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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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    • Related Articles Role of serum 25-hydroxyvitamin D levels and vitamin D receptor gene polymorphisms in patients with rosacea: a case-control study. Clin Exp Dermatol. 2018 Sep 23;: Authors: Akdogan N, Alli N, Incel Uysal P, Candar T Abstract
      BACKGROUND: Vitamin D has significant effects on the immune system and thereby on the pathogenesis of rosacea. However, there is a lack of information on the vitamin D status and vitamin D receptors (VDRs) of patients with rosacea.
      AIM: To evaluate the role of vitamin D in rosacea susceptibility.
      METHODS: A case-control study was conducted, enrolling patients with rosacea and healthy controls (HCs). Five VDR gene single nucleotide polymorphisms (SNPs) (Cdx2, FokI, ApaI, BsmI and TaqI) and serum 25-hydroxyvitamin D3 [25(OH)D3 ] levels were compared between patients and HCs.
      RESULTS: The study enrolled 60 patients (M/F: 14/46) and 60 age- and sex-matched HCs (M/F: 14/46). Age (mean ± SD) was 48 ± 11 years for both groups. The serum 25(OH)D3 levels (median ± interquartile range) were higher in patients with rosacea (12.9 ± 6.8 ng/mL) than in HCs (10.5 ± 3.7 ng/mL) (P < 0.001). Subjects with high serum 25(OH)D3 levels had a 1.36-fold increased risk of rosacea (95% CI 1.17-1.58). Heterozygous and mutant ApaI polymorphisms increased rosacea risk by 5.26-fold (95% CI 1.51-18.35) and 3.69-fold (95% CI 1.19-11.48), respectively, whereas mutant TaqI polymorphisms decreased the risk by 4.69 times (95% CI 1.37-16.67). Heterozygosity for Cdx2 alleles increased rosacea risk, whereas wildtype ApaI and mutant TaqI alleles decreased it.
      CONCLUSIONS: The present study suggests that an increase in vitamin D levels may contribute to the development of rosacea. ApaI and TaqI polymorphisms, and heterozygous Cdx2, wildtype ApaI and mutant TaqI alleles were significantly associated with rosacea. These results indicate a possible role of vitamin D and VDR pathways in the pathogenesis of rosacea, although causality could not be assessed.
      PMID: 30246390 [PubMed - as supplied by publisher] {url} = URL to article
    • Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience. J Am Acad Dermatol. 2018 Sep 18;: Authors: Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC Abstract
      Among individuals with skin of color, rosacea has been reported less frequently than in those with white skin, but it is not a rare disease. In fact, rosacea may be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin, as well as underestimation of the susceptibility of more highly pigmented skin to dermatologic conditions like rosacea whose triggers include sun exposure. Many people with skin of color who have rosacea may experience delayed diagnosis leading to inappropriate or inadequate treatment, greater morbidity, and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. This paper reviews the epidemiology of rosacea in skin of color and highlights variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. It presents strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.
      PMID: 30240779 [PubMed - as supplied by publisher] {url} = URL to article
    • Full Text The four components of this treatment are: (1) Dextran sulfate is an anionic polymer of sulfated glucose [1] Dextran sulfate contains approximately 17% sulfur which is equivalent to approximately 2.3 sulfate groups per glucosyl residue. [2]  (2) 4-t-butylcyclohexanol  [BCH; TRP-regulin ®] [3] (3) pongamia oil [4] (4) hesperidin methyl chalcone [HMC] [5] Some of the products mentioned in the above post, "Avène redness-relief cosmetic products for sensitive skin prone to redness" are:  
      Eau Thermale Avène Antirougeurs Clean Redness-Relief Refreshing Cleansing Lotion
      Eau Thermale Avène Tolérance Extrême Emulsion
      Eau Thermale Avène Antirougeurs Calm Soothing Repair Mask
      Eau Thermale Avène Xeracalm A.D Lipid-Replenishing Cleansing Oil
      Eau Thermale Avène Skin Recovery Cream
      Eau Thermale Avène Cicalfate Restorative Skin Cream
      Eau Thermale Avène Extremely Gentle Cleanser Lotion
      Eau Thermale Avène Antirougeurs Dermo Cleansing Milk
      Eau Thermale Avène Antirougeurs Day Redness Relief Soothing SPF 25 Cream
      Eau Thermale Avène Antirougeurs Fort Relief Concentrate End Notes  [1] Dextran Sulfate, Sodium Salt (CAS 9011-18-1), Santa Cruz Biotechnology [2] Dextran Sulfate, Sigma Aldrich, Millipore Sigma [3] PubChem, Sigma Aldrich, ChemSpider, Paula's Choice, Safety Data Sheet, Effective treatment for sensitive skin: 4-t-butylcyclohexanol and licochalcone A [4] derived from the seeds of the Millettia pinnata tree [5] Paula's Choice, Truth in Aging, Douglas Laboratories, 
    • Effects of dextran sulfate, 4-t-butylcyclohexanol, pongamia oil and hesperidin methyl chalcone on inflammatory and vascular responses implicated in rosacea. Clin Cosmet Investig Dermatol. 2018;11:421-429 Authors: Hernandez-Pigeon H, Garidou L, Galliano MF, Delga H, Aries MF, Duplan H, Bessou-Touya S, Castex-Rizzi N Abstract
      Background: Rosacea is a chronic facial skin disorder characterized by inflammation and vascular abnormalities. The pathophysiology of rosacea involves increased activation of the capsaicin receptor, TRPV1, the vascular endothelial growth factor (VEGF) pathway, and cathelicidin LL-37, MMP-9, and KLKs. We evaluated the activity of four compounds (dextran sulfate, 4-t-butylcyclohexanol [BCH; TRP-regulin®], pongamia oil, and hesperidin methyl chalcone [HMC]) on inflammatory and vascular responses implicated in rosacea.
      Materials and methods: The anti-inflammatory activity of dextran sulfate was evaluated on PGE2 production after PMA stimulation of NCTC-2544 keratinocytes, and on normal human epidermal keratinocytes (NHEKs) after proinflammatory stimulation to mimic a rosacea environment. The anti-angiogenic activity of dextran sulfate was measured by analyzing pseudotube formation in co-cultured human microvascular endothelial cells/normal human dermal fibroblasts. HMC modulation of vascular responses and IL-8 cytokine production after SP stimulation was evaluated in human skin explants. We also assessed the effect of BCH on TRPV1 activation, and the effect of combined BCH and pongamia oil on the inflammatory response of NHEKs.
      Results: Dextran sulfate strongly and significantly inhibited PMA-induced PGE2 production, inhibited KLK5 and MMP-9 mRNA expression, and IL-8, IL-1α and VEGF production, and displayed a highly significant inhibitory effect on VEGF-induced pseudotube formation. In SP-stimulated human skin explants, HMC significantly decreased the proportion of dilated vessels, total vessel area, and IL-8 production. BCH significantly and dose-dependently inhibited TRPV1 activation, and BCH and pongamia oil inhibited CXCL1 and CXCL6 mRNA expression and IL-8 production in NHEKs. Combined BCH/pongamia oil inhibited IL-8 production synergistically.
      Conclusion: These in vitro results showed that dextran sulfate, BCH, pongamia oil and HMC, possess complementary soothing and anti-redness properties, supporting their combination in Avène redness-relief cosmetic products for sensitive skin prone to redness, and for topical adjunctive rosacea treatment.
