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Went to my new dermatologist, Julie Harper, MD, Dermatology and Skin Care Center of Birmingham for the first visit. Dr. Harper is last year's past president of the AARS. The screenshot below shows she is still president today! Dr. Harper insists she is the past president. So I gave her a list of what I have been using to treat whatever is on the back of my scalp here: Over the counter Equate Anti-Dandruff Therapeutic Shampoo (T Gel) Baby Shampoo Nizoral (ketoconazole 1%) Braunfels Labs Sulfur Butter Cream 'n Ointment Zhongzhou Cream Sesderma Sebovalis Facial Gel (key ingredients 8% lithium gluconate - 0.5% Piroctone olamine - 4.5% glycolic acid - Calendula extract) Yesto tea tree scalp treatment Clotrimazole cream Aqua Vive Shampoo Prescription Doxycycline 100 mg twice a day for twenty days Fluocinolone Acetonide Topical Oil She examined my face and asked some questions about different spots that I had scratched, examined the back of my scalp and said I had folliculitis, which is what my primary nurse practitioner diagnosed as well. I asked her about that and she said that I probably have SD, rosacea and folliculitis and that they may all be related to each other. She advised me to stop using everything and prescribed AZELAIC ACID 15% GEL 50GM and Finacea 15% (Azelaic Acid) for my face, oral doxycycline 20 mg twice a day for my face and scalp, a sample of amzeeq (minocycline) topical foam 4% for my scalp, samples of Free and Clear Shampoo for my hair, and samples of LaRoche-Posay Anthelios Clear Skin Dry Touch Sunscreen which she told me to use when in the sun. I am scheduled for a followup visit on September 30. Saw Dr. Harper for fifteen minutes and asked her about listing her name on the RRDi MAC. She said she would look into it. I will follow her Rx treatments and recommendations and see what happens. Update August 20. My insurance won't cover the Finacea and requires I pay for this out of pocket. One Rx is for AZELAIC ACID 15% GEL 50GM which costs over $300 and another Rx for FINACEA 15% AER FOAM which costs over $400. Needless to say, I cancelled those two Rx(s). The generic doxycycline was approved and is being shipped to me through the mail. I called Dr. Harper's office and explained what happened (left a voice mail, of course). My insurance company says if the doctor fills out a certain form and goes through some hoops they can cover some of the amount of the two I just cancelled. I need to know what my out of pocket costs are for either one of them before I approve either one. I wondered why we don't hear more about Azeliac Acid and Finacea and now I know why. Who can afford it? I know there are ways to approach the pharmaceutical company and get discounts but when I tried to approach Galderma with a discount for Soolantra I was told my insurance (Medicare) doesn't allow me to participate in this program. Going through all the hoops to get a discount is not for the faint of heart and they make this very difficult to get these brand name prescriptions available to those who cannot afford it. So I went through the hoops to get the savings card discount for Finacea and after filling out the form was told I don't qualify since I am on Medicare. Figure that one? Update August 22 After going through some hoops I got the generic version of the azeliac gel for $47 initially through GoodRx but ended up using Geesons Pharmacy since my dermatologist sent the Rx to Geesons. Today my insurance company approved giving both the gel and foam after my dermatologist went through some hoops to explain why I needed azeliac acid rather than metronidazole and the Finacea Foam costs me $57. Both are being mailed to me and should arrive Monday. Turns out my insurance company who also provides a mail order pharmacy service (Humana) offers the generic gel for $39. So if I had just been patient I could have saved $8. Opps. I just noticed there is an over the counter The Ordinary Azelaic Acid Suspension in the RRDi affiliate store or Paula's Choice 10% Azelaic Acid Booster or Lyfetrition Azelaic Acid Serum or Strata Dermatalogics Melazepam Cream (all these treatments have the key ingredient azeliac acid). Got the 20 mg tabs of doxycycline today! Took the first one! (0 reviews)

amzeeq (minocycline) topical foam, 4% is for acne which has been FDA approved and is available and Zilxi 1.5% for rosacea available.

Apurva, I have been having scalp issues toward the back of my neck and sides of the scalp and have used the following treatments: Over the counter Equate Anti-Dandruff Therapeutic Shampoo (T Gel) Baby Shampoo Cotrimazole cream Nizoral (ketoconazole 1%) shampoo Braunfels Labs Sulfur Butter Cream 'n Ointment Zhongzhou Cream Sesderma Sebovalis Facial Gel (key ingredients 8% lithium gluconate - 0.5% Piroctone olamine - 4.5% glycolic acid - Calendula extract) Yesto tea tree scalp treatment Aqua Vive Prescription Doxycycline 100 mg twice a day for twenty days Fluocinolone Acetonide Topical Oil So far nothing has resolved the issue. On Wednesday I will be seeing a new dermatologist and hopefully will get her recommendation on this issue. Update on this dated January 16, 2021: I used Azelaic Acid on this issue which seems to help, then I tried putting a tablespoon of Tea Tree Oil into about six ounces of Baby Shampoo and used this up and sometimes putting full strength Tea Tree Oil on some of the itchy spots on my scalp and this seems to be working better than anything. I will be continuing the tea tree oil with baby shampoo treatment for a while.

An article published by the Vice Media Group written by Carly Minsky, Scientists Have Shown There's No 'Butterfly Effect' in the Quantum World, in discussing quantum computers had this to say about the butterfly effect: "New research in quantum physics from Los Alamos National Laboratory has shown that the so-called butterfly effect can be overcome in the quantum realm in order to “unscramble” lost information by essentially reversing time." "What this means is that a quantum system can effectively heal and even recover information that was scrambled in the past, without the chaos of the butterfly effect."

