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"Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs , are drugs with analgesic, antipyretic and, in higher doses, anti-inflammatory effects - they reduce pain, fever and inflammation. The term "non-steroidal" is used to distinguish these drugs from steroids, which (among a broad range of other effects) have a similar eicosanoid-depressing, anti-inflammatory action. As analgesics, NSAIDs are unusual in that they are non-narcotic. NSAIDs are sometimes also referred to as non-steroidal anti-inflammatory agents/analgesics (NSAIAs) or non-steroidal anti-inflammatory medicines (NSAIMs). The most prominent members of this group of drugs are aspirin, ibuprofen, and naproxen partly because they are available over-the-counter in many areas. (Paracetamol (acetaminophen) is classified as having antipyretic and analgesic properties, and is not an NSAID.) Beginning in 1829, with the isolation of salicin from the folk remedy white willow bark, NSAIDs have become an important part of the pharmaceutical treatment of pain (at low doses) and inflammation (at higher doses). Part of the popularity of NSAIDs is that, unlike opioids, they do not produce sedation or respiratory depression and have a very low addiction rate. NSAIDs, however, are not without their own problems (see below). Certain NSAIDs, including ibuprofen and aspirin, have become accepted as relatively safe and are available over-the-counter without prescription in some countries." [1] NSAIDs include, but are not limited to, naproxen, nabumetone, diclofenac, sulindac, oxaprosin, diflunisal, bromfenac, aspirin, piroxicam, indomethacin, etodolac, ibuprofen, fenoprofen, flurbiprofen, ketorolac, nimesulide, NS-398, ketoprofen, trisalicylates, acetominophen, oxaprosin, salsalate, rofecoxib, and celecoxib. NSAIDs are being used to treat rosacea due to its anti-inflammatory effects. For example: "A method of treating or preventing rosacea in a patient, comprising topical administration, of a pharmaceutical preparation comprising a nonsteroidal anti-inflammatory drug (NSAID) selected from the group consisting of piroxicam, diclofenac, ibuprofen, oxaprozin, indomethacin,. isoxicam, ketoprofen, sulindac, tolmetin, flurbiprofen, meclofenamic acid, suprofen, tenoxicam, zomepirac, diflunisal, naproxen, fenoprofen, flufenamic acid, and aspirin, and combinations thereof." [2] Methods of administering diclofenac compositions for treating rosacea United States Patent Application 20060062750 A method of treating rosacea includes: (a) providing a composition containing 1-3 wt. % diclofenac or a salt thereof, 0.5-1.5 wt. % benzyl alcohol, 10-30 wt. % PEG monomethyl ether, 0.1-3.0 wt. % sodium hyaluronate; and 70-80 wt. % water; and ( applying the composition, in an effective amount, to skin of a person in need of the treating. [3] US Patent 7105172 - Treatment of rosacea The present invention results from my discovery of a causal link between the activation of the bradykinin pathway and rosacea. Accordingly, the invention features a method of treating or preventing rosacea by administering a compound that inhibits a component or components of the bradykinin activation pathway. By "a nonsteroidal anti-inflammatory drug (NSAID)" is meant a compound that prevents or reduces inflammation. Preferred NSAIDs include, but are not limited to, naproxen, nabumetone, diclofenac, sulindac, oxaprosin, diflunisal, bromfenac, aspirin, piroxicam, indomethacin, etodolac, ibuprofen, fenoprofen, flurbiprofen, ketorolac, nimesulide, NS-398, ketoprofen, trisalicylates, acetominophen, oxaprosin, salsalate, rofecoxib, and celecoxib. [4] The present invention has the advantage of providing novel targets to regulate in the treatment of rosacea and to provide treatment alternatives to antibiotics. The antibiotics may have limited efficacy and cause adverse effects such as gastrointestinal intolerance, photosensitivity, the development of antibiotic-resistant infections, and yeast infections. BigPatents India ANTI - ACNE ROSACEA GEL COMPOSITION CONTAINING RUPTURABLE BEADS OF A NSAID Application 638/MUM/2008 published 2008-04-18, filed 2008-03-26 "In correspondence, published by the American Medical Association, oral administration of NSAID's, such as Motrin (oral ibuprofen), in full doses (tablets of 800 mg) is suggested during periods of high activity of rosacea. However, this modality cannot be recommended due to the known gastrointestinal side effects, which occur in high incidence of 4-16%. There remains a need therefore for a safe and effective treatment for rosacea to supplement or supplant current treatments. Summary of the invention The present invention comprises pharmaceutical preparations having enhanced efficacy for topical treatment of rosacea. These preparations comprise an NSAID as the therapeutic agent for the topical treatment of rosacea. Another aspect of this invention involves the use of an NSAID in combination with a nitroimidazole, for the treatment of rosacea." [5] "NSAIDs also play a role in the treatment of ocular surface disease, said Robert Latkany, M.D., founder and director, Dry Eye Clinic, New York Eye and Ear Infirmary, New York. “I use them in patients with ocular rosacea, allergic conjunctivitis, and dry eye,” he said. “They don’t work 100% of the time, but there’s a subgroup of patients who benefit nicely from them. And I think they’re safer than steroids.” He finds that ocular rosacea patients with secondary dry eye benefit the most from their use, with some patients taking them for months at a time, while others just use them as needed to quiet their symptoms. Dr. Latkany also has used NSAIDs in patients with Sjögren’s syndrome. “They’re a reasonable option,” he said." [6] Dr. Latkany is a member of the RRDi MAC. End Notes [1] Wikipedia [2] WIPO (WO/2002/074290) DERMATOLOGICAL PREPARATIONS CONTAINING A NSAID [3] www.freepatentsonline.com [4] US Patent 7105172 - Treatment of rosacea [5] www.wipo.int [6] Ocular pharmacology NSAIDs make a comeback

