Guide

Life-on-hold reports how to Alleviate Mirvaso Rebound Flushing

There are basically two schools of thought when it comes to treating rosacea, the 'more is better' philosophy, and the 'less is more' thought. + = √ More is Better Generally, the 'more is better' philosophy treatment plan is what rosaceans prefer, based upon anecdotal reports of what a typical rosacean is using to treat rosacea. This is usually because their physician recommends an oral systemic treatment, either low dose, timed released doxycycline as well as a topical ivermectin (Gold Standard). Old school dermatologists continue to prescribe a high dose oral doxycycline and a metronidazole topical. These are just two examples of multiple treatments for rosacea, and there are other examples too numerous to list. Anecdotal reports of rosaceans using over the counter products for rosacea usually range from two or more treatments at the same time. Physicians use multiple approaches in treating rosacea. For example, a patient with severe rosacea phenotype 2 and 4 was treated with multiple treatments. Rosaceans typically will think that if this little treatment improves my rosacea then 'more is better' and while on occasion this may be the case, i.e., Carvedilol (Coreg) to treat flushing, the dosage may actually need to be increased if the physician recommends, this is not always the case, when it comes to using multiple, concurring rosacea treatments. Furthermore, when taking more than one drug for rosacea, there are drug interactions to consider (synergism). - = + Less is More Of course, not every decision you make about rosacea treatment means 'less is more,' but in the number of concurring treatments, this should be a chief concern. The less is more approach simply means to use just one rosacea treatment at a time to see if it improves the rosacea. If you think the treatment is working to improve your rosacea, then stop the treatment to see if the rosacea comes back or gets worse. If it does come back or gets worse, it usually indicates the treatment worked. The best way to prove it does work is then again use the one treatment again after you have stopped the treatment and see if your rosacea improves again. Voila! Eureka! This rosacea treatment has proved to work and if the treatment is stopped my rosacea returns or gets worse. Then if you still feel you need to add another treatment along with the one that is working for you, add another or second treatment for rosacea and notice if it gets better or gets worse. If it gets worse, stop the treatment and see if you return to your baseline (how your skin was before you started the second treatment). If you return to baseline then if you want to completely convince yourself you could try it again to see the results. If the same, surely this is enough convincing. If not, then experiment. If the second treatment improves your rosacea along with the first treatment, then wondeful! To convince yourself, remove the second treatment to see what happens? If removing the second treatment your rosacea gets worse, then you know. Try using the second treatment again and see if it improves again. Convinced? You could then even add a third or fourth rosacea treatment, but do so in this systematical, one at a time approach or 'less is more.' You can do this simple approach of 'less is more' using the above method since you can clearly know if a rosacea treatment is for you or not. Multiple Treatments for Rosacea Can Cause Confusion If you are taking multiple treatments for rosacea, this can create a quagmire of confusion. Lets take a typical example to show you. Lac_77 at RF [post no 4] replied to a thread about Mirvaso rebound with the following post dated April 29, 2020 at 01:58 PM: "I had the same reaction to you only a few weeks ago After only 5 days of using it it sent my skin crazy. I stopped using it and the symptoms persisted for about another 5 days, then returned back to how it was previously thankfully (still terrible though). I hope that is the same for you." Lac_77 [post no 1] started a thread on the very same day (April 29 at 02:07 PM) just a few minutes after posting the initial post mentioned above about "seriously intense flushing constantly" due to his five month course of accutane. So, his experience using Mirvaso, pales into insignificance when you consider five months of accutane at 20 mg/day. To conclude the Mirvaso for his flushing issue would be tantamount to a blatant injustice. How can anyone figure out what causes 'permanent' damage in these cases of concurring rosacea treatment which blurs into confusion. Also when someone uses photo dynamic