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  1. Skin Pharmacol Physiol 2007;20:199–210 DOI: 10.1159/000101807 Beneficial Long-Term Effects of Combined Oral/Topical Antioxidant Treatment with the Carotenoids Lutein and Zeaxanthin on Human Skin: A Double-Blind, Placebo-Controlled Study P. Palombo, G. Fabrizi, V. Ruocco, E. Ruocco, J. Fluhr, R. Roberts, P. Morganti
  2. "In conclusion, the present study indicates that the administration of lutein and zeaxanthin provides multiple benefits to the skin...Although these benefits were obtained regardless of whether lutein and zeaxanthin were administered orally or topically, the study demonstrated that an additional benefit is achieved through the simultaneous administration of these xanthophylls by both routes." [1] Marcello, a lawyer, says, "Ten days ago, I bought Lutein-Z with zeaxanthin (10 mg) from Jamieson brand and started to take it with Canola oil (to improve lutein's absorption). That, of course, was to protect my eyes and nothing else. Then a couple of days later I noticed that I had no more new pustules on my face. Not a single new one !!! I was honestly wondering what was happening, then I realized that the only thing that could explain it was my new intake of lutein. It's been 10 days now since I took my first pill and my face is still completely clear." [post no. 1] Also see post no 20 in this thread] "Lutein from Latin luteus meaning "yellow" is a xanthophyll and one of 600 known naturally occurring carotenoids." Wikipedia"Zeaxanthin is one of the most common carotenoid alcohols found in nature. It is important in the xanthophyll cycle." Wikipedia Lutein is distantly related to isotretinoin since Lutein is a naturally occurring carotenoid (an organic pigment that have vitamin A activity meaning that Lutein can be converted to retinol), while isotretinoin is a retinoid, "a class of chemical compounds that are vitamers of vitamin A or are chemically related to it." Wikipedia This may be related to a deficiency of Vitamin A which has been "associated with chronic malabsorption of lipids, impaired bile production and release, and chronic exposure to oxidants, such as cigarette smoke, and chronic alcoholism (in secondary deficiency). Wikipedia "Dr Lange also likes to add 6 mg of astaxanthin along with some lutein and zeaxanthin in moderate to marked cases of blepharitis for the additional anti inflammatory properties when used together with omega 3." Natural Treatment for Blepharitis by Dr Michael Lange ElaineA says, "My meibomian glands are making the oily tear film much more easily now. And my eyelids feel and look less swollen. My vision seems much sharper as well. Having a working oily tear film really helps the eyes." If you decide to try oral Lutein with Zeaxanthin please use our Amazon Affiliate store by clicking on the banners below (we get a small fee if you purchase through our store and you will helping our non profit organization). We have found one topical at Amazon that contains Lutein, Nucerity Rejuvenating Barrier. Another topical containing Lutein is FloraGLO™ Lutein Topical (not available at Amazon). Please post your experience in this thread. Mahalo. The color of an egg yolk is from the xanthophyll carotenoids lutein and zeaxanthinImage courtesy of Wikipedia End Notes [1] Skin Pharmacol Physiol 2007;20:199–210 DOI: 10.1159/000101807 Beneficial Long-Term Effects of Combined Oral/Topical Antioxidant Treatment with the Carotenoids Lutein and Zeaxanthin on Human Skin: A Double-Blind, Placebo-Controlled Study P. Palombo, G. Fabrizi, V. Ruocco, E. Ruocco, J. Fluhr, R. Roberts, P. Morganti
  3. Admin


    From 1998 through 2005 there was an incredible volunteer spirit that drove the formation of the RRDi. Since 2005 the force that motivated so many to bring together rosacea sufferers into a non profit organization has dwindled to just a flickering wick. Why is it that rosaceans (rosacea sufferers) don't volunteer anymore? Andy Seth, an entrepreneur, has a blog post, The Way We Think About Volunteering Is Dead Wrong, states, "research shows that the happiest volunteers are those who give 2 hours per week. That’s it. 2 hours." If the RRDi could get any rosacean to volunteer 2 hours a weeks, that would be miraculous. Are there volunteers who actually volunteer that many hours a week? There must be, otherwise the study is bogus. If we could get any RRDi member to just post their thought or experience with rosacea for 15 minutes a week that would be incredible. We have dotted the RRDi forum with requests to RRDi members to simply post anything and the 1200 plus members as of this date are simply miniscule when it comes to posting. Getting our members to post is a challenge. If you have some insight how to get our members to post, we are all ears. You can reply to this post and comment to your heart's content. Of course, that is the issue, the RRDi members' hearts are not content to post. Why is that? The research Mr. Seth referred to may have been the study commented on by the American Psychological Association that reports, "Volunteers lived longer than people who didn't volunteer if they reported altruistic values or a desire for social connections as the main reasons for wanting to volunteer, according to the study." This same study, Andrea Fuhrel-Forbis, the co-author concludes: "It is reasonable for people to volunteer in part because of benefits to the self; however, our research implies that should these benefits to the self become the main motive for volunteering, they may not see those benefits." One of the benefits is what is called 'helper's high' which has been scientifically confirmed. [1] Of course, if a RRDi member who has rosacea helps another rosacea sufferer that would be the basis for receiving the 'helper's high.' Rosaceans supporting rosaceans. In trying to understand why volunteering amongst rosaceans has continued on this downward course, and googling this for an answer, The Guardian has an article about this subject and concluded, "But while the benefits of volunteering are clear, there is worrying evidence that the people who could benefit most from giving their time are precisely those least likely to be involved." Volunteer Match (which the RRDi has joined) has an article on this subject and states that the Bureau of Labor Statistics Report shows "that volunteer rates have been steadily declining for over a decade," [2] and comments, "There’s an endless supply of reasons that could explain why volunteer rates are falling. Last year, upon seeing the results, VolunteerMatch President Greg Baldwin argued that volunteer rates are falling because we as a nation don’t invest enough resources in the nonprofit sector. Without resources, nonprofits simply don’t have the capacity to effectively engage volunteers. Someone in the comments of that post argued that the falling rates can be attributed to the fact that more people are overworked with less time on their hands. Others say people are simply lazier than they used to be. I personally think it could be attributed to a shifting trend away from community involvement, due to the emergence of online communities, young people moving more often, and other factors." [3] In the above article mentioned [3] there are a number of comments and I think Ron from Florida's [April 16, 2016] comment is insightful: "When I was younger, volunteering and giving back was part of life. It was something that we did and didn’t think twice about it. I don’t see that same philosophy these days. It’s to the point that schools here require some level of community service to complete your graduation requirements." Stem Learning reports, "It is suggested that stagnating volunteer numbers and in some areas, reducing numbers of volunteers, along with cuts made by local authorities falling disproportionately upon the volunteering sector funding, suggests a potential fall in people volunteering per se. Furthermore the 2015/16 Community Life survey, highlighted 14.2 million people formally volunteered at least once a month in 2014/15 and although rates are mostly unchanged, it appears irregular volunteering appear to show a 5% drop!" Carey Nieuwhof lists 6 REASONS YOU'RE LOSING HIGH CAPACITY VOLUNTEERS. I don't see how those six reasons are related to the RRDi, but I am all ears to anyone who can point out to me what the RRDi isn't doing or not doing with regard to Carey's six reasons. Our page on volunteering covers most of what Carey is discussing. Without a doubt this explains the situation. Any thoughts on this subject would be much appreciated. Online Volunteering Dr. Natalie Hruska says that the studies indicating a drop in volunteering over the past decade "do not factor in kinds of volunteerism today, like virtual volunteering" and writes there is "a necessity to redefine what volunteerism is and how we understand it today." [4] End Notes [1] Helper's High: The Benefits (and Risks) of Altruism, Psychology Today [2] According to the 2015 report, 24.9% of the U.S. population over the age of 16 volunteered at least once in the past year. In 2011, this percentage was 26.8%, and in 2005 it was 28.8%. [3] The U.S. Volunteer Rate Is Still Dropping. Why?, Tess Srebro | March 25, 2016 | Industry Research | Engaging Volunteers, Volunteer Match [4] Dr. Natalie Hruska, April 12, 2016 POST to the article in end note 2. Dr. Hruska has a video below that discusses online volunteering: Dr. Hruska has written a book on this subject, Managing the First Global Technology: Reflections on a relevant application of the Internet, in Kindle or Paperback.
  4. Dr. Ben Johnson, RRDi MAC Member, discusses a holistic approach to treating rosacea in an interview with Lori Crete, Licensed Esthetician, Spa 10.
  5. I had a mole on my forehead that I was told that 3% Hydrogen Peroxided might remove, so I dabbed a little on the mole and after some weeks it did indeed remove the mole. However, I noticed that the rosacea or seb derm on my forehead that was near the mole also cleared up. So I experimented and began putting 3% Hydrogen Peroxide on my red spots on my forehead and after some days they began to fade away too! Since then I have been putting 3% Hydrogen Peroxide on all my facial rosacea red spots and letting it dry, then adding the ZZ cream, just before bed and this regimen seems to really work for me. I also have taking the Lutein/Zeazanthin 40 mg capsule each day. I also avoid sugar as much as possible and eat very low carbohydrate.
  6. Admin