An article in Dermatology Times by Rebecca Bryant entitled, Miracle-worker aspirin represses rosacea flushing, quotes Joseph B. Bikowski, M.D., a dermatologist practicing in Sewickley, Pa., and a clinical associate professor of dermatology at Ohio State University in Columbus as saying, "I have both migraines and rosacea. Several years ago, I was talking to Dr. Albert Klingman. He mentioned that there was an increased incidence of rosacea in people who have migraines. I knew some neurologists give one baby aspirin a day to migraine sufferers to try and prevent the dilation of blood vessels in the brain." The report goes on to say that Dr. Bikowski: "He asked his rosacea patients to take a daily aspirin (81 mg) and maintain a log of flushing incidents, rating each day on a 1 to 10 scale. Within a month, many patients were experiencing less flushing and shorter episodes of erythema. The goal of aspirin therapy is to suppress the vascular dilation associated with rosacea. In theory, that suppresses the body's flush response and reduces the incidence of persistent erythema." Therefore, asprin may help reduce flushing in rosacea and is a simple over-the-counter solution. The NRS says, "aspirin may reduce the effects of niacin-containing foods in sufferers affected by these substances." [1] Linda Sy M.D., suggests "At bedtime: Take 1 baby aspirin; 1 chlor-trimeton(4 mg) and 1 tab of Tums (Calcium Carbonate, an antacid to offset the gastric irritating effect of the aspirin." [2] Enteric Coated Asprin Dr. Bikowski asked his rosacea patients to take a daily aspirin (81 mg) and maintain a log of flushing incidents, rating each day on a 1 to 10 scale. Within a month, many patients were experiencing less flushing and shorter episodes of erythema. Dr. Bikowski argues, "Aspirin therapy is safe. It's great for the heart. It's great for the colon. Why not the skin?" He further notes that there are few contraindications for aspirin use, it's inexpensive and it can be taken in combination with most drugs. Dermatologists should advise patients of the standard warnings about the use of aspirin, even at low dosage. These include: Look for enteric-coated tablets, which are more likely to dissolve in the intestines, avoiding stomach problems. End Notes [1] NRS Tripwires [2] RSG quote

Paxil (PAROXETINE), Zoloft (SERTRALINE), and Prozac (FLUOXETINE) are serotonin reuptake inhibitor (SSRI) used sometimes in the treatment for anxiety in rosacea sufferers. Xanax (alprazolam)—a benzodiazapene similar to Valium (diazepam) and Buspar (busprione) may also be used at times. {1] Psychotropics have also been used as reported in anecdotal reports. end notes [1] rosacea.derm.net

“Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. It is one of the most poisonous naturally occurring substances in the world. Though it is highly toxic, it is used in minute doses both to treat painful muscle spasms, and as a cosmetic treatment in some parts of the world. It is sold commercially under the brand names Botox and Dysport for this purpose. The terms Botox and Dysport are trade names and are not used generically to describe the neurotoxins produced by the clostridia species.” [1] Botox has been used as a novel method for the treatment of persistent facial flushing in rosacea sufferers. “We report a case of persistent facial flushing that was resistant to multiple pulsed dye laser treatments and was successfully treated with botulinum toxin A. Results: The post treatment appearance was dramatic, and the patient was highly satisfied with the cosmetic outcome.” [2] End Notes [1] Wikipedia [2] Botulinum Toxin for the Treatment of Facial Flushing Melanie Yuraitis, MS, and Carolyn I. Jacob, MD Dermatologic Surgery, Volume 30, Number 1, January 2004, pp. 102-104(3)

“Additional topical therapies including benzoyl peroxide, clindamycin, retinoids, topical steroids, calcineurin inhibitors, and permethrin are not approved for the treatment of rosacea and play variable roles in the management of this condition.” Topical therapies for rosacea. Nally JB, Berson DS; J Drugs Dermatol. 2006 Jan;5(1):23-6

Antibiotics have been used to treat rosacea for over fifty years. The most popular antibiotics used in the treatment for rosacea are: Azithromycin (Zithromax) Clindamycin (Clindagel, Cleocin and Cleocin T) Dapsone Doxycycline (Doryx, Oracea) Doxycycline Hyclate (Periostat) Doxycycline Monohydrate (Monodox) Erythromycin Minocycline Rifaximin Tetracycline Macrolide Antibiotics seem to be more popular with rosaceans than tetracycline. Macrolides include: erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), dirithromycin (Dynabac), roxithromycin (Rulid, Surlid). There are, of course, other antibiotics used to treat rosacea, which you can discuss with your physician. For example, Minocycline as Good as Doxycycline for Rosacea. An article issued in August 2012 reports, "it now seems clear that the role of antibiotics in patients with rosacea depends upon their anti-inflammatory rather than their antimicrobial properties." [1] Thus the emergence of Oracea or low dose doxycycline. Short term antibiotics for rosacea is an acceptable treatment, however, there may be issues with long term antibiotic treatment. Read Antibiotic Resistance, Bacterial Overgrowth. Another report says, Antibiotics targeting brain’s inflammatory response may exacerbate cognitive deficits in children. Why not add your experience by posting in this thread what antibiotic treatment your physician prescribed and your thoughts? End Notes [1] J Drugs Dermatol. 2012 Jun;11(6):725-30. Diagnosis and treatment of rosacea: state of the art. Baldwin HE.