therapy, i.e., IPL, Laser, etc., there are reports that these devices all cause skin damage as well and the difficulty of sorting through what has caused 'permanent' damage is a maze of spider webs, not to mention what are the systemic oral treatments doing to the issue as well, since most rosaceans are taking oral medication treatment at the same time, i.e., antibiotics, anti-flushing drugs, etc. and possibly other topicals all at the same time! Other factors to consider that may have a bearing on the damage is the environment, i.e., sun, chemicals, activities, heat, cold, etc., which can further aggravate the damage, since they should also be ruled out. To conclude, multiple treatments for rosacea not only confuse but also blur treatment decisions. A 'less is more' approach would resolve this. One Treatment at a Time - Less is More That is why using ONE treatment at a time is so much better than taking multiple rosacea treatments since it is so difficult to figure out what is helping and what is causing damage in multiple treatments for rosacea which is common among rosaceans who figure 'more is better' rather than a simplified approach. 'Less is more' is a better approach. The typical example above with Lac_77 who has damaged his skin with accutane treatment taking high dose for five months and then he tries Mirvaso on already damaged skin, what do you think would happen? This is an example of multiple treatments confusing the issue and how the more is better approach can really cause damage and further confusion. Less is More in Medicine The less is more approach in medicine is particularly advocated in homeopathic medicine. The JAMANetwork has a page dedicated to this concept. Jessica A. Otte, MD, has a website and a blog devoted to this subject. Joan Stephenson, PhD, Contributing Writer for MedPage Today, wrote an article on a movement concerning this topic stating, "Whatever changes are needed to move the less-is-more movement forward, the idea has staked its claim in the culture of medicine." "In dermatology, doctors are opting to order the medicines they want, without the inactive ingredients they don’t, at the dosage they need, and dispensing these medicines directly to patients at the point of care. These doctors are taking control of how they are treating their patients." [1] “It is an art of no little importance to administer medicines properly; but it is an art of much greater and more difficult acquisition to know when to suspend or altogether omit them” [2] "In our collective enthusiasm to diagnose and treat disease, a growing body of evidence indicates that we may often be doing too much of a good thing." [3] Rocky Bilhartz, MD wrote an article, stating, "You can always do less in medicine, but you’re amiss by thinking that less is always more. What’s good for the group is not always good for the individual." [4] So not every rosacea treatment decision warrants a 'less is more' approach. A significant number of articles on the 'less is more' in medicine focuses on economic waste and reducing costs. One article is typical, "As 2017 ended, the influential writer and cardiologist Lisa Rosenbaum challenged the tenets of the less-is-more movement in the New England Journal of Medicine....Rosenbaum concluded that "Mitigating waste is imperative," but she argued that doing so means considering the nuances of complex medical decisions and that what may be perceived as a greed for dollars may reflect a hunger for information." [5] Conclusion Whether you choose a 'more is better' or a 'less is more' approach in your treatment decisions with your rosacea will without a doubt have consequences. There really are treatments that work with either method and you, the rosacea patient, has the decision to decide which is the best one to use for your rosacea. Always, the remember the customer (the rosacean) is always right. The customer is coming to the medical provider (the seller) for advice and counsel which the customer (the rosacean) is paying for. Whatever the customer decides is always right (including consequences, risks and benefits). Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] When Less Is More in Medicine, Sep 23, 2019, Physician's Weekly [2] Healthc Policy. 2016 Feb; 11(3): 6–7. De-prescribing: When Less Is More in Healthcare Jennifer Zelmer, PhD, Editor-in-chief [3] Learning More from ‘Less is More’ Medicine By Carla Berg | September 13, 2017, Society for Participatory Medicine [4] The problem of “less is more” in American health care, Rocky Bilhartz, MD, KevinMD.com [5] In Defense of Less-Is-More, John Mandrola, MD, Commentary, MedScapehttps://www.medscape.com/viewarticle/891091#vp_1

