Guide

The RRDi has been around for quite a while and we publish on our website for free what rosacea sufferers all over the world have said works to control their rosacea. A significant number of rosaceans say this simple method to control rosacea using this two step regimen does indeed work which is non prescription. We have added a third step for those of you considering using prescription treatment from a dermatologist. Will it work for you? The only way to know is to try it. There is no rosacea treatment regimen that works for every rosacea sufferer, not one. We have dubbed this the Rosacea X-Factor. However, this is what we recommend you try and we hope you will reply in this thread your results. (1) Diet First, keep in mind this recommendation is only for thirty days. After the thirty days, go back to eating whatever you want. What you are probably eating is mostly carbohydrate since the typical American diet is high carbohydrate. Carbohydrate is simply different forms of sugar. There are absolutely no nutrients in carbohydrate, none. Carbohydrate is simply carbon, hydrogen and oxygen (absolutely no vitamins, minerals, or any nutrients). Sugar is the fire that inflames rosacea. For example, oats, brown rice, fruit, sweet potato have significant carbohydrate. It is extremely difficult to cut out all carbohydrate. But if you can reduce your carbohydrate to no more than 30 grams a day for 30 days to see if this improves your rosacea, then you will know. What will you learn? Sugar/carbohydrate is a rosacea trigger. If you do see improvement within the thirty days, at the end of the thirty days go back to your oats, brown rice, fruit, sweet potato or whatever you are eating and see what happens. This simple diet just for thirty days will either work or it won't in improving your rosacea. Please read a list of anecdotal reports that this actually works. To help you understand how to figure out how many grams of carbohydrate you may be eating, just take a bowl of oats which contains 27 grams of carbohydrate in a half a cup. So if you decide to eat that half a cup of oats, you now only have 3 grams of carbohydrate to your 30 gram limit for the day. The only way you can do this is stick to broccoli since one cup (91 grams) of raw broccoli contains 6 grams of carbs. Kale is ok too, since one cup (67 grams) of raw kale contains 7 grams of carbs. You can have a lot of broccoli and kale in your day and still keep within the 30 gram limit. So anything that goes into your mouth that you digest, simply watch how many grams of carbohydrate and limit it to 30 grams a day. And watch how many carbohydrate is in anything you drink! Liquid or any food, 30 gram carbohydrate limit. Only for 30 days. 30 grams/30 days. Dr. Atkin's Carb Counter book helps you understand how to count carbs. So what do you eat? Protein and Fat, as much as you want, no limit. And remember, when someone or some authority says eating high protein/fat is bad, the reply is, 'this is just for thirty days.' Thirty days on a high protein/diet is not bad. No one can cite any clinical paper that eating high protein/fat for just thirty days is any health risk. Remember, just thirty days. No risk. And if you like meat, fish, and chicken it will be easier. If you are a vegan, it will be more difficult to find the protein/fat to eat but it can be done. The Rosacea Diet has a vegan 30 day diet. Remember, this is only for thirty days. At the end of the thirty days you can then eat whatever you want (sugar and carbohydrate), as much as you want and see what happens. Does your rosacea return when you eat high sugar/carbohydate? If so, you have learned something. Then you decide what to do about this. Not everyone chooses this course since it is so difficult. Why? Because sugar is addictive. Your choice. You obviously can keep eating whatever you want. This is just a recommendation, just like the following topical. (2) Topical As for a topical, recommend the ZZ cream. Before you use, be sure to apply a dab of the ZZ cream on your inner wrist and see if your skin turns red? If so, you are allergic to the ZZ cream. Remember that if you use the ZZ cream it gets worse before it gets better. It takes at least a month to see any improvement with the ZZ cream and three to four months for clearance. 'Getting worse before it gets better' is a common occurrence in medicine, not just in using the ZZ cream. (3) Rx Treatments Gold Prescription Standard Treatment for Rosacea More Information on Rx TreatmentsConclusion These two simple treatments may work to control your rosacea if you reduce your sugar/carbohydrate to 30 grams a day for 30 days and use the ZZ cream as a topical. Third, if you opt for Rx treatments, watch the above video so you will have some questions for your dermtologist when you visit. It will take at least 30 days to see improvement with step one, and 90 to 120 days for clearance in step two. If you opt for step three is usually takes two to three MONTHS for clearance. 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.