Methotrexate is sometimes prescribed for rosacea, ‘usually as second-line therapy.’ "Other second-line therapies include: trimethoprim-sulfamethoxazole (Bactrim, Septra), methotrexate, dapsone, primaquine, chloroquine (Aralen), and oral prednisone; however, no studies have evaluated the comparative efficacy or optimal dosing regimens of these agents." American Family Physician Rosacea: A Common, Yet Commonly Overlooked, Condition B. WAYNE BLOUNT, M.D., M.P.H. and ALLEN L. PELLETIER, M.D. See also: Prevention, Treatment and Complications of Rosacea By Groshan Fabiola, Ezine@rticles

Rosacea 101 page 54-5 by permission of the author Sodium sulfacetamide-sulfur is an antibiotic and drying agent combination medicine and works by promoting the shedding of the top layer of skin (keratolysis). “The combination of sodium sulfacetamide and sulfur is unique in the rosacea armamentarium because of its dual use as topical therapy and therapeutic cleanser. Several formulations of sulfacetamide 10% and sulfur 5% are now available as topical lotions and cleansers. The sulfacetamide/sulfur cleansers serve as adjunctive therapy by providing additive effects to other topical and oral therapies for rosacea with favorable tolerability and cosmetic appeal.” [279] “After 12 weeks of treatment with sodium sulfacetamide 10% and sulfur 5% cream with sunscreens, there was a significantly greater percentage reduction (80%) in inflammatory lesions compared with metronidazole 0.75% cream (72%)(P = .04), as well as a significantly greater percentage of subjects with improved erythema (69% vs 45%, respectively; P = .0007). In addition, the sodium sulfacetamide 10% and sulfur 5% cream with sunscreens group had a significantly greater proportion of subjects with success in global improvement at week 12 compared with the metronidazole 0.75% cream group (79% vs 59%, respectively; P = .01).” [280] “Sulfur has antifungal, antibacterial, and keratolytic activity. In the past, its use was widespread in dermatological disorders such as acne vulgaris, rosacea, seborrheic dermatitis, dandruff, pityriasis versicolor, scabies, and warts. Adverse events associated with topically applied sulfur are rare and mainly involve mild application site reactions. Sulfur, used alone or in combination with agents such as sodium sulfacetamide or salicylic acid, has demonstrated efficacy in the treatment of many dermatological conditions.” [281] “Sulfur is a time-honored therapeutic agent useful in a variety of dermatologic disorders. Its keratolytic action is due to formation of hydrogen sulfide through a reaction that depends upon direct interaction between sulfur particles and keratinocytes. The smaller the particle size, the greater the degree of such interaction and the greater the therapeutic efficacy. When applied topically, sulfur induces various histologic changes, including hyperkeratosis, acanthosis, and dilatation of dermal vasculature.” [282] Avar, Avar e Green, Plexion, Plexion SCT, Plexion TS, Rosanil, Rosac, Rosula, and Rosula NS are brand name sodium sulfacetamide-sulfur prescriptions. Addendum Sulphur has been used for a long time to treat rosacea. 283 The following warning is issued by Mission Pharmacal about using sulfacetamide: "Sulfonamides are known to cause Stevens-Johnson syndrome in hypersensitive individuals. Stevens-Johnson syndrome also has been reported following the use of sodium sulfacetamide topically. Cases of drug-induced systemic lupus erythematosus from topical sulfacetamide also have been reported." [1] End Notes 279 Evaluating the role of topical therapies in the management of rosacea: focus on combination sodium sulfacetamide and sulfur formulations. Del Rosso JQ; Cutis. 2004 Jan;73(1 Suppl):29-33. 280 Combination sodium sulfacetamide 10% and sulfur 5% cream with sunscreens versus metronidazole 0.75% cream for rosacea. Torok HM, Webster G, Dunlap FE, Egan N, Jarratt M, Stewart D. Cutis. 2005 Jun;75(6):357-63. 281 The use of sulfur in dermatology. Gupta AK, Nicol K; J Drugs Dermatol. 2004 Jul-Aug;3(4):427-31. 282 Sulfur revisited. Lin AN, Reimer RJ, Carter DM; J Am Acad Dermatol. 1988 Mar;18(3):553-8. 283 PATIENT AT the Skin Clinic of the Women's Medical College. Rosacea is a chronic disease of the middle period of life. These "rosy drops" sometimes present a central point of a somewhat darker hue. In severe cases a fiery triangle may be seen on either cheek. In the most remarkable form of the disease the nose may attain the size of the fist. The eruption had troubled her more or less for six years and had been much worse than usual during the last month. She complained greatly of discomfort after eating and often vomited her food. The gastric irritability having subsided under a restricted diet, she was ordered Aug. 6, 1878, a mixture containing sulphate of iron and sulphate of magnesia, and for local application an ointment of sulphur, four parts, cosmoline, ninety-two parts. This was followed by rapid improvement, and when seen again on Sept. 17, all trace of the eruption had disappeared, and she felt much stronger and better. Source [1] Mission Pharmacal Contact Us page: WARNINGS Sulfonamides are known to cause Stevens-Johnson syndrome in hypersensitive individuals. Stevens-Johnson syndrome also has been reported following the use of sodium sulfacetamide topically. Cases of drug-induced systemic lupus erythematosus from topical sulfacetamide also have been reported. In one of these cases, there was a fatal outcome. KEEP OUT OF THE REACH OF CHILDREN.