Because of spammers, we still approve each post before it goes live on our website, since guests still have to follow the RRDi rules when posting in the feedback forum of our website. To post in the community support of our website (the one you are currently in) you will have to register an account or in any other part of our website, for example, the major forums of rosacea topics, since this is one of the benefits of being a RRDi member (all that is required besides following the rules is to register your email address). Would anyone care to post why you don't want to register an account and post your comment on our website? We get lots of traffic, but hardly any posts from guests or members. We would appreciate your comment.

As Miracle Max said, it would take a miracle! We can only hope that rosaceans would come together into one group and accomplish this. Donate

Quantification for Demodex Density Counts What are the numbers revealing? In normal humans demodex density is reported to be "1 or 2 per square centimetre of skin". In rosacea sufferers with demodectic rosacea "the number rises to 10 to 20." [1] Methods and Tools Used to Quantify There are a number of methods or tools used to quantify demodex density counts. We will continue to update this page as we learn more. Cellophane Tape Method, Scraping, Plucking Eyelash and Eyebrow Hair "Methods used to collect Demodex mites from humans include biopsy, the cellophane tape method (placing tape on the face to stick to the mites), scraping areas where mites are likely to reside, and plucking eyelash and eyebrow hairs." [2] Confocal Laser Scanning Microscope (CLSM) A paper published by the British Journal of Dermatology reports, "With the help of CLSM it is possible to non-invasively detect, image and quantify Demodex mites in facial skin of patients with rosacea." [3] The Confocal Laser Scanning Microscope [CLSM] hopefully will be in every dermatologist's office so that we can get some data on how may sufferers have demodectic rosacea. [4] Another paper discusses the Confocal LS Microscope and stated, "there are limitations to the use of this method to accurately detect absolute numbers of mites in human skin." [5] According to a Russian study, the CLSM in vivo method is the best method of quantifying demodex density counts which needs to be validated by comparing the other tools used. Reflectance confocal microscopy (RCM) An article in 2014 says, "Reflectance confocal microscopy is a fast, direct and noninvasive method for Demodex-associated diseases and it is superior to SSSB for Demodex mite detection." [6] "Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM." [16] Cellophane Tape Method (CTP, Squeezing Method, Skin Scrapings, and the Standardized Skin Surface Biopsy (SSSB) "To collect mites for further research, the cellophane tape method (CTP), squeezing method, or skin scrapings can be used. CTP seems to be more effective with a positive rate at 91%, whereas squeezing gives a 34% positive diagnosis. Standardized Skin Surface Biopsy (SSSB) is the most commonly used method for comparing densities of mites between patients with dermatoses and healthy controls." [7] SNS [superficial needle-scraping] Direct Microscopic Examination (DME) & SSSB Compound Microscope image courtesy of Wikimedia Commons "Standardized skin surface biopsy (SSSB) and direct microscopic examination (DME) are commonly used to determine Demodex mites density (Dd)." [8] Another paper in Thailand states that SSSB has been 'considered to be the gold standard technique' but after careful investigation that the Skin Scraping technique is just as valid. [9] Microscope (simple) Potassium Hydroxide (KOH) "Potassium hydroxide (KOH) preparation of skin scrapings is a much simpler procedure that can be used to detect pathogens in the superficial skin...Potassium hydroxide preparation of skin scrapings is an effective, time saving and practical technique to detect Demodex mites with accuracy comparable to the standard biopsy method." [9] SLI [scattered light intensity] SSSB with DME Better Than CLSM? According to one report, if you use a skin scraping with a light microscope, no, which says, "The severity of the condition does not depend on the quantitative load of the mites in the scrape." However when using a 'Confocal laser scanning in vivo microscopy', yes, which this same report concludes, "Confocal laser scanning in vivo microscopy is an effective diagnostic method to detect Demodex mites that does not require preliminary preparation for analysis and allows detecting Demodex mites at the level of the spiky epidermis layer, which is not accessible for scarification, to identify the species belonging to the size of Demodex mites (from 100 up to 200 μm - Demodex brevis, 200 to 400 μm – Demodex folliculorum)." [10] SSSB [standardized skin surface biopsy] DERMOSCOPY The advantage of dermoscopy can be shown in a report by Friedman et al which states,"Our case is an example of how dermoscopy could have helped in demodicidosis recognition, since the patient was incorrectly treated with topical steroids possibly with the diagnosis of seborrheic dermatitis. However, when we evaluated the patient, dermoscopy did not reveal what would be expected for seborrheic dermatitis (dotted vessels in a patchy distribution and fine yellowish scales), but revealed, instead, features associated with demodicidosis (“Demodex tails” and “Demodex follicular openings”). [11] "In 54 patients, the dermoscopy examination yielded a specific picture consisting of Demodex "tails" and Demodex follicular openings. In patients with an inflammatory variant of demodicidosis, reticular horizontal dilated blood vessels were also visualized. Microscopically, skin scrapings demonstrated Demodex in 52 patients. Overall, the dermoscopy findings showed excellent agreement with the microscopy findings (kappa value 0.86, 95% CI 0.72–0.99, P < 0.001)." Dermoscopy of demodicidosis shows the so-called "Demodex tails", which are visualised as creamy/whitish gelatinous threads protruding out of follicular openings (black arrow), and “Demodex follicular openings”, which appear as round and coarse follicular openings containing light brown/greyish