      PMID: 30233225 [PubMed] {url} = URL to article
    • One paper links Fungal keratitis associated with ocular rosacea
    • Related Articles Procedural management of rhinophyma: A comprehensive review. J Cosmet Dermatol. 2018 Sep 17;: Authors: Krausz AE, Goldberg DJ, Ciocon DH, Tinklepaugh AJ Abstract
      BACKGROUND: Rhinophyma is a cosmetically deforming disease characterized by nodular overgrowth of the lower 2/3 of the nose and is considered the end stage of acne rosacea.
      AIMS: Review the spectrum of procedural techniques for treatment of rhinophyma with a focus on the advantages and disadvantages of each modality.
      METHODS: A comprehensive literature search was conducted using the search terms "rhinophyma," "treatment," and "surgery" in PubMed. Case reports, case series, and small retrospective trials using procedural techniques for management of rhinophyma were included for review. Animal studies, non-English articles, and reports of medical treatment of rhinophyma were excluded.
      RESULTS: There are currently no prospective, randomized controlled studies evaluating procedural management of rhinophyma. The most commonly employed treatments include scalpel excision, resection with heated knives, dermabrasion, electrosurgery and lasers, specifically carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG). The main complication associated with complete excision of rhinophymatous tissue is excessive scarring. To correct for this adverse effect, partial or tangential excision with preservation of underlying adnexal structures is now the accepted technique, irrespective of the chosen modality.
      CONCLUSION: There is no accepted gold standard for management of rhinophyma, and each modality succeeds in maintaining hemostasis, reducing scarring and achieving satisfactory cosmesis to different degrees. There is a conflicting data on the theoretical risk of recurrence with partial excision due to incomplete removal of tissue. Further studies evaluating this risk and alternate methods of prevention are required.
      PMID: 30225926 [PubMed - as supplied by publisher] {url} = URL to article
    • Diagnostic Indicators of Rosacea and Demodicosis. Acta Derm Venereol. 2018 Sep 18;: Authors: Forton FMN, De Maertelaer V Abstract
      Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic importance of clinical signs and symptoms that are poorly recognized as being associated with these conditions. In addition to well-known signs (vascular signs (present in 80% of patients), papules (39%), pustules (22%) and ocular involvement (21%)), other signs and symptoms (discreet follicular scales (93%), scalp symptoms (pruritus, dandruff or folliculitis; 38%) and pruritus (15%)) may also suggest a diagnosis not only of demodicosis, but also of papulopustular rosacea. Facial Demodex densities (measured by 2 consecutive standardized skin biopsies) were higher when ocular or scalp involvement was present, suggesting more advanced disease, but further investigations are needed to confirm this hypothesis. Recognition of these clinical signs and symptoms should encourage dermatologists to perform a Demodex density test, thus enabling appropriate diagnosis to be made.
      PMID: 30226528 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles FINACEA™ (Azelaic Acid) Foam, 15. Skinmed. 2016;14(6):445-447 Authors: Gupta AK, Foley KA, Abramovits W PMID: 28031132 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Treatment of rhinophyma with the Versajet™ Hydrosurgery System and autologous cell suspension (ReCELL®): A case report. J Cosmet Laser Ther. 2018 Apr;20(2):114-116 Authors: K Y, B R K, T D, E G Abstract
      This is a case report of a 63-year-old male patient who presented with rhinophyma of 17 years duration. Several medical treatments were applied previously, with no response or poor improvement. We present our experience by combining the Versajet™ Hydrosurgery System and ReCELL® in a heavy smoker patient, which led to a good aesthetic outcome. With the combined technique, we did not encounter any difficulties either within the operation or in the follow-up period. We obtained less complications and faster wound healing, which in return led to higher patient satisfaction.
      PMID: 28872937 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Subtyping, phenotyping or endotyping rosacea: how can we improve disease understanding and patient care? Br J Dermatol. 2018 Sep;179(3):551-552 Authors: Thyssen JP PMID: 30222873 [PubMed - in process] {url} = URL to article
    • ElaineA [post no 3] reports trying this treatment and posts on September 14, 2018, "I am still clear at 7 months post oral treatment."
    • Related Articles Demodex blepharitis: clinical perspectives. Clin Optom (Auckl). 2018;10:57-63 Authors: Fromstein SR, Harthan JS, Patel J, Opitz DL Abstract
      Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. Demodex mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.
      PMID: 30214343 [PubMed] {url} = URL to article
    • Oxymetazoline Hydrochloride 1% Cream (Rhofade) for Persistent Facial Erythema Associated with Rosacea. Am Fam Physician. 2018 Jun 15;97(12):808-810 Authors: Garcia C, Birch M PMID: 30216014 [PubMed - in process] {url} = URL to article
    • Topical Steroid Damaged/Dependent Face (TSDF): A Study from a Tertiary Care Hospital in Eastern India. Indian J Dermatol. 2018 Sep-Oct;63(5):375-379 Authors: Pal D, Biswas P, Das S, De A, Sharma N, Ansari A Abstract
      Background: Awareness against abuse of topical corticosteroids (TC), especially over the face, has been going on for last 5 years in India. In spite of that we are getting lots of cases in our hospitals.
      Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face among the dermatology outpatient department (OPD) attendees and to analyze its causes.
      Methods: This study was conducted in a tertiary care medical center of eastern India. Patients with relevant facial dermatoses were asked about their current use of topical formulations and confirmed to be TSDF were included in the study.
      Results: A total of 748 patients with facial dermatoses were screened, of which 271 (36.22%) were using TC. Of them mostly young adults between 20 and 29 years (37.10%) were using TC. Average duration between starting of use of medication and the onset of symptoms was 5 months. Ninety-eight (36.16%) patients were using topical corticosteroid for the treatment of acne and 74 (27.30%) were using as depigmenting cream. About 108 (39.85%) patients bought medicine over the counter being recommended by pharmacist/shop owner. Rosacea like features with photosensitivity was the most common adverse effect found in 79 (29.15%) patients whereas comedonal acne/acne exacerbation were found in 68 (25.09%) patients. Most of them (227, 83.76%) were unaware about the side effects of steroids.
      Conclusions: TC misuse in patients with facial dermatoses is still quite common even after efforts to grow the awareness among population.
      PMID: 30210157 [PubMed] {url} = URL to article
    • Thanks Vestpocket for your post on this subject and pointing out how tiny the population of only 24 people in the study was. Wouldn't it be a novel idea for a group of rosaceans to get together and fund their own research. For example, let's get 10,000 rosacea sufferers together in a non profit organization dedicated to find the cure for rosacea and each rosacean donates $1 to this non profit organization who when funds a rosacea double blind, placebo controlled, clinical study on a rosacea trigger, such as coffee, or for that matter, whatever the 10,000 rosacea sufferers deemed to be a clinical subject worth investigating. Certainly one of the RRDi MAC members might be interested in receiving $10,000 to conduct such a clinical study that rosaceans would like to fund rather than the current status quo studies being done now by the other two non profit rosacea organizations.  As mentioned in the initial post, there is a difference between a flushing trigger and a rosacea flareup trigger. When you drink coffee (or for that matter ingest caffeine from green tea or whatever) after you flush, and eventually recover from the flush, does the flush exacerbate your rosacea seriously, or after the flush subsides, is your rosacea unchanged?
