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  1. Apurva, 

    My dermatologist told me that I have SD on my forehead and into the hair. For about three months I have now had some issues similar on the back of my head just above the neck that has not responded to my normal shampoo, Coal Tar (I usually use a generic T-Gel from Walmart or CVS), so I tried using Nizorol (Ketoconazole) brand shampoo which did improve the issue but it simply didn't go away. What really helped was using an old jar of Sulfur Butter from a tip Joanne Whitehead posted a while back. We do feature it in our affiliate store but when I tried to purchase another jar it wasn't available on Amazon. So I contacted the Braunfels Labs company website, and it is no longer listed. So I contacted the company asking what happened and got a response from DP Davidson, who explained that the Sulfur Butter is still available but on a different website, sulfursoap.com.  So I ordered another jar since this cream contains the following ingredients: 

    sulfurbutteringredients.png

    Your experience and mine indicates that fungus and rosacea (yeast is a fungus) has not been ruled out and even though SD and rosacea can co-exist, there is probably some relationship between the two skin diseases. Not sure what ingredient in the Sulfur Butter is improving my fungus issue in my scalp but I think the Shea Butter, Hemp Oil, Avocado Oil and Jojoba Oil may have something to do with it along with the sulfur. 


  2. 320px-4724507933_07ac954c27_bFluorose.jpg
    image courtesy of Wikimedia Commons

    "A 40-year-old Caucasian woman presented to our dermatology clinic with rosacea. She was prescribed oral doxycycline 50mg once daily and metronidazole lotion at bedtime. Seven weeks after starting this regimen without complaint, she contacted the office stating her teeth had become discolored “overnight.” "

    The article explains that "Chemicals and medications associated with staining of teeth" should be reviewed with rosacea patients and "question patients about their oral hygiene regimen and develop cooperative relationships with our dental colleagues."

    J Clin Aesthet Dermatol. 2019 Oct; 12(10): 12–13.
    Published online 2019 Oct 1.
    PMCID: PMC6937148
    Sudden Onset of Tooth Discoloration
    Brooke A. Jackson, MD, FAAD and Cierra D. Taylor, BA


  3. American_Academy_of_Dermatology_svg.png.
     

    The Journal of the American Academy of Dermatology, February 2020, mentions the new phenotype classification with this statement: 

    "The new system is consequently based on phenotypes that link to this process, providing clear parameters for research and diagnosis, as well as encouraging clinicians to assess and treat the disorder as it may occur in each individual."

    J Am Acad Dermatol. 2020 Feb 06;:
    Standard Management Options for Rosacea: the 2019 Update by the National Rosacea Society Expert Committee.
    Thiboutot D, Anderson R, Cook-Bolden F, Draelos Z, Gallo R, Granstein R, Kang S, Macsai M, Gold LS, Tan J


  4. It is that time again, after five years, to nominate and approve the RRDi Board of Directors. If you are a voting member, you will be able to nominate or approve the board of directors by following the directions in this post. If you can't access the post, after you login, this means you are a member of the RRDi but do not have voting rights. If you want to change your membership from a member to a voting member follow the directions in this post


  5. metronidazole_tablets.png

    The papers below are discussing ORAL metronidazole, however, you should be aware of these studies with regard to the Central Nervous System, the brain, neuropathy and treatment with metronidazole (considered one of the Anti-parasitic Prescription Agents).  

    "This microdialysis study describes the steady-state brain distribution of metronidazole in patients and confirms its extensive distribution....These findings demonstrate that the extensive distribution of metronidazole within brain ECF contributes to the CNS toxicity observed occasionally during treatments with this antibiotic. " [1]

    "Metronidazole is a potential cause of reversible autonomic neuropathy." [2]

    "Cerebellar toxicity is a rare adverse event in patients treated with metronidazole." [3]

    "Metronidazole is a commonly used antimicrobial drug. When used excessively, it can cause encephalopathy." [4]

    "Nevertheless, six cases of peripheral neuropathy with metronidazole have been reported, and we describe here a further patient with peripheral neuropathy due to metronidazole." [5]

    "Metronidazole is distributed extensively within CSF, with a mean CSF to unbound plasma AUC0-τ ratio of 86% ± 16%." [6]