plugs surrounded by an erythematous halo (black arrowhead) (f). See Fig 4, Item f [12] A paper by Karabay et al shows photos of using SSSB. [13] "Besides diagnostic purposes, dermoscopic assessment in erythro-telangiectatic rosacea may also be helpful in monitoring post-treatment changes (with reduction of vascular and non-vascular findings, especially when treated with lasers) and predicting therapeutic response to topical treatments [32]. Indeed, according to a preliminary analysis on 20 patients suffering from erythro-telangiectatic rosacea, the presence of protruding follicular plugs is associated with a better response to an 8-week course of ivermectin 10 mg/g cream compared to metronidazole 1% gel used for the same time span (personal observations). This would be due to the possible active effect of the former therapy on Demodex folliculorum as there is a correlation between protruding follicular plugs on dermoscopy and a higher mite density that may be seen in rosacea (typically less than 5 mites/cm2)." [15] "Papulopustular rosacea has specific dermoscopic findings. In our opinion, dermoscopy is not the best method for the diagnosis of Demodex mites proliferation in rosacea." [17] "A thorough knowledge of entodermoscopy will empower dermatologists to promptly, non-invasively, and confidently diagnose and manage cutaneous infections and infestations, both as a lone modality, as well as in facilitating patient approval for an invasive diagnostic test, if required." [18] "As dermoscopy is a fast, inexpensive, and noninvasive method, it can be used for the diagnosis and monitoring of inflammatory dermatoses (such as rosacea)." [19] Dermatoscopy Fluorescence-advanced videodermatoscopy What is Dermatoscopy? "Improvements with dermatoscope attachments to mobile devices enable dermatoscopic images to be easily uploaded into patients’ medical records. Dermatoscopes will continue to become smaller. Hopefully, image uploading capabilities will become integrated into these devices. Eventually, dermatoscopes will utilize MBL algorithms to offer diagnostic suggestions." [14] Do It Yourself (DIY) Supereyes Macro Lens-Disposable Dermatoscope Supereyes Smartphone Microscope Camera Adapter Thumbnail-squeezing method Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Demodex Density Count - What are the Numbers? [2] Plos | OneUbiquity and Diversity of Human-Associated Demodex MitesMegan S. Thoemmes , Daniel J. Fergus, Julie Urban, Michelle Trautwein, Robert R. Dunn [3] Br J Dermatol. 2012 Jun 20. doi: 10.1111/j.1365-2133.2012.11096.x. Non-invasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy.Sattler EC, Maier T, Hoffmann VS, Hegyi J, Ruzicka T, Berking C. [4] Counting Demodex Mites with a Confocal Laser MicroscopeDavid Pascoe, Rosacea Support Group [5] Br J Dermatol. 2013 Feb 16. doi: 10.1111/bjd.12280. Demodex quantification methods: Limitations of Confocal Laser Scanning Microscopy (CLSM). Lacey N, Forton FM, Powell FC. [6] Skin Res Technol. 2014 Feb 13.Reflectance confocal microscopy vs. standardized skin surface biopsy for measuring the density of Demodex mites.Turgut Erdemir A, Gurel MS, Koku Aksu AE, Bilgin Karahalli F, Incel P, Kutlu Haytoğlu NS, Falay T. [7] Iran J Parasitol. 2017 Jan-Mar; 12(1): 12–21. PMCID: PMC5522688Human Permanent Ectoparasites; Recent Advances on Biology and Clinical Significance of Demodex Mites: Narrative Review ArticleDorota LITWIN, WenChieh CHEN, Ewa DZIKA, and Joanna KORYCIŃSKA [8] Ann Dermatol. 2017 Apr; 29(2): 137–142.Demodex Mite Density Determinations by Standardized Skin Surface Biopsy and Direct Microscopic Examination and Their Relations with Clinical Types and Distribution PatternsChul Hyun Yun, Jeong Hwan Yun, Jin Ok Baek, Joo Young Roh, and Jong Rok Lee [9] Indian J Dermatol Venereol Leprol [View Image] Skin scrapings versus standardized skin surface biopsy to detect Demodex mites in patients with facial erythema of uncertain cause – a comparative study Sumanas Bunyaratavej, Chuda Rujitharanawong, Pranee Kasemsarn, Waranya Boonchai, Chanai Muanprasert, Lalita Matthapan, Charussi Leeyaphan [10] Dermatol Reports. 2019 Jan 23; 11(1): 7675.Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mitesAlexey Kubanov, Yuliya Gallyamova, and Anzhela Kravchenko [11] Dermatol Pract Concept. 2017 Jan; 7(1): 35–38.Usefulness of dermoscopy in the diagnosis and monitoring treatment of demodicidosisPaula Friedman, Emilia Cohen Sabban, and Horacio Cabo [12] Int J Dermatol. 2010 Sep;49(9):1018-23.Dermoscopy as a diagnostic tool in demodicidosis.Segal R, Mimouni D, Feuerman H, Pagovitz O, David M. [13] An Bras Dermatol. 2020 Mar-Apr; 95(2): 187–193.Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitisEzgi Aktaş Karabay and Aslı Aksu Çerman [14] J Am Acad Dermatol. 2019 Apr; 80(4): 1121–1131. Emerging imaging technologies in dermatologyPart II: Applications and limitations Samantha L. Schneider, MD, Indermeet Kohli, PhD, Iltefat H. Hamzavi, MD, M. Laurin Council, MD, Anthony M. Rossi, MD, and David M. Ozog, MD [15] Dermatol Ther (Heidelb). 2020 Oct 08;: Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview. Errichetti E [16] Br J Dermatol. 2015 Jul;173(1):69-75. doi: 10.1111/bjd.13783. Epub 2015 May 29.Reflectance confocal microscopy for monitoring the density of Demodex mites in patients with rosacea before and after treatmentEC Sattler, VS Hoffmann, T Ruzicka, TV Braunmühl, C Berking [17] Dermoscopy of papulopustular rosacea and comparison of dermoscopic features in patients with or without concomitant Demodex folliculorum [18] Indian Dermatol Online J. 2021 Mar-Apr; 12(2): 220–236. Entodermoscopy Update: A Contemporary Review on Dermoscopy of Cutaneous Infections and Infestations Sidharth Sonthalia, Mahima Agrawal, Jushya Bhatia, Md Zeeshan, Solwan Elsamanoudy, Pankaj Tiwary, Yasmeen Jabeen Bhat, Abhijeet Jha, and Manal Bosseila [19] Indian J Dermatol. 2021 Mar-Apr; 66(2): 165–168. Dermoscopic Findings of Rosacea and Demodicosis Yesim Akpinar Kara and Hatice Kaya Özden1

Soolantra prices may vary but a 45 gram tube costs approximately $12.91/gram if you don't have insurance to cover it. Check with your insurance provider for your actual cost. The price below is a screen shot from GoodRx.