    • Related Articles Dermatoscopy of Granulomatous Disorders. Dermatol Clin. 2018 Oct;36(4):369-375 Authors: Errichetti E, Stinco G Abstract
      Although diagnosis of cutaneous granulomatous disorders (CGDs) is usually suspected based on morphologic findings, localization, and anamnestic data, clinical differentiation from each other and from similar dermatoses may be challenging. Recently, dermatoscopy has been demonstrated to be a useful tool for assisting the recognition of several CGDs. This article provides a current overview of the dermatoscopic features of the main noninfectious and infectious CGDs, including sarcoidosis, necrobiosis lipoidica, granuloma annulare, rheumatoid nodules, and leishmaniasis. Other, less common, CGDs are briefly addressed, including granulomatous rosacea, acne agminata, and leprosy.
      PMID: 30201146 [PubMed - in process] {url} = URL to article
    • Related Articles A Prunus persica genome-wide RNA-seq approach uncovers major differences in the transcriptome among chilling injury sensitive and non-sensitive varieties. Physiol Plant. 2018 Sep 11;: Authors: Nilo-Poyanco R, Vizoso P, Sanhueza D, Balic I, Meneses C, Orellana LA, Campos-Vargas R Abstract
      Chilling injury represents a major constrain for crops productivity. Prunus persica, one of the most relevant rosacea crops, have early season varieties that are resistant to chilling injury, in contrast to late season varieties, which display chilling symptoms such as mealiness (dry, sandy fruit mesocarp) after prolonged storage at chilling temperatures. To uncover the molecular processes related to the ability of early varieties to withstand mealiness, postharvest and genome-wide RNA-seq assessments were performed in two early and two late varieties. Differences in juice content and ethylene biosynthesis were detected among early and late season fruits that became mealy after exposed to prolonged chilling. Principal Component and Data Distribution Analysis revealed that cold stored late variety fruit displayed an exacerbated and unique transcriptome profile when compared to any other postharvest condition. A differential expression analysis performed using an empirical Bayes mixture modeling approach followed by co-expression and functional enrichment analysis uncover processes related to ethylene, lipids, cell wall, carotenoids and DNA metabolism, light response, and plastid homeostasis associated to the susceptibility or resistance of P. persica varieties to chilling stress. Several of the genes related to these processes are in QTLs associated to mealiness in P. persica. Together, these analyses exemplify how P. persica can be used as a model for studying chilling stress in plants. This article is protected by copyright. All rights reserved.
      PMID: 30203620 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Efficient isolation and observation of the most complex human commensal, Demodex spp. Exp Appl Acarol. 2018 Sep 06;: Authors: Clanner-Engelshofen BM, Ruzicka T, Reinholz M Abstract
      Demodex spp. mites are an often neglected member of the human skin microbiome. Mostly they are commensals, although their pathophysiological role in rosacea, spinulosis folliculorum, and other skin diseases is recognized. Little is known about their life cycle, biology, and physiology. Demodex mites cannot be cultivated in vitro, thereby complicating research immensely. The manual extraction from human sebum is laborious and death can only be detected by surrogate markers like ceased movement or loss of fluorescence. Here we present a new approach for the extraction of larger mite numbers and the hitherto most precise way to detect death. The extraction of mites from sebum and debris by hand can be accelerated by a factor 10 using sucrose gradient centrifugation, which is well tolerated by the mites. Staining with propidium iodide allows for easy identification of dead mites, excluding frail mites that stopped moving, and has no negative effect on overall mite survival. We anticipate our methods to be a starting point for more sophisticated research and ultimately in vitro cultivation of Demodex spp. mites.
      PMID: 30191497 [PubMed - as supplied by publisher] {url} = URL to article
    • Advances in Acne and Rosacea Therapy. Semin Cutan Med Surg. 2018 Jun;37(3S):S63-S66 Authors: Stein Gold LF, Alexis AF, Harper JC, Tan JKL Abstract
      New topical therapies have demonstrated efficacy in patients with moderate or severe acne who might otherwise have required therapy with systemic antibiotics or isotretinoin. Increasing knowledge about the pathogenesis of acne has facilitated the development of therapies with novel modes of action. New and investigational therapies also are available or in development for the treatment of both the papulopustular and erythematous manifestations of rosacea. Semin Cutan Med Surg 37(supp3):S63-S66 © 2018 published by Frontline Medical Communications.
      PMID: 30192344 [PubMed - in process] {url} = URL to article
    • This is also a myth based on a poorly designed study, and it is a common for someone to skim the study and come to a false conclusion.     There WAS an increase in the MTCI (malar temperature circulation index) of the cold-caffeine/caffeine pill administered group(s). That's a number indicating the difference in baseline temperature of your skin vs. the temperature after the studied element was introduced. For reference, redness was seen at MTCI of 1.4 or higher. MTCI ranged from 0.8 bare minimum to 2.2 for the average high values. Since 0.8 was the bare minimum seen, all agents had an effect, even the caffeine. These are low doses of caffeine -- a single cup of coffee is 90-120 mg, and the researchers stopped at 200 mg when administering caffeine pills. The caffeine did have an effect on increased blood flow to the cheeks at this dose.  In fact, the MCTI was 0.8 to 1.1 in the caffeine treated participants, where 1.4 is the flushing threshold (per the researchers.)  Naturally, if 200 mg brought the skin that close to flushing they ought to have tried 300 to 400 mg, which would have likely brought the MCTI to 1.6 to 2.2 -- very visible flushing. However, they did not try any higher doses, so we can not draw a conclusion.   What the study actually found is that in a tiny sample of 24 people, a 200 mg caffeine pill did increase malar skin temperature towards the flush point, but didn't cause visible flushing at a 200 mg dose.  It also found that in some of the cohort, hot water alone caused a reaction just as bad as caffeine alone!   More specifically, the 200 mg caffeine pill group saw MTCI of 0.8 to 1.1. Cold coffee was nearly identical. The hot water people saw 1.1 to 3.6 MTCI. So, in some of the participants, the caffeine pill WAS exactly as bad as hot water.  The worst reaction was, of course, the group administered caffeine + hot water.   The dose of caffeine used is very important, because the average daily caffeine intake among caffeine drinkers is much higher.  Per Villanova University, "More than half of all American adults consume more 300 milligrams (mg) of caffeine every day, making it by far America's most popular drug."     Let's look at the actual numbers from the study: (agent: MTCI) Hot coffee: 1.4 - 2.2 (a few were higher) Hot water: 1.1 - 2.2 (a few were higher) Cold coffee: 1.1- 2.2 200 mg caffeine.: 0.8-1.1 So, essentially, we know caffeine has an effect, and at 200 mg, it's slightly lower than what would cause visible redness. It stands to reason that doubling the caffeine would cause a more pronounced effect, but the authors did not bother to try this obvious test of their hypothesis.   24 people is a tiny sample. Caffeine allergy is uncommon, and a 24 person cohort would easily miss these people. For example, my mother, from a single cup of black coffee, becomes dizzy and violently ill. That'd be a classic example of caffeine intolerance. No such people were part of the study.   If you had a 24 person study, you'd miss all sorts of genetic anomalies. You wouldn't even find a person with common peanut allergy in a group that small due to the indicience of same, so this study is only worth the fact that heat is a contributor to flushing. It does not tell us that caffeine is not.   Anecdotally, my interest in this crappy study from 1981 is because my sole rosacea trigger is caffeine.  I'm not a coffee drinker.  I developed rosacea from a few years of strong green tea (10 minute brews, multiple tablespoons of raw leaf per day.)   Hot drinks, and hot herbal teas without caffeine have absolutely no effect on my flushing.   However, even a half cup of COLD white tea, or a single sip of yerba mate, or COLD green tea sends me into an immediate reaction within 30 minutes, followed by a 12 hour period of facial itching and very hot cheeks.  Every single time.   Caffeine reaction is very real.  I know of two popular rosacea bloggers who accidentally removed caffeine from their diet (say, because of stomach upset) and had all flushing symptoms resolve after years of playing around with other factors and medications that had no effect. 