    End Notes

    [1] Frasca D, Dahyot-Fizelier C, Adier C, et al. Metronidazole and hydroxymetronidazole central nervous system distribution: 1. microdialysis assessment of brain extracellular fluid concentrations in patients with acute brain injury. Antimicrob Agents Chemother. 2014;58(2):1019–1023. doi:10.1128/AAC.01760-13

    [2] J Child Neurol, 21 (5), 429-31  May 2006
    Metronidazole: Newly Recognized Cause of Autonomic Neuropathy
    Lisa D Hobson-Webb, E Steve Roach, Peter D Donofrio
    PMID: 16901452  DOI: 10.1177/08830738060210051201

    [3] Int J Infect Dis. 2008 Nov;12(6):e111-4. doi: 10.1016/j.ijid.2008.03.006. Epub 2008 Jun 3.
    Cerebellar ataxia following prolonged use of metronidazole: case report and literature review.
    Patel K, Green-Hopkins I, Lu S, Tunkel AR.

    [4] Kalia V, Vibhuti, Saggar K. Case report: MRI of the brain in metronidazole toxicity. Indian J Radiol Imaging. 2010;20(3):195–197. doi:10.4103/0971-3026.69355

    [5] Br Med J. 1977 Sep 3; 2(6087): 610–611. doi: 10.1136/bmj.2.6087.610 PMCID: PMC1631560, PMID: 198056
    Metronidazole neuropathy.
    W G Bradley, I J Karlsson, and C G Rassol

    [6] Antimicrob Agents Chemother. 2014;58(2):1024-7. doi: 10.1128/AAC.01762-13. Epub 2013 Nov 25.
    Metronidazole and hydroxymetronidazole central nervous system distribution: 2. cerebrospinal fluid concentration measurements in patients with external ventricular drain.
    Frasca D, Dahyot-Fizelier C, Adier C, Mimoz O, Debaene B, Couet W, Marchand S.


  6. 233px-Skin.png
    sweat pore image courtesy of Wikimedia Commons

    There are some sources that state that rosacea causes large pores, particularly the pores on the nose. Here are some typical examples: 

    "Signs of the third stage of rosacea include persistent deep redness and many dilated veins, especially around the nose. An early sign of the third stage is fibroplasia -- growth of excess tissue -- which can produce enlarged pores." [1]

    "The bumps and pimples, as well as skin thickening, that accompany rosacea causes pores to enlarge and become more visible." [2]

    "The bumps and pimples, as well as skin thickening, that accompany rosacea cause pores to enlarge and become more visible." [3]

    If you will note, two different sources state the exact same words!

    The general consensus among rosacea authorities is that blackheads are not associated with rosacea. While large pores may be a concern to you, what can you do for this issue? 

    Nose Pores

    "Unfortunately, there’s nothing you can do to literally shrink large nose pores. But there are ways you can help make them appear smaller." [4]

    Treatment

    Natasha Burton has ten natural treatments to reduce or minimize pores. [5]

    Non-comedogenic skin care products (product won't clog your pores, i.e. oil free). [6]

    Retinoids [7]

    Clay Masks [8]

    Exfoliate

    Nose Stripsir?t=rosaresedevei-20&l=ur2&o=1

    Hyaluronic Acid [9]

    Conclusion

    Why not volunteer and post what you have done to reduce your large pores so others who are concerned with this issue can benefit. That is what this is all about, rosaceans helping rosaceans. 

    End Notes

    [1] A Fine Complexion Need Not Become A Distant Memory, Lynn Drake, MD, Rosacea Review Newsletter of the NRS, Summer 1997

    [2] More Than Just a Red Face: Seven Signs of Rosacea, April 12, 2018, DermatologistOnCall 

    [3] More than just a red face: 7 signs of rosacea, MDLive

    [4] What Causes Large Nose Pores and What Can You Do?, Healthline

    [5] 10 Natural Remedies for Shrinking Your Pores, Natasha Burton, StyleCaster

    [6] What Can Treat Large Facial Pores?, AAD

    [7] "Certain products that have retinol [a derivative of vitamin A and well-known acne fighter and anti-ager] can make pores appear smaller," says Dr. Jaliman. "The way they work, as do other prescription strength retinoids, is to increase cell turnover so they unclog the pores, making them appear smaller."
    Can You Shrink Pore Size? A Top Dermatologist Explains The Possiblities, Simone Kitchens, Updated September 21, 2017, Huff Post

    The following retinol product is an example of reducing pores: 

    [8]

    [9] "Overall, the study concluded that intradermal low molecular weight hyaluronic acid fillers do in fact have the potential to reduce pore size — and that's in addition to improving the skin's overall texture and radiance." 
    New Study Says Hyaluronic Acid Fillers Can Lead to Smaller Pores, Game-changing, BY KALEIGH FASANELLA, Allure

    Hyaluronic Acid Serum

    Amazing Formulas Hyaluronic Acid

    The Ordinary Hyaluronic Acid 2% + B5

    Pure Hyaluronic Acid Serum Powder

    Tree of Life Hyaluronic Acid Serum

    Cosmedica Skincare Pure Hyaluronic Acid Serum

    NatureBell Hyaluronic Acid

    Eve Hansen Hyaluronic Acid Cream


  7. On 2/1/2020 at 10:25 PM, BlackMamba24 said:

    Thanks for the response. This is very helpful. I've been doing as you directed with the routine the last two days and it's been OK. One new small blemish but other blemishes seem to be clearing a bit, so I'm optimistic the ZZ cream will make a difference. I do like the way it feels when it's on - like I can tell something is actually happening in my skin!

    Additionally I did purchase Andalou Naturals Face Cream with Probiotic C Renewal. I've read it can be very good for this type of skin and it was on the list of topical probiotics. I'm going to test it tomorrow morning after I rinse. Any experience with this cream?

    To answer your questions, I believe I am phenotype 4. It's mostly just the acne at this point. My dermatologist says other people have it much worse, but my case is extremely stubborn and other treatments that have worked for his other patients aren't doing the trick for me yet. The worst part is it can flare at anytime and when it does, it impacts my confidence especially at work.

    I purchased the original ZZ cream. I'm wondering how long the little jar will last. It looks like it's not available on Amazon right now, so I guess I will need to make it last. Is it going to be that hard to re-purchase?

    Thanks for the other tips on the diet. I'm reluctant to give up the carbs at that rate, but we'll see how this progresses. I've already cutback a great deal on the sweets and dairy, but haven't gone completely cold. This may be my next move and I think I will request a copy of the diet. 

    I'll definitely stay engaged on the forum. ZZ cream has given me some new hope. I have a dermatoligist appointment in a couple weeks and will see what he thinks about the ZZ cream and if I should continue with the doxycycline. I did have a couple other questions:

    Do you have an acarid soap you recommend?

    Do you recommend taking Lutein or any other OTC vitamins?

    Do you take a probiotic for your gut?

    Thanks again for your help!

    You can still purchase the ZZ cream from Demodex Solutions by clicking here. I will send you a copy of the Rosacea Diet. Unless your dermatologist is open minded I doubt if he will have anything good to say about the ZZ cream. The Acarid Soap from Demodex Solutions is good. I take this Lutein every day. I also take a cheap probiotic twice a day.  I used to purchase the expensive one but I can't afford it anymore. I also take a huge handful of vitamins and supplements every day, so just read what I list in the Rosacea Diet book. Also read this post about nutritional deficiencies in rosaceans. I also take ElaineA's salt/borax bath just about every day. Keep us posted on your progress. 


  8. foamix_logo.jpg.b7fe788391363851a7e3f0d3

    Results of Two Phase 3, Randomized, Clinical Trials, FMX103 1.5%, conclusion: 

    FMX103 1.5% was efficacious for moderate-to-severe papulopustular rosacea, while maintaining a favorable safety profile

    The authors of the paper add this limitation, "The generalizability of these data from a controlled clinical trial should be examined in a real-world setting."

    For more information


  9. On 1/29/2020 at 7:52 PM, BlackMamba24 said:

    Hello Brady, this is my first post but I've been reading your posts for over a month.

    I have suffered from rosacea or adult acne for about one year and after trying all of the dermatologists ideas (doxy, minocycline, azithromycin, bactrim, as well as soolantra, metro gel and retina), I stumbled onto this forum and saw that you suggested the ZZ cream. I went online and purchased.

    After using for a couple days, everything seems to be getting worse. I read this might be what happens, but I was disappointed today to see several new blemishes and very dry skin. I have some questions I'm hoping someone with more experience might be able to help answer.

    I think what I'm really looking for is the complete regimen for using ZZ cream? From which soap, to which moisturizer, to which sunscreen .... I'm really lost on how to proceed. 

    Is it OK to use an acarid soap with ZZ cream or is that too much sulfur? I did both for a couple days but my skin is now extremely dry so I've gone back to my original Cetaphil soap.

    I'm just really struggling to find any relief. I had some success with my first IPL treatment, but my second (v-beam) and third didn't work so well. I had great success for a couple weeks with bactrim, but it gave me a terrible rash.

    I'm not 100 percent positive it's demodex, but that's my hunch as i often have itchy feeling. My doctor really isn't helping me get to the root cause of the issue. He's all out of antibiotics and doesn't seem to have any other solutions. I'm hopeful the ZZ cream can work, but the dryness is extremely difficult to hide.

    Any recommendations on regimen for using ZZ cream would be helpful. Thank you. 

    Yes, if you are suffering from demodectic rosacea, IT GETS WORSE BEFORE IT GETS BETTER. A significant number of rosaceans who use the ZZ cream complain of dry skin and, of course, the ZZ cream contains sublimed sulfur which dries the skin even more. You may want to try this regimen: 

    (1) Just before bed, wash face with acarid soap and rinse with lots of water. 

    (2) Apply the ZZ cream on face especially the red areas and pimples. Let it dry before you lay your face on a pillow. Be careful when applying around your eyes, and if you do get near your eyes, close your eyes and then go to bed asap. ZZ cream causes tearing of the eyes. 

    (3) In AM, wash the ZZ cream off with just water. Then apply your favorite moisturizer. Many have recommended rose hip oil or shea butter or whatever your favorite moisturizer. 

    Repeat steps 1 thru 3 each day. 

    Also, avoid eating sugar/carbohydrate for just thirty days. Try to reduce your intake to less than 30 grams of carbohydrate a day. You should notice improvement in your skin. Drink lots of water. If you want a free copy of my Rosacea Diet use the contact form and request a copy. Also you may want to think about taking oral and topical probiotics to help your gut. While demodectic rosacea is a valid rosacea variant, also GUT Rosacea is a variant. 

    You may want to start your own post on your experience in this same category in our forum, or create your own blog or club. I will be one of your followers. 

    Questions, what phenotype do you have? Which ZZ cream did you purchase, Original or Cosmetic

     

     


  10. protopic.jpg

    Davvidml at RF started a thread about using Protopic (Topical Tacrolimus) mentioning it helps reduce his facial swelling and states, "My first post here, diagnosed with Rosacea 6 years ago, type 1 with severe flushing on my cheeks and swelling that makes my face look huge. I have tried numerous treatments over the year, antibiotics, soolantra with nothing helping at all. For the past three weeks I have been using Protopic and (after the 15 days) I have a MASSIVE reduction in swelling of my cheeks. My skin can still flush and turn red but the swelling is almost none existant. My face looks the same size it did 6 years ago before I had Rosacea. I really thought my cheeks had permanently enlarged. Others on here who have bad swelling or Rhinophyma might want to try this."

    redtere pointed out in the same thread above started by Davvidml in post no 4, ""These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability," and refers to a medical journal on this subject. [2]

    Precooling topical calcineurin inhibitors tube; reduces burning sensation

    We need more anecdotal reports like the above to substantiate this. Furthermore, it needs to be established if this is a short term benefit and what the long term risks of taking topical Tacrolimus are. 

