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  1. Elimination Diets (sometimes also referred to Exclusion Diets) was first proposed by Dr. Albert Rowe in 1926 and expounded upon in his book, Elimination Diets and the Patient’s Allergies, the first edition published in 1941. [1] Rosacea Trigger Avoidance is usually what is proposed by the NRS Factors That May Trigger Rosacea Flare-Ups which includes diet triggers, of which 18 are proposed: Foods: Liver Yogurt Sour cream Cheese (except cottage cheese) Chocolate Vanilla Soy sauce Yeast extract (bread is ok) Vinegar Eggplant Avocados Spinach Broad-leaf beans and pods, including lima, navy or pea Citrus fruits, including tomatoes, bananas, red plums, raisins or figs Spicy and thermally hot foods Foods high in histamine Beverages: Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne Hot drinks, including hot cider, hot chocolate, coffee or tea While probably most rosaceans after learning about the NRS Factors That May Trigger Rosacea Flare-Ups either from what others have told them or from their physician or on the internet may try to avoid items on this list in their diet; the results from avoiding these items in their diet may prove helpful to some but many report otherwise. This is because there has never been proven in any clinical study that a specific rosacea trigger will trigger a rosacea flare up in every case. Not one. The only exception is a study done by JK Wilkin that discovered that it was not the caffeine in coffee that produces flushing but instead the heat. [2] Liver, Yogurt, Sour Cream, Cheese, Eggplant, and Spinach are the subject of an article worth your time reading that will help you in your understanding how elimination diets may or may not help your rosacea, depending on what you think an elimination diet is. Apparently some, according to this thread, feel that if a rosacean decides to try avoiding any of the rosacea diet triggers proposed by the NRS or some other source that this is an elimination diet. For example, a rosacean decides to avoid spicy and thermally hot foods that this one has engaged in an elimination diet. Dr. Michael agrees with me that this is not the case for he answers my question about this subject with the following statement: “No, simply avoiding known or suspected triggers is not an elimination diet because this approach starts with the answer the elimination diet is designed to ask. Namely, what are my triggers or sensitivities? A proper elimination diet involves two phases: (1) an strict elimination phase whereby all potential offending foods and chemicals are avoided and (2) a slow, systematic reintroduction of each potential offending food and chemical class in an attempt to identity your own individual sensitivities.” [3] While an elimination diet may help you discover what is triggering your rosacea it is probably one of the more difficult diet approaches to take and certainly isn’t a popular one for there are few reports available that this has been successfully accomplished with rosacea. Simply avoiding certain food and drink which is what rosacea trigger avoidance is all about certainly isn’t an elimination diet. Click here for more information on GENERAL rosacea triggers and click here for rosacea diet triggers. Why not volunteer and post your comment on elimination diets and what you think they are. Wouldn't it be amazing if rosaceans got together in a non profit organization like this one and actually do something together about rosacea? Do you see the green reply button? If you look carefully you will see it and why not post your comment for other rosaceans to read? You may be surprised that your comment might be helpful to others. End Notes [1] Rowe, A., Elimination Diets and the Patient's Allergies. 2nd Edition. Lea & Febiger, Philadelphia, PA: 1944 [Second Edition Available] [2] Coffee a Trigger for Rosacea? Good News for Coffee Lovers! [3] Michael_V post #3 [Michael is a physician]
  2. The Gut-Brain Axis is well established. Is there also a Gut-Brain-Skin Axis? The Huff Post speculates there is. [17] You may already have thought about this anyway that somehow the gut is connected to the skin problems you are having. If there is no connection, why do doctors prescribe oral antibiotics for rosacea, i.e., Oracea, which has 10 mg of timed released doxycycline that is released in the gut (the other 30 mg are immediately released)? A study confirms antibiotics mess with the gut. The study, published in the Proceedings of the National Academy of Sciences, supports the common wisdom that antibiotics can damage the ‘good’ germs living in the body. [1] Clearing up any unhealthy bugs and getting a healthy flora may improve not only the skin but also a number of other health issues and “relief from allergies, acne, arthritis, headaches, autoimmune disease, depression, attention deficit, and more–often after years or decades of suffering.” [2] Bacteria has been one of the theories postulated as the cause of rosacea but this has never been proven. If bacteria isn’t involved the question is always asked, then, why do antibiotics clear rosacea? The usual response is the anti-inflammatory role of antibiotics is what treats rosacea. There is now a low dose antibiotic (Oracea) used to treat rosacea. However, the long term risks of antibiotic treatment, whether low dose or not, is something to consider which may include an upset stomach, antibiotic resistance and bacterial overgrowth. But the question proposed in this article is, do you have a gut feeling about rosacea? "The brain has a role to play as well, making many call it the gut-brain-skin axis. In this theory, anxiety and stress lead to intestinal permeability and dysbiosis in the gut. This, in turn, leads to inflammation that contributes to skin inflammation." [17] A report connects gut microbes with rosacea. [9] Another report said, "a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h." [8] "Acne, along with eczema, rosacea, psoriasis and dermatitis, is not a skin condition. These issues are all autoimmune disorders, that sit inside the gut. You must heal the gut, in order to clear the skin. This is the reason why no topical application alone has ever worked permanently to resolve your skin issues." [24] Antibiotics Antibiotics, without a doubt, plays a role in the treatment of rosacea in the gut. Could it be possible that rosacea is somehow related to something going wrong in your gut? Long term antibiotic treatment has some serious side effects and risks associated with it. [3] Probiotics An article by Whitney Bowe, M.D., Probiotics in Acne and Rosacea, Dr. Bowe suggests taking probiotics may help rosacea. [10] Dr. Bowe has written a book, The Beauty of Dirty Skin, worth reading. One way is to balance the good bacteria (should be 80%) with the bad bacteria (should be 20%) accomplished by adding probiotics to your intake. There are a number of probiotics on the market that contain several strains of the good bacteria to choose from. Wouldn't it be good to do a clinical study on rosacea sufferers who take probiotics with a double blind, placebo controlled group to see? The RRDi could sponsor such a clinical study if we had 10K members who each donated one dollar. Why not join the RRDi and help us reach this goal? Sugar Another article suggests five ways to kill bugs in your gut and one of these suggestions is to stop eating sugar which I have been saying since 1999 with my book, Rosacea Diet, that will help control your rosacea. Dr. Hyman, the writer of the article suggests that what is in your gut may be the problem for a number of health problems including skin diseases. [2] Most rosaceans use trigger avoidance in their treatment of rosacea and the subject of diet triggers always comes up. Rosaceans have a gut feeling that what they are eating and drinking may have something to do with their rosacea but can’t seem to get a handle on it. While some rosaceans on the internet know that sugar is a potential rosacea trigger, the NRS and other rosacea 'authorities' still avoid listing sugar on any ‘official trigger list’ (the RRDi lists sugar as a rosacea trigger). Since 1999 I have been explaining why sugar is a rosacea trigger and more rosaceans have confirmed that reducing sugar in the diet does indeed help control their rosacea. Sugar is feeding your rosacea which makes your face warm, not to mention the burning and redness that sometimes results from consuming sugary drink and food. Sugar feeds the fire of rosacea. What does sugar do in your gut? It feeds whatever is in your gut. Gut Diseases and Rosacea There has been some discussion of how treating IBS, IBD, SIBO, and H Pylori has helped rosacea using antibiotics. You might want to read this interesting post by Nanobugs, especially the last part of the post. So maybe after this article you may have a gut feeling that your rosacea is related to what you are eating and drinking. Maybe your gut is trying to tell you something? Cybele Fishman, MD, wrote an article on this subject, published in Yahoo Health, stated, "Although why rosacea and SIBO are connected is still not totally clear, there is a connection in at least a subset of patients." [12] Leonard Weinstock, MD has published a web site with the assistance of an educational grant from Galderma through the RRDi which was announced September 6, 2015 that discusses this subject. [13] In a large Danish study it was reported, "The investigators found that there was a higher prevalence in rosacea patients of a variety of GI disorders. Compared with individuals without rosacea during the study period, those with rosacea were 46 percent more likely to have celiac disease, 45 percent more likely to have Crohn's disease, 34 percent more likely to have irritable bowel syndrome and 19 percent more likely to have ulcerative colitis." [14] In 2015, John Hopkins study found that rosacea patients were more likely than people without the disorder to suffer from gastroesophageal reflux disease (GERD) and other GI disorders. [15] "Eighty-nine percent of the patients with acne, papular-pustular rosacea and seborrhoic dermatitis responded to E. coli Nissle therapy with significant amelioration or complete recovery in contrast to 56% in the control arm (P < 0.01). Accordingly, in the E. coli Nissle treated patients life quality improved significantly (P < 0.01), and adverse events were not recorded. " [16] We need to better understand Microbiome-based therapeutic strategies. One report says, "We found no significant difference in facial microbiome alpha and beta diversity between related twins discordant for rosacea." [18] There are a number of anecdotal reports that low stomach acid may be connected to rosacea. [20] A report states, "one study reported improvement in rosacea following successful treatment of small intestinal bacterial overgrowth." [21] "Scientists have shown that transplanting gut bacteria, from an animal that is vulnerable to social stress to a non-stressed animal, can cause vulnerable behavior in the recipient. The research reveals details of biological interactions between the brain and gut that may someday lead to probiotic treatments for human psychiatric disorders such as depression." [23] Metagenome Microbiome "While further research is required in this area, patients may be advised on measures to support a healthy gut microbiome, including the consumption of a fiber-rich (prebiotic) diet." [21] A paper worth reading on the subject of gut flora discusses the 'metagenome' or the 'second genome' in the human gut which holds microbes containing more genes in the flora in the intestinal system than the rest of our bodies. The paper says, "This creates a huge dataset that has to be disentangled." [4] The paper discusses how understanding gut flora may be a key to understanding diseases. The Huff Post writes, "the skin has