    • Related Articles Thiol/disulfide homeostasis as a marker of oxidative stress in rosacea: a controlled spectrophotometric study. Cutan Ocul Toxicol. 2018 Sep 03;:1-15 Authors: Sener S, Akbas A, Kılınc F, Baran P, Erel O, Aktas A Abstract
      BACKGROUND: Rosacea is the chronic inflammatory disease of the facial skin. Although its etiology is not clear yet, inflammatory processes triggered by oxidative stress and oxidation of lipids have been suggested to have a role. While studies on the relationship between inflammation and oxidative stress are ongoing, thiol metabolism and its role in oxidative stress have also begun to be investigated. Thiols are among the key molecules of protein metabolism in the organism and they are firstly consumed antioxidants in case of oxidative stress. Thiols regulate intracellular redox metabolism and protect keratinocytes against the results of oxidative alterations in the stratum corneum. There is a balance known as dynamic thiol/disulfide homeostasis between thiols and their oxidized forms; disulfides.
      AIM: This study aimed to determine the effects of oxidative stress on protein metabolism in rosacea patients by investigating thiol/disulfide homeostasis using a newly developed and fully automated method. Determination of plasma thiol levels provides important clues regarding the extent of free radical-mediated oxidation of proteins causing damage in rosacea.
      METHODS: The study included 50 rosacea patients who were diagnosed clinically or histopathologically with rosacea and 42 age- and gender-matched healthy controls. Serum plasma levels of native thiol, total thiol, and disulfide were determined. The following ratios were calculated: Disulfide/native thiol ratio, disulfide/total thiol ratio, and native thiol/total thiol ratio.
      RESULTS: The mean age was 41.8±10.5 in the rosacea patients (35 females) and 42.5±10.3 years in the control group (33 females). The mean disulfide level was found to be significantly higher in the rosacea patients than in the control group (23.4±5.5 µM/L and 17.3±6.2µM/L, respectively; p < 0.001). The mean disulfide/native thiol ratio (0.055±0.016 vs. 0.041±0.017) and the mean disulfide/total thiol ratio (0.049±0.012 vs.0.037±0.013) were significantly higher and the mean native thiol/total thiol ratio (0.884±0.118 vs. 0.923±0.027) was significantly lower in the patients as compared with the controls (p < 0.05 for all).
      CONCLUSION: In rosacea patients, the thiol/disulfide balance was observed to shift towards disulfides, which could be considered an indicator of oxidative stress in rosacea.
      PMID: 30173569 [PubMed - as supplied by publisher] {url} = URL to article
    • The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis. Australas J Dermatol. 2018 Sep 03;: Authors: Maarouf M, Platto JF, Shi VY Abstract
      Nutrition plays a critical role in the manifestation and management of inflammatory pilosebaceous disorders. There is rich potential for insight into the impact of dietary effects on the pathophysiology of inflammatory pilosebaceous disorders including acne vulgaris, hidradenitis suppurativa, rosacea, and the closely related seborrhoeic dermatitis. Acne vulgaris and hidradenitis suppurativa are thought to have similar diet-modulating pathogenic pathways. Western diet influences Acne vulgaris and hidradenitis suppurativa by increasing insulin and modulating FOX01/mTOR, resulting in over-expression of cytokeratins, hyperproliferation of keratinocytes, and hypercornification of the follicular wall. Key receptors in rosacea are alternatively activated by UV radiation, hot beverages, spicy foods, vanilla, cinnamon, caffeine, alcohol, cold temperatures, and niacin- and formalin-containing foods, to increase oedema and flushing, resulting in erythema, telangiectasia, and warmth, characteristic features of the condition. Seborrhoeic dermatitis, while not a follicular disorder, is closely related, and can be modulated by dietary influences, such as biotin and probiotics. This overview summarizes the role that nutrition plays on these disorders, and identifies dietary modifications as potential adjunctive therapies.
      PMID: 30175843 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Expression of inflammatory and fibrogenetic markers in acne hypertrophic scar formation: focusing on role of TGF-β and IGF-1R. Arch Dermatol Res. 2018 Aug 29;: Authors: Yang JH, Yoon JY, Moon J, Min S, Kwon HH, Suh DH Abstract
      Acne vulgaris is a universal skin disease and it may leave a scar when the original skin lesion disappears. These scars can cause cosmetic problems and psychological burden, leading to poor quality of life of patients. Acne scars are classified into atrophic scars and hypertrophic scars. As most of the acne scars are atrophic, many studies have been conducted focusing on the treatment of atrophic lesions. This study was conducted to investigate the underlying pathogenesis of acne hypertrophic scars by identifying roles of fibrogenetic and inflammatory markers. Skin biopsy samples were obtained from hypertrophic scars of face and back and from adjacent normal tissues as control group. Some samples from back were immature hypertrophic scars and the other samples were in mature stages. Immunohistochemistry staining and quantitative PCR were performed for fibrogenetic and inflammatory markers. Both in mature and immature hypertrophic scars, vimentin and α-SMA were increased. Production of TGF-β3 protein as well as transcription of TGF-β3 was also significantly elevated. In contrast, expression of TGF-β1 showed no increase. Instead, expression levels of SMAD2 and SMAD4 were increased. Elevations of CD45RO, TNF-α and IL-4 and reduction of IL-10 were observed. In immature hypertrophic scars, IGF-1R and insulin-degrading enzyme expression were increased. Increased apoptosis was observed in immature stages of hypertrophic scars but not in mature stages. Elevations of TGF-β3, SMAD2 and SMAD4 in hypertrophic scars and increase of IGF-1R in immature stages may give some clues for acne hypertrophic scar formation.
      PMID: 30167815 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles A Rare Dermatologic Disease in Pregnancy: Rosacea Fulminans- Case Report and Review of the Literature. Open Access Maced J Med Sci. 2018 Aug 20;6(8):1438-1441 Authors: Demir O, Tas IS, Gunay B, Ugurlucan FG Abstract
      BACKGROUND: Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. The pathways that lead to the development of rosacea are not well understood. The relationship of pyoderma faciale (also known as rosacea fulminans) to rosacea also is uncertain. We aimed to write this article with the aim of showing how a pregnant patient who has been aggravated by the degree of lesions on the face during the first trimester of pregnancy is treated and to show what is in the literature in this issue.
      CASE REPORT: A 22-year-old woman complained of painful erythema, papules and pustules on the face. She had fever and malaise during the sixth week of her first pregnancy and a history of the mild eruption and seborrhea before her pregnancy with flaring over the preceding 4 weeks. Dermatologic examination revealed red erythema of all involved facial areas; the lesions consisted of papules, pustules and nodules. The case was diagnosed as rosacea fulminans (pyoderma faciale) by these findings. In the literature, there are some effective therapeutic options such as retinoids, tetracyclines, antiandrogenic contraceptives, and dapsone and these were not used because they are contraindicated in pregnancy. Amoxicillin-clavulanic acid 1 gr/day, wet compresses, and a fusidic acid cream were started. After the activity of the disease had been suppressed for 10 days, antibiotic was stopped, and the other treatment options were applied topically for the next month. One month after cessation of treatment, the lesions had disappeared with only mild erythema remaining. There was minimally flushing on the face and no telangiectasia.
      CONCLUSION: In conclusion, there is no substantial evidence as to the mechanism by which pregnancy may trigger this conditioner whether the gender of the fetus influences the development of rosacea fulminans, but is generally accepted that hormonal changes in pregnancy play an important role. The pathogenesis of rosacea fulminans remains uncertain, but it is obvious that the further basic and clinical research is required to optimise the management of this rare facial dermatosis.
      PMID: 30159072 [PubMed] {url} = URL to article
    • Related Articles The investigation of the relationships of demodex density with inflammatory response and oxidative stress in rosacea. Arch Dermatol Res. 2018 Aug 27;: Authors: Falay Gur T, Erdemir AV, Gurel MS, Kocyigit A, Guler EM, Erdil D Abstract
      The relationships of demodex density with systemic oxidative stress, inflammatory response, and clinical severity in rosacea are not clear. This study aimed to (a) analyze the levels of systemic oxidative stress, antioxidant capacity, inflammatory parameters, and matrix metalloproteinases (MMPs) in systemic circulation in patients with rosacea, (b) identify the relationship between mite density and both oxidative stress and inflammation, and (c) investigate the role of photoaging and sebum secretion in etiopathogenesis. Forty patients with rosacea and 40 age-, sex-, and skin phenotype-matched healthy volunteers were included in the study. Clinical disease severity of the patients was determined. Sebum levels were measured in both the groups, and photoaging was evaluated. Reflectance confocal microscopy was used to calculate demodex density. Serum total antioxidant capacity (TAC), total oxidant capacity (TOC), myeloperoxidase (MPO), MMP-1, MMP-9, arylesterase (ARES), interleukin-1β (IL-1β), paraoxonase-1 (PON-1), and tumor necrosis factor-α (TNF-α) levels were also analyzed. The patients with rosacea had significantly higher serum TOC and lower TAC levels (p < 0.001). The serum ARES and PON-1 levels were significantly lower (p = 0.045 and p < 0.001, respectively); however, the serum levels of MMP-1, MMP-9, IL-1β and MPO were higher in the patient group. Demodex parameters were higher in the patient group compared to the control group. There was no significant correlation between the number of mites and disease severity. In addition, the number of mites was not correlated with the serum levels of TAC, TOC, OSI, MPO, MMP-1, MMP-9, ARES, PON-1, TNF-α, and IL-1β. However, sebum levels were directly proportional to the number of mites. Photoaging severity was similar between the patients and control subjects. The changing sebaceous microenvironment in rosacea leads to an increase in the number of demodex mites. However, increased demodex density does not alter disease severity, level of oxidative stress, or inflammation. Although none of the patients with rosacea had any underlying systemic disease, patients' systemic oxidative stress and inflammation parameters were found high in systemic circulation. It is assumed that the patients with rosacea are more prone to systemic diseases.
      PMID: 30151656 [PubMed - as supplied by publisher] {url} = URL to article
    • Head-and-neck dermatitis: Diagnostic difficulties and management pearls. Pediatr Dermatol. 2018 Aug 28;: Authors: Maarouf M, Saberian C, Lio PA, Shi VY Abstract
      Head-and-neck dermatitis is a variant of atopic dermatitis (AD) often seen in children and is challenging to diagnose, as it frequently overlaps with other eczematous dermatoses. Successful head-and-neck dermatitis (HND) treatment requires identification of common triggers and clinical mimickers, such as airborne dermatitis, periorificial dermatitis, and steroid-induced rosacea. Head-and-neck involvement negatively impacts quality of life and is often harder to treat than other body parts, as long-term topical corticosteroid use carries higher risks for skin atrophy on the face. Heating and flushing associated with HND further exacerbate the itch-and-scratch-cycle and disrupt sleep. We aim to address diagnostic gaps, identify clinical mimickers, and share clinical pearls in managing HND, including cooling pillows, thermal water sprays, rice starch paper facial masks, and tips to minimize food and saliva-induced facial irritation.
      PMID: 30152560 [PubMed - as supplied by publisher] {url} = URL to article
    • Let's review what the good points of having a non profit organization for rosacea founded by rosacea sufferers for patient advocacy vs the other two non profits for rosacea founded by non rosacea sufferers (NRS, and the AARS). (1) The purpose of this non profit obviously isn't for personal profit since everyone who has had anything to do with the RRDi hasn't done it for money. All Volunteers. Compare that with the other two non profit organizations for rosacea (NRS, and the AARS) and follow the money.  (2) There is a wealth of rosacea treatment data in the member forum in logical categories. The search feature can help you find what you are looking for.  (3) Education grants.  (3) The RRDi MAC is one of the Crown Jewels, since these medical and research professionals have some interest in rosacea and have graciously volunteered to have their name listed on our website and have agreed to answer questions and help guide the RRDi.  (4) The affiliate shopping cart is an incredible source of over the counter treatments and publications related to treatment not only for rosacea, but also other skin conditions.  You can review what research the NRS and the AARS have engaged in, and decide if you think these two non profit organizations funding for research is the way it should be done. Or if you think there should be improvement into what rosacea research needs to be done, think about this option:  Reaching the goal of 10,000 rosacea sufferers becoming members of the RRDi. Each member contributes one dollar a year. The RRDi could sponsor their own unique rosacea research that rosacea sufferers want done and fund it themselves. Can you do that with the other two non profit organizations for rosacea?   So think about all this and volunteer! Join the RRDi. Contact admin and let us know you want to volunteer. 
    • Related Articles Rhinophyma treatment using Versajet hydrosurgery. ANZ J Surg. 2017 Dec;87(12):E331-E332 Authors: Wong WL, Wong She R, Mathy JA PMID: 26073902 [PubMed - indexed for MEDLINE] {url} = URL to article
    • Related Articles Treatment of Rosacea using acupuncture for improving the local skin microcirculation: A case report. Medicine (Baltimore). 2018 Aug;97(34):e11931 Authors: Gao Y, Lin W, Zhou S, Shi G, He J, Chen Y Abstract
      RATIONALE: Rosacea is an irritating disease that affects patients' health and life quality. The current treatments for rosacea have limited efficacy and are generally not satisfying most patients. This report presents a patient diagnosed with rosacea who was treated with acupuncture to a satisfactory effect. Laser Doppler was used to measure the local blood perfusion of the nose before, during, and after acupuncture treatment. The Dermatology Life Quality Index (DLQI) was used to measure the impact of rosacea on the quality of the patient's life.
      PATIENT CONCERNS: A 52-year-old woman had been diagnosed with rosacea 18 months before this study. She had tried medical treatments in other hospitals with metronidazole cream, antifungal drugs, and steroidal ointments, but the effect was poor and limited.
      DIAGNOSES: In this study, the diagnosis of rosacea (stage I, subtype Erythematotelangiectatic) was made by a dermatologist according to physical examination).
      INTERVENTIONS: The patient's treatment included a half-hour of acupuncture 3 times per week.
      OUTCOMES: The patient experienced significant improvements in the region around the nose after 3 sessions of acupuncture treatment within the first week and reported that there was no relapse for 6 months after acupuncture treatment. The perfusion of blood flow was redistributed during and after acupuncture treatment according to laser Doppler measurements. The patient's DLQI score substantially improved. The patient was generally satisfied with the acupuncture treatment.
      LESSONS: The results suggested that acupuncture might be an alternative therapy for facial localized rosacea. As well, acupuncture may be effective in treating rosacea through redistributing micro-circulation of blood at the localized area of effect. The overall costs of the rosacea treatment may be reduced, provided that this therapy is demonstrated to be effective in future controlled studies.
      PMID: 30142810 [PubMed - in process] {url} = URL to article
    • Related Articles Effectiveness of photopneumatic technology: a descriptive review of the literature. Lasers Med Sci. 2018 Aug 24;: Authors: Rajabi-Estarabadi A, Choragudi S, Camacho I, Moore KJ, Keri JE, Nouri K Abstract
      Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.
      PMID: 30143923 [PubMed - as supplied by publisher] {url} = URL to article
    • "SCFA (short-chain fatty acids) molecules are a subset of fatty acids that are churned out by some types of gut microbes during the fermentation of fiber. They're associated with maintaining gut health and protecting against disease....And experiments recently showed that certain types of bacteria extracted from baby feces could promote the production of short-chain fatty acids (SCFA) in mice, and in a medium simulating the human gut...."Short-chain fatty acids are a key component of good gut health," lead study author Hariom Yadav, an assistant professor of molecular medicine at Wake Forest School of Medicine, said in a statement....Fecal microbiota transplants (FMT), or "poop transplants," can treat a type of gut disorder with an infusion of diverse bacteria from a healthy digestive system, distilled from a donor's poop. This helps to correct imbalances of microbial diversity when the gut microbiome is dominated by the bacteria Clostridium difficile (C. diff), which can lead to serious gut disorders." "Previous studies have investigated the use of probiotics — those healthy gut bacteria — by testing their impact in guts already affected by disease, the researchers wrote in the study. For the new investigation, they wanted to see how a probiotic would impact SCFA production in a healthy gut. They chose to work with baby poop because infants' gut microbiomes are typically free from age-related diseases "such as diabetes and cancer," and because of the sheer abundance of infant feces at their disposal. ("Their poop is readily available," Yadav said.)" Will Baby Poop Bacteria Become the New Probiotic?
      By Mindy Weisberger, Senior Writer, Live Science "While the new study examined what happened to mice after they received the mixture — there hasn’t been a study on humans yet — Yadav says that 'we are also planning to put these probiotics in yogurt, kombucha, and several other mediums for human use.' ” Why Scientists Think Baby Poop Is a Medical Gold Mine
      Probiotics are the future, baby.
      By Sarah Sloat, Inverse
       
    • The worldwide epidemiology of rosacea. Br J Dermatol. 2018 Aug;179(2):239-240 Authors: Parisi R, Yiu ZZN PMID: 30141542 [PubMed - in process] {url} = URL to article
    • Elevated Tear Human Neutrophil Peptides 1-3, Human Beta Defensin-2 Levels and Conjunctival Cathelicidin LL-37 Gene Expression in Ocular Rosacea. Ocul Immunol Inflamm. 2018 Aug 24;:1-10 Authors: Gökçınar NB, Karabulut AA, Onaran Z, Yumuşak E, Budak Yıldıran FA Abstract
      PURPOSE: To investigate the role of innate immunity in ocular rosacea.
      METHODS: Thirty-two patients with ocular rosacea patients (group-1) and 28 healthy volunteers (group-2) who served as controls were enrolled in the study. Tear function parameters were assessed, conjunctival impression cytology was performed and tear samples were collected. Human-neutrophil-peptides (HNP) 1-3 and human-beta-defensin-2 (hBD-2) levels were measured in tears by using ELISA tests. Cathelicidin leucin-leucin-37 (LL-37), hBD-2, human-beta-defensin-9 (hBD-9) gene expression levels were measured in the conjunctival impression cytology samples using real-time polymerase chain reaction.
      RESULTS: Tear HNP1-3 (p = 0.024), hBD-2 (p < 0.001), conjunctival LL-37 gene expression rate (p = 0.014) and ocular surface disease index scores (p = 0.001) were higher and the tear break-up time was lower (p = 0.003) in group-1. No other differences were found between the groups.
      CONCLUSION: The results of this study suggest the role of abnormal innate immunity in the pathophysiology of ocular rosacea by revealing elevated antimicrobial peptide levels.
      PMID: 30142005 [PubMed - as supplied by publisher] {url} = URL to article
    • Screening for depression in rosacea patients. Cutis. 2018 Jul;102(1):36-38 Authors: Alinia H, Cardwell LA, Tuchayi SM, Nadkarni A, Bahrami N, Richardson IM, Huang KE, Feldman SR Abstract
      Rosacea patients often are burdened with embarrassment, social anxiety, and psychiatric comorbidities. The Patient Health Questionnaire 9 (PHQ-9) is a validated and reliable self-administered tool for diagnosis of depression and designation of depression severity. This study aimed to examine the relationship between rosacea severity scores and level of depression using a validated rosacea self-assessment tool and the PHQ-9, respectively. Our results indicated that there is a direct relationship between rosacea severity and level of depression, and the PHQ-9 could prove useful in screening for depression in rosacea patients given the high incidence of psychiatric comorbidities in this patient population.
      PMID: 30138493 [PubMed - in process] {url} = URL to article
    • Related Articles Parkinson's disease pathogenesis, evolution and alternative pathways: A review. Rev Neurol (Paris). 2018 Aug 18;: Authors: Alexoudi A, Alexoudi I, Gatzonis S Abstract
      Sporadic Parkinson's disease (PD) is one of the most common neurodegenerative diseases of the elderly. In the scientific literature, surveys aiming to investigate the potential diagnostic biomarkers for PD have focused on skin and intestinal tissue biopsies, whereas more recent studies have reported an association between PD and skin disorders, such as seborrheic dermatitis and rosacea. In addition, a connection between PD and Crohn's disease has been established. These data suggest the hypothesis of a possible link between the gastrointestinal tract and skin and the development of PD. In fact, the nervous system, gastrointestinal tract and skin are analogous in their embryological development and, therefore, have molecular networks and pathogenic pathways in common. Based on these data, it may be assumed that the gastrointestinal tract and skin might be implicated in the pathogenesis of PD. The evolutionary hypothesis might also be a useful tool for further investigations into the overlap across neurological, gastrointestinal and skin disorders.
      PMID: 30131173 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Structure and gating mechanism of the transient receptor potential channel TRPV3. Nat Struct Mol Biol. 2018 Aug 20;: Authors: Singh AK, McGoldrick LL, Sobolevsky AI Abstract
      Transient receptor potential vanilloid subfamily member 3 (TRPV3) channel plays a crucial role in skin physiology and pathophysiology. Mutations in TRPV3 are associated with various skin diseases, including Olmsted syndrome, atopic dermatitis, and rosacea. Here we present the cryo-electron microscopy structures of full-length mouse TRPV3 in the closed apo and agonist-bound open states. The agonist binds three allosteric sites distal to the pore. Channel opening is accompanied by conformational changes in both the outer pore and the intracellular gate. The gate is formed by the pore-lining S6 helices that undergo local α-to-π helical transitions, elongate, rotate, and splay apart in the open state. In the closed state, the shorter S6 segments are entirely α-helical, expose their nonpolar surfaces to the pore, and hydrophobically seal the ion permeation pathway. These findings further illuminate TRP channel activation and can aid in the design of drugs for the treatment of inflammatory skin conditions, itch, and pain.
      PMID: 30127359 [PubMed - as supplied by publisher] {url} = URL to article
    • Evaluation of the Performance of a Nature-Based Sensitive Skin Regimen in Subjects With Clinically Diagnosed Sensitive Skin. J Drugs Dermatol. 2018 Aug 01;17(8):908-913 Authors: Draelos ZD, Levy SB, Lutrario C, Gunt H Abstract
      BACKGROUND: Unique whole formula nature-based sensitive skin products are formulated to minimize irritation while providing conditioning and soothing benefits to clinically diagnosed sensitive skin.
