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  1. Ivermectin (Stromectol) is a drug used in the USA for the eradication of mites in animals. It was announced at a yahoo r-s group on October 20, 2004 that this drug may give significant relief to some rosaceans. Here is a quote: "... Oral Ivermectin (Stromectol) is making a huge difference in these sufferers facial symptoms and flushing triggers (yes, I said flushing triggers). Ivermectin is an anti-mite drug that is related to the macrolide antibiotics. It has a very good safety profile and less side effects than most antibiotics (and not one major side effect)..." [1] Another report: "Demodex is a saprophyte parasite in mammals. In Man, it is associated with differing clinical profiles (rosacea-like dermatitis, folliculitis and blepharitis). We report a case of demodecidosis in an HIV-infected patient that was successfully treated with ivermectin. CASE REPORT: A man from Laos, infected by HIV and treated for glandular tuberculosis, presented with a prurigenous eruption on the face and the pre-sternal and interscapular areas. Direct examination of scraped product and histopathological examinations confirmed the diagnosis of demodecidosis. Clinical cure was obtained after 2 single cures of ivermectin a one month's distance. DISCUSSION: The features of demodecidosis are often similar to those of rosacea. In immunodeficient patients, the semiology remains the same but the eruption is more abundant. During HIV-infection, demodecidosis occurs at the AIDS stage or with a CD4 count lower than 200/mm3. Many anti-dust mite molecules are used to treat the disease but frequently lead to irritation. Administration of a single cure of ivermectin, repeated if necessary, appears to be an interesting alternative to contact anti-dust mite agents." [2] Another report: "...Oral or topical ivermectin may also be useful in such cases..." [3] This topic has raised a number of questions and comments at the r-s yahoo group where all this originated. One clinical study in Germany says Ivermectin was ineffective and oral metronidazole was better. [4] Galderma has applied for a patent using ivermectin and hydrocortisone "for treating skin conditions and afflictions, and especially for treating rosacea (formerly known as acne rosacea." [5] Anecdotal Reports #1 #2 #3 #4 #5 Ivermectin for Demodex Thread at RF More info More info on Demodex Mites and Rosacea. End Notes [1] Rosacea Support Group post Wed Oct 20, 2004 [2] Demodecidosis in a patient infected by HIV: successful treatment with ivermectin Clyti E, Sayavong K, Chanthavisouk K. [3] The Management of Rosacea. Rebora, A.. American Journal of Clinical Dermatology, 2002, Vol. 3 Issue 7, p489, 8p; [4] Demodex abscesses: clinical and therapeutic challenges. Schaller M, Sander CA, Plewig G. J Am Acad Dermatol. 2003 Nov;49(5 Suppl):S272-4. [5] AVERMECTIN/HYDROCORTISONE COMPOSITIONS FOR TREATING AFFLICTIONS OF THE SKIN. E.G., ROSACEA
  2. Atopic Dermatitis (Eczema) is a rosacea mimic that can be quite confusing to differentiate from rosacea since if you click on Google images of eczema, it certainly looks like rosacea, so be sure to rule out atopic dermatitis (eczema). Eczema can be anywhere on the body but if it on your face, it is a rosacea mimic. Furthermore, you may have rosacea along with atopic dermatitis, therefore exczema can be a co-existing condition with rosacea. Medline Plus says, "Eczema is a term for several different types of skin swelling. Eczema is also called dermatitis. It is not dangerous, but most types cause red, swollen and itchy skin. Factors that can cause eczema include other diseases, irritating substances, allergies and your genetic makeup. Eczema is not contagious." [1] Click here for an image of eczema. Eczema is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term inflammation. The inflammation causes the skin to become itchy and scaly. Long-term irritation and scratching can cause the skin to thicken and an have a leather-like texture. One report shows a hypersensitivity to gluten. [2] Nummular Eczema "Staphylococcus aureus plays an important role in skin and soft tissue infections and contributes to the pathophysiology of complex skin disorders such as atopic dermatitis." [3] Allergic Eczema, aka Contact Dermatitis "Allergic eczema, also known as contact dermatitis, is a skin condition that occurs when a person's skin comes into contact with an allergen." [4] This could be any allergic reaction that manifests on the facial area which looks like rosacea, i.e., countdracula's post about an allergic reaction to onions and garlic. "Our results showed that there may be an association between nickel sensitivity and rosacea. Nickel sensitivity may be one of the underlying pathology or a triggering factor of the rosacea." [5] End Notes [1] Medline Plus [2] Cutaneous hypersensitivity to gluten. Tammaro A, Narcisi A, De Marco G, Persechino S. Dermatitis. 2012 Sep;23(5):220-1. [3] Case Rep Dermatol. 2017 May-Aug; 9(2): 19–25. Published online 2017 May 22. doi: 10.1159/000473872 PMCID: PMC5465516 Successful Treatment of Chronic Staphylococcus aureus-Related Dermatoses with the Topical Endolysin Staphefekt SA.100: A Report of 3 Cases Joan E.E. Totté, Martijn B. van Doorn, and Suzanne G.M.A. Pasmans [4] Everything you need to know about allergic eczema, MedicalNewsToday Last reviewed Mon 18 June 2018 By Rachel Nall, RN, BSN, CCRN Reviewed by Debra Sullivan, PhD, MSN, RN, CNE, COI [5] Endocr Metab Immune Disord Drug Targets. 2019 Jan 01;: Nickel Sensitivity In Rosacea Patients: A Prospective Case Control Study. Çifci N
  3. Keratosis pilaris rubra faceii [KPRF] is characterized by redness (erythema) and the presence of rough bumpiness (follicular spines) which may begin at birth or during childhood or adolescence. You can see how confusing this would be to differentiate from rosacea. KPRF can also be a co-existing condition. "If it is possible to get rosacea on your arms, it would be incredibly unusual. Keratosis pilaris might be the more likely culprit, since keratosis pilaris usually affects the arms. (Keratosis pilaris is a very common skin condition in which keratin protein forms hard plugs within hair follicles). Keratosis pilaris can get red, dry and irritated (usually from scratching it), it is commonly misdiagnosed as rosacea on the face....Another possibility is eczema that can crop up anywhere, and one of the common areas is top of the arms. Eczema also goes misdiagnosed quite commonly as rosacea." Does rosacea only affect the face? ZocDoc Click here for an example of KPRF. Individual with KPRF World of Felton photo of KP DermIS Images Keratosis pillars 101 KPRF is listed also as a co-existing condition Treatment KP Elements KP Elements Treatment Cream and Scrub Combo Pack Differin Gel, according to Wikipedia, contains "Adapalene [which] is a third-generation topical retinoid primarily used in the treatment of mild-moderate acne, and is also used off-label to treat keratosis pilaris as well as other skin conditions." Anecdotal Reports mcinnis' report on misdiagnosis Bowthy's 'cure' JonathanB's chemical peels poppe says to take Selective serotonin reuptake inhibitors (SSRIs) at post no 3 in this thread.
  4. Admin


    Erysipelas produces a rash that is red, slightly swollen, very defined (well demarcated), warm, and tender to the touch. This individual has infection in the skin on both sides of the face, however, bilateral (both side) involvement is infrequent. [1] Erysipelas may produce symptoms that affect the entire body (systemic) such as fever and chill. Erysipelas is a rosacea mimic. Click here for more info. Click here for images of erysipelas. End Notes [1] Image of individual with erysipelas
  5. Accutane (Isotretinoin) has been used for many years to treat acne rosacea in higher doses so if you are taking high dose Accutane (20-40 mg or higher) you should read this Accutane Article. Low Dose Isotretinoin (5 mg to 10 mg) Please post your comments on isotretinoin in this thread by clicking on the REPLY button. Low dose isotretinoin has been successfully used to treat recalcitrant cases of rosacea: "As previously discussed, isotretinoin is a viable alternative for recalcitrant cases of rosacea. In a large-scale, placebo-controlled, randomized, 12-week, multicenter study, Gollnick et al demonstrated complete remission in 24% and marked improvement in 57% of patients with isotretinoin 0.3 mg/kg therapy daily, in contrast with remission in 14% and marked improvement in 55% of patients treated with doxycycline 100 mg daily for 14 days, then 50 mg daily. Patients treated with isotretinoin rated treatment results at the end of the study as “excellent improvement” more frequently, at 32.6% in comparison with 24.2% for patients treated with doxycycline." Clin Cosmet Investig Dermatol. 2015; 8: 159–177. Published online 2015 Apr 7. doi: 10.2147/CCID.S58940 PMCID: PMC4396587 PMID: 25897253 Update on the management of rosacea Allison P Weinkle, Vladyslava Doktor, and Jason Emer ------------------------------------------------------------------------------------ "For severe cases of inflammatory papules and pustules or for inflammatory papules and pustules that do not respond to oral antibiotics or that recur after the discontinuation of oral antibiotics, treatment with low-dose oral isotretinoin (0.25 to 0.30 mg per kilogram of body weight per day) for 12 to 16 weeks has been shown to be effective in two randomized, controlled trials." N Engl J Med 2017; 377:1754-1764DOI: 10.1056/NEJMcp1506630RosaceaNovember 2, 2017, Esther J. van Zuuren, M.D.