Hi Kara, Welcome to the RRDi. It would be good to know if your partner did get a diagnosis of rosacea (or what exactly) and what particular antibiotic and how much, whether low dose or high dose, I.e., how many milligrams per day? Is your partner applying any topical(s)? The laser mentioned in the article in this thread, pulsed dye, has been around for years. Coherent model 899 ring dye laser, with rhodamine 6G dye, pumped with a 514 nm argon laser. The laser is tuned somewhere around 580 nm. Photo taken by Han-Kwang at the AMOLF Institute in Amsterdam, Netherlands. P - image courtesy of Wikipedia Commons By the way, the article is an abstract made available through an RSS feed from PubMed published in Dermatologic Therapy. So this pulsed dye laser is usually in either a dermatology or cosmetic surgeon clinic and as you can imagine expensive. One treatment with an experienced practitioner as you can imagine is expensive, between $350 to $600 US Dollars and usually three or more treatments are required. Most insurance companies in the USA will cover such treatment if they are designated a medical diagnosis but usually such treatments are considered cosmetic and are not covered. I imagine the same conditions exist in the UK regarding whether insurance covers such laser treatments or not. You would have to ask. Most Rosaceans who rave about Laser treatment have to spend the money out of pocket. There are others who have negative experience with laser. By the way, some Rosaceans have now purchased their own light device, sometimes laser, others purchase LED or IPL devices since they are now available to the pubic. There is a learning curve using these devices and you can easily damage your skin so if you decide to go that route take care. Our store has some listed in broad band light. Using laser is just one of the many light devices under the treatment called photo dynamic therapy. The article in this thread used the pulsed dye laser along with intradermal botulinum toxin type-A, a particular botulinum used in cosmetics. This treatment is also expensive and the practitioner should have experience using it since you can imagine if you were his first patient you might feel uneasy. The article concludes this combination of treatment “demonstrated high efficacy and satisfaction rate with this combined approach and a low side-effect profile.” If it cost several thousand dollars, you would expect such results. Just remember that you sign off on a lot of waivers and notices that you are warned of the risks and side effects of laser and botulinum treatment. Dr. Braun performs Botox Injections on a client at Vancouver Laser & Skin Care Skin. Botox Injections temporarily reduces or eliminates frown lines, forehead creases, crow’s feet near the eyes and thick bands in the neck. By temporarily blocking the nerve impulses, the muscles that cause wrinkles relax, giving the skin a smoother, more refreshed appearance. - image courtesy of Wikimedia Commons There are clinical papers showing improvement in rosacea using Botox, I.e., Botox for Rosacea. Depending on what your partner is suffering with, recommend your partner read our welcome page or our newbies page. Some have found that simply reducing sugar/carbohydrate in the diet improves rosacea or whatever skin issue along with the topical ZZ cream.

To give you an idea of the prescription rosacea market you can view the number of prescriptions for the four leading rosacea prescription treatments shown below in two graphs the first one in surrogates, and the second one in market size as revealed in a Menlo Therapeutics investor presentation dated March 2020.

Before/after photos released by an investor presentation dated March 2020 .

"Dry Eye Disease (DED) is a common ocular condition that needs prompt diagnosis and careful treatment interventions....In this review, we demonstrated the mechanism of action of IPL, including its benefits on DED. The emerging evidence shows that the role of IPL in DED is novel and therapeutic. These results direct us to conclude that IPL is a potentially beneficial tool and essential future therapy for dry eye disease." Int J Med Sci. 2020; 17(10): 1385–1392.Published online 2020 Jun 1. doi: 10.7150/ijms.44288 Use of Intense Pulsed Light to Mitigate Meibomian Gland Dysfunction for Dry Eye Disease Abhishek Suwal, Ji-long Hao, Dan-dan Zhou, Xiu-fen Liu, Raja Suwal, and Cheng-wei Lu Image [Diffuse lissamine green staining in a person with severe keratoconjunctivitis sicca.] Courtesy of Wikimedia Commons

Just received the TEA Form 990 for 2019, which this non profit is not required to file Form 990 EZ for 2019 since donations were less than $50K (only received $21,578.00 in donations in 2019) and could have filed Form 990 N. TEA spent $18K on 'printing, publications, postage, shipping and other expenses.' So no research grants were sponsored in 2019. No money spent on staff or 'conventions' for members. Considering TEA has over 2000 members who donated $21K, this non profit gets high marks for what is being accomplished according to the mission statement and still has over $125K in the bank in net assets. Read the Form 990 yourself. We could only wish that RRDi members would donate half as much as TEA members do. TEA 990 . 2019.pdf

I continue to take the Puritan Pride Lutein/Zeazanthin because I do think it helps dry my oily skin and as you point out, for the 'antioxidant effects' and I think it is similar to taking an oral retinoid since Lutein/Zeazanthin is actually a xanthophylls (carotenoid) that 'is a virulence factor with an antioxidant action that helps the microbe evade death by reactive oxygen species used by the host immune system." It may improve the eyes as well. We haven't had other anecdotal reports that it clears rosacea as Marcel the attorney raves about in his initial report. Keep us posted on your results. It has not cured my rosacea, but I still think it is worth taking daily. I take one a day.

