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  • Misdiagnosed Rosacea

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    Articles, References and Anecdotal Reports

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

    Articles and References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


    Anecdotal Reports of Misdiagnosis

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

    1. Bob reports his rosacea was misdiagnosed for discoid lupus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    More cases of misdiagnosed rosacea (or vice versa)

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    • There are several acne treatments used to treat rosacea, i.e., Dapsone, Sarecycline, Azithromycin, Minocycline, and the list continues, not to mention the plethora of over the counter acne treatments to consider. A typical example of an acne treatment, Benzaclin, that is also used to treat rosacea is discussed in the following paper:  “Based on the theory that rosacea shares the same inflammatory features of acne, a recent study showed that, just as the combination of benzoyl peroxide 1 percent and clindamycin 5 percent gel is a powerful treatment modality for reducing Propionibacterium acnes levels, it also significantly reduces the papules and pustules of rosacea, according to Debra L. Breneman, M.D..… ‘Benzaclin, once daily, was found to be well tolerated and effective in the reduction of papules and pustules in patients with rosacea,’ said Dr. Breneman. ‘This lends credence to the theory that P. acnes is a potential aggravating factor in rosacea. This gives dermatologists a very effective treatment for rosacea.’ ” [1] Herbal Extracts for Acne  One report on the 'clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris' concludes, "This herbal extracts can be a new therapeutic option for patients with mild to moderate acne vulgaris who are reluctant to use drugs." [2]  The herbal extracts include: Mangosteen extract Lithospermum officinale extract Tribulus terrestris L. extract Houttuynia cordata Thunb extract End Notes [1] Dermatology Times Publish date: Apr 1, 2003 P. Acnes Possible Factor in Rosacea BenzaClin a significant Tx in lesion reduction Beth Kapes Another example similar to above paper discussing topical benzoyl peroxide 5%/clindamycin 1% (BP/C) gel (BenzaClin) concluded, "These results showed that BP/C was significantly more effective than vehicle in improving papules and pustules associated with rosacea.' Cutis. 2004 Jun;73(6 Suppl):11-7. Photographic review of results from a clinical study comparing benzoyl peroxide 5%/clindamycin 1% topical gel with vehicle in the treatment of rosacea. Leyden JJ, Thiboutot D, Shalita A. [2] J Dermatolog Treat. 2019 Oct 16:1-5. doi: 10.1080/09546634.2019.1657792. [Epub ahead of print] Clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris: an 8-week, double-blinded, randomized, controlled trial. Yang JH, Hwang EJ, Moon J, Yoon JY, Kim JW, Choi S, Cho SI, Suh DH.
    • image courtesy of WikiMedia Commons The RRDi financial situation is continuously posted at this url and as of this date, March 30, 2020, we have $771.42 in the bank. Based upon how we are spending donations (the income includes the small amount of affiliate fees we receive from Amazon) we will run out of funds in several months. So we are concerned about this and decided to first post this on our website before using the newsletter tool and send this same announcement to the members who have opted to receive our newsletter. You may wonder how much we are spending in donations currently and for the first three months of 2020 we averaged our expenses to $164/month. You can view how we spent donations for last year here. So you can see our current funds will only last us several months at the present rate of expenditure.  So let's compare this with how much money the NRS spends its donations (who is one of the other non profit organizations for rosacea). The only way we can get an idea how the NRS spends its donations is to look at the last financial report filed by the NRS as shown on Form 990 that the NRS files with the Internal Revenue Service for 2018 which is available for public viewing (the NRS releases its 2019 Form 990 much later and when it does we always review it since we have been reviewing how the NRS spends its donations since 1998).  So let's compare how the NRS spends it donations, that is, the amount each month is spent with what the RRDi spends each month.  For 2018, the NRS received in donations a total of $465,042. During this same period the NRS spent a total of $601,532 (yes the NRS can spend more than it takes in because of the assets they own which the NRS draws upon when the expenses are greater than donations). So on average, in 2018 the NRS spent over $50,000 each month! What did the NRS spend most of it donations on? The answer if you investigate is $432,408 was spent for the year (over $36,000 each month on average) on two private contractors owned by the director/president of the NRS, Sam Huff. So if you are happy with how the NRS is spending its donations that is just one of the other non profit organizations for rosacea that will continue if the RRDi runs out of funds and can't pay our monthly expenses.  So the comparison is: RRDi spends                           NRS spends $164/month                           $50,000/month (of this amount $36,000 is spent on two private contractors owned by Sam Huff) Just for the record, the NRS claims on its Form 990 for 2018 that 25.31% of the total donations received in 2018 were from public support. What is one of the most interesting revelations found on the from its Form 990 for 2018 report is that it reveals how much money was received from the pharmaceutical companies which is shown in a screen shot below: The above screen shot doesn't reveal for how long a period each of the above pharmaceutical companies have been giving the NRS 'excess contributions' but it does reveal the amounts. So if you are happy the way these pharmaceutical companies are contributing to the NRS and the way the NRS is spending its contributions and if the RRDi runs out of funds to keep going, you will surely have the NRS since it has lots of money to spend, especially on two private contractors owned by Sam Huff, the director/president of the NRS.  So it is simply up to you whether you want the RRDi to keep going or simply dissolve because of lack of funds. If you want to help out the RRDi there are two options, (1) donate, or, (2) volunteer (and help us get donations). If you have any questions or concerns, why not find the green reply button and post?
    • image courtesy of Free paper chain v.2 Stock Photo We obviously aren't sure of what community support means to you, but we are trying to figure that out by forming a NON PROFIT organization for rosacea patient advocacy and encouraging rosaceans to come together by joining the RRDi and taking steps to obtain and disseminate community support for those who are suffering from rosacea. What has the RRDi done in this regard? (1) Creating a website with pages of information, a forum of rosacea topics, a community support category, member driven rosacea blogs, galleries and clubs.   (2) Journal of the RRDi and the ability for anyone (amateur or professional) to submit a paper on rosacea to be published. (3) A legal non profit organization to allow donations to be tax deductible. (4) Education grants and the ability to volunteer as a grant writer for your non profit organization.  (5) A way for you to volunteer to help rosacea sufferers. (6) Attracting sponsors to support our non profit organization. (7) Instructions on how to use our forum.  So, what does community support mean to you? Please find the green reply button and post what it means to you? We would love to understand your concerns.  You may think that posting in a community of rosacea sufferers your experience with rosacea and getting some feedback is what community support means to you? If so, this is the correct forum category to do that by finding the green reply button and post your concern. 
    • "In a statement released Sunday night, the U.S. Department of Health and Human Services announced it had received 30 million doses of hydroxychloroquine sulfate and one million doses of hloroquine phosphate donated to a national stockpile of potentially life-saving pharmaceuticals and medical supplies. Hydroxychloroquine and chloroquine, which are oral prescription drugs used primarily to prevent and treat malaria, are both being investigated as potential therapeutics for COVID-19." Coronavirus live updates: FDA gives anti-malaria drugs emergency approval to treat COVID-19 The two drugs are being investigated as potential treatments for COVID-19., By Morgan Winsor and Emily Shapiro, March 30, 2020, 8:05 AM, ABC News Virus has never been ruled out in rosacea. 