its own microbiome that is just as important to health as that of the gut microbiome. Although it has not yet been studied as in depth as the gut microbiome, studies have found it to be one of the most diverse microbiomes in the body. The microbiota provides protection through acting as a barrier against potential issues. It is essential to have a good balance between the commensal and pathogenic bacteria, and dysbiosis has the potential to contribute to skin disorders and diseases, just as in the gut. These similarities also lead to many connections between disorders of the gut and skin." [17] Read more about Microbiome-based therapeutic strategies. One study by Nature Publishing Group discusses how recent research suggests that humans might be divided into three types of gut bacteria: Bacteroides, Prevotella and Ruminococcus. This may lead to personalizing medical treatment based upon which type gut microbes you predominantly have. [5] "The three gut types can explain why the uptake of medicines and nutrients varies from person to person," reports Jeroen Raes, a bioinformatician at Vrije University. [6] This may develop into a new ‘biological fingerprint’ on the same level as blood types and tissue types. [7] This may lead to a 'gut type diet' (similar to the blood type diet). "A growing number of studies suggest that part of what determines how the human body functions may be not only our own genes, but also the genes of the trillions of microorganisms that reside on and in our bodies." [11] "The microbiome is a new frontier in human health. JAX research is revealing the powers of our own microbes to fundamentally change our understanding of diseases of all kinds." [22] Conclusion In conclusion, if you choose to treat rosacea with antibiotics, whether low dose or not, there may be long term effects and risks that you should consider, including the possibility that such treatment may not be helping your rosacea at all. It may only be treating the symptoms of rosacea and in the long term exacerbates rosacea. Obviously treating a case of severe rosacea with antibiotics and getting relief is a good idea, but should you be taking antibiotics long term for rosacea? What is your gut telling you? Maybe you have Gastrointestinal Rosacea [GR], aka, Gut Rosacea. Do you have a gut feeling about your rosacea? End Notes [1] Study confirms antibiotics mess with gut ABC Science, Maggie Fox, Reuters, Tuesday, 14 September 2010 Original Article: les_dethlefsen_david_relman.pdf [2] 5 Steps to Kill Hidden Bugs in Your Gut That Make You Sick Mark Hyman, MD The Huffington Post . September 30, 2010 [3] Antibiotic Resistance, Bacterial Overgrowth Candida Albicans, SIBO, Side Effects of Long Term Antibiotic Therapy, [4] Human gut microbes hold 'second genome' By Doreen Walton Science reporter, BBC News [5] Gut study divides people into three types Nicola Jones Published online 20 April 2011 | Nature | doi:10.1038/news.2011.249 [6] What’s in your gut? Microbiota categories might help simplify personalized medicine By Katherine Harmon | April 20, 2011 Scientific American [7] Each human has one of only three gut ecosystems New Scientist, 18:04 20 April 2011 by Andy Coghlan [8] Remission of rosacea induced by reduction of gut transit time. Kendall SN. Clin Exp Dermatol. 2004 May;29(3):297-9. [9] Is rosacea another disorder of gut microbes? Coyle WJ. Curr Gastroenterol Rep. 2009 Aug;11(4):253-4. [10] Probiotics in Acne and Rosacea Probiotic use improved acne, rosacea symptoms The Beauty of Dirty Skin [11] The Environment Within: Exploring the Role of the Gut Microbiome in Health and Disease Lindsey Konkel, Jayne Danska, Sarkis Mazmanian, Lisa Chadwick Environ Health Perspect. 2013;121(9):a276-a281. [12] How Your Gut Health Is Linked To Rosacea, Yahoo Health, Cybele Fishman, MD [13] RRDi Announcement on Rosacea Rescue [14] Br J Dermatol. 2016 Aug 8. doi: 10.1111/bjd.14930. Rosacea and gastrointestinal disorders - a population-based cohort study. Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JP. [15] J Am Acad Dermatol. 2015 Oct;73(4):604-8. doi: 10.1016/j.jaad.2015.07.009. Epub 2015 Aug 6. Rosacea is associated with chronic systemic diseases in a skin severity-dependent manner: results of a case-control study. Rainer BM, Fischer AH, Luz Felipe da Silva D, Kang S, Chien AL. [16] World J Gastroenterol. 2016 Jun 21;22(23):5415-21. doi: 10.3748/wjg.v22.i23.5415.Intestinal-borne dermatoses significantly improved by oral application of Escherichia coli Nissle 1917.Manzhalii E, Hornuss D, Stremmel W. For More Info (related to the above article) [17] The Gut-Skin Axis: The Importance of Gut Health for Radiant Skin, Deanna Minich, Ph.D., Contributor, Huff Post "Moreover, there is increasing evidence connecting the skin condition with the gastrointestinal microbiome, which has been described as the skin-gut axis." J Eur Acad Dermatol Venereol. 2019 Sep 14;: The gut microbiome alterations in allergic and inflammatory skin diseases - an update. Polkowska-Pruszyńska B, Gerkowicz A, Krasowska D [18] Characterization of the facial microbiome in twins discordant for rosacea. Exp Dermatol. 2017 Dec 28;: Zaidi AK, Spaunhurst K, Sprockett D, Thomason Y, Mann MW, Fu P, Ammons C, Gerstenblith M, Tuttle MS, Popkin DL The NRS website in discussing the above study quote states that this "study in twins has found a significant correlation between severity of rosacea and facial bacterial dysbiosis – an imbalance in the mix of bacteria, fungi and viruses that are normal inhabitants of the healthy face – potentially providing a basis for future research into what causes rosacea and how to treat it." [19] [19] Twin Study Shows Change in the Facial Microbiome May Impact Rosacea, NRS WebBlog, Posted: 01/15/2018 [20] Marie Antoinette post no 1 at RF is one such anecdotal report. Here are some more: mrsmoof boo2facialredness beccabear122Hammer [21] Dermatol Pract Concept. 2017 Oct 31;7(4):31-37. doi: 10.5826/dpc.0704a08. eCollection 2017 Oct. Diet and rosacea: the role of dietary change in the management of rosacea. Weiss E1, Katta R1. [22] Jackson Laboratory and the Microbiome [23] Transplanting gut bacteria alters depression-related behavior, brain inflammation in animals Knowledge of stress biology may eventually yield bacterial treatments for psychiatric disorders Children's Hospital of Philadelphia, ScienceDaily [24] The real reason that nothing has ever worked to resolve your acne, eczema, psoriasis or rosacea – until now!, Shan Jones, Chucking Goat
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  4. Chapter 27 Sugars to Avoid Rosacea 101 by Brady Barrows Copyright 2007 Permission by author This chapter should be used to refer when you are using the thirty-day diet plan for vegetarians or omnivores. The Nutrition Facts Label (see Appendix X3—Nutrition Facts Label ) appearing on all USA products sold in America can be used to find the total amount of carbohydrate in a product. If you are in another country hopefully there is something on the product that lists something. There is also a list of ingredients usually on every USA product that may list sugars used. Both of these can be used to figure out if sugar is in a product, first the Nutrition Facts Label and second, the LIST OF INGREDIENTS. Keep in mind the food process industry has figured out ways to hide the sugar in a product. You have to be smart to figure whether a product has sugar in it to avoid the product for thirty days. Of course, you as the diet authority can eat as much sugar as you want, but I am suggesting you avoid this entire list of sugars for thirty days to see if you control your rosacea and feel healthier. At the end of the thirty days you may decide to avoid sugar for life! I think I have compiled one of the longest lists of sugars you can find that is used by the processed food industry that keeps finding new ways to add sugar to your life. This list is by no means complete because as soon as I publish this current list I find new ones. What I suggest is that you at least read the list. This will give you an idea of how invasive sugar has become in the processed food industry in all its various forms. After all, carbohydrate is simply different units of sugar so it is only a matter of breaking some food down into a simple sugar to be added to a product so it tastes sweeter and you buy it. If you find one not on this list, please join the Rosacea Diet Users Support Group (see Chapter 23, Support) and post it so I can add it to a future revision of this book. I also keep a current list of the Sugars to Avoid in a file on the yahoo group site for you to read. SUGAR TO AVOID (For thirty days avoid the following sugars, sugar substitutes and sugar alcohol s, which may appear on any list of ingredients) Sugar to Avoid List for Rosacea Diet Updated August 18, 2007 Agave Nectar Arabinose Apricot nectar Barley malt Beet Sugar Blackstrap Molasses Brown Sugar Cane Juice Cane Sugar Corn Sweetener Corn Syrup Corn solids Dark brown sugar molasses Date Sugar Dextrose (an optical isomer of glucose which is dextrorotatory) Evaporated cane juice Fruit Juice Concentrate (any type fruit—apple, pear, grape, etc.) Fructooligosaccharides Fructose (C6H12O6) Galactose; (C6H12O6) Glucose (C6H12O6) Glycogen High Fructose Corn Syrup (HFCS) Honey Invert Sugar (50:50 fructose-glucose) Invert Syrup Lactose (C12H22O11) Levulose Maltose Maltodextrin Mannose Maple Syrup Molasses Monosaccharides Muscovado (Natural light brown muscovado sugar ) Organic sugar Organic powdered sugar Papaya Nectar Peach Nectar Polycose Polydextrose Polysaccarides Powdered sugar Raffinose Rapadura Raw Sugar Rice syrup Sorghum Starch Stachyose Sucanat Sucrose (C12H22O11) Sugar Cane Juice Sugar Cane natural organic Sucanat Sugar crystals Syrup (any type no matter what) Turbinado Sugar Turbino Unsulfured Molasses Xylose Sugar Substitutes 414 Sugar Alcohols415 Acesulfame-K Acesulfame Potassium Alitame Aspartame Aspartame-Acesulfame-Salt Brazzein Curculin Cyclamate Dulcin Equal Glycerol Glycyrrhizin Hydrogenated starch hydrolysates Lo Han Luo Han Guo Fruit extract Mabinlin Maltooligosaccharide Miraculin Monellin Pentadin Neohesperidine dihydrochalcone Neotame Nutrisweet P-4000 Saccharin Splenda Stevia Stevia plus fiber Sucralose Sweet and Slender Tagatose Thaumatin Arabitol Erythritol Glycerol Hydrogenated Starch Hydrolysates (HSH) Isomalt Lactitol Maltitol Mannitol Sorbitol Xylitol At the end of the thirty days you may introduce sugar , sugar substitutes or sugar alcohol s into your diet to see if they trigger your rosacea. The only way to be sure is avoid all sugar for thirty days to clean out your system and to let your taste buds relaxe from introducing any sugar into your body. When you try any sugar after the thirty days you will notice how sweet it is. Your current taste buds are sugar insensitive. After the thirty days your tasted buds will be so sensitive to sugar it will blow your mind. The sugar alcohol s-xylitol, mannitol, and sorbitol have some calories or carbohydrate that slightly increase blood glucose level. Avoid anything that says ‘syrup’ whether corn syrup or ‘any’ syrup! Some sugar substitutes may have carbohydrate so look at the Nutrition Facts Label and note any carbohydrate or sugar grams. Watch out for maltitol and corn syrup solids. NO SUGAR SUBSTITUES even if it has ZERO sugars or carbohydrate for thirty days, NONE. It doesn’t matter whatever name it is called, whether calorie-free sweeteners like Nutrisweet, Splenda, Equal, aspartame, saccharin, and acesulfame-K, NO SUGAR SUBSTITUTES —AFTER the thirty days you can experiment with sugar substitutes all you want. You will figure out if your health suffers by this simple thirty-day experiment of avoiding sugar substitutes . You will know if you can use them or not when you try them again, no matter what the health authorities say about the safety