There are a number of drugs used by physicians as anti-flushing or as antihypertensive agents such as: Antihistamines, Clonidine, Epinephrine, Lanreotide, Megestrol acetate, Monoxidine, Propranolol (Inderal), Sandostatin LAR, Nadadol, Rilmenidine, and Veralipride. Ketamine 0.5% and Amitriptyline 1% has been reported in at least one case. Propranolol (Inderal) has been used for the treatment of persistent flushing in rosaceans. [1] Carvedilol (brand name Coreg) has also been used for treating Refractory Facial Flushing and Persistent Erythema of Rosacea. [2] For a comprehensive list of anti-flushing drugs (prescription and non prescription) click here. Discuss with your physician whether any of these drugs may help you. Prescription and Non Prescription Flushing Avoidance Blushing & Flushing Triggers End Notes [1] Symptomatic treatment of idiopathic and rosacea-associated cutaneous flushing with propranolol Helen Craige MD and Jack B. Cohen DO; Journal of the American Academy of Dermatology, Volume 53, Issue 5, November 2005, Pages 881-884. [2] Carvedilol for the Treatment of Refractory Facial Flushing and Persistent Erythema of Rosacea. Hsu CC, Lee JY. Arch Dermatol. 2011 Jul 18. More info on flushing click here.

Finacea (USA) and Azelex (Europe) are two brand name prescription azelaic acid formulas that rosaceans are reporting works to control rosacea. Finacea comes in a gel or a foam. Azelex cream is made by Allergan. Both products are made by Bayer Healthcare. According to OptimRx "Sandoz launched an authorized generic version." Bayer Healthcare is offering a savings coupon for Finacea by clicking here (For US audiences only) or you may try the Bayer Savings Card (For US audiences only) There are a number of over the counter azelaic acid treatments: Azelaic Acid Fine Powder 25 Grams Azelaic Acid Micro Powder 150 Grams 99% Ecological Formulas Strata Melazepam Emollient Cream GIGI Bioplasma Azelaic Cream 15% For Oily Skin The Ordinary Azelaic Acid Suspension 10% In 2007 here was the status of Azelaic acid: Rosacea 101 page 53-4 by permission of author There are conflicting reports about azelaic acid. Consider the first report reported in April 2007: “Results of this study demonstrated a significantly greater potential for irritation from azelaic acid compared with metronidazole gel.” [275] With this report done in August 2006: “Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.” [276] However, some rosaceans may report irritation with azelaic acid while others report it is effective in controlling rosacea. Azelaic acid appears to be an accepted treatment so you should be aware of it use in rosacea. “Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group.” [277] “Azelaic acid (AzA) initially was released in a 20% cream formulation, which has been shown to be effective in the treatment of mild to moderate rosacea. Recently, a 15% gel formulation was developed that vastly improved the delivery of AzA and has been proven by multiple studies to be effective in the treatment of rosacea. We present studies that examine both of these formulations, first in comparison with their vehicles and then in contrast with other well-accepted topical treatments of rosacea, such as metronidazole cream and gel.” [278] End Notes 275 Cumulative irritation potential among metronidazole gel 1%, metronidazole gel 0.75%, and azelaic acid gel 15%. Colón LE, Johnson LA, Gottschalk RW; Cutis. 2007 Apr;79(4):317-21. 276 Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials. Liu RH, Smith MK, Basta SA, Farmer ER; Arch Dermatol. 2006 Aug;142(8):1047-52. 277 Interventions for rosacea. van Zuuren EJ, Graber MA, Hollis S, Chaudhry M, Gupta AK, Gover M. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003262. 278 A clinical overview of azelaic acid. Elewski B, Thiboutot D; Cutis. 2006 Feb;77(2 Suppl):12-6.