    Placebo Effect

    An interesting article in The New York Times Magazine states, "Enough people reported good results that patients were continually lined up at Mesmer’s door waiting for the next session." Dr. Mesmer is where the word mesmerize comes from. The article explains how 'double blind' placebo controlled clinical studies originated and why drug companies have to differentiate between a drug's actual pharmaceutical effect and the placebo effect. I particularly like this paragraph in the article: "What if, Hall wonders, a treatment fails to work not because the drug and the individual are biochemically incompatible, but rather because in some people the drug interferes with the placebo response, which if properly used might reduce disease? Or conversely, what if the placebo response is, in people with a different variant, working against drug treatments, which would mean that a change in the psychosocial context could make the drug more effective? Everyone may respond to the clinical setting, but there is no reason to think that the response is always positive. According to Hall’s new way of thinking, the placebo effect is not just some constant to be subtracted from the drug effect but an intrinsic part of a complex interaction among genes, drugs and mind. And if she’s right, then one of the cornerstones of modern medicine — the placebo-controlled clinical trial — is deeply flawed."What if the Placebo Effect Isn’t a Trick?, The New York Times Magazine
  7. Admin

    Neurogenic Rosacea

    The RRDi recognizes Neurogenic Rosacea as a rosacea variant, and is no longer considered a subtype of rosacea. Please read this notice about Subtypes "Neurogenic rosacea was first described by Scharschmidt et al. in 2011, and since then, there have been very few reports of its existence. It is characterized by dramatic facial redness, with burning, stinging and dysaesthesia that is out of proportion to the flushing or inflammation. A relatively high number of patients have neurological or neuropsychiatric conditions, including complex regional pain syndrome, essential tremor, depression and obsessive compulsive disorder. Treatment is difficult, and a poor response is typically seen with standard treatments used in rosacea. Some success has been seen with neuroleptic agents (e.g. pregabalin, gabapentin), tricyclic antidepressants and duloxetine. Endoscopic thoracic sympathectomy has also been used with some success in treating debilitating facial flushing." [1] The above article discusses a patient with neurogenic rosacea that was treated with pregabalin (Lyrica) and states the following: "The patient could not tolerate gabapentin, but within 2 months of starting pregabalin, her symptoms improved dramatically, with a reduction in facial burning sensation, redness and swelling. She is currently being maintained on pregabalin 300 mg in the morning and 225 mg at night." [1] "We propose that this group of patients with strikingly prominent neurologic symptoms represents an under recognized subgroup of rosacea that we term neurogenic rosacea. By highlighting and formally naming this subgroup, we hope to increase awareness and recognition of these patients and aid the practicing dermatologist in their therapeutic management" [2] The main difference between Neurologic Rosacea and Subtype 1, ETR, is the patient exhibits some additional neurologic or neuropsychiatric symptoms or signs such as headaches, depression, anxiety, Raynaud phenomenon, migraines, chronic pain and regional pain syndrome. David Pascoe has an excellent article on treatments for this subtype and another interesting follow up on this with an article entitled, Neuropeptide PACAP Modulators for Neurogenic Rosacea. An interesting statement in the article worth mentioning is this: "Because our understanding of this enigmatic subclass of rosacea is extremely limited, further research is clearly needed to better describe the underlying pathophysiologic characteristics and to identify additional effective treatment methods." [1] laser_cat has a post about her experience with Neurogenic Rosacea. Not Neuropathic Rosacea Neurogenic Rosacea should not be confused with Neuropathic Rosacea, another proposed subtype, similar, but has not gained a wider acceptance as the term to use. Treatment Other than the treatment mentioned in the cited articles here are some other treatments to consider: laser_cat at RF who suffers from neurogenic rosacea posts that amlodipine has helped in her struggle and lists other drugs she is taking to fight this. [3] Conclusion In conclusion, the differentiating factor for neurogenic rosacea is mentioned in the article: "A notably high percentage of patients had neurologic (43% [6 of 14]) or neuropsychiatric (50% [7 of 14]) conditions, including complex regional pain syndrome, essential tremor, depression, and obsessive-compulsive disorder. Neurovascular disorders, including headaches (71% [10 of 14]) and Raynaud phenomenon (29% [4 of 14]), as well as rheumatologic disorders (36% [5 of 14]), including lupus, rheumatoid arthritis, fibromyalgia, mixed connective tissue disease, and psoriatic arthritis, were also common." [2] The article proposed the following: "We propose that this group of patients with strikingly prominent neurologic symptoms represents an underrecognized subgroup of rosacea that we term neurogenic rosacea. By highlighting and formally naming this subgroup, we hope to increase awareness and recognition of these patients and aid the practicing dermatologist in their therapeutic management." It would be pertinent to differentiate erythromelalgia (EM) from Neurogenic Rosacea in a differential diagnosis. End Notes [1] Clin Exp Dermatol. 2015 Dec;40(8):930-1. doi: 10.1111/ced.12630. Epub 2015 Mar 2. Neurogenic rosacea: an uncommon and poorly recognized entity? Parkins GJ, Maan A, Dawn G. You can download a black and white copy of the article by clicking here or a color copy by clicking here. [2] Neurogenic Rosacea: A Distinct Clinical Subtype Requiring a Modified Approach to Treatment Tiffany C. Scharschmidt, MD; John M. Yost, MD, MPH; Sam V. Truong, MD; Martin Steinhoff, MD, PhD; Kevin C. Wang, MD, PhD; Timothy G. Berger, MD Arch Dermatol. 2011;147(1):123-126. doi:10.1001/archdermatol.2010.413 Neurogenic Rosacea pdf [3] laser_cat at RF post no 2
  8. Admin