      OBJECTIVE: To evaluate and compare the efficacy and tolerability of a regimen of cleanser containing natural oils, beeswax, and witch hazel, and day & night creams containing natural oils, glycerin, and botanical anti-inflammatories (NR); and a synthetic dermatologist-recommended regimen of cetyl alcohol, sodium lauryl sulphate-containing cleanser and glycerin, polyisobutene-containing lotion (CR) in clinically diagnosed sensitive skin resulting from eczema/atopic dermatitis, rosacea, or cosmetic intolerance.
      METHODS: 120 subjects were randomized to receive either NR or CR, twice daily for 4 weeks in this double-blind study. Blinded investigator-rated and subject-rated overall skin appearance was assessed using a 5-point scale (0=none, 4=severe) at baseline, 2 weeks, and 4 weeks. Noninvasive skin assessments for skin hydration and skin barrier function were made by corneometry and TEWL, respectively.
      RESULTS: NR resulted in a 34% improvement from baseline in investigator-rated overall skin appearance (P less than 0.001); and CR resulted in a 4% improvement. Similar NR and CR results were found in the other efficacy parameters: tactile and visual smoothness, clarity, and radiance. Both regimens improved barrier function from baseline to week 4 (17%, 15%; NR, CR, P equals NS). NR maintained hydration from baseline to week 4 while CR increased hydration by 21% (P less than 0.001). No clinically significant tolerability issues were reported in either regimen at week 4.
      CONCLUSIONS: The study demonstrated that NR was effective, well tolerated, and superior to CR in the management of sensitive skin. J Drugs Dermatol. 2018;17(8):908-913.
      PMID: 30124733 [PubMed - in process] {url} = URL to article
    • tranexamic acid solution in treatment of erythematotelangiectatic rosacea.
    • Tranexamic acid solution
    • Photodynamic therapy for rosacea in Chinese patients. Photodiagnosis Photodyn Ther. 2018 Aug 14;: Authors: Fan L, Yin R, Lan T, Hamblin MR Abstract
      BACKGROUND: Rosacea is a common chronic cutaneous disorder which is characterized by flushing, erythema, papulopustules and telangiectasia. The pathogenesis of the disease is still unknown. A multifaceted approach is necessary to control the disease because of its tendency to relapse. New more effective treatment options are desirable to achieve a complete remission. Aminolevulinic acid-photodynamic therapy (ALA-PDT) is a well-established treatment for non-melanoma skin cancer and precancerous lesions. ALA- PDT can also be used for inflammatory disease, including acne vulgaris. However, little is known about the efficacy and safety of ALA-PDT for rosacea in Chinese patients with Fitzpatrick skin types III and IV.
      OBJECTIVES: To investigate the efficacy and safety of ALA-PDT in the treatment of rosacea classified as erythematotelangiectatic type or papulopustular type.
      METHODS: Twenty rosacea patients with either erythematotelangiectatic or papulopustular types were enrolled. 5% 5-Aminolevulinic acid in an oil-in-water emulsion was applied to the lesions under occlusion with plastic film for 2 h, and the lesions were irradiated with 100 mW/cm2, 80-90 J/cm2, LED red light (635 ± 15 nm) over 15 minutes in each session with four sessions at 10-day intervals. Objective measures (severity of flushing, erythema and telangiectasia, number of inflammatory lesions, VISIA Red Complexion Analysis images), subjective symptoms (including itching, prickling, burning, etc.) were recorded at baseline and at 4, 12 and 24 weeks after the last treatment. Adverse effects were recorded at each treatment and follow-up visit.
      RESULTS: During the follow-up period, all patients showed gradual objective clinical improvement compared with baseline (P < 0.01). Clinical inflammatory lesions disappeared completely in all patients after 24 weeks. Subjective symptoms, including flushing, itching, prickling, burning et al, had vanished and did not show any relapse during the follow-up period. The main side effects of ALA-PDT were pain, erythema, swelling and post- inflammatory hyperpigmentation. All side-effects were transient and tolerated by all the patients. No patients were dissatisfied with the therapeutic outcome.
      CONCLUSIONS: ALA-PDT is an effective and safe approach for the treatment of rosacea of erythematotelangiectatic or papulopustular types, to control clinical manifestations and reduce subjective symptoms.
      PMID: 30118905 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles The new therapeutic choice of tranexamic acid solution in treatment of erythematotelangiectatic rosacea. J Cosmet Dermatol. 2018 Aug 11;: Authors: Bageorgou F, Vasalou V, Tzanetakou V, Kontochristopoulos G Abstract
      BACKGROUND: Erythematotelangiectatic rosasea is a common,chronic, relapsing disease characterized mainly by vascular components, for which many therapies may exist but with limited efficacy.
      OBJECTIVES: We decided to test the efficacy of tranexamic acid when applied topically on the affected areas.,Tranexamic acid is an antifibrinolytic,thus we considered it could be effective at this type of rosacea.
      METHODS: This is an unblinded study. We included 20 patients, having erythematotelangiectatic rosacea. All patients were women between 27 and 65 years-old. We divided the patients in two groups,the first group was treated only with tranexamic acid solution (Transamin inj/sol 500 mg/5 mL) infused wet dressing for 20 minutes, and the second group was treated with microneedling simultaneously with tranexamic acid solution topical application followed by tranexamic acid solution infused dressing therapy,every 15 days for four sessions.
      RESULTS: The improvement assecion was outlined according to the Investigator Global Assessment of Rosacea Severity Score (IGA-RSS) and the use of clinical photos and dermoscopy. All patients were improved in the end of the therapy. There was statistically significant improvement, 2 units IGA-RSS in the first group, whereas 3 units IGA-RSS in the second group. The improvement lasted more than four months. The tolerability of the use of tranexamic acid was also asessed.
      CONCLUSIONS: According to our results a new really promising simple, safe and cheap treatment option targeting mainly to the vascular net and the erythema of rosacea is proposed.
      PMID: 30099833 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Treatment of erythematotelangiectatic rosacea, facial erythema, and facial telangiectasia with a 577-nm pro-yellow laser: a case series. Lasers Med Sci. 2018 Aug 10;: Authors: Kapicioglu Y, Sarac G, Cenk H Abstract
      Various lasers have been used for the treatment of erythematotelangiectatic rosacea (ETR), facial erythema (FE), and facial telangiectasias (FT). The assessment of the treatments of all of these conditions with a 577-nm pro-yellow laser has not been reported yet. The aim of this work was to assess the efficacy and safety of the 577-nm pro-yellow laser in ETR, FE, and FT. Forty patients suffering from ETR, FE, and FT (25 female and 15 male) were enrolled in this study. All of the patients were treated with 577-nm pro-yellow laser (QuadroStarPRO YELLOW® Asclepion Laser Technologies, Germany) at 4-week intervals, for one to four sessions. The assessment of the treatment was made based on the digital photographs and the percentage of fading of the erythema and telangiectasias in the lesions. Significant clinical improvement (80-100%) was observed in the first or second sessions of the treatment in FE and ETR patients and in second and fourth sessions of the treatment in FT patients. The treatment was very well tolerated. No side effect was observed except for a few patients who had mild to moderate erythema fading away in 12-24 h. This case series has shown that the pro-yellow laser is a very effective, safe, and well-tolerated treatment for ETR, FE, and FT.