UPDATE "The study concluded that treatment with hydroxychloroquine significantly reduces the death rate of COVID-19 patients, Zervos said. Of those treated with hydroxychloroquine alone, 13% of them died, compared to the 26.4% who died and were were not treated with the drug. There was an overall 18.1% in-hospital mortality rate and patients were over the age of 18, with a median age of 64." Hydroxychloroquine is effective in treating COVID-19, says Henry Ford Health System study, Andrew Mullin, MLive

Diagram depicting the major determinants of gastric acid secretion, with inclusion of drug targets for peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). Image courtesy of Wikimedia Commons. Proton Pump Inhibitors Theory One of the systemic cormorbidities in rosacea is the use of Proton Pump Inhibitors (PPIs). What are PPIs? "Proton-pump inhibitors (PPIs) are members of a class of medications whose main action is a profound and prolonged reduction of stomach acid production." [1] These include omeprazole, lansoprazole and the antibiotics clarithromycin and amoxicillin. Why are they called proton pump inhibitor? "They are called 'proton pump inhibitors' because they work by blocking (inhibiting) a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the 'proton pump'). This chemical system is found in the cells in the stomach lining that make stomach acid." [2] What do PPIs do that is related to causing rosacea? One of the related rosacea theories is the Low Gastric Acid and Rosacea which has been around for sometime now, back to a paper in 1931 by Epstein and Susnow. [3] PPIs inhibit gastric acid production. What happens in the stomach without a doubt is related to what happens in the gut. There are a number of rosacea theories related to the gut, i.e, IBD and Rosacea, IBS and Rosacea, SIBO and Rosacea, and Rosacea and the Gut. GUT Rosacea is listed as a variant of rosacea. H Pylori (Helicobacter Pylori) in the gut has been a subject of investigation with rosacea for sometime now and continues to be investigated in clinical papers. Antibiotics have been the mainstay of medical treatment for rosacea, particularly those medicines derived from tetracycline, i.e., doxycycline, which work in the gut and has an effect on the stomach and bowel microbiota. The vast majority of rosacea patients have taken antibiotics, usually high dose for a significant period of time or low dose for even much longer periods. There is evidence that PPIs may even contribute to antibiotic resistance. [4] PPIs Systemic Cormorbidity in Rosacea Related to Gastric Acid Reduction One paper concluded, "In conclusion, prolonged PPI use was associated with an increased risk of rosacea, particularly in women and patients with peptic ulcers." [5] Theory Therefore, the theory that the use of PPIs may have a relationship in causing rosacea. Obviously not all rosacea sufferers have used PPIs so this is just one theory among the long list. For example, one theory is that rosacea is caused by demodex mites, but not all rosacea sufferers have any increase in demodex mites and treatment for demodex doesn't improve the rosacea, nevertheless, the theory is still listed since some rosacea sufferers respond well to treatment for demodectic rosacea. Ergo, the PPI and rosacea theory stands. A theory. End Notes [1] Proton-pump inhibitors, Wikipedia [2] Proton Pump Inhibitors, Dr Laurence Knott, Patient [3] Cal West Med. 1931 Aug;35(2):118-20.ACNE ROSACEA: WITH PARTICULAR REFERENCE TO GASTRIC SECRETION.Epstein N, Susnow D.ACNE_ROSACEA_GASTRIC_SECRETION_Hypochlorhydria_Acid_Epstein_1931.pdf [4] JAMA Intern Med 2020 Feb 24 Does Gastric Acid Suppression Encourage Antibiotic Resistance? Abigail Zuger, MD reviewing Willems RPJ et al. JAMA Intern Med 2020 Feb 24 Lee TC and McDonald EG. J Clin Microbiol. 2005 Jul; 43(7): 3059–3065.doi: 10.1128/JCM.43.7.3059-3065.2005 Effect of pH and Antibiotics on Microbial Overgrowth in the Stomachs and Duodena of Patients Undergoing Percutaneous Endoscopic Gastrostomy Feeding Graeme A. O'May, Nigel Reynolds, Aileen R. Smith, Aileen Kennedy, and George T. Macfarlane [5] J Dermatol. 2020 Jul 01;: Use of proton pump inhibitors and risk of rosacea: A nationwide population-based study. Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH

An interesting title to an article, "Eating black raspberries might reduce inflammation associated with skin allergies, a new study indicates" [1] intrigued me into an investigation. My wife commented that blackberries are the same. A cursory Google search said otherwise. [2] Wikipedia shows after entering 'black raspberry,' "Not to be confused with blackberry. Black raspberry is a common name for three species of the genus Rubus." Ironically, Rubus is part of the Rosaceae family. The one used in this clinical study was Rubus occidentalis (above image courtesy of Wikimedia Commons). The article refers to a clinical investigation paper that was "funded by National Cancer Institute (NCI/NIH), grant number K01CA207599 awarded to S.O., and the Ohio State University Foods for Health (FFH) Discovery Theme & Food Innovation Center (FIC) Seed Grant awarded to S.O. and USDA Hatch Funds (OHO01470) awarded to J.L.C." [3] Currently I am noticing where authors are getting the money to study such novel investigations like 'black raspberries,' since the RRDi would love to research novel studies like this for rosacea but can't drum up the money and rosaceans are not donating and have left for all the social media private rosacea groups chattering the same as they did twenty years ago about rosacea and doing nothing constructive about researching rosacea. Why they continue to support the status quo rosacea research mostly sponsored by pharmaceutical companies baffles my mind. [4] This isn't an easy read nor for the novice so you may want to stick to what Emily Henderson wrote about this subject. [2] But if you want to deep dive into this a little more I noticed some facts that Emily doesn't mention. For example, the authors state, "Recent studies have shown that diet plays a significant role in mitigating the development of allergic illnesses, with the consumption of antioxidant rich foods shown to be particularly efficacious in reducing allergic responses." [3] If you search you will find that there are a number of foods considered rich in antioxidant besides black raspberries, but it sounds way more interesting to eat black raspberries than say kale or spinach, not to mention the fun of it. Emily failed to mention that the authors of the study supplemented Protocatechuic acid (PCA), a 'gut microbial metabolite of anthocyanins' with not the fresh fruit black raspberries, but instead used "5% w/w freeze-dried black raspberry (BRB) powder sensitized with DNFB (n = 5), or AIN-76A." The authors seem more interested in the synergistic effect of PCA with BRB. PCA occurs in nature, i.e., green tea has lots of it. Here are some tidbits Emily didn't detail: (1) Used 2.4-dinitrofluorobenze (DNFB) to recapitulate the human disease Contact hypersensitivity (CHS). (2) Four groups of mice were used for the study, all female, in groups of five mice. Each group had different diets, first group had 'standardized minimal nutrient rodent chow AIN-76A sensitized with vehicle only (n = 5),' second group had 'minimal nutrient rodent chow AIN-76A sensitized with DNFB (n = 5),' third group had 'AIN-76A supplemented with 5% w/w freeze-dried black raspberry (BRB) powder sensitized with DNFB (n = 5),' and the fourth group 'AIN-76A supplemented with 500 ppm protocatechuic acid (PCA.' The authors conclude, "In summary, we demonstrate that the dietary intake of BRB and its anthocyanin metabolite PCA have an inhibitory effect on CHS. We also distinguish between PCA specific immunomodulatory effects and the global effects of the complex mixture of BRB phytochemicals on the pathways associated with CHS." So while this is an interesting subject, I would be careful eating a lot of black raspberries since the fructose in fresh berries can initiate a rosacea trigger, notwithstanding the antioxidant effect. [5] Maybe if you skin is clear, you may have a small bowl which would be nice and who knows, maybe fresh black raspberries might be good for rosacea? Maybe a little. Just watch out for the fructose! Reply to this TopicThere 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. End Notes [1] Eating black raspberries might reduce inflammation associated with skin allergies, a new study indicates, Emily Henderson, B.Sc., News-Medical.Net [2] THE DIFFERENCE BETWEEN BLACK RASPBERRIES AND BLACKBERRIES, Black Raspberry Buzz Huff Post concurs: Blackberry vs Black Raspberry: What's The Difference?, By Julie R. Thomson, Huff Post [3] Nutrients. 2020 Jun 6;12(6):E1701. doi: 10.3390/nu12061701. Full Text Black Raspberries and Protocatechuic Acid Mitigate DNFB-Induced Contact Hypersensitivity by Down-Regulating Dendritic Cell Activation and Inhibiting Mediators of Effector Responses Kelvin Anderson, Nathan Ryan, Arham Siddiqui, Travis Pero, Greta Volpedo, Jessica L Cooperstone, Steve Oghumu [4] Rosacea Research in Perspective of Funding [5] Sugar = Rosacea Fire

