation is only for thirty days. After the thirty days, go back to eating whatever you want. What you are probably eating is mostly carbohydrate since the typical American diet is high carbohydrate. Carbohydrate is simply different forms of sugar. There are absolutely no nutrients in carbohydrate, none. Carbohydrate is simply carbon, hydrogen and oxygen (absolutely no vitamins, minerals, or any nutrients). Sugar is the fire that inflames rosacea.  For example, oats, brown rice, fruit, sweet potato have significant carbohydrate. It is extremely difficult to cut out all carbohydrate. But if you can reduce your carbohydrate to no more than 30 grams a day for 30 days to see if this improves your rosacea, then you will know. What will you lerarn? Sugar/carbohydrate is a rosacea trigger.  If you do see improvement within the thirty days, at the end of the thirty days go back to your oats, brown rice, fruit, sweet potato or whatever you are eating and see what happens. This simple diet just for thirty days will either work or it won't in improving your rosacea. Please read a list of anecdotal reports that this actually works.  To help you understand how to figure out how many grams of carbohydrate you may be eating, just take a bowl of oats which contains 27 grams of carbohydrate in a half a cup. So if you decide to eat that half a cup of oats, you now only have 3 grams of carbohydrate to your 30 gram limit for the day. The only way you can do this is stick to broccoli since one cup (91 grams) of raw broccoli contains 6 grams of carbs. Kale is ok too, since one cup (67 grams) of raw kale contains 7 grams of carbs. You can have a lot of broccoli and kale in your day and still keep within the 30 gram limit. So anything that goes into your mouth that you digest, simply watch how many grams of carbohydrate and limit it to 30 grams a day. And watch how many carbohydrate is in anything you drink! Liquid or any food, 30 gram carbohydrate limit. Only for 30 days. 30 grams/30 days. Dr. Atkin's Carb Counter book helps you understand how to count carbs. So what do you eat? Protein and Fat, as much as you want, no limit. And remember, when someone or some authority says eating high protein/fat is bad, the reply is, 'this is just for thirty days.' Thirty days on a high protein/diet is not bad. No one can cite any clinical paper that eating high protein/fat for just thirty days is any health risk. Remember, just thirty days. No risk. And if you like meat, fish, and chicken it will be easier. If you are a vegan, it will be more difficult to find the protein/fat to eat but it can be done. The Rosacea Diet has a vegan 30 day diet. Remember, this is only for thirty days. At the end of the thirty days you can then eat whatever you want (sugar and carbohydrate), as much as you want and see what happens. Does your rosacea return when you eat high sugar/carbohydate? If so, you have learned something. Then you decide what to do about this. Not everyone chooses this course since it is so difficult. Why? Because sugar is addictive. Your choice. You obviously can keep eating whatever you want. This is just a recommendation, just like the following topical. (2) Topical As for a topical, recommend the ZZ cream. Before you use, be sure to apply a dab of the ZZ cream on your inner wrist and see if your skin turns red? If so, you are allergic to the ZZ cream. Remember that if you use the ZZ cream it gets worse before it gets better.  It takes at least a month to see any improvement with the ZZ cream and three to four months for clearance. 'Getting worse before it gets better' is a common occurrence in medicine, not just in using the ZZ cream. Conclusion These two simple treatments may work to control your rosacea if you reduce your sugar/carbohydrate to 30 grams a day for 30 days and use the ZZ cream as a topical. It will take at least 30 days to see improvement with step one, and 90 to 120 days for clearance in step two. 