  6. Accutane (Isotretinoin) has been used for many years to treat acne rosacea in higher doses so if you are taking high dose Accutane (20-40 mg or higher) you should read below as well as the list of anecdotal reports causing Accutane induced rosacea. If you are taking low dose Accutane (isotretinoin) 5 - 10 mg read this post. Isotretinoin is a retinoid and is frequently used in the treatment of rosacea. You should carefully follow the directions of your physician if you are prescribed this treatment for rosacea and frequently monitor your treatment and discuss any concerns you may have about this drug with your physician. The RRDi would be remiss if we did not give you the following information about the risks and benefits of this treatment for rosacea. Many rosaceans report taking low dose isotretinoin for rosacea and are very happy campers. However, there are some who are not happy. You should know as much as you possibly can about this drug if you are taking it for your rosacea. Oral isotretinoin is marketed under various trade names, most commonly Accutane (Roche), Amnesteem (Mylan), Claravis (Barr), Isotane (Pacific Pharmaceuticals), Sotret (Ranbaxy), or Roaccutane (Roche); while topical isotretinoin is most commonly marketed under the trade names Isotrex or Isotrexin (Stiefel). If fact, isotretinoin has become quite popular with rosaceans who report that taking low doses works marvelously for them in controlling rosacea. For an example of a recent clinical report on the use of isotretinoin: "Recently, a big randomized double-blind dose-response and comparative study revealed that an optimized dosage of 0,3 mg/kg was superior to other dosages and non-inferior to doxycycline as gold standard of systemic rosacea treatment and proved effective and safe in papulopustular and phymatous subtypes. However, the substance is still not licensed for this indication The efficacy of isotretinoin in rosacea is probably mainly related to anti-inflammatory mechanisms as well as anti-oxidative, anti-angiogenic and antifibrotic properties. The classical antiseborrheic effect of isotretinoin might play a role in special subtypes like the phymatous type or rosacea fulminates." [4] Accutane is being prescribed for rosacea more than ever according to anecdotal reports. More reports of accutane treatment for rosacea in low dose prescriptions seem to be the current popular treatment without much discussion on the risks and side effects. Accutane was initially used to treat acne but has become quite common to hear of physicians prescribing it for rosacea. However, particularly pregnant women should be warned clearly of the risks associated with accutane. In addition, a rosacean should ask his doctor what are the risks associated with taking accuatane, including the side effects and determine if the risks are worth the benefits. This what is called the risk-benefit analysis. If you decide to accept risks of this treatment, you will discover later what these risks are for yourself but at least you were warned. Taking Accutane without considering the risks is like jumping into a dark deep hole blind folded. What you land on could hurt later. One report describes dermatologists who prescribe isotretinoin as "isotretinologists" who need to "to save this wonderful drug from oblivion." [5] "In a recent case in New Jersey, a former user of the acne medication Accutane has been awarded over $25 million after the medication was found to cause inflammatory bowel disease. The plaintiff, 38-year-old Andrew McCarell, testified that he had begun using the medication in 1995. His worsening bowel conditions required five surgeries. Finally, his colon had to be removed. Accutane has created an ongoing legal nightmare for its developer, Roche Holding AG. The company stopped selling the drug in June of 2009 because of the numerous complaints it received, although its spokespersons still say that competition from generics—and the high cost of defending against personal injury lawsuits—are the real reasons why the drug was discontinued. Roche has had over 1,000 (one thousand!) law suits concerning Accutane. Virtually all have argued that the company has never adequately warned of its risks. The drug, which came onto the market in 1982, has been blamed for many health problems including depression, Crohn’s disease, and birth defects. F. Hoffmann-La Roche Ltd. apparently will continue to manufacture and distribute Roaccutane outside the USA. Other manufacturers have continued to market isotretinoin since Roche's patent on the drug has now become generic and anyone can manufacture it in the USA. Unsurprisingly, a statement issued by Roche pretends to empathy but disavows any responsibility: 'Our sympathies remain with Andrew McCarrell over his disease. Both the finding and the amount of damages were unsupported by the evidence. Roche acted appropriately in providing information about Accutane, including a direct warning about inflammatory bowel disease, to the medical, scientific and regulatory communities.' Roche is planning to attempt to have McCarell’s award reduced or eliminated on appeal—along with all the others." [1] Accutane (Isotretinoin) is a very powerful, yet equally dangerous, prescription drug used to combat acne rosacea. Accutane is mainly used to minimize (or shut down) the oil gland activity. Since excessive oil gland activity is linked to severe acne, Accutane has been touted as the closest thing to an acne cure. However, since excessive oiliness is only one facet to the acne rosacea disease, the results are always temporary. At first, the drug seems to work wonders. Patients will notice a huge decrease (about 6 out of 10 will have up to 100% clarity) in their acne rosacea lesions, flushing, and redness. It may take months, or it may take a couple years, but the acne rosacea will usually return. Plus, the acne rosacea will usually become much more serious because of three things: (1) your skin needs a normal flow of oil to help lubricate and cleanse itself. By restricting this basic action, you're asking for more internal problems to manifest themselves; and (2) the liver becomes damaged from the use of this drug. The liver is the most important organ in regards to a clean system (especially for skin care); and last, but not least, (3) You may experience post-accutane rosacea. Read WhyMe?'s Report on using Accutane. Here are some of the common side effects: Severe dry skin, Itching Rashes, Chapped Lips, Nose bleeds, Headaches, Nausea, Blurred Vision, Mood Swings, Stomach Pains, Diarrhea, Rectal Bleeding, Joint Pains, Muscle Pains, Yellowing of Skin, Sensitivity to Sun, Decreased Night Vision, Hair Loss (even yrs later), Depression, Thoughts of Suicide, Increased Blood Fat Level, Birth Defects, Loss of Visions, Arthritis. "Dysfunctional meibomian glands often cause dry eyes, one of the more common eye conditions.....Meibomian gland dysfunction may be caused by some prescription medications, notably isotretinoin." Wikipedia Drug interactions The concurrent use of isotretinoin with tetracycline antibiotics or vitamin A supplementation is not recommended. Concurrent use of isotretinoin with tetracyclines significantly increases the risk of idiopathic intracranial hypertension. Concurrent intake of Vitamin A supplementation increases the risk of vitamin A toxicity. Concurrent use of isotretinoin with methotrexate increases the risk of hepatotoxicity and may increase methotrexate levels. The combination is used with caution and close monitoring of adverse effects and liver function tests. source > http://en.wikipedia.org/wiki/Accutane Please be very careful when considering using this dangerous drug and be informed about the risks. Accutane has become Hoffmann-La Roche’s top-selling product, used by an estimated 5 million Americans alone. Acknowledged as the most effective treatment for the severe, scarring form of acne, increasingly, Accutane is being prescribed for rosacea. This is because more and more rosaceans are demanding this drug from their physician without a doubt. The popularity of Accutane is only exceeded by IPL or other light therapy devices among rosaceans. However, in the past year Accutane has been pulled off the online pharmacy websites in the USA. Why is this? "Isotretinoin is a known human teratogen, causing birth defects and/or subnormal cognitive performance in prenatally-exposed children." Accutane Litagation Team One report says isotretinoin, "can transiently raise cholesterol levels and perhaps aggravate inflammatory bowel disease (IBD). source Ryan Green reports the following: "Most patients suffering from severe acne tried several, less risk-laden treatments before finally giving the cancer drug Accutane a try. But could other medications, including anti-acne antibiotics, have actually been the cause of what has been called Accutane side effects, including Accutane inflammatory bowel disease?" [2] Recently an article entitled, Accutane lawsuits and the 'learned intermediary doctrine,' [3]. by David J. Goldberg, M.D., J.D. who serves on the RRDi MAC, explains that physicians may be flying solo if they prescribe Accutane during pregnancy. Accutane's history is linked to 240 suicides worldwide and Accutane side effects have been a controversial topic since its arrival to the U.S. market in 1982. Your physician might not have mentioned any of this, but you should be aware of the side effects and risks associated with this drug, which may include and are not limited to depression, birth defects, psychiatric disorders, Accutane induced instances of inflammatory bowel disease, lupus, Crohn's Disease, Ulcerative Colitis, Rectal Bleeding, Central Nervous System damage, Bone & Muscle Damage, Hearing & Vision damage, Liver Damage, Pancreatitis, Immune System damage, Lipid (high levels of fats and cholesterol in blood) problems, Kidney damage, shortness of breath, fainting, unusual thirst, or frequent urination, weakness, leg swelling, convulsions, slurred speech, problems moving, serious mental health problems and last but not least, skin damage. Serious brain problems have been reported. Accutane can increase the pressure in your brain. This can lead to permanent loss of sight, or in rare cases, death. In some people, Accutane can cause serious allergic reactions. Stop taking Accutane and get emergency care right away if you develop hives, a swollen face or mouth, fever, rash, red patches or bruises on your legs or have trouble breathing. Certain symptoms may mean that your internal organs are being damaged. These organs include the liver, pancreas, bowel (intestines), and esophagus (connection between mouth and stomach). If your organs are damaged, they may not get better even after you stop taking Accutane. Stop taking Accutane and call your prescriber if you get severe stomach, chest or bowel pain, trouble swallowing or painful swallowing, new or worsening heartburn, diarrhea, rectal bleeding, yellowing of your skin or eyes, or dark urine. These side effects have been serious enough resulting in Roche Accutane labeling changes to occur over twenty times since its approval. Recently the USA FDA made this announcement: The Food and Drug Administration is announcing the approval of a strengthened risk management program, called iPLEDGE, for Accutane and generic isotretinoin. In addition, the U.S. Food & Drug Administration (FDA) is launching a special Web page to warn consumers about the dangers of buying isotretinoin (Accutane) online. "A national registry on Friday began accepting names of Americans who take the anti-acne drug Accutane, part of a federal effort to limit use of the birth-defect-causing drug by pregnant women." source > http://tinyurl.com/akehm The common less serious side effects of Accutane are dry skin, chapped lips, dry eyes, and dry nose that may lead to nosebleeds. People who wear contact lenses may have trouble wearing them while taking Accutane and after therapy. Sometimes, people’s acne may get worse for a while. One report says, "Teens whose acne is treated with isotretinoin may face twice the risk of eye infections, including conjunctivitis and styes, researchers say." [4] This has made it difficult to obtain Accutane [generic name, isotretinoin] online and many rosaceans have been trying to find it online in different countries that are not under the jurisdiction of the USA FDA. Because of the problems associated with the prescribing of Accutane, several law firms have teamed up for the purpose of "achieving justice and results for Accutane victims." source Roche is countering all this with information and their own team of lawyers. Physicians are still prescribing isotretinoin for rosacea, usually in low doses. Many rosaceans are reporting success using this drug for rosacea. But I have written this editorial for you to be aware of the risks involved. Buyer beware. Remember you are still the customer even if your physician views you as a patient and Roche views you as a user. Low Dose Study Shows Isotretinoin Just as Effective as Doxycycline Systemic isotretinoin in the treatment of rosacea - doxycycline- and placebo-controlled, randomized clinical study. Gollnick H, Blume-Peytavi U, Szabó EL, Meyer KG, Hauptmann P, Popp G, Sebastian M, Zwingers T, Willers C, von der Weth R. Department of Dermatology and Venereology, University of Magdeburg, Germany. Summary Background: Systemic isotretinoin has been known for decades to be effective in the treatment of severe forms of rosacea, but it must be used off-label because of the lack of evidence-based data. Patients and Methods: 573 patients with rosacea subtype II and III received one of three different dosages of isotretinoin (0.1 mg, 0.3 mg, or 0.5 mg per kg body weight), doxycycline (100 mg daily for 14 days, then 50 mg daily) or placebo in a double-blinded, randomized way for 12 weeks in 35 German centers. Results: Isotretinoin 0.3 mg/kg proved to be the most effective dose with significant superiority versus placebo. Isotretinoin 0.3 mg/kg showed also significant non-inferiority versus doxycycline with reduction of lesions of 90 % compared to 83 % with doxycycline. Investigators diagnosed complete remission in 24 % and marked improvement in further 57 % of patients with isotretinoin treatment, in contrast to remission in 14 % and marked improvement in 55 % of patients treated with doxycycline. Isotretinoin 0.3 mg/kg revealed a similar safety profile as for the treatment of acne. Isotretinoin 0.5 mg/kg showed more dermatitis facialis as compared to 0.3 mg/kg. Conclusions: Isotretinoin 0.3 mg/kg is an effective and well-tolerated therapy option for the treatment of rosacea subtype II and III and can therefore be used successfully as an alternative to therapy with oral antibiotics. J Dtsch Dermatol Ges. 2010 Mar 12. My comment is if isotretinoin is as effective as doxycycline for severe forms of rosacea, then it would be a prudent to be informed of the risks of both drugs and make an informed decision on which risks you want to live with. It might be that the doxycycline risks are less dangerous than the risks associated with isotretinoin. Accutane Induced Rosacea Read the reports Society and Culture Accutane is marketed under a number of brand names listed by Wikipedia. Rosacea sufferers have reported taking low dose isotretinoin prescribed by their physicians. End Notes [1] Accutane costs N.J. man his colon—but Roche resists paying up [3] Could Antiobiotics Cause Accutane IBD? Ryan Green | July 19th, 2011 | Posted in Accutane Lawsuit News [3] Accutane lawsuits and the 'learned intermediary doctrine' David J. Goldberg, M.D., J.D., Dermatology Times, ModernMedicine, Oct. 1, 2006 [4]Isotretinoin associated with eye infection risk Jun 6, 2012, By: Bill Gillette, Dermatology Times E-News Rosacea : Systemic therapy with retinoids. Hautarzt. 2011 Oct 22; Authors: Thielitz A, Gollnick H [5] Dermatol Ther. 2006 Jul-Aug;19(4):241-50. Coping with the isotretinoin registry. Baldwin HE. Testimonials Read these testimonials. Additional Sources Isotretinoin (marketed as Accutane) Capsule Information Accutane Capsules (isotretinoin) Medication Guide Roche Accutane Product Informantion ROACCUTANE Action Group Roche Roaccutane Info Accutane Side Effects The Accutane Team A survey of pregnant women using isotretinoin. Robertson J, Polifka JE, Avner M, Chambers C, Delevan G, Koren G, Lavigne SV, Martinez LP, Miller RK, Carey JC. Utah Department of Health, Division of Community and Family Health Services, Birth Defects and Genetics Program, Pregnancy RiskLine, Salt Lake City, Utah. Wikipedia on Accutane
  7. 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] Coffee May Be Good for Your Skin There is no evidence that coffee or caffeine causes a rosacea flareup. In fact, one study concluded the converse: "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] The New York Times commented on this study and reports, "Yet another reason to drink coffee: A new study suggests it can be good for the complexion." [4] 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 See Screen Shot: [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. [4] Coffee May Tame the Redness of Rosacea, Nicholas Bakalar, The New York Times
  8. First off what are 'stages' of rosacea? Usually in past literature on rosacea stages refer to the 'subtypes' of rosacea. In many reports on rosacea, especially those written in the past, rosacea is spoken of as progressing in stages and that the progression leads to rhinophyma (Phenotype 5). For example, note this report from Better Medicine, Heathgrades, discussing the 'stages of rosacea" from mild to moderate to severe to rhinophyma rosacea, implying that rosacea progresses in stages. [1] A CNN Health Report on the Stages of Rosacea in 2017 continues this myth. You may find similar reports that imply or state that rosacea progresses into stages. However, current thought on this subject is far from this idea and simply isn't proven to be true. For example note these reports: “The notion that the erythematotelangiectatic stage generally transforms into the papulo-pustular, inflammatory stage is simply wrong and grossly misleading. Firstly, the papulo-pustular stage mainly occurs in males in whom rosacea is a more serious disease at all stages. The papulo-pustular stage is actually uncommon in females.” [2] “Rosacea is often divided into four stages, according to the progressive nature of the condition. However, the progression is not absolute. For unknown reasons, certain patients may skip a stage. Others experience ocular symptoms as the first manifestation of the condition.” [3] Also, there is controversy on the classification of rosacea into subtypes and variants which is related to this subject. Current types are now considered to be phenotypes, so the subtype classification is not the current classification. The Phenotype classification is superior to the subtype classification. There is no data suggesting that you move progressively through the six phenotypes of rosacea. While you may have more than one phenotype at the same time, there is nothing indicating you will progress in stages through each one. One report concluded that "A small proportion of rosacea subjects may progress between subtypes." [4] "Although rosacea findings may change over time, no proven natural progression exists.[5] Conclusion While any rosacea sufferer may indeed have a case of rosacea that gets worse, it does not mean that every rosacea sufferer progresses from a mild stage of rosacea into stages that get worse. The consensus is that if you fail to treat rosacea it will probably get worse, but not necessarily in 'stages' which is usually referring to the former subtypes and now is considered the phenotypes of rosacea. End Notes [1] The Stages of Rosacea, Linda Wasmer Smith, Better Medicine, Heathgrades [2] A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman , M.D., Ph.D. Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A. The William J. Cunliffe Lectureship 2003—Manuscript [3] Consult Your Pharmacist Differentiating Between Rosacea and Acne W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD candidate :U.S. Pharmacist [4] Br J Dermatol. 2013 Apr 21. doi: 10.1111/bjd.12385. [Epub ahead of print] An observational cross-sectional survey of rosacea: Clinical associations and progression between subtypes. Tan J, Blume-Peytavi U, Ortonne JP, Wilhelm K, Marticou L, Baltas E, Rivier M, Petit L, Martel P. Department of Medicine, University of Western Ontario, London, Ontario and Windsor Clinical Research Inc., Windsor, Ontario, Canada. [5] Am Fam Physician. 2015 Aug 1;92(3):187-196. Rosacea: Diagnosis and Treatment LINDA K. OGE', MD, HERBERT L. MUNCIE, MD, AMANDA R. PHILLIPS-SAVOY, MD, MPH
  9. Obtaining a diagnosis for rosacea may seem to be fairly straight forward but considering that there are reports of misdiagnosis it would be good for rosaceans to be educated on this subject so that if one experiences a misdiagnosis it will not be a surprise and will understand better how a diagnosis is obtained. A recent survey by Galderma/NRS says that the results “highlight the low awareness and complicated diagnosis path for this common condition.” Generally, one diagnostic differentiator is when treatments for acne exacerbate the problem, this is used as an indicator in a diagnosis of rosacea. Rosacea is sometimes referred to as 'adult acne' in older papers, later called 'acne rosacea' and because it looks like acne. Rosacea is generally adult onset, and older adults obtaining a rosacea diagnosis is common. However, there are rare reports of children receiving a diagnosis of rosacea. First and foremost is that diagnosis is the sole prerogative legally and ethically of a physician. So the information in this editorial is not meant to substitute or replace a physician’s diagnosis but is simply for a rosacea sufferer to understand the subject of a rosacea diagnosis for educational purposes. Knowing what is involved in obtaining a diagnosis of rosacea is quite helpful in basic Rosacea 101 which is a subject I am quite familiar with and wish to pass on this information freely to those who wish to increase their rosacea knowledge. When you read in rosacea social media groups the common question, 'IS THIS ROSACEA?' asked to a group of rosacea sufferers by posting photos of your face, do you really think that this group is qualified to differentiate rosacea from this list? However, learning how a diagnosis of rosacea is obtained by a physician can be rewarding and help you better to ask pertinent questions to your dermatologist. There is no histological, serological or other diagnostic tests for rosacea and a diagnosis is simply arrived at by a patient history and physical examination. [1] Some clinical tests may be done, i.e., blood tests, skin biopsies, scans, etc., to rule out rosacea mimics or other diseases. However, there are now certain devices recommended to be more objective in diagnosing rosacea. [12] The NRS Classification System (2002) into subtypes and one variant is the first clearly defined proposal to identify and classify rosacea. [2] It is of interest to note that this classification system is based on morphology rather than causality. Understanding this classification and variant system was the beginning of a better understanding for this disease, however, it has been controversial from the beginning. Dermatologists who are still using the subtype classification system are somewhat able to better diagnose rosacea and it may be that your physician is familiar with this old classification, however, some physicians are not keeping up with this latest classification system and may be relying on past knowledge on this subject. Phenotype Classification of Rosacea The new direction of classifying rosacea is a phenotype based treatment. Physical Examination, History & Tests Does rosacea spread beyond the facial region? Frank Powell, MD, who served on the NRS ‘expert committee‘ that classified rosacea says in his book, “There is no laboratory test or investigation that will confirm the diagnosis of PPR. Specific investigations may be required to rule out similar appearing conditions (many of which will be identified by listening carefully to the patient’s medical history and examining the skin lesions). These include skin swabs for bacterial culture, skin scrapings for the presence of demodex mites, scrapings for fungal KOH and fungal culture, skin biopsy for histologic examination, (and rarely culture) skin surface biopsy for demodex mite quantification, patch tests, photopatch tests, and very rarely systemic workup with appropriate blood tests and radiological examinations.” [3] To rule out demodectic rosacea “Potassium hydroxide examination, standardized skin surface biopsy, skin biopsy, or a combination of these are essential to establish the diagnosis.” [4] However, some researchers state that if you use a skin scraping with a light microscope, there may be no reliable data on demodex density counts. However when using a 'Confocal laser scanning in vivo microscopy', there is a significantly more reliable data to count on simply using a skin scraping with a microscope. [11] In some cases to rule out rosacea mimics such as lupus and scleroderma it is suggested that obtaining an ANA blood test and other blood tests might be considered. [5] Another test you might consider having is the Autologous serum skin test (ASST) to rule out chronic uticaria. One report says it is necessary to perform individual bacterial cultures and antibiograms on rosacea patients. [6] Another report suggests testing mucin to differentiate lupus. [7] Another test to consider is to rule out Grave’s disease with blood tests. According to Ladonna, “…my husband took me to the dermatologist and she said it was Rosacea and couldnt be anything but….So he took me to many doctors, and finally a wonderful doctor took a shot in the dark blood test and discovered my problem. Later more involved tests and scans confirmed it. I was Hyperthyroid…specifically Graves Disease…” So from the above tests it shows that a five minute visit to your dermatologist who simply diagnoses you with rosacea and doesn’t take any of the tests mentioned above to differentiate other rosacea mimics might mean you could receive a misdiagnosis. There is anecdotal evidence that many rosaceans report a quick diagnosis in five minutes or less. Galderma has patented a diagnostic test for rosacea. Taking a Patient History and Biopsies In Powell’s last chapter, [3] entitled, General Considerations, he suggests asking questions to the patient in taking a history, specifically: (1) Asking about polycythemia? (2) Whether the patient has been using a steroid cream? (3) Any other medication such as niacin or antacids? (4) Whether there has been any frequent flushing? (5) Any complementary or alternative medicines, i.e., herbal products? (6) Eye symptoms? (7) Any family history of rosacea? Biopsies to rule out demodectic rosacea is another important consideration. One report suggests a biopsy to rule out Morbus Morbihan. If you physician neglects to ask any of the above questions you might simply bring the above questions to his attention in a respectful tone so that a proper diagnosis of your skin condition can be obtained. Not knowing the answers to the above questions may hinder a proper diagnosis. Rosaceanet (ADD) has 15 questions to ask you and then recommends something to you if you would like more info on a diagnosis. [8] If you note the disclaimer it says, "This questionnaire does not provide medical advice. It should not be used to diagnose rosacea. Only a medical doctor such as a dermatologist can make this diagnosis. The purpose of this questionnaire is to help you seek medical care if you believe that you may have rosacea. A dermatologist can provide you with a diagnosis and proper treatment." As more information on diagnosis is discovered that is pertinent to this article it will be updated. Dermoscopy Dermoscopy may prove useful according to this source: "Dermoscopy, in addition to its well-documented value in evaluation of skin tumours, is continuously gaining appreciation also in the field of general dermatology." [9] "The dermoscopic hallmark of rosacea is represented by the presence of linear vessels characteristically arranged in a polygonal network (vascular polygons) {click for image}." [10] Non-Invasive Object Skin Measurement A study recommends a more objective skin measurement for erythema, demodex density counts, rosacea severity, etc, using certain device tools. [12] End Notes [1] National Rosacea Society, Answer to Question 5 http://www.rosacea.org/patients/faq.php#test "There is no appropriate and reliable method of evaluating and monitoring severity in rosacea." Nailfold capillaroscopy as a diagnostic and prognostic method in rosacea. Fonseca GP, Brenner FM, Muller CD, Wojcik AL. An Bras Dermatol. 2011 Feb;86(1):87-90. [2] Classification of Rosacea http://www.rosacea.org/class/classysystem.php [3] Rosacea Diagnosis and Management by Frank Powell with a Contribution by Jonathan Wilkin [4] Demodicosis: a clinicopathological study. Hsu CK, Hsu MM, Lee JY. J Am Acad Dermatol. 2009 Mar;60(3):453-62 [5] Scroll to Alba’s Post #6 about ANA Blood Tests [6] Necessary to perform individual bacterial cultures and antibiograms in rosaceans? A new study on acne and rosacea patients concluded these findings: CONCLUSIONS: 1. In the cases of acne vulgaris the majority of isolated bacteria from conjunctival sac included Streptococcus spp., Staphylococcus spp. and Enterobacteriaceae. 2. In the severe cases of rosacea the main bacteria found in conjunctival sac were S. aureus, S.pyogenes, P.aeruginosa, E. faecalis, A. baumanii, P. fluorescens. 3. Because of changeable drug-sensitivity of bacterial strains, it seems to be necessary to perform individual culture and antibiogram in every patient with inflammatory lesions, in particular in clinically severe and resistant to therapy cases of acne vulgaris and rosacea. 4. The higher frequency of the bacterial colonisations in the conjunctival sac in patients with acne vulgaris and rosacea can be a potential source of ocular infections in the cases of local and systemic disorders of protective mechanisms. 5. Estimation of bacterial flora and antibiotic sensitivity of bacteria isolated from conjunctival sac, the skin of the eyelids and skin lesions should be perform, especially when patients are prepared for eye surgery. Source of the above information [7] Mucin is not a rare finding in rosacea is the title of a research study done by A. Fernandez-Flores at the Service of Cellular Pathology, Clinica Ponferrada in Spain. http://www.ncbi.nlm.nih.gov/pubmed/20191122?dopt=Abstract http://www.clinicaponferrada.com/ Mucins are a family of high molecular weight, heavily glycosylated proteins (glycoconjugates) produced by epithelial tissues in most metazoans. They are being investigated for their potential as diagnostic markers. http://en.wikipedia.org/wiki/Mucin The study concluded "that: 1. mucin is a common finding in granulomas of rosacea; 2. this mucin is probably not related to any progression to the mucinous variant of rhinophyma; 3. since discoid erythematosus lupus is a clinical differential of rosacea, it is important to be aware of the fact that mucin is a common finding in the granulomas, in order not to misdiagnose both entities." Here is another potential diagnostic marker to differentiate rosacea from lupus. [8] Rosaceanet American Academy of Dermatology Could I Have Rosacea? [9] J Eur Acad Dermatol Venereol. 2013 Mar 12. doi: 10.1111/jdv.12146. [Epub ahead of print] Dermoscopic patterns of common facial inflammatory skin diseases. Lallas A, Argenziano G, Apalla Z, Gourhant JY, Zaballos P, Di Lernia V, Moscarella E, Longo C, Zalaudek I. [10] Dermatol Ther (Heidelb). 2016 Dec; 6(4): 471–507. Published online 2016 Sep 9. doi: 10.1007/s13555-016-0141-6 PMCID: PMC5120630 Dermoscopy in General Dermatology: A Practical Overview Enzo Errichetti, Giuseppe Stinco [11] Russian Study on Demodex Mites and Rosacea Illuminating [12] Br J Dermatol. 2019 May 23;: Non-invasive objective skin measurement methods for rosacea assessment: a systematic review. Logger JGM, de Vries FMC, van Erp PEJ, de Jong EMGJ, Peppelman M, Driessen RJB
  10. Alarmins are "antimicrobial peptides (AMPs) such as defensins and cathelicidins [1], which not only kill microbes but also trigger host-tissue responses, including leukocyte chemotaxis, angiogenesis, expression of extracellular matrix components, and inflammation."** Abnormal levels of cathelicidin LL37*** in the skin have been linked to rosacea. Cathelicidin and Richard Gallo have almost become synonomous in the rosacea world. Richard Gallo is doing research on cathelicidin's role in rosacea. There has been much excitment concerning cathelcidin's pathogenic role in rosacea along with kallikrein 5 (KLK5). Kallikrein 5 (KLK5) is a protein. Kallikreins are a subgroup of serine protease. More info on KLK5 A report in JAAD in 2010 concluded that "because an excess of KLK5 and cathelicidin has been hypothesized to contribute to the development of rosacea, finding that an effective treatment for rosacea can decrease expression of these molecules further supports the involvement of KLK5 and cathelicidin in the pathogenesis of this disease." [1] The above journal reports that Finacea was effective in treating rosacea and the report was sponsored by Intendis, the manufacturer of Finacea. In August 2007 major newspapers across the country said scientists have found the cause of rosacea. For instance the Los Angeles Times, the Washington Post, and Medical News Today all had headlines discussing this subject. Here is the actual abstract from Nature Medicine. Does it claim that the cause of rosacea has really been found? Many rosaceans would like to think so. Richard L. Gallo and colleagues noticed that patients with rosacea had elevated levels of cathelicidin and elevated levels of stratum corneum tryptic enzymes (SCTEs). Cathelicidin antimicrobial protein is an antimicrobial protein found in specific granules of polymorphonuclear leukocytes (PMNs). Stratum Corneum Tryptic Enzyme (SCTE) is part of the the kallikrein family protease. Antibiotics have been used in the past to treat rosacea, but antibiotics may only work because they inhibit some SCTEs. ----------------------Begin Abstract Increased serine protease activity and cathelicidin promotes skin inflammationin rosacea Kenshi Yamasaki, Anna Di Nardo, Antonella Bardan, Masamoto Murakami, Takaaki Ohtake, Alvin Coda1, Robert A Dorschner1, Chrystelle Bonnart, Pascal Descargues, Alain Hovnanian, Vera B Morhenn & Richard L Gallo Nature Medicine, 5 August 2007 | doi:10.1038/nm1616 Acne rosacea is an inflammatory skin disease that affects 3% of the US population over 30 years of age and is characterized by erythema, papulopustules and telangiectasia1, 2, 3. The etiology of this disorder is unknown, although symptoms are exacerbated by factors that trigger innate immune responses, such as the release of cathelicidin antimicrobial peptides4. Here we show that individuals with rosacea express abnormally high levels of cathelicidin in their facial skin and that the proteolytically processed forms of cathelicidin peptides found in rosacea are different from those present in normal individuals. These cathelicidin peptides are a result of a post-translational processing abnormality associated with an increase in stratum corneum tryptic enzyme (SCTE) in the epidermis. In mice, injection of the cathelicidin peptides found in rosacea, addition of SCTE, and increasing protease activity by targeted deletion of the serine protease inhibitor gene Spink5 each increases inflammation in mouse skin. The role of cathelicidin in enabling SCTE-mediated inflammation is verified in mice with a targeted deletion of Camp, the gene encoding cathelicidin. These findings confirm the role of cathelicidin in skin inflammatory responses and suggest an explanation for the pathogenesis of rosacea by demonstrating that an exacerbated innate immune response can reproduce elements of this disease. 1. Division of Dermatology, University of California, San Diego, and VA San Diego Health Care System, 3350 2. La Jolla Village Drive, San Diego, California 92161, USA. 3. Department of Dermatology, Asahikawa Medical College, Asahikawa 078-8510, Japan. 4. Department of Medicine, Asahikawa Medical College, 2-1-1-1 Midorigacka Hidashi, Asahikawa 078-8510, Japan. 5. INSERM, U563, Toulouse F-31000, France. Université Paul-Sabatier, Toulouse F-31000, France. 6. CHU Toulouse, Department of Genetics, Place du Dr. Baylac, Toulouse F-31000, France. --------------------End Abstract It appears that this team of scientists may be on to something, but as for finding the cause of rosacea, this appears to be a bit premature, but of course, most rosaceans are excited and hopeful about this research. According to one report by Jen Christensen of WHOI, "skin samples and biopsies from rosacea patients had significantly higher levels of cathelicidin. In addition, the cathelicidin found in rosacea patients was a different form than that found in people without rosacea. Researchers also found patients had higher levels of an enzyme called stratum corneum tryptic enzyme (SCTE). This enzyme appears to convert the cathelicidin into another peptide that triggers rosacea symptoms. Dermatologist Richard Gallo, M.D., Ph.D., says the findings explain why tetracycline, a type of antibiotic, reduces symptoms in some patients with rosacea. Tetracycline inhibits the enzymes that convert the cathelicidin into an inflammatory peptide. But it doesn’t work for everyone. In the future, Gallo would like to see the development of medications that specifically target the enzyme or the proteins and prevent the onset of rosacea symptoms. The JAAD report explains that Gallo and his team are now reporting in 2010 that Finacea may be the treatment they are looking for. [2] Here is another report on this subject that needs further explanation: The Epidermal Vitamin D System and Innate Immunity: Some More Light Shed on This Unique Photoendocrine System? Siegfried Segaert, Thierry Simonart Department of Dermatology, University Hospital Leuven, Leuven, and Department of Dermatology, Hôpital Universitaire Erasme, Brussels, Belgium Dermatology 2008;217:7-11 (DOI: 10.1159/000118506) Click here for some explanation of the above report. "Skin biopsies of patients with rosacea and normal controls were compared, and the rosacea samples had elevated cathelicidin based on immunostaining and analysis of cathelicidin mRNA....Rosacea samples had elevated abundance of SCTE compared with normal skin samples, and protease activity was also elevated based on in situ zymography. To ascertain whether the elevated active cathelicidin peptides could contribute to the rosacea symptoms, the most abundant peptides, LL-37 and FA-29, from the rosacea samples were added to cultured human keratinocytes or injected subcutaneously into mice. These rosacea-enriched peptides stimulated interleukin-8 production from the keratinocytes and caused erythema, vascular dilation, neutrophil infiltration, thrombosis, and hemorrhage in the injected skin." [3[ Vitamin D and Cathelicidins "Current studies have unexpectedly identified vitamin D3 as a major factor for the regulation of cathelicidin expression. This finding may provide new strategies in the management of infectious and inflammatory diseases of the skin by targeting control of the expression and function of cathelicidin and other AMPs." [4] End Notes [1] Cathelicidins are small cationic peptides that possess broad-spectrum antimicrobial activity. These gene-encoded 'natural antibiotics' are produced by several mammalian species on epithelial surfaces and within the granules of phagocytic cells. Since their discovery over a decade ago, cathelicidins have been speculated to function within the immune system, contributing to a first line of host defense against an array of microorganisms. Consequently, cathelicidins have captured the interest of basic investigators in the diverse fields of cell biology, immunology, protein chemistry and microbiology. A burgeoning body of experimental research now appears to confirm and extend the biological significance of these fascinating molecules. This article reviews the latest advances in the knowledge of cathelicidin antimicrobial peptides, with particular emphasis on their role in defense against invasive bacterial infection and associations with human disease conditions. [2] J Am Acad Dermatol 2009;60:AB1. Abstract P103, American Academy of Dermatology, 68th Annual Meeting, March 5–9, 2010, Miami, Florida (JAAD Poster Abstracts, March 2010 / Volume 62 / Number 3) [3] Sci. STKE, 14 August 2007 Vol. 2007, Issue 399, p. tw290 [DOI: 10.1126/stke.3992007tw290] Hyperactive Antimicrobial Response Produces Rosacea Nancy R. Gough Science's STKE, AAAS, Washington, DC 20005, USA [4] Cathelicidins: multifunctional defense molecules of the skin. Peric M, Koglin S, Ruzicka T, Schauber J. Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München. Dtsch Med Wochenschr. 2009 Jan;134(1-2):35-8. Epub 2008 Dec 17. Gallo's theory and resources Scand J Infect Dis. 2003;35(9):670-6. Cathelicidins and innate defense against invasive bacterial infection.Nizet V, Gallo RL. Department of Pediatrics, Division of Infectious Diseases University of California, San Diego, La Jolla 92093, USA PMID: 14620153 [PubMed - indexed for MEDLINE] Antimicrobial peptides and the skin immune defense system Jürgen Schauber, MDa and Richard L. Gallo, MD, PhDb J Allergy Clin Immunol. 2008 August; 122(2): 261–266. Published online 2008 April 25. doi: 10.1016/j.jaci.2008.03.027. This thread has an enormous amount of research on this subject. ** "The term "alarmins" has been used to describe antimicrobial peptides (AMPs) such as defensins and cathelicidins, which not only kill microbes but also trigger host-tissue responses, including leukocyte chemotaxis, angiogenesis, expression of extracellular matrix components, and inflammation. Rosacea, an inflammatory skin disease, exhibits many of these resultant characteristics. Thus, Yamasaki and colleagues recently identified altered levels and post-translational processing of cathelicidin in skin from rosacea patients. When cultured with human keratinocytes, abnormal cathelicidin peptides resulted in erythema and vascular dilatation. Deletion of the cathelicidin gene in a mouse model of skin irritation resulted in significantly less inflammation than in wild-type animals. In addition, increases in the activity of serine proteases that lead to activation of cathelicidin were implicated in inflammatory changes associated with rosacea. Thus, manipulation of antimicrobial peptides and their postsecretory processing may be a focus for the development of effective therapeutic strategies for rosacea." Editorial Journal of Investigative Dermatology (2007) 127, 2493. doi:10.1038/sj.jid.5701133 ***Autoimmune disease: Skin deep but complex Nicole Baumgarth1 & Charles L. Bevins Nature 449, 551-553 (4 October 2007) | doi:10.1038/449551a; Published online 3 October 2007 Rosacea May Be Caused by Immune Response, Not Bacteria By Neil Osterweil, Senior Associate Editor, MedPage Today Published: August 06, 2007 Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. There is evidence that Vitamin D is "a major regulator of the expression of the cationic antimicrobial peptide cathelicidin."
  11. Differential Diagnosis of Rosacea Authoritative Resource Guide Below is a list with sources showing a differential skin disease(s) to consider in diagnosing rosacea. Can you see why a dermatologist is better qualified to differentiate this list rather than asking a social media group of rosacea sufferers 'IS THIS ROSACEA?' Just because a patient presents with erythema doesn't mean it is rosacea and should be differentiated from this list, which by the way is not an exhaustive list and will keep growing as we learn of new ones: Acne @ Acne Agminata ** Acne Venenata* Acne Vulgaris* Actinic Reticuloid ^ Allergic Conjunctivitis @ Anaphylaxis ! Atopic dermatitis $ Autosensitization dermatitis [5] Basal Cell Carcinoma + Bromoderma ** Carcinoid Syndrome # [6] Chronic discoid lupus erythematosus # Chronic Topical Corticosteroid Therapy ^ Crohn’s disease @@ Climacterum ! Colon Cancer @@ Contact and photocontact dermatitis $ Corticoid Damage* Cutaneous Rosai-Dorfman {1] Demodicidiosis* Dermatomyositis* Drug eruptions (particularly from iodides and bromides) % Eosinophilic pustular folliculitis (EPF) [2] Erysipelas ^ Erythema Infectiosum * FACE syndrome @@ Fractional Microneedling Radiofrequency Induced Rosacea Gram-negative Folliculitis* Growth Factor Receptor Inhibitor “acne” + Haber's syndrome # Iododerma ** Kaposi varicelliform eruption (eczema herpeticum) Keratosis Pilaris [4] Lichen Spinulosus [4] Lupus Erythematosus ^ [6] Lupus Miliaris Disseminatus (Faciei)* Lupus Vulgaris ** Mastocytosis Syndrome @ Medications $ Medullary Carcinoma of the Thyroid ! Melkerrson-Rosenthal syndrome [3] Mitral Valve Incompetence ** Mixed Connective Tissue Disease [6] Morbihan´s Disease* Pancreatic cell tumor ! Perioral Dermatitis* Periocular Dermatitis* Pheochromocytoma ! Photodermatitis # Photosensitivity diseases Photosensitive Eruption [6] Physical erythema $ Polycythemia Vera [6] Polymorphous light eruption # Polymyositis % Pregnancy @@ Prosopitis Granulomatosa* Pustular Folliculitis** Pyoderma faciale & Renal Carcinoma ! Rhinophyma* Rubeosis Diabeticorum* Sarcoidosis ** Sarcoidosis, Small Nodular Type* Seborrheic Dermatitis* Secondary Lues* Skin Granulomas % Sterile Eosinophilc Pustulosis* Steroid rosacea @@ Subacute Cutaneous Lupus Erythematosus SCLE* Syphilis ^ Systemic Lupus Erythematosus @ Tuberculosis ^ Ulcerative Colitis @@ Ocular Rosacea Differential Diagnosis: Sebaceous Gland Carcinoma % Seborrheic Blepharokeratoconjunctivitis % Staphylococcal Blepharokeratoconjunctivitis % Systemic Mastocytosis [6] Trichodysplasia spinulosa (TS) [4] End Notes *DermIS # Journal of the Royal Society of London, Vol. 90, March, 1997, p.247 @ American Family Physician, August 1, 2002 $ Diagnosis and Treatment of Rosacea, Aaron F. Cohen, MD, and Jeffrey D. Tiemstra, M, J Am Board Fam Pract 2002;15:214 –7.) % Treatment of Acne Rosacea Reviewed CME/CE, Laurie Barclay, MD, Charles Vega, MD, FAAFP, MedscapeCME Clinical Briefs ^ Acne Rosacea, Marian S. Macsai, Mark J. Mannis, and Arthur C. Huntley, 1996 by Lippincott-Raven Publisher ** Rosacea: Differential Diagnoses & Workup, Agnieszka Kupiec Banasikowska, MD, Saurabh Singh, MD, eMedicine from WebMD + Rosacea, Guy F. Webster, MD, PhD, Medical Clinics of North America - Volume 93, Issue 6 (November 2009) ! The flushing patient: Differential diagnosis, workup, and treatment, Leonid Izikson, MD, Joseph C. English III, MD, Matthew J. Zirwas, MD. Journal of the American Academy of Dermatology - Volume 55, Issue 2 (August 2006) & DermNet NZ @@ Rosacea: A Review, Brittney Culp, BA and Noah Scheinfeld, MD, P&T, 2009 January; 34(1): 38–45. [1] Cutaneous Rosai-Dorfman disease presenting as a granulomatous rosacea-like rashs. Shi XY, Ma DL, Fang K. Chin Med J (Engl). 2011 Mar;124(5):793-4. [2] J Dermatol. 2013 Mar 12. doi: 10.1111/1346-8138.12125. Clinical and histopathological differential diagnosis of eosinophilic pustular folliculitis. Fujiyama T, Tokura Y. [3] Diagn Pathol. 2013 Nov 13;8(1):188. Melkerrson -Rosenthal syndrome, a rare case report of chronic eyelid swelling. Kajal B, Harvey J, Alowami S. [4] "The differential diagnosis of TS can be broad, including keratosis pilaris and related disorders, lichen spinulosus, sarcoidosis, rosacea, and perforating disorders." JAAD Case Rep. 2019 Apr; 5(4): 352–354. Published online 2019 Apr 5. doi: 10.1016/j.jdcr.2019.02.001 PMCID: PMC6453831 Widespread keratosis pilaris–like eruption in an immunocompromised child Alice Frigerio, MD, PhD, Tuna Toptan, MD, PhD, Yuan Chang, MD, James Abbott, MD, Sarah D. Cipriano, MD, and Anneli R. Bowen, MD [5] JAAD Case Rep. 2019 May; 5(5): 410–412. Autosensitization dermatitis: A case of rosacea-like id reaction Sarah D. Ferree, BA, Connie Yang, BA, and Arianne Shadi Kourosh, MD, MPH [6] According to Izikson et al, "When evaluating patients with rosacea, it is important to exclude the diagnoses of polycythemia vera, photosensitive eruption, lupus erythematosus, mixed connective tissue disease, carcinoid syndrome, systemic mastocytosis, or side effects from long-term facial application of topical steroids." Blushing Propensity and Psychological Distress in People with Rosacea. Su D, Drummond PD. Clin Psychol Psychother. 2011 Jun 23. doi: 10.1002/cpp.763.
  12. There are a number of prescription drugs you could ask your physician about that have been reported to help reduce flushing. There are also over the counter drugs [OTC] non prescription treatments used to reduce or avoid flushing as well. This post is dedicated to those of you searching for methods to control or reduce flushing. Post your own method in this thread, please. "Flushing can be treated with medications that have provided some success in other studies, including beta-blockers, clonidine (Catapres, Boehringer Ingelheim), naloxone (Narcan, Endo), ondansetron (Zofran, GlaxoSmithKline), and selective serotonin reuptake inhibitors (SSRIs). However, evidence supporting many of these therapies is limited." [1] The prescription drugs in the list below came from anecdotal reports posted in various online support groups for rosacea that reported that their physician prescribed the drug to reduce flushing or an anecdotal report mentioning the drug. The same is true for the sources listed for the non prescription treatments [OTC] and all these sources are listed in the end notes. Lastly, there is a subheading if you scroll below of 'Other Treatments' for flushing avoidance. Prescription Drugs Amlodipine (very low dose) [28] Amitriptyline (Elavil) [37] Antihistimines (also available OTC) [9] Atenolol [6] Benadryl Botulinum Toxin [30] Brimonidine Carvedilol [7] Citalopram (brand names: Celexa, Cipramil and others) Clonidine [1] Cymbalta [2] Diclofenac [16] Duloxetine [2] Effexor [2] Epinephrine Famotidine [24] Gabapentin [2] Hormone Replacement Therapy Hydroxychloroquine (Plaquenil) [4] Ketamine 0.5% and Amitriptyline 1% Lanreotide Loratadine (Claratin) [5] Lyrica [2] Maxalt [2] Megestrol acetate Mepacrine (INN), also called quinacrine (USAN) or by the trade name Atabrine Metoprolol Metformin [35] Mirtazapine (Remeron) [12] Monoxidine Montelukast (Singulair) [5] MSM [33] Nadadol Naloxone [1] Naltrexone [32] Ondansetron [1] Pavinetant [25] Paxil [26} Propranolol (Inderal) [8] Pseudoephedrine [3] Ranitidine (Zantac) [5] Roxicodone [2] Sandostatin LAR Serotonin Reuptake Inhibitors (SSRIs) [1] Treximet [2] Triptran ( Imitrex or Sumatriptan) [19] Venlafaxine [17] Veralipride [18] OTC NON PRESCRIPTION (or other treatments) [9] Antihistimines (OTC) [9] Aspirin Before Elixir [13] Benadryl Breathing Exercises [29] Bromelain [10] [23] Chili (capsaicin) [36] codeRed [14] Diamine oxidase (DAO) [34] Giviscon [21] Ibuprofen [27] MSM [22] Quercetin [10] [23] Red clover Sepia Tablets [15] Topical ibuprofen [20] Vitamin C [10] [23] Other Treatments Tixel followed by topical application of 100 U of abobotulinumtoxin [31] End Notes [1] Rosacea: A Review Brittney Culp, BA and Noah Scheinfeld, MD P T. 2009 January; 34(1): 38–45. realwork says, "SSRI's work the best for me. Luckily I didn't suffer many side effects." post no. 2 Nat007 writes about "Medication that has proved to be helpful for facial flushing, redness and burning" [2] Cymbalta [Duloxetine] Anecdotal report from Meg post #3 on 6/14/11 Momof reports [in post no 11], "I have been taking 60mg Duloxetine in the morning for the past few days ( instead of amitriptyline) and it is proved a magic bullet." [3] valby - Post #8 6/16/11 at 3:04AM [4] Post #14 by shantelle 6/20/11 at 04:51 AM antwantsclear recommends hydroxychloroquine [see post no 4] [5] Brook - Post #11 6/25/11 [6] Read Judworth's post 28th November 2011 02:13 PM Post #2 [7] Pronounced facial flushing and persistent erythema of rosacea effectively treated by carvedilol, a nonselective b-adrenergic blocker J AM ACAD DERMATOL VOLUME 67, NUMBER 3, Letters, page 491 jlb2010 Post #1 "Carvedilol, 6.25 mg twice a day, was prescribed for the first week, followed by 3 times a day thereafter. She monitored her blood pressure and pulse rate regularly at home, and no hypotension or bradycardia was noted. A dramatic improvement in the erythema and telangiectasia was noted in 2 weeks." Carvedilol for the Treatment of Refractory Facial Flushing and Persistent Erythema of Rosacea Chia-Chi Hsu, MD; J. Yu-Yun Lee, MD; Department of Dermatology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan Download pdf J Am Acad Dermatol. 2012 Sep;67(3):491-3. Pronounced facial flushing and persistent erythema of rosacea effectively treated by carvedilol, a nonselective β-adrenergic blocker. Hsu CC, Lee JY. "These findings demonstrate facial flushing and persistent erythema can be effectively treated by carvedilol long-term with a fast onset of improvement in a dose well tolerated." J Dermatolog Treat. 2017 Jul 27;:1-16 Long term management of distinct facial flushing and persistent erythema of rosacea by treatment with carvedilol. Pietschke K, Schaller M [8] Symptomatic treatment of idiopathic and rosacea-associated cutaneous flushing with propranolol. Craige H, Cohen JB. J Am Acad Dermatol. 2005 Nov;53(5):881-4. [9] Over The Counter (non prescription) [10] DianaLynn's anecdotal report [12] J Support Oncol. 2004 Jan-Feb;2(1):50-6. Pilot evaluation of mirtazapine for the treatment of hot flashes. Perez DG, Loprinzi CL, Barton DL, Pockaj BA, Sloan J, Novotny PJ, Christensen BJ. The Effect of Mirtazapine for Treatment of Hot Flashes in Depressed Woman with Breast Cancer Receiving Tamoxifen: A Case Report Lee SH; Ko YH; Joe SH. Korean Journal of Psychopharmacology; 17(1): 101-104, 2006. Obstet Gynecol. 1990 Oct;76(4):573-8. Alpha 2-adrenergic mechanism in menopausal hot flushes. Freedman RR1, Woodward S, Sabharwal SC. pleasehelp123 reports taking Mirtazapine nat007 and BlueDog report taking Mirtazapine Chai reports taking Mirtazapine with a severe rebound of rosacea when withdrawing from it [13] Before Elixir PREVENTS ALCOHOL FLUSH: Reduces flushing of face and symptoms of Alcohol Flush [14] codeRed [15] 'There's also anecdotal evidence that sepia tablets - a homeopathic remedy - can help flushes. I have had many patients who found that it helped.' Why your 'flushing' could be a red alert to see your doctor By Caroline Bellamy, Daily Mail carveArchives_of_Dermatology_2011_147.pdf [16] Violetsareblue post #13 [17] realwork, post #5 DunkWheezy post no 35 says, "Ever since I started taking a 37.5mg Venlafaxine pill daily I haven't had a problem with flushing. Ask your doctor about trying it, it majorly helped me and I'm sure it could help you. I take a super low dose and experience no side effects." Prim Care Companion J Clin Psychiatry. 2007; 9(1): 70–71. PMCID: PMC1894834 Alleviation of Hot Flashes With Increase in Venlafaxine Dose Prasad R. Padala, M.D., Srinivas B. Rapuri, M.D., and Kalpana P. Padala, M.D. [18] Climacteric. 2010 Apr;13(2):141-6. doi: 10.3109/13697130903219208. Reduction of serum serotonin precursors after veralipride treatment for postmenopausal hot flushes. Carretti N, Florio P, Reis FM, Comai S, Bertazzo A, Petraglia F. [19] laser_cat [20] Eur Neuropsychopharmacol. 2013 Dec;23(12):1747-53. doi: 10.1016/j.euroneuro.2013.07.013. Epub 2013 Aug 6. Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing. Drummond PD, Minosora K, Little G, Keay W. [21] Boris reports, "taking a slug of giviscon liquid before i head out to the pub stops me from flushing completely." [22] antwantsclear post no 7 writes, "Helpful supplements for me include Solgar MSM 1000mg (you can take up to six per day but start with one initially). Higher Nutrition for Healthy Veins. Symprove probiotic (this is very helpful). Zinc 15mg twice per day. Vaxa Buffer pH." [23] BVokey post no 12 says, "Vitamin C, msm, riboflavin (by itself, not in a b-complex vitamin)" [24] realwork at RF says, "Famotidine massively reduces the alcohol flush. Always consult your doctor first before taking any medication." [25] Pavinetant (INN, USAN; developmental code names MLE-4901, AZD-4901, AZ-12472520, AZD-2624) "In November 2017, development of the medication for hot flashes and PCOS was also terminated after its developer assessed the clinical risks and benefits." Wikipedia"In 28 healthy women aged 40–62 years, oral administration of a 40 mg dose twice per day for 4 weeks reduced the number of hot flushes during week 4 by 45 percentage points (95% CI 22–67) compared with placebo (intention-to-treat adjusted means: placebo 49·01 [95% CI 40·81–58·56] vs MLE4901 19·35 [15·99–23·42]; adjusted estimate of difference 29·66 [17·39–42·87]; p<0·0001). This finding was also supported by an objective assessment of flushes, using the Bahr sternal skin conductance monitor. Reductions in the number of flushes might be less important to women than measures of quality of life, thus it is of interest that the authors found hot flush severity, bother, and interference to be significantly reduced during treatment with MLE4901."The Lancet Volume 389, No. 10081, p1775–1777, 6 May 2017New pathways in the treatment for menopausal hot flushesJenifer Sassarini, Jenifer Sassarini, Richard A Anderson [26] antrax1 (Post no 1}says, "My wonder: 5 MG paxil a day. Works GREAT for itching, flushing and blushing. I barely blush and flush now (was VERY severe, even considered ETS surgery)." [27] Violetsareblue [post no 6] says, "Taking a 200 or 400 mg ibuprofen every now and then (twice per week max) if I know I will be triggered. This has helped me a lot to feel that I can have control over the condition. Its not good to do it on daily basis, but for me it is a great help just mentally knowing that I have some sort of control. [28] laser_cat at RF post no 12 writes, "The amlodipine is helpful for both pain + flushing, I think by evening out blood flow / oxygen tension in my face." [29] Flugs reports, "If I close my eyes, exhale deeply, and relax for about 10 seconds, then open my eyes again and look in the mirror, my face is completely pale. The effect only lasts a few seconds before the usual pinkness in my cheeks returns… but, sometimes, if I’m heading towards a light flush, I can actually head it off at the pass by doing this." [30] "Intradermal botulinum toxin injection may be an effective treatment for refractory erythema and rosacea flushing that deserves further study in a larger patient population." Dermatology Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea Park K.Y., Hyun M.Y., Jeong S.Y., Kim B.J., Kim M.N., Hong C.K. [31] Lasers Surg Med. 2018 Oct 12. doi: 10.1002/lsm.23023. [Full text with images] The toxic edge-A novel treatment for refractory erythema and flushing of rosacea. Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O [32] Flugs reports "I need more time to know if it has - or will - help reduce flushing. Perhaps if the face pain / sensitivity goes the tendency to flush may reduce through time. I also think that I will need to continue to zap the caps and redness a bit more, in order to get rid of the excess infrastructure that makes flushing so easy." (There are others in Flug's thread that are trying Naltrexone) [33] "I've been taking 4000mg a day for 3 days and I've flushed maybe 5 times since I started. I was flushing 10-20 times a day. It's really life changing!" RickSaw12, Reddit [34] Diamine oxidase (DAO), also known as histaminase, is an enzyme (EC involved in the metabolism, oxidation, and inactivation of histamine and other polyamines such as putrescine or spermidine in animals." Wikipedia mac5400 posts at Reddit, "I now take an OTC supplement called UmbrelluxDAO before i eat or drink. It contain the enzymes responsible for metabolizing histamine. And I barely flush anymore. The chronic rosiness on my cheeks has significantly reduced; more than any cream I've ever tried. In combination with a low histamine diet, i think i finally found the "cure" to my "rosacea." It's such a breakthrough for me. This supplement is life-changing." [35] Metformin Brands: Glucophage, Riomet, Fortamet, Glumetza, and Glucophage XR Markhill8 at RF states, "Four weeks ago I started taking 500mg Metformin once a day (right before my evening meal). By the third day my flushing had decreased and after around 10 days had reduced drastically. Now I do not flush at all to food and interestingly the other triggers like heat and laying down to sleep (always use to flush with head getting warm on the pillow) no longer make me flush. My nose seems to be decreasing in volume also (edema slowly going) because I no longer flush. If I do something that use to bring on a flush like taking a really warm shower, now I just get a slight tingling feeling that used to herald a massive flush but now only lasts for around 1-2 minutes with no redness or swelling. I don't have diabetes and have type 1 Rosacea with flushing/ nose swelling. For the last week I have reduced the dose to 500mg every other day and it is still working. I hope to reduce it to 500mg every 3 days after another two weeks and see if it still works. Food it seems is a massive delayed trigger for me that is driving my Rosacea." [36] sepi, Rosacea Forum Capsaicin is the active ingredient in chili peppers that makes them hot. Capsaicin is used in medicated creams and lotions to relieve muscle or joint pain. Rugby Capsaicin 0.025% Cream CAPZASIN-HP CREME Zostrix Maximum Strength Natural Pain Relief Cream, Capsaicin Pain Reliever: [37] Momof reports, "...25mgx2 daily ( 50mg) of Amitriptyline has definitely helped the crazy nerves in my face..."
  13. Natural Treatments for Rosacea Aloe Apple Cider Vinegar Argan Oil Aspirin Azelaic Acid Cream Baking soda & hydrogen peroxide Betaine Hydrochoride Black Cohosh Bromelain Burdock B Vitamins Calendula Celazome Serum Vitae Chamomile Chrysanthellum Indicum Cream ClearSkin-A Coconut Oil Colloidal oatmeal CoQ10 Enzyme Cucurcim Digestive Enzymes Decleor EGF Emu Oil EmerginC Fenugreek Feverfew Flaxseed Oil Gamma-linolenic acid (GLA) Grapeseed Extract Green Tea Cream Herpanicine Honey (Raw) Mask Jojoba Oil Juice Beauty Kerstin Florian Hyaluronic Serum Licorice Milk of Magnesia (Epsom Salt) Niacinamide Ole Henriksen Oil of Oregano Olive Leaf Ocean Essence Omega-3 fatty acids Ovanté Pine Tar Soap Probiotics Red Clover Rose Hip Sea Buckthorn Selenium Serrazyme Skinactives Rosacea Control Serum with EGF Soy Isoflavones Topical facial cream that contains alpha lipoic acid (ALA) and vitamin C prepared by a compounding pharmacist Tumeric Vitamin B Vitamin C Vitamin D Vitamin K Woebyzyme Zinc Interesting Post Innovations in natural ingredients and their use in skin care. Fowler JF Jr, Woolery-Lloyd H, Waldorf H, Saini R. J Drugs Dermatol. 2010 Jun;9(6 Suppl):S72-81; quiz s82-3.
  14. Photo Dynamic Therapy [PDT] are all light devices used for rosacea treatment, sometimes called Broad Band Light. Laser has been around the longest and the newest lasers are quite effective for rosacea. Intensity Pulsed Light (IPL) Therapy is a newer (than laser) treatment for rosaceans. Reports have indicated successful cosmetic improvement for rosacea. However the side effects include skin peeling, potential loss of facial hair and pain. Many have reported having to return after some time (months or years) for more treatment. The newest treatment for rosacea are LED lamps with various brand name which are are too numerous to mention here, but blue and red light emitting diode based therapy are the two more popular ones. Many rosaceans report buying home LED devices or making a LED device themselves for their rosacea. If any other light devices become available they will be posted in this section.
  15. Admin


    ETS is a major surgery that involves surgical removal or clamping of sympathetic nerves that supply the hands, neck and face. This surgery may decrease facial blushing and flushing. A similar surgery is endoscopic upper thoracic sympathectomy (EUTS). You might want to read this article about Micro ETS at R2 by David H. Nielson, MD. Please read this article about Corposcindosis before you rush off to get ETS. You should clearly understand not only the benefits of using ETS but also the risks and side effects. One of the posssible risks and side effects is anhidrosis. ETS may stop the blushing/flushing but also upper body sweating. ETS may create a situation where the top part of the body has lost vascular control and cannot sweat, while the bottom part retains vascular control and sweats more. One report on EUTS said "the sympathetic dysfunction of the heart was limited to the decrement of mean heart rate although EUTS partially destroys sympathetic fibers innervating the heart." [1] ETS patients may report feeling too hot and too cold at the same time. A newspaper article in the UK reported a very postive report using "an ultrasonic dissector which cuts through tissue by vibrating up to 50,000 times a second." However, another report from a newspaper shows what risk may be involved with ETS, death. [2] There used to be a great page on ETS at the rosaceagroup.org but now it is missing. Reports on ETS: # 1 - mmw21 #2 - rosacea_patient #3- Mermaid #4 - fab0149 Question #4 Mermaid again #5 - Mike's Report #6 - Songboy #7 - dogsr124 #8 - peteroche (see post #'s 3 & 5 #9 - "Unfortunately i haven't got all the answers for you, but i can advise you to not even consider ETS. I have had it done and all it does is add more problems to your life, such as overheating and compensatory sweating." burner, post no 4, RF #10 - "I have had ETS surgery for type 1 rosacea flushing and it is the worst decision that i ever made. In my opinion this surgery should be banned, as it has no effect whatsoever on flushing, but instead gives you more complications and problems to deal with such as compensatory sweating and increased core temperature. Please don't even consider it as it is not the answer." burner post 2 at RF #11 - "I wish it was an option. But I had ETS 7 years ago and everything is back and even worse. My body cant regulate heat no more which triggers my rosacea symptoms (I think). I'm looking at getting reversal Do not do ETS" opare post no 3 Anhidrosis and EM Some report having Anhidrosis and Erythromelalgia (EM) which is in a thread at RF. Links on ETS http://www.truthaboutets.com/TruthAboutETS.MainPage.html http://www.ets-sideeffects.netfirms.com/home3.4.html ESFB Channel Forum ETS Reversals Forum Aurelia's comment on ETS End Notes [1] Changes of autonomic functions by endoscopic upper thoracic sympathectomy on idiopathic hyperhidrosis Kondo M, Mezaki T, Higuchi K, Watanabe Y, Kuzuhara S. Rinsho Shinkeigaku. 2000 Nov;40(11):1069-75. [2] €5m payout to family after fatal operation, Ann O’Loughlin, Independent.ie National News, December 01, 2005
  16. Admin


    According to this initial report, Oracea works for rosacea sufferers: "After 16 weeks' therapy, anti-inflammatory dose doxycycline 40 mg was significantly more effective in improving rosacea than placebo, providing a greater reduction in the total inflammatory lesion count (primary endpoint) than placebo." [1] "In addition, there were significant differences in the distribution of baseline and week 12 IGA scores in the PP group (P = .0012). At week 12, most participants (63.6%) had mild CEA scores; the distribution was significantly different from baseline (P = .0407). Only 7% of participants had treatment-related adverse events (AEs), mostly mild or moderate in severity. Thus the 40-mg formulation of doxycycline proved to be effective and well-tolerated in a real-world setting in participants with rosacea who were receiving topical therapy but still experiencing symptoms." Effectiveness and safety of doxycycline 40 mg (30-mg immediate-release and 10-mg delayed-release beads) once daily as add-on therapy to existing topical regimens for the treatment of papulopustular rosacea: results from a community-based trial. According to one report, " A sub-antimicrobial dose of slow release doxycycline 40 mg daily is an effective long-term therapy for ocular rosacea. It is not associated with the side effects of long-term antibiotic therapy or the risk of resistance.' [2] 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. [5] There is speculation that generic Oracea may be available according this 2010 report (More info}. However, this has never happened. Cost The price range for Oracea is from $218 to $289 for 30 capsules (40 mg) at the different drug stores in the USA. Click here for the current price. So if you are interested in asking your physician for a prescription you might want to read below about price discounts: There was the Best Face Forward Program to obtain a 30 days supply of Oracea for $25, but now Galderma is offering a savings coupon. Click here to find out more about the CareConnect Savings Card. Exclusive rebates—save on your MetroGel; 1% and/or Oracea; prescriptions or go to bestfaceforward.com for savings cards. One report says 'the company is no longer honoring the $25.00 deal. Another report about this is similar. However, another report says the savings card works as long as you have insurance. If you don't have insurance there is a telephone number to call to ask questions: 1-866-954-5516 The web sites mentioned still show the savings card is available for the discount so the odds are Galderma will honor the savings coupon and if you are willing to jump through some Galderma hoops you may be able to save money. If you were low income you could get Oracea for free back in 2010 by asking your pharmacist questions how to do this. Prescribing Information In Canada, the UK and in Europe Oracea is known as Efracea. MHRA Product Info on Efracea According to Galderma, "Oracea (doxycycline, USP) is the first and only oral therapy approved by the FDA to treat the inflammatory lesions (red bumps, blemishes, and pustules) of rosacea." It may not help the erythma or redness associated with rosacea. Oracea was originally made by Collagenex which was bought up by Galderma for $420 Million in April 2008 has now been promoted by Galderma as a first line of treatment dermatologists should use along with topical Metronidazole (usually Metrogel - also a Galderma product or other Galderma topical forms of metronidazole). Galderma was formed in 1981 as a joint venture between Nestle and L’Oreal. David Pascoe has been following this closely and has more scoops on Oracea than anyone. If you have no idea what Oracea is, it is a special form of tetracycline called doxycycline in an enteric coated capsule which makes it timed released and only in 40 mg. doses which makes it 'submicrobal, anti-inflammatory' and not anti-bacterial. Supposedly Oracea touts the claim that it will not cause antibiotic resistance. Therefore, it is now being promoted as a long term solution for rosacea. Joseph P. Shovlin, O.D., points out that "When Periostat went generic, CollaGenex re-introduced it as a 40mg, once-daily, time-released pill called Oracea, which gained FDA approval for treating rosacea in May 2006. Oracea is the drug of choice for rosacea, says Joseph Bikowski, M.D., assistant professor of dermatology at Ohio State University. However, the cost may be prohibitory. It is about $4 a pill. For that reason, some clinicians prescribe doxycycline off-label." The New York Times reports that sales of Oracea for the first half of 2006 totaled $9.1 million. According to Pascoe he says that if he is reading the graph right, Oracea prescriptions numbered 1.2 million a month in December 2007. Oracea sales was worth approximately $104 million for the twelve-month period ending July 2009. This figure is up almost 200% from the previously reported sales of $52.5 million in 2007. Click here for Source You can imagine how many prescriptions have been handed out now that Galderma is targeting dermatologists all over the world with this prescription drug for rosacea, touted as the 'only FDA approved oral prescription for rosacea.' Business Wire reports that a "double-blind, placebo-controlled trial enrolled a total of 72 rosacea patients at 3 centers....The study successfully met this endpoint and demonstrated a statistically significant, greater reduction in inflammatory lesions at Weeks 12 and 16 in the Oracea + MetroGel group compared to the Placebo + MetroGel group." A conference reports that "A multi-center, randomized double-blind trial compared the efficacy and safety of anti-inflammatory dose doxycycline 40 mg daily (Oracea) versus non enteric-coated doxycycline 100 mg once daily. Patients in both arms of the study were also treated with metronidazole1% (Metrogel 1%) once a day. At the end of 16 week, there was the same onset and extent of therapeutic effect in both groups based primarily on reduction in inflammatory lesions. The major difference in both groups was in the number of subjects who experienced gastrointestinal side effects, such as nausea, vomiting and abdominal pain. The non-enteric-coated doxycycline 100-mg once-a-day group reported significantly more side effects, especially gastrointestinal side effects, with no cases of nausea, vomiting or abdominal pain noted in the group receiving anti-inflammatory-dose doxycycline." [3] Another report Pascoe brings out is that 100 mg doxycycline no better than Oracea. Pascoe also has an interesting article he entitles, "Galderma wants to own the Rosacea Market" which is worth reading. The biggest complaint from rosaceans is the high cost of this prescription. Some have been getting rebates from Galderma but again and again the complaints are how much this prescription costs. Paul says, "...There is no difference between delayed release 40mg Oracea vs. 50 mg doxycycline. The only difference is price..." Scroll down to Comment #82 "Efficacy of ORACEA beyond 16 weeks and safety beyond 9 months have not been established." [4] "Treatment with doxycycline significantly reduced inflammatory lesions and improved investigator global assessment scores compared with placebo. Cathelicidin expression and protein levels decreased over the course of 12 weeks in patients treated with doxycycline. Low levels of protease activity and cathelicidin expression at 12 weeks correlated with treatment success. Low protease activity at baseline was a predictor of clinical response in the doxycycline treatment group." [6] End Notes [1] Doxycycline 40 mg Capsules (30 mg Immediate-Release/10 mg Delayed-Release Beads): Anti-Inflammatory Dose in Rosacea. McKeage K, Deeks ED. Am J Clin Dermatol. 2010;11(3):217-22. [2] Treatment of ocular rosacea with 40 mg doxycycline in a slow release form. Pfeffer I, Borelli C, Zierhut M, Schaller M. J Dtsch Dermatol Ges. 2011 Jun 15. doi: 10.1111/j.1610-0387.2011.07723.x [3] Skin &Aging Supplement to the February 2009 27th Anniversary Fall Clinical Dermatology Conference [4] Product insert for Oracea [5] J Drugs Dermatol. 2012 Jun;11(6):725-30. Diagnosis and treatment of rosacea: state of the art. Baldwin HE. [6] J Am Acad Dermatol. 2016 Jun;74(6):1086-92. doi: 10.1016/j.jaad.2016.01.023. Epub 2016 Mar 5. Improved clinical outcome and biomarkers in adults with papulopustular rosacea treated with doxycycline modified-release capsules in a randomized trial. Di Nardo A, Holmes AD, Muto Y, Huang EY, Preston N, Winkelman WJ, Gallo RL.