Topical retinoids are mainly used for acne but there are some dermatologists prescribing Rx topical retinoids for rosacea, i.e., Differin (adapalene), Retin-A Micro (Tretinoin Microspheres), Tazret (Tazarotene), and others. "Also referred to as retinoic acid or vitamin A acid, topical retinoids are available as gels, ointments, creams, or foams to be applied directly to the skin. They work by promoting the exfoliation of dead skin cells as well as by boosting the production of new skin cells. The new cells then push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties." [1] "As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted." [2] "Expert groups and evidence-based guidelines agree that topical retinoids should be considered the foundation of acne therapy." So this article explains the increased use of retinoids by physicians over antibiotics since there is concern over antibiotic resistance. This article states, "The use of retinoids plus BPO targets multiple pathways and can often eliminate the need for antibiotics, reducing the likelihood of antibiotic resistance." [3] "Topical retinoids have clearly demonstrated benefit in rosacea. "Some dermatologists choose to avoid them, because they are more difficult to use, but over the long term, they really do make a difference for these patients," Dr. Pelle says. "In my experience, at one month you get an improved skin texture, at four months flushing is much less frequent, and at one year there is a normal flush response, substantially decreased redness and few to no flares requiring tetracyclines." " [4] There is a thread at RF that inspired this post. [5] There are a number of over the counter retinols available in our affiliate store. [6] What is the difference between a retinol and a retinoid? "Essentially, retinol is just a specific type of retinoid." [7] End Notes [1] What to Know About Topical Retinoids for Acne, Heather L. Brannon, MD, very well health [2] Topical tretinoin resolves inflammatory symptoms in rosacea, in small study [3] Increased Retinoid Therapy for Acne [4] 'Subtype-directed' approach targets rosacea, Jan 01, 2005, DermatologyTimes [5] Retinoid highly recommended by top-rated dermatologist on RRDi, beherenow [6] https://irosacea.org/search/?q=retinol&quick=1 [7] What’s the Difference Between Retinol and Retinoids, Marissa Laliberte, Reader's Digest

We are pleased to announce that members can now post REVIEWS in our affiliate store. Here is a screen shot of a review: In the screen shot above the review can be viewed if you click on the tab PRODUCT REVIEWS and MEMBERS can RESPOND TO THIS REVIEW. So if you find an item in our store and you have used the item and want to review it all you do is, (1) Find the item in the store, (2) login with your RRDi account (only requires registering with an email address), (3) Scroll down to the product information tab and next to this tab find the PRODUCT REVIEWS tab and click on it. (4} Find the WRITE A REVIEW black button and click on it (5) Write your review in the comment box

Stratum corneum hydration (SCH) is a measurement useful for assesing the outermost layer of the epidermis. "Transepidermal water loss (TEWL or TWL) is the loss of water that passes from inside a body (animal or plant) through the epidermis (that is, either the epidermal layer of animal skin or the epidermal layer of plants) to the surrounding atmosphere via diffusion and evaporation processes." Wikipedia A paper concluded that the GPSkin® Barrier device "determines TEWL and SCH accurately in healthy and impaired skin barrier state and can monitor skin barrier function in rosacea during treatment. The GPSkin device is much more practical compared to previous skin barrier tools when used in clinical practice.' [1] "Based on these findings, we concluded that GPSkin provides reasonably precise and reliable measurements of SC hydration and TEWL as compared to current devices." [2] "GPSkin Barrier® is a reliable, affordable, and versatile device for assessing epidermal permeability barrier function and SC hydration."[3] "Transepidermal water loss (TEWL) is the amount of water that passively evaporates through skin to the external environment due to water vapor pressure gradient on both sides of the skin barrier and is used to characterize skin barrier function." [4] "Now, over half of world’s top 10 skincare brands have already adopted the gpskin Barrier (www.gpower.kr) as a skin diagnostic device." [5] 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. More information on diagnosing rosacea. End Notes [1] Skin Res Technol. 2020 Jun 23;: Value of GPSkin for the measurement of skin barrier impairment and for monitoring of rosacea treatment in daily practice. Logger JGM, Driessen RJB, de Jong EMGJ, van Erp PEJ [2] Skin Res Technol. 2019 Sep;25(5):612-617. doi: 10.1111/srt.12692. Epub 2019 Apr 3. Validation of a Novel Smartphone Application-Enabled, Patient-Operated Skin Barrier Device Erin E Grinich , Anuja V Shah, Eric L Simpson [3] Skin Res Technol. 2019 Jan;25(1):25-29. doi: 10.1111/srt.12590. Epub 2018 Jun 4. Validation of GPSkin Barrier ® for Assessing Epidermal Permeability Barrier Function and Stratum Corneum Hydration in Humans L Y , Z Wang, Z Li, C Lv, M-Q Man [4] Science Direct Transepidermal Water Loss, Skin Structure and Function Golara Honari, Howard Maibach, in Applied Dermatotoxicology, 2014 [5] Dematology.com