of these sugar substitutes . Remember that you are the diet authority, not anyone else. Some have found that certain sugar substitutes trigger allergic reactions or cause health problems. The real reason for no sugar substitutes for thirty days is so you can taste sugar in your food and drink, to be able to detect it! If you are sprinkling or adding sugar substitutes to your food or drink during the 30 Day Diet Plan, there is no way for you to be able to taste if sugar is somehow present in any of the food or drink you consume. Consequently you will then be more sensitive to the taste of sugar in your food or drink to avoid it for the 30 Days. AFTER the thirty days, you may experiment all you want. First, prove to yourself that the Rosacea Diet does CONTROL your rosacea and helps you feel healthier! You will be surprised at how sensitive you become in detecting sugar in your food and drink and how it creeps into processed food and drink. Most sugar substitutes are processed from sugar and are just as unhealthy for you as sugar , if not more so. What do you think the long-term health risks are from sugar substitutes ? You will find out if you use them. So if you have to use a sugar substitute AFTER the 30-day Rosacea Diet plan, I recommend Stevia, a natural leaf that is 300 times sweeter than sugar with zero carbohydrate grams found in health stores. Who knows what the long-term use of Stevia may do to you but you may be able to use it instead of sugar or sugar substitutes and be healthier? So Stevia is my recommendation and you will just have to live with the health consequences. Some have claimed that Stevia poses no health risks. One thing I have found with Stevia is less is more. The more Stevia the worse it tastes. The less Stevia the better it tastes. You can find out more information on Stevia by typing in Stevia into any search engine and boom you get more information that you can handle. Sweet Leaf Stevia Plus Fiber contains a packet that has less than 1 gram of carbohydrate per serving. More info at: http://www.steviaplus.com An alternative is Sweet and Slender Natural sweetener made from fructose and Luo Han Guo fruit extract that contains less than one gram of carbohydrate per packet. Both of these products can be found at the following urls: http://www.sweetandslender.com Another product made by Renew Life is SweetLife made from fructose, Lo Han and fructooligosaccharides which has one gram of carbohydrate per gram serving. My recommendation is avoid all other sugar substitutes and sugar for the rest of your life but since you are the diet authority, you choose. It may be possible that some of the sugar substitutes mentioned above might not pose any health problems but I don’t recommend eating 149 pounds of any sugar substitute in a year. Moderation in sugar substitutes is quite obvious. End Notes 414 http://en.wikipedia.org/wiki/Sugar substitutes 415 http://en.wikipedia.org/wiki/Sugar alcohol Addendum Sugar and Rosacea More on Sugar
  5. This post has been promoted to an article The above article is a must read to understand sugar's connection with rosacea, so after you read the above article scroll down through this thread for more interesting and educational posts on sugar and rosacea.... Sugar = Rosacea Fire
  6. Note: The article below is based upon a chapter in Rosacea 101: Includes the Rosacea Diet by permission of the author: Sugar is the fuel that burns the inflammation in rosacea. Think of the fire triangle: Heat, Fuel, and Oxygen. Sugar is like adding some very combustible fuel to the burning inflammation of rosacea. Sugar = Rosacea Fire Reduce the fuel and the fire is reduced. To understand why sugar has a role in rosacea you should understand the affect high glycemic sugar has on human health. Sugar and spice and everything nice. Sugar is not nice. The above two statements cannot be both true. Mom and the processed food industry conditioned you that sugar is nice. (See Appendix W—The Diet Authority) Sugar is not nice. Sugar is toxic. Sugar triggers the rosacea inflammation. Sugar Busters! by H. Leighton Steward, Morrison C. Bethea, M.D., Samuel S. Andrews, M.D., and Luis A Balart, M.D. states on page 17 that “SUGAR IS TOXIC!” Three of the authors are medical doctors and recommend a low-sugar diet, avoiding carbohydrate with a high glycemic index. Do you get it? Medical doctors are saying that sugar is toxic. How can they write a book stating that sugar is toxic and still be licensed physicians? That is because it is true, sugar is cumulatively toxic over time. William Dufty summarizes the toxic effect of sugar in his book, Sugar Blues, when he kicked the habit. Dufty threw all the sugar in his kitchen out and just ate grains and vegetables. He wrote, “In about forty eight hours, I was in total agony, overcome with nausea, with a crashing migraine. If pain was a message, this was a long one, very involved, intense but in code. It took hours to break the code. I knew enough about junkies to recognize reluctantly my kinship with them. I was kicking cold turkey, the thing they talked about with such terror. After all, heroin is nothing but a chemical. They take the juice of the poppy and they refine it into opium and then they refine it to morphine and finally to heroin. Sugar is nothing but a chemical. They take the juice of the cane or the beet and they refine it to molasses and then they refine it to brown sugar and finally to strange white crystals. It’s no wonder dope pushers dilute pure heroin with milk sugar —lactose—in order to make their glassine packages a treat to the eye. I was kicking all kinds of chemicals cold turkey—sugar , aspirin, cocaine, caffeine, chlorine, fluorine, sodium, monosodium glutamate, and all those other multisyllabic horrors listed in fine print on the tins and boxes I had just thrown in the trash. I had it very rough for about twenty-four hours, but the morning after was a revelation. I went to sleep with exhaustion, sweating and tremors. I woke up feeling reborn.” [398] You may or may not experience such withdrawals depending on how much you are addicted to sugar. Dufty ate a high carbohydrate diet when he went off sugar, which was at the very least, better than eating a diet full of sugar . Eating a high carbohydrate diet helps reduce the addictive withdrawal symptoms of getting off sugar. Carbohydrate is units of different type sugar . If you eat the ‘typical American diet’ that includes 149 pounds of sugar a year, addiction to sugar is no doubt the reason many cannot stop eating sugar. William Dufty wrote in 1975 on page 175 of his book, “It is mind boggling today to read through medical histories and other tomes and find again and again that the basic cause of diabetes mellitus is still unknown, that it is chronic and incurable, or that it is due to the failure of the pancreas to secrete an adequate amount of insulin . It’s still Greek to the best of them.” [399] In 2007 on the American Diabetes Association’s website, when you click on Basic Diabetes Information, you may read this statement: “The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.” [400] Thirty-two years after Dufty’s statement that ‘it’s still Greek to the best of them’ holds true. And PubMed shows similar results: “Cardiovascular disease is the main cause of mortality in patients with diabetes.” [401] “Although the link between diabetes and cardiovascular disease is not fully understood, loss of the modulatory role of the endothelium could be implicated in the pathogenesis of diabetic vascular complications.” [402] “Although diabetes mellitus is predominantly a metabolic disorder, recent data suggest that it is as much a vascular disorder.” [403] “The vascular chronic complications are the main cause of morbidity and mortality in patients with diabetes mellitus … Knowledge of the molecular mechanisms involved in the pathogenesis of endothelial dysfunction may ultimately result in novel approaches to the treatment and prevention of cardiovascular disease in people with diabetes mellitus.” [404] However a recent report in 2007 revealed the following novel idea: “A promising nutritional approach suggested by this thematic review is carbohydrate restriction. Recent studies show that, under conditions of carbohydrate restriction, fuel sources shift from glucose and fatty acids to fatty acids and ketones, and that ad libitum-fed carbohydrate-restricted diets lead to appetite reduction, weight loss, and improvement in surrogate markers of cardiovascular disease.” [405] You would think that there would be some diabetic research on diet’s role in diabetes, now wouldn’t you? Notice this report: “There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes” [406] The authors of the above report didn’t think the following study reported in 1997 was of high quality even though this was done at the Department of Nutrition, Harvard School of Public Health: “Our results support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women..”407 Nor did they find this one of high quality done at the same group: “Intake of carbohydrates that provide a large glycemic response has been hypothesized to increase the risk of NIDDM, whereas dietary fiber is suspected to reduce incidence … These findings support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of NIDDM in men.” [408] And you ask, why point out research reports on diabetes? Because there are not any reports on the role of a high glycemic diet and rosacea. I am merely pointing out how the medical and clinical researchers ignore the role diet plays in vascular disorders and diabetes. There is evidence that diet plays a role in the metabolic syndrome (See Appendix 8—Metabolic Syndrome ) There is evidence that diet plays a role in acne.. (See Appendix U—Diet and Acne) There is a theory that rosacea is a vascular disorder (See Chapter, What Causes Rosacea?) and that diabetes may not only be a metabolic syndrome but also a vascular disorder. There is a connection here. Sugar plays a role in rosacea too. The mainstream health authorities appear to be clueless to diet’s connection with disease. But you do see the connection don’t you? Some of the above quotes show that obesity plays a factor in diabetes. Diet plays a role in the metabolic syndrome . Medical authorities agree that diabetics are at a higher risk for heart disease. Yet connecting sugar consumption over the years to either disease is overlooked, minimized or lacking by these medical authorities. If you look at a graph published in the book Sugar Busters!, it shows how the consumption of sugar has climbed dramatically only in the last couple of centuries. Now compare this with a graph on the dramatic climb of diabetes during this same period, it doesn’t take a clinical study to see the connection. The damage of high sugar consumption to a person’s body not only effects diseases like diabetes and heart disease but also possibly is one of the major factors in many other diseases. Remember 170 million people on this planet have diabetes and the number continues to rise along with increases in world sugar production. Obesity is now the culprit used by medical authorities as being the factor for several major diseases. Does diet play a factor in obesity? Sugar is a huge factor in obesity. Reducing sugar in your diet will reduce obesity. Eliminating sugar from your diet promotes health and well being. Eliminating sugar in a rosacean diet controls rosacea and you will see improvement over a 30 day period if you reduce your carbohydrate intake to 30 grams a day. Weight loss will result when you reduce sugar in your diet. How does this happen? Your body breaks down all food into glucose so that the cells can use the energy and live. Any excess glucose is converted to glycogen (“animal starch”) and stored in your liver, muscles and blood to be used if needed. This is a