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  • Misdiagnosed Rosacea
    Articles, References and Anecdotal Reports

    misdiagnosed_rosacea.pngArticles and References

     

    There are articles on rosacea that mention misdiagnosed rosacea. While this isn't a massive problem, nevertheless, here is a list of different sources that mention the subject

     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Anecdotal & Other Reports of Misdiagnosis

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

    "Just an update and to show the importance of knowing what you have, I saw a Rosacea specialist with 20 years of treating and research under his belt, and made the appointment saying "Trying to treat Rosacea" as the reason. The second I came in he was confused and wondered where the Rosacea patient was. He looked at me and told me I absolutely do not have Rosacea, he's seen thousands of cases over decades and it's simply not it. And it's not caused by being choked, ever. It was thinned skin due to Steroid Creams, and thankfully, he caught that because the General Practitioner who 'diagnosed' me with Rosacea prescribed steroid cream. The most alarming was that the general practitioner gave me Metrogel which I understand is meant to help Pimples, and I have absolutely zero of those." AlenaCena post #68

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

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

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

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

    Bob reports his rosacea was misdiagnosed for discoid lupus

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

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

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

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

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

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

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

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

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

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

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

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

    DC says his physician misdiagnosed his dermatitis as rosacea.

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

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

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

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

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

    RedFacedRedHead says her rosacea turned out to be KP.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    says, "I think it took about 10 mins for a NHS dermatologist to tell me that I didnt have rosacea. She looked at my skin said there was no visible erythema or papules and pustules to suggest rosacea, and that I needed to stop "reading stuff on the internet". I had to actually ask for a blood test to rule out lupus etc!!!!!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Before I left, I asked him for a definitive answer one way or the other, and he told me NO, I do not have Rosacea.....To the point of the original thread, I'd like to determine what it is I have. The doctor seems sure it's not Rosacea, but as evidenced by my ongoing battle with Dermatologists prior, I believe if I went to 10 Dermatologists I would receive 10 different opinions. Rosacea, ruddy complexion, acne, allergic rash, facial blushing, too much Niacin, high blood pressure, lupus...these people don't know anything, and with no insurance I'm not going to waste $100 a visit to find out precisely nothing."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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    • Related Articles Spotlight on brimonidine topical gel 0.33% for facial erythema of rosacea: safety, efficacy, and patient acceptability. Patient Prefer Adherence. 2017;11:1143-1150 Authors: Anderson MS, Nadkarni A, Cardwell LA, Alinia H, Feldman SR Abstract
      BACKGROUND: Brimonidine tartrate is a highly selective alpha 2 agonist that induces direct vasoconstriction of small arteries and veins, thereby reducing vasodilation and edema.
      OBJECTIVE: To review the current literature regarding the safety, efficacy, and patient acceptability of brimonidine 0.33% gel.
      METHODS: A PubMed search was performed using the terms brimonidine 0.33% gel, rosacea, safety, efficacy, and acceptability. Peer-reviewed clinical trials and case reports from 2012 to 2016 were screened for inclusion of safety, efficacy, and/or patient acceptability data.
      RESULTS: Brimonidine topical gel 0.33% is associated with mild, transient skin-related adverse reactions. Efficacy may be achieved within 30 minutes of administration with maximal reductions in erythema 3-6 hours after administration. Patient satisfaction with use of brimonidine topical gel is superior to vehicle gel for facial appearance, treatment effect, facial redness, and daily control of facial redness.
      LIMITATIONS: Studies were typically limited to 1-year follow-up. Only one study has examined the use of brimonidine topical gel in combination with other rosacea and acne medications.
      DISCUSSION: Brimonidine topical gel 0.33% is a safe, effective, and patient-accepted treatment for facial erythema of rosacea.
      PMID: 28740369 [PubMed] {url} = URL to article
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      BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a hereditary cancer syndrome associated with several endocrine as well as non-endocrine tumors and is caused by mutations in the MEN1 gene. Primary hyperparathyroidism affects the majority of MEN1 individuals by age 50 years. Additionally, MEN1 mutations trigger familial isolated hyperparathyroidism. We describe a seemingly unaffected 76-year-old female who presented to our Genetics Clinic with a family history of primary hyperparathyroidism and the identification of a pathogenic MEN1 variant.
      CASE PRESENTATION: The patient was a 76 year-old woman who appeared to be unaffected. She had a family history of a known MEN1 pathogenic variant. Molecular testing for the known MEN1 mutation c.1A > G, as well as, biochemical testing, MRI of the brain and abdomen were all performed using standard methods. Molecular testing revealed our patient possessed the MEN1 pathogenic variant previously identified in her two offspring. Physical exam revealed red facial papules with onset in her seventies, involving her cheeks, nose and upper lip. Formerly, she was diagnosed with rosacea by a dermatologist and noted no improvement with treatment. Clinically, these lesions appeared to be facial angiofibromas. Brain MRI was normal. However, an MRI of her abdomen revealed a 1.5 cm lesion at the tail of the pancreas with normal adrenal glands. Glucagon was mildly elevated and pancreatic polypeptide was nearly seven times the upper limit of the normal range. The patient underwent spleen sparing distal pancreatectomy and subsequent pathology was consistent with a well-differentiated pancreatic neuroendocrine tumor (pNET).
      CONCLUSIONS: Age-related penetrance and variable expressivity are well documented in families with MEN1. It is thought that nearly all individuals with MEN1 manifest disease by age 40. We present a case of late-onset MEN1 in the absence of the most common feature, primary hyperparathyroidism, but with the presence of a pNET and cutaneous findings. This family expands the phenotype associated with the c.1A > G pathogenic variant and highlights the importance of providing comprehensive assessment of MEN1 mutation carriers in families that at first blush may appear to have isolated hyperparathyroidism.
      PMID: 28736585 [PubMed] {url} = URL to article
    • The Healthy Geezer: Red, bumpy nose is rosacea, not booze, By Fred Cicetti, Times Herald-Record
    • Related Articles Improvement of Rosacea During Acyclovir Treatment: A Case Report. Am J Clin Dermatol. 2017 Jul 21;: Authors: Badieyan ZS, Hoseini SS PMID: 28733947 [PubMed - as supplied by publisher] {url} = URL to article
    • Phymatous (Rhinophyma) [aka Subtype 3] This phenotype responds to treatment very well. Phymatous rosacea is uncommon. The most frequent phymatous manifestation is rhinophyma (known familiarly as "whiskey nose" "brandy nose" or "rum blossom"). In its severe forms, rhinophyma is a disfiguring condition of the nose resulting from hyperplasia of both the sebaceous glands and the connective tissue. Rhinophyma occurs much more often in men than in women (approximate ratio, 20:1), [1] and a number of clinicopathologic variants have been described. [2] Although rhinophyma is often referred to as "end-stage rosacea," it may occur in patients with few or no other features of rosacea. The diagnosis is usually made on a clinical basis, but a biopsy may be necessary to distinguish atypical, or nodular, rhinophyma from lupus pernio (sarcoidosis of the nose); basal-cell, squamous-cell, and sebaceous carcinomas; angiosarcoma; and even nasal lymphoma. [3] Older papers usually mention how rosacea progresses in stages and ends up in subtype 3, but recent studies indicate that this is not necessarily true. One can develop phenotype 5 without going through any 'stages.' [read this post] One report says, "It can affect nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma is the most frequent location..." [15] For images of phenotype 5 (formerly Subtype 3) click below: http://goo.gl/BI2lf;  28 Images of Rhinophyma A classic example of Subtype 3 is WC Fields (the rosacea poster boy):
      Another classic example is this painting in the Louvre, "The Old Man and His Grandson" by Ghirlandiao around the year 1480.