    Rosacea Diet

    Rosacea Diet Triggers always come up in a discussion of rosacea. Just about every dermatologist parrots the NRS list of proposed rosacea diet triggers, especially physicians explain to their patients to avoid "spicy food and wine." There is a much longer trigger factor list that include other proposed food and drink triggers. An interesting read is Liver, Yogurt, Sour Cream, Cheese, Eggplant, and Spinach that discusses this subject. There are some who can eat anything and their skin looks great. This is probably due to genetics. There is a theory that rosacea is genetic and we have simply been dealt with a bad set of rosacea prone genes. Whether diet really does affect rosacea or acne, do you think that eating a diet with the proper proportion of protein, fat, carbohydrate and essential nutrients improves health? If a person has a poor diet without a proper proportion of the three food groups and lacks the essential nutrients, would that effect the skin? The Rosacea Diet that I have proposed since 1999 you can obtain for free if you join the RRDi and mention when joining you want a free copy and explains in detail what to ingest and what to avoid for just 30 days to see if this improves your skin. Most rosacea sufferers will not do this because it means reducing your carbohydrate intake to 30 grams a day for 30 days, a task that very few are willing to undertake because sugar is addictive. Also due to a misunderstanding on what carbohydrate actually is, many think that carbohydrate is an essential nutrient which is far from the truth. The Rosacea Diet is simply a short test that clearly shows whether reducing carbohydrate for thirty days helps clear your skin. After this simple test one can modify carbohydrate intake according to one's individual situation and may be able to use this method to help control your rosacea, because in RF you will find that the majority will tell you that diet does indeed affect rosacea and acne. While there are a few who claim diet doesn't have anything to do with rosacea, these are definitely in the minority. It would be good to substantiate this in a poll, but the NRS has already done that with its survey asking what food and drink triggers your rosacea and came up with the 'official' diet trigger list which all the dermatologists parrot, namely 'spicy food and wine.' Did the NRS even mention sugar or carbohydrate in its poll? No. The NRS avoids mentioning sugar or carbohydrate as a rosacea diet trigger. The RRDi does list sugar and carbohydrate as rosacea diet triggers.
  9. Admin

    Autumn and Rosacea Flare-ups

    Thanks Apurva Tathe for your tips.
  10. If you have a question or concern with your rosacea please post here and get help from our community of rosaceans.
  11. The NRS Weblog reports on October 22, 2018, "Over the course of nearly two decades since the National Rosacea Society (NRS) issued its first research grants, this program has fostered dramatic strides in the understanding of rosacea, and has now awarded more than $1.5 million to date. Funded exclusively by donations from individuals, the NRS research grants program was established in 1999 to provide support for medical research into the potential causes and other key aspects of this poorly understood disorder that may lead to improvements in its treatment, care and potential cure." [1] [bold italics added] The report then notes some of the notable studies funded with more than $1.5 million dollars, which some of these are quite good. The NRS states clearly on this blog report that all the money spent on these studies came from individual donations from members of the NRS. However, let's really look at the math on this. The RRDi has kept an accurate record of all the donations from 1998 thru 2016 and the total amount reported donations to the NRS amounts to $13,898,646. [2] The total amount reported by the NRS spent on rosacea research studies during this same period amounts to $1,403,031, which is a difference of about $96,969. You might minimize this difference but $96K to the RRDi is a big deal. If the RRDi had $96K we would spend 90% on rosacea research studies. But what is a even a bigger deal is that the NRS reports over this same period that only 10.09% of the amount donated to the NRS comes from public support (what the NRS reports in the weblog articles as 'exclusively by donations from individuals). So what does does the math now reveal? $1,402,378.38 is the actual amount reported by the NRS to the Internal Revenue Service. That is a difference of $97K, which is closer to the same amount in the previous paragraph. [2] Ok, just a $1K difference, but it helps confirm the math. So what's the big deal you ask? Go back and look at the total amount of donations reported by the NRS during this time period. Yes, almost $14 million. Look again at how much money was spent on rosacea research studies? Actually $1.4 million. So how much money of the TOTAL donations was spent on rosacea research? You do the math. Ok, I will do it for you: 10%. So for every dollar donated to the NRS ten cents is spent on rosacea research. One might ask, where did the other 90% of the donations come from when only 10% comes from public support? If you look on the NRS website home page, scroll down till you read, "Maintenance of this website in 2018 is supported by unrestricted educational grants from the following companies so that individual donations can be used to fund research" and notice the list of companies who sponsor the NRS, pharmaceutical corporations with a vested interest in rosacea. However, the NRS reports that all the rosacea research studies are "Funded exclusively by donations from individuals." So what are these educational grants funded by these pharmaceutical companies? There are none listed that are sponsored by any pharmaceutical companies shown on the NRS website. Why not ask the NRS? Better yet, why not ask the NRS for a copy of the Form 990 for 2017 that you are entitled to review yourself and see where all the money is spent. Yes, it takes time to read a Form 990 but you can get the gist of the entire report in about a twenty minute review. For example, here is a review of the 2016 Form 990. If it is really true that the public support reported amounts to $1.4 million, just think about what rosacea research could have been accomplished if more money was spent on rosacea research rather than the 10 percent the NRS spent of its total donations? Say 20 percent? Or what about 50%? How much should a non profit organization for rosacea spend on rosacea research of its total donations? If you are meditating on all this, you might ask, where did most of the 90 percent of the donations go to? What was most of the donations the NRS received over this period spent on? The answer is two private contractors, that are owned by the president of the NRS, Sam Huff. And the most surprising thing about all this is that members of the NRS don't care how the NRS spends its donations and keeps giving the NRS donations. I still haven't figured out why the members of the NRS keep donating but it is obvious they love the NRS and how it spends its donations. For more info. End Notes [1] NRS Research Grants Program Drives Key New Discoveries Posted: 10/22/2018, NRS Weblog [2] NRS Form 990 Spreadsheet 1998 thru 2016
  12. The NRS has funded a study that differentiates the difference between Subtype 1 (erythematotelangiectatic) rosacea and Telangiectatic Photoaging (TP), a rosacea mimic which is a condition with visible blood vessels from sun damage. The NRS report on this subject states, "mast cell tryptase, an enzyme released by mast cells that is associated with inflammation, was found to be four times higher in subtype 1 rosacea skin than in TP skin, and 25 times higher than in the control group. Rosacea skin also showed significantly more evidence of matrix remodeling, a skin damage process leading to greater vasodilation." [1] It should be noted that the subtype classification of rosacea has been improved with the new phenotype classification so that Subtype 1 has been split into two distinct phenotypes, Phenotype 2 and Phenotype 3. End Notes [1] New Study Defines Rosacea and Damage From the Sun Posted: 06/15/2015, NRS Weblog
  13. Admin