  17. Flushing is one of the primary signs of rosacea and has become so important to most rosaceans to the point of confusing flushing with rosacea. However, flushing is one of the signs of rosacea, just as erythma (redness), pustules and pimples are signs of rosacea. To confuse flushing as rosacea is like confusing pustules and pimples as rosacea. While flushing is indeed one of the distinguishing signs differentiating rosacea from acne or other rosacea mimics, not all rosacea sufferers flush or blush any more than the general public or complain of flushing. Another important point to consider is that a rosacea sufferer may experience a flush or blush that subsides and does not result in a rosacea flare up. Many rosacea sufferers do indeed complain of frequent and prolonged flushing which aggravates rosacea. One clinical paper says that "rosacea sufferers thought that that they blushed more intensely and were more embarrassed than controls during most of the tasks." [10] This has led to some theories that rosacea is a vascular disorder which assumes that flushing is at the heart of this disorder. However, this has never been proven. Gerd Plewig, MD, says, "there is no direct evidence that rosacea is primarily a vascular disorder. The response of the facial vessels to adrenaline, histamine and acetylcholine is normal, and the vessels do not seem abnormally fragile so the main abnormality is probably in the dermis surrounding blood vessels rather than in vessel walls. In addition, the distribution of rosacea is not identical with the flush area." [1] The controversy about flushing is best described by a noted authority on rosacea, Albert Kligman who wrote, "I, and others, regard rosacea as fundamentally a vascular disorder which ineluctably begins with episodes of flushing, eventuating in the 'red' face." [2] However, another noted authority on rosacea, Dr. Frank Powell "insists that episodes of flushing are not a prerequisite for making a diagnosis of rosacea, and that some patients can develop the full-blown disease without a prior history of frequent flushing. Rebora too, another investigator, says that flushing is not a necessary stage in the sequence leading up to the full-blown 'red face'." [4] [12] Powell in his book wrote a chapter on Flushing and Blushing and confirms what other clinicians have found that while both are seen 'sufficiently often enough' in rosacea patients and both flushing and/or blushing are the 'first features of rosacea to appear in some patients," nevertheless, "flushing and blushing are not necessarily a component of the clinical picture in all patients with rosacea." [5] Another paper put this controversy into perspective: "Flushing due to rosacea may be mistaken for sensitive skin, which can manifest as abnormal sensations during fairly acute reactions to a variety of triggers, many of which are shared by rosacea and sensitive skin. Nevertheless, the two conditions are clearly different. Rosacea is a vascular disease, worsens gradually over time, manifests as flares triggered chiefly by systemic factors, is largely confined to the facial and/or ocular regions, and responds to specific treatments. Sensitive skin, in contrast, is an epidermal cosmetic problem that runs a variable course, with diffuse skin involvement and flares triggered mainly by contact factors. The flares respond to specific cosmetics and are usually worsened by treatments for rosacea." [8] When rosaceans complain of frequent flushing, especially accompanied by burning, flushing avoidance is one of the chief means of controlling it usually with anti-flushing drugs. Rosacea triggers can be divided into two categories: (1) Anything that produces a rosacea flare up (2) Anything that causes a flush or blush To reiterate, it is important to remember that not every flush produces a rosacea flare up. It is possible to flush and later your skin returns to normal. Another important point is to differentiate between rosacea flushing and other conditions that produces flushing. According to Izikson et al, "When evaluating patients with rosacea, it is important to exclude the diagnoses of polycythemia vera, photosensitive eruption, lupus erythematosus, mixed connective tissue disease, carcinoid syndrome, systemic mastocytosis, or side effects from long-term facial application of topical steroids." [6] However, most rosaceans are more concerned with flushing/blushing and avoiding anything that could cause a flush/blush. Balance is the key and to not become obsessed with flushing avoidance. The following study underscores why a rosacean should be careful not to become overly obsessed with flushing avoidance: "Blushing propensity scores are elevated in people with severe rosacea. Fear of blushing may contribute to social anxiety and avoidance in such cases. Cognitive-behavioural therapy for fear of blushing may help to reduce social anxiety in people with severe rosacea." [7] It is important to differentiate flushing disorders from rosacea. As one report puts it, "The differential diagnosis of cutaneous flushing is extensive and encompasses a variety of benign and malignant entities." [11] "However, trigger causation mechanisms are currently unclear.....These data indicate that rosacea affects SSNA and that hyperresponsiveness to trigger events appears to have a sympathetic component." [13] Treatment Prescription and Non Prescription Drugs ETS Micro ETS at R2 Stellate Ganglion Nerve Block More Help More info on triggers More info on Flushing More info on Flushing Avoidance End Notes [1] Rosacea: classification and treatment. T Jansen and G Plewig J R Soc Med. 1997 March; 90(3): 144–150. [2] A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman, M.D., Ph.D. The William J. Cunliffe Lectureship 2003 –Manuscript [4] Rebora A: The management of rosacea. Am J Clin Dermatol 2002; 3: 489-496. [5] Rosacea Diagnosis and Management by Frank Powell with a Contribution by Jonathan Wilkin [6] The flushing patient: differential diagnosis, workup, and treatment. Izikson L, English JC 3rd, Zirwas MJ. Department of Dermatology, University of Pittsburgh Medical Center, Pennsylvania, USA. J Am Acad Dermatol. 2006 Aug;55(2):193-208. [7] Blushing Propensity and Psychological Distress in People with Rosacea. Su D, Drummond PD. Clin Psychol Psychother. 2011 Jun 23. doi: 10.1002/cpp.763. [8] Sensitive skin and rosacea: nosologic framework. Misery L. Laboratoire de Neurobiologie cutanée, Université de Brest, France; Service de Dermatologie, CHU de Brest, 29609 Brest, France. Ann Dermatol Venereol. 2011 Nov;138 Suppl 3:S207-10. [10] Blushing in rosacea sufferers. Drummond PD, Su D. J Psychosom Res. 2012 Feb;72(2):153-8. Epub 2011 Oct 1 [11] J AM ACAD DERMATOL, AUGUST 2006, p. 193 - 208 The flushing patient: Differential diagnosis, workup, and treatment Leonid Izikson, MD, Joseph C. English, III, MD, and Matthew J. Zirwas, MD [12] Anecdotal reports of patients who received a diagnosis of rosacea who report no flushing: Rhea, 4th August 2012 01:58 PM [13] J Neurophysiol. 2015 Sep;114(3):1530-7. doi: 10.1152/jn.00458.2015. Epub 2015 Jul 1. Augmented supraorbital skin sympathetic nerve activity responses to symptom trigger events in rosacea patients. Metzler-Wilson K, Toma K, Sammons DL, Mann S, Jurovcik AJ, Demidova, Wilson TE.
  18. Admin


    This post has been promoted to an article The RRDi has collected a number of cosmetics to consider in your search by using our affiliate store.
  19. Admin


    Note these reports: “Patients with distraught feelings due to their rosacea may consider cosmetic camouflage to cover the signs of rosacea.” [1] “Dermatoses may have a significant impact on a patient’s quality of life, namely the relationship to others, self-image and self-esteem … Thus, the use of decorative cosmetics in disfiguring skin diseases is an effective, well-tolerated measure increasing the patients’ quality of life. We therefore suggest that decorative cosmetics can complement the treatment of disfiguring skin diseases.” [2] However, cosmetics and make up can be irritating to rosacea and is one of the trigger factors to consider. Using hypoallergenic cosmetic products may help. A survey done by the NRS reports: “Over 59 percent of those responding to the survey said they use cosmetic products that are hypoallergenic—associated with a low occurrence of an allergic reaction—and 49 percent use fragrance-free makeup. Forty-eight percent of the respondents said they used cosmetics that are SPF-enhanced—containing a sun protection ingredient—and 44 percent use products that are oil-free.” [3] Green is the make up color preference to cover the red. Note this report about green: “In addition to following proper medical therapy and a daily facial cleansing regimen recommended by your doctor, effective camouflaging techniques are available. Green makeup, for instance, can be used to counteract redness. Green-tinted prefoundations are available in liquids or creams at most cosmetic counters, and there is also a green-tinted moisturizer on the market.” [4] Yellow based make up foundations can also be used as this report points out: “In the survey of more than 900 rosacea patients, 88 percent of the respondents said cosmetics help or somewhat help to conceal its effects on facial appearance. Of those surveyed, 54 percent said they turn to yellow-based natural tones or green-tone makeup to offset the rosacea redness, compared with 25 percent who reported using more traditional pink-based natural tones.” [5] Is it ok to use cosmetics when being treated for rosacea? Absolutely, as long as the cosmetics do not irritate or aggravate the rosacea. You might want to consider the Red Cross Skin Camouflage. [6] There is at least one anecdotal report that it works. [7] The other make up foundation to consider is the Oxygenetix Breathable Foundation. [8] One report says, "Our results suggest that dermatologists should encourage patients with disfiguring dermatoses to utilize appropriate and safe makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence." [9] "Cosmetic camouflage provides a significant emotional benefit for patients with facial skin conditions, and this is substantiated by a literature review and personal experience." [10] For more information End Notes [1] Rosacea and its management: an overview. Gupta AK, Chaudhry MM: J Eur Acad Dermatol Venereol. 2005 May;19(3):273-85. [2] Decorative cosmetics improve the quality of life in patients with disfiguring skin diseases. Boehncke WH, Ochsendorf F, Paeslack I, Kaufmann R, Zollner TM. Eur J Dermatol. 2002 Nov-Dec;12(6):577-80 [3] Survey Says Green and Yellow Can Hide the Facial Redness of Rosacea Rosacea Review, Fall 2003, National Rosacea Society http://www.rosacea.o...l/article_3.php [4] Right Makeup Helps Create Flawless Look Rosacea Review, Winter 2003, National Rosacea Society http://www.rosacea.o...r/article_2.php [5] Survey Says Green and Yellow Can Hide the Facial Redness of Rosacea Rosacea Review, Fall 2003, National Rosacea Society http://www.rosacea.o...l/article_3.php [6] Skin camouflage British Red Cross [7] Craigsho's anecdotal report on Red Cross Skin Camouflage [8] Oxygenetix Breathable Foundation Leaps from Doctor's Offices to the Hollywood Limelight PR Newswire [9] Interest of corrective makeup in the management of patients in dermatology. Seité S, Deshayes P, Dréno B, Misery L, Reygagne P, Saiag P, Stengel F, Roguedas-Contios A, Rougier A. Clin Cosmet Investig Dermatol. 2012;5:123-8. doi: 10.2147/CCID.S33172. [10] Clin Cosmet Investig Dermatol. 2012;5:173-182. Epub 2012 Nov 1. Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review. Levy LL, Emer JJ.
  20. Periorol Dermatitis is a rosacea mimic and is considered in a differential diagnosis of rosacea. It can co-exist with rosacea and some clinicians consider Periorol Dermatitis as a rosacea variant. The RRDi classifies Rosacea Periorial Dermatitis as a rosacea variant. "Perioral” refers to the area around the mouth, and “dermatitis” indicates a rash or irritation of the skin. Usually Periorol Dermatitis is characterized by tiny red papules (bumps) around the mouth. The areas most affected by perioral dermatitis are the facial lines from the nose to the sides and borders of the lips, and the chin. The areas around the nose, eyes, and cheeks can also be affected. There are small red bumps, mild peeling, mild itching, and sometimes burning associated with perioral dermatitis. When the bumps are the most obvious feature, the disease can look like acne. For more info.
  21. Glandular Rosacea is recognized as a rosacea variant. "In 2004 in an article appearing in the Journal of the American Academy of Dermatology, Crawford et al. proposed the concept of glandular rosacea to describe another phenotype distinct from the four subtypes introduced by the expert committee. Glandular rosacea occurs predominantly in males who characteristically have oily skin, large pores, a tendency to rhinophyma, and inflammatory lesions, including papules, pustules and nodulocystic lesions, that extend onto the lateral cheeks and neck." [1] Whether Glandular Rosacea should be classified as a phenotype, subtype or variant remains to be seen, but for now it is listed with the variants of rosacea to end the confusion (we also listed it previously as a proposed subtype). End Notes [1] Literature review highlights renewed interest in rosacea research Dermatology Times, Modern Medicine, Nov 1, 2006, Cheryl Guttman, page 2
  22. Rosacea Variant: Granulomatous Rosacea [also known as Lupoid rosacea] This is the only variant as of this date recognized by the NRS 'expert committee' who first classified rosacea into subtypes and variants. This variant of rosacea is characterized by firm, yellow, brownish or redish, cutaneous papules or nodules. These lesions are less inflammatory and frequently sit upon relatively normal-appearing skin but sometimes it is diffusely red and thickened. Typically, they are monomorphic in each individual patient affecting the cheeks and the periorifical areas. For diagnosing this form of rosacea, other signs and symptoms of rosacea are not necessary. Diascopy with a glass spatula reveals the lupoid character of the infiltrations. Lupoid or granulomatous rosacea may lead to scarring of the skin. [1] "Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved." [9] Granulomatous rosacea Image Dermatology Online Journal One source describes granulomatous rosacea: "A rare caseating granulomatous variant of rosacea (acne agminata/lupus miliaris disseminatus faciei) can manifest with inflammatory erythematous or flesh-colored papules distributed symmetrically across the upper part of the face, particularly around the eyes and the nose. The lesions tend to be discrete, and surrounding erythema is not a marked feature but may be present. This pattern of rosacea is sometimes associated with scarring and may be resistant to conventional treatment." [1] "...Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease." It is associated with demodex. [2] "Histological investigation revealed follicular cysts and a chronic granulomatous perifolliculitis with many of Demodex folliculorum." [3] Another report had a similar finding. [4] A report by Neri, et. al., suggested that Idiopathic Facial Aseptic Granuloma (IFAG), or pyodermite froide du visage be "considered the possibility that IFAG might be included in the spectrum of granulomatous rosacea (GR)." [5] Treatment Dapsone [6] Isotretinoin (10-20 mg daily) [7] "The aetiopathogenetic role of Helicobacter pylori in rosacea remains controversial. We report a 27-year-old man with a 4-year history of intractable rosacea. Histopathology showed epithelioid granulomas. H. pylori infection was proven directly on gastroscopy and by serological testing. Treatment with clarithromycin, metronidazole and pantoprazole eradicated H. pylori. Skin changes were markedly improved by the end of this therapy and had resolved completely 2 months later. The patient has been followed up, and has remained free of symptoms for 3 years. We suggest that H. pylori may be involved in the aetiopathogenesis of granulomatous rosacea." [8] elmonxito says he is convinced that removing some of his infected teeth improved his granulomatous rosacea. [10] "a 66-year-old lung transplant recipient, who was successfully treated with oral metronidazole and ivermectin cream." [11] End Notes [1] rosacea.dermis.net [2] Granulomatous rosacea associated with Demodex folliculorum. Amichai B, Grunwald MH, Avinoach I, Halevy S. Int J Dermatol. 1992 Oct;31(10):718-9. [3] Tubero-pustular demodicosis Grossmann B, Jung K, Linse R. Hautarzt. 1999 Jul;50(7):491-4. [4] Demodex folliculorum and the histogenesis of granulomatous rosacea Grosshans EM, Kremer M, Maleville J. Hautarzt. 1974 Apr;25(4):166-77. [5] Should Idiopathic Facial Aseptic Granuloma Be Considered Granulomatous Rosacea? Report of Three Pediatric Cases. Neri I, Raone B, Dondi A, Misciali C, Patrizi A. Pediatr Dermatol. 2012 Feb 16. doi: 10.1111/j.1525-1470.2011.01689.x. [6] Hautarzt. 2013 Apr;64(4):226-8. doi: 10.1007/s00105-013-2556-7. Successful treatment of granulomatous rosacea with dapsone. Ehmann LM, Meller S, Homey B. Hautklinik des Universitätsklinikums Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland. [7] Hautarzt. 2013 Nov 1. Lupoid rosacea as a special form of rosacea : Review of pathogenesis and therapeutic options. Vanstreels L, Megahed M. Source Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland [8] Eur J Gastroenterol Hepatol. 2001 Nov;13(11):1379-83. Resolution of granulomatous rosacea after eradication of Helicobacter pylori with clarithromycin, metronidazole and pantoprazole. Mayr-Kanhäuser S1, Kränke B, Kaddu S, Müllegger RR. [9] J Med Case Rep. 2017; 11: 230. Published online 2017 Aug 20. doi: 10.1186/s13256-017-1401-5 PMCID: PMC5563383 Granulomatous rosacea: a case report A. Kelaticorresponding author and F. Z. Mernissi [10] Demodex follicularum connected to Granulomatous rosacea, post no 4 by elmonxito [11] Hautarzt. 2019 Sep 27;: [Granulomatous rosacea in a lung transplant recipient : A possible therapy option in a unique group of patients]. Ansorge C, Technau-Hafsi K Other Sources A case of granulomatous rosacea: Sorting granulomatous rosacea from other granulomatous diseases that affect the face. Omar Khokhar MD, and Amor Khachemoune MD CWS Dermatology Online Journal 10 (1): 6 Granulomatous rosacea. Sánchez JL, Berlingeri-Ramos AC, Dueño DV. Am J Dermatopathol. 2008 Feb;30(1):6-9. J Cutan Med Surg. 2012 Dec 1;16(6):438-441. Isotretinoin for the Treatment of Granulomatous Rosacea: Case Report and Review of the Literature. Rallis E, Korfitis C.
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    Subtype 4

    Please read this notice about Subtypes Subtype 4: Ocular Ocular rosacea is common but often not recognized by the clinician.[1] It may precede, follow, or occur simultaneously with the skin changes typical of rosacea. In the absence of accompanying skin changes, ocular rosacea can be difficult to diagnose, and there is no test that will confirm the diagnosis. Patients usually have mild, nonspecific symptoms, such as burning or stinging of the eyes. A sensation of dryness is common, and tear secretion is frequently decreased. [2] Mild-to-moderate ocular rosacea (including blepharoconjunctivitis, chalazia, and hordeola) occurs frequently, whereas serious disease with the potential for visual loss, such as that which results from keratitis, occurs rarely. "Probably the first description of ocular rosacea was by the famous English dermatologist Willan in the earl 1800’s whose handwritten note on an illustration fo a patient with PPR documented the presence of ocular inflammation." [16] Ocular problems occur in at least 50 percent of patients with rosacea. [3] "Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity." [14] There may be a clinical diagnositic test now available for ocular rosacea. [4] One report said, "Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters." [12] For images of Ocular Rosacea click here: http://goo.gl/ESG4n Treatment Treating ocular rosacea (from the AAO) Topical Cyclosporine Proves Beneficial For Ocular Rosacea [6] Avermectin Milbemycin Eyewash for Ocular Rosacea [7] Might consider demodex mite treatment. [8] Terpinen-4-ol (T4O) Pass [11] One report states, "We suggest that a clinically acceptable dosage of PRP provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES [Dry eye syndrome]." [13] Cliradex [15] Diagnostic Test While there is no diagnostic test for Ocular Rosacea there may be indicators coming down the pipeline for such a test. One paper suggests, "The abundance of highly fucosylated N-glycans in the control samples and sulfated O-glycans in ocular rosacea patient samples may lead to the discovery of an objective diagnostic marker for the disease." [9] Another paper suggests, "The high abundance of oligosaccharides in the tear fluid of patients with rosacea may lead to an objective diagnostic marker for the disease." [10] "There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent." [14] Links [5] Dry Eye: Awareness, Diagnosis, and Management All of the ocular rosacea articles at rosacea news Ocular Rosacea: Dr. Eric Jones, MD Ocular Rosacea: Dr. Mark J. Mannis, MD Ocular Rosacea: Curse of the Celts and Celebs, Heather Potter, MD, University of Wisconsin, School of Medicine and Public Health End notes [1] Kligman AM. Ocular rosacea: current concepts and therapy. Arch Dermatol 1997;133:89-90.[CrossRef][iSI] [Medline] [2] Gudmundsen KJ, O'Donnell BF, Powell FC. Schirmer testing for dry eyes in patients with rosacea. J Am Acad Dermatol 1992;26:211-214.[iSI] [Medline] [3] Rosacea: A Common, Yet Commonly Overlooked, Condition B. WAYNE BLOUNT, M.D., M.P.H. and ALLEN L. PELLETIER, M.D. Am Fam Physician. 2002 Aug 1;66(3):435-441. [4] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan, Hao Liu,‡ Carlito B. Lebrilla, Lenio S. Alvarenga, and Mark J. Mannis J. Proteome Res., 2005, 4 (6), pp 1981–1987, October 6, 2005, American Chemical Society Trail of Tears May Lead to the First Diagnostic Test for Ocular Rosacea Ocular Rosacea Test Updated: 6/21/2006 9:16:46 AM Dental Care & Health Care Articles [5] Link list courtesy of David Pascoe [6] Topical Cyclosporine Proves Beneficial For Ocular Rosacea Skin and Allergy News, Medical Dermatology BRUCE JANCIN, Skin & Allergy News Digital Network [7] Patent applied for by Galderma David Pascoe's comment on the above patent [8] In vitro and in vivo killing of ocular Demodex by tea tree oil. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC. Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA. Br J Ophthalmol. 2005 Nov;89(11):1468-73. [9] Glycomic analysis of tear and saliva in ocular rosacea patients: the search for a biomarker. Vieira AC, An HJ, Ozcan S, Kim JH, Lebrilla CB, Mannis MJ. Ocul Surf. 2012 Jul;10(3):184-92. Epub 2012 May 3. [10] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan,Hao Liu, Carlito B. Lebrilla, Lenio S. Alvarenga,and Mark J. Mannis J. Proteome Res., 2005, 4 (6), pp 1981–1987, DOI: 10.1021/pr0501620, Publication Date (Web): October 6, 2005 [11] In clinical trials as of August 2012: Demodex Blepharitis Treatment Study (DBTS) [12] Can J Ophthalmol. 2012 Dec;47(6):504-8. doi: 10.1016/j.jcjo.2012.07.009. Central corneal thickness in patients with mild to moderate rosacea. Onaran Z, Karabulut AA, Usta G, Ornek K. [13] Optometry. 2012 Mar 30;83(3):111-3. Dry-eye--is inflammation just the tip of the iceberg? Jarka ES, Kahrhoff M, Crane JB. [14] Arq Bras Oftalmol. 2012 Oct;75(5):363-9. Ocular rosacea: a review. Vieira AC, Höfling-Lima AL, Mannis MJ. [15] One report on Cliradex is from yoegan on 5th April 2013 10:01 PM Post #467 [16] Rosacea: Diagnosis and Management, By Frank Powell
  24. Admin

    Subtype 3

    Please read this notice about Subtypes Subtype 3 is now known as Phenotype Phymatous (Rhinophyma)
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