      There are Five Variants of Rhinophyma:
      Glandular
      Fibrous
      FibroangiomatousActinic
      Rhinophymous
      leishmaniasis  This is a great thread to read about Subtype 3. Treatment There are a number of different treatments for rhinophyma, including surgery, but it is better to treat the rosacea before it reaches the advance stage of rhinophyma. However, once rhinophyma has developed it can usually be corrected by surgery using either laser, scapel, or dermabrasion. The good thing about rhinophyma is that though this condition is generally regarded as a severe form of rosacea it is a relatively rare disorder involving thickening of the skin on the nose and the presence of many oil glands and this condition can usually can be corrected. Accutane is usually the drug of choice, but your physician may use other prescription drugs such as antibiotics if you have this skin disorder. Other treatment may involve cryosurgery, dermashaving and electrosurgery. "Coblation of rhinophyma is an effective treatment with few side effects." [4] ""...Initially, the mass was thought to be rhinophyma, but biopsy of the mass revealed noncaseating granulomata consistent with sarcoidosis. The mass resolved following several steroid injections..." [5] Radiofrequency is used to treat rhinophyma. [6]Rhinophyma treated with kilovoltage photons {7]Treatment of rhinophyma with ultrasonic scalpel: case report [8] Radiosurgical excision of rhinophyma. [9] "Surgery is indisputably the treatment of choice for rhinophyma." [10] This report said, "Despite many advances in fundamental understanding, surgical techniques, and related technologies, no single method has been universally embraced and employed as the "gold standard." " [11] Smoothbeam laser [13] Surgical Management [14] Another report says, "Both tangential excision and carbon dioxide laser are well-established, reliable procedures for rhinophymaplasty that preserve the underlying sebaceous gland fundi allowing spontaneous re-epithelialization without scarring with similar outcomes and high patient satisfaction. The original nose shape and nearly normal skin surface texture are preserved by quickly removal of the hypertrophic tissue sparing the pilosebaceous tissue. The CO(2) laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs." [16] Another report, which says, "a surgical "gold standard" for treating the distorting phymatous skin alterations has not yet been established," it goes on to state, "the combination of a bovine collagen-elastin with simultaneous autologous non-meshed split-thickness skin grafting" was used in a surgery, and "may ultimately avoid the recurrence of rhinophyma and contribute to a full skin repair leading to satisfactory functional and aesthetic outcome." [17] "This report describes a simple, safe, efficient, and cost-effective approach to the treatment of severe rhinophyma using a scalpel and the electroscalpel, instruments readily available in every operating room." [18] Scalpel Excision and Wire Loop Tip Electrosurgery [19] One reports says, "The CO2 laser is more capital intensive and results in higher fees compared with the simpler cold blade tangential excision. In our experience the ease of use, accuracy and precision of the lasers offer is not justified by the increased costs." [20] Salicylic acid 30% • Jojoba oil • Glycolic acid 70% • Baking Soda • Dawn Ultra Low Dose Isotretinoin Another treatment has been reported, coblation. The report says, "A hand-held coblation ‘wand’ emits a slow stream of saline solution – sterilised salt water – from the end that comes into contact with the nose. At the same time, it emits waves of radiofrequency energy to excite the molecules in the solution which ‘sands’ down the tissue. It also uses a low heat to cauterise (clot) any bleeding blood vessels." [12] Anecdotal Reports  Nose Swelling, big pores, phymous tissue--please post! End Notes [1] Roberts JO, Ward CM. Rhinophyma. J R Soc Med 1985;78:678-681.[iSI] [Medline] [2] Aloi F, Tomasini C, Soro E, Pippione M.
      The clinicopathologic spectrum of rhinophyma.
      J Am Acad Dermatol 2000;42:468-472.[CrossRef][iSI] [Medline] [3] Murphy A, O'Keane JC, Blayney A, Powell FC.
      Cutaneous presentation of nasal lymphoma: a report of two cases.
      J Am Acad Dermatol 1998;38:310-313.[iSI] [Medline]

      [4] Coblation of rhinophyma.
      Timms M, Roper A, Patrick C.J Laryngol Otol. 2011 Apr 27:1-5.

      [5] Sarcoidosis of the external nose mimicking rhinophyma. Case report and review of the literature.
      Goldenberg JD, Kotler HS, Shamsai R, Gruber B.Ann Otol Rhinol Laryngol. 1998 Jun;107(6):514-8.

