Guide

The literature available so far provides low-quality evidence of a modest effect of IVM in improving clinical outcomes in COVID-19, with some data on prophylactic use. Pertinently we feel that the purists would wait for the ideal trial that would have to factor in the initial period of infection, severity, clinical parameters, and possibly a higher dose, but the emergent desire for administering a cheap drug supplants the rigors of such parameters. The drug has already found its way in many regional, state, and International protocols of clinical care though more evidence would be welcome to establish its role and as evidenced by the data in Table 3, a growing evidence of its use is being published and we feel it is one of the few drugs that has transcended in-vitro data to clinical applicability. IVM is a drug that is safe, cheap, and widely available with multimodal action. The wide applicability with mass prophylaxis campaigns in various tropical disorders certifies its safety. The dermatological indications extend beyond scabies and pediculosis. The repurposing of this drug for COVID-19 is based on firm in-vitro data and therapeutic data suggests that it is a useful drug in the early virus replicative phase of the disease. It can be given at higher doses based on the available data which may achieve the ideal serum levels for an antiviral action. While it has established a firm place in the management of several nematodal and ectoparasitic infections, the anti-inflammatory, anti-cancer, and anti-viral/bacterial role of IVM make it a versatile drug, the full potential of it will evolve over the years. Current Use of Ivermectin in Dermatology, Tropical Medicine, and COVID-19: An Update on Pharmacology, Uses, Proven and Varied Proposed Mechanistic Action

IVM has broad-spectrum in-vitro antiviral activity against many RNA and DNA viruses, including human immunodeficiency virus-1 (HIV-1), dengue virus (DENV), influenza, Venezuelan equine encephalitis virus (VEEV), a flavivirus, pseudorabies virus, and Zika virus. In addition to controlling filariasis, the mass drug administration (MDA) of IVM has also had effects on limiting the spread of malaria. Current Use of Ivermectin in Dermatology, Tropical Medicine, and COVID-19: An Update on Pharmacology, Uses, Proven and Varied Proposed Mechanistic Action

Topical IVM has shown to downregulate the proinflammatory genes IL-8, cathelicidin LL-37, HBD 3, TLR-4, and TNF-α in papulopustular rosacea along with its antiparasitic action against Demodex. IVM 1% cream is now approved by US FDA for the treatment of inflammatory rosacea. IVM not only targets Demodex folliculorum but also reduces the inflammation associated with the condition. Results of a two-week controlled, investigator-blinded trials revealed that IVM 1% cream is superior to placebo in reducing inflammatory lesions in papulopustular rosacea, with near-complete treatment response, and improving patient satisfaction and quality of life.[54] In addition, IVM 1% cream was found to be better than metronidazole 0.75% cream for decreasing the inflammatory lesion count, reaching “clear” or “almost clear” response and patient satisfaction.[78] IVM is also well-tolerated and beneficial for the treatment of perioral dermatitis. Current Use of Ivermectin in Dermatology, Tropical Medicine, and COVID-19: An Update on Pharmacology, Uses, Proven and Varied Proposed Mechanistic Action

Every dermatological disease assessed had a significant increase in TME when compared to the prior year. This increase was most significant for acne vulgaris (808%), psoriasis (792%), malignant skin neoplasms (716%), atopic dermatitis (609%), rosacea (566%) and contact dermatitis (529%). Published online 2021 Aug 19. doi: 10.1016/j.jid.2021.07.109 LB767 A multicenter analysis of patients using telemedicine for dermatological conditions during the COVID-19 pandemic

Rosacea-like eruptions following COVID-19 vaccination More Information

Rosacea-like eruptions following COVID-19 vaccination More Information

I haven't tried it. Some have complained about the 'Cetephil' base that Soolantra uses complaining it irritated their skin. Some love Cetaphil for their skin, so everyone is different. We were hoping that this new Teva Generic would be different and would help out. Sorry it didn't work out for you. Thanks for your report. You are now in the running for a free jar of the ZZ cream which some have reported works better than Soolantra. For a comparison spreadsheet of the base with Soolantra click here.