    • This question was asked and I am sharing my answer here as well.   Basically everyone has demodex mites and it has been thought that the mites have some sort of undisclosed symbiotic relationship, i.e., the mites eat sebum which helps the mites and helps the humans keep sebum stasis. One report states, "....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host." - See Jarmuda et al published in the Journal of Medical Microbiology (second article mentioned in this post). While this same report says that 'most human populations' have NOT been sampled for demodex mites the general belief is that demodex are common throughout humanity and pose no problem as a pathogen except in the case of demodectic rosacea as far as known.    A Russian study on the mites says, "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte."  It is comparable to bacteria which humans have a relationship with, there is good bacteria and bad bacteria. The probiotic bacteria and the pathogen bacteria. The demodex mites usually pose no problem with the vast majority of humans since they are possibly on everyone. Why they become more numerous seems to be of more importance.    For some unknown reason the mites are in higher density in rosacea patients. We don't know if the rosacea cause this increase in mites or does the increase in mites cause the rosacea, the old chicken or egg conundrum? There is evidence that reducing the mite density count improves rosacea.  It is clear that the mites like human skin since they eat sebum.     Maybe the increase of sugar/carbohydrate in the diet increases sebum which in turn increases the mite population, and voila, the inflammation of rosacea?    I don't think all rosacea is demodectic. GUT Rosacea is a different variant, but may be connected or associated.  The list of systemic comorbidities with rosacea keeps growing. The gut microbiome is obviously connected with skin microbiome (see my post on this).  
    • Related Articles Epidemiological features of rosacea in Changsha, China: A population-based, cross-sectional study. J Dermatol. 2020 Mar 24;: Authors: Li J, Wang B, Deng Y, Shi W, Jian D, Liu F, Huang Y, Tang Y, Zhao Z, Huang X, Li J, Xie H Abstract Rosacea is a common chronic skin disorder of unknown etiology. While population prevalence rates range 0.2-22% in Europe and North America, prevalence in China is currently undetermined. We conducted a large population-based case-control study to determine the present epidemiological status of rosacea in China, involving 10 095 participants aged 0-100 years (mean age, 35.5 ± 19.1; 50.5% female). A census of rosacea among 15 communities in Changsha in south central China was conducted with skin examination by board-certified dermatologists. Rosacea was observed in 3.48% (95% confidence interval, 3.13-3.85%) of the study population. Subtype distribution was erythematotelangiectatic in 47.6%, papulopustular in 35.0% and phymatous in 17.4%. Family history was noted in 37.8% and ocular symptoms in 31.3%. Associations with rosacea were observed for melasma, hypertension, hyperthyroidism and breast cancer in females (P < 0.05), and also for hyperthyroidism and peptic ulcers in males (P < 0.05). Our results provide baseline information about epidemiological aspects of rosacea in China. PMID: 32207167 [PubMed - as supplied by publisher] {url} = URL to article
    • Yes, because its all about immune system and HCQ does modulate the immune system in various ways and regulate the overactivity of immune system in some conditions. Not only does it work in getting rid of symptoms but it actually works behind the disease cause.
    • The president announced on March 19, 2020 that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19.  Virus has never been ruled out in rosacea.  CNN has a followup report on this.  There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him.  Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea?  If you do take hydroxycholoroquine and your rosacea improves, please let us know.
    • Related Articles Rosacea is Characterized by a Profoundly Diminished Skin Barrier. J Invest Dermatol. 2020 Mar 18;: Authors: Medgyesi B, Dajnoki Z, Béke G, Gáspár K, Szabó IL, Janka EA, Póliska S, Hendrik Z, Méhes G, Törőcsik D, Bíró T, Kapitány A, Szegedi A Abstract Rosacea is a common, chronic inflammation of sebaceous gland-rich facial skin characterized by severe skin dryness, elevated pH, transepidermal water loss, and decreased hydration levels. Until now, there has been no thorough molecular analysis of permeability barrier alterations in the skin of rosacea patients. Thus, we aimed to investigate the barrier alterations in papulopustular rosacea (PPR) samples compared to healthy sebaceous gland-rich (SGR) skin, using RNASeq analysis (n=8). Pathway analyses by Cytoscape ClueGo revealed 15 significantly enriched pathways related to skin barrier formation. RT-PCR and immunohistochemistry were used to validate the pathway analyses. The results showed significant alterations in barrier components in PPR samples compared to SGR, including the cornified envelope and intercellular lipid lamellae formation, desmosome and tight junction organizations, barrier alarmins, and antimicrobial peptides. Moreover, the barrier damage in PPR was unexpectedly similar to atopic dermatitis (AD); this similarity was confirmed by immunofluorescent staining. In summary, besides the well-known dysregulation of immunological, vascular, and neurological functions, we demonstrated prominent permeability barrier alterations in PPR at the molecular level, which highlight the importance of barrier repair therapies for rosacea. PMID: 32199994 [PubMed - as supplied by publisher] {url} = URL to article
    • "Webster et al. report a multicentre, randomized, double‐masked, parallel‐group, vehicle‐controlled study to evaluate the safety and efficacy of minocycline gel 1% and 3%. Topical minocycline had insignificant systemic absorption but produced significant reductions in mean inflammatory lesion counts with both the 1% and 3% concentrations. The response rate in the vehicle group was quite high, as is often the case in diseases with fluctuating inflammation. However, the 3% concentration of minocycline showed a significantly greater proportion of patients achieving Investigator's Global Assessment success at week 12 compared with vehicle. A topical minocycline foam formulation is in development, and this may provide a further useful option for treating papulopustular rosacea. How topical minocycline compares with other topical rosacea treatments is as yet unclear." Br J Dermatol. 2020 Mar 18;: Expanding treatment options for rosacea. Hampton PJ
    • Related Articles Expanding treatment options for rosacea. Br J Dermatol. 2020 Mar 18;: Authors: Hampton PJ PMID: 32189331 [PubMed - as supplied by publisher] {url} = URL to article Full Text
    • Related Articles Value of reflectance confocal microscopy for the monitoring of rosacea during treatment with topical ivermectin. J Dermatolog Treat. 2020 Mar 19;:1-9 Authors: Logger JGM, Peppelman M, van Erp PEJ, de Jong EMGJ, Nguyen KP, Driessen RJB Abstract Background: Reflectance confocal microscopy (RCM) enables noninvasive Demodex mite detection in rosacea. Objective scoring of rosacea severity is currently lacking.Objectives: To determine the value of RCM for monitoring Demodex, inflammation and vascular parameters in rosacea during treatment.Methods: In 20 rosacea patients, clinical and RCM examination were performed before, during, and 12 weeks after a 16-week treatment course with topical ivermectin. Using RCM, number of mites and inflammatory cells, epidermal thickness, and vascular density and diameter were measured. RCM features were correlated with clinical assessment.Results: Treatment resulted in clinical reduction of inflammatory lesions. Mites were detected in 80% of patients at baseline, 30% at week 16, and 63% at week 28. The number of mites reduced significantly during treatment, but no changes in inflammatory cells, epidermal thickness or vascular parameters were observed. Correlation between number of inflammatory lesions and mites was low. None of the RCM variables were significant predictors for clinical success.Conclusions: RCM enables anti-inflammatory effect monitoring of topical ivermectin by determining mite presence. Quantifying exact mite number, and inflammatory and vascular characteristics is challenging due to device limitations. In its current form, RCM seems of limited value for noninvasive follow-up of rosacea in clinical practice. PMID: 32189533 [PubMed - as supplied by publisher] {url} = URL to article
    • The president announced today that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19. As mentioned in the initial post in this thread, virus has never been ruled out in rosacea. CNN has a followup report on this.  There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him.  Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea?  If you do take hydroxycholoroquine and your rosacea improves, please let us know.
    • "In this case report, we detail the response of a 37-year-old Caucasian man with an overlap of erythematotelangiectatic rosacea and telangiectatic photoaging to brimonidine tartrate gel. With the application of brimonidine only on half of his face, skin analysis images, clinician's and patient's assessment showed that there was significant improvement in the erythema. This case has lent insight into how brimonidine can be used to assess the extent of photoaging by eliminating the erythema of rosacea to some degree. We propose that it can be used as a non-invasive test to differentiate between the two conditions, sparing patients from skin biopsies and molecular analysis." Australas J Dermatol. 2017 Feb;58(1):63-64. doi: 10.1111/ajd.12430. Epub 2016 Jan 13. Rosacea or photodamaged skin? Use of brimonidine gel in differentiating erythema in the two conditions. Oon HH, Lim ZV.
    • Telangiectatic Photoaging  "Telangiectatic photoaging is characterized by less transient and nontransient erythema, a more lateral distribution of erythema and telangiectasia, less neurogenic mast cell activation, and less MMP-mediated matrix remodeling than ETR. These data demonstrate that TP is a distinct clinical entity from ETR that can be distinguished on the basis of clinical, histologic, and gene expression findings." JAMA Dermatol. 2015;151(8):825-836. doi:10.1001/jamadermatol.2014.4728 Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging Yolanda R. Helfrich, MD; Lisa E. Maier, MD; Yilei Cui, PhD; et al JAMA Dermatol. 2015 Aug;151(8):825-36. doi: 10.1001/jamadermatol.2014.4728. Clinical, Histologic, and Molecular Analysis of Differences Between Erythematotelangiectatic Rosacea and Telangiectatic Photoaging. Helfrich YR, Maier LE, Cui Y, Fisher GJ, Chubb H, Fligiel S, Sachs D, Varani J, Voorhees J. JK Wilkin has a comment on the above article published in JAMA and another in the NEJM. 
    • Related Articles Identification of Long Noncoding RNA Associated ceRNA Networks in Rosacea. Biomed Res Int. 2020;2020:9705950 Authors: Wang L, Lu R, Wang Y, Wang X, Hao D, Wen X, Li Y, Zeng M, Jiang X Abstract Rosacea is a chronic and relapsing inflammatory cutaneous disorder with highly variable prevalence worldwide that adversely affects the health of patients and their quality of life. However, the molecular characterization of each rosacea subtype is still unclear. Furthermore, little is known about the role of long noncoding RNAs (lncRNAs) in the pathogenesis or regulatory processes of this disorder. In the current study, we established lncRNA-mRNA coexpression networks for three rosacea subtypes (erythematotelangiectatic, papulopustular, and phymatous) and performed their functional enrichment analyses using Gene Onotology, KEGG, GSEA, and WGCNA. Compared to the control group, 13 differentially expressed lncRNAs and 525 differentially expressed mRNAs were identified in the three rosacea subtypes. The differentially expressed genes identified were enriched in four signaling pathways and the GO terms found were associated with leukocyte migration. In addition, we found nine differentially expressed lncRNAs in all three rosacea subtype-related networks, including NEAT1 and HOTAIR, which may play important roles in the pathology of rosacea. Our study provided novel insights into lncRNA-mRNA coexpression networks to discover the molecular mechanisms involved in rosacea development that can be used as future targets of rosacea diagnosis, prevention, and treatment. PMID: 32185228 [PubMed - in process] {url} = URL to article Full Article (if anyone can make heads or tails of this article it would be much appreciated if someone could translate this paper into layman's language)  Please comment on this by clicking the green REPLY button.  In the abstract paragraph above it mentions 'NEAT1 and HOTAIR, which may play important roles in the pathology of rosacea.' If you look at the diagram above at the top of the post you can find NEAT1 near the center of the diagram in red and HOTAIR just below NEAT1 to the right in blue. That probably helped you out a lot, didn't it? Just trying to helpful. 
    • image courtesy of Wikimedia Commons                             Related Articles Distinguishing rosacea from sensitive skin by reflectance confocal microscopy. Skin Res Technol. 2020 Mar 16;: Authors: Ma Y, Li L, Chen J, Chen T, Yuan C Abstract BACKGROUND: The updated standard classification and pathophysiology of rosacea have provided clear and meaningful evaluation parameters; however, differentiating rosacea from sensitive skin (SS) remained an obstacle for dermatologists around the world, especially in China. Herein, we aimed to find a better characteristic to distinguish rosacea from SS by using reflectance confocal microscopy (RCM). METHOD: Forty rosacea patients and 143 healthy subjects were recruited in this study. Firstly, a SS questionnaire and a lactic acid sting test were conducted among healthy subjects. Next, two major groups were divided out, including a SS group (40 subjects) and a normal skin control group (NS, 60 subjects). The cutaneous structures of face and fossa cubitalia were imaged by RCM. RESULTS: We found that more parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae (P < .05) in rosacea patients than that of the NS group, whereas there were no significant differences, were found in rosacea patients and the SS group. Strikingly, we found that rosacea patients have a larger depth of honeycomb pattern than that of SS subjects (P < .05). But, the epidermal thickness of rosacea did not differ from that of SS groups. There was also no significant difference of epidermal thickness and honeycomb structure depth between rosacea patients and NS group. CONCLUSION: From the RCM images of parakeratosis, honeycomb pattern, spongiform edema, and dermal papillae, we found that RCM might be a faithful tool to distinguish rosacea from NS group. The depth of honeycomb structure of SS was more superficial than rosacea patients, whereas no significant difference between rosacea patients and NS group. RCM may provide a new method for evaluating the development of rosacea although it failed to distinguish rosacea and SS effectively. PMID: 32180258 [PubMed - as supplied by publisher] {url} = URL to article What is reflectance confocal microscopy?
    • Rosa canina image courtesy of Wikimedia Commons Related Articles Molecular mechanism of the anti-diabetic activity of an identified oligosaccharide from Rosa canina. Res Pharm Sci. 2020 Feb;15(1):36-47 Authors: Bahrami G, Miraghaee SS, Mohammadi B, Bahrami MT, Taheripak G, Keshavarzi S, Babaei A, Sajadimajd S, Hatami R Abstract Background and purpose: Because of the high prevalence, diabetes is considered a global health threat. Hence, the need for effective, cheap, and comfortable therapies are highly felt. In previous study, a novel oligosaccharide with strong anti-diabetic activity in the crude extract of Rosa canina fruits, from the rosacea family, was identified. The present study was designed to ensure its efficacy using in vivo and in vitro studies. Experimental approach: Crude extract and its purified oligosaccharide were prepared from corresponding herb. Adult male Wistar rats were randomly divided into four groups of 10 each, as follows: group 1, healthy control rats given only sterile normal saline; group 2, diabetic control rats received sterile normal saline; group 3, diabetic rats treated with crude extract of Rosa canina (40% w/v) by oral gavage for 8 weeks; group 4, diabetic rats treated with purified oligosaccharide of Rosa canina (2 mg/kg) by oral gavage for 8 weeks. After treatment, body weight, fasting blood glucose, serum insulin levels and islet beta-cell repair and proliferation were investigated. The possible cytoprotective action of oligosaccharide was evaluated in vitro. The effect of oligosaccharide on apoptosis and insulin secretion in cell culture media were examined. Real-time PCR was used to determine the expression level of some glucose metabolism-related regulator genes. Findings / Results: In the animal model of diabetes, the insulin levels were increased significantly due to the regeneration of beta-cells in the islands of langerhans by the purified oligosaccharide. In vitro cell apoptosis examination showed that high concentration of oligosaccharide increased cell death, while at low concentration protected cells from streptozotocin-induced apoptosis. Molecular study showed that the expression of Ins1 and Pdx1 insulin production genes were increased, leading to increased expression of insulin-dependent genes such as Gck and Ptp1b. On the other hand, the expression of the Slc2a2 gene, which is related to the glucose transporter 2, was significantly reduced due to insulin concentrations. Conclusion and implications: The purified oligosaccharide from Rosa canina was a reliable anti-diabetic agent, which acted by increasing insulin production in beta-cells of the islands of Langerhans. PMID: 32180815 [PubMed] {url} = URL to article
    • "Using isotretinoin for 1-2mg/kg/day for 3-4 months produces 60%-95% clearance of inflammatory lesions in patients with acne. Doses as low as 0.1mg/kg/day have also proven successful in the clearance of lesions. Encouraging results have also been seen in small numbers of patients with rosacea, Side effects affecting the mucocutaneous system and raised serum triglyceride levels occur in most patients receiving isotretinoin." Profiles Drug Subst Excip Relat Methodol. 2020;45:119-157 Isotretinoin. Khalil NY, Darwish IA, Al-Qahtani AA
    • Related Articles Isotretinoin. Profiles Drug Subst Excip Relat Methodol. 2020;45:119-157 Authors: Khalil NY, Darwish IA, Al-Qahtani AA Abstract Isotretinoin is chemically named as: (2Z, 4E, 6E, 8E)-3,7-Dimethyl-9-(2,6,6-trimethylcyclohex-1-enyl)nona-2,4,6,8-tetraenoic acid. It is an orally active retinoic acid derivative for the treatment of severe refractory nodulocystic acne. It acts primarily by reducing sebaceous gland size and sebum production, and as a result alters skin surface lipid composition. Using isotretinoin for 1-2mg/kg/day for 3-4 months produces 60%-95% clearance of inflammatory lesions in patients with acne. Doses as low as 0.1mg/kg/day have also proven successful in the clearance of lesions. Encouraging results have also been seen in small numbers of patients with rosacea, Side effects affecting the mucocutaneous system and raised serum triglyceride levels occur in most patients receiving isotretinoin. Isotretinoin is strictly contraindicated in women of childbearing potential. This profile discusses and explains names of isotretinoin, its physical and chemical characteristics. It also includes methods of preparation, thermal and spectral behavior, methods of analysis, and pharmacology. PMID: 32164966 [PubMed - in process] {url} = URL to article
    • Staphylococcus epidermidis image courtesy of Wikimedia Commons Bacteria has been implicated and investigated as the leading microbe associated with rosacea for over sixty years. Antibiotics have been prescribed for rosacea, particularly tetracycline and more recently with doxycycline, along with many other antibiotics, which leads to the bacteria theory on the cause of rosacea. There has been a bias in most, if not all, the clinical papers investigating the skin microbiome in rosacea patients ignoring other microbes, i.e., virus, archea, fungus, protozoa.  Demodex mites have been the other most investigated microbe of the skin microbiome with a vast number of clinical papers. A typical paper indicating this bias towards chiefly investigating bacteria and demodex is the following conclusion on this subject: "Although we were not able to pinpoint a causative microbiota, our study provides a glimpse into the skin microbiota in rosacea and its modulation by systemic antibiotics.'  J Clin Med. 2020 Jan; 9(1): 185. Published online 2020 Jan 9. doi: 10.3390/jcm9010185 PMCID: PMC7019287 PMID: 31936625 Characterization and Analysis of the Skin Microbiota in Rosacea: Impact of Systemic Antibiotics Yu Ri Woo, Se Hoon Lee, Sang Hyun Cho, Jeong Deuk Lee, and Hei Sung Kim The above paper only investigated bacteria and mentions demodex and ignores all other microbes of the skin microbiota.  Microorganisms of the Human Microbiome
    • image courtesy of Pinterest Odd that a rosacea plant would have natural antibacterial properties. The photo above is one of Pyrus glabra while the one below is Pyrus syriaca: image courtesy of Wikimedia commons
    • Topical ivermectin has been found effective in the treatment of T‐cell‐mediated skin inflammatory diseases. For more information. 
    • "Altogether, our results show that IVM is endowed with topical anti‐inflammatory properties that could have important applications for the treatment of T‐cell‐mediated skin inflammatory diseases." Topical ivermectin improves allergic skin inflammation E. Ventre  A. Rozières  V. Lenief  F. Albert  P. Rossio  L. Laoubi  D. Dombrowicz  B. Staels  L. Ulmann  V. Julia  E. Vial  A. Jomard  F. Hacini‐Rachinel  J.‐F. Nicolas  M. Vocanson
    • Related Articles Fatty acid profile and in vitro biological properties of two Rosacea species (Pyrus glabra and Pyrus syriaca), grown as wild in Iran. Food Sci Nutr. 2020 Feb;8(2):841-848 Authors: Hazrati S, Govahi M, Mollaei S Abstract The high demands for the consumption of edible oils have caused scientists to struggle in assessing wild plants as a new source of seed oils. Therefore, in this study, the oil yield, fatty acid and tocopherol compositions, antioxidant and antibacterial activities of the oils obtained from Iran's two endemic plants (Pyrus glabra and Pyrus syriaca) were investigated. The obtained oil yields from the P. glabra and P. syriaca seeds were 33 ± 0.51 and 26 ± 0.28 w/w%, respectively. Oleic acid (C18:1) with the amount of 49.51 ± 1.05% was the major fatty acid in the P. glabra oil, while the main fatty acids in the P. syriaca seed oil belonged to linoleic acid (C18:2) and oleic acid (C18:1) with the amounts of 46.99 ± 0.37 and 41.43 ± 0.23%, respectively. The analysis of tocopherols was done by HPLC, and the results indicated that the P. glabra and P. syriaca seed oils were rich in α-tocopherol (69.80 ± 1.91 and 45.50 ± 1.86 mg/100 g oil, respectively), constituting 86.24 and 89.01% of total detected tocopherols, respectively. The study on the reducing capacity of the oils indicated that the P. glabra oil had more reducing capacity than the P. syriaca oil. Moreover, the antioxidant activity of the P. glabra seed oil (43.4 ± 0.7 µg/ml) was higher than the P. syriaca seed oil (46.3 ± 1.2 µg/ml). Also, the investigation of the antibacterial activities indicated that the P. glabra and P. syriaca oils have an inhibitory effect on the studied bacteria. The results indicate that the oils of these plants can be appropriate sources of plant oils which can act as natural antibacterial agents. PMID: 32148793 [PubMed] {url} = URL to article
    • For a long time microorganisms of the skin microbiome have been suggested as a cause of rosacea. The list includes, bacteria, virus, and demodex mites. Further, there are some papers that suggest that the gut microbiome may be involved in rosacea. Microorganisms of the Human Microbiome "Antiparasitics are a class of medications which are indicated for the treatment of parasitic diseases, such as those caused by helminths, amoeba, ectoparasites, parasitic fungi, and protozoa, among others." Wikipedia "Broad-Spectrum antiparasitics, analogous to broad-spectrum antibiotics for bacteria, are antiparasitic drugs with efficacy in treating a wide range of parasitic infections caused by parasites from different classes." Wikipedia Prescription Antinematodes include ivermectin.  Prescription Antiprotozoals include metronidazole (also used for its anti-inflammatory effect),  mepacrine, artemisinin, chloroquine, hydroxychloroquine, tinidazole, ornidazole, and secnidazole.  Other prescription anti-parasitic drug therapies are Anticestodes, Antitrematodes, Antiamoebics, AntiFungals, and new drug therapies such as "triazolopyrimidines and their metal complexes have been looked at as an alternative drug to the existing commercial antimonials.' Wikipedia
    • Oshea Herbals is one of the topmost skincare companies, which produces effective and skin-friendly D-Tan Face Packs. However, if you are facing skin-problems then do buy this face pack and treat your problems.
    • Does anyone have any experience of doing chemical exfoliation on rosacea skin? Chemical exfoliation is very good for skin once in a while but what about rosacea skin?      
    • Thanks BlackMamba24 for the update and so happy for you!
    • Related Articles Severe rosacea in a child. J Fr Ophtalmol. 2020 Mar 02;: Authors: Tijani M, Albaroudi N, Boutimzine N, Cherkaoui O PMID: 32139082 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Granulosis rubra nasi seen through the dermatoscope. JAAD Case Rep. 2020 Mar;6(3):234-236 Authors: Palit A, Sethy M, Nayak AK, Ayyanar P, Behera B PMID: 32140525 [PubMed] {url} = URL to article
    • Related Articles Pulsed Dye Laser Alone Versus Its Combination With Topical Ivermectin 1% In Treatment of Rosacea: A Randomized Comparative Study. J Dermatolog Treat. 2020 Mar 06;:1-22 Authors: Osman MA, Shokeir HA, Hassan AM, Kahlifa MA Abstract Background While the aetiology of rosacea is multifactorial, it is not surprising that treatment has been controversial. Pulsed dye laser (PDL) has been successfully used to treat vascular components of rosacea. Ivermectin 1% cream is an emerging treatment of rosacea.Objective To provide a comprehensive clinical and dermatoscopic comparative study between the efficacy and safety of pulsed dye laser alone versus its combination with topical ivermectin 1% in the treatment of rosacea.Materials and methods Thirty Patients were randomly divided into two groups. Group A (n = 15) treated with 585 nm PDL, and group B (n = 15) treated with 585 nm PDL and topical ivermectin 1% cream. All patients received four laser treatments with a 4-week interval. The efficacy of treatment was assessed by photographs and dermoscopic photomicrographs at baseline and 3 months after the final treatment. The patient's level of satisfaction was also recorded.Results At the 3-month follow-up, group B induced better clinical improvement than group A. However, this difference was not significant. No serious adverse events were observed in either treatment group.Conclusion This study supports the efficacy of PDL treatment for patients with rosacea. PDL could be more effective when combined with ivermectin 1% cream. PMID: 32141785 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles [THE ROLE OF HELICOBACTER PYLORI IN ROSACEA AND PATHOGENETIC TREATMENT]. Georgian Med News. 2020 Jan;(298):109-112 Authors: Beridze L, Ebanoidze T, Katsitadze T, Korsantia N, Zosidze N, Grdzelidze N Abstract Rosacea is a chronic, recurrent skin disease. It may be aggravated by various factors. An increased incidence of rosacea has been reported in those who carry the stomach bacterium Helicobacter pylori. The purpose of this study was determination of the relationship of this infection with rosacea and to investigate effectiveness of eradication therapy of H. pylori. As our results showed, 80.9% of study patients were infected with H. pillory. There was correlation between infection rates and rosacea severity. In most cases the positive test results for H. Pylori was found in patients with moderate to severe form of disease. The results of the treatment of different forms of rosacea confirmed the effectiveness of the eradication therapy of H. Pylori, regarding as one of the pathogenic cause of rosacea and the way in the choice of treatment. More wide studies of pathophysiological aspects of causes of rosacea will be promising and help in treating rosacea. These data indicate the important role of H.Pylori in the development of rosacea and recommend taking into account in the therapy of this dermatosis. PMID: 32141861 [PubMed - as supplied by publisher] {url} = URL to article
    • Hi Brady, I wanted to check back in with an update. I have to tell you, things have improved over the last week. I credit the improvement to ZZ Cream. It's really starting to make a significant difference and I'm grateful to you as this is where I learned about it. I started with ZZ Cream (the gold original bottle) in late January that I ordered on Amazon UK. It wasn't immediately successful. In fact, there were some very depressing days. In mid-February, I had a dermatolgist appointment. You were right, my doctor wasn't overly supportive, however, he is kind and he understood why I was searching forums and ordering things from China. He recommended at that appointment that I take his advice and start using Accutane (he had already recommended this course). This was not what I wanted, but in mid-February my skin was not good, despite having used ZZ Cream for about three weeks. I strongly considered stopping the ZZ Cream and starting Accutane. I decided to give it another week to finish the first bottle. I was really at a crossroads - planning which day I was going to get bloodwork to start the Accutane. The first bottle lasted me about one month and nothing really changed. My doctor said he thought using Accutane, which is highly regulated by the FDA, might actually be safer than ZZ cream, which comes from out of the country without regulations. It was a fair point and since it wasn't working, I nearly stopped. But on Feb. 24, one week after my appointment, I received a second order of ZZ Cream that I had ordered in early February when I was worried the first little bottle wouldn't last. That order was made on eBay. The weekend before the 24th, I was contemplating when I would get my bloodwork. After some sleepless nights, I decided that since I had already bought the second ZZ cream, I would keep going. I had read on a different forum that it can take as long as one year to fully work, so I figured Accutane would be there if this second bottle didn't work. Anyway, long story short, the second black bottle seemed to make an immediate difference. I noticed last weekend (about six days after starting bottle No. 2) things had improved. I woke up today (12 days after starting the second bottle) and my skin looked better than it had since I used Bactrim back in November! Like my pre-Rosacea days almost!  I did notice tonight I have a little bump in between my eyebrows, which is a place I never use the ZZ cream. But my skin is so much better. I just wanted to share how it's going and thank you. I know it's long way from over and I have to just keep using the cream. I've already ordered a third bottle. I was a little concerned that with coronavirus they might not allow shipments, or something might be off with the production. But fingers crossed this good fortune will continue and my next shipment will arrive! I will say, I cut back on sugar dramatically, and tried to minimize carbohydrates as much as possible, especially later in the day. But I never fully cut sugar and went to 30g of carbs. Hoping I won't have to go that route as that is extremely difficult, but all options still under consideration as I battle this ugly disease! Thanks again for your wisdom. I do appreciate what I learned on the forum.