    Is Coffee A Rosacea Trigger?

    A more recent study concludes: "Increased caffeine intake from coffee was inversely associated with the risk of incident rosacea. Our findings do not support limiting caffeine intake as a means to prevent rosacea. Further studies are required to explain the mechanisms of action of these associations, to replicate our findings in other populations, and to explore the relationship of caffeine with different rosacea subtypes." See end note 3 in the first post of this thread for the source.
  14. Admin

    Is Coffee A Rosacea Trigger?

    Coffee is Not a Rosacea Flareup Trigger First off just remember that whenever you hear about rosacea triggers that usually the list of triggers haven't been substantiated in any clinical studies and most of the triggers are simply anecdotal reports. However, one trigger has been substantiated that should be removed from the list and this trigger is coffee. It is not a rosacea trigger and coffee lovers can rejoice. The NRS lists coffee as a trigger [1] and as a result many physicians believe this and pepetuate this misconception by telling their patients to avoid coffee. As a result rosaceans believe that coffee is a rosacea trigger when it is not. Actually the NRS says that the trigger is HOT beverages such as coffee. It would be just as valid to add to the NRS list HOT WATER! But thankfully the confusion is cleared up due to the only known rosacea trigger that has ever been actually studied in a clinical report (1981) which reports hot coffee is no more a rosacea trigger than hot water so what you need to be careful about is drinking HOT beverages to avoid a flush. [2] There is no evidence that coffee or caffeine causes a rosacea flareup. In fact, one study concluded the following: "Increased caffeine intake from coffee was inversely associated with the risk of incident rosacea. Our findings do not support limiting caffeine intake as a means to prevent rosacea. Further studies are required to explain the mechanisms of action of these associations, to replicate our findings in other populations, and to explore the relationship of caffeine with different rosacea subtypes." ]3] Difference Between a Rosacea Flareup Trigger and a Flushing Trigger There is a difference between a rosacea flareup trigger and a flushing trigger. To understand the difference read this article. Coffee a Flushing Trigger There is evidence that coffee is a flushing trigger. Rosacea LTD IV has a page, Your Red Face May be Caused by Caffeine Intoxication. File This Under Unfair: Your Coffee Habit May Be Causing Your Hot Flashes, Prevention, By CAROLINE PRADERIO What are the Side Effects of Caffeine?, verywell, By Elizabeth Hartney, PhD states, "Flushed Face -- a red face at work might make you look embarrassed, and can be embarrassing!" "Hot coffee is the most problematic source of hot flashes because you are dealing with two triggers, a hot beverage and caffeine." Caffeine & Hot Flashes by DORIE KHAN, Livestrong End Notes [1] See the NRS 'Official' Trigger List lists coffee under Beverages > Hot Drinks > Coffee : http://www.rosacea.org/patients/materials/triggers.php [2] Oral thermal-induced flushing in erythematotelangiectatic rosacea. Wilkin JK; J Invest Dermatol. 1981 Jan;76(1):15-8. The effects of caffeine and coffee, agents widely alleged to provoke flushing in patients with erythematotelangiectatic rosacea, were investigated. Neither caffeine nor coffee at 22 degrees C led to flushing reactions. Both coffee at 60 degrees C and water at 60 degrees C led to flushing reactions with similar temporal characteristics and of similar intensities. It is concluded that the active agent causing flushing in coffee at 60 degrees C is heat, not caffeine. [3] JAMA Dermatol. 2018 Oct 17. doi: 10.1001/jamadermatol.2018.3301. Association of Caffeine Intake and Caffeinated Coffee Consumption With Risk of Incident Rosacea In Women. Li S, Chen ML, Drucker AM, Cho E2,5,6, Geng H, Qureshi AA, Li WQ.
  15. Thanks Apurva, and also thanks for your article on co-existence.
  16. Hi Apurva, I was reluctant to download a docx file since it is an odd way of posting instead of simply copying and pasting your document into the post? I checked to see if your file contained any viruses or malware by using VirusTotal and it passed, so I opened the file and I am copying and pasting your article here for the benefit of everyone else not having to go through this process. It might be best to simply write your posts. Here is the contents of your article below: begin article___________ Co-existence of Rosacea, Seborrheic dermatitis and Blepharitis There have been a lot of reports on accounting other chronic skin conditions with rosacea and it is true that you can have multiple conditions simultaneously with rosacea. I have experienced rosacea, seborrheic dermatitis and blepharitis together with the combination of erythema and telangiectasia. The very first time this condition appeared as a lesion on half part of nose and cheek and then covered the other part of the face with having scaly torn skin and inflamed eyes. After years of my experience and dealing with these conditions, the symptoms include : Swollen flushed skin, visible dilated blood vessels with stinging and burning sensation on face. SD can cause skin scaly and flaky and can burn with itch and appears mostly on front hair line,forehead and eyebrows that if you itch the flaky and crusty skin falls off like dandruff. Blepharitis usually involves upper eyelid and causes inflamed eyelids, teary red eyes and the most important visual aspect is greasy dandruff like scales form on eyelashes covering half of it. The conditions can go beyond your cheeks and nose and affect earlobes and chin area and can cause flaky and rough chin area with small bumps. The flare ups can last anywhere from few minutes to one day or to one month and they again come back but when it goes you can feel the temperature decrease but it can leave red bumps that looks like acne but gradually the red appearance goes with time but it waxes and wanes. Co-existence : The occurrence of other chronic inflammatory diseases like seborrheic dermatitis and blepharitis are common in patients with rosacea and the good news is, the treatment of other condition does not aggravate the signs and symptoms of rosacea and lessen the flare ups in the meantime. Blepharitis is an inflammation of the eyelids in which the base of the eyelids are swollen and red and flaky greasy like crusts occur around the eyelashes with frequently mildly sticking eyelids and flaky dandruff of eyebrows sometimes called seborrheic blepharitis.(1) It is reported that demodex can worsen the condition of rosacea but it can also aggravate the condition of seborrheic blepharitis.(2) SD can typically occur as rash on the face and a sheet of lesion on back and middle chest area and middle and underneath breast lines. The underlying cause of seborrhoeic dermatitis is not clear, but a type of yeast called Malassezia furfur is involved.(3) I will emphasize these conditions thoroughly in later posts but for now I will explain the treatment I had with these three conditions : When my doctors diagnosed these three conditions, first they prescribed me low dose oral doxycycline capsules (100mg) daily at night. 1. Doxycycline is an antibiotic used for treating bacterial infections.The drug is also sold under the brand names Oracea, Doryx, Monodox, Periostat, and Vibramycin. Doxycycline is in a class of medications called tetracyclines, and it's a broad-spectrum antibiotic, it works against a wide range of bacteria.This medication is used to prevent malaria and treat a wide range of infections, including: skin infection.(4,5) Side effects: stomach upset, constipation, nausea, heavy head. 2. You can apply topical metronidazole gel 0.75% on the affected skin area. Apply a thin layer of gel once or twice daily.I used to apply once at night daily. It is an antibiotic and it works by decreasing redness and inflammation by stopping the growth of certain bacteria and parasites.This antibiotic treats only certain bacterial and parasitic infections. It will not work for viral infections. (6) Side effects : burning and eye irritation if it gets close to the eyes. 3. Ketoconazole 2 % and Zinc pyrithione 1 % (Shampoo) for the fungal and yeast infections of the skin. Ketoconazole an active ingredient works by interfering and weakening with the formation of the fungal cell membrane. It better works with seborrheic dermatitis and blepharitis. Thoroughly apply on wet hair and massage and leave it for 5 minutes and then rinse it out. It does not make lather like other shampoos. Take a drop on finger, rub it and apply gently on eyelashes on tightly closed eyes and rinse it properly. With 8 weeks of proper use twice in a week completely cured me with SD and blepharitis. Side effects : itchy and dry scalp 4. If you have dermatitis on your chest and breast lines and back, you can use the composition of Boric acid and Clotrimazole cream together. It works by reducing inflammation and inhibiting the growth of fungi. Apply a thin layer of this base and rub until it absorbs completely twice or thrice daily. I applied this on my front and back area for four to five days and it worked wonder and the lesions gradually disappeared. Note : before taking any above medication consult your doctor or physician and alcohol should not be consumed during any medication it can worsen the condition of rosacea and if you are pregnant or on breast-feeding and any other condition like diabetes or heart problem, take this medications as directed by your doctor. Instead relying on oral and topical steroids my doctor prescribed me with bacterial and fungal medications because taking steroids for SD and blepharitis can exacerbate the condition of rosacea and relying on antibiotics and anti-fungal treatments can lessen the condition of SD and blepharitis and keep the rosacea at bay. References : https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/blepharitis.(1) http://eyewiki.aao.org/Blepharitis.(2) http://www.londoneyeunit.co.uk/services/blepharitis/.(3) https://www.everydayhealth.com/drugs/doxycycline.(4) https://www.webmd.com/drugs/2/drug-8648-7073/doxycycline-hyclate-oral/doxycycline-oral/details.(5) https://www.webmd.com/drugs/2/drug-6426/metro end article_________________
  17. Admin

    Treatments for Demodex Skin Mites

    Thanks so much for your post, very detailed and informative and without a doubt will help many.
  18. Leo Pharma has announced it is purchasing Finacea, as well as other dermatological treatments from Bayer according to this news release.
  19. Nasdaq reports "Aclaris Therapeutics to Acquire Worldwide Rights to RHOFADE® from Allergan." Aclaris originally owned Rhofade and sold it to Allergan and is now buying it back.
  20. Admin

    ZOSSO, aka ZZ Cream

    Besides still taking the Lutein/Zeazanthin treatment, I use the ZZ cream about four or five nights a week on some red spots, however, in addition, before I do apply the ZZ cream, I have been applying a small amount (half teaspoon) of 3% hydrogen peroxide from Walmart (57 cents a bottle) to some red spots and let this dry before applying the ZZ cream. I have noticed when applying the 3% hydrogen peroxide it doesn't sting but after it dries and deeply penetrates the skin I get some stinging which is odd to me but indicates it is finding something down deeper in my skin to work on. The results have been good so I am updating my photos below today:
  21. Please post your experience with the ZZ cream in this thread. Zinc Oxide Sulfur Sublimate Ointment (ZOSSO), aka Z Cream, ZZ Cream, Zhongzhou Cream
  22. Admin

    Rosacea: Beyond the visible

    smart2005ct, That is such good news you are seeing Percy Lehmann, MD, who volunteers on the RRDi MAC. Keep us posted on your progress.
  23. Galderma has released a report, Rosacea: Beyond the visible, which is an "An open letter to doctors treating rosacea," answering seven questions proposed about treating rosacea. Galderma sponsored a 'global survey of rosacea burden' of 710 rosaceans and 554 doctors which is used as data for the report with the stated goal of achieving total clearance (IGA 0). The report acknowledges, "Although we can’t yet promise ‘clear’ to all people, current treatments are now getting more people to ‘clear’, with combined therapy or even with monotherapy. By aiming for ‘clear’ (IGA 0) we can help free more people from their rosacea burden." One statement that explains rosacea best in the report is, "Ultimately, rosacea is a subjective and entirely individual experience." While we try to categorize rosacea into phenotypes and treatment protocols, there is no one treatment that works for everyone.
  24. Please read this notice about Subtypes NOTE This controversy existed since 2002 when the NRS proposed a subtype classification of rosacea. In November 2016 the RRDi endorsed the Phenotype classification of rosacea. Galderma acknowledged the phenotype classification about a year later. In November 2017 the NRS has now moved forward with classifying rosacea into phenotypes and published a paper recognizing phenotypes. [10] This article remains to explain why this controversy existed but the subtype controversy is no longer worth debating since we have moved into this new direction diagnosing rosacea into phenotypes, which has proved superior to the subtype classification. There is no controversy with the phenotype classification of rosacea. However, for those who want to learn why we have moved away from the subtype classification you may read the article below to understand the history of the subtype controversy. The RRDi recognized Neurogenic Rosacea as a subtype of rosacea in 2011, but now recognizes it as a rosacea variant. In 2010, a report by the ROSIE [ROSacea International Expert] Group reports that, “Classification of rosacea into stages or subgroups, with or without progression, remained controversial.”[1] This ROSIE group is comprised of “European and US rosacea experts.” Two of the experts in the group are MAC members of the RRDi, Dr. Draelos and Dr. Jensen. The report, was released by J Eur Acad Dermatol Venereol and said, "the ROSIE group proposed that therapy decision making should be in accordance with a treatment algorithm based on the signs and symptoms of rosacea rather than on a prior classification." This prior classification of rosacea into subtypes and one variant was released by the National Rosacea Society in 2002 by an 'expert committee.' [2] The ROSIE group report concluded: "The group suggested a rational, evidence-based approach to treatment for the various symptoms of the condition. In daily practice this approach might be more easily handled than prior subtype classification, in particular since patients often may show clinical features of more than one subtype at the same time." [1] This is not a new controversy. The late Albert Kligman, a noted expert on rosacea, stated in 2003 about the NRS classification of rosacea into four subtypes and one variant: ”In my view this is a vast oversimplification which will not solve the diagnostic dilemmas that confront us. I see no reason not to give equal nosologic status to granulomatous rosacea, rosacea conglobata, rosacea inversa (formerly called pyoderma faciale), rosacea fulminans, edematous rosacea (a devastating variety) or combinations with seborrheic dermatitis, lupus erythematosus, acne vulgaris, and still other variants. Reducing the classification to four sub-types does little to clarify and eliminate the inherent complexities of this mysterious disease.” [3] Dr. Kligman passed away in 2010. Another report released after the ROSIE group report mentioned above had this remark about how a ‘proper standardization’ is needed: “It is to be remarked that the quality of most studies evaluating rosacea treatment is rather poor, mainly due to a lack of proper standardization. For a major breakthrough to occur in the management of rosacea, we need both a better understanding of its pathogenesis and the adherence of future clinical trials to clearly defined grading and inclusion criteria, which are crucial for investigators to correctly compare and interpret the results of their work.” [4] This controversy is simply because the NRS subtype classification is based not on nosology but rather on morphology." Nosology (from Ancient Greek νόσος (nosos), meaning "disease", and -λογία (-logia), meaning "study of-") is a branch of medicine that deals with classification of diseases. Diseases may be classified by etiology (cause), pathogenesis (mechanism by which the disease is caused), or by symptom(s).....A chief difficulty in nosology is that diseases often cannot be defined and classified clearly, especially when etiology or pathogenesis are unknown. Thus diagnostic terms often only reflect a symptom or set of symptoms (syndrome)." Wikipedia No doubt this controversy will continue until more is known about the cause of rosacea. What is the morphology of rosacea? Morphology in biology deals with the outward appearance (shape, structure, colour, pattern) as well as the form and structure as opposed to physiology which deals with the function of an organism. The NRS 'expert committee' said in its initial report on this classification of rosacea into subtypes and one variant: "As knowledge increases, it is hoped that the definition of rosacea may ultimately be based on causality, rather than on morphology alone." [2] So this was a start into everyone being on the same page when it comes to diagnosing rosacea. And the NRS 'expert committee' concluded in its report: "This investigational instrument is intended to set the stage for a better understanding of rosacea and its subtypes among researchers and practitioners by fostering communication and facilitating the development of a research-based classification system. As a provisional standard classification system, it is likely to require modification in the future as the pathogenesis and subtypes of rosacea become clearer, and as its relevance and applicability are tested by investigators and clinicians. The committee welcomes reports on the usefulness and limitations of these criteria." [2] The future is here and the ROSCO panel has moved the classification in a superior direction. [8] Since the jury is still out on what exactly is causing rosacea and the fact that rosacea's definition is still controversial amongst the medical community, we need to keep an open mind about what constitutes rosacea. What is puzzling is that the NRS 'expert' committee excluded three rosacea mimics as variants of rosacea: Rosacea fulminans, Steroid-induced acneiform eruption, and Perioral dermatitis. The committee has their reasons for this and said: "The committee noted that certain disorders may have been prematurely identified as associated with rosacea or as a variant of rosacea, and for clarity should be recognized at this time as separate entities. There is insufficient basis at present to include the following conditions as types of rosacea." [2] The RRDi classifies these as rosacea variants. What is puzzling is the NRS absolutely makes no mention of demodectic rosacea as a rosacea variant, while the RRDi does. In 2011 a new group of physicians have proposed a new subtype of rosacea called Neurogenic Rosacea. A paper published in Europe had this to say about this subject: "The classification of rosacea into stages or subtypes, without considering the possibility of progression from one to another, will probably remain controversial until additional knowledge on the pathophysiology of rosacea is obtained." [5] So if in the future we learn that rosacea is caused by a single entity or by several different entities or in combination we might have a completely different classification system or one similar but based upon 'causality' rather than morphology. And most important is that we certainly need more knowledge about rosacea. Until then, diagnosis of rosacea sometimes results in misdiagnosis and continues to be mysterious and bewildering. Dr. Frank Powell, at the 2012 annual meeting of the American Academy of Dermatology, is reported to have said that the subtypes in rosacea may be different conditions. [6] ROSCO Panel In 2016, the ROSCO panel wrote, "The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype." [7] “Given the overlap of rosacea features across subtypes and the fact that no single treatment completely addresses all rosacea features, the current approach of diagnosing and treating rosacea by subtype may hinder individualised patient management. A new approach is needed to bring us closer to helping each and every rosacea patient receive the right treatment according to their signs and symptoms.” Jerry Tan, MD [8] “While the rosacea management landscape has advanced, the current subtype-based view of the disease can hinder progress by limiting the way we consider treatment options. These new ROSCO recommendations should help to make a positive impact on future treatment development and ultimately help improve the lives of people with rosacea through a symptom-led approach.” Esther J. van Zuuren, MD [8] "The panel agreed on phenotype-based treatments for signs and symptoms presenting in individuals with rosacea." [9] The ROSCO panel doesn't discuss rosacea variants. RRDi Endorses the ROSCO Panel The RRDi has endorsed the phenotype based treatment diagnosis proposed by the ROSCO panel in November 2016, the first non profit organization for rosacea to do this. Please read this notice about Subtypes End Notes [1] Rosacea – global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group Elewski BE, Draelos Z, Dréno B, Jansen T, Layton A, Picardo M. J Eur Acad Dermatol Venereol. 2010 Jun 23. Full Text Available [2] Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea Wilkin J, Dahl M, Detmar M, Drake L, et al. Journal of the American Academy of Dermatology April 2002 • Volume 46 • Number 4 • 2002;46:584-587. [3] A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman, M.D., Ph.D. [4] Rosacea Treatments: What’s New and What’s on the Horizon? Gallo R, Drago F, Paolino S, Parodi A. Am J Clin Dermatol. 2010;11(5):299-30 [5] Clinical presentations and classification of rosacea. Jansen T. Department of Dermatology, Venereology and Allergology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. Ann Dermatol Venereol. 2011 Nov;138 Suppl 3:S192-200. [6] Research suggests rosacea subtypes may be different conditions Dermatology Times, Dec 1, 2012, John Jesitus [7] Br J Dermatol. 2016 Oct 8. doi: 10.1111/bjd.15122. [Epub ahead of print] Updating the diagnosis, classification and assessment of rosacea: Recommendations from the global ROSacea COnsensus (ROSCO) panel. Tan J, Almeida L, Bewley A, Cribier B, Dlova N6, Gallo R, Kautz G, Mannis M, Oon H, Rajagopalan M, Steinhoff M, Thiboutot D, Troielli P, Webster G, Wu Y, van Zuuren E, Schaller M. [8] ROSCO Panel Recommends New Approach on Rosacea Diagnosis by Phenotype [9] Br J Dermatol. 2016 Nov 12. doi: 10.1111/bjd.15173. Rosacea treatment update: Recommendations from the global ROSacea COnsensus (ROSCO) panel. Schaller M, Almeida L, Bewley A, Cribier B, Dlova N, Kautz G, Mannis M, Oon H, Rajagopalan M, Steinhoff M, Thiboutot D, Troielli P, Webster G, Wu Y, van Zuuren E, Tan J. [10] Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee
  25. I have said it before and I will continue to say it again, self-diagnosis of rosacea is not a good idea. Physicians, particularly dermatologists, are trained and educated in the art of diagnosis and should be the ones to determine a diagnosis of rosacea. There really are no substitutes. You may want to consult other health care professionals as well for rosacea, but diagnosis of rosacea is reserved for physicians . Please get a diagnosis. The problems with rosaceans and physicians have become public knowledge posted all over the internet and are listed here for your information and consideration to resolve these issues. It is important to work together with a physician in determining an accurate diagnosis and a personal treatment regimen for your skin problem. What matters need to be identified and resolved? Trusting a physician, communicating with a physician and following up with your physician’s treatment. Trusting & Communicating with your Physician A typical initial visit with a dermatologist begins with making an appointment usually weeks in advance, sometimes months. In the meantime, a rosacean (or one who thinks rosacea is the problem or hasn’t a clue what is going on with his/her skin) is reading as much information on rosacea on the internet or by reading this book or other books, asking everyone, trying whatever non prescription , over the counter, products and methods one thinks might work or is suggested by well meaning friends. This sufferer reads about rosacea and has determined that it must be rosacea or it may be possible that the sufferer has no idea what skin condition is the problem. Finally the day arrives to visit the dermatologist. One must wait in the waiting room for what seems like an eternity with other patients who obviously have their own skin issues. You are ushered into an exam room where a nurse or other assistant takes a brief history and may take some vital signs and records everything and your chief complaint. You wait some more. Finally, after what seems like another eternity, the physician enters the room and spends maybe 10 minutes with you, explains to you that you have rosacea, gives you some samples to try, hands you a prescription and tells you to make a follow-up appointment. [1] The physician rushes off to the next exam room. You are left stunned. If this is the first time you have ever heard of rosacea, you are a bit more stunned than those who have read this book. You may no doubt relate to this initial first visit with a physician. Rosaceans who experience this are a bit upset at the lack of patience, empathy and compassion for rosacea patients. It is not to say that all physicians are like this, but this experience of an initial visit is typical. Complaints of the lack of physician empathy for rosacea is common among the various rosacea support groups and forums. There may be several reasons why this happens, but first and foremost is to understand the physician’s point of view. Rosaceans tend to be self-centered, and that is understandable, since after all, we are the ones suffering with rosacea. Rosacea is a very confusing and debilitating disease. It changes your life forever. Rosaceans come to a physician for comfort, help and treatment and want some compassion, understanding and communication. But wait a minute. Think about it. Remember, we are coming to a physician for help. We need to make it possible for the physician to listen to us, but at the same time we need to keep our minds open to what the physician may tell us. Knowing the physician’s point of view will help you establish better communication, trust and hopefully better treatment. Follow up visits will be better and you will look forward to the visit rather than dreading it. Becoming a physician is not an easy task. The medical schools make physicians go through some hoops and hurdles that many just simply would not even attempt. Generally speaking, physicians are very dedicated, hard workers and usually have higher IQs than the general public. It would be a mistake to think otherwise, since if this is not true, then we are certainly at a loss. I like to think that physicians who have attained to being a licensed medical doctor are more knowledgeable than me on rosacea. This entitles them to some respect, whether you agree with a physician or not. You can disagree with respect. The two initials behind their name, M.D., gives them the title doctor. It would be wise to recognize, honor and respect their office of appointment as a practitioner of medicine. Rosaceans who treat their docs with disrespect will not get very far with physician treatment. It is important for rosaceans to give their doctor the honor they deserve that goes with the title and this alone will improve communication better than all the other tips on how to win friends and influence doctors. With the advent of lawyers, physicians have to cover themselves with malpractice insurance that affects patient care since one of the chief concerns of a physician is whether or not it is possible to keep practicing medicine in such a litigious world. You may not think this is important to your care but this affects physician care of a patient. It would be good to understand that it isn’t easy to care for patients when a patient could turn on a physician and bite him. Physicians may be very careful when approaching a new patient who may be a rattlesnake. Because of the nature of rosacea and psychology (see Chapter 6, Psychology and Rosacea) rosaceans tend to be frustrated, upset, angry, confused, disappointed, depressed, and possibly aggressive. While the physician should be aware of the psychology factor in rosacea, a rosacean needs to understand what the point of view of the physician is on this subject. While one physician understands the psychological factors in rosacea, another physician may dismiss these factors as minimal, which explains the physician’s behavior. Physicians are usually very busy, with a huge patient load with other patients who are suffering horrible skin conditions, which, by the way may be worse than your rosacea [or whatever skin condition you may suffer]. A physician may prefer to refer a patient with psychological rosacea issues to an expert dealing with such problems, like a psychiatrist or a psychologist. Find out how his point of view is on this matter if you are feeling upset at a physician’s bed side manner. Besides, the physician has treated rosacea before and for the first visit, this is what is done. Now if you have been to other physicians before, this takes on a whole list of other reasons why it is so important to understand the physician’s point of view on the initial visit. Did you explain to the physician that you have been to another (or possibly other physicians ) for this problem? The physician has a right to know what you have done before coming to him, doesn’t he? The only way to understand what the physician’s point of view (POV) is to ask. For example, you might ask him, ‘Doc, are you really busy today to answer my questions?’ Or how about, ‘Doc, I see that you are in a rush and need to tend to other matters, but could you answer just a few of my questions or would it be better to make an appointment later to help me understand some matters that are important to me?’ If the physician has the time you might want to point out how you are feeling about your rosacea, i.e., the frustration, anger or depression that accompanies rosacea. You might be surprised at what the doctor’s point of view is if you respect his and take into account that a physician has a right to his own point of view. The physician may have more empathy with your point of view if you have empathy for the physician’s POV. When making an appointment with a physician for an initial visit and you want questions answered, it would be good to explain to the one whom you make the appointment with that answers to your questions are important and want sufficient time for the physician to answer your questions. This might go a long way to help the doctor understand your needs. If you present yourself as knowledgeable on the subject of rosacea this can present some problems. After all, the physician has gone to medical school specializing in dermatology and you begin spouting out some rosacea knowledge to the physician, what do you think the physician’s point of view is of you telling him about rosacea? Remember, you came to him for advice, treatment and help? Rosaceans should want to build a good relationship with the physician and presenting yourself as more knowledgeable about rosacea than the physician tends to destroy the relationship considering that you are paying him for his advice, diagnosis, analysis, prescription and treatment. If you preface a comment about your knowledge of rosacea with, ‘You probably know more about this than I do, but could you answer my question about [whatever]?’ will go a lot further to establishing a good relationship with your physician than belittling a physician or coming across that you know more than the physician about rosacea, which may not be true at all. After all, consider what the physician must know to differentiate rosacea from other skin conditions. The list of rosacea mimics and other skin conditions and diseases that requires a differential diagnosis from rosacea taxes most physicians . To conclude that a physician doesn’t know as much as he should about rosacea is a bit judgmental, wouldn’t you agree? A physician’s job can be at times quite demanding and overwhelming. With the patient load and who knows what else is happening in a physician’s life, if we come across like know-it-alls about rosacea, do you really expect a physician to go along with such disrespect? Maybe a physician prefers to dismiss such a patient quickly and move on to one who appreciates his services more? “Dermatologists need to ask their patients about their use of all medications including herbs, vitamins and supplements, according to Dr. Wu. “I suggest taking an extra five or 10 minutes to find out what your patients are using on their skin in addition to what you’re prescribing for them.” [2] Also it is important for the patient to discuss everything with their physician. A NRS survey reveals that "72 percent of patients said that they never discussed the unseen symptoms of rosacea — such as burning, stinging and itching — with their doctor." [4] Rosaceans should build bridges with their physicians , not tear them down. Usually when a rosacean visits a physician it is because everything else simply doesn’t work. It is the last resort, sort of like when one visits the dentist. So, instead of concentrating on what you think the physician should do, try to listen to his suggestions. The physician may be right. During the initial visit you should explain to the physician what other treatments you may be doing for your rosacea, i.e., natural treatments, over the counter products, herbal remedies, vitamins , supplements, diet, whatever. It is very important to explain to your physician if you have visited any other physician for rosacea before visiting him. The physician has a right to know what you have done for your rosacea before seeing him. “Due to the fact that many patients fail to inform their physicians about their use of herbal ingredients, dermatologists should be aware of what patients may be using and be able to advise them about the efficacy of these ingredients or the potential for adverse effects.” [3] This is especially true when you consider the synergistic effect of multiple treatments for rosacea. You physician deserves to know what you are currently doing to control your rosacea, even if it hasn’t been working. He may advise you to stop all other treatment and follow his treatment regimen or may explain that what you are doing is just fine and to continue it. But the physician needs to know. Follow up Visits Basically, whatever the physician suggests you do, usually a follow up visit is made. That is why the physician asks you to set up an appointment before you leave the office. This is done to follow up whether the treatment suggested is working. Why? Because not all treatments work for every rosacean. (See Appendix X—X Factor [Rosacea 101 book]) You have to be the judge whether to continue a treatment suggested if it is making your rosacea worse. There are some treatments for rosacea that initially make matters worse before it gets better, i.e., Soolantra. You should ask your physician whether or not the treatment he is suggesting will make it worse before it gets better so you will know what to expect. However, if it continues to get worse, you will have to be the judge as to when to stop the treatment and report back to the physician at the follow up visit what exactly happened. The follow up visit may include new treatment to follow. This is not unusual for a rosacean to receive several treatment regimens before finding one that controls your rosacea. Finding a Physician Finding a physician who is knowledgeable with rosacea and has a record of happy rosacea patients is the dream of all rosaceans who use physicians to treat their rosacea. Many of the forums and rosacea support groups offer suggestions or recommendations of physicians they have used and some report whom not to use. Word of mouth has always been the best source of whether a physician is recommended. Understanding Diagnosis of Rosacea It would be good to also understand what is involved in diagnosing rosacea. Click here for a report on this subject. You may want to print the following published paper and bring this with you to your dermatologist to give him a copy: Forum for Nord Derm Ven 2017, Vol. 22, No. 1Rosacea: Time for a New Approach • Rosacea-Time-for-a-New-Approach.pdfCARSTEN SAUER MIKKELSEN, PETER BJERRING, MARGARETA LIRVALL, MARGARETA SVENSSON, HELENE RINGE HOLMGREN, ALEXANDER SALAVA AND THEIS HULDT-NYSTRØM An educational supplement published in DermatologyTimes sponsored by Galderma, Best_Practices_in_the_Treatment_of_Rosacea.pdf, is another article for your consideration. End Notes [1] For anecdotal reports of a five minute or less diagnosis of rosacea click here. [2] Herbal therapy for rosacea Some herbs help, others hinder patient’s condition By: Jane Schwanke, Dermatology Times, Nov 1, 2006 [3] J Drugs Dermatol. 2006 Jan;5(1):29-32. Treatment of rosacea with herbal ingredients. Wu J: J Drugs Dermatol. 2006 Jan;5(1):29-32. [4] Survey Reveals Gaps in Doctor-Patient Communication, NRS Posted: 07/30/2018 [5] Rosacea: Beyond the visible Addendum David Pascoe has an article, Make your Doctor a Rosacea Expert, which is related to this subject.