Azelaic Acid 15% Foam (AAF) vs Metronidazole Cream (MC) and Metronidazole Gel (MG) "MG- and MC-treated patients more frequently reported treatment concerns and side effects than AAF-treated patients, and tolerability of those side effects was higher for patients treated with AAF. While treatment cost is a more frequent concern in patients treated with AAF, these patients less frequently reported concerns with treatment efficacy and reported similar or greater tolerance to side effects than patients treated with either MC or MG." J Drugs Dermatol. 2020 Mar 01;19(3):295-304 Rosacea Treatment Satisfaction: Matching Adjusted Indirect Treatment Comparison Analysis of Metronidazole Gel or Cream vs Azelaic Acid Foam. Williamson T, LaRose A, Cameron J, Lott J, Eaddy M, Hopson S, Shih HC, Tennant LT Conclusion So according to the above paper you probably should consider AAF over MC/MG and refer this paper to your dermatologist who is prescribing metronidazole instead of azelaic acid.

The controversy about hydroxychloroquine continues. "Not all researchers have given up on the drug, however, and recent developments show it is not yet dead as a potential weapon against COVID-19, especially as a preventative in people not yet exposed to the virus." Hydroxychloroquine is not dead yet, Lisa Cavazuti, NBC News --------------------------------------------------------------------------------------------------- "Once praised as a miracle cure for covid-19, an antimalarial drug called hydroxychloroquine has rarely been out of the headlines since the start of the pandemic. It was hoped it might find a new use as a therapy in patients who are unwell with the novel coronavirus. But in recent weeks a scientific picture has emerged of a treatment that does not appear to be helping patients at all, and might even be causing harm. Whether it helps seems clear now: it doesn’t. When it comes to the harm, though, it turns out that the scientific literature may be misleading. On June 4th the Lancet, a respected medical journal, retracted a high-profile paper published only a month previously. This had suggested that hydroxychloroquine and its analogue, chloroquine, actually increased the death rate in hospitals when taken by those with covid-19. This led the World Health Organisation to halt its trials of the drug. It also caused considerable concern to patients and to those enrolled on other such trials." Hydroxychloroquine is embroiled in yet more controversy, The Economist

Dr Sam Buntin discusses rosacea being one of the most common skin disorders, yet is often misdiagnosed as something else. Knowing you have it is key if you’re to avoid the many pitfalls associated with this volatile condition. She offers beauty and lifestyle choices that can actually aggravate rosacea. More with Dr. Buntin All you NEED to know about Rosacea with Dr Sam & Dr Emma Retinoids and Rosacea Five Skincare Cheats to Manage Rosacea | Dr Sam in the City ROSACEA WITH DR SAM BUNTING | TRINNY Rosacea Q & A with Trinny Woodall | Dr Sam Bunting 5 Skincare Rules You MUST Follow If You Have Sensitive Skin | Dr Sam Bunting A Derm-Approved Guide to Red, Sensitive Skin! | Dr Sam in The City How to Manage Rosacea in Winter | DERMSquared | Dr Sam in The City How To Tackle Big Pores | Dr Sam Bunting DR SAM BUNTING ON... ROSACEA | CAROLINE HIRONS | MARCH 2015

Dermatologist Dr. Davindra Singh explains the causes of Rosacea and shares tips on how to treat the skin condition.

"ImageJ is a Java-based image processing program developed at the National Institutes of Health and the Laboratory for Optical and Computational Instrumentation (LOCI, University of Wisconsin)." [1] ImageJ for Rosacea "ImageJ is a simple, rapid, objective and reproducible tool to monitor erythema in rosacea patients during treatment. The photographs allow retrospective analysis, evaluation of large and small lesions, and discrimination of subtle redness differences." [2] Open Source Java "ImageJ Ops is a framework for reusable image processing operations. Ops extends Java's mantra of "write once, run anywhere" to image processing algorithms." [3] "ImageJ and its Java source code are freely available and in the public domain. No license is required." [4] Download Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] ImageJ, Wikipedia [2] Skin Res Technol. Nov; 26(6): 804–812. Evaluation of a simple image-based tool to quantify facial erythema in rosacea during treatment. Logger JGM, de Jong EMGJ, Driessen RJB, van Erp PEJ [3] "ImageJ is an open source Java image processing program inspired by NIH Image. It runs on any computer with a Java 1.8 or later virtual machine." ImageJ About [4] ImageJ Features