    • image courtesy of the CDC Sugar is just as much a valid rosacea trigger as any of the other proposed rosacea triggers since Sugar = Rosacea Fire. You will not learn that sugar is a rosacea trigger from any other rosacea non profit organization because the RRDi is the only one that lists sugar as a rosacea trigger. This post will help you understand how you can figure out better what added sugar is in the processed food or drink you might consume to see how much sugar you are allowing in your diet.  We reported in 2015 how the FDA was considering make a a change on the nutrition facts label about how many grams of added sugar is in a food or drink (the eighth post in this thread dated Posted July 25, 2015). The FDA did change the Nutrition Facts Label to show added sugar with this announcement in October 2018 that allows certain manufacturers until 2021 to comply with the change. While there are six new differences in the label, item number 3 is about added sugar and note what the FDA states about this: "3. Added sugars are now listed to help you know how much you are consuming. The 2015-2020 Dietary Guidelines for Americans recommends you consume less than 10 percent of calories per day from added sugars. That is because it is difficult to get the nutrients you need for good health while staying within calorie limits if you consume more than 10 percent of your total daily calories from added sugar." October 2018 announcement Healthline had this to say about the above label change: "Before this label change, different types of sugars were lumped into a total sugars category on the Nutrition Facts label. For example, many fruit yogurts contain sugars from three sources: lactose from milk, natural sugars from fruit, and added sugars. All of these were tallied as one figure under total sugars. The new labels will distinguish added sugars to help people understand exactly how much they’re eating, which shouldn’t be more than 10 percent of their daily calories, according to the FDA’s dietary guidelines." New Nutrition Labels Reveal How Much Added Sugar You’re Eating, Healthline, November 2, 2018 WebMD had this to say about the label change: "It can be tough to recognize added sugars by looking at the list of ingredients on a label, the U.S. Centers for Disease Control and Prevention says. Brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, molasses, raw sugar and sucrose are just some of the many different ingredients that contribute added sugars to food, the CDC notes. To make things simpler for consumers, the FDA proposed a new line on the Nutrition Facts label that totals up all these sources of added sugar." 'Added Sugars' Label on Foods May Save Many Lives, Dennis Thompson, WebMD Later, the FDA allows manufacturers of certain "single-ingredient sugars and syrups and certain cranberry products' that "allow for the use of a “†” symbol immediately following the percent Daily Value declaration for Added Sugars, which leads consumers to a statement that provides information about the gram amount of Added Sugars, as well as information about how that amount of sugar contributes to the percent Daily Value." Statement on new guidance for the declaration of added sugars on food labels for single-ingredient sugars and syrups and certain cranberry products, Susan T. Mayne Ph.D., Director - Center for Food Safety and Applied Nutrition (CFSAN) The CDC has this to say about the amount of added sugar you should consume each day:  "Americans should keep their intake of added sugars to less than 10% of their total daily calories as part of a healthy diet. For example, in a 2,000 daily calorie diet no more than 200 calories should come from added sugars." Know Your Limit for Added Sugars To convert calories to grams you should remember that there are 4 calories in one gram of carbohydrate. So the above recommendation from the CDC which is based upon the new FDA recommendation means that 10% of added sugar amounts to 50 grams of carbohydrate. Sugar is carbohydrate. Further, the added sugar is just what the label is pointing out to you besides the natural sugar or carbohydrate in the food or drink your are consuming. So if you look at the new label at the top of this post the TOTAL carbohydrate (sugar) contained in the item is 37 grams. Of that 37 grams there is included 10 grams of added sugar. In other words, if the product didn't add the 10 grams of sugar the food item still has 27 grams of carbohydrate (sugar).  If you want to learn for your self whether reducing sugar (carbohydrate) in your diet improves your rosacea, looking at the Nutrition Facts Label can be an eye opener for many who are not aware how much carbohydrate (sugar) is in the diet. A simple test to discover that sugar (carbohydrate) is a rosacea trigger for you, reduce the amount of sugar (carbohydrate) in your diet to no more than 30 grams a day for 30 days. During this test you should see some improvement in your rosacea within the thirty days. After the thirty days, gorge yourself with all the sugar and carbohydrate you want and see if your rosacea comes back? That is the basic nutshell version of the Rosacea Diet. This post on the new label requirements for added sugar makes it easier for you to spot added sugar.  The New York Times had this to say about added sugar: "While you might think you’re not eating much sugar, chances are you’re eating a lot more than you realize. Added sugar lurks in nearly 70 percent of packaged foods and is found in breads, health foods, snacks, yogurts, most breakfast foods and sauces. The average American eats about 17 teaspoons of added sugar a day (not counting the sugars that occur naturally in foods like fruit or dairy products). That’s about double the recommended limit for men (nine teaspoons) and triple the limit for women (six teaspoons). For children, the limit should be about three teaspoons of added sugar and no more than six, depending on age and caloric needs." Make 2020 the Year of Less Sugar, Tara Parker-Pope, The New York Times, December 31, 2019 The above article also included a seven day challenge.  There was a follow up article on the above article which added:  "As an example, take a look at the label on whole milk, which shows 11 grams of sugar in a one-cup serving. That sounds like a lot, but the new label will make it clear that all that sugar occurs naturally as lactose and that the same cup of milk has zero grams of added sugar. A chocolate milk label will show 26 grams of total sugar, which includes 11 grams of lactose, and the extra information that a serving has 15 grams of added sugar."  Dried Fruit, Oats and Coffee: Answers to Your Sugar Questions Our 7-Day Sugar Challenge prompted a number of questions about cutting added sugar from our daily diet. Tara Parker-Pope, The New York Times, Jan. 8, 2020    