Differential Diagnosis from Rosacea? An article published in the Chinese Medical Journal states that Sensitive Skin (SS) should be a differential diagnosis from Rosacea, concluding, “The pathogenesis, medication, and prognosis of rosacea and SS are quite different, so it is necessary to find reliable non-invasive method to differentiate between the two conditions.” [1] However, another paper states the following: "Cosmetics were the most frequent source of sensitization, followed by topical medications-notably corticosteroids and antifungal agents." [13] Are you aware there is such a thin line between sensitive skin and rosacea? Skin Condition or Syndrome? "A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder." Wikipedia "Sensitive skin is a skin condition in which skin is prone to itching and irritation experienced as a subjective sensation when using cosmetics and toiletries. When questioned, over 50% of women in the UK and US, and 38% of men, report that they have sensitive skin." [2] "Using the Delphi method, sensitive skin was defined as 'A syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. These unpleasant sensations cannot be explained by lesions attributable to any skin disease. The skin can appear normal or be accompanied by erythema. Sensitive skin can affect all body locations, especially the face'." [3]. Some authorities propose listing SS as a syndrome, stating, "Moreover, the presence of erythema in patients with sensitive skin does not imply that the erythema is due to sensitive skin, as sensitive skin is sometimes associated with skin diseases, particularly atopic dermatitis (AD). AD is not the only dermatosis that can be associated with sensitive skin; in fact, some authors propose to define a subcategory of sensitive skin associated with dermatological diseases (for example: AD, rosacea, psoriasis, seborrhoeic dermatitis, acne, etc.)." [3] "SS is defined as a syndrome defined by the appearance of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that would not normally cause such sensations..." [4] "Sensitive skin syndrome (SSS) is a common and challenging condition, yet little is known about its underlying pathophysiology. Patients with SSS often present with subjective complaints of severe facial irritation, burning, and/or stinging after application of cosmetic products. These complaints are out of proportion to the objective clinical findings. Defined as a self-diagnosed condition lacking any specific objective findings, SSS is by definition difficult to quantify and, therefore, the scientific community has yet to identify an acceptable objective screening test...Defined as a self-diagnosed condition, SSS is by definition difficult to quantify. Some of the contradictions between investigators could be explained by flawed methodologies since the scientific community has yet to identify an acceptable objective screening test for sensitive skin...SSS is very common and poses a challenge to physicians and patients alike. We are still far from understanding the underlying mechanisms involved. Therefore, more basic science research is warranted. " [5] Sensitive Skin vs Rosacea It is common for rosaceans to complain of sensitive skin and the line between sensitive skin and rosacea is very thin. Do you want the RRDi to sponsor some investigative clinical research into sensitive skin and rosacea? Could 10K members of the RRDi each donate one dollar to sponsor such research? "A still unanswered question is whether improper formulations could also prove to be counterproductive in other types of sensitive skin, such as rosacea." Tests for Sensitive Skin Lactic acid sting test (LAST) [11] Treatment "A bakuchiol nature-based anti-aging moisturizer is well tolerated and effective in individuals with sensitive skin." [6] Differin Detox + Soothe 2Step Face Mask [10] Eau Thermale Avene Hypersensitive Skin Regimen Kit for Sensitive and Irritated Skin [7] Eau Thermale Avene XeraCalm A.D Lipid-Replenishing Cream, Atopic Dermatitis, Eczema-Prone, Fragrance-Free, Pump [7] Eau Thermale Avène Cicalfate+ Restorative Protective Cream [7] Eau Thermale Avene Cicalfate Post- Procedure, Soothing Skin Recovery Lotion [7] Flushing Avoidance Treatments REN Clean Skincare - Evercalm Anti-Redness Serum [8] REN Clean Skincare - Evercalm Gentle Cleansing Milk [8] REN Clean Skincare Stop Being So Sensitive Evercalm Value 3-Piece Set [8] PCA SKIN Anti-Redness Serum [9] PCA SKIN ReBalance Face Cream [9] Rose Hip Oil Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Chin Med J (Engl). 2020 Aug 5. doi: 10.1097/CM9.0000000000001001. A predictive model for differential diagnosis between rosacea and sensitive skin: a cross-sectional study Xiao-Yan Wang, Yun-Yi Liu, Yi-Xuan Liu, Wei-Wei Ma, Jia-Wen Zhang, Zi-Jing Liu, Juan Liu, Bing-Rong Zhou, Yang Xu [2] Sensitive Skin, Wikipedia Allergic Dermatitis Image Courtesy of Wikimedia Commons [3] ActaDV Definition of Sensitive Skin: An Expert Position Paper from the Special Interest Group on Sensitive Skin of the International Forum for the Study of Itch Laurent Misery, Sonja Ständer, Jacek C. Szepietowski, Adam Reich, Joanna Wallengren, Andrea W. M. Evers, Kenji Takamori, Emilie Brenaut, Christelle Le Gal-Ianotto, Joachim Fluhr, Enzo Berardesca, Elke Weisshaar [4] Sensitive Skin and Rosacea [5] Indian J Dermatol. 2012 Nov-Dec; 57(6): 419–423.doi: 10.4103/0019-5154.103059 The Sensitive Skin Syndrome Hadar Lev-Tov and Howard I Maibach [6] J Drugs Dermatol. 2020 Dec 01;19(12):1181-1183 Clinical Evaluation of a Nature-Based Bakuchiol Anti-Aging Moisturizer for Sensitive Skin. Draelos ZD, Gunt H, Zeichner J, Levy S [7] [8] [9] [10] [11] Clin Cosmet Investig Dermatol. 2021; 14: 1215–1225. Questionnaire and Lactic Acid Sting Test Play Different Role on the Assessment of Sensitive Skin: A Cross-sectional Study Yao Pan, Xue Ma, Yanqing Song, Jinfeng Zhao, and Shiyu Yan [12] Optimizing Emollient Therapy for Skin Barrier Repair in Atopic Dermatiti [13] "We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications." Contact Allergy in Patients With Rosacea