A paper concludes, "The developed complex treatment of rosacea patients with combined and differentiated use against the background of standard therapy of antihistamines with anti-inflammatory activity of fast (containing bilastine) and prolonged action (ketotifen fumarate) and antioxidant drug ethylmethylhydroxypyridine succinate significantly improves both the immediate and long-term clinical results of treatment of such patients." [1] Ethylmethylhydroxypyridine is Emoxypine (2-ethyl-6-methyl-3-hydroxypyridine). [2] It is also called Mexidol or Mexifin. Emoxypine is similar to pyridoxine, which has been discussed improving SD at this post at RF. It is available non prescription at Amazon through the RRDi Affiliate Store: Emoxypine Capsules (125mg x 60 capsules $26.99) Emoxypine (Mexidol) Succinate (125mg x 28 capsules $69.99) Emoxypine Succinate Capsules (125mg x 60 capsules $19.99 ) Emoxypine Succinate Powder (30 grams $54.99) Mexidol 50 Tablets (125mg x 50 tablets $26.50) Anecdotal Reports There are no known reports thus far. You could be the first one if you try it and find the green reply button and reply to this post. Mknlvi at RF started a thread on this subject and was the original source of this information. End Notes [1] DOI: https://doi.org/10.37321/dermatology.2019.3-4-04 Comprehensive treatment of rosacea patients taking into account the indicators of inflammatory mediators and the state of prooxidant-antioxidant homeostasis [2] Emoxypine, Wikipedia

Thanks to David Pascoe at RSG, "A pre-proof version of an article to appear in the Journal of the American Academy of Dermatology details a small double blind study that found that oral hydroxychloroquine 200 mg twice a day offered similar benefits to rosacea sufferers compared to doxycycline 100 mg a day." [1] End Notes [1] Hydroxychloroquine works same as doxycycline for rosacea, David Pascoe, RSG Am Acad Dermatol. 2020 May 18;S0190-9622(20)30915-4. doi: 10.1016/j.jaad.2020.05.050. Online ahead of print. Efficacy and Safety of Hydroxychloroquine for Treatment of Patients With Rosacea: A Multi-Center, Randomized, Double-Blind, Double-Dummy, Pilot Study Ben Wang, Xin Yuan, Xin Huang, Yan Tang, Zhixiang Zhao, Bin Yang, Baoqi Yang, Yue Zheng, Chao Yuan, Hongfu Xie, Ji Li

Secukinumab has been in clinical trial since 2017. A recent update from Healio states, "Patients treated with secukinumab for papulopustular rosacea saw significant improvements in quality of life and reduction of severity markers, according to a study presented at the American Academy of Dermatology virtual meeting." [1] Cosentyx is the brand name for secukinumab, which "is a human IgG1κ monoclonal antibody that binds to the protein interleukin (IL)-17A, and is marketed by Novartis for the treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritis. It inhibits a member of the cytokine family, interleukin 17A." [2] "Secukinumab is a recombinant fully human IgG1/kappa monoclonal antibody and is manufactured in Chinese hamster ovary cells." [2] "Study participants received 300 mg of secukinumab weekly for five weeks, and then monthly for two months....Among the 17 patients who were available for the final analysis, results showed a significant reduction in papule count at the 16-week follow-up, with a median decrease of -5 papules." [3] How does Cosentyx work? The following video, while it explains how it works for psoriasis, the principles shown in the animated video explain how it works for rosacea. The Cosentyx Connect Personal Support Program may help in savings and other options. Anecdotal Reports There is a thread at RF where at least two anecdotal reports of using Cosentyx is reported. [4] Reply to this TopicThere is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Clinical Trials, Third Post, RRDi [2] Secukinumab, Wikipedia [3] IL-17 inhibition a path of interest in rosacea treatment, July 8, 2020, Ilya Petrou, M.D., Dermatology Times [4] Jedimaster2cool started the thread and Dan3dwards reports he has joined the clinical trial in this thread at RF.