      [6] Management of mild to moderate rhinophyma with a radiofrequency.
      Erisir F, Isildak H, Haciyev Y.J Craniofac Surg. 2009 Mar;20(2):455-6. [7] Rhinophyma treated with kilovoltage photons.
      Skala M, Delaney G, Towell V, Vladica N.Australas J Dermatol. 2005 May;46(2):88-9. [8] Treatment of rhinophyma with ultrasonic scalpel: case report.
      Tenna S, Gigliofiorito P, Langella M, Carusi C, Persichetti P.J Plast Reconstr Aesthet Surg. 2009 Jun;62(6):e164-5. Epub 2008 Dec 12. [9] Radiosurgical excision of rhinophyma.
      Somogyvári K, Battyáni Z, Móricz P, Gerlinger I.Dermatol Surg. 2011 May;37(5):684-7.
      doi: 10.1111/j.1524-4725.2011.01965.x. Epub 2011 Apr 1. Letter: radiosurgical excision of rhinophyma.
      Niamtu J 3rd.Dermatol Surg. 2012 May;38(5):816-7. doi: 10.1111/j.1524-4725.2012.02383.x. [10] Rhinophyma in rosacea : What does surgery achieve?
      Sadick H, Riedel F, Bran G.Hautarzt. 2011 Oct 19. [11] Nuances in the management of rhinophyma.
      Facial Plast Surg. 2012 Apr;28(2):231-7Authors: Little SC, Stucker FJ, Compton A, Park SS [12] How salt-blasting surgery cured my disfiguring condition called 'drinker's red nose'
      By ROGER DOBSON
      Mail Online / Health
      PUBLISHED: 16:07 EST, 12 May 2012 | UPDATED: 17:23 EST, 12 May 2012
      Read more: http://www.dailymail...l#ixzz1uvARY8Et [13] J Dermatolog Treat.
      2012 Apr;23(2):153-5. Epub 2010 Oct 22. Moderate rhinophyma successfully treated with a Smoothbeam laser.
      Chou CL, Chiang YY [14] Conn Med. 2014 Mar;78(3):159-60.
      Surgical management of rhinophyma: a case report and review of literature.
      Ferneini EM, Banki M, Paletta F, Ferneini CM. [15] An Bras Dermatol. 2012 Dec;87(6):903-5.
      Gnatophyma: a rare form of rosacea.
      Macedo AC, Sakai FD, Vasconcelos RC, Duarte AA. [16] J Craniomaxillofac Surg. 2012 Dec 8. pii: S1010-5182(12)00248-X. doi: 10.1016/j.jcms.2012.11.009.
      Surgical correction of rhinophyma: Comparison of two methods in a 15-year-long experience.
      Lazzeri D, Larcher L, Huemer GM, Riml S, Grassetti L, Pantaloni M, Li Q, Zhang YX, Spinelli G, Agostini T. [17] Int J Surg Case Rep. 2012 Nov 10;4(2):200-203. doi: 10.1016/j.ijscr.2012.11.003. [Epub ahead of print]
      The surgical treatment of rhinophyma-Complete excision and single-step reconstruction by use of a collagen-elastin matrix and an autologous non-meshed split-thickness skin graft.
      Selig HF, Lumenta DB, Kamolz LP. Aesthetic Plast Surg. 2013 Jan 8. [Epub ahead of print] Optimizing Cosmesis with Conservative Surgical Excision in a Giant Rhinophyma. Lazzeri D, Agostini T, Spinelli G.   [18] Aesthetic Plast Surg. 2013 Mar 1. [Epub ahead of print] Management of Severe Rhinophyma With Sculpting Surgical Decortication. Husein-Elahmed H, Armijo-Lozano R.   [19] Dermatol Surg. 2013 Apr 5. doi: 10.1111/dsu.12193. [Epub ahead of print] Treatment of Severe Rhinophyma Using Scalpel Excision and Wire Loop Tip Electrosurgery. Prado R, Funke A, Brown M, Ramsey Mellette J. Source
      Northeast Dermatology Associates, Andover, Massachusetts. [20] J Craniomaxillofac Surg. 2013 Jul;41(5):429-36. doi: 10.1016/j.jcms.2012.11.009. Epub 2012 Dec 8.
      Surgical correction of rhinophyma: comparison of two methods in a 15-year-long experience.
      Lazzeri D1, Larcher L, Huemer GM, Riml S, Grassetti L, Pantaloni M, Li Q, Zhang YX, Spinelli G, Agostini T.
    • Related Articles [Rosacea: New data for better care]. Ann Dermatol Venereol. 2017 Jul 17;: Authors: Cribier B Abstract
      In the last 10 years, numerous studies have been published that throw new light on rosacea, in all areas of the disease. This overview summarises all the key developments, based on the indexed bibliography appearing in Medline between 2007 and 2017. Recent epidemiological data show that the prevalence of the disease is doubtless greater than estimated hitherto (more than 10% of adults in some countries) and that we should not overlook rosacea in subjects with skin phototypes V or VI, a condition that exists on all continents. A new classification of rosacea by phenotype comprising major and minor signs has been put forward; it provides a more rational approach to suitable management based upon symptoms, the severity of which may be graded into 5 classes. The treatments with the best-demonstrated efficacy (updated Cochrane study) are topical metronidazole, azelaic acid and ivermectin, and oral doxycycline; isotretinoin is effective against resistant forms but is off-label. In ocular rosacea, the reference treatment is doxycycline in combination with topical therapy of the eyelids. The physiopathology is complex and involves several factors: vascular (vasodilatation, vascular growth factors), neurovascular (hypersensitivity, neuropathic pain, neuropeptides), infectious (Demodex folliculorum and its microbiota) and inflammatory (abnormal production of pro-inflammatory peptides of the innate immune system). In addition, there is a genetic predisposition as demonstrated by the weight of familial history and comparison of homozygous and heterozygous twins. There is also activation of several genes involved in immunity, inflammation and lipid metabolism; the theory of hydrolipid film anomalies has been posited once more. There has thus been a tremendous leap forward in the field of rosacea research, with therapeutic progress and improved understanding of the underlying mechanisms, which should enable the future development of more targeted treatments as well as global management of this disease, which has major social and emotional consequences on the life of patients.
      PMID: 28728857 [PubMed - as supplied by publisher] {url} = URL to article
    • Face flushing? You might want to look at what you’re drinking: Alcohol can raise your risk of a skin condition called rosacea, a new study published in the Journal of the American Academy of Dermatology suggests. In the study, researchers quizzed nearly 83,000 people on their alcohol intake every four years. They discovered that the more total alcohol they drank, the more likely they were to develop rosacea over the 14-year follow up. How Booze Can Make Your Face Red, Flushed, and Swollen, BY CHRISTA SGOBBA, Men's Health
    • In an interview with Linda Stein Gold, MD, Soolantra Cream Clinical Investigator who also volunteers on the RRDi MAC, Dr. Stein Gold says, "I see topical ivermectin therapy as first line therapy for Papulopustular Rosacea." The ZZ cream is an excellent non prescription treatment to consider. 
    • Persistent Erythema, Phenotype 2, is the most difficult phenotype to treat. Mirvaso and Rhofade are two treatments for phenotype 2. You should read the posts about Mirvaso and Rhofade. There have been reports of rebound with both, but particularly with Mirvaso (less rebound reports with Rhofade).
    • Rosacea Trial in Austin, Texas
    • softilly's treatment for erythematotelangiectatic rosacea:  
    • Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jul 12;: Authors: Chang YS, Huang YC Abstract
      BACKGROUND: The reported prevalence and degrees of Demodex mite infestation in rosacea vary widely.
      OBJECTIVE: We sought to conduct an evidence-based meta-analysis of the prevalence and degrees of Demodex mite infestation in patients with rosacea.
      METHODS: Systematic literature review and meta-analysis were conducted. Odds ratios for prevalence of infestation and standardized mean difference (SMD) for Demodex density in patients with rosacea were pooled. Subgroup analysis for type of rosacea, control group, and sampling and examination methods were also performed.
      RESULTS: Twenty-three case-control studies included 1513 patients with rosacea. Compared with the control patients, patients with rosacea were more likely to be infested by Demodex mites [odds ratio, 9.039; 95% confidence interval (CI), 4.827-16.925] and had significantly higher Demodex density (SMD, 1.617; 95% CI, 1.090-2.145). Both erythematotelangiectatic rosacea (SMD, 2.686; 95% CI, 1.256-4.116) and papulopustular rosacea (SMD, 2.804; 95% CI, 1.464-4.145) had significantly higher Demodex density than did healthy control patients.
      LIMITATIONS: Interstudy variability was high, and a causal relationship could not be established by case-control studies.
      CONCLUSIONS: Patients with rosacea had significantly higher prevalence and degrees of Demodex mite infestation than did control patients. Demodex mites may play a role in both erythematotelangiectatic rosacea and papulopustular rosacea.
      PMID: 28711190 [PubMed - as supplied by publisher] {url} = URL to article
    • If you’re suffering from rosacea, your doctor might simply tell you that there’s no real way to treat it and that you’ll probably have to deal with it for the rest of your life. But as with most other health conditions, the root cause of rosacea is almost certainly linked to your state of health in general, and particularly your diet and lifestyle. This article will seek to provide some simple, natural remedies to treat your rosacea to not only reduce the symptoms, but hopefully also prevent it from flaring up in the future. 5 Natural Remedies To Treat Rosacea, by Liivi Hess, The Alternative Daily
    • Related Articles Possible role of Helicobacter pylori in diseases of dermatological interest. J Biol Regul Homeost Agents. 2017 07 13;31(2 Suppl. 2) Authors: Guarneri C, Lotti J, Fioranelli M, Roccia MG, Lotti T, Guarneri F Abstract
      Helicobacter pylori is a gram-negative, flagellate, microaerophilic bacterium identified for the first time about 30 years ago, as a pathogenic factor of gastritis and peptic ulcer. Soon after, it was linked to several gastrointestinal and extra-gastrointestinal diseases (hematological, cardiovascular, neurological, pulmonary and ocular diseases, obesity, diabetes mellitus, growth retardation and extragastric MALT lymphoma). Association and possible cause-effect correlation with H. pylori infection were suggested in diseases of dermatological interest such as chronic urticaria, rosacea, Henoch-Schoenleins purpura, idiopathic thrombocytopenic purpura, cutaneous and oral lichen planus, atopic dermatitis, recurrent aphthous stomatitis, systemic sclerosis, psoriasis, Sjögrens syndrome, Behçet's disease, pruritus, alopecia areata, primary cutaneous marginal zone B-cell lymphomas, vitiligo, chronic prurigo, multiformis, prurigo nodularis, leukocytoclastic vasculitis, prurigo pigmentosa, eczema nummulare, primary cutaneous MALT-type lymphoma, sublamina densa-type linear IgA bullous dermatosis, Sweet's syndrome, cutaneous T-cell pseudolymphoma and pemphigus vulgaris. A critical review of the literature up to May 2017 shows clear evidence of H. pylori involvement only for some of the above purported associations, while in the majority of cases data appear contrasting and/or obtained on a not adequately large study population. Further clinical and laboratory research, with more adequate methodological and statistical basis, is required to assess the actual existence and relevance of many purported associations, as well as the possible role of H. pylori and the underlying pathogenic mechanisms.
      PMID: 28702966 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Light-based devices in the treatment of cutaneous vascular lesions: An updated review. J Cosmet Dermatol. 2017 Jul 13;: Authors: Garden BC, Garden JM, Goldberg DJ Abstract
      BACKGROUND: Light-based devices have been used to treat cutaneous vascular lesions almost since the original development of the laser. After the introduction of the initial continuous wave and pulsed laser systems, the pulsed lasers became the gold standard device. Since then, new devices and methods to treat patients have been introduced.
      OBJECTIVE: To review and summarize the current literature specific to treatment of cutaneous vascular lesions with light-based devices.
      METHODS: A review of the current literature of light-based devices used for the treatment of vascular lesions.
      RESULTS AND CONCLUSIONS: New systems continue to be developed to treat vascular lesions with advantages and disadvantages compared to older devices. Nonlaser sources such as intense pulsed light and radiofrequency devices can also be used in the treatment of these patients. Newer approaches may lead to even better results.
      PMID: 28703427 [PubMed - as supplied by publisher] {url} = URL to article
    • Botox jabs could offer a long-lasting solution for those who suffer the discomfort and embarrassing ‘blushing’ of rosacea.
      When tiny droplets of the wrinkle-busting nerve toxin are injected in diluted form into the forehead and cheeks, they have been found to reduce the redness which is the main symptom of the incurable skin disease. The breakthrough has been shown in early-stage trials to help all forms of the condition, including those characterised by acne-like spots on the face, and the severe skin-thickening form rhinophyma. Blush like Bridget Jones? A jab of Botox could help reduce redness and cut out acne-like spots, By Sara Malm In San Diego For Mail On Sunday, Daily Mail    
    • Rosacea has for over 60 years has been treated with antibiotics. The current strategy is that antibiotics are not targeting microbes but are used for anti-inflammatory effects. However, there are a number of microbes that have been associated with rosacea (Candida Albicans, Chlamydophila pneumoniae, Demodex Mites, Helicobacter Pylori, Propionibacterium acnes, Staphylococcus epidermidis, and list keeps growing). With demodectic rosacea there are at least two microbes associated (Bacillus oleronius and Bartonella quintana [see end note 31 and 68 in this article]). Antibiotic treatment is used for treating other diseases and it is noted that rosacea is improved in many cases as a side note. For example, patients treated with antibiotics for SIBO or IBS who also have rosacea note that rosacea is improved. 