Gold Standard Treatment for Rosacea moved to here.

Folliculitis is another rosacea mimic added to the long list of skin conditions or diseases in a differential diagnosis of rosacea. DermNet NZ has a number of photos with various causes due to bacteria, yeasts (fungus), virus, parasites, immunosuppression, inflammatory skin diseases, i.e., Lichen planus, Lupus and others, and environmental causes, i.e., chemicals, drugs (steroids). One report mentions "rosacea-like folliculitis" in describing it as a rosacea mimic. [1]. A google image search shows some photos that mimic rosacea. Deep dive into folliculitis. End Notes [1] J Clin Med. 2020 Apr; 9(4): 1241. Published online 2020 Apr 24. doi: 10.3390/jcm9041241 Dupilumab for the Treatment of Atopic Dermatitis in an Austrian Cohort-Real-Life Data Shows Rosacea-Like Folliculitis Tamara Quint, Patrick M. Brunner, Christoph Sinz, Irene Steiner, Robin Ristl, Kornelia Vigl, Susanne Kimeswenger, Katharina Neubauer, Detlev Pirkhammer, Martin Zikeli, Wolfram Hoetzenecker, Norbert Reider, Christine Bangert Pruritis and Rosacea MORE INFORMATION

Higher doses of isotretinoin, but more importantly, low dose isotretinoin, has been reported to be a successful treatment for rosacea. You should be aware of the risk/benefit ratio with this treatment if you are not aware of these facts. Are you aware of isotretinoin induced rosacea? For more information on isotretinoin. However, in some cases there are reports of it inducing a worsening case of rosacea inflammation, hence, the possibility of causing Isotretinoin Induced Rosacea (IIR), aka, Iatrogenic Rosacea or Rosaceiform Dermatitis [see list of differential diagnosis of rosacea to consider]. Just as long term treatment with Topical calcineurin inhibitors (TCIs) or with long term steroid treatment can result in Steroid induced rosacea, long term isotretinoin treatment can also isotretinoin induce rosacea. For example, one report states regarding treating acne with isotretinoin, "However, isotretinoin must be used with caution, as paradoxical induction/exacerbation of acne fulminans has been reported." [1] Acne fulminans (AF) developed during use of isotretinoin in low doses. [2] "Isotretinoin treatment for acne can lead to inflammatory flare-ups or an aggravation, occasionally leading to acne fulminans." [3] One paper lists the adverse effects (AEs) of isotretinoin treatment in acne which may include, "resulting mostly from changes to the eyelids and the surface of the cornea or lacrimal abnormality that leads to dry eye. The association is documented in the literature, with case reports describing blepharoconjunctivitis, keratoconjunctivitis sicca, cutaneous photosensitivity, contact lens intolerance, refractive changes, papilledema, pseudotumor cerebri, and abnormal retinal function....abnormal meibomian gland secretion, blepharoconjunctivitis, corneal opacities, decreased dark adaptation, decreased tolerance to contact lenses, decreased vision, increased tear osmolarity, meibomian gland atrophy, myopia, ocular discomfort, ocular sicca, photophobia, pseudotumor cerebri, and keratitis." [4] Furthermore, there are anecdotal reports of Accutane Induced Rosacea. A typical example of these reports is Dave, who posted, "I'm 6 months post accutane and still having some flushing issues but it is getting a bit better. I'd say I started to see slight improvement during months 5 and 6. I've talked to other who said it took up to a year for the flushing to resolve itself." [flying_er post no 2 30th December 2011 04:55 PM] The list of anecdotal reports keeps growing. The treatment for Isotretinoin (Accutane) Induced Rosacea will be listed in this post for your benefit. Treatment (1) Obviously stop isotretinoin intake and call your dermatologist and make an appointment for further treatment. "All abnormal findings in these studies were reversible shortly after cessation of the isotretinoin treatment." [4] (2) Let the skin heal on its own for a few days, washing only with cool water. (3) Take analgesic medicine for any pain Anecdotal Treatments Lucy says she uses mepacrine. [Lease143 post no 1] lucy_nic87 started a thread on this subject and uses Finacea, propanolol, clonidine, mepacrine Peter B reports he is on mepacrine and clonidine which help control the worst of the flushing. Ray reports quinacrine helps Plaquenil (Hydroxychloroquine) chris123 started a thread on this treatment and reports at post no 21, "It's been about 2 months since I started the plaquenil, and the past 2 weeks or so my flushing has subsided materially. I don't flush as often, and when I do it's not quite as severe, and it doesn't last as long." 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. So if you have a treatment that works for your isotretinoin induced rosacea, why not help other rosaceans with this same issue and find the reply to this topic button and post! End Notes [1] Indian Dermatol Online J. 2013 Apr-Jun; 4(2): 133–142. Paradoxes in dermatology Keshavmurthy A. Adya, Arun C. Inamadar, and Aparna Palit [2] An Bras Dermatol. 2011 Sep-Oct;86(5):983-5. Acne fulminans and isotretinoin: case report. Pereira MF, Roncada EM, Oliveira CM, Monteiro R, Abreu MA, Ortigosa LC. [3] Ann Dermatol Venereol. 2001 Mar;128(3 Pt 1):224-8. Acne flare-up and deterioration with oral isotretinoin Chivot M. [4] JAMA Dermatology July 2012 Ocular Adverse Effects of Systemic Treatment With Isotretinoin Meira Neudorfer, MD; Inbal Goldshtein, MSc; Orna Shamai-Lubovitz, MD; et al

Watch Video The logo of the RRDi includes a butterfly because rosacea typically manifests itself in a facial butterfly formation. "Half a century ago, Edward Lorenz, SM ‘43, ScD ‘48, overthrew the idea of the clockwork universe with his ground-breaking research on chaos." [1] Lorenz created an analogy with the flapping wings of a butterfly what beautifully describes how the initial conditions may create an effect not imagined. What are the initial conditