Guide

Rory, Once you have tasted sugar in all its different forms, whether high fructose corn syrup or sucrose, etc., it is a difficult habit to break. However, our ancestors before the 18th century never ate as much sugar as the average human does today. I like the way The Sugar Buster! authors put it this way on page 36–37 of their book, “… Pro-sugar lobbying by sugar growers, cola manufactures and the packaged-food industry has been very effective in influencing our government. What politician wants to tell his constituents they should no longer eat sugar ?” (I quote this in my book, Rosacea 101, Chapter 26, page 100, however, I have posted the entire chapter here for your enjoyment). As I point out in my chapter about sugar and rosacea in my book, sugar is big business. Science is in bed with the sugar industry. However as you have pointed out, in the last ten years there are way more articles and data to substantiate that sugar is really bad for health and to limit its intake drastically to improve health. I have listed such articles in this area of the forum with links to such data: Carbohydrate & Sugar Avoidance and in the articles section of the site here: Carbohydrate Trigger Avoidance Also in my book, Rosacea 101, Appendix U. page 225, I wrote the following about Diet and Acne: Diet and Acne There is evidence that diet plays a role in acne according to the following report two reports: Report 1 “Although the pathogenesis of acne is currently unknown, recent epidemiologic studies of non-Westernized populations suggest that dietary factors, including the glycemic load, may be involved,” write Robyn N. Smith, MD, from RMIT University in Melbourne, Australia, and colleagues. “Recently, there has been a reappraisal of the diet and acne connection because of a greater understanding of how diet may affect endocrine factors involved in acne.… Hyperinsulinemia has been implicated in acne pathophysiology because of its association with increased androgen bioavailability and free concentrations of insulin -like growth factor I (IGF-I).… … It has been postulated that the frequent consumption of high carbohydrates lead to hyperinsulinemia. Hyperinsulinemia has been implicated in acne pathophysiology because of its association with increased androgen bioavailability and free concentrations of IGF-I.”594 Report 2 “During the course of the last 30 to 40 years, a general consensus has emerged within the dermatology community that diet has no role in the etiology of acne … Given the dogma in current dermatology textbooks, it might be assumed that there has been a long and well-established literature conclusively demonstrating that diet and acne are unrelated and that the 2 articles most frequently cited as definitive evidence against the diet/acne hypothesis merely represent capstone studies that confirm previous observations and conclusions. In actuality, both assumptions have little factual basis. Two reviews of the diet/acne literature covering 80 references and spanning 66 years from 1906 to 1972 clearly demonstrate the inconclusive and conflicting nature of the historical literature. Examination of many of these early studies shows them to be rife with contradictory results and conclusions due in part to numerous limitations of study design, such as the lack of control groups, inadequate sample size, no statistical treatment of data, the lack of blinding and/or placebos, and inadequate or no baseline diet data, as well as imprecise and inconsistent measurement procedures commonly seen in early, developing technology. Furthermore, most early investigators did not have the benefit of research elucidating the endocrine mechanisms underlying acne’s pathogenesis, let alone its molecular underpinnings. Accordingly, they commonly did not examine etiologic variables we now understand to be important. In summary, there is little substantive evidence in the historical literature that conclusively supports or refutes the role of diet in the etiology of acne. page 226 A MEDLINE search revealed that, since 1971, no single human study has been published examining the role of diet in the etiology of acne … Over the course of the past 50 years, the major proximate causes of acne have been well-described. Despite this knowledge, the following quote is representative of the state of affairs regarding acne’s ultimate cause: “despite years of research, the basic cause of acne remains unknown …” To understand how diet may influence the development of acne, it may be useful to first review: (1) the range of lesions within acne’s umbrella designation, (2) the epidemiology of the disease, and (3) the widely recognized proximate causes of acne.… Acne is believed to develop from the interplay of 5 major pathogenetic factors: (1) increased proliferation of basal keratinocytes within the pilosebaceous duct, (2) incomplete separation of ductal corneocytes from one another via impairment of apoptosis and subsequent obstruction of the pilosebaceous duct, (3) androgen-mediated increases in sebum production, (4) colonization of the comedo by Propionibacterium acnes, and (5) inflammation both within and adjacent to the comedo … A significant body of evidence now exists demonstrating that diet influences a number of hormones that regulate both keratinocyte proliferation and corneocyte apoptosis … Highly glycemic and insulinemic foods are ubiquitous elements in western diets and comprise 47.7% of the per capita energy intake in the United States … that high glycemic meals in normal male subjects significantly (P 0.05) elevate day-long plasma insulin concentrations. Further, numerous studies as summarized by Ludwig46 and Liu and co-workers47 establish that chronic consumption of high glycemic load carbohydrates may cause long-term hyperinsulinemia and insulin resistance … Hence, elevations in the free IGF-1/IGFBP-3 ratio promote keratinocyte proliferation through at least 2 primary pathways. The development of hyperinsulinemia and insulin resistance elicits a pathological rise in serum concentrations of nonesterified free fatty acids (NEFAs), which in turn has been shown to cause over expression of the EGF receptor. For acne patients, consumption of low glycemic index diets may be therapeutic not only because of their beneficial effects on insulin metabolism but also because these diets are known to reduce plasma NEFA, which may influence keratinocyte proliferation and differentiation via the EGF receptor pathway … Sebum production is stimulated by androgens, and, when excessive, can be pathogenetically involved in the development of acne. Accordingly, hyperinsulinemia may promote acne by its well-established androgenic effect … The final factor involved in the pathogenesis of acne is inflammation of the dermis surrounding the 3 types of inflammatory acne lesions (papules, pustules, and nodules). Inflammation of the dermis is primarily thought to be caused by an immunological reaction to P. acnes, an anaerobic Grampositive bacterium, which colonizes the sebum-rich environment of the closed comedo. Certain agents (peptidoglycan–polysaccharides) within the cell wall of P. acnes may directly induce the expression of proinflammatory cytokines (tumor necrosis factor alpha, interleukin [IL]-1, and IL-8) from peripheral blood monocytes (PBMs) in a dose-dependent manner. Increased concentrations of these cytokines can stimulate other inflammatory mediators, including prostanoids and leukotrienes. It has been suggested that overproduction of inflammatory cytokines by PBMs in response to P. acnes may underlie the development severe inflammatory acne … Dietary interventions using low glycemic load carbohydrates may have therapeutic potential in the treatment of acne because of the beneficial endocrine effects these diets possess. A large interventional study page 227 has demonstrated that diets rich in low glycemic foods reduced serum testosterone and fasting glucose while improving insulin metabolism and increasing SHBG …”595 Since the role of diet in acne has now been clearly established there is without a doubt a clear connection of diet playing a role in rosacea as well. Eventually similar studies will be published showing the role diet plays in rosacea. the endnotes refer to the reference the quote is taken from (if you need these, let me know) I know this really isn't good news to a rosacea sufferer, but the fact is, sugar is really bad for your health and it is the fuel that is burning rosacea. Cut back the fuel and the fire reduces dramatically.