This is odd to me that a 2020 article is discussing a 'Cross-sectional study of Finnish adults aged 70 to 93 as part of the Norther Finland Cohort 1966 Study.'' Why not examine adults the same age today?

In the spirit of posting 'everything rosacea' the RRDi is announcing this 'natural' treatment which the official website states, "Grahams Natural Rosacea Cream is a natural formula which includes clinically tested ingredients to reduce redness. Designed to reduce inflammation and soothe sensitive skin, our rosacea cream will hydrate and calm the skin." It is made in Australia and here are the ingredients: Water Purified, Medium-chain Triglycerides, Cetostearyl Alcohol, Simmondsia chinensis (Jojoba) Seed Oil, Coconut Oil, Macrogol Cetostearyl Ether / Polyoxyl 20 Cetostearyl Ether, Tocopherol, Gluconolactone, Niacinamide, Taurine, Phenoxyethanol, Glyceryl Monocaprylate, Ethyl Ascorbic Acid, Retinyl Palmitate, Lactic Acid. If you have used this treatment please find the green reply button and post your experience.

"We compiled a comprehensive list of candidate medicinal herbs for skincare by analyzing terms employed in the Donguibogam and identified the characteristics of 52 such herbs using SRKs. Each herb exhibited a different skincare function. Our findings will guide the development of new skincare products via experimental and clinical studies....Further in-depth experimental studies are needed, though our work reduces the time required for future experimentation and product development. Our results enhance the understanding of the previously unknown characteristics of medicinal herbs used for skincare and facilitate the discovering additional novel herbs." [1] The Dongui Bogam (동의보감) is a Korean book compiled by the royal physician, Heo Jun (1539 – 1615) and was first published in 1613 during the Joseon Dynasty of Korea. The title literally means “a priceless book about medicines of an Eastern Country”. [2] Wouldn't it be novel of a grassroots rosacea non profit organization to sponsor clinical studies on this? What if 10K members of the RRDi each donated one dollar and sponsored these kind of studies into medicinal herbs for skincare? Why not donate a dollar now to start the process? End Notes [1] Integr Med Res. 2020 Dec; 9(4): 100436. Identification of candidate medicinal herbs for skincare via data mining of the classic Donguibogam text on Korean medicine Gayoung Cho, Hyo-Min Park, Won-Mo Jung, Woong-Seok Cha, Donghun Lee, Younbyoung Chae [2] Dongui Bogam, Wikipedia image courtesy of Wikimedia Commons

The RRDi is sponsoring free rosacea blogs so you can have your own private or public blog. That way you can direct your friends to your own blog and discuss what you are doing to control your rosacea. These blogs are usually public but you may want your own private blog. If you want your own private rosacea blog here are the steps: PRIVATE BLOG The default blog is public so all you do is change it to private and only invite your friends to view your blog. (1) To setup your blog you first need to be a member of the RRDi by registering with just your email address. (2) Go to Blogs and look for the CREATE A BLOG button: (3) Look for the ONLY THE MEMBERS I CHOOSE CAN READ THIS BLOG radio button: Then click continue to setup your blog. If you need assistance, use the Invision Community help center or use the RRDi support center (only available for members of the RRDi). Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post.

I just had to post this since I just came up with it. The rosaceans come and go, talking about their rosacea woes, some of these reports glow, while others are lows, still others crow.

There are a number of co-existing conditions associated with rosacea that are not uncommon. Some are uncommon. Here is the list to consider: Acne Vulgaris Blepharitis Blepharokeratoconjunctivitis (BKC) Dry Skin (Xeroderma) Eczema Frontal fibrosing alopecia Hyperkeratosis Lupus Melasma Ocular Cicatricial Pemphigoid (OCP) Periorol Dermatitis Seborrheic Dermatitis Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post.

"Blepharokeratoconjunctivitis (BKC) is a chronic inflammatory disease of the lid margin with secondary conjunctival and corneal involvement..." "This is a retrospective review of 14 patients with the history of chronic red eyes with corneal involvement. All patients were diagnosed with ocular demodicosis based on the results of eyelash sampling. All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg)....Rosacea was present in only three patients." Indian J Ophthalmol. 2020 May; 68(5): 745–749. Demodex blepharokeratoconjunctivitis affecting young patients: A case series Nikunj Vinodbhai Patel, Umang Mathur, Arpan Gandhi, and Manisha Singh image courtesy of PMC Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

This a a FAQ.

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A case of Demodex-induced Lupus miliaris disseminatus faciei was treated with "ornidazole tablets (500 mg twice a day) and recombinant bovine basic fibroblast growth factor gel (0.2 g/cm twice a day) for an 8-week period" and the results showed "the facial erythematous papules were improved, and no new skin lesions were observed. The patient showed no signs of recurrence during the 6-month follow-up." Medicine (Baltimore). 2020 Jul 02;99(27):e21112 Demodex-induced Lupus miliaris disseminatus faciei: A case report. Luo Y, Wu LX, Zhang JH, Zhou N, Luan XL

AARS 2018 Form 990 Review Total Contributions from public support (99.25%) in the amount of $304,583.Total Expenses were $207,657.At the end of the 2016 the AARS reports 'net assets or fund balances' totaling $462,175. The AARS spent most of the expenses on 'conferences, meetings and conventions' in the amount of $148,728 for its prestigious members who are comprised mostly of dermatologists. The next largest expense was on 'management' in the amount of $48,000. The third largest expense was on its website which amounted to $4,473. In 2018 the AARS didn't spend any of its donations on research grants. Schedule B, page 2 reveals the top contributors: Galderma $50,000 L'oreal $35,000 Cutanea Life Sciences $15,000 Ortho Dermatologics $35,000 Bayer Healthcare $20,000 Allergan USA $35,000 Total $190,000 The six skin care industry corporations above contributed 62% of the total donations. You can read the Form 990 yourself: 2018_AARS Form 990 signed by JHarper 8.6.19.pdf You can read for yourself the mission of the AARS and what they did in 2018 in the screenshot below of Form 990 Part III:

image courtesy of Nutrients A report concluded, "Overall, probiotics and prebiotics are promising in protecting the skin against UVR-induced skin damage." Nutrients. 2020 Jun; 12(6): 1795. Published online 2020 Jun 17. doi: 10.3390/nu12061795 PMCID: PMC7353315 PMID: 32560310 Potential of Skin Microbiome, Pro- and/or Pre-Biotics to Affect Local Cutaneous Responses to UV Exposure VijayKumar Patra,1,2 Irène Gallais Sérézal,3,4 and Peter Wolf2,*

UPDATE "Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19." Annals of Internal Medicine, 16 Jul 2020 Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 A Randomized Trial Caleb P. Skipper, MD et al "Hydroxychloroquine did not lead to faster symptom improvement among patients who had Covid-19 symptoms and were not hospitalized, according to a new study published Thursday in the Annals of Internal Medicine." New Covid-19 study, despite flaws, adds to case against hydroxychloroquine By MATTHEW HERPER, STAT "Hydroxychloroquine does not appear to keep people from getting the disease after they’ve been exposed to someone who has it. It does not change how many people hospitalized with Covid-19 die of the disease. It does not reduce symptoms for people with milder cases who aren’t in the hospital." Hydroxychloroquine Still Doesn’t Do Anything, New Data Shows, Wired "The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized." Hydroxychloroquine studies show drug is not effective for early treatment of mild covid-19 Laurie McGinley, The Washington Post, MSN