    • Hi Kara,  Welcome to the RRDi. It would be good to know if your partner did get a diagnosis of rosacea (or what exactly) and what particular antibiotic and how much, whether low dose or high dose, I.e., how many milligrams per day? Is your partner applying any topical(s)?  The laser mentioned in the article in this thread, pulsed dye, has been around for years.     Coherent model 899 ring dye laser, with rhodamine 6G dye, pumped with a 514 nm argon laser. The laser is tuned somewhere around 580 nm. Photo taken by Han-Kwang at the AMOLF Institute in Amsterdam, Netherlands. P - image courtesy of Wikipedia Commons By the way, the article is an abstract made available through an RSS feed from PubMed published in Dermatologic Therapy. So this pulsed dye laser is usually in either a dermatology or cosmetic surgeon clinic and as you can imagine expensive. One treatment with an experienced practitioner as you can imagine is expensive, between $350 to $600 US Dollars and usually three or more treatments are required. Most insurance companies in the USA will cover such treatment if they are designated a medical diagnosis but usually such treatments are considered cosmetic and are not covered. I imagine the same conditions exist in the UK regarding whether insurance covers such laser treatments or not. You would have to ask. Most Rosaceans who rave about Laser treatment have to spend the money out of pocket. There are others who have negative experience with laser. By the way, some Rosaceans have now purchased their own light device, sometimes laser, others purchase LED or IPL devices since they are now available to the pubic. There is a learning curve using these devices and you can easily damage your skin so if you decide to go that route take care. Our store has some listed in broad band light. Using laser is just one of the many light devices under the treatment called photo dynamic therapy.  The article in this thread used the pulsed dye laser along with intradermal botulinum toxin type-A, a particular botulinum used in cosmetics. This treatment is also expensive and the practitioner should have experience using it since you can imagine if you were his first patient you might feel uneasy.  The article concludes this combination of treatment “demonstrated high efficacy and satisfaction rate with this combined approach and a low side-effect profile.”  If it cost several thousand dollars, you would expect such results. Just remember that you sign off on a lot of waivers and notices that you are warned of the risks and side effects of laser and botulinum treatment.  Dr. Braun performs Botox Injections on a client at Vancouver Laser & Skin Care Skin. Botox Injections temporarily reduces or eliminates frown lines, forehead creases, crow’s feet near the eyes and thick bands in the neck. By temporarily blocking the nerve impulses, the muscles that cause wrinkles relax, giving the skin a smoother, more refreshed appearance. - image courtesy of Wikimedia Commons There are clinical papers showing improvement in rosacea using Botox, I.e., Botox for Rosacea. Depending on what your partner is suffering with, recommend your partner read our welcome page or our newbies page. Some have found that simply reducing sugar/carbohydrate in the diet improves rosacea or whatever skin issue along with the topical ZZ cream.
    • Hi i read your article and find it very interesting. My partner has a very aggressive form of rosacea that sometimes spreads up to the eye. Most of the time he is on antibiotics but as soon as he stops the flushing starts again. Is this treatment that you mentioned available in London???? If not where can it be done.
    • To give you an idea of the prescription rosacea market you can view the number of prescriptions for the four leading rosacea prescription treatments shown below in two graphs the first one in surrogates, and the second one in market size as revealed in a Menlo Therapeutics investor presentation dated March 2020.  
    • Before/after photos released by an investor presentation dated March 2020 . 
    • Related ArticlesPulsed dye laser followed by intradermal botulinum toxin type-A in the treatment of rosacea-associated erythema and flushing. Dermatol Ther. 2020 Jul 07;: Authors: Al-Niaimi F, Glagoleva E, Araviiskaia E Abstract Rosacea is a common inflammatory skin disease characterized by erythema, episodes of flushing and inflammatory lesions. It typically affects the face and is more prevalent among fair skin individuals affecting women more than men. Various treatments are available for rosacea with light-based therapies commonly used in the management of erythema. The use of intradermal botulinum toxin type-A has been reported to be beneficial in the treatment of rosacea-associated erythema and flushing with good results and a low side-effect profile. In this article we present our experience on the successful combination of both pulsed dye laser and intradermal botulinum toxin type-A in erythema and flushing in 20 rosacea patients. In addition to subjective improvement we measured the degree of erythema using a 3D Antera™ camera in order to quantify our results. We demonstrated high efficacy and satisfaction rate with this combined approach and a low side-effect profile. To our knowledge the combination of laser and intradermal botulinum toxin in the management of rosacea has not been previously reported. This article is protected by copyright. All rights reserved. PMID: 32633449 [PubMed - as supplied by publisher] {url} = URL to article
    • "Dry Eye Disease (DED) is a common ocular condition that needs prompt diagnosis and careful treatment interventions....In this review, we demonstrated the mechanism of action of IPL, including its benefits on DED. The emerging evidence shows that the role of IPL in DED is novel and therapeutic. These results direct us to conclude that IPL is a potentially beneficial tool and essential future therapy for dry eye disease." Int J Med Sci. 2020; 17(10): 1385–1392.Published online 2020 Jun 1. doi: 10.7150/ijms.44288 Use of Intense Pulsed Light to Mitigate Meibomian Gland Dysfunction for Dry Eye Disease Abhishek Suwal, Ji-long Hao, Dan-dan Zhou, Xiu-fen Liu, Raja Suwal, and Cheng-wei Lu Image [Diffuse lissamine green staining in a person with severe keratoconjunctivitis sicca.] Courtesy of Wikimedia Commons
    • Just received the TEA Form 990 for 2019, which this non profit is not required to file for 2019 since donations were less than $50K (only received $21,578.00 in donations in 2019).  TEA spent $18K on 'printing, publications, postage, shipping and other expenses.' So no research grants were sponsored in 2019. No money spent on staff or 'conventions' for members.  Considering TEA has at least 3000 members who donated $21K, this non profit gets high marks for what is being accomplished according to the mission statement and still has over $125K in the bank in net assets.  Read the Form 990 yourself. We could only wish that RRDi members would donate half as much as TEA members do.   TEA 990 . 2019.pdf
    • I continue to take the Puritan Pride Lutein/Zeazanthin because I do think it helps dry my oily skin and as you point out, for the 'antioxidant effects' and I think it is similar to taking an oral retinoid since Lutein/Zeazanthin is actually a xanthophylls (carotenoid) that 'is a virulence factor with an antioxidant action that helps the microbe evade death by reactive oxygen species used by the host immune system."   It may improve the eyes as well. We haven't had other anecdotal reports that it clears rosacea as Marcel the attorney raves about in his initial report. Keep us posted on your results. It has not cured my rosacea, but I still think it is worth taking daily. I take one a day. 
    • I’m wondering if anyone has continued this treatment and would share results. I took my first oil today and plan to continue to just for the antioxidant effects.  I wake up with a few to many p&ps daily and am experimenting with the results.
    • Related ArticlesRosacea and the cardiovascular system. J Cosmet Dermatol. 2020 Jul 03;: Authors: Searle T, Al-Niaimi F, Ali FR Abstract Rosacea and the cardiometabolic syndrome are both associated with chronic inflammation and a pro-inflammatory phenotype. Emerging clinical evidence supports the relationship between rosacea and cardiometabolic syndrome hypertension and obesity. This article reviews our current findings and understanding in the skin and cardiovascular relationship in rosacea. Rosacea appears to be associated with hypertension, dyslipidaemia and obesity. The role of smoking in rosacea is currently less clear. It remains uncertain whether treatment of these risk factors will aid improvement of rosacea. Greater understanding of rosacea and its association with the cardiovascular system and underlying risk factors could allow for a greater understanding of the body's inflammatory response as well as the formulation of new guidelines for attending clinicians. Dermatologists treating rosacea patients might need to consider enquiring and evaluate their patients' underlying cardiovascular risk factors. PMID: 32621366 [PubMed - as supplied by publisher] {url} = URL to article
    • A rare case of lupoid leishmaniasis defying diagnosis for a decade. J Cutan Pathol. 2020 Jul 04;: Authors: Gehlhausen J, Sibindi C, Ko CJ, Grant M, Zubek A Abstract Cutaneous leishmaniasis is a common disease affecting millions in endemic areas worldwide. We present a case of lupoid leishmaniasis, a rare variant of cutaneous leishmaniasis, which clinically mimicked sarcoidosis and/or granulomatous rosacea for ten years until ultimate diagnosis. An 82-year-old U.S. citizen with an extensive travel history presented with a ten-year history of facial plaques on the cheeks and was previously diagnosed and treated as sarcoidosis. Multiple biopsies (previously and at presentation) revealed tuberculoid granulomas with negative special stains for microrganisms and negative sterile tissue cultures for AFB, bacteria, and fungal organisms. A diagnosis of granulomatous rosacea was rendered and multiple medical therapies were attempted, none with sustained improvement. Repeat biopsy of a new lesion revealed intracellular organisms consistent with leishmaniasis, which was confirmed by PCR. Lupoid leishmaniasis is a rare presentation of cutaneous leishmaniasis including facial plaques that can mimic granulomatous diseases affecting the face including sarcoidosis and granulomatous rosacea. Cutaneous leishmaniasis can sometimes be challenging to diagnose through standard histopathologic examination; IHC for CD1a can be used to augment tissue-based examination and PCR should be sent early in cases with sufficient concern. This article is protected by copyright. All rights reserved. PMID: 32623733 [PubMed - as supplied by publisher] {url} = URL to article
    • Efficacy and Safety Results of Micellar Water, Cream and Serum for Rosacea in comparison to a control group. J Cosmet Dermatol. 2020 Jul 05;: Authors: Guertler A, Jøntvedt NM, Clanner-Engelshofen BM, Cappello C, Sager A, Reinholz M Abstract BACKGROUND: Rosacea is a common inflammatory skin disorder with centrofacial erythema, flushing, telangiectasia, papules/pustules and possible ocular or phymatous manifestation. Patients' skin is particularly sensitive to chemical and physical stimuli leading to burning, stinging, dryness and skin tightness. OBJECTIVE: Dermatological evaluation of the efficacy and safety of skin care products designed for centrofacial erythema in rosacea patients, in comparison to a control group using objective measurements. Rosacea symptoms (itching, tension, warmth, burning, dryness) and quality of life were examined. METHODS: Sixty Caucasians with centrofacial erythema were enrolled in an eight-week prospective study, fifty of them exclusively using the study products (micellar water, cream and serum) with ten participants randomly assigned to a control group. Patients were evaluated at baseline (V0), at four weeks (V1) and at eight weeks (V2). Three-dimensional objective measurements (VECTRA® ) as well as standardized questionnaires were used. RESULTS: Results were compared with the control group. A significant reduction of 16% in skin redness as indicated by VECTRA® analysis was seen in the intervention group comparing V0 to V2. Furthermore, rosacea associated symptoms diminished by 57.1%, while life quality of affected patients within the intervention group improved by 54.5% comparing V0 to V2 respectively. CONCLUSIONS: A skin care regime suitable for sensitive and redness prone skin led to an enhanced clinical appearance, to a decrease of associated symptoms in rosacea patients and to an improved life quality. PMID: 32623833 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesRosacea induced by selexipag in a patient with pulmonary arterial hypertension. Dermatol Ther. 2020 Jul 02;:e13947 Authors: Dominguez-Santas M, Diaz-Guimaraens B, Burgos-Blasco P, Ortega-Quijano D, Suarez-Valle A, Saceda-Corralo D PMID: 32618056 [PubMed - as supplied by publisher] {url} = URL to article
    • UPDATE "The study concluded that treatment with hydroxychloroquine significantly reduces the death rate of COVID-19 patients, Zervos said. Of those treated with hydroxychloroquine alone, 13% of them died, compared to the 26.4% who died and were were not treated with the drug. There was an overall 18.1% in-hospital mortality rate and patients were over the age of 18, with a median age of 64." Hydroxychloroquine is effective in treating COVID-19, says Henry Ford Health System study, Andrew Mullin, MLive
    • Diagram depicting the major determinants of gastric acid secretion, with inclusion of drug targets for peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). Image courtesy of Wikimedia Commons.  Proton Pump Inhibitors Theory One of the systemic cormorbidities in rosacea is the use of Proton Pump Inhibitors (PPIs). What are PPIs?  "Proton-pump inhibitors (PPIs) are members of a class of medications whose main action is a profound and prolonged reduction of stomach acid production." [1] Why are they called proton pump inhibitor? "They are called 'proton pump inhibitors' because they work by blocking (inhibiting) a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the 'proton pump'). This chemical system is found in the cells in the stomach lining that make stomach acid." [2] What do PPIs do that is related to causing rosacea?  One of the related rosacea theories is the Low Gastric Acid and Rosacea which has been around for sometime now, back to a paper in 1931 by Epstein and Susnow. [3]  PPIs inhibit gastric acid production.  What happens in the stomach without a doubt is related to what happens in the gut. There are a number of rosacea theories related to the gut, i.e, IBD and Rosacea, IBS and Rosacea,  SIBO and Rosacea, and Rosacea and the Gut. GUT Rosacea is listed as a variant of rosacea. H Pylori (Helicobacter Pylori) in the gut has been a subject of investigation with rosacea for sometime now and continues to be investigated in clinical papers.  Antibiotics have been the mainstay of medical treatment for rosacea, particularly those medicines derived from tetracycline, i.e., doxycycline, which work in the gut and has an effect on the stomach and bowel microbiota. The vast majority of rosacea patients have taken antibiotics, usually high dose for a significant period of time or low dose for even much longer periods. There is evidence that PPIs may even contribute to antibiotic resistance. [4] PPIs Systemic Cormorbidity in Rosacea Related to Gastric Acid Reduction One paper concluded, "In conclusion, prolonged PPI use was associated with an increased risk of rosacea, particularly in women and patients with peptic ulcers." [5] Theory Therefore, the theory that the use of PPIs may have a relationship in causing rosacea. Obviously not all rosacea sufferers have used PPIs so this is just one theory among the long list. For example, one theory is that rosacea is caused by demodex mites, but not all rosacea sufferers have any increase in demodex mites and treatment for demodex doesn't improve the rosacea, nevertheless, the theory is still listed since some rosacea sufferers respond well to treatment for demodectic rosacea. Ergo, the PPI and rosacea theory stands. A theory.  End Notes [1] Proton-pump inhibitors, Wikipedia [2] Proton Pump Inhibitors, Dr Laurence Knott, Patient [3] Cal West Med. 1931 Aug;35(2):118-20.ACNE ROSACEA: WITH PARTICULAR REFERENCE TO GASTRIC SECRETION.Epstein N, Susnow D.ACNE_ROSACEA_GASTRIC_SECRETION_Hypochlorhydria_Acid_Epstein_1931.pdf  [4] JAMA Intern Med 2020 Feb 24 Does Gastric Acid Suppression Encourage Antibiotic Resistance? Abigail Zuger, MD reviewing Willems RPJ et al. JAMA Intern Med 2020 Feb 24 Lee TC and McDonald EG.  J Clin Microbiol. 2005 Jul; 43(7): 3059–3065.doi: 10.1128/JCM.43.7.3059-3065.2005 Effect of pH and Antibiotics on Microbial Overgrowth in the Stomachs and Duodena of Patients Undergoing Percutaneous Endoscopic Gastrostomy Feeding Graeme A. O'May, Nigel Reynolds, Aileen R. Smith, Aileen Kennedy, and George T. Macfarlane [5] J Dermatol. 2020 Jul 01;: Use of proton pump inhibitors and risk of rosacea: A nationwide population-based study. Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH
    • Related ArticlesUse of proton pump inhibitors and risk of rosacea: A nationwide population-based study. J Dermatol. 2020 Jul 01;: Authors: Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH Abstract Proton pump inhibitors (PPI) are commonly used drugs. However, little is known about the association between PPI use and rosacea. This study aimed to investigate the association between PPI use and rosacea risk. Patients with prior PPI therapy, including 1067 rosacea cases and 4268 matched controls, were identified from the National Health Insurance Research Database in Taiwan. The cumulative defined daily dose (cDDD) was used to quantify the PPI use. Logistic regression was used for the analyses. After adjustment for potential confounders, PPI use with cDDD of more than 365 was significantly associated with an increased risk of rosacea (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.10-2.15). Rosacea risk was significantly associated with PPI use of cDDD of more than 365 in women (OR, 1.62; 95% CI, 1.08-2.46) but not in men. Stratified by PPI indications, risk of rosacea was significantly associated with PPI use of cDDD of more than 365 for peptic ulcer (OR, 1.58; 95% CI, 1.12-2.21). In conclusion, prolonged PPI use was associated with an increased risk of rosacea, particularly in women and patients with peptic ulcers. PMID: 32613686 [PubMed - as supplied by publisher] {url} = URL to article
    • An interesting title to an article, "Eating black raspberries might reduce inflammation associated with skin allergies, a new study indicates" [1] intrigued me into an investigation. My wife commented that blackberries are the same. A cursory Google search said otherwise. [2] Wikipedia shows after entering 'black raspberry,' "Not to be confused with blackberry. Black raspberry is a common name for three species of the genus Rubus." Ironically, Rubus is part of the Rosaceae family. The one used in this clinical study was Rubus occidentalis (above image courtesy of Wikimedia Commons).  The article refers to a clinical investigation paper that was "funded by National Cancer Institute (NCI/NIH), grant number K01CA207599 awarded to S.O., and the Ohio State University Foods for Health (FFH) Discovery Theme & Food Innovation Center (FIC) Seed Grant awarded to S.O. and USDA Hatch Funds (OHO01470) awarded to J.L.C." [3] Currently I am noticing where authors are getting the money to study such novel investigations like 'black raspberries,' since the RRDi would love to research novel studies like this for rosacea but can't drum up the money and rosaceans are not donating and have left for all the social media private rosacea groups chattering the same as they did twenty years ago about rosacea and doing nothing constructive about researching rosacea. Why they continue to support the status quo rosacea research mostly sponsored by pharmaceutical companies baffles my mind. [4] This isn't an easy read nor for the novice so you may want to stick to what Emily Henderson wrote about this subject. [2] But if you want to deep dive into this a little more I noticed some facts that Emily doesn't mention. For example, the authors state, "Recent studies have shown that diet plays a significant role in mitigating the development of allergic illnesses, with the consumption of antioxidant rich foods shown to be particularly efficacious in reducing allergic responses." [3] If you search you will find that there are a number of foods considered rich in antioxidant besides black raspberries, but it sounds way more interesting to eat black raspberries than say kale or spinach, not to mention the fun of it.  Emily failed to mention that the authors of the study supplemented Protocatechuic acid (PCA), a 'gut microbial metabolite of anthocyanins' with not the fresh fruit black raspberries, but instead used "5% w/w freeze-dried black raspberry (BRB) powder sensitized with DNFB (n = 5), or AIN-76A."  The authors seem more interested in the synergistic effect of PCA with BRB. PCA occurs in nature, i.e., green tea has lots of it. Here are some tidbits Emily didn't detail:  (1) Used 2.4-dinitrofluorobenze (DNFB) to recapitulate the human disease Contact hypersensitivity (CHS). (2) Four groups of mice were used for the study, all female, in groups of five mice. Each group had different diets, first group had 'standardized minimal nutrient rodent chow AIN-76A sensitized with vehicle only (n = 5),' second group had 'minimal nutrient rodent chow AIN-76A sensitized with DNFB (n = 5),' third group had 'AIN-76A supplemented with 5% w/w freeze-dried black raspberry (BRB) powder sensitized with DNFB (n = 5),' and the fourth group 'AIN-76A supplemented with 500 ppm protocatechuic acid (PCA.'  