wonderful storehouse of packed energy that can easily be converted back to glucose when needed. There is one problem. The body can only store about 14 ounces of glycogen or about 400 grams.409 A gram of glucose has four calories. The entire amount of stored glycogen is approximately 1600 to 1800 calories. Since there is limited glycogen storage, if your diet includes a generous amount of sugars and carbohydrate and your glycogen storehouse is full, the excess sugars and carbohydrate will be converted to FAT and the body gains weight. The Rosacea Diet stops this excess conversion of sugars and carbohydrate into fat, thus resulting in weight loss over time. This is just one of the reasons why sugar should be avoided in your diet not to mention you will feel healthier! Refined sugar [sucrose] in crystallized form is artificial usually made from either sugar beets or sugarcane. Some may claim that sugar is natural , but would you call the crystallized powder heroin derived from morphine ‘natural ,’ because it is made from the opium of a poppy? Refined table sugar doesn’t occur naturally, it is an artificially manufactured process. I toured a sugar plantation and factory in Kauai, Hawaii in 2003 and saw the process how sugar cane is made into raw sugar . Lime is used. What is done to raw sugar to make this product into a pure white crystal? There is no way you can call this natural . It is a manufactured processed artificial sugar reducing the sugar cane plant into an addictive pure white crystal not unlike how the poppy flower is used to make opium into morphine and heroine. This process is a manufacturing artificial process not found in nature. You simply do not find these white crystals called sugar or heroine in nature. You may ask, ‘if sugar is so bad for your health, why do the health or diet authorities minimize the toxic effects of sugar ?’ The Sugar Buster! authors put it this way on page 36–37 of their book, “… Pro-sugar lobbying by sugar growers, cola manufactures and the packaged-food industry has been very effective in influencing our government. What politician wants to tell his constituents they should no longer eat sugar?” Why do health ‘authorities’ continue to bless sugar ? Another reason may be the quote below: “The American Dietetic Association, which trains registered dieticians to direct preparation of hospital and institutional food, has been soundly criticized for its association with the Sugar Association and companies like Coca Cola and M&M Mars. Such groups supply about 15% of the ADA’s annual budget …” [410] Sugar is big business. It permeates the food industry. If you think the tobacco industry is powerful, the sugar industry is just as entrenched powerfully in the world’s economy if not more so. Even if it reached the point of a warning label of sugar ’s toxic effects like the tobacco industry has been forced to use on its product, people will continue to eat sugar just as those who smoke ignore the warning label. Only people who care about their health will be motivated enough to remove sugar from their diet. There is so much information on the web or in your public library showing the harmful effects of sugar . Just go to any major search engine and type in ‘sugar ’ in the search box and you will be amazed at the results. Or spend a few hours at your local library. Any dentist will tell you that sugar causes cavities: “There is new evidence showing that excessive sugar consumption increases the risk of caries, even if the correlation between sugar intake and dental health has weakened due to exposure to fluoride.” [411] “Numerous lines of evidence have conclusively established the role of sugars in caries etiology and the importance of sugars as the principal dietary substrate that drives the caries process has not been scientifically challenged … Measures to educate the public on the dangers of frequent sugar consumption, combined with recommendations for proper oral hygiene and fluoride use, are still warranted.” [412] If you stop eating sugar , it may not help the cavity already formed in your tooth, but it will help prevent other cavities from forming. Does that mean you will not ever get a cavity again if you never eat sugar again? Well, no, you might get one, but your chances are drastically reduced to practically zero. Most dentists will tell you that as long as you brush your teeth and avoid sugar you will reduce your cavity possibilities to near zero in a normal healthy adult. Have you noticed how many people are losing their teeth and how much sugar they consume? Dentists know the connection sugar has with rotten teeth. They are only glad to replace your teeth with artificial ones. Do you really think that cavities are the only thing ‘rotten’ in your body from all the sugar you have been eating over your lifetime? And is obesity the only health problem aggravated by sugar? The Australians have a report about a guideline for sugar consumption: “The Australian Dietary Guidelines are currently being revised and updated. There has been public discussion about the advisability of retaining a guideline for sugar because of insufficient evidence linking sugar consumption to ill health. However, there are concerns about the quality of the self-reported food intake data on which this conclusion is based. In addition, the doubling in diabetes prevalence in Australia in the past 20 years, which is linked to increased obesity from consumption of energy-dense foods, including those with added sugars (sugar -sweetened drinks being particularly important), provides a strong rationale for retaining a dietary guideline for sugar .” [413] Do you think that sugar only causes cavities in your teeth? Could sugar play a role in your rosacea? If you continue to study this topic you will be more convinced of the role sugar has in your rosacea and you can do something about it. There are a number of articles and books you may read on this subject which are listed below or can be found on the web or ordered through your local library: Pure, White and Deadly, John Yudkin, Viking, 186, Penguin, 188, Davis-Poynter Ltd; ASIN: 070670006 Sweet and Dangerous: The New Facts About the Sugar You Eat As a Cause of Heart Disease, Diabetes, and Other Killers. by John Yudkin Metabolic Effects of Utilizable Dietary Carbohydrate by Sheldon Reiser (Editor) (Hardcover—August 1982) The Saccharine Disease: Conditions Caused by the taking of Refined Carbohydrate, such as sugar and white flour by T. L. Cleave; Nurs Times. 1974 Aug 15;70(33):1274-5 Dismantling a Myth: The Role of Fat and Carbohydrate in Our Diet by Wolfgang Lutz Refined Carbohydrate Foods and Disease: Some Implications of Dietary Fiber by D. Burkitt The conception of the saccharine disease. An outline. Cleave TL; J R Nav Med Serv. 1971 Spring;57(1):10-9 Letter: Sugar , heart-disease, and diabetes. Cleave TL; Lancet. 1974 Mar 23;1(7856):515 Sugar and sugars: myths and realities. Coulston AM, Johnson RK; J Am Diet Assoc. 2002 Mar;102(3):351-3 Carbohydrate and sucrose intake in the causation of atherosclerotic heart disease, diabetes mellitus, and dental caries. Bierman EL; Am J Clin Nutr. 1979 Dec;32(12 Suppl):2644-7 Carbohydrates, sucrose, and human disease. Bierman EL; Am J Clin Nutr. 1979 Dec;32(12 Suppl):2712-22 Sucrose, coronary heart disease, diabetes, and obesity: do hormones provide a link?—Yudkin J; Am Heart J. 1988 Feb;115(2):493-8 Sugar and disease. Danowski TS; J Med Soc N J. 1979 Nov;76(12):849-50 Are you beginning to believe and understand that sugar is something a rosacean should avoid and is a trigger for rosacea? Diabetes and Rosacea (Update) The GWAS by Chang et al., also revealed that patients with rosacea shared a genetic locus with type 1 diabetes mellitus; this association was further confirmed by a population-based study as well. A recent study also revealed the presence of insulin resistance in rosacea, demonstrating significantly higher fasting blood glucose levels in patients with rosacea than in controls. As increased glucose intolerance along with dyslipidemia and hypertension are the factors that comprise metabolic syndrome, this association in rosacea might be related to cathelicidin, oxidative stress and endoplasmic reticulum (ER) stress, which are implicated in the pathogenesis of both rosacea and metabolic disorders. However, the advanced state of diabetes mellitus, which is associated with longer disease duration or high hemoglobin A1c levels, has conversely been recently associated with a decreased risk of rosacea. Thus, the underlying mechanism involved in this paradoxical association remains to be clarified." Int J Mol Sci. 2016 Sep; 17(9): 1562.Published online 2016 Sep 15. doi: 10.3390/ijms17091562, PMCID: PMC5037831Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory ConditionYu Ri Woo, Ji Hong Lim, Dae Ho Cho, and Hyun Jeong Park Addendum and Updates There is evidence that sugar is connected to acne. A NY Time article discusses this connection. The article refers to the following study: Journal of the American Academy of Dermatology Volume 57, Issue 2, August 2007, Pages 247–256 The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial Robyn N. Smith, BAppSc (Hons), Neil J. Mann, BSc (Hons), BAppSc, PhD, Anna Braue, MBBS, MMed, Henna Mäkeläinen, BAppSc, George A. Varigos, MBBS, FACD, PhD, More on Sugar Sugars to Avoid Sugar Industry and Coronary Heart Disease Research End Notes 398 Sugar Blues, William Dufty, 1975, Warner Books, Inc, p. 22–3 399 Sugar Blues, William Dufty, 1975, Warner Books, Inc, p. 77-8 400 http://diabetes.org/about-diabetes.jsp 401 The pathophysiology of cardiovascular disease in diabetes mellitus and the future of therapy. Thomas JE, Foody JM; J Cardiometab Syndr. 2007 Spring;2(2):108-13 402 Endothelial dysfunction in diabetes mellitus. Cosentino F, L&uuml;scher TF; J Cardiovasc Pharmacol. 1998;32 Suppl 3:S54-61 403 Clinical significance of cardiovascular dysmetabolic syndrome . Deedwania PC; Curr Control Trials Cardiovasc Med. 2002 Jan 7;3(1):2 404 The endothelial dysfunction in diabetes mellitus. P&#259;nu&#351; C, Mo&#355;a M, Vladu D, Vanghelie L, R&#259;ducanu CL. Rom J Intern Med. 2003;41(1):27-33 405 Low-carbohydrate nutrition and metabolism. Westman EC, Feinman RD, Mavropoulos JC, Vernon MC, Volek JS, Wortman JA, Yancy WS, Phinney SD; Am J Clin Nutr. 2007 Aug;86(2):276-84 406 Dietary advice for treatment of type 2 diabetes mellitus in adults. Nield L, Moore H, Hooper L, Cruickshank J, Vyas A, Whittaker V, Summerbell C. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004097 407 Dietary fiber , glycemic load, and risk of non-insulin -dependent diabetes mellitus in women. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. JAMA. 1997 Feb 12;277(6):472-7 408 Dietary fiber , glycemic load, and risk of NIDDM in men. Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC; Diabetes Care. 1997 Apr;20(4):545-50 409 Nutrition For Dummies, 1997, Carol Ann Rinzler, IDG Books Worldwide, Inc., p. 81 410 Nourishing Traditions, Sally Fallon with Mary G. Enig, Ph.D, New Trends Publishing, 1999, P. 571 411 Eating patterns, diet and dental caries. Karjalainen S; Dent Update. 2007 Jun;34(5):295-8, 300 412 Sugars—the arch criminal? Zero DT; Caries Res. 2004 May-Jun;38(3):277-8 413 Importance of retaining a national dietary guideline for sugar . O’Dea K, Mann JI; Med J Aust. 2001 Aug 6;175(3):165-6
  7. No, self diagnosis of rosacea is not a good idea. A physician, particularly a dermatologist is the legal and ethical way to obtain a diagnosis of rosacea. There are many rosacea mimics and many things to differentiate that physicians are trained for. And internet diagnosis is not the way to go. Visit your dermatologist for a diagnosis. What Is Rosacea? What is involved with diagnosing rosacea? Differential Diagnosis of Rosacea Co-existing Conditions
  8. Admin

    Is Flushing Rosacea?

    No. Flushing is not rosacea. Flushing is one of the signs or symptoms of rosacea and is usually the distinguishing sign or symptom in a differential diagnosis. To believe that flushing is rosacea is like believing that a red face is rosacea or that having pimples is rosacea. Redness and pimples are simply signs of rosacea just as flushing is one of the signs. For a more information on flushing click here. Trigger, Tripwire, Flareup, Flush (What's the difference?)
  9. "Dermatomyositis (DM) is a connective-tissue disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin." [1] Click here for Dermatomyositis - Image A.D.A.M. Inflammation of the connective tissues (dermatomyositis) typically produces a reddish-purple (violaceous) rash. The rash is named after the tendency of plants to grow toward the sun (heliotropic) and is characteristic of dermatomyositis. [2] Dermatomyositis - Image medical-look.com More Images DermIS End Notes [1] Wikipedia [2] The New York Times
  10. With vascular disorders, the prevailing opinion is that genetics plays a key role. For instance, if your parents have heart disease, hypertension, stoke or diabetes, there is no doubt that the odds are that you have a genetic predispostion to whatever vascular disorder you parent(s) have or had. Rosacea seems to have this same genetic predispostion to run in families. There is a debate in the vascular theory field whether gentics plays a key role, or the environment. Some feel that a combination of the two seems to be the most reasonable explanation. Somehow the environment triggers the genetic predispostion for rosacea. The prevailing view of most clinical researchers on this subject is that genetic factors cannot be controlled, but there are controllable risk factors. For instance, notice this statement made by the American Heart Association: "Males and people with a family history of premature cardiovascular disease have an increased risk of atherosclerosis. These risk factors can't be controlled. Research shows the benefits of reducing the controllable risk factors for atherosclerosis." [1] Most literature says that the environmental factors, including lifestyle factors, have a bearing on the progression of any of the vascular disorder diseases. What are some of the key lifestyle factors usually mentioned by clinical researchers and physicians? Diet (Junk food, obesity) Obesity or Overweight Exercise (or physicial inactivity) Psychological Factors, (ie., Quality of life, stress or the Type A personality) Tobacco Free (tobacco use or exposure to tobacco smoke) If rosacea is a vascular disorder, which is one view among professionals today, then the lifestyle factors should come into play just like all the other vascular disorders. Why would lifestyle be excluded for rosacea if it is a vascular disorder? Some would like to believe that lifestyle isn't a factor in this disease because they simply want to keep their present lifestyle without altering their present eating, drinking, lack of physical inactivity, obesity, tobacco exposure, or current psychological habits. Whether the lifestyle factors are considered in the pathophysiology of rosacea or not, research should be done to show whether lifestyle factors are rosacea triggers or not. At present lifestyle factors are dismissed by most medical professionals for rosacea treatment and rarely discussed, with the exception that stress is generally accepted by most authorities as aggravating or triggering rosacea. However, rosacea, even though it has been around for a long time, has not had the numbers of cases in the millions as it has today worldwide, just as there is also a significant rise in all types of vascular disorders worldwide. Research suggests that genetics and family history is the prime reason for this rise in vascular diseases, but the environmental factors are contributing to the progression of this. If the environmental factors aren't related to the progression of this increase, what accounts for this rise in numbers? And why do medical authorities mention that controllable risk factors can help reduce the odds of having a problem? There is evidence that vascular diseases begin in childhood. Note this quote from the AHA: "Atherosclerosis is a slow, complex disease that typically starts in childhood and often progresses when people grow older." [1] There is even evidence that rosacea may begin in childhood evidenced by children who are known to flush. Note this quote: "Rosacea tends to begin in childhood as common facial flushing, often in response to stress. A diagnosis beyond this initial stage of rosacea is unusual in the pediatric population." [2] With rosacea all the potential triggers are environmental factors and usually related to flushing. Lifestyle which includes, diet, obesity, exercise, smoking, psychologicial factors such as quality of life, stress, or the Type A personality should also be considered factors when trying to control rosacea. Having a healthy diet, getting the appropriate exercise, stopping smoking, reducing your weight, and having a good quality of life with appropriate self-esteem should be part of the regimen to help control rosacea. Have you ever heard anyone say much about these factors when considering rosacea? Most dermatologists simply hand you a prescription for Metrogel and antibiotics or offer IPL. When other vascular disorder patients are given education on what to do, lifestyle is usually discussed with the patient. Patients with vascular disorders are encouraged to change their lifestyle which may have been the factor that aggravated the problem whether it is genetic or not. The nature verses nurture debate on what causes rosacea will continue until research pinpoints the cause of rosacea. Lifestyle may have an effect on the progress of rosacea. In the meantime, why not consider changing your lifestyle to see if your rosacea improves? Diet Lifestyle Change Many rosaceans have changed their lifestyle with diet and have noted a remarkable way to control rosacea with the diet. While no clinical studies have been done on this lifestyle change, there has been research articles on this subject with acne. In the past, the traditional view among researchers and physicians is the diet has no role in the pathophysiology of acne. However the following article in the Detroit News of February 19, 2003 says a report in the "December issue of the Archives of Dermatology, a Western diet may be a reason 79 percent to 95 percent of American teen-agers have acne." [3] Here is another report. There are many anecdotal reports that rosaceans who have tried altering their diet lifestyle have marvelous success in controlling rosacea. End Notes [1] Atherosclerosis American Heart Association [2] Rosacea in the pediatric population. Lacz NL, Schwartz RA. Cutis. 2004 Aug;74(2):99-103. [3] December, 2002 issue of Archives of Dermatology
  11. Oxidative stress mechanisms in tissue injury. Free radical toxicity induced by xenobiotics and the subsequent detoxification by cellular enzymes (termination). Image courtesy of Wikimedia Commons The 'antioxidant system defect hypothesis' in rosacea patients was mentioned in a report published in Clinical & Experimental Dermatology, Volume 28 Issue 2 Page 188 - March 2003. [1] The report summary stated: "A possible link between superoxide dismutase activity and malondialdehyde level with the clinical manifestations of rosacea was investigated. We found differences in superoxide dismutase activities between mild rosacea (stages I and II) and severe involvement (stage III) groups, as well as between disease and control groups that were statistically significant (P < 0.05). In the mild involvement group (stages I and II), the superoxide dismutase activity was higher than in the control group (P < 0.05), while the malondialdehyde levels did not differ from the control. In the severe involvement group (stage III), the superoxide dismutase activity was lower than in the control group (P < 0.05), and this was coupled to a raised level of malondialdehyde (P < 0.05). These findings clearly show that in the mild involvement phase of rosacea patients, superoxide dismutase activity was stimulated to protect the skin against reactive oxygen species so that the malondialdehyde levels were maintained. In contrast, in more severe disease, due to a decrease in the capacity of the antioxidant defence system, the malondialdehyde levels were increased. These findings support the 'antioxidant system defect hypothesis' in rosacea patients." [1] bold added One indicator of this hypothesis is found in another paper that concluded, "Main finding of our study was that when compared with the control group, serum bilirubin and UA levels were significantly lower in rosacea patients. These levels sustain the hypothesis that antioxidant status and oxidative stress are important in the pathogenesis of rosacea." [11] Marjorie Lazoff, MD Comments Marjorie Lazoff, MD commented on the above report back in 2003 with a post at the now defunct Rosacea Knowledge Yahoo Group and here is a reproduction of her post: "Regardless of its pathogenesis, any physical insult, if severe enough, induces the release of proinflammatory mediators, including ROIs. This is not unique to rosacea, it is a common pathway for injury. In fact, some people hypothesize it as THE common pathway explaining all tissue injury and death, holding the key to perfect health and theoretical immortality. For those not familiar, reactive oxygen species (ROS), including tissue-toxic reactive oxygen intermediates (ROI), are normal byproducts whenever oxygen is metabolized into water -- a process which occurs in every cell of the body. ROIs are potentially damaging to tissues but they are extremely short lived and local enzymes and metabolic processes usually keep ROIs in check. However, increased ROIs are generated in times of high metabolic demands -- illness or other physical stressors, local or systemic inflammation (as in the presence of neutrophils and other immune mediators) -- and also specific environmental forces such as sunlight (to the skin) and smoking and pollution (to the lungs). In these conditions -- and considering genetic, age, and general health status -- protective controls may not be adequate. Local damage from these ROIs occurs, and the damage may even become widespread and deadly. The pathophysiology involving ROIs is called oxidative stress.The damage in oxidative stress includes the lipid-rich cell membranes where, in the presence of ROIs, lipids are abnormally metabolized. Cell membranes are very important because they filter chemicals going in and out of the cell, and because they house receptors that activate or inhibit cell activities.This study uses common lab measurements to evaluate oxidative stress in the skin of rosaceans. Superoxide dismutase (SOD) is one of many enzymes that destroy ROS, in this case the particular ROS called superoxide. One of the lipid peroxidation metabolites in plasma and cell membrane dysfunction is malondialdehyde (MD). SOD and MD are commonly used to measure oxidative stress in any organ system, or systemically. I've noticed through the years that some countries, esp in Eastern Europe and Japan, are researching free oxygen radicals and oxidative stress in all diseases, one by one. So taken in context, this is a banal study documenting what was already known -- in ANY inflammatory situation, ROIs are formed. The same group has measured SOD and MD in many other condition -- rosacea is just an example of literally hundreds of diseases where free radical formation can be shown to occur. It gets a little silly -- I recall one Japanese study measured fewer ROSs in children who swam more laps in a pool than other group of children! But most research in this area that I'm familiar with over the past ten years or so is much more serious, and revolves around critical care -- systemic infections, multiple organ failure, heart attacks and brain injuries and other situations when low blood flow, and so decreased oxygen, is occurring. It's truly fascinating stuff but, at present, has unfortunately not yielded many clinical therapies.The article reposted by Matija on rosacea-support about the anti-oxidant properties of topical metronidazole (Metros, Noritate) provides clinical perspective supporting the same view this article does: that rosacea is primarily an inflammatory condition with secondary vascular effects. I don't necessarily agree or disagree but I see it as increasing important theory in understanding rosacea, esp recently over the past five years." [2] Breaking Down All This for the Faint of Heart Let's try to break all this down for normal people to understand. First off we have to understand what the 'antioxidant' means when discussing this theory. Antioxidant An antioxidant "is a molecule that inhibits the oxidation of other molecules." In biology, antioxidants can terminate the chain reaction caused by free radicals resulting from oxidation. Oxidant An oxidant is "is a substance that has the ability to oxidize other substances — in other words to cause them to lose electrons." In biology, "Oxidation is a chemical reaction that can produce free radicals, leading to chain reactions that may damage cells." Free Radicals Free Radicals, in chemistry are a huge subject, however, in biology, they are "any unstable molecule with one or more unpaired electrons which is formed through normal cell metabolism. Free radicals are also highly reactive and are associated with many disease states. They can lead to the formation of larger groups, also known as reactive oxygen species (ROS). These groups cause DNA damage and other harmful effects." [3] Oxidative Stress "Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage." Oxidative Stress, Ferritin and Rosacea Superoxide dismutase Superoxide dismutase [SOD[ is a class of enzymes that is an important antioxidant defense in nearly all living cells exposed to oxygen. The above report [1] found that SOD activity was higher in mild rosacea group with no difference in the malondialdehyde (MDA) level. MDA is is a marker for oxidative stress. However, in the severe rosacea group SOD was lower and the MDA level was higher. Ferritin Somewhat related to this theory is an article published in a Croatian publication that discusses the "the role of oxidative stress triggered by UV light and iron metabolism in the pathophysiology of rosacea." [4] The article discusses how rosacea patients have significantly higher ferritin, a protein, "which is fundamental in the generation of oxidative stress." Oxidative Stress, Ferritin and Rosacea Serum paraoxonase/arylesterase 1 Serum paraoxonase/arylesterase 1 (PON1) is a glycoprotein that has been found to be decreased in rosacea patients. "Serum PON1 enzyme activities have decreased significantly in rosacea." [5] This same report [5] states, "Recent evidence suggests that oxidative stress may be an important phenomenon in the pathophysiology of rosacea." Ozone-oxygen Mixture Treatment One report that discusses the "possible involvement of pro- and antioxidant imbalance in the pathogenesis of rosacea" proposes "oxidative therapy options for rosacea, treatment with an ozone-oxygen mixture in particular..." [6] Reactive Oxygen Species [ROS] "ROS involvement in rosacea pathology has been discussed as explanation for the action of medicines for rosacea treatment." [7] "Our results suggest that rosacea is an oxidative stress condition, as reflected by the increased ROS activity and decreased AOP, regardless of HP infection." [8] "A paradox in metabolism is that, while the vast majority of complex life on Earth requires oxygen for its existence, oxygen is a highly reactive molecule that damages living organisms by producing reactive oxygen species." [9] "In a biological context, ROS are formed as a natural byproduct of the normal metabolism of oxygen and have important roles in cell signaling and homeostasis. However, during times of environmental stress (e.g., UV or heat exposure), ROS levels can increase dramatically. This may result in significant damage to cell structures. Cumulatively, this is known as oxidative stress." [10] End Notes [1] Clin Exp Dermatol. 2003 Mar;28(2):188-92. The role of free oxygen radicals in the aetiopathogenesis of rosacea. Oztas MO, Balk M, Ogüs E, Bozkurt M, Ogüs IH, Ozer N. [2] Marjorie Lazoff, MD at R-K Yahoo group http://groups.yahoo.com/group/rosacea-knowledge/message/1466 [3] Free Radicals: Why are they Bad? 7 Tips to Avoid Free Radical Damage, Better Health Organization [4]Lijec Vjesn. 2011 Jul-Aug;133(7-8):288-91. The role of oxidative stress and iron in pathophysiology of rosacea Tisma VS, Poljak-Blazi M. The above report appears to be a followup to a 2009 paper below J Am Acad Dermatol. 2009 Feb;60(2):270-6. Oxidative stress and ferritin expression in the skin of patients with rosacea [5] J Eur Acad Dermatol Venereol. 2015 Feb;29(2):367-70. doi: 10.1111/jdv.12556. Epub 2014 May 22. Decreased serum paraoxonase and arylesterase activities in patients with rosacea. Takci Z, Bilgili SG, Karadag AS, Kucukoglu ME, Selek S, Aslan M. [6] Klin Lab Diagn. 2010 Apr;(4):13-6. Oxidative stress level in patients with rosacea and a rationale for the therapeutic use of an ozone-oxygen mixture. Bitkina OA, Kopytova TV, Kontorshchikova KN, Bavrina AP. [7] J Dermatol Sci. 2009 Aug; 55(2): 77–81. The molecular pathology of rosacea Kenshi Yamasaki, M.D., Ph.D. and Richard L. Gallo, M.D., Ph.D. [8] Int J Dermatol. 2004 Jul;43(7):494-7. Plasma reactive oxygen species activity and antioxidant potential levels in rosacea patients: correlation with seropositivity to Helicobacter pylori. Baz K, Cimen MY, Kokturk A, Aslan G, Ikizoglu G, Demirseren DD, Kanik A, Atik U. [9] Antioxidant, Wikipedia [10] Reactive oxygen species (ROS), Wikipedia [11] J Cosmet Dermatol. 2020 Mar 31;: Serum bilirubin and uric acid antioxidant levels in rosacea patients. Turkmen D
  12. Melanotan II is a synthetic analog of the naturally occurring peptide hormone alpha-melanocyte stimulating hormone (α-MSH) that has been shown to have tanning and aphrodisiac properties in preliminary studies and clinical trials. It is a cyclic lactam analog of α-MSH with the amino acid sequence Ac-Nle-cyclo[Asp-His-D-Phe-Arg-Trp-Lys]-NH2. "Afamelanotide, originally developed under the names "Melanotan 1" or "Melanotan I" for skin tanning, a drug currently in trials in implant form as a prophylactic treatment for a series of light affected skin is also included in this report. As of 2009 no compound incorporating the melanotan II peptide has ever been approved for use by any governmental drug regulatory bodies outside of clinical trials. Unlicensed and untested powders sold as "melanotan II" are found on the Internet however, multiple regulatory bodies have warned consumers they may be unsafe and ineffective." [1] However, the Italian government in 2010 has approved Afamelanotide (melanotan) according to this report by David Pascoe. Some rosaceans report in the various rosacea online support groups they are using it and you can no longer read about it by clicking here the the rosacea archive. Scenesse (INN: afamelanotide) is Clinuvel's proprietary first-in-class photoprotective drug, currently in Phase II and III clinical trials. The link More info about this is not longer available. Melanotan II "It was under development as drug candidate for female sexual dysfunction and erectile dysfunction but clinical development ceased by 2003, and as of 2018, no product containing melanotan II was marketed and all commercial development had ceased.[1] Unlicensed, untested, or fraudulent products sold as "melanotan II" are found on the Internet, and purported to be effective as "tanning drugs", though side effects such as uneven pigmentation, new nevi (moles), and darkening or enlargement of existing moles are common and have led to medical authorities discouraging use." [1] End Notes [1] Wikipedia More info
  13. By far the most used topical prescription used is metronidazole for rosacea treatment in the form of a gel, lotion or cream. Noritate, Rosex, Metrogel, MetroLotion and Metrocream are the preferred brands. Generic metronidazole is now available. Metronidazole is an antiprotozoal and antibacterial agent used to treat redness and inflammation. Metronidazole is an antibiotic and antiprotozoal medication and is one of the Anti-parasitic Prescription Agents. MetroGel Product Insert. Metronidazole has been around for a long time for rosacea and usually you hear about the topical gel or cream. For many years topical metronidazole is usually one of the first topical line of treatments for rosacea along with oral antibiotics (or low dose timed release doxycycline like Oracea). If you doctor prescribes topical metronidazole after diagnosing you with rosacea, your doctor is old school (the new gold standard is different). Note this report on the topical use of metronidazole: "Metronidazole cream, gel, and lotion vehicles have similar efficacies. There were no substantial differences between concentrations of 0.75% and 1%, or between once daily and twice daily regimens." [1] Cumulative irritation potential among metronidazole gel 1%, metronidazole gel 0.75%, and azelaic acid gel 15% However, now metronidazole is being presribed orally for rosacea, particularly demodectic rosacea. FDA Report on Metronidazole Oral “Furthermore, there is some evidence that oral metronidazole and tetracycline are effective.” [2] “Severer or persistent cases may be treated with oral metronidazole, tetracyclines or isotretinoin .” [3] You should read about an anecdotal experience of oral metronidazoe: Siliconmessiah Siliconmessiah Continued We will see if we hear more about such treatments being used by other rosaceans and if there are any side effects or risks involved with such oral doses of metronidazole for rosacea. One of the oral brand names is Flagyl. Note this statement from rxlist.com: "To reduce the development of drug-resistant bacteria and maintain the effectiveness of Flagyl and other antibacterial drugs, Flagyl should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria." Warnings and Precautions from rxlist.com Division of Surgical Pathology, Johns Hopkins Hospital, Baltimore, MD, USA. ; Am J Forensic Med Pathol. 