While guests can view a significant number of posts and pages on the RRDi website, Guests cannot view the PRIVATE member forum. For example, here are the topics posted today, August 11, 2021. To view these topics, Guests need to register an email address. See this screen shot below for the topics posted today:

"Minocycline hydrochloride combined with photodynamic therapy can effectively improve the skin barrier function of patients, relieve clinical symptoms, and enhance the overall efficacy and quality of life. It is also safe and patients are highly satisfied with the cosmetic effect." Effect of minocycline hydrochloride combined with photodynamic therapy on skin barrier function of patients with acne Am J Transl Res. 2021; 13(7): 8427–8432.

"P-glycoprotein 1 (permeability glycoprotein, abbreviated as P-gp or Pgp) also known as multidrug resistance protein 1 (MDR1) or ATP-binding cassette sub-family B member 1 (ABCB1) or cluster of differentiation 243 (CD243) is an important protein of the cell membrane that pumps many foreign substances out of cells. " [1] "Adenosine triphosphate–binding cassette subfamily B member 1 (ABCB1), also known as permeability glycoprotein, multidrug-resistant protein 1, or cluster of differentiation 243 (CD243), is a crucial protein for purging foreign substances from cells." [2] "Growing evidence suggests that ABCB1 manipulation may be a strategy to optimize treatment effects in dermatology. First, variations in ABCB1 are associated with the risk of adverse effects of ivermectin, azathioprine, and various antihistamines. Second, variations in ABCB1 are associated with treatment responsiveness to many crucial dermatologic agents, including colchicine, biologic agents, cyclosporine, antihistamine, methotrexate, and topical steroids. Third, ABCB1 is crucial for transepidermal delivery of topical agents, notably topical corticosteroids. ABCB1 expression increases in erosive lichen planus, which may contribute to therapeutic refractoriness to topical corticosteroids. Finally, food may also play a considerable role in ABCB1 expression, and food may affect the efficacy and safety of some medications, such as cyclosporine. However, we must interpret the data carefully because many of the studies were performed in cell lines instead of primary culture and in vivo studies. The regulatory mechanism may differ among these processes, and the data do not reflect the processes in vivo. Because the role of ABCB1 in malignancy has been studied extensively, further investigation is warranted to elucidate the roles of ABCB1 in nonneoplastic dermatologic diseases." [2] End Notes [1] P-glycoprotein, Wikipedia - Image courtesty of Wikimedia Commons [2] ABCB1 in dermatology: roles in skin diseases and their treatment J Mol Med (Berl). 2021 Aug 9 : 1–12.

The coronavirus-19 (COVID) pandemic has hindered health care provider operations, and its impact on patient willingness to seek in-person dermatologic care lacks extensive study. Understanding how a pandemic may influence patient motivation to consult a dermatologist may facilitate efficient allocation of health care provider resources both during and after COVID. Participants (n = 416) were recruited through Amazon Mechanical Turk, a web-based survey platform. Subjects were randomized to one of fourteen groups, each entailing a pre-COVID or during-COVID hypothetical scenario of a socially stigmatized skin condition: scalp psoriasis, herpes labialis, acne vulgaris, rosacea, tinea faciei, melanoma, or a benign nevus. Subjects rated their willingness to schedule an in-person dermatology appointment on a 5-point Likert scale (ie, willingness score). Sociodemographic data were collected. Herpes labialis, tinea faciei, and melanoma prompted higher willingness scores during COVID (3.94; 4.03; 3.54) compared with pre-COVID (3.81; 4.0; 3.32); scalp psoriasis, acne vulgaris, rosacea, and benign nevi prompted lower willingness scores during COVID (3.33; 2.88; 3.67; 3.07) compared with pre-COVID (3.93; 3.19; 4.21; 3.7). The benign nevus group displayed the largest decrease in willingness scores from pre-COVID (3.7) to during COVID (3.07). Patients reported higher willingness to seek in-person evaluation for conditions associated with stronger social stigmas, such as scalp psoriasis and herpes labialis, during COVID. We did not control for subject familiarity with each skin condition, and perceived degree of disfigurement was not measured. Patient willingness to seek treatment during COVID may be changing rapidly and, at this time, does not appear to be largely affected by the pandemic. Impact of COVID-19 on patient willingness to seek in-person dermatologic care J Am Acad Dermatol. 2021 Sep; 85(3): AB101.