      PMID: 30097757 [PubMed - as supplied by publisher] {url} = URL to article
    • Very good question ( I am positive we all know the answer which is called BIG ECONOMIC INTERESTS or in a single word MONEY). It is enough to watch this short video  and see that along the time mankind used radioactive products for beauty and heroin for cough. It took a lot of time to admit that tobacco is dangerous for human being health too. Maybe centuries will pass till sugar will be on the list. Meanwhile lets just be happy Chocolate is on the list...... What can we do if Rosaceans are not united in a world of DIVIDE ET IMPERA!???
    • A post at RF in the News Feeds > Other News Feeds > NRS - Common Connection Between Rosacea Dietary Triggers refers to post at the NRS Blog which discusses rosacea diet triggers with Dr. Rajani Katta, clinical assistant professor of medicine at Baylor College of Medicine and the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. Dr. Katta mentions the "gut and skin health" but "we need to do more research to determine what that connection is." She categorizes rosacea diet triggers into "four categories: cinnamaldehyde-related, capsaicin-related, heat-related and alcohol-related." Dr. Katta nor the NRS ever mention that sugar and carbohydrate are rosacea diet triggers which has been well established with anecdotal reports here at RF, just as valid as the anecdotal reports used by the NRS to establish the NRS diet trigger list which is based upon a survey of rosacea sufferers. Sugar and carbohydrate simply doesn't fit into the four categories proposed by Dr. Katta. Have you ever wondered by the NRS avoids listing sugar and carbohydrate as a rosacea diet trigger?
    • David Pascoe wrote a post about how the United Kingdom Medicines and Healthcare Regulatory Agency (MHRA) has issued a Drug Safety Interactive Drug Analysis Profile for the topical treatment Mirvaso, using the Yellow Card Scheme and also mentioned Rhofade (Oxymetazoline Hydrochloride). You can read the Interactive Drug Analysis Profile with the suspected Adverse Drug Reactions (ADRs) reported through the Yellow Card Scheme which include adverse side effects such as cardiac disorders, among many other reported symptoms from users. David also mentions a report that concludes that oxymetazoline may cause drug-induced valvulopathy, a heart disorder. [1] UK residents can now receive news updates from the MHRA and report side effects to medicines via the Yellow Card app.
      You will need to create a separate account on the app to report and download it from the Apple App Store, or Google Play Store. USA residents can report adverse effects using Mirvaso to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch or fill out an online report.  End Notes [1] Warning About Using Rhofade With Cardiovascular Disease
    • David Pascoe wrote a post about how the United Kingdom Medicines and Healthcare Regulatory Agency (MHRA) has issued a Drug Safety Interactive Drug Analysis Profile for the topical treatment Mirvaso, using the Yellow Card Scheme. You can read the Interactive Drug Analysis Profile with the suspected Adverse Drug Reactions (ADRs) reported through the Yellow Card Scheme which include systemic cardiovascular effects, i.e., bradycardia, hypotension and dizziness, among many other reported symptoms from users according to the MHRA. UK residents can now receive news updates from the MHRA and report side effects to medicines via the Yellow Card app.
      You will need to create a separate account on the app to report and download it from the Apple App Store, or Google Play Store. USA residents can report adverse effects using Mirvaso to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch or fill out an online report.   
    • Granulomatous Rosacea Versus Lupus Miliaris Disseminatus Faciei-2 Faces of Facial Granulomatous Disorder: A Clinicohistological and Molecular Study. Am J Dermatopathol. 2018 Aug 06;: Authors: Chougule A, Chatterjee D, Yadav R, Sethi S, De D, Saikia UN Abstract
      Granulomatous rosacea (GR) and lupus miliaris disseminatus faciei (LMDF) are 2 forms of facial granulomatous diseases. Although they show some morphological overlap, they have distinct clinical presentation. This study was performed to demonstrate the clinical and histological features of GR and LMDF and to establish their relationship to tuberculous etiology by molecular technique. All the cases of GR (n = 20) and LMDF (n = 10) diagnosed on skin biopsy over the past 6 years were reviewed along with their clinical detail. Polymerase chain reaction (PCR) was performed using primers specific for Mycobacterium tuberculosis. The mean age of patients with GR was 45 years 10 months (range 18-75 years) as compared to 33 years 5 months (range 18-57 years) in patients with LMDF. The GR cases comprised 13 men and 7 women patients, whereas all 10 LMDF cases were seen in men. GR cases had papular lesion over an erythematous base on face, whereas LMDF cases had papular/nodular/nodulocystic lesions on the face and neck. Histologically, GR cases showed small granulomas without necrosis in a background of variable lymphoid infiltrate and dilated capillaries, whereas LMDF showed large granulomas with caseous necrosis and minimal inflammation. Five cases (25%) of GR showed degenerating Demodex folliculorum mites. No case of GR or LMDF showed positivity for mycobacterial polymerase chain reaction. Despite some similarities, GR and LMDF show distinct clinical and histological features. Thus, LMDF is a distinct clinicopathological entity separate from the GR, with different etiopathogenesis. However, none of the conditions are related to a tuberculous etiology.
      PMID: 30085956 [PubMed - as supplied by publisher] {url} = URL to article
    • Dear Brady, I have just send a message to Helios Clinic in Wuppertal, Germany. I am very eager to know what can be done for me. Sometimes I wish I was Madonna just because of this https://www.facebook.com/donate/280231332752230/280231336085563. I had a short change of messages with Helene Segara yesterday and even she is a very well known international artist is struggling to collect money to protect animals in France. It is heart breaking. Problems are everywhere on Planet Earth and if artists have problems in raising money from donations what a humble citizen like me can do? I will keep you posted always. God help us all.
    • You are kind, but I need not be considered. If you keep searching like you are doing, you will find a way to control your suffering and your reliance on God Almighty. Keep us posted on your progress. 
    • Comments on: "In Vitro Safety Pharmacology Profiling of Topical α-Adrenergic Agonist Treatments for Erythema of Rosacea". Drugs R D. 2018 Aug 04;: Authors: Gil D PMID: 30078127 [PubMed - as supplied by publisher] {url} = URL to article
    • Dear Brady, I did not send an email to Bianka Sobolewska, M.D.  in Germany because in her profile is written that she deals with Ocular Rosacea. From those contacted, from Helios Clinic in Wuppertal Germany the managers told me that Mr.  Percy Lehmann, M.D. is in his vacation and will be back in the office today and they will tell me what can be done for me. Also Mr.  Stefano Veraldi, M.D., Ph.D.  answered me from Italy but he told me that only a consultation will be necesary and no hospitalization and I am very afraid of trying anything alone at home and being the only one seeing the consequences. Finding financial support for the solution it is still a challenge. With all my psyhiatrical medication(an anxiolytic, an antidepressant and a supplement with vitamin B12 and amino acids for physical and intellectual fatigue that is an adjuvant to treatment with anxiolytics and antidepressants) for so many years my situation is still peaks and valleys and I still have days when I am terribly tired(like at the debut of it in September 2009) and all I can do is to lay down in bed and keep my eyes closed. Finding a solution that works for me is a very difficult task. When I am fine I think that I can conquer the world, when I am terribly down all I want is to end up asap. I feel like in September 2009 I jumped in in the roller coster of death. It is like God Almighty is putting me to an endless test of faith. I am just wondering what Rosaceans could do without a beacons of light like YOU???
    • The physicians who volunteer on the RRDi MAC were picked because they specialize in rosacea. 
    • are there a list of doctors that specialize in rosacea?
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