    Cautions

    "However, previous case reports have demonstrated an association between granulomatous rosacea (GR) and topical tacrolimus use." [1]

    ""On the one hand, the immunosuppressive properties of tacrolimus might facilitate overgrowth of follicular Demodex in susceptible patients, as suggested by the predominance of the pustular component in the flares (Figure 1B) and the abundance of Demodex in 2 patients who underwent biopsy. Rosacealike demodicosis has been reported in local and systemic immunosuppression, which suggests that Demodex proliferation is facilitated by local or systemic immunosuppressive factors. We recently observed a case where a flare of rosaceiform dermatitis during treatment of facial atopic dermatitis with 1% pimecrolimus cream was associated with the appearance of Demodex, and the good response of patients to oral doxycycline is another indication of the pathogenic role of Demodex. On the other hand, tacrolimus ointment has vasoactive properties, and facial flushing is a significant adverse reaction to the treatment. As local vasomotor instability is a feature of rosacea, tacrolimus ointment may in the long term constitute an additional risk factor in sensitive patients. This may explain the insidious development of rosacea during long-term treatment, as was seen in our patient 6 and in the report of Bernard et al. Moreover, the occlusive properties of the tacrolimus ointment base may play an aggravating role, especially in patients with seborrhea." [3]

    End Notes 

    [1] Journal of Drugs in Dermatology/  2015;14(6):628-630.
    Severe Tacrolimus-Induced Granulomatous Rosacea Recalcitrant to Oral Tetracyclines
    June 2015 | Volume 14 | Issue 6 | Case Reports | 628 | Copyright © June 2015
    Lissy Hu BA, Christina Alexander BA, Nicole F. Velez MD, F. Clarissa Yang MD, Alvaro Laga Canales MD MMSc, Stephanie Liu MD, and Ruth Ann Vleugels MD MPH

    [2] Nature Communications, 2017;8:14345. Published 2017 Feb 10.
    Topical tacrolimus for the treatment of secondary lymphedema
    Jason C. Gardenier, Raghu P. Kataru, Babak J. Mehrara

    [3] End note 287 in the first post of this thread

     


  11. 5866fca81c9a2_514iU9azuL._SX522_.jpg.4a0

    An article published in Photobiomodulation, Photomedicine and Laser Surgery in January 2020 states, "Our video directly demonstrates the effect of IPL on a live Demodex mite extracted from a freshly epilated eyelash. The results suggest that IPL application with settings identical to those used for treatment of DED due to MGD causes a complete destruction of the organism."

    Photobiomodul Photomed Laser Surg. 2020 Jan 27;:
    Real-Time Video Microscopy of In Vitro Demodex Death by Intense Pulsed Light.
    Fishman HA, Periman LM, Shah AA


  12. Nicholas, 

    Thanks for the link to the article, which is a good find! I have added artemesinin to the list of anti-malaria treatments used for successful rosacea treatment. Technically, artemisinin is not an anti-viral, but an anti-malaria treatment used on Plasmodium falciparum, a protozoa. Hopefully, we will hear of anecdotal reports of Rosaceans using artemisinin for rosacea with positive results. Your volunteering to post such articles is what the RRDi is all about, helping rosaceans with rosacea research!

    Artemisinin is available over the counter and considered one of the Anti-parasitic Prescription Agents.

    "Artemisinin derivatives are known for their ability to suppress immune reactions such as inflammation." Wikipedia


  13. An article about any conflict of interest (COI) with the authors of dermatological textbooks is an interesting read, highlighting the need for more transparency acknowledging the funding of the authors. [1]

    Note this paragraph: 

    "In recent years, dermatologists’ relationship with industry has increased immensely. The global pharmaceutical market in dermatology is projected to exceed $34 billion per year by 2023 (Prescient & Strategic Intelligence, 2018). The relationship with industry is a complicated subject. Support from industry has been important for the advancement of dermatology and has provided funding support for a range of activities, including clinical trials, educational materials, and travel support for residents and fellows. These funds are integral for the growth and maintenance of the specialty. For example, exhibit revenue from technical exhibits at large meetings helps support registration and educational costs for attendees and provides funding for other non-income-producing activities. The pervasiveness of industry is incontrovertible and spans a gamut ranging from continuing medical education programs to educational grants to advertisements in journals (Sams and Freedberg, 2000)."

    Here are some highlights of the study: 

    (1) The study was limited to eight textbooks and states about these that all eight "are listed on the American Academy of Dermatology (AAD) website as board preparation resources recommended by members of the AAD Resident and Fellows committee under the category of general dermatology textbooks." 

    "The most recent editions of eight commonly used books were selected and are listed as follows: Dermatology (4th edition, 2017), Andrews’ Diseases of the Skin: Clinical Dermatology (12th edition, 2015), Dermatology Secrets Plus (5th edition, 2015), Genodermatoses: A Clinical Guide to Genetic Skin Disorders (2nd edition, 2004), Comprehensive Dermatologic Drug Therapy (3rd edition, 2012), Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence (5th edition, 2015), Dermatology: Illustrated Study Guide and Comprehensive Board Review (2nd edition, 2017), and Clinical Dermatology: A Manual of Differential Diagnosis (3rd edition, 2003)."

    (2) "The total compensation for 381 authors in 2016 was $5,892,221....The top 10% of dermatologists who collected payments received $5,267,494, which represented 89% of the total payment amount.....The payment distribution was skewed with a minority of dermatologists receiving the majority of payments."

    (3) "Given the financial incentives of pharmaceutical companies, the pharmaceutical industry has a particular interest in targeting young physicians in training as they foster their own disease treatment and prescribing patterns."

    (4) "This study helps to further characterize the relationship between authors of general dermatology textbooks and industry. Continued discussion to foster transparency among physicians, regulators, and the public with regard to various topics, such as policies, physician behaviors, and the potential for CoI in educational resources, is important."

    The paper acknowledges the limitations such as only USA physicians were included and other limitations. But you do get an idea of why transparency should be acknowledged in the textbooks that dermatologists are using so that as the authors of the study put it, "Whether industry payments to authors affect the quality of information in dermatology textbooks for better or for worse remains uncertain" so that "readers can draw their own conclusions."

    End Notes

    [1] International Journal of Women's Dermatology
    Conflicts of interest among dermatology textbook authors 
    Jorge Roman, MD, David J. Elpern, MD, and John G. Zampella, MD

    Etcetera

    Related to skin industry funding of textbook authors are the following two posts: 
    Rosacea Research in Perspective of Funding
    Rosacea Research in Perspective of Idiopathic Diseases

     

     


  14. Imiquimod-cream-5-for-genital-warts_1024x1024.jpg

    Mosquitoes and Virus and Imiquimod Cream

    As noted in the post on Protozoa and Rosacea, treatment for malaria [protozoa] has improved some cases of rosacea using mepacrine, chloroquine, and hydroxychloroquine. An article published in Science Daily [1] points out, "There are hundreds of viruses spread by biting mosquitoes which can infect humans...At present, there are no anti-viral medicines and few vaccines to help combat these infections." The article discusses using a skin cream with the active ingredient imiquimod and reports, "By applying skin cream after a bite, researchers found that they could pre-emptively activate the immune system's inflammatory response before the virus becomes a problem. The cream encouraged a type of immune cell in the skin, called a macrophage, to suddenly spring into action to fight off the virus before it could spread around the body."

    Wouldn't it be novel for 10K RRDi members to get together and each donate a dollar and then sponsor a clinical researcher to investigate if using imiquimod as the active ingredient might improve rosacea?  Do you think any pharmaceutical company or other rosacea non profit organization would ever investigate this? How do you get 10K RRDi members to come together and  all agree that this should be done? 

    Maybe we might learn that some rosaceans somehow apply this imiquimod cream by diluting it with a moisturizer, coconut oil, shea butter, or something to see if this improves their rosacea. If so, then possibly, as this thread points out, could a virus be connected to rosacea?  

    End Notes 
    [1] Mosquito-borne diseases could be prevented by skin cream, Science Daily


  15. 276px-Phage_injecting_its_genome_into_bacteria.svg.png
    Phage injecting its genome into bacteria - image courtesy of Wikimedia Commons

    Bacteriophage are a particular virus that are included in the human microbiome that "have been used for over 90 years as an alternative to antibiotics in the former Soviet Union and Central Europe as well as in France." Human Microbiome, Brady Barrows

    Some researchers are trying to find foods that encourage bacteriophage to act as an antibiotic in the gut, for example, stevia, they say as the "most potent prophage inducer" and explains, "The ability to kill specific bacteria, without affecting others, makes these compounds very interesting."

    "These findings are important. Scientists now know that the microbiome can influence our physical and mental health; it can also cause inflammation and increase cancer risk. If scientists can work out how to alter the microbiome in specific ways, they can, in theory, remove or reduce these risks."

    Common foods alter gut bacteria by influencing viruses, MedicalNewsToday

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