Rosacea 101 page 55 by permission of the author Immunosuppressants are chemical agents (such as pimecrolimus or tacrolimus) that suppresses the immune response. Pimecrolimus (Elidel) and Tacrolimus (Protopic) are known as calcineurin inhibitors acting on immunophilins. Tacrolimus is a fungal product (Streptomyces tsukubaensis) and a macrolide lactone and acts by inhibiting calcineurin. “The topical calcineurin inhibitors (TCIs) pimecrolimus and tacrolimus are approved for atopic dermatitis but have additional potential in other inflammatory skin diseases … whereas the response in rosacea and rosacea-like eruptions has been mixed.” [283] Pimecrolimus has been used to treat steroid-induced rosacea. (See Chapter 8) “Tacrolimus ointment is increasingly used for anti-inflammatory treatment of sensitive areas such as the face, and recent observations indicate that the treatment is effective in steroid-aggravated rosacea and perioral dermatitis.” [284] “Topical calcineurin inhibitors have been efficacious in the treatment of other inflammatory disorders of the skin, and tacrolimus has been reported as an effective treatment option for erythrotelangiectatic rosacea.… It appears pimecrolimus may be efficacious in the treatment of erythrotelangiectatic and papulopustular rosacea and may be considered in patients with recalcitrant disease.” [285] “Twenty-four patients with erythrotelangiectatic or papulopustular rosacea were treated with 0.1% tacrolimus topical ointment in a 12-week open-label trial. Erythema was significantly improved in both rosacea subtypes (P<.05).” [286] Not all patients respond well to immunosuppressants. For example, “Six adult patients with inflammatory facial dermatoses were treated with tacrolimus ointment because of the ineffectiveness of standard treatments. Within 2 to 3 weeks of initially effective and well-tolerated treatment, 3 patients with a history of rosacea and 1 with a history of acne experienced sudden worsening with pustular rosaceiform lesions. Biopsy revealed an abundance of Demodex mites in 2 of these patients. In 1 patient with eyelid eczema, rosaceiform periocular dermatitis gradually appeared after 3 weeks of treatment. In 1 patient with atopic dermatitis, telangiectatic and papular rosacea insidiously appeared after 5 months of treatment.” [287] Another report said, “Unfortunately, Antille and colleagues now report the occurrence of a rosaceiform dermatitis as a complication of treatment with topical tacrolimus ointment.” [288] These drugs are not without side effects and risks. Because the majority of them act non-selectively, the immune system loses its ability to successfully resist infections and spreading of malignant cells. There are also other side effects like hypertension, dyslipidemia, hyperglycemia, peptic ulcers, liver and kidney injury. The immunosuppressive drugs also interact with other medicines and affect their metabolism and action. Addendum "Recently, reports have indicated that the continuous use of topical calcineurin inhibitors such as tacrolimus may induce rosacea-like dermatitis (RD)." [1] End Notes 283 The role of topical calcineurin inhibitors for skin diseases other than atopic dermatitis. Wollina U; Am J Clin Dermatol. 2007;8(3):157-73 284 Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Antille C, Saurat JH, Lubbe J; Arch Dermatol. 2004 Apr;140(4):457-60. 285 Pimecrolimus for treatment of acne rosacea. Crawford KM, Russ B, Bostrom P: Skinmed. 2005 May-Jun;4(3):147-50. 286 Tacrolimus effect on rosacea. Bamford JT, Elliott BA, Haller IV; J Am Acad Dermatol. 2004 Jan;50(1):107-8. 287 Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Antille C, Saurat JH, Lubbe J; Arch Dermatol. 2004 Apr;140(4):457-60. 288 ibid [1] Tacrolimus-Induced Rosacea-Like Dermatitis: A Clinical Analysis of 16 Cases Associated with Tacrolimus Ointment Application. Teraki Y, Hitomi K, Sato Y, Izaki S. Dermatology. 2012 May 22.

Co-Existence with Rosacea There are numerous reports that rosacea and Seborrheic Dermatitis can co-exist! Yes, you can have SD and rosacea at the same time. [3] Misdiagnosed SD looks so much like rosacea that some rosaceans have reported that their rosacea was misdiagnosed as SD or vice versa! [4] Photos Images courtesy of DermNet NZ [8] Cause "The cause of seborrhoeic dermatitis remains unknown, although many factors have been implicated. The widely present yeast, Malassezia furfur (formerly known as Pityrosporum ovale), is involved, as well as genetic, environmental, hormonal, and immune-system factors. A theory that seborrhoeic dermatitis is an inflammatory response to the yeast has not been proven. Those afflicted with seborrhoeic dermatitis have an unfavourable epidermic response to the infection, with the skin becoming inflamed and flaking. In children, excessive vitamin A intake can cause seborrhoeic dermatitis. Lack of biotin, pyridoxine (vitamin B6) and riboflavin (vitamin B2) may also be a cause." [1] In May 2007 it was published, "The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor." [1a] An article published in 2007 [2] may help you if you have been diagnosed with SD since the real cause may be a fungi called Malassezia Globosa. The article mentions three factors that my be involved with SD; sebum, microbial metabolism (specifically, Malassezia yeasts), and individual susceptibility. "Pyrithione Zinc (PTZ) is a potent monographed anti-fungal agent against M. globosa. It treats seborrheic dermatitis/dandruff and provides symptomatic relief, reducing the irritation response while inhibiting the causal agent. The particles that comprise this anti-fungal can be engineered into flat platelet shapes to deliver optimized scalp coverage resulting in improved efficacy." [2a] "High colonization with Staphylococcus epidermidis, along with impaired skin permeability barrier function, contributes to the occurrence of SD....The results show a predominance of Acinetobacter, Staphylococcus, and Streptococcus on lesional sites. The authors suggest that, in addition to Malassezia, these commensal bacteria might contribute to SD development. Likewise, our preliminary study indicated a greater predominance of these phyla on SD lesional skin as compared to normal controls (unpublished data). Studies on both French and Chinese populations suggested that dandruff scalps, often associated with SD, are associated with a high incidence of M. restricta and Staphylococcus epidermidis." [21] "Although the causes of SD are not completely understood, it appears to result from a combination of the following three factors: sebaceous gland secretion, presence of Malassezia yeast, and the host immune response." [23] Not Contagious According to several reputable sources, SD is not contagious. [8] Support Groups You can use this thread if you have SD and post here and hopefully others with SD will do the same. Genetic Marker? "A new gene associated with a variant of psoriasis and seborrheic dermatitis has been identified by a research group led by Dr. Ohad Birk at the Morris Kahn Laboratory of Human Genetics at Ben Gurion University and Soroka Medical Center. ...Psoriasis and seborrheic dermatitis affect 2-3% of the population worldwide and 85% of AIDS patients...." [5] Number of SD Sufferers Worldwide If you take the 2% figure that would mean there are over 150 million Psoriasis/SD sufferers worldwide, less than the number of rosacea sufferers worldwide, which is probably not the case. The NPF says the number for psoriasis is 2 to 3 percent of the worldwide population. The number world wide who suffer from SD is said to be "1 to 5 percent" according this report, so clearly the combined number would be higher. Signs and Symptoms Wikipedia reports, "Seborrhoeic dermatitis' symptoms appear gradually and usually the first signs are flaky skin and scalp. Symptoms occur most commonly anywhere on the skin of the face, behind the ears and in areas where the skin folds. Flakes may be yellow, white or grayish. Redness and flaking may also occur on the skin near the eyelashes, on the forehead, around the sides of the nose, and the chest and upper back. In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back. Commonly, patients experience mild redness, scaly skin lesions and in some cases hair loss. Other symptoms include patchy scaling or thick crusts on the scalp, red, greasy skin covered with flaky white or yellow scales, itching, soreness and yellow or white scales that may attach to the hair shaft. Seborrheic dermatitis can occur in infants younger than three months and it causes a thick, oily, yellowish crust around the hairline and on the scalp. Itching is not common among infants. Frequently, a stubborn diaper rash accompanies the scalp rash.[6] Usually, when it occurs in infants the condition resolves itself within days and with no treatment.[citation needed] In adults, symptoms of seborrheic dermatitis may last from a few weeks, to years. Many patients experience alternating periods of inflammation. The condition is referred to a specialist when self-care has proven unsuccessful. Treatments for Seborrheic Dermatitis Because of the microbial metabolism that may be involved, Wikipedia says Pyrithione Zinc (PTZ) is effective against SD. [7a] Biom8 [25] Ciclopiroxolamine 1% cream, twice daily for 28 days followed by once daily for 28 days [23] climbazole and piroctone olamine [19] Clotrimazole Crude honey [24] Dermadexin [14] Miconazole Nonpathogenic E. coli strain Nissle 1917 [20] Oral itraconazole given in a dose of 200mg/day for one week, followed by a maintenance dose, resulted in clinical improvement of SD symptoms in two open-label trials. [23] Ovace Promiseb Topical Cream for seborrheic dermatitis may be something to consider. "Promiseb®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials)." [17] Sea Salt Baths (see post #2) "Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis." [7] Sebuderm Stellate ganglion block (SGB) [26] "The therapy consists mainly of antifungal agents, corticosteroids, immunomodulators, and keratolytics." [6] "Treatment options for nonscalp and scalp seborrheic dermatitis include topical agents and shampoos containing antifungal agents, anti-inflammatory agents, keratolytic agents, and calcineurin inhibitors. Because multiple body sites are usually involved, the physician should examine all commonly affected areas. Patients should be made aware that seborrheic dermatitis is a chronic condition that will probably recur even after successful treatment." [9] topical 4% Quassia amara gel [18] Topical ketoconazole [15] Topical Nicotinamide (NCT) [12] topical corticosteroids (short-term) [16] "topical treatment with tacrolimus, fusidic acid, or moisturizers." [21] Urea [13] Anecdotal Reports Tom Busby's SD Treatment Protocol Seborrheic Dermatitis and Telangiectasia (dilated blood vessels) flurb says, "I am buying Fage brand 2% plain yogurt and I apply a thin layer for 20 minutes a day to my face. I then rinse it off and moisturize with MCT Oil and Cerave PM Moisturizer. I also shampoo my hair with Hegor 150. The yogurt is a mild exfoliator which helps with scaling but isn't irritating. It also helps with the mild acne caused by my rosacea. If you can't find Fage yogurt in your area, just try to find a thicker plain greek yogurt with live cultures in it." Rory (post #5) says, "Cyclopirox Olamine 1% cream, Ketoconazole 2 % cream or Climbazole 1% cream may be better options." gora recommends Excipial U Lipolotio [13] TJM23 recommends eliminating stress (post no 1) Jonu's Definitive Guide to Beat Malassezia Conditions Washing Clothes to Eliminate Malassezia Differences in Treatment "The topical anti-inflammatory treatments were more effective in achieving total clearance of symptoms than placebo by 1.4-fold to 8.5-fold, but there are no considerable differences in the anti-inflammatory topical treatments or in comparison with azoles for short-term treatment. There is no evidence of treatment effects in long-term, continuous, or intermittent use of these compounds despite the chronic nature of the disease." [10] "Lithium salts were more effective than azoles in producing total clearance." [11] Pityrosporum Folliculitis (PF) "Pityrosporum is part of the normal skin flora, but overgrows in certain conditions. Overgrowth is associated with oily skin, humidity or other pre-existing dermatologic conditions such as seborrheic dermatitis and severe dandruff." [22] So you might want to rule out PF from SD. End Notes [1] Wikipedia [1a] Adult Seborrheic Dermatitis A Status Report on Practical Topical Management James Q. Del Rosso, DO [2] J Investig Dermatol Symp Proc. 2007 Dec;12(2):15-9. Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis. Dawson TL Jr. [2a] Real cause of seborrhea discovered! by Artist » Thu Jan 31, 2008 5:17 pm [3] "Rosacea and seborrheic dermatitis are both inflammatory skin disorders that cause redness, lesions, and itching, and they frequently occur together." The Rosacea-Seborrheic Dermatitis Link, by Diana Rodriguez, Medically Reviewed by Lindsey Marcellin, MD, MPH, everyday Health [4] Misdiagnosed Rosacea [5] Psoriasis gene ID'd by Israeli researchers Posted by Randall, Google Groups, 6/14/2006 U-M scientists ID major psoriasis susceptibility gene By Sally Pobojewski Medical School Communications, University of Michigan [6] Seborrheic Dermatitis Aschoff R, Kempter W, Meurer M. Hautarzt. 2011 Mar 24. [7] Am Fam Physician. 2015 Feb 1;91(3):185-90. Diagnosis and treatment of seborrheic dermatitis. Clark GW, Pope SM, Jaboori KA. [7a] DermaHarmony Zinc Therapy Soap Noble Formula 2% Pyrithione Zinc Noble Formula Cream Noble Formula Zinc Spray [8] DermNet NZ • Mayo Clinic • CNN Health [9] J Clin Aesthet Dermatol. 2013 Feb;6(2):44-9. Optimizing treatment approaches in seborrheic dermatitis. Gary G. [10] JAMA Dermatol. 2015 Feb;151(2):221-2. doi: 10.1001/jamadermatol.2014.3186. Topical anti-inflammatory agents for seborrheic dermatitis of the face or scalp: summary of a Cochrane Review. Kastarinen H, Okokon EO, Verbeek JH. [11] Cochrane Database Syst Rev. 2014 May 19;(5):CD009446. doi: 10.1002/14651858.CD009446.pub2. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkkä J, Oravilahti T, Rannanheimo PK, Verbeek JH. [12] J Dermatolog Treat. 2014 Jun;25(3):241-5. doi: 10.3109/09546634.2013.814754. Epub 2013 Jul 5. Topical nicotinamide for seborrheic dermatitis: an open randomized study. Fabbrocini G1, Cantelli M, Monfrecola G. [13] Urea is mentioned as a treatment for SD in an article by Dermnet New Zealand Excipial Urea Excipial Urea Hydrating Healing Lotion EXCIPIAL U Lipolotion [14] Dermadexin™ A New Treatment for Dermatitis, Astion Pharma A/S "Cipher Pharmaceuticals announced it has acquired three products from Astion Pharma that are focused on inflammatory dermatological diseases. he products include Dermadexin, a topical barrier-repair cream containing the pharmacologically active ingredient P3GCM. Dermadexin was approved in the European Union (EU) in 2014 as a Class III medical device for treating seborrheic dermatitis." Cipher acquires three dermatology products from Astion Pharma, Healio Dermatology Cipher Pharmaceuticals has announced that "Dermadexin™ is a patent-protected topical barrier-repair cream containing P3GCM. It received approval in the European Union (EU) in 2014 as a Class III medical device for the alleviation of symptoms of facial dermatitis such as redness, scaling and itching." Source Dermadexin is a patent-protected topical barrier-repair cream containing the pharmacologically active ingredient P3GCM. The product was approved in the European Union (EU) in 2014 as a Class III medical device for the treatment of seborrheic dermatitis, an inflammatory skin disorder affecting the scalp, face, and torso. Dermadexin SD Cream has been tested in two placebo-controlled, multi center clinical trials (436 patients) where it displayed a marked and statistically significant effect on the symptoms of facial seborrhoeic dermatitis with a fast onset of action and an increasing effect over time. Source Also known as Helioclin® Dermatitis SD Cream in Europe. Source Cipher Pharmaceuticals announces acceptance of 510(k) submission for Dermadexin™ by FDA DermadexinTMa new treatment for dermatitis (pdf) FDA Accepts Dermadexin 510(K) Submission Company Overview of Astion Pharma, Worldwide Rights to Dermadexin, Pruridexin And ASF-1096 (Bloomberg) Cipher Pharmaceuticals Pipeline [15] "Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body." See end note [7] [16] "Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis." See end note [7] [17] Am J Clin Dermatol. 2017 Apr;18(2):193-213. doi: 10.1007/s40257-016-0232-2. Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review. Gupta AK,, Versteeg SG. [18] J Drugs Dermatol. 2013 Mar;12(3):312-5. Efficacy of topical 4% Quassia amara gel in facial seborrheic dermatitis:a randomized, double-blind, comparative study. Diehl C, Ferrari A. [19] "confirms the science for my positive experience using climbazole and piroctone olamine against malassezia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125955/ Ann Dermatol. 2016 Dec; 28(6): 733–739.Published online 2016 Nov 23. doi: 10.5021/ad.2016.28.6.733PMCID: PMC5125955Efficacy and Safety of Cream Containing Climbazole/Piroctone Olamine for Facial Seborrheic Dermatitis: A Single-Center, Open-Label Split-Face Clinical StudyHae Jeong Youn, Soo Young Kim, Minji Park, Won Hee Jung, Yang Won Lee, Yong Beom Choe, and Kyu Joong Ahn Begin Tom Busby comment about climbazole and piroctone olamine: "To convert µg/ml to percentage, move the decimal place 4 places to the left -- you can see in the Korean study (linked above) that very tiny percentages of climbazole and piroctone olamine are effective against malassezia. However, I make a true oil-in-water emulsion of dissolved climbazole and piroctone olamine, and it's not clear how the test-product was made (how climbazole and piroctone olamine powders were dissolved and then emulsified) -- this makes all the difference for effectiveness, in my opinion. Second, the Korean study refers to Sensibio DS+ cream as a "crude mixture," twice, which makes me think that the powders (climbazole and piroctone olamine) are not dissolved properly. Third, the test-culture medium used in the Korean study is capable of dissolving climbazole and pirocotone olamine powder, and so, the cosmetic itself, Sensibio DS+ cream, could be much less effective on the human skin. Finally, no one should buy or use the tested product, Sensibio DS+ cream, because the primary oil in it is coconut oil, which feeds malassezia. This is a terrible idea, and this product is not going to work, except in the manner of one step forward, two steps back. It's expensive too, about $24 for 40 ml." Tom Busby post #4 [20] Nonpathogenic E. coli strain Nissle 1917 [21] Chin Med J (Engl). 2017 Jul 20; 130(14): 1662–1669. doi: 10.4103/0366-6999.209895 PMCID: PMC5520552 High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis Qian An, Meng Sun, Rui-Qun Qi, Li Zhang, Jin-Long Zhai, Yu-Xiao Hong, Bing Song, Hong-Duo Chen, and Xing-Hua Gao [22] "Pityrosporum is part of the normal skin flora, but overgrows in certain conditions. Overgrowth is associated with oily skin, humidity or other pre-existing dermatologic conditions such as seborrheic dermatitis and severe dandruff." Wikipedia More Info on Pityrosporum Folliculitis [PF] [23] J Clin Aesthet Dermatol. 2013 Feb; 6(2): 44–49. PMCID: PMC3579488 Optimizing Treatment Approaches in Seborrheic Dermatitis Goldenberg Gary, MD [24] Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff. Al-Waili NS. Eur J Med Res. 2001 Jul 30;6(7):306-8. [25] Biom8 Official Web Site • Biom8 Review at RF • Biom8 are products by Michael Anders who runs Skindrone [26] Korean J Anesthesiol. 2016 Apr; 69(2): 171–174. Published online 2016 Mar 30. doi: [10.4097/kjae.2016.69.2.171] PMCID: PMC4823414 PMID: 27064785 Seborrheic dermatitis treatment with stellate ganglion block: a case report Gun Woo Kim, Ki Ho Mun, Jeong Yun Song, Byung Gun Kim, Jong Kwon Jung, Choon Soo Lee, Young Deog Cha, and Jang Ho Other Articles Treatment of Seborrheic Dermatitis BETTY ANNE JOHNSON, M.D., PH.D., and JULIA R. NUNLEY, M.D. Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia

There are two PF skin conditions that are rosacea mimics to rule out. (1) Pityriasis folliculorum “Pityriasis folliculorum [PF] is an often over-looked clinical entity” and cases are ‘mostly female.’ Frank Powell, MD explains that there is ‘usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.’ These individuals often apply moisturizers and complain of a burning or itchy sensation. He also states that the diagnosis of PF is ‘facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.’ This condition ’seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.’ [1] "Topical ivermectin has recently been FDA approved as therapy for rosacea. We present the case of a woman with pityriasis folliculorum who showed significant improvement from using topical ivermectin with no adverse events related to treatment." [2] (2) Pityrosporum Follicultis (another PF) or Malassezia folliculitis (MF) "Pityrosporum folliculitis or Malassezia folliculitis is a skin condition caused by infection by pityrosporum yeast." Wikipedia What is Pityrosporum Folliculitis? Dermnet NZ eMedicine Medscape Simple Skin Care Science See subheading Pityrosporum Follicultis in this post. "As acne vulgaris and MF coexist in 12.2 to 27 percent of cases, it may be necessary to combine antifungal treatments along with typical acne medications. Use of antibiotics; however, may alter normal flora and lead to the yeast’s overgrowth. For this reason, other anti-acne medications are preferred over antibiotics, as antibiotics are counterproductive." [3] End Notes [1] Rosacea Diagnosis and Management by Frank Powell with a Contribution by Jonathan Wilkin [2] Pityriasis Folliculorum: Response to Topical Ivermectin. J Drugs Dermatol. 2017 Dec 01;16(12):1290-1292 Darji K, Burkemper NM [3] J Clin Aesthet Dermatol. 2014 Mar; 7(3): 37–41. Malassezia (Pityrosporum) Folliculitis Richard M. Rubenstein, MD and Sarah A. Malerich, BS Links http://www.jaad.org/article/S0190-96...789-5/fulltexthttp://medf.nsu.ru/files/%D0%A0%D0%B...0%BA%D1%81.pdfhttps://www.ncbi.nlm.nih.gov/pubmed/22017468http://www.microbiologyresearch.org/...308661D481B318

Lupoid rosacea (also known as "Granulomatous rosacea," "Micropapular tuberculid", or "Rosacea-like tuberculid of Lewandowsky") is characterized by the development of epithelioid (lupoid) granulomas in a diffuse pattern. [1] DermIS Photo of Lupoid Rosacea The NRS only recognizes one variant, Granulomatous Rosacea. However, most medical literature discuss several other rosacea variants and there is no universal agreement of what constitutes a rosacea variant. The RRDi recognizes a number of rosacea variants including Lupoid Rosacea, aka, Granulomatous rosacea. [1] Wikipedia

Lupus and its variants can mimic rosacea. One rosacean reported that an initial diagnosis of rosacea turned out to be Discoid Lupus. Lupus can also be a co-existing condition. Check out this Mayo Clinic Image of Lupus and how it looks like rosacea. Other Lupus Images by DermIS Some of the types of Lupus to consider in a differential diagnosis: Lupus chronic Lupus Erythematosus, Acute Lupus SLE Lupus Subacute Lupus Subcutaneous Lupus vulgaris Lupus miliaris disseminatus faciei [1] Subacute Cutaneous Lupus Erythematosus SCLE Systemic Lupus Erythematosus End Notes [1] Dermatology. 2003;206(2):120-3. Lupus miliaris disseminatus faciei: a distinctive rosacea-like syndrome and not a granulomatous form of rosacea. van de Scheur MR, van der Waal RI, Starink TM.

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