The authors conclude, "In summary, we demonstrate that the dietary intake of BRB and its anthocyanin metabolite PCA have an inhibitory effect on CHS. We also distinguish between PCA specific immunomodulatory effects and the global effects of the complex mixture of BRB phytochemicals on the pathways associated with CHS." So while this is an interesting subject, I would be careful eating a lot of black raspberries since the fructose in fresh berries can initiate a rosacea trigger, notwithstanding the antioxidant effect. [5] Maybe if you skin is clear, you may have a small bowl which would be nice and who knows, maybe fresh black raspberries might be good for rosacea? Maybe a little. Just watch out for the fructose! End Notes [1] Eating black raspberries might reduce inflammation associated with skin allergies, a new study indicates, Emily Henderson, B.Sc., News-Medical.Net [2] THE DIFFERENCE BETWEEN BLACK RASPBERRIES AND BLACKBERRIES, Black Raspberry Buzz Huff Post concurs:  Blackberry vs Black Raspberry: What's The Difference?, By Julie R. Thomson, Huff Post [3] Nutrients. 2020 Jun 6;12(6):E1701.  doi: 10.3390/nu12061701. Full Text Black Raspberries and Protocatechuic Acid Mitigate DNFB-Induced Contact Hypersensitivity by Down-Regulating Dendritic Cell Activation and Inhibiting Mediators of Effector Responses Kelvin Anderson, Nathan Ryan, Arham Siddiqui, Travis Pero, Greta Volpedo, Jessica L Cooperstone, Steve Oghumu  [4] Rosacea Research in Perspective of Funding [5] Sugar = Rosacea Fire
    • Related ArticlesExcessive cleansing: an underestimating risk factor of rosacea in Chinese population. Arch Dermatol Res. 2020 Jun 27;: Authors: Li G, Wang B, Zhao Z, Shi W, Jian D, Xie H, Huang Y, Li J Abstract Appropriate skincare is essential in the prevention and management of rosacea. We sought to investigate whether cleansing habits, the initial step of skin care, would influence the onset and progression of rosacea and their associations with clinical features of rosacea in the Chinese population. We analyzed the daily cleansing habits data collected from 999 rosacea cases and 1010 skin-healthy controls from China. Overall, the high frequency of cleansing (more than once daily) (OR = 1.450) and the large amount of cleansers (> 5 pieces/year) (OR = 1.612) presented a positive correlation with rosacea occurring. The cleansing duration and types of cleansers appeared not to be correlated with the onset of rosacea in this study. Significant risk factors also included the deep cleansing habits, such as the overuse of cleansing tool (more than four times/week) (OR 2.179) and oil control and exfoliating behaviors via daily used products (OR 2.435), facial mask (OR 1.459) or projects in beauty salons (OR 2.688). The analysis of the clinical features of rosacea showed that patients who prefer deep cleansing were more prone to present an initial symptom of papule and pustule (OR 1.63-3.15). What is more, using daily exfoliating products presented a positive correlation with the progression of the symptoms from flushing to erythema (OR = 2.01), papule and pustule (OR = 2.28) and telangiectasis (OR = 2.14), and the affected areas from a single area to pan facial (OR = 1.650). In conclusion, excessive cleansing habits were substantial risk factors for the incidence and progression of rosacea in the Chinese population. PMID: 32594335 [PubMed - as supplied by publisher] {url} = URL to article
    • Topical retinoids are mainly used for acne but there are some dermatologists prescribing Rx topical retinoids for rosacea, i.e., Differin (adapalene), Retin-A Micro (Tretinoin Microspheres), Tazret (Tazarotene), and others. "Also referred to as retinoic acid or vitamin A acid, topical retinoids are available as gels, ointments, creams, or foams to be applied directly to the skin. They work by promoting the exfoliation of dead skin cells as well as by boosting the production of new skin cells. The new cells then push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties." [1] "As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted." [2] "Expert groups and evidence-based guidelines agree that topical retinoids should be considered the foundation of acne therapy." So this article explains the increased use of retinoids by physicians over antibiotics since there is concern over antibiotic resistance. This article states, "The use of retinoids plus BPO targets multiple pathways and can often eliminate the need