      A paper worth reading on the subject of gut flora discusses the 'metagenome' or the 'second genome' in the human gut which holds microbes containing more genes in the flora in the intestinal system than the rest of our bodies. The paper says, "This creates a huge dataset that has to be disentangled." [see end note 4] The paper discusses how understanding gut flora may be a key to understanding diseases.

      One study by Nature Publishing Group discusses how recent research suggests that humans might be divided into three types of gut bacteria: Bacteroides, Prevotella and Ruminococcus. This may lead to personalizing medical treatment based upon which type gut microbes you predominantly have. [see end note 5] "The three gut types can explain why the uptake of medicines and nutrients varies from person to person," reports Jeroen Raes, a bioinformatician at Vrije University. [see end note 6] This may develop into a new ‘biological fingerprint’ on the same level as blood types and tissue types. [see end note 7] This may lead to a 'gut type diet' (similar to the blood type diet].
    • A recent paper on "microbiome-based therapeutic strategies' states, "designing a geographically tailored therapeutic approach would need an in-depth understanding of how population and environmental parameters can affect the microbial communities and their metabolic potentials, which, we hope, may be attained in near future through construction of pan microbiome of human populations around the globe."  The five major body habitats of the human microbiome, the Gut ( has the largest number of microbes and the greatest variety of species compared to other body habitats), Oral-cavity, Respiratory Tract, Skin (Studies suggested that diseases like atopic dermatitis, psoriasis, rosacea, acne etc. are often caused not because of pathogens but due to disruption in normal skin microbiota), and Urogenital Tract (UGT) shows "a gradual transition in the gross compositional structure along with a continual decrease in diversity of the microbiome, especially of the gut microbiome, as the human populations passed through three stages of subsistence like foraging, rural farming and industrialized urban western life."    Front Microbiol. 2017; 8: 1162.
      Published online 2017 Jun 23. doi:  10.3389/fmicb.2017.01162
      PMCID: PMC5481955
      Geography, Ethnicity or Subsistence-Specific Variations in Human Microbiome Composition and Diversity
      Vinod K. Gupta, Sandip Paul, and Chitra Dutta Rosacea has been connected to the gut microbiome, but obviously the skin microbiome is something to consider, and we need more research on this. In an article discussing an infection with the Leishmania parasite "To my knowledge, this is the first case where anyone has shown that a pre-existing skin microbiome can influence the outcome of an infection or a disease," said Elizabeth Grice, co-senior author and assistant professor in the departments of Dermatology and Microbiology in Penn's Perelman School of Medicine. "This opens the door to many other avenues of research." [1]  End Notes [2] A perturbed skin microbiome can be 'contagious' and promote inflammation, Science Daily
    • Related Articles An observational descriptive survey of rosacea in the Chinese population: clinical features based on the affected locations. PeerJ. 2017;5:e3527 Authors: Xie HF, Huang YX, He L, Yang S, Deng YX, Jian D, Shi W, Li J Abstract
      BACKGROUND: There is currently no study that has evaluated the differences in epidemiological and clinical characteristics among rosacea patients according to different facial sites.
      METHODS: Clinical and demographic data were obtained from 586 rosacea patients. The patients were divided into four groups based on the main sites involved with the rosacea lesions (full-face, cheeks, nose, or perioral involvement). Clinical signs were measured through self-reported, dermatologist-evaluated grading of symptoms, and physiological indicators of epidermal barrier function.
      RESULTS: There were 471 (80.4%), 49 (8.4%), 52 (8.9%), and 14 (2.4%) cases in the full-face, cheek, nasal and perioral groups, respectively. Compared with the healthy control, the full-face group had lower water content and higher transepidermal water loss (TEWL) in the cheeks, and chin; the perioral group had lower water content and higher TEWL in the chin; while the nasal group had the normal water content and TEWL. Compared with the full-face group, the nasal group had more severe phymatous changes, less severe self-reported and dermatologist-evaluated grading of symptoms. All the patients in the perioral or the nasal group had their first rosacea lesions start and remain at the chin or on the nose. In the full-face group, 55.8% of patients had their lesions start with the full face, 40.1% on the cheek, and the rest (4.1%) on the nose.
      CONCLUSION: Significant differences in clinical features were observed among rosacea patients with lesions at four different sites. The lesion localization of each group was relatively stable and barely transferred to other locations.
      PMID: 28698821 [PubMed - in process] {url} = URL to article
    • Related Articles Pediatric blepharokeratoconjunctivitis: is there a 'right' treatment? Curr Opin Ophthalmol. 2017 Jul 10;: Authors: Rousta ST Abstract
      PURPOSE OF REVIEW: This article highlights the importance of recognizing blepharokeratoconjunctivitis (BKC) in children and reviews the clinical characteristics and current therapeutic modalities.
      RECENT FINDINGS: The mainstay of BKC treatment remains controlling the meibomian gland inflammation and treating cobormid conditions. BKC can occur in the setting of ocular rosacea and Demodex infestation. Small studies have shown treatment benefits of topical cyclosporine A as well as oral azithromycin in pediatric BKC.
      SUMMARY: BKC is a cause for visual loss in children, and therefore pediatric ophthalmologists should be more vigilant about early diagnosis and long-term treatment. There is a lack of randomized controlled trials on this topic and no standardized outcome measures. Better ways to measure the clinical outcome of various treatment modalities need to be developed.
      PMID: 28696955 [PubMed - as supplied by publisher] {url} = URL to article
    • Many never touch alcohol but have rosacea. In certain people, overproduction of two inflammatory proteins and their subsequent interaction lead to the rise of a third protein that causes rosacea. Living With Rosacea, By Dr. Brian McDonough, CBSPhilly
    • "Especially during the summer, the initial redness of rosacea can easily be confused with a sunburn that lingers or doesn't go away," said Dr. John Wolf, chairman of dermatology at Baylor College of Medicine. "It's important for anyone who suspects they may have rosacea to see a dermatologist for diagnosis and appropriate medical therapy." The 'Sunburn' That Won't Go Away: Summer Tips for Controlling Rosacea, PRWeb, benzinga
    • The RRDi has now over 1000 charter members who have graciously joined providing contact information so that they can vote in our decision making of who serves on the board of directors every five years. We have now opened up our membership to anyone who will provide an email address and a cryptic display name without giving us all the contact information. These new members who do not provide full contact information will not be able to vote for who serves on the board of directors, but will have posting privileges in the forum. We hope to increase our membership since many are reluctant to join if they have to provide contact information. This way, only those who really want to vote will graciously provide such information if they want to. Otherwise, a new member can be totally anonymous.  We are also allowing those to use their Facebook accounts to register an account with our forum, as well as Twitter.   
    • Just set up new facebook registration/login ability and testing the posting.
    • There are no known articles that have actually studied whether rosacea is contagious but any papers published about this question says that rosacea is not contagious. "Rosacea is not catching." [1] There are some communicable skin conditions and here is a list. A recent paper published by Cell Host & Microbe states, "In a new study, researchers at the University of Pennsylvania have shown for the first time that, not only can infection with the Leishmania parasite alter the skin microbiome of affected mice, but this altered microbial community can be passed to uninfected mice that share a cage with the infected animals." An article discussing this paper says, "To my knowledge, this is the first case where anyone has shown that a pre-existing skin microbiome can influence the outcome of an infection or a disease," said Elizabeth Grice, co-senior author and assistant professor in the departments of Dermatology and Microbiology in Penn's Perelman School of Medicine. "This opens the door to many other avenues of research." " Obviously we need better understanding of Microbiome-based therapeutic strategies. Demodectic Rosacea May Be Contagious Danners points out in post #10, "This question has been asked several times on this forum, with similar experiences described by the person posing the question. Doctors and online medical articles say these are not communicable diseases, however there are several, if not hundreds of anecdotal posts on acne.org, reddit and this forum that say otherwise." Are we discussing demodectic rosacea now? A point worth mentioning is that babies do not have demodex mites. So how do most humans have demodex mites on their skin if they are not transferred? So therefore, isn't it possible to 'catch' demodectic rosacea, which is a variant of rosacea? One paper on this subject states, "The transfer of Demodex mites between individuals appears to happen less frequently than the transfer of lice (Pediculus humanus), another human-associated arthropod species, as would be expected considering the more external habitat of lice in comparison with these pore-dwelling mites." [2] Another paper explains, "Conversely, if Demodex lack strong geographic structure, it suggests the movement of mites among humans must occur very frequently (perhaps even with social greeting rituals) and across large geographic distances." [3] This same source states the following about transmission of mites between humans:  "Little is known about the transmission of mites among humans. Recent studies find that many symbiotic microbes are passed directly from mother to offspring during breast-feeding or during birth (especially if birth is vaginal), and dogs acquire their Demodex mites as nursing pups. In light of this, the same means of mite transmission seems possible in humans, supported by the fact that in one study, Demodex mites were found in 77% of nipple tissue from mastectomies. Yet that we found mites on all adults but only 70% of 18 year olds, suggests that perhaps mite colonization does not strictly occur vertically, from parent to child. These results are in line with earlier morphological (largely postmortem) studies in which mites were found to be more prevalent on adults than on children. Mites could be more ubiquitous on children than noted in postmortem studies or herein but at levels or in locations that make the mites difficult to detect even with the use of molecular approaches. One study of Demodex mites on Tokelau islanders found that mites were present on a greater number of children than on adults. These conflicting findings highlight our limited understanding of how and when mites move onto and among human bodies." [3] "Presumably, Demodex passes to newborns through close physical contact after birth; however, due to low sebum production, infants and children lack significant Demodex colonization....Infestation of both species is more common in males than in females, with males more heavily colonizing than females (23% vs 13%) and harboring more D. brevis than females (23% vs 9%)....The mites are transferred between hosts through contact of hair, eyebrows, and sebaceous glands on the nose." [4] Logic concludes that demodectic rosacea may be contagious. However, why does one human (a) with rosacea who cohabits and consorts with another human (b) for many years not pass on rosacea to human (b) ? Obviously in such cases rosacea is not infecting human (b). So how can we prove beyond any doubt that demodectic rosacea may be contagious? A peer reviewed, double blind, placebo controlled clinical study should suffice to answer this question. How can this be done?  Conclusion So, wouldn't it be nice if say ten thousand rosacea sufferers got together and each donated a dollar and then paid a physician to study this subject and write an article that nails the coffin on this? That brings us to a different subject, 'how do you bring together 10,000 rosacea sufferers together who can publish their own research on rosacea?' Can the RRDi do this? End Notes [1] British Skin Foundation, Rosacea [2] PNAS | December 29, 2015 | vol. 112 | no. 52 | 15963
      Global divergence of the human follicle mite Demodex folliculorum: Persistent associations between hostancestry and mite lineages
      Michael F. Palopolia,, Daniel J. Fergusb, Samuel Minota, Dorothy T. Peia, W. Brian Simisond, Iria Fernandez-Silvad, Megan S. Thoemmesc, Robert R. Dunnc, and Michelle Trautweind [3] PLoS ONE 9(8): e106265
      Ubiquity and Diversity of Human-Associated Demodex Mites
      Megan S. Thoemmes , Daniel J. Fergus, Julie Urban, Michelle Trautwein, Robert R. Dunn
      https://doi.org/10.1371/journal.pone.0106265 [4] Indian J Dermatol. 2014 Jan-Feb; 59(1): 60–66.doi:  10.4103/0019-5154.123498 PMCID: PMC3884930
      Human Demodex Mite: The Versatile Mite of Dermatological Importance
      Parvaiz Anwar Rather and Iffat Hassan For more information on the study of demodex mites, read Megan Thoemmes, PhD Student | Dunn Lab  
    • "Red man syndrome is the most common adverse reaction to the drug vancomycin (Vancocin). It’s sometimes referred to as red neck syndrome. The name comes from the red rash that develops on the face, neck, and torso of affected people." Healthline
    • Related Articles A Pilot, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Safety of IncobotulinumtoxinA Injections in the Treatment of Rosacea. J Drugs Dermatol. 2017 Jun 01;16(6):549-554 Authors: Dayan SH, Ashourian N, Cho K Abstract
      <p>BACKGROUND: Rosacea has a variable presentation. Whereas the pathophysiology may differ, erythema, and flushing are the most consistent findings in all patients.</p> <p>OBJECTIVE: To evaluate the safety and efficacy of incobotulinumtoxinA in reducing the severity of rosacea symptoms.</p> <p>METHODS: Nine subjects with erythematotelangiectactic or papulopustular rosacea were randomized in 2 groups. Subjects in Group 1 (n=4) received up to a total of 20 U of incobotulinumtoxinA in the affected area (across both cheeks). Subjects in Group 2 (n=5) were injected with equal volumes of a saline solution. Rosacea Clinical Scores and subject satisfaction were evaluated at baseline and at 1, 4, 12, and 16 weeks post-treatment. At week 16, both groups were injected with incobotulinumtoxinA. Follow-up visits were performed at 1 and 4 weeks post-retreatment.</p> <p>RESULTS: Patients in Group 1 exhibited reduction in the primary features of rosacea within 4 weeks of treatment with incobotulinumtoxinA. Consistent with this observation, patients in Group 2 (who had received the placebo in the first arm without significant changes to their symptoms) exhibited reductions in all of the primary and some of the secondary features upon treatment with incobotulinumtoxinA.</p> <p>CONCLUSIONS: IncobotulinumtoxinA may be a safe and effective agent to reduce the severity of rosacea symptoms and increase patient satisfaction.</p> <p><em>J Drugs Dermatol. 2017;16(6):549-554.</em></p>.
      PMID: 28686772 [PubMed - in process] {url} = URL to article
    • Related Articles Efficacy and Tolerability of a Cosmetic Skin Care Product With Trans-4-t-butylcyclohexanol and Licochalcone A in Subjects With Sensitive Skin Prone to Redness and Rosacea. J Drugs Dermatol. 2017 Jun 01;16(6):605-610 Authors: Jovanovic Z, Angabini N, Ehlen S, Mokos ZB, Subotic M, Neufang G Abstract
      <p>BACKGROUND: Sensitive skin and rosacea are skin conditions, which may affect the quality of life of the patients considerably. In vitro and in vivo data indicated that the combination of trans-t-butylcyclohexanol and licochalcone A is an effective combination for alleviating the increased sensitivity of rosacea subtype I.</p> <p>OBJECTIVE: Objective of this open dermocosmetic study was to investigate the efficacy and tolerability of a skin care product containing the anti-inflammatory licochalcone A and the TRPV1 antagonist trans-t-butylcyclohexanol in subjects with sensitive skin prone to redness and rosacea.</p> <p>METHODS: 1221 subjects with sensitive skin and rosacea stage 0-II applied the test product twice daily for 4 weeks. Clinical assessment of sensitive skin and rosacea symptoms were performed at baseline and after 4 weeks. Additionally, at treatment end the test subjects filled a self-assessment questionnaire.</p> <p>RESULTS: After 4 weeks of application, both, clinical and subjective assessment have shown improvement of all symptoms of sensitive skin and rosacea in a significant number of subjects (P less than 0.001). The test product was efficacious and very well tolerated also when used in conjunction with pharmacological treatments of the skin condition under scrutiny.</p> <p>Conclusions: The study confirmed the good tolerability and efficacy of the skin care product in the management of sensitive skin prone to redness and rosacea when used alone or in combination with other therapies.</p> <p><em>J Drugs Dermatol. 2017;16(6):605-611.</em></p>.
      PMID: 28686779 [PubMed - in process] {url} = URL to article
    • "The great thing about infrared saunas is that they can also help people who have rosacea, a condition that causes redness, and sometimes pus-filled bumps on your face. According to Spa Lé La’s website, infrared saunas offer the benefit of being anti-inflammatory, and therefore, it’s not irritating to the skin." This is how going to the spa can help with rosacea, pain, and stimulating collagen, by Alyssa Morin, Hello Giggles