There is evidence that demodex infestation primarily changed the dominant flora and relative abundance of ocular surface microbial communities and meibomian gland dysfunction (MGD) may play an important role in this process. Ophthalmol Ther. 2021 Sep; 10(3): 601–617. Demodex Infection Changes Ocular Surface Microbial Communities, in Which Meibomian Gland Dysfunction May Play a Role

"Keratinocytes are the primary type of cell found in the epidermis, the outermost layer of the skin. In humans, they constitute 90% of epidermal skin cells." [1] "These findings reveal the specific epithelial differentiation in normal central facial skin, and epithelial–immune crosstalk in lesions providing insight into an initial keratinocyte pattern in the pathogenesis of rosacea." [2] "In conclusion, we extensively and comprehensively investigated the characteristics of central facial skin and rosacea lesions in a stepwise manner. We potentially revealed the communication between the skin barrier and innate immune system, keratinocyte–immune crosstalk, and provided insights into the initial keratinocyte pattern for the pathogenesis of rosacea. Finally, our findings suggested STAT1 might be a potential therapeutic target for rosacea." [2] "Epidermal RNA-seq and immunohistochemistry analysis further validated the epithelial-derived STAT1 signature in rosacea lesions." [2] "Signal transducer and activator of transcription 1 (STAT1) is a transcription factor which in humans is encoded by the STAT1 gene. It is a member of the STAT protein family. " [3] "Bacterial peptidoglycan (PGN) stimulates toll-like receptor 2 (TLR2) on the surface of keratinocytes (KCs), triggering signaling pathways that promote an innate immune response. " [4] End Notes [1] Keratinocyte, Wikipedia - image courtesty of Wikimedia Commons [2] Front Immunol. 2021; 12: 674871. Keratinocyte-Immune Cell Crosstalk in a STAT1-Mediated Pathway: Novel Insights Into Rosacea Pathogenesis [3] STAT1, Wikipedia - STAT1 image courtesy of Wikimedia Commons [4] AhR Regulates Peptidoglycan-Induced Inflammatory Gene Expression in Human Keratinocytes

"Most of the research performed has focused on bacteria. Bacteria are nonetheless not the only inhabitants of human skin. Additionally, fungi, phages and micro-eukaryotes are present on the skin and most likely play a role in normal skin homeostasis." Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001 Skin microbiome transplantation and manipulation: Current state of the art Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"Rosacea has also been linked to a dysbiosis of the skin microbiome. An increased abundance of Demodex mites are observed in this disease. An interesting suggestion was made by Parodi et al. who reported an interplay between the skin and bacterial overgrowth in the small intestine. Rosacea patients had a significantly higher overgrowth of gut bacteria than controls and elimination of the overgrowth, using an antibiotic, resulted in an almost complete regression of the skin pathology for a prolonged time. These findings support the pathogenetic role of the gut microbiome in rosacea lesions, although the exact relationship remains to be elucidated. Additionally, research even investigated the microbiota of the Demodex mites, but final conclusions are still outstanding." Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001 Skin microbiome transplantation and manipulation: Current state of the art Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"Rosacea has also been linked to a dysbiosis of the skin microbiome. An increased abundance of Demodex mites are observed in this disease. An interesting suggestion was made by Parodi et al. who reported an interplay between the skin and bacterial overgrowth in the small intestine. Rosacea patients had a significantly higher overgrowth of gut bacteria than controls and elimination of the overgrowth, using an antibiotic, resulted in an almost complete regression of the skin pathology for a prolonged time. These findings support the pathogenetic role of the gut microbiome in rosacea lesions, although the exact relationship remains to be elucidated. Additionally, research even investigated the microbiota of the Demodex mites, but final conclusions are still outstanding." Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001 Skin microbiome transplantation and manipulation: Current state of the art Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"Probiotics and diet manipulations have been successfully applied to (partly) restore skin disorders. The gut-skin axis is not only governed by diet, and even acts bidirectionally with UVB and topical allergies directly influencing the gut [19], [20], [21]. Therefore, the cross-talk between the gut and skin is an important factor to take into consideration in regard to skin disorders." Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001 Skin microbiome transplantation and manipulation: Current state of the art Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"The Western diet, which is rich in fat and carbohydrates and low in fibre, has altered the gut microbiome, which can lead to an impaired mucus layer and, in further stages, an impaired intestinal barrier. This contributes to an inflammatory state in the body that can be expressed as a skin pathology." Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001 Skin microbiome transplantation and manipulation: Current state of the art Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