1996 Dec;17(4):343-6. Sudden death due to metronidazole/ethanol interaction. Cina SJ, Russell RA, Conradi SE. Cautions of Metronidazole Use from Medscape Adverse Reactions from epocrates.com Precautions and Side Effects from healthcentral.com Precautionary Drug Insert from intekom.com Special Precautions It is a standard recommendation to avoid alcohol while taking metronidazole, although recent research suggests that the medication might not actually interact significantly with alcohol Metronidazole can cause seizures. Let your healthcare provider know immediately if you have a seizure while taking this drug. If you are pregnant or breastfeeding, please note this warning about using Metronidazole: Metronidazole is considered a pregnancy Category B medication. This means that it is probably safe for use during pregnancy, although the full risks are not known. Talk to your healthcare provider about the risks and benefits of using this drug when pregnant (see Metronidazole and Pregnancy for more information). Currently, it is not recommended that women in their first trimester take metronidazole to treat trichomoniasis (a sexually transmitted infection) or bacterial vaginosis. emedtv.com Other warnings from emedtv.com: Metronidazole can worsen a pre-existing yeast infection (such as thrush or a vaginal yeast infection). These yeast infections usually require treatment with an antifungal medication. If you have liver disease, your body may not metabolize this medication as well as it should. As a result, your healthcare provider will probably recommend a lower metronidazole dosage. Adverse Effects From Wikipedia: Common adverse drug reactions (≥1% of patients) associated with systemic metronidazole therapy include: nausea, diarrhea, and/or metallic taste in the mouth. Intravenous administration is commonly associated with thrombophlebitis. Infrequent adverse effects include: hypersensitivity reactions (rash, itch, flushing, fever), headache, dizziness, vomiting, glossitis, stomatitis, dark urine, and/or paraesthesia. High doses and/or long-term systemic treatment with metronidazole is associated with the development of black hairy tongue, leukopenia, neutropenia, increased risk of peripheral neuropathy and/or CNS toxicity Metronidazole is listed by the International Agency for Research on Cancer (IARC) as a potential human carcinogen. Although some of the testing methods have been questioned, it has been shown to cause cancer in experimental animals. Yet, metronidazole was shown to be safe in humans. It appears to have a fairly low potential for cancer risk and under most circumstances the benefits of treatment outweigh the risk. Metronidazole is banned in the EU for veterinary use in the feed of animals. Earlier studies suggested a relation between metronidazole and various birth defects. Those studies are nowadays considered flawed and more recent studies "do not support a significant increased risk for birth defects or other adverse effects on the fetus." Common adverse drug reactions associated with topical metronidazole therapy include local redness, dryness, and/or skin irritation; and eye watering (if applied near eyes). Wikipedia Interaction with alcohol Consuming alcohol while taking metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia, and shortness of breath. Consumption of alcohol is typically advised against by patients during systemic metronidazole therapy and for at least 48 hours after completion of treatment. However, some studies call into question the mechanism of the interaction of alcohol and metronidazole, and a possible central toxic serotonin reaction for the alcohol intolerance is suggested. Metronidazole is also generally thought to inhibit the liver metabolism of propylene glycol (found in some foods, medicines, and in many electronic cigarette e-liquids), thus propylene glycol may potentially have similar interaction effects with metronidazole.. Wikipedia Potentially fatal serotonin syndrome Recently, according to Wikipedia there have been reported cases of SSRI/SNRI and metronidazole induced serotonin syndrome, this information is not included on the metronidazole patient information leaflet. Am J Public Health. 2003 Mar;93(3):489-92. Outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with mebendazole and metronidazole use among Filipino laborers in Taiwan. Chen KT, Twu SJ, Chang HJ, Lin RS. Possible Side Effects with Oral Metronidazole Read this post End Notes [1] J Drugs Dermatol. 2006 Apr;5(4):317-9. Metronidazole in the treatment of rosacea: do formulation, dosing, and concentration matter? Yoo J, Reid DC, Kimball AB [2] Cutis. 2005 Mar;75(3 Suppl):13-6; discussion 33-6. The rigor of trials evaluating Rosacea treatments. van Zuuren EJ, Graber MA; Cutis. 2005 Mar;75(3 Suppl):13-6; discussion 33-6. [3] Dermatology. 2005;210(2):100-8. Rosacea: an update. Buechner SA; Dermatology. 2005;210(2):100-8.
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    Laser is one of the older light devices used for treating rosacea and is included in the category of Photo Dynamic Therapy (PDT) for the treatment of rosacea. Here are the most common lasers mentioned: Pulsed dye laser (595 nm, yellow) Smoothbeam laser [4] Safe and effective for the treatment of port-wine stains for patients of all ages, including infants and children Highest degree of success on the head and neck Less success on extremities and torso Minimal risk of scarring or pigment alteration Some models utilize a dynamic cooling system to decrease pain and epidermal injury Lighter skinned patients respond quicker, due to deeper penetration of the laser energy Newer models may produce less bruising Treatment of choice for port-wine stains and facial erythema in rosacea Other indications include hemangiomas, spider angiomas, telangiectasias, venous lakes, scars, and warts Pulsed Nd:YAG (KTP) green laser (532 nm, green) Suited to treat superficial vessels Little or no bruising seen Most effective for lighter skinned patients, tanned skin may lead to increased incidence of skin injury Skin cooled through contact cooling and/or cooling gels Indications include telangiectasias, adult port-wine stains, cherry angiomas, spider angiomas, and venous lakes Intense pulsed light source (515-1200 nm) Multiple wavelengths delivered simultaneously Bruising occurs with treatment and correlates with response to treatment Useful for port-wine stains, telangiectasias, hemangiomas [1] While there are some positive reports that laser works for rosacea there are a number of reports indicating otherwise. For instance Banshee's report that she no longer recommends laser. [2] Jenn is another one who reports a bad reaction to laser. [3] There are many reports posted about laser treatment for rosacea, some good and many otherwise. End Notes [1] Skin Therapy Letter Written for dermatologists by dermatologists. Indexed by the US National Library of Medicine. [2] Banshee's full report [3] Jenn's report [4] J Dermatolog Treat. 2012 Apr;23(2):153-5. Epub 2010 Oct 22. Moderate rhinophyma successfully treated with a Smoothbeam laser. Chou CL, Chiang YY.
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    L. E. D.

    Low level, light emitting diode therapy has been reported to help rosacea in some of the anecdotal reports in internet rosacea groups. Some rosaceans even build home made devices while others receive therapy from well established cosmetic and dermatological treatment centers. LED is just one of the many Photo Dynamic Therapies (PDT) for rosacea. "LED photomodulation treatment may accelerate the resolution of erythema and reduce posttreatment discomfort in IPL-treated patients with photodamage." [1] "Several lamps that generate visible light, many of them using light-emitting diodes (LEDs), have recently found their way to the dermatologic armamentarium. Claims of their value in the treatment of a variety of conditions ranging from cosmetic (antiwrinkle) to acne, rosacea, and skin cancer are made to market them.... ...Blue light (407-420 nm) and red light (633- 660 nm) are promoted for the treatment of acne. They work by exciting high amounts of intracellular porphyrins naturally generated by Propionibacterium acnes (P. acnes).....Blue light and blue-red combinations have demonstrated efficacy in mild to moderate inflammatory acne, having a physical modality comparable to treatment with topical clindamycin but inferior to benzoyl peroxide plus clindamycin....Red light (633 nm) may aid in effectively healing long-term torpid ulcers and may enhance angiogenesis in the rabbit ear chamber model...." [2] There are many rosaceans who have reported building their own LED devices for rosacea. There are red, blue, and yellow LED devices and possibly other colors. You should consider Twickle Purple's post when going this route. [3] "Coupled blue and red light-emitting diodes therapy "could represent an effective, safer, and well-tolerated approach for the treatment of such conditions." [4] There are LED devices listed in our store. Instructions for building your own red light unit from IowaDavid Anecdotal Reports ladycappuccino [post no 3] - "If your only problem is flushing, then I would opt for a red light therapy. It knocked off my flushinh, made it practically non existent." End Notes [1] J Cosmet Dermatol. 2008 Mar;7(1):30-4. Use of light-emitting diode photomodulation to reduce erythema and discomfort after intense pulsed light treatment of photodamage. Khoury JG, Goldman MP. [2] SKINmed. 2005; 4 (1): 38-41. ©2005 Le Jacq Communications, Inc. Light Emitting Diode-Based Therapy William Abramovits, MD; Peter Arrazola, BA; Aditya K. Gupta, MD, PhD, FRCP© [3] Twickle Purple's Post on LED Research [4] J Med Case Rep. 2020 Jan 28;14(1):22 Coupled blue and red light-emitting diodes therapy efficacy in patients with rosacea: two case reports. Sorbellini E, De Padova MP, Rinaldi F