3D medical animation still of Cytokines that are important in cell signaling. Image courtesy of Wikimedia Commons While more rosacea research has been focused since 2007 on Cathelicidin, another cytokine is emerging as a possible link to rosacea, interleukin 17A (IL17A), with a report of using a biologic treatment for rosacea, secukinumab. [1] For several years the cytokine, cathlecidin, has been considered linked to rosacea because it is found in high levels with rosacea patients. [2] The following animated video explains how this works in treatment for psoriasis (using secukinumab) which is now being used to treat rosacea: Cytokines "Cytokines are a broad and loose category of small proteins (~5–20 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrine, paracrine and endocrine signaling as immunomodulating agents." [3] "Their definite distinction from hormones is still part of ongoing research." [3] Therefore, cytokines are important in health and in disease prevention and when working properly everything is fine. However, just like the hormone insulin, when in proper amount secreted it works like a charm. If you are too low on insulin or too high things get a bit tricky when it comes to health. The same is true with cytokines. Cytokines in the right amount, everything is hunky dory, but when too many are present it can create quite a storm, or if not enough, things can get worse. The theory is that cytokines need to be investigated more in what role they play in rosacea inflammation. "At the heart of the inflammatory response are the mechanisms that stimulate the production of inflammatory mediators and cytokines." [16] A Cytokine storm is associated with Covid 19 deaths as well as with the 1918 Spanish Flu epidemic. One research paper "provided a comprehensive and objective analysis of the main studies on the influence of cytokines in ocular inflammatory diseases." [22] Cytokines and the Rosacea Immune System Disorder Theory Cytokines are related to the theory that rosacea is an immune system disorder. [4] Mast cells have important effects on the pathogenesis of rosacea and produce cytokines. Both interleukin 17A and cathlecidin are cytokines that are related to inflammation in disease. What is interesting is that "Cytokines also play a role in anti-inflammatory pathways and are a possible therapeutic treatment for pathological pain from inflammation or peripheral nerve injury. There are both pro-inflammatory and anti-inflammatory cytokines that regulate this pathway." [3] The first cytokine discovered was Interferon-alpha, an interferon type I, identified in 1957 as a protein that interfered with viral replication. [5] Could it be possible that the cytokine response in rosacea sufferers is somehow related to virus? [7] For over sixty years the focus has been on bacteria or demodex. Could it be that the investigation should focus more on virus as the culprit why the cytokines are reacting? Virus are so tiny that the bacteria or demodex may carry a pathogen virus that is triggering the cytokine response. Has anyone even looked into this? Have you seen any paper that has ruled out virus in rosacea? "Cathelicidin antimicrobial peptides (CAMP) LL-37 and FALL-39 are polypeptides...serve a critical role in mammalian innate immune defense against invasive bacterial infection..." [2] "These peptides are potent, broad spectrum antibiotics which demonstrate potential as novel therapeutic agents. Antimicrobial peptides have been demonstrated to kill Gram negative and Gram positive bacteria, enveloped viruses, fungi and even transformed or cancerous cells." [10] Dr. Gallo, et al, has applied for a patent, PREVENTION OF ROSACEA INFLAMMATION, United States Patent Application 20160030386, related to this. [11] "Toll-like receptor 2 (TLR2) and TLR4 signaling may induce differential secretion of T helper 1 (Th1) and Th2 cytokines, potentially influencing the development of autoimmune or atopic diseases....TLR proteins mediate cellular activation, including the expression of cytokines induced by a variety of bacterial products..." [14] IL-17 Interleukin 17A is an inflammatory cytokine. "Inflammatory cytokines are predominantly produced by and involved in the upregulation of inflammatory reactions. Excessive chronic production of inflammatory cytokines contribute to inflammatory diseases, that have been linked to different diseases...A balance between proinflammatory and anti-inflammatory cytokines is necessary to maintain health. Aging and exercise also play a role in the amount of inflammation from the release of proinflammatory cytokines." [9] "Our study showed increased serum IL-17 levels in rosacea patients and a significant correlation between IL-17 concentrations and secondary features of the disease suggesting IL-17 may contribute to pathogenesis of rosacea and may be a new target for rosacea treatment." [19] Other Cytokines and Rosacea "Additionally, we identified the upregulation of IL-5 and IL-13 in PPR conditioned culture medium. IL-5 and IL-13 are type 2 cytokines that play important roles in the pathophysiology of allergic diseases. Although the elevation of these cytokines in PPR has not been previously reported, PPR has been associated with airborne allergies (Rainer et al. 2015). A recent publication identified IL4l1 and IL4R as differentially expressed genes in PPR lesional tissue compared to NLS, suggesting the type 2 axis may play a role in PPR pathology (Shih et al. 2019)." [12] Without a doubt we will be learning more on further research with interleukin 17A (IL17A) and possible other cytokines that are involved in the inflammation of rosacea. "...adipokines may contribute to various aspects of the homeostasis of the skin, e.g., melanogenesis, hair growth, or wound healing, just as to the pathogenesis of dermatological diseases such as psoriasis, atopic dermatitis, acne, rosacea, and melanoma." [15] [bold added] Adipokines are cytokines. Bradykinin, another cytokine, has long been associated with rosacea. [17] "Besides, aspirin administration decreased the microvessels density and the VEGF expression in rosacea-like skin. We further demonstrated that aspirin inhibited the activation of NF-κB signaling and the release of its downstream pro-inflammatory cytokines." Pro-inflammatory cytokine CCL20 "stimulates inflammation by recruiting Th17 T-lymphocytes and dendritic cells and is elevated in papulopustular rosacea." [20] "Taken together, our findings revealed that mTORC1-mediated angiogenesis responding to LL37 might be essential for the development of rosacea and targeting angiogenesis might be a novel potential therapy." [21] "In this study, we aimed at examining the serum levels of a series of chemokines (including CCL2, CCL3, CCL20, CXCL1, CXCL8, CXCL9, CXCL10, and CXCL12) implicated in rosacea and their correlation with disease severity." [23] [24] "In conclusion, our results showed that the destruction of the skin barrier aggravates the inflammation levels and immune infiltration of rosacea partly by activating STAT3-mediated cytokine signal pathways in keratinocytes." [25] Treatment Magnesium decreases inflammatory cytokine production by modulation of the immune system. [8] Secukinumab (Cosentyx) [1] "Treatment of patients with isotretinoin significantly decreased monocyte TLR-2 expression and subsequent inflammatory cytokine response to P. acnes by one week of therapy. This effect was sustained six months following cessation of therapy, indicating that TLR-2 modulation may be involved in the durable therapeutic response to isotretinoin...Disorders characterized by inflammation such as acne, rosacea, psoriasis, psoriatic arthritis, and Behcet’s disease have been linked to dysregulation of innate immune signaling...Isotretinoin’s mechanism of action in inducing long-term remissions of acne is unknown....The mechanism by which retinoids affect TLR expression is unknown." [bold added] [13] Topical ivermectin has been found effective in the treatment of T‐cell‐mediated skin inflammatory diseases. [6] Independent Rosacea Research Could a group of rosacea sufferers in a non profit organization like the RRDi collectively get together and sponsor their own research on rosacea? For example, if 10K members each donated a dollar, could it be possible that this money could be used to sponsor their own independent rosacea research on cytokines? What do you think? If you want to do something about this read this post. Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Secukinumab (Cosentyx) [2] Cathelicidin [3] Cytokine, Wikipedia [4] Innate Immune Response Disorder [5] Proc R Soc Lond B Biol Sci. 1957 Sep 12;147(927):258-67. doi: 10.1098/rspb.1957.0048. Virus interference. I. The interferon A ISAACS, J LINDENMANN [6] Ivermectin Anti-Inflammatory Properties [7] Virus and Rosacea [8] J Immunol. 2012 Jun 15;188(12):6338-46. doi: 10.4049/jimmunol.1101765. Epub 2012 May 18. Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism Jun Sugimoto, Andrea M Romani, Alice M Valentin-Torres, Angel A Luciano, Christina M Ramirez Kitchen, Nicholas Funderburg, Sam Mesiano, Helene B Bernstein J Inflamm Res. 2018 Jan 18;11:25-34. doi: 10.2147/JIR.S136742. eCollection 2018. Magnesium deficiency and increased inflammation: current perspectives Forrest H Nielsen [9] Inflammatory cytokine, Wikipedia [10] Antimicrobial peptides (AMPs), Wikipedia [11] Gallo Patent for the 'Prevention of Rosacea Inflammation' [12] J Invest Dermatol. 2020 Sep 14;: Paired Transcriptomic and Proteomic Analysis Implicates IL-1β in the Pathogenesis of Papulopustular Rosacea Explants. Harden JL, Shih YH, Xu J, Li R, Rajendran D, Hofland H, Chang ALS [13] J Invest Dermatol. 2012 Sep; 132(9): 2198–2205. Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients Melanie C. Dispenza, Ellen B. Wolpert, Kathryn L. Gilliland, Pingqi Dai, Zhaoyuan Cong, Amanda M. Nelson, Diane M. Thiboutot [14] J Interferon Cytokine Res. Author manuscript; available in PMC 2007 Nov 2. TLR2 and TLR4 Stimulation Differentially Induce Cytokine Secretion in Human Neonatal, Adult, and Murine Mononuclear Cells BIANCA SCHAUB, ABDELOUAHAB BELLOU, FIONA K. GIBBONS, GERMAN VELASCO, MONICA CAMPO, HONGZHEN HE, YURONG LIANG, MATTHEW W. GILLMAN, DIANE GOLD, SCOTT T. WEISS, DAVID L. PERKINS, and PATRICIA W. FINN1 [15] Int J Mol Sci. 2020 Nov 28;21(23): Adipokines in the Skin and in Dermatological Diseases. Kovács D, Fazekas F, Oláh A, Törőcsik D [16] Int J Mol Sci. 2021 Jan; 22(2): 721. The Role of Endogenous Antimicrobial Peptides in Modulating Innate Immunity of the Ocular Surface in Dry Eye Diseases Youssof Eshac, Rachel L. Redfern, and Vinay Kumar Aakalu [17] Bradykinin Rosacea Theory [18] Aspirin alleviates skin inflammation and angiogenesis in rosacea [19] Serum IL-17 levels in Patients with Rosacea [20] Glucocorticoids Promote CCL20 Expression in Keratinocytes [21] PubMed RSS Feed - -mTORC1-Mediated Angiogenesis is Required for the Development of Rosacea [22] J Clin Med. 2022 Feb; 11(3): 661. Influence of Cytokines on Inflammatory Eye Diseases: A Citation Network Study Beatriz G. Gálvez, Clara Martinez-Perez, Cesar Villa-Collar, Cristina Alvarez-Peregrina, Miguel Ángel Sánchez-Tena [23] "Chemokines (from Ancient Greek χῠμείᾱ (khumeíā) 'alchemy', and κῑ́νησῐς (kī́nēsis) 'movement'), or chemotactic cytokines, are a family of small cytokines or signaling proteins secreted by cells that induce directional movement of leukocytes, as well as other cell types, including endothelial and epithelial cells." Wikipedia [24] Increased serum levels of CCL3, CXCL8, CXCL9, and CXCL10 in rosacea patients and their correlation with disease severity [25] PubMed RSS Feed - -Multi-Transcriptomic Analysis and Experimental Validation Implicate a Central Role of STAT3 in Skin Barrier Dysfunction Induced Aggravation of Rosacea