There are a number of papers indicating improvement with rosacea taking Carvedilol. Here is a growing list: RRDi List of Papers on Carvedilol for Rosacea

The RRDi is pleased to announce a new page, Rosacea Episodes.

More Information

You may be having issues trying to navigate our website using a mobile device so here is a helpful tutorial to find Rosacea Topics. Watch Video. You will have to register as a member to view some of the content below. Step one - Finding the Menu on the Home page (iOS - hopefully Android users are similar) - Look for the three bars top right corner (click): You should then see the following menu: Just under the HOME button find the NAVIGATOR button and click on it and you should see the following menu: The first word 'Navigator' is simply the title of this menu (don't click on it). The menu choices are now shown below this word, 'Navigator,' and you should begin scrolling down till you see the following: The menu button ROSACEA TOPICS is the second to the last choice. Click on ROSACEA TOPICS which brings you to the following screen: You may want to turn your mobile device horizontally to view the videos and subforums and scroll down to see all the choices: Now you can view the subforums but you are not allowed to enter a subforum without being a member of the RRDi. Membership requires a subscription and all you do register and then you can view over 7K posts and over 5.4K rosacea topics. Learn more. Hope this helps mobile device users on how to navigate our website. If you have questions, find the reply to this topic button and ask.

Melaleuca alternifolia image courtesy of Wikimedia Commons There are a number of anecdotal reports of using Tea Tree oil (TTO) for rosacea, usually diluted at least 50/50 with some other oil, i.e., rose hip oil, most of these reports found at the Rosacea Forum. There are numerous over the counter treatments for acne containing TTO. [1] There are anecdotal reports that adding Tea Tree oil to baby shampoo has been used as a cleanser. [2] There are a few clinical papers on using Tea Tree oil for medical uses showing it has antimicrobial and anti-inflammatory properties. [3] "Australian tea tree oil (TTO) and its extract terpinen-4-ol (T4O) are found to be effective in moderating demodex-related diseases. Their possible effects are lowering the mite counts, relieving the demodex-related symptoms and modulating the immune system especially the inflammatory response." [4] TTO may cause an allergic reaction and may be too harsh for rosacea sensitive skin so be sure to dilute it. "The survival times of the six different TTO groups confirmed a dose-related pattern, all of which had survival times shorter than the negative control (immersion oil). TTO 25% had comparable efficacy to the positive control agent (permethrin 5%)." [5] • Tea Tree Oil and Baby Shampoo • End Notes [1] Int J Antimicrob Agents. 2015 Feb;45(2):106-10 Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action K A Hammer [2] Tea Tree Oil and Baby Shampoo [3] Clin Microbiol Rev. 2006 Jan; 19(1): 50–62. Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties C. F. Carson, K. A. Hammer, and T. V. Riley [4] Parasitology. 2018 Oct;145(12) Can the tea tree oil (Australian native plant: Melaleuca alternifolia Cheel) be an alternative treatment for human demodicosis on skin? Nelson Siu Kei Lam, Xin Xin Long, Robert C Griffin, Mu-Kai Chen, James Cg Doery [5] The comparative in vitro killing activity of tea tree oil versus permethrin on Demodex folliculorum of rosacea patients

Just to clarify, when a member doesn't post for 30 days, the active member is then is manually switched to the inactive member group. When an inactive member logs in they are given the opportunity to subscribe. However, anyone who subscribes and continues to donate each month does not have to be active or post as long as the subscription is active.