    • Identification of an epidermal marker for reddened skin: Vascular endothelial growth factor A. J Dermatol. 2017 Jul;44(7):836-837 Authors: Kajiya K, Kajiya-Sawane M, Ono T, Sato K PMID: 28677138 [PubMed - in process] {url} = URL to article
    • Prescription costs for acne and rosacea medications for Medicare patients were higher from specialists compared with primary care physicians in family medicine or internal medicine, according to recently published study results in the Journal of the American Academy of Dermatology. Costs for acne, rosacea prescriptions for Medicare patients higher with specialists vs. PCPs, Healio Dermatology
      Zhang M, et al. J Am Acad Dermatol. 2017;doi:10/1016/j.jaad.2017.4.1127.
    • "I find myself struggling with a response. I know they think they’re giving me a compliment, so I don’t want to embarrass them by saying that I have a skin disease. Ask Amy: They think it’s a compliment when they mention my disease, By AMY DICKINSON | Tribune Content Agency, The Mercury News
    • Experiences of rosacea and its treatment: An interpretative phenomenological analysis. Br J Dermatol. 2017 Jul 01;: Authors: Johnston SA, Krasuska M, Millings A, Lavda AC, Thompson AR Abstract
      BACKGROUND: Whilst rosacea is a chronic skin condition, the condition can often have a large psychosocial impact on the individual. There is therefore a need to understand the experience of living with rosacea from the patient perspective.
      OBJECTIVES: To examine the experience of living with rosacea and the experience of seeking and receiving treatment.
      METHODS: Nine participants took part in semi-structured interviews, which were analysed using interpretative phenomenological analysis.
      RESULTS: Three superordinate themes were identified within the data; self-consciousness, which focused on the fear of others' assigning blame to participants for having caused symptoms; avoidance, concealment, and hiding emotions, referring to the coping strategies participants employed in response to rosacea; and inconsistencies in GP treatment and guidance, which focused on the need for medical professionals to assess the psychosocial well-being of patients with rosacea.
      CONCLUSIONS: Rosacea can have a negative impact on the daily life of people with the condition, contributing to lowered self-esteem, embarrassment, and feelings of shame. Engaging in emotion-focused and behavioural/avoidant-focused coping strategies increased participant's confidence and reduced their avoidance of social situations. However, such strategies might still serve to maintain underlying unhelpful cognitive processes. Consequently, it is important for medical professionals to assess for the presence of cognitive factors that might contribute to maintaining distress in patients with rosacea, and where unhelpful thoughts or beliefs are reported, patients may need to be referred for psychological support. This article is protected by copyright. All rights reserved.
      PMID: 28667759 [PubMed - as supplied by publisher] {url} = URL to article
    • "While the definitive cause of rosacea is unknown at this time, there are a few factors that are prevalent among those who suffer from this common skin condition." Twelve top tips for dealing with rosacea, Chris Barry, Starts at 60
    • Avenova is for dry eye syndrome. For more info click here. 
    • "Over 30 million Americans share these chronic symptoms which may be due to blepharitis,  meibomitis also known as meibomian gland dysfunction (MGD) often described more simply as dry eye syndrome...there is a new weapon called Avenova® that is designed for removal of microorganisms and debris that contribute to these conditions such as dry eye, MGD, blepharitis, Meibomitis and Stye." Avenova is made by NovaBay Pharmaceuticals  Rebate – Pay no more than $35*. Rx Only  
    • Related Articles Dermatologic Features of Classic Movie Villains: The Face of Evil. JAMA Dermatol. 2017 Jun 01;153(6):559-564 Authors: Croley JA, Reese V, Wagner RF Abstract
      Importance: Dichotomous dermatologic depictions of heroes and villains in movies have been used since the silent film age.
      Objective: To evaluate the hero-villain skin dichotomy in film by (1) identifying dermatologic findings of the all-time top 10 American film villains, (2) comparing these dermatologic findings to the all-time top 10 American film heroes quantitatively and qualitatively, and (3) analyzing dermatologic portrayals of film villains in depth.
      Design, Setting, and Participants: In this cross-sectional study, dermatologic findings for film heroes and villains in mainstream media were identified and compared quantitatively using a χ2 test with α < .05, as well as qualitatively. The all-time top 10 American film villains and heroes were obtained from the American Film Institute 100 Greatest Heroes and Villains List.
      Main Outcomes and Measures: Primary outcomes include identification and frequencies of dermatologic findings of the top 10 film villains and of the top 10 film heroes.
      Results: Six (60%) of the all-time top 10 American film villains have dermatologic findings, including cosmetically significant alopecia (30%), periorbital hyperpigmentation (30%), deep rhytides on the face (20%), multiple facial scars (20%), verruca vulgaris on the face (20%), and rhinophyma (10%). The top 10 villains have a higher incidence of significant dermatologic findings than the top 10 heroes (60% vs 0%; P = .03).
      Conclusions and Relevance: Dermatologic findings of the all-time top 10 American villains are used in film to highlight the dichotomy of good and evil, which may foster a tendency toward prejudice in our society directed at those with skin disease.
      PMID: 28384669 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Oral Isotretinoin May Improve the Symptoms of Chronic Rhinosinusitis. J Clin Diagn Res. 2017 May;11(5):WL01 Authors: Aktaş H, Ergin C, Tunç A, Ertuğrul S PMID: 28658888 [PubMed - in process] {url} = URL to article
    • Related Articles Bilateral Morganella Morganii keratitis in a patient with facial topical corticosteroid-induced rosacea-like dermatitis: a case report. BMC Ophthalmol. 2017 Jun 28;17(1):106 Authors: Zhang B, Pan F, Zhu K Abstract
      BACKGROUND: Bilateral keratitis rarely occurs in individuals without predisposing factors. Here we describe the clinical course of a patient who developed a bilateral keratitis caused by Morganella. morganii which might be associated with long term using of topical corticosteroids-containing preparations on the face.
      CASE PRESENTATION: A 52-year-old female patient presented with marked bilateral corneal infiltration and hypopyon without any usual predisposing factors for bilateral infectious keratitis. There was diffuse erythema with itching on face before the onset of eye discomforts. Microbiological culture of materials from both corneas revealed significant growth of Morganella morganii. Topical corticosteroid-induced rosacea-like dermatitis was diagnosed by dermatologist because of the characteristic eruptions and long history of using the corticosteroids-containing cosmetic creams on her face. The corneal ulcers responded well to levofloxacin eye drops and ofloxacin ointment and healed with opacity and neovascularization.
      CONCLUSION: This case illustrates that bilateral bacterial corneal infection can develop in patients with long term using of topical corticosteroids-containing preparations on the face. To our knowledge, this is the first case of bilateral keratitis caused by Morganella morganii.
      PMID: 28659135 [PubMed - in process] {url} = URL to article
    • "Another possibility was that Raja’s eye problems stemmed from inflammation, Ngo thought; this could explain why both eyes were affected. Ocular rosacea, a type of the condition better known for causing red skin on the face, might make sense." When eye irritation is more than it seems at first glance, By ALLISON BOND, Stat
    • "Exercise can trigger a bout of flushing, facial redness and itchy skin - the key symptoms of rosacea - because it increases your body's core temperature. Indeed, 80 per cent of people in a survey by the National Rosacea Society said it aggravated theirs, particularly if it was high-intensity aerobic exercise. To retain the health benefits of exercise, the National Rosacea Society recommend sufferers do low- to medium-intensity exercise - like Pilates - instead. Similar to yoga, Pilates works by strengthening, stretching, and stabilising key muscles." Rosacea treatment: THIS form of exercise could significantly improve your skin, by LAUREN CLARK, Express
    • Related Articles Diagnosis and Treatment of Rosacea Fulminans: A Comprehensive Review. Am J Clin Dermatol. 2017 Jun 27;: Authors: Walsh RK, Endicott AA, Shinkai K Abstract