    • Related Articles Skincare Habits and Rosacea in 3,439 Chinese Adolescents: A University-based Cross-sectional Study. Acta Derm Venereol. 2020 Mar 04;: Authors: Zuo Z, Wang B, Shen M, Xie H, Li J, Chen X, Zhang Y Abstract The pathogenesis of rosacea remains unclear but has been reported to correlate with skin barrier function. The objective of this study was to elucidate the skincare habits of Chinese adolescents and determine the relationship between skincare habits and rosacea. A university-based cross-sectional investigation included 310 rosacea cases and 3,129 healthy controls who underwent health examinations and completed a questionnaire about daily skincare habits. Fitzpatrick skin phototype IV is a protective factor against rosacea (adjusted adds ratio (aOR) 0.40; 95% confidence interval (CI) 0.22-0.72). Long bath duration (≥ 11 min, aOR 2.60; 95% CI 1.01-6.72) and frequent use of facial cleansers (≥ 2 times/day, aOR 1.70; 95% CI 1.17-2.36) were positively associated with rosacea, but bath frequency (p = 0.22), water temperature (p = 0.53), and sun protection (p = 0.65) were not associated with rosacea. Inappropriate skincare habits, including extended bath durations and frequent use of facial cleansers, significantly increase the risk of rosacea in Chinese adolescents. PMID: 32128599 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Thumbnail-squeezing method: an effective method for assessing Demodex density in rosacea. J Eur Acad Dermatol Venereol. 2020 Mar 03;: Authors: Huang HP, Hsu CK, Yu-Yun Lee J Abstract D. folliculorum, and D. brevis are human ectoparasites living in hair follicles and sebaceous glands of the skin, respectively, and most commonly on the face. They are normal flora, but D. folliculorum can cause disease when it proliferates excessively or penetrates the dermis. Increased densities of Demodex have been reported in rosacea-by reflectance confocal microscopy (RCM), two consecutive SSSB (2-SSSB)7 and a superficial needle-scraping method. PMID: 32124497 [PubMed - as supplied by publisher] {url} = URL to article Demodex Density Count - What are the Numbers?
    • While the above study admitted the limit of a small sample size, as well as, 'The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation,' it doesn't mention that Light Microscopy Skin Scraping is Not as Reliable as 'Confocal laser scanning in vivo microscopy' which is more reliable. See item one in this post. What it does conclude is demodex mites are indeed in higher density in rosacea patients over the control group.  Demodex Density Count - What are the Numbers?  
    • Related Articles Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis. An Bras Dermatol. 2020 Feb 12;: Authors: Aktaş Karabay E, Aksu Çerman A Abstract BACKGROUND: Demodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. OBJECTIVE: To investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. METHODS: This prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. RESULTS: In terms of gender and age, no significant difference was found between the patients and controls (p>0.05). Demodex infestation rates were significantly higher in patients than in controls (p=0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p=0.001; p=0.024; p=0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p=0.001 and p=0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p=0.294). STUDY LIMITATIONS: Small sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. CONCLUSION: The findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation. PMID: 32113677 [PubMed - as supplied by publisher] {url} = URL to article
    • "Oral ivermectin (200 micrograms/kg/day) is also a treatment alternative for PPR although it is supported with level D evidence. In patients with treatment resistant rosacea, combination of oral ivermectin and permethrin 5% cream can be considered since this combination was found to be effective in decreasing demodex density in immunocompromised patients as well." Clin Cosmet Investig Dermatol. 2020; 13: 179–186. Published online 2020 Feb 20. doi: 10.2147/CCID.S194074 PMCID: PMC7039055 PMID: 32110082 Conventional and Novel Treatment Modalities in Rosacea Burhan Engin, Defne Özkoca, Zekayi Kutlubay, and Server Serdaroğlu
    • The February 2020 issue of the Clinical, Cosmetic and Investigational Dermatology reports, "Therefore, in 2017, there was a shift from subtypes to phenotypes in the diagnosis of rosacea and at least one diagnostic or two major phenotypes are required in order to diagnose a patient with rosacea."
    • I have been noticing the fact that how all the factors come together in an interplay to cause any condition and how paying attention to the factors and working with them would relieve you from the symptoms. My yeast overgrowth was aggravating my flushing, my blood vessels had become very dilated and at one point my skin was a full dry land and I coincidentally conversed with Dr. O’Desky our MAC member and she understood the condition and asked me to do gut cleaning. I was already a little bit resolved with the condition but did gut cleaning and not only gut cleaning but I have had such foods which kept my gut pH alkaline and I was already washing my face and scalp with ketoconazole with zinc pyrithione lotion and now my skin is in good condition not only yeast overgrowth was reduced but my intense prolonged flushing is at bay, meaning very mild flushing and one more thing I have considered, the environmental factor. My skin has withstood the extremities of temperature frequency  this season. So I was on with my internal and external cure meanwhile when the favorable temperature stability came it automatically helped to get my skin breathe and respond to the cure. So I observed how gut microbiota and skin microbiota are in close connection with each other and not only skin microbiota but gut microbiota also reacts and responds to the environmental factors. So I concluded how skin microbiota overgrowth and then its stability was responding to gut and temperature changes and how in turn that yeast growth was controlling the already existing inflammation of the skin.