"The U.S. Food and Drug Administration revoked its emergency authorization for hydroxychloroquine, a controversial malaria drug promoted by President Donald Trump for treating the coronavirus. The agency said in a letter the decision is based on new evidence that made it unreasonable to believe hydroxychloroquine and chloroquine "may be effective in diagnosing, treating or preventing" COVID-19, the illness caused by the virus." Hydroxychloroquine: FDA pulls emergency use of malaria drug touted by Trump to treat the coronavirus Adrianna Rodriguez USA TODAY

"The U.S. Food and Drug Administration revoked its emergency authorization for hydroxychloroquine, a controversial malaria drug promoted by President Donald Trump for treating the coronavirus. The agency said in a letter the decision is based on new evidence that made it unreasonable to believe hydroxychloroquine and chloroquine "may be effective in diagnosing, treating or preventing" COVID-19, the illness caused by the virus." Hydroxychloroquine: FDA pulls emergency use of malaria drug touted by Trump to treat the coronavirus Adrianna Rodriguez USA TODAY

If you are convinced that avoiding sugar/carbohydrate improves your rosacea or other skin issue, yet you have a sweet tooth, you probably are on a search for zero calorie sugar substitutes. Of course, in the USA, the ones offered are massive, which a partial list is shown below may have zero calories or at the very least low calories. Image courtesy of Rosacea 101: Includes the Rosacea Diet, Brady Barrows So which one should you use? Of course, your preference is the king of decisions, but which one would be the most natural or healthiest one to use in this list? Stevia For years, Stevia was the one most health authorities choose. However, according to Healthline, "The use of stevia in foods is a bit confusing. The FDA Trusted Source hasn’t approved whole leaf or crude stevia extracts as a food additive. Despite being used for centuries as a natural sweetener, the FDA considers them unsafe. They claim literature indicates stevia in its most natural form may affect blood sugar. It may also affect reproductive, renal, and cardiovascular systems." Medical News Today points out, "Some people have allergic reactions to steviol glycosides that are not extremely pure. Stevia is part of the Asteraceae plant family, which includes daisies, sunflowers, and chrysanthemums. Anyone with allergies to these plants or others in the family should avoid stevia products." Luo Han Guo (Monk Fruit or Siraitia grosvenorii) Therefore, Luo Han Guo (Siraitia grosvenorii or monk fruit) is emerging as a better choice. The safety is beyond any doubt since it is generally recognized as safe (GRAS) by the U.S. Food and Drug Administration. "The plant is most prized for its sweet fruits, which are used for medicinal purposes and as a sweetener. In traditional Chinese medicine, it is used for cough and sore throat and in southern China it is believed to be a longevity aid. The fruits are generally sold in dried form, and traditionally used in herbal tea or soup." [1] (image courtesy of Wikimedia Commons) Monk Fruit "The interior fruit is eaten fresh, and the rind is used to make tea. The monk fruit is notable for its sweetness, which can be concentrated from its juice. The fruit contains 25 to 38% of various carbohydrates, mainly fructose and glucose. The sweetness of the fruit is increased by the mogrosides, a group of triterpene glycosides (saponins). The five different mogrosides are numbered from I to V; the main component is mogroside V, which is also known as esgoside." [1] Monk fruit is available in liquid, granule, and powder forms and is safe for children, pregnant women, and breast-feeding women. Monk fruit gets its sweetness from antioxidant mogrosides. One study found monk fruit extract has the potential to be a low-glycemic natural sweetener. [2] Another study concluded mogrosides may help reduce oxidative stress. [3] Available in the RRDi Affiliate Store Namanna Organic Monk Fruit Natural Sweetener NatriSweet Monk Fruit Extract Now Foods, Organic Monk Fruit Liquid End Notes [1] Siraitia grosvenorii, Wikipedia [2] Yao Xue Xue Bao. 2009 Nov;44(11):1252-7. Insulin Secretion Stimulating Effects of Mogroside V and Fruit Extract of Luo Han Kuo (Siraitia Grosvenori Swingle) Fruit Extract Ying Zhou, Yan Zheng, Jeff Ebersole, Chi-fu Huang [3] Braz J Med Biol Res. 2013 Nov; 46(11): 949–955. Antioxidant effect of mogrosides against oxidative stress induced by palmitic acid in mouse insulinoma NIT-1 cells Q. Xu, S.Y. Chen, L.D. Deng, L.P. Feng, L.Z. Huang, and R.R. Yu

One report indicates that ivermectin was successful in treating Pityriasis folliculorum. [1] "An association with pityriasis folliculorum has also been described [with demodicosis]." More information on Pityriasis folliculorum: For more information [1] Pityriasis Folliculorum: Response to Topical Ivermectin.J Drugs Dermatol. 2017 Dec 01;16(12):1290-1292Darji K, Burkemper NM