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    IPL is one of the Photo Dynamic Therapies (PDT) for rosacea. Intensity Pulsed Light (IPL) Therapy is one of the hottest treatment for rosacans. 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. Rosacea: significant results with a significant reduction in vessel number and size and a complete disappearance of papules have been achieved after 4 IPL sessions. Figure 1. One report says: "IPL significantly reduces erythema and telangiectasia of rosacea and this is sustained for at least 6 months." [1] Another report: "As demonstrated by truly objective and quantitative means, intense pulsed light is effective for reducing rosacea-associated blood flow, telangiectasia, and erythema." [2] Not everyone reports that IPL helps. Belinda reports, "I had three IPL treatments with a highly respected laser specialist doctor. After the third I experienced scars appearing accross my face, facial fat loss which has left me looking guant and aged, increased redness and MORE broken cappillaries. For the first few weeks my skin looked great, put then the scars, dents, fat loss and increased redness appeared over the next few months. It was incredibly traumatic and upsetting." [3] Mistica reports some "Possible unwanted effects of IPL." Steve reports that he is "Still Red After 12 Luminus One IPL Sessions." There are many reports that IPL doesn't work for many rosaceans. However, there are other reports that it works for them. One anecdotal report says that after the first treatment with IPL herpes broke out on the face. [4] There is evidence that IPL kills demodex mites. [5] "About 2.5 years ago I began having the debilitating burning you all speak of. It was so bad that I had to take time off of work. I went to a plastic surgeon and supposed laser specialist. He conducted about 5 aggressive IPL sessions. It completely took away the burning however it left me with some skin damage (I am positive). THis doc told me that IPL is the gold standard in treatment of burning and veins from rosacea. I was so totally vulnerable that I took his word as God and did what he said. Plus I was desperate for relief. When I felt that I began to notice little lines connecting on my face I brought it up with him. He of course denied it completely. I could not touch IPL after that, except for on my nose to help breakdown the vasculature. I have nose swelling and I hate it." [6] "Although rosacea is difficult to treat, we believe that IPL can be therapeutically useful in such cases." [7] IPL for Meibomian Gland Dysfunction "To conclude, treatment with 540 nm-IPL improved facial telangiectasia in late-stage rosacea that remained after sequential anti-mite therapy and effectively reduced the recurrence of rosacea." [8] Warnings IPL Burns from Perth Home Operator January 23rd, 2012, by David Pascoe | in the news, IPL IPL - Warning to others - don't do this long term !! - The Taff 21st October 2012 Support Groups IPL and Laser Damage Support End Notes [1] Treatment of rosacea with intense pulsed light: significant improvement and long-lasting results. Papageorgiou P, Clayton W, Norwood S, Chopra S, Rustin M. Department of Dermatology, Royal Free Hampstead NHS Trust, London NW3 2QG, U.K. Br J Dermatol. 2008 Sep;159(3):628-32. Epub 2008 Jun 28. [2]Objective and quantitative improvement of rosacea-associated erythema after intense pulsed light treatment. Mark KA, Sparacio RM, Voigt A, Marenus K, Sarnoff DS. Department of Dermatology, New York University School of Medicine, New York, USA. Dermatol Surg. 2003 Jun;29(6):600-4. [3] Belinda's full report [4] jdubbed's report • A later report says it was a 'heat rash.' [5] Improves acne, rosacea Intense Pulsed Light Eradicates Demodex Mites Timothy F. Kirn Sacramento Bureau [6] wendykay post no 8 [7] J Dermatol. 2018 Jun 28;: Successful treatment of erythematotelangiectatic rosacea with intense pulsed light: Report of 13 cases. Tsunoda K, Akasaka K, Akasaka T, Amano H [8] Exp Ther Med. 2020 Jun;19(6):3543-3550 Improved telangiectasia and reduced recurrence rate of rosacea after treatment with 540 nm-wavelength intense pulsed light: A prospective randomized controlled trial with a 2-year follow-up. Luo Y, Luan XL, Zhang JH, Wu LX, Zhou N
  17. Gram negative folliculitis is an inflammation of follicles caused by a bacterial infection that can result from long-term antibiotic treatment. Patients who are being treated with antibiotics for severe acne may develop Gram negative folliculitis. Image - Wikipedia Commons The word “Gram” refers to a blue stain used in laboratories to detect microscopic organisms. Certain bacteria do not stain blue and are called “Gram negative. [1] Gram-negative folliculitis is an acne condition caused by Gram-negative organisms. Usually people who had Gram-negative folliculitis are they who had complication with acne vulgaris and rosacea, and also develops in patients who have received systemic antibiotics for prolonged periods. Image - media.clinicaladvisor.com Gram-negative folliculitis occurs in patients who have had moderately inflammatory acne for long periods and have been treated with long-term antibiotics, mainly tetracyclines, a disease in which cultures of lesions usually reveals a species of Klebsiella, Escherichia coli, Enterobacter, or, from the deep cystic lesions, Proteus. {2] Images of Gram-negative Folliculitis by DermIS H Pylori, a gram negative bacteria, has been implicated in many rosacea research papers as being a factor in rosacea. This controversy continues to be debated. An interesting thread to read on this was started by Rory. http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?30120-Gram-negative-Perioral-Dermatitis End Notes [1] Acnenet American Academy of Dermatology [2] Wikipedia
  18. This variation of Rosacea is relatively rare and is sometimes referred to in medical literature as Rosacea Fulminans or in certain cases as Halogen Rosacea.
  19. The Classic Butterfly of Rosacea and the T - Zone In discussing rosacea the 'butterfly' or T - Zone usually comes up. Butterfly Here is a graphic of the classic butterfly in rosacea: Image - Wikipedia Commons The facial butterfly is usually associated with rosacea but can also be found in lupus patients. "In the case of lupus, the butterfly or malar rash can appear on other parts of the body, aside from the face. For instance, it could appear on the arms, legs, or trunk." [1] "The prototypical butterfly-shaped skin lesion of SLE, which has also led many of the patient organizations to identify with the butterfly, has in essence retained its position over time. Defined as 'fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds', it sometimes poses problems in differential diagnosis, mainly against rosacea and occasionally against dermatomyositis." [2] RRDi Logo The RRDi uses the butterfly as part of its logo. What is the butterfly effect in rosacea? T - Zone The T - Zone can be clearly seen in this graphic: Image - bellasugar.com [1] End Notes [1] Bel Marra Health [2] Curr Rheumatol Rep. 2020; 22(6): 18. New Criteria for Lupus Martin Aringer, Nicolai Leuchten, Sindhu R. Johnson
  20. Pyoderma Faciale (PF) is also known as Rosacea Fulminans
  21. There are reports that may indicate migraine headaches may be associated with rosacea. For instance, one report says, "Studies have found possible associations between rosacea and the face mite Demodex folliculorum, Helicobacter pylori infection, and migraine headaches. [1] Another report says, "the association of rosacea with migraine headaches suggests an inherent vascular lability in individuals with rosacea." [2] The NRS reports that "women with rosacea may be more likely to experience migraine headaches than those without rosacea, according to findings reported in the medical journal Dermatology." This same report says "the authors speculated that changes in vascular reactivity caused by age-related modifications in sexual hormones might be the reason for this finding." [3] "We observed a slightly increased risk for female migraineurs to develop rosacea, particularly in women with severe migraine aged 50 years or older." [4] "One case-controlled study of 53,927 rosacea patients who were identified using a UK database between 1995 and 2009, showed that women (but not men) were significantly more likely to develop rosacea if they had previously experienced migraines." [5] "So the research team analyzed 172 oral samples and nearly 2,000 fecal samples taken from the American Gut Project, and sequenced which bacteria species were found in participants who suffered migraines versus those who did not. And it turns out, the migraineurs have significantly more nitrate-reducing bacteria in their saliva than those who don’t suffer these headaches. And it turns out, the migraineurs have significantly more nitrate-reducing bacteria in their saliva than those who don’t suffer these headaches. Having too many nitrates in the body, which can aid cardiovascular health in best case scenarios, has been linked to migraines for unlucky folks. Now this new research suggests that’s because having too much oral nitrate-reducing bacteria, which converts nitrates into nitric oxide in the body, leads to the pounding headaches." [6] The above quote is related to the article, Do You Have A Gut Feeling About Your Rosacea? "We found a significantly higher prevalence and risk of incident migraine especially in female patients with rosacea. These data add to the accumulating evidence for a link between rosacea and the central nervous system." [7] "Our meta-analysis confirmed an association in occurrence of migraine and rosacea." [8] Notes [1] Rosacea: A Common, Yet Commonly Overlooked, Condition B. WAYNE BLOUNT, M.D., M.P.H., and ALLEN L. PELLETIER, M.D. University of Tennessee Health Science Center, Memphis, Tennessee American Family Physician, August 1, 2002 [2] Rosacea: a reaction pattern associated with ocular lesions and migraine? Ramelet AA., PMID: 7979452 [PubMed - indexed for MEDLINE] [3] The Proposed Inflammatory Pathophysiology of Rosacea from SKINmed Dermatology for the Clinician Rosacea Linked with Increase in Migraine Rosacea Review, Winter 1998 Postmenopausal female rosacea patients are more disposed to react with migraine. Berg M, Liden S, Dermatology. 1996;193:73-74. Study Finds Association Between Rosacea & MigraineNRS Posted: 01/03/2017 [4] J Am Acad Dermatol. 2013 May 1. pii: S0190-9622(13)00308-3. doi: 10.1016/j.jaad.2013.03.027. Migraine, triptans, and the risk of developing rosacea: A population-based study within the United Kingdom. Spoendlin J, Voegel JJ, Jick SS, Meier CR. [5] Rosacea and Migraine by By Dr Ananya Mandal, MD [6] This is why some foods trigger migraines BY NICOLE LYN PESCE, NEW YORK DAILY NEWS Wednesday, October 19, 2016 [7] Prevalence and risk of migraine in patients with rosacea: A population-based cohort study. J Am Acad Dermatol. 2016 Nov 3; Egeberg A, Ashina M, Gaist D, Gislason GH, Thyssen JP [8] The relationship between migraine and rosacea: Systematic review and meta-analysis. Cephalalgia. 2017 Jan 01;:333102417731777 Christensen CE, Andersen FS, Wienholtz N, Egeberg A, Thyssen JP, Ashina M
  22. 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
  23. 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] Treatment Pimecrolimus Dupilumab 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
  24. 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 Oraser Body Emulsion Plus by ZO® Skin Health [1] 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. End Notes [1] KERATOSIS PILARIS, Dr Sarah Norman BM BS BMedSci (Hons) DRCOG MRCGP MEWI MBCAM, Aesthetic Medicine • May 2016 aesthetic-medicine-article.pdf
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    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
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