      Rosacea fulminans is a rare inflammatory condition of the central face marked by the abrupt onset of erythematous coalescing papules, pustules, nodules, and draining sinuses. Due to infrequent reporting in the literature, the pathophysiology, classification, and nomenclature of this condition remain controversial. This comprehensive review evaluated a total of 135 cases of rosacea fulminans for clinical and histopathologic features and reported treatment strategies. Patients were 91% female with an average age of onset of 31.3 years. Only 19% of cases reported duration of symptoms longer than 3 months, and reports of recurrence were uncommon. A majority of patients had history of rosacea or flushing, and common triggers included hormonal shifts, emotional stress, and medications. Extrafacial or systemic involvement was rare. Though oral and topical antibiotics were frequently utilized to treat rosacea fulminans, there was a clear shift in reported treatments for rosacea fulminans following the introduction of isotretinoin use in 1987, marked by increased reliance on isotretinoin in addition to topical and systemic corticosteroids. Newer treatments were associated with superior improvement compared with antibiotic monotherapy, most notably dramatically reduced rates of scarring, though reduced rates of disease recurrence were not evident. Several patterns revealed through this review reinforce the classification of rosacea fulminans as a severe yet distinct variant of rosacea and highlight key distinguishing clinical features and treatment options for optimal management.
      PMID: 28656562 [PubMed - as supplied by publisher] {url} = URL to article
    • "I wish I could say I was the perfect skin regiment person. I work at night usually, so when I wake up it’s like noon. I will usually wash my face, just with water, to wake myself up. I do like to moisturize right off the bat. I’m very simple when it comes to my product. I’ll use Neutrogena, I’ve used Shiseido. Those are my favorite two that I vacillate between. And now I use Rhofade as part of my daily routine as a person who has had rosacea for years, and nothing ever really worked. (Chenoweth is a spokesperson for the brand.) With consistent use, this works. So I put on Nivea chapstick, I put on my lashes, and call it a day. On a daily basis, I don’t wear makeup—I let my skin breathe." Kristin Chenoweth On Her Skincare Secret, Fashion Tricks, And Her Dream Role, Celia Shatzman, Forbes
    • Related Articles VORWORT. J Dtsch Dermatol Ges. 2016 Dec;14 Suppl 6:3 Authors: Luger TA PMID: 27869371 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Rosazea-Management: Update über allgemeine Maßnahmen und topische Therapieoptionen. J Dtsch Dermatol Ges. 2016 Dec;14 Suppl 6:17-28 Authors: Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M Abstract
      Obwohl bislang für die Rosazea keine kurative Therapie besteht, können verschiedene Optionen zur Behandlung der Symptome und zur Vorbeugung von Exazerbationen empfohlen werden. Neben Selbsthilfemaßnahme wie der Vermeidung von Triggerfaktoren und einer geeigneten Hautpflege sollte das Rosazea-Management bei Patienten mit erythematöser und leichter bis schwerer papulopustulöser Rosazea die Anwendung topischer Präparate als First-Line-Therapie umfassen. Da Überlappungen der charakteristischen Rosazea-Symptome im klinischen Alltag die Regel sind, sollte die medikamentöse Therapie auf die individuellen Symptome zugeschnitten werden; auch eine Kombinationstherapie kann erforderlich sein. Zu den für die Behandlung der Hauptsymptome der Rosazea zugelassenen Wirkstoffen gehören Brimonidin gegen das Erythem sowie Ivermectin, Metronidazol oder Azelainsäure gegen entzündliche Läsionen. Ihre Wirksamkeit wurde in zahlreichen validen, gut kontrollierten Studien belegt. Darüber hinaus existieren verschiedene nicht zugelassene topische Behandlungsmöglichkeiten, deren Wirksamkeit und Sicherheit noch in größeren, kontrollierten Studien zu untersuchen ist.
      PMID: 27869373 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Aktueller Stand der systemischen Rosazea-Therapie. J Dtsch Dermatol Ges. 2016 Dec;14 Suppl 6:29-37 Authors: Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M Abstract
      Basierend auf den Daten zahlreicher Studien sind orale Tetracycline - und hier insbesondere Doxycyclin als Tetracyclin der zweiten Generation - die Grundpfeiler der systemischen Rosazea-Therapie. Bisher ist dafür jedoch nur Doxycyclin 40 mg in antientzündlicher Dosierung mit veränderter Wirkstofffreisetzung zugelassen. Seit Einführung der Therapie mit Doxycyclin einmal täglich in nicht antibiotischer Dosierung wird die orale Therapie häufiger als Erstbehandlung bei mittelschwerer bis schwerer papulopustulöser Rosazea verschrieben. Oft wird diese Behandlung aufgrund der besseren Wirksamkeit im Vergleich zur Monotherapie auch mit einer topischen Behandlung kombiniert. Obwohl in der Systemtherapie weitere, nicht zugelassene Wirkstoffe wie Makrolide, Isotretinoin und Carvedilol mit viel versprechenden Ergebnissen untersucht wurden, ist die vorliegende Erfahrung bisher begrenzt, so dass diese Substanzen speziellen Situationen vorbehalten bleiben sollten.
      PMID: 27869375 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Physikalische Methoden zur Behandlung der Rosazea. J Dtsch Dermatol Ges. 2016 Dec;14 Suppl 6:38-44 Authors: Hofmann MA, Lehmann P Abstract
      Die Rosazea ist durch vielfältige vaskuläre Veränderungen gekennzeichnet. Neben Teleangiektasien und Erythemen treten häufig auch sogenannte "Flushings" auf. Haupteinsatzgebiete von Licht- und Lasersystemen sind diese vaskulären Veränderungen, wie Erytheme und Teleangiektasien. Neben dem KTP-Laser, dem Farbstofflaser (PDL) und dem Nd:YAG-Laser kommen auch Blitzlampen (IPL) zum Einsatz. Neben der Rückbildung der vaskulären Komponente, ist auch eine Verbesserung der papulopustulösen Komponente beschrieben. Während der KTP-Laser sehr gute Ergebnisse bei Teleangiektasien zeigt, werden der Farbstofflaser und die Blitzlampen bevorzugt bei flächigen Erythemen eingesetzt. Der ND:YAG-Laser kann bei Teleangiektasien und Erythemen eingesetzt werden, birgt aber von allen Systemen das nicht einschätzbare Narbenbildungsrisiko in sich. Die Bildung von Phymen stellt eine klinische Ausprägung der Rosazea dar. Das am häufigsten vorkommende ist das Rhinophym. Bei moderaten und schweren Formen steht die Abtragung im Vordergrund. Die klassische chirurgische Abtragung stellt eine Möglichkeit zur Behandlung dar, häufig kommt es hierbei jedoch intraoperativ zu stärkeren Blutungen. Alternativmethode ist die Elektrochirurgie und die Dermabrasion, wobei bei beiden Methoden Narbenbildungen auftreten können. Neuere Methoden wie die CO2 -Laserabtragung, eventuell in Kombination mit der Erbium:YAG-Abtragung, stellen sichere und komplikationsärmere Varianten dar.
      PMID: 27869376 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty. J Am Acad Dermatol. 2017 Jun 23;: Authors: Zhang M, Silverberg JI, Kaffenberger BH Abstract
      BACKGROUND: Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking.
      OBJECTIVE: To describe the medications used for treating acne/rosacea in the Medicare population and evaluate differences in costs between specialties.
      METHODS: A cross-sectional study was performed of the 2008 and 2010 Centers for Medicare and Medicaid Services Prescription Drug Profiles, which contains 100% of Medicare part D claims.
      RESULTS: Topical antibiotics accounted for 63% of all prescriptions. Patients ≥65 years utilized more oral tetracycline-class antibiotics and less topical retinoids. Specialists prescribed brand name drugs for the most common topical retinoids and most common topical antibiotics more frequently than family medicine/internal medicine (FM/IM) physicians by 6%-7%. Topical retinoids prescribed by specialists were, on average, $18-$20 more in total cost and $2-$3 more in patient cost than the same types of prescriptions from FM/IM physicians per 30-day supply. Specialists (60%) and IM physicians (56%) prescribed over twice the rate of branded doxycycline than FM doctors did (27%). The total and patient costs for tetracycline-class antibiotics were higher from specialists ($18 and $4 more, respectively) and IM physicians ($3 and $1 more, respectively) than they were from FM physicians.
      LIMITATIONS: The data might contain rare prescriptions used for conditions other than acne/rosacea, and suppression algorithms might underestimate the number of specialist brand name prescriptions.
      CONCLUSION: Costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options.
      PMID: 28651825 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Evaluation of a novel very high sun-protection-factor moisturizer in adults with rosacea-prone sensitive skin. Clin Cosmet Investig Dermatol. 2017;10:211-219 Authors: Grivet-Seyve M, Santoro F, Lachmann N Abstract
      BACKGROUND/OBJECTIVE: Rosacea-prone sensitive skin requires high sun-protection factor (SPF) moisturizers. This study evaluated Daylong Extreme SPF 50+ lotion, a novel cream containing five ultraviolet filters, two emollients, and three skin conditioners.
      SUBJECTS AND METHODS: This was an open-label, single-center study. On day 1, before treatment, subjects answered a questionnaire on their skin conditions and sunscreen habits, and both subjects and dermatologist evaluated skin status. Subjects applied the product once daily in the morning to the face for 21 days, and after approximately 3-5 minutes they assessed tolerability and short-term cosmetic acceptability in a questionnaire and daily diary. On day 22, the dermatologist and subjects evaluated skin status for long-term tolerance and cosmetic acceptability.
      RESULTS: The study enrolled 44 individuals (mean age 58.8 years, 91% female). At baseline, most subjects (39 of 44) showed erythema, and ~30% showed dryness and scaling. Dermatologists noted four cases of pustules and one case of papules. After 21 days' treatment with the product, the dermatologist reported significantly less erythema, dryness and scaling, three cases of pustules and two cases of papules. At baseline, ~75% of subjects noted a feeling of dryness, >50% reported tension, and nearly 25% reported tickling. After using the product for 21 days, subjects reported significantly less tension, dryness, and tickling. Some subjects noted itching and burning before and after using the product. One subject noted papules during treatment. Most subjects said that the product was pleasant, did not irritate the skin or cause stinging/burning, was easy to apply, quickly absorbed, and nongreasy, improved skin moisturization, helped prevent sun-provoked facial redness, did not worsen rosacea, and was easily incorporated into their skincare regimen. Half would switch to the product, and 80% of subjects would buy and recommend the product.
      CONCLUSION: The product was well tolerated in rosacea-prone subjects, producing objective and subjective improvements in skin status and symptoms.
      PMID: 28652793 [PubMed - in process] {url} = URL to article
    • Related Articles Dual anti-inflammatory and antiparasitic action of topical ivermectin 1% in papulopustular rosacea. J Eur Acad Dermatol Venereol. 2017 Jun 27;: Authors: Schaller M, Gonser L, Belge K, Braunsdorf C, Nordin R, Scheu A, Borelli C Abstract
      BACKGROUND: Recently, therapy of rosacea with inflammatory lesions (papulopustular) has improved substantially with the approval of topical ivermectin 1% cream. It is assumed to have a dual mode of action with anti-inflammatory capacities and anti-parasitic effect against Demodex, which however has not yet been demonstrated in vivo.
      AIM: To find scientific rationale for the dual anti-inflammatory and anti-parasitic mode of action of topical ivermectin 1% cream in patients with rosacea.
      METHODS: A monocentric pilot study was performed including 20 Caucasian patients with moderate to severe rosacea, as assessed by investigator global assessment (IGA score ≥ 3) and a demodex density ≥ 15/cm(2) . Patients were treated with topical ivermectin 1% cream once daily (Soolantra(®) ) for ≥12 weeks. The density of Demodex mites was assessed with skin surface biopsies. Expression of inflammatory and immune markers were evaluated with RT-PCR and by immunofluorescence staining.
      RESULTS: The mean density of mites was significantly decreased at week 6 and week 12 (p<0.001). The gene expression levels of IL-8, LL-37, HBD3, TLR4 and TNF-α were downregulated at both time points. Reductions in gene expression were significant for LL-37, HBD3 and TNF-α at both follow up time points and at week 12 for TLR4 (all p<0.05). Reduced LL-37 (p<0.05) and IL-8 expression was confirmed on the protein level by immunofluorescence staining. All patients improved clinically and 16 out of 20 patients reached therapeutic success defined as IGA score ≤ 1.
      CONCLUSION: Topical ivermectin 1% cream acts by a dual, anti-inflammatory and anti-parasitic mode of action against rosacea by killing Demodex spp. in vivo, in addition to significantly improving clinical signs and symptoms in the skin. This article is protected by copyright. All rights reserved.
      PMID: 28653460 [PubMed - as supplied by publisher] {url} = URL to article
    • The Role of Polyphenols in Rosacea Treatment: A Systematic Review. J Altern Complement Med. 2017 Jun 26;: Authors: Saric S, Clark AK, Sivamani RK, Lio PA, Lev-Tov HA Abstract
      OBJECTIVES: Various treatment options are available for the management of rosacea symptoms such as facial erythema, telangiectasia, papules and pustules, burning, stinging, and itching. Botanical therapies are commonly used to treat the symptoms. The objective of this review is to evaluate the use of polyphenols in rosacea treatment.
      DESIGN: PubMed, Embase, Biosis, Web of Knowledge, and Scopus databases were systematically searched for clinical studies evaluating polyphenols in the management of rosacea.
      RESULTS: Of 814 citations, 6 met the inclusion criteria. The studies evaluated licochalcone (n = 2), silymarin (n = 2), Crysanthellum indicum extract (n = 1), and quassia extract (n = 1). The studies only evaluated topical formations of stated polyphenols. Main results were summarized.
      CONCLUSIONS: There is evidence that polyphenols may be beneficial for the treatment of rosacea symptoms. Polyphenols appear to be most effective at reducing facial erythema and papule and pustule counts. However, studies included have significant methodological limitations and therefore large-scale, randomized, placebo-controlled trials are warranted to further assess the efficacy and safety of polyphenols in the treatment of rosacea.
      PMID: 28650692 [PubMed - as supplied by publisher] {url} = URL to article
    • A Journal of Family Practice article says, "Using intention-to-treat analysis, permethrin 5% cream was as effective as metronidazole 0.05% gel and significantly superior to placebo at improving erythema (change from a baseline score of 2.60 to 1.34), papules (change from baseline count of 6.04 to 1.73), and pustules (change from baseline count of 2.30 to 0.56)." This same article reports, "Permethrin 5% cream is superior to metronidazole 0.75% gel and placebo in decreasing Demodex folliculorum, and is as effective as metronidazole 0.75% gel in treating erythema and papules." This may be a prescription or a non prescription treatment for rosacea. Ask your doctor. For more information read this post. 
    • A Journal of Family Practice article says, "Using intention-to-treat analysis, permethrin 5% cream was as effective as metronidazole 0.05% gel and significantly superior to placebo at improving erythema (change from a baseline score of 2.60 to 1.34), papules (change from baseline count of 6.04 to 1.73), and pustules (change from baseline count of 2.30 to 0.56)." This same article reports, "Permethrin 5% cream is superior to metronidazole 0.75% gel and placebo in decreasing Demodex folliculorum, and is as effective as metronidazole 0.75% gel in treating erythema and papules." For more information read this post. 
    • Em270 from Canada, at RF, posted a link to Kate's Rosacea non prescription treatment for rosacea blog, permethrin 5% scabies, which lists a long list of over the counter treatments for your consideration. If anyone confirms this works for rosacea, please post in this thread.  I can't find any product at the USA Amazon site that comes close to this treatment. If anyone does find something at Amazon, please post in this thread. Kate says she uses Quellada Lotion available in Australia. She says it is available outside of Australia as Kwellada-P available at Amazon Canada.  U Michigan article
      PubMed article A Journal of Family Practice article says, "Using intention-to-treat analysis, permethrin 5% cream was as effective as metronidazole 0.05% gel and significantly superior to placebo at improving erythema (change from a baseline score of 2.60 to 1.34), papules (change from baseline count of 6.04 to 1.73), and pustules (change from baseline count of 2.30 to 0.56)." This same article reports, "Permethrin 5% cream is superior to metronidazole 0.75% gel and placebo in decreasing Demodex folliculorum, and is as effective as metronidazole 0.75% gel in treating erythema and papules." It is apparently odd that you can't purchase this product over the counter in the USA, however, according to this article you can purchase it on ebay.  I did find a 1% Permethrin cream at Amazon. 
    • Related Articles Rosacea in black South Africans with skin phototypes V and VI. Clin Exp Dermatol. 2017 Jun 22;: Authors: Dlova NC, Mosam A Abstract
      Rosacea is a chronic facial dermatosis considered to affect primarily white patients with light phototype skin, and is poorly documented in black patients. The aim of this study was to document the clinical features of rosacea in patients with phototypes V and VI. An 8-year retrospective chart review of patients with a clinical and histological diagnosis of rosacea or acne rosacea was undertaken. Of 6700 patients, 15 (0.2%) had rosacea. All were of African descent with skin phototype V or VI. Mean age was 47 years, and female : male ratio was 14 : 1. Of the 15 patients, 5 (33%) were positive for human immunodeficiency virus; 5 (33%) had used topical steroids to treat the roseacea; 6 (40%) had phototype V and presented with erythema, telangiectasia and erythematous papules, while 9 (60%) had phototype VI skin and presented with skin-coloured papules; and 10 (67%) had histology showing granulomatous rosacea, while 5 (33%) declined a facial skin biopsy. A high index of suspicion is required to diagnose rosacea in black patients as the classic signs of erythema and telangiectasia are difficult to discern.
      PMID: 28639713 [PubMed - as supplied by publisher] {url} = URL to article
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