A rare condition involving SD is eyebrow hairloss. Sickening started an interesting thread on this subject if you are suffering from this disorder. A similar thread was started by angelstar. Sometimes it can be confused with Frontal Fibrosis Alopecia.

Just wanted to update what I have been using for about three weeks. I purchased Sesderma Sebovalis Facial Gel (key ingredients 8% lithium gluconate - 0.5% Piroctone olamine - 4.5% glycolic acid - Calendula extract) from the company website since it is not available at Amazon. I learned about it from Yatzil at RF [post no 1] and have heard about Piroctone Olamine which is the ingredient in this gel that I think may improve SD. I have been having what I think is SD on the back of my scalp near my neck going up the scalp to near the top of my head. I have tried over the last eight to ten months, Sulfur Butter, Equate Coal Tar Shampoo, Yesto Tea Tree Scalp Treatment, Nizoral none of which worked. I tried borax and epsom salt baths. Then I went to a nurse practitioner who initially examined me and took a sample of my scalp and sent it to the lab diagnosing me with folliculitis and handing me a prescription for doxycycline 100 mg twice a day for ten days. After a few days she phoned me and said I had Staphylococcus. After the ten days I noticed that my scalp issue was a lot 'dryer' but still had it. She gave me a second Rx for Doxycycline 100 mg twice a day for another ten days. Took that and basically still had the issue but it was dryer. Went back to the nurse practitioner and told her I think it is a fungus so she prescribed Fluocinolone Acetonide Topical Oil which I tried for a couple of weeks however, it did stop the itch, but didn't do anything to relieve the fungal issue. At the same time I received Tom Busby's AquaVive which I have been using for a month as well. What I have noticed is that whatever the issue is, my guess it is a fungus, is beginning to dry up whatever it is but it still lingers. I have stopped the Fluocinolone and am continuing the borax/epsom salt baths and AquaVive. I just received my second tube of Sesderma Sebovalis Facial Gel. I also still use the ZZ cream on facial red spots and try to follow my Rosacea Diet by reducing sugar/carbohydrate as much as possible but I confess, I cheat on occasion. My scalp issue is still present and it is dryer but I still have spots that itch like crazy and won't go away. Once in a while I put the Sulfur Butter or dab a bit of the Fluocinolone on an itchy spot when it drives me crazy. The Sesderma Sebovalis isn't working either. I recently tried a tube of clotrimazole cream for a few days and it didn't do anything. I am seeing a dermatologist in Birmingham on August 19 about this. Got an appointment with Dr. Julie Harper, in Birmingham in August. She happens to be the president of the AARS. Looking forward to seeing her and her insight into my back of the scalp issue. My rosacea has flared up a bit so I am using the ZZ cream on my face and forehead. I just tried some horse paste on the back of my scalp to see if ivermectin might eradicate my issue back there. I am still using Tom Busby's shampoo. I am not too impressed with the Sebovalis Facial Gel. It didn't address the back of my scalp issue. I still have it, and have backed off using the Sebovalis.