Rory, Have you seen the following? There is evidence that sugar is connected to acne. A NY Time article discusses this connection. The article refers to the following study: Journal of the American Academy of Dermatology Volume 57, Issue 2, August 2007, Pages 247–256 The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial Robyn N. Smith, BAppSc (Hons), Neil J. Mann, BSc (Hons), BAppSc, PhD, Anna Braue, MBBS, MMed, Henna Mäkeläinen, BAppSc, George A. Varigos, MBBS, FACD, PhD, I posted the above here.

"The real bad news comes for white wine lovers, though: It turns out drinking white wine significantly increased study participants’ risk of rosacea. In fact, drinking five or more glasses a week elevated their risk by 49 percent." Drinking White Wine Can Increase Your Risk Of Rosacea, New Study Shows, Tricia Goss, simplemost

Mild acne. Probably the other factor worth considering is sun damage. I was sun burnt many times when I was a kid and teenager. There is a lot of data suggesting that rosacea is a result of sun damage.

Absolutely. Carbs trigger my rosacea big time. Sometimes I cheat like eating some Häagen-Dazs® Vanilla Ice Cream and zits appear and more redness. I try to keep on a low carb high protein/fat diet. But as anyone who has tried to do this, it is tough to never cheat.

fanugi started a thread at RF asking if there was an alternative to the high cost of Soolantra. One option may be open you is the Galderma CareConnect Patient Savings Card: If you don't qualify here are some other options from anecdotal reports from rosaceans: Tom Busby, extraordinaire senior member at RF, replies in post #2, "the only cheaper alternative [to Soolantra] is Ivomec, which is intended to be injected into farm animals -- it's 1% ivermectin and is non-prescription." However, there are others such as Noromectin, Durvet Ivermectin Paste, Ivermax Parasiticide, Vetrimec, Ivomec Eprinex, Promectin, and the list goes on and on. There are a number of brands of horse paste to consider. Then a lively discussion of several others in the same thread who have tried various ivermectin products for animals showing that there are some willing to go this route to save money and post the results. Post no 24 (rascali) is worth the read. For more information click here

"Allergan, (NYSE: AGN), a leading global pharmaceutical company, announced that Emmy® and Tony® award-winning actress and singer, Kristin Chenoweth will kick off the "Less Red, More You" campaign today at an exclusive event in New York City. As part of the campaign, Ms. Chenoweth, who suffers from rosacea, will ignite a nationwide conversation about the typically underserved condition while raising awareness for RHOFADE™ cream, a new product indicated for the topical treatment of persistent facial erythema associated with rosacea in adults." Kristin Chenoweth Kicks Off 'Less Red, More You' Campaign To Launch RHOFADE™ (Oxymetazoline HCL) Cream, 1%, PR Newswire

"What rosacea? I thought as sat across from Chenoweth. Her skin looked utterly radiant — even glowier than that time I watched her glide across the stage as Glinda in Wicked years ago. She assured me her recent clear skin is a work in progress, courtesy of Rhofade, a new topical prescription cream that's getting a lot of good buzz in the dermatology world." The Real Reason You'll Never Catch Kristin Chenoweth In A Sheet Mask, by KELSEY CASTAÑON, Refinery29

“When I turned 25 something really weird happened, a skin problem. I couldn’t afford to go to a dermatologist at that time [because] I was off-Broadway,” she tells SELF. “I was trying everything over the counter, all the wrong things, like Cortaid on your face.” Eventually, a dermatologist diagnosed Chenoweth with rosacea." Kristin Chenoweth Is Done Hiding Her Rosacea, By Jessica Cruel, Self

"Common of adverse effects seen in our study after applying topical corticosteroids and acne or acneiform eruptions was the most common side effects, similar to other authors’ data. A study showed rosacea to be more common than acne. In our study 89 patients suffered from TSDF, a term coined by Sarasswat A., Lahiri K. et al. Various other adverse effects, such as erythema, telengiectasias, dyspigmentation and perioral dermatitis was also seen." J Dermatol Case Rep. 2017 Mar 31; 11(1): 5–8. Published online 2017 Mar 31. doi: 10.3315/jdcr.2017.1240 PMCID: PMC5439689 Misuse of topical corticosteroids on facial skin. A study of 200 patients. Rohini Sharma,, Sameer Abrol, and Mashqoor Wani

"In conclusion, we have found that LCs are essential for maintaining subbasal nerve health and for regulating ocular surface inflammation in DE disease." PLoS One. 2017; 12(4): e0176153. Published online 2017 Apr 25. doi: 10.1371/journal.pone.0176153 PMCID: PMC5404869 Langerhans cells prevent subbasal nerve damage and upregulate neurotrophic factors in dry eye disease Eun Young Choi, Hyun Goo Kang, Chul Hee Lee, Areum Yeo, Hye Mi Noh, Nayeong Gu, Myoung Joon Kim, Jong Suk Song, Hyeon Chang Kim, and Hyung Keun Lee

"While many people may find their skin gets sensitive and red at times, for people with rosacea these symptoms are more serious and permanent." BEAUTYGLOSSARY: WHAT IS ROSACEA?, Bazaar

Kristin Chenoweth Launches RHOFADE Campaign "Allergan plc, (NYSE: AGN), a leading global pharmaceutical company, announced that Emmy® and Tony® award-winning actress and singer, Kristin Chenoweth will kick off the "Less Red, More You" campaign today at an exclusive event in New York City. As part of the campaign, Ms. Chenoweth, who suffers from rosacea, will ignite a nationwide conversation about the typically underserved condition while raising awareness for RHOFADE™ cream, a new product indicated for the topical treatment of persistent facial erythema associated with rosacea in adults." Kristin Chenoweth Kicks Off 'Less Red, More You' Campaign To Launch RHOFADE™ (Oxymetazoline HCL) Cream, 1%, PR Newswire Image courtesy of Wikipedia Famous Rosaceans

"When treating rosacea, I always prescribe topical agents first and, if necessary, add an oral medication. I wean my patients off of oral medication as soon as possible and use a maintenance topical regimen to keep their skin clear," says Carin H. Gribetz, MD, assistant clinical professor of dermatology at Mount Sinai Hospital in New York. A Side-by-Side Look at the Most Common Rosacea Treatments, by Elizabeth Szaluta, MPH, Medscape

A Link to One Type in Particular Has Been Established. Patients with rosacea often experience flushing and paroxysmal burning of the face and chest—a phenotype termed "neurogenic rosacea." Intriguingly, patients with neurogenic rosacea also may have a higher prevalence of migraines (recurrent headaches and nausea, triggered by light or sound). Graeme M. Lipper, MD, Medscape, News & Perspective > Viewpoints Prevalence and Risk of Migraine in Patients With Rosacea: A Population-Based Cohort Study Egeberg A, Ashina M, Gaist D, Gislason GH, Thyssen JP J Am Acad Dermatol. 2017;76:454-458.

Thought I would update my Soolantra thread. I stopped Soolantra as you can review on February 13. I then got some samples from my dermatologist with the following prescription treatments: Avar-e Green Color Corrective Emolilent Cream (sodium sulfacetamide 10%, sulfur 5%) Ovace Plus Cream (sodium sulfacetamide 10%) Ovace Plus Lotion (sodium sulfacetamide 9.8%) My dermatologist gave me a number of Soolantra samples too! In March, April and through today I would try the above three samples alternatively as well as use Soolantra once in a while (about once a week). I have found that the Avar-e Green seems to work the best for me. However the other day I got a sunburn because I go to the beach and swim just about every day and really got burnt. Not good for rosacea. But I have enclosed some update photos. I will continue to use this thread to post my regimen since I include Soolantra once a week.

I see. I know that low carb/high protein helps control my rosacea. I think that Soolantra works for some just like every other treatment for rosacea. I do think it is worth trying out since so many say it works for them. Soolantra is definitely one of the treatments in the armamentarium for rosacea.

"Rosacea can be referred to as “adult acne” and this is a different entity altogether – rosacea is an inflammatory condition that can cause redness and/or acne-like bumps on the face. It can be triggered by sun exposure, stress, spicy foods and alcohol. There are topical and oral treatment options available depending on disease severity." DocTalk: Dr. Megan Joint, By Katie Green, Observer-Reporter

"“I immediately notice the quality of the skin and hair, which gives me tremendous insight into the patient’s diet and stress levels,” says Whitney Bowe, MD, a board-certified Dermatologist in New York City." This Is the First Thing Your Dermatologist Notices About You BY AUBREY ALMANZA, Reader's Digest

"At the age of 46, Pamela was suffering from an advanced form of rosacea called rhinophyma. However, the cause of this unusual growth of nose condition is unknown, but it commonly develops after rosacea begins on the face between the ages of 25 and 50. She tried every medicine prescribed by the doctor but nothing worked. She was suffering from an unfortunate medical condition. After her interview being telecasted on TV, she was offered free surgery by Dr. Ann Zedlitz to correct the growth of her nose! And today, after her surgery she looks like this now!" HER NOSE STARTED TO GROW UNCONTROLLABLY AT AGE 15, TODAY SHE LOOKS LIKE THIS By Akanksha Manhas, PagalParrot More on Phenotype Phymatous

Laser is usually the preferred way to remove spider veins. Joe Niamtu, III, MD, show how he does it with the handy dandy Iridex 940 laser:

Tom Busby, expert extraordinaire at RF, wrote "VeinWave, or the newer version, VeinGogh, will remove facial spider veins. A needle about the size of a human hair, with a small electric current, heats up the vein and coagulates the blood. Then the blood is reabsorbed and the skin is clear." 4th June 2013 03:32 AM Post #7 "Vein wave is a through the skin radiofrequency treatment for small visible veins. This has very little recovery and little bruising and works fairly well, the main issue is to find an office that has a machine made within the last year (only 5 in US) as previous models were underpowered and may not have resulted in complete treatment." Jordan Knepper, MD Ann Arbor Vascular Surgeon, realself, July 26th, 2016 "There are many ways to remove surface veins. I would suggest laser therapy instead of vein wave to eliminate facial spider veins. Laser can be more powerful than RF." Dr. Karamanoukian, Los Angeles, realself, January 4, 2017 Albert Malvehy, MD, treats this unwanted occurrence using foam sclerotherapy.

Rosacea Therapeutics Market Pipeline Review H1 2017

Looks like the NRS is responding to the new phenotype classification of rosacea by the ROSCO panel with this abstract. We await the full article to view all the content.

Importance There is a limited therapeutic armamentarium for recalcitrant cases of childhood rosacea. Observations We report the case of a 12-year-old girl who presented with severe ocular and cutaneous rosacea unresponsive to oral doxycycline, oral isotretinoin, and topical tacrolimus. A biopsy specimen showed numerous mites within the folliculosebaceous unit. Treatment with a single dose of oral ivermectin achieved resolution of her symptoms. Conclusions and Relevance The causative role of Demodex folliculorum should be considered in immunocompetent children with rosacea or rosacea-like refractory eruptions. In such cases, treatment with ivermectin can be beneficial. Case Report/Case Series The cutting Edge January 2014 Severe Demodexfolliculorum–Associated Oculocutaneous Rosacea in a Girl Successfully Treated With Ivermectin Megan Brown, MD; Angela Hernández-Martín, MD; Ana Clement, MD; et al PubMed