for antibiotics, reducing the likelihood of antibiotic resistance." [3] "Topical retinoids have clearly demonstrated benefit in rosacea. "Some dermatologists choose to avoid them, because they are more difficult to use, but over the long term, they really do make a difference for these patients," Dr. Pelle says. "In my experience, at one month you get an improved skin texture, at four months flushing is much less frequent, and at one year there is a normal flush response, substantially decreased redness and few to no flares requiring tetracyclines." " [4] There is a thread at RF that inspired this post. [5] There are a number of over the counter retinols available in our affiliate store. [6]  What is the difference between a retinol and a retinoid? "Essentially, retinol is just a specific type of retinoid." [7] End Notes [1] What to Know About Topical Retinoids for Acne, Heather L. Brannon, MD, very well health  [2] Topical tretinoin resolves inflammatory symptoms in rosacea, in small study [3] Increased Retinoid Therapy for Acne [4] 'Subtype-directed' approach targets rosacea, Jan 01, 2005, DermatologyTimes [5] Retinoid highly recommended by top-rated dermatologist on RRDi, beherenow [6] https://irosacea.org/search/?q=retinol&quick=1 [7] What’s the Difference Between Retinol and Retinoids, Marissa Laliberte, Reader's Digest
    • Related ArticlesUpdate on the pathogenesis and management of ocular rosacea: an interdisciplinary review. Eur J Ophthalmol. 2020 Jun 25;:1120672120937252 Authors: Jabbehdari S, Memar OM, Caughlin B, Djalilian AR Abstract PURPOSE: Rosacea is one of the most common conditions affecting the ocular surface. The purpose of this review is to provide an update on the pathogenesis and treatment of rosacea based on the dermatology and ophthalmology literatures. METHODS: Literature searches were conducted for rosacea and ocular rosacea. Preference was given to systematic reviews, meta-analysis, case-controlled studies, and documented case reports while excluding poorly documented case studies and commentaries. The data were examined and independently analyzed by more than two of the authors. RESULTS: Rosacea is a complex inflammatory condition involving the pilosebaceous unit. Its underlying mechanism involves an interplay of the microbiome, innate immunity, adaptive immunity, environmental triggers, and neurovascular sensitivity. The latest classification of rosacea includes three dermatologic subgroups and a fourth subgroup, ocular rosacea. Ocular rosacea clinically displays many features that are analogous to the cutaneous disease, such as lid margin telangiectasia and phlyctenulosis. The role of environmental triggers in the exacerbation of ocular rosacea appears to be understudied. While lid hygiene and systemic treatment with tetracycline drugs remain the mainstay of treatment for ocular rosacea, newer dermatologic targets and therapies may have potential application for the eye disease. CONCLUSIONS: Ocular rosacea appears to embody many of the manifestation of the dermatologic disease. Hence, the basic pathophysiologic mechanisms of the ocular and cutaneous disease are likely to be shared. Better understanding of the ocular surface microbiome and the immunologic mechanisms, may lead to novel approaches in the management of ocular rosacea. PMID: 32586107 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesColor Doppler Ultrasound Evaluation of Management of Papulopustular Rosacea. J Am Acad Dermatol. 2020 Jun 23;: Authors: Bustos R, Cortes A, McNab ME, Fuentes E, Castro A, Wortsman X PMID: 32590034 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles[Treatmentof rhinophyma with laser and surgery]. Ugeskr Laeger. 2020 Jun 15;182(25): Authors: Borhani-Khomani K, Møller MP, Thomsen MV, Karmisholt K, Hædersdal M, Bonde CT Abstract Rhinophyma is a disfiguring skin condition characterised by progressive hyperplasia of the nasal sebaceous glands and proliferation of blood vessels and connective tissue. It is considered the end stage of rosacea and affects primarily older males of Northern European descent. Several surgical and laser treatment options are available. None of these has been compared in randomised, controlled prospective trials. In this review, we provide an overview of the different treatment modalities and account for their respective strengths and limitations. PMID: 32584764 [PubMed - as supplied by publisher] {url} = URL to article
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