    • Related Articles Conventional and Novel Treatment Modalities in Rosacea. Clin Cosmet Investig Dermatol. 2020;13:179-186 Authors: Engin B, Özkoca D, Kutlubay Z, Serdaroğlu S Abstract Rosacea is a common skin disease that is troublesome for both the patients and the dermatologists. Erythema, telengiectasia, papulopustular changes and phymatous changes are the main problems faced by the patients and dermatologists in everyday practice. Due to the chronic and relapsing nature of the disease, patients are usually unsatisfied with conventional treatment methods. This article aims at redefining rosacea according to the 2017 consensus and reviewing the different treatment modalities for different manifestations of the disease in depth. PMID: 32110082 [PubMed - as supplied by publisher] {url} = URL to article [abstract] Full Article
    • Phenotype 4 used to be classified as Subtype 2 (Papules & Pustules), which looks similar to acne vulgaris with the exception that blackheads are not indicated in rosacea.  Papule, Pustule, Pimple, Comedo, Lesion, Cyst & Abscess Explained Treatment for Phenotype 4
    • "In this longitudinal cohort study of more than 82 000 participants with more than 1.1 million person-years of follow up, higher caffeine intake was associated with lower rosacea risk after adjustment for several confounders. Overall, participants who drank 4 cups of coffee per day were less likely to develop rosacea compared with participants who did not drink coffee. A dose-response association was found for both increasing caffeine and coffee intake. The authors hypothesized that caffeine’s vaso-constrictive and immune suppressive effects might decrease the risk of rosacea." Source JAMA Dermatol. 2018 Dec 1; 154(12): 1385–1386. doi: 10.1001/jamadermatol.2018.3300 PMCID: PMC6510488 NIHMSID: NIHMS1020506 PMID: 30347020 One More Reason to Continue Drinking Coffee–It May Be Good for Your Skin Mackenzie R. Wehner, MD, MPhil and Eleni Linos, MD, MPH, DrPH, 
    • image courtesy of Wikimedia Commons There is a hypothesis that the 'cross reaction between the GroEl chaperonin antibodies against the B.oleronius and human GroEl chaperonin' 'will not fold normally the ALDH2, and then the enzyme will not metabolize the acetaldehyde' and therefore, 'As a result, high amounts of acetaldehyde will circulate for longer time in the blood, until the liver CYP2E1(p450) enzyme system finally metabilizes the acetaldehyde, during that period of time the patients will experience a flushing as well as the people with the "Asian flushing syndrome" suffer when they drink ethanol.' Med Hypotheses, 84 (4), 408-12  Apr 2015 Hypothesis of Demodicidosis Rosacea Flushing Etiopathogenesis Mary Ann Robledo, Mariana Orduz
    • Flushing avoidance is one of the chief concerns of Phenotype 1 rosaceans. For more information. 
    • Related Articles Non-infectious granulomatous dermatoses. J Dtsch Dermatol Ges. 2019 May;17(5):518-533 Authors: Schmitt A, Volz A Abstract Granulomatous dermatoses comprise a wide range of etiologically and clinically distinct skin diseases that share a common histology characterized by the accumulation of histiocytes include macrophages. While the pathogenesis of these disorders is not fully understood, the underlying mechanism is thought to involve a reaction pattern caused by an immunogenic stimulus. Antigen-presenting cells and the effect of various cytokines play a key role. Our understanding of granulomatous reaction patterns has been advanced by insights drawn from observations of such reactions in patients on immunomodulatory therapy and in individuals with genetic immunodeficiency. Traditionally, a distinction is made between infectious and non-infectious granulomatous dermatoses. The present CME article addresses granulomatous skin diseases for which there is no evidence of a causative infectious agent. Common representatives include granuloma annulare, necrobiosis lipoidica and cutaneous sarcoidosis. Granulomatous dermatoses may be part of the clinical spectrum of various systemic disorders or may be associated therewith. Some neoplastic disorders may mimic granulomatous dermatoses histologically. Given the pathogenetic diversity involved, the clinical presentation, too, is quite varied. Overall, however, each disorder is characterized by typical clinical features. The diagnosis always requires thorough clinicopathologic correlation. Treatment is preferably based on the underlying pathogenesis and frequently involves anti-inflammatory agents. In most cases, however, there is insufficient study data. The dermal nature of these disorders frequently poses a therapeutic challenge, especially with respect to topical treatment. PMID: 31115996 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Ball-and-stick model of cromolyn molecule gif image courtesy of Wikimedia Commons "Cromolyn sodium or other MC stabilizers affect the release of histamine and other inflammatory mediators from MCs to ameliorate erythema in ETR. Drugs including brimonidine and BoNT can also reduce the recruitment of MCs and inhibit MC degranulation to improve inflammation associated with rosacea." Front Med (Lausanne). 2019; 6: 324. Published online 2020 Jan 28. doi: 10.3389/fmed.2019.00324 PMCID: PMC6997331 PMID: 32047752 The Theranostics Role of Mast Cells in the Pathophysiology of Rosacea Lian Wang, Yu-Jia Wang, Dan Hao, Xiang Wen, Dan Du, Gu He, and Xian Jiang
    • I Agree 100 percent. Mirvaso caused a permanent worsening of my rosacea — it took literally three years for it to return to somewhat worse than baseline. This stuff should be totally illegal and I am so angry at my GP for giving me a sample tube of it. It ruined my skin permanently. The people who market this **hit should be clobbered. 
    • Related Articles "Shedding Light" on How Ultraviolet Radiation Triggers Rosacea. J Invest Dermatol. 2020 Mar;140(3):521-523 Authors: McCoy WH Abstract Treating rosacea begins with avoiding its triggers. Though they vary among patients, UVR is regarded as a universal rosacea trigger. Until now, the mechanism underlying this pathology has resisted characterization. The work of Kulkarni and colleagues sheds light on how UVR causes rosacea inflammation. Their findings appear to apply to all rosacea subtypes and suggest new therapeutic strategies. PMID: 32087829 [PubMed - as supplied by publisher] {url} = URL to article
    • The Top 100 Most Cited Articles in Rosacea: A Bibliometric Analysis. J Eur Acad Dermatol Venereol. 2020 Feb 20;: Authors: Wang Y, Zhang H, Fang R, Tang K, Sun Q Abstract BACKGROUND: Many articles in rosacea have been published. Bibliometric analysis is helpful to determine the most influential studies in a specific field. OBJECTIVE: To identify the top 100 most cited articles in rosacea using the bibliometric analysis method. METHODS: We searched in the Web of Science database on November 20th, 2019. Articles were listed in descending order by their total citations. The top 100 most cited articles in rosacea were identified and analyzed. RESULTS: The top 100 most cited articles were published between 1971 and 2015. The largest number of articles were published in a single interval in 2011-2015. The average annual citations were constantly ascending, and the total citations were positively correlated with annual citations. The 100 articles were classified into different research focuses: treatment (35%), pathogenesis (27%), clinical features and diagnosis (14%), pathophysiology (6%), associated diseases (4%), epidemiology (3%) and others (11%). 19 articles were randomized controlled trials (RCT), 14 focused on the association between rosacea and Demodex, and five focused on the association between rosacea and Helicobacter pylori. 25 publications focused on a specific subtype of rosacea, mainly papulopustular and ocular rosacea. The 100 articles were published in 32 journals. 79 different first corresponding authors were from 20 different countries, mostly in North America and Europe. Steinhoff. M from University of California published the most articles as the corresponding author. CONCLUSIONS: This study identified the top 100 most cited articles in rosacea and analyzed their bibliometric characteristics, which may pave the way for further research. PMID: 32078196 [PubMed - as supplied by publisher] {url} = URL to article
    • I think he may have an oily skin and oily scalp so using warm to hot water helped him a lot and did not cause much problem but if one has a dry skin and dry scalp this technique would not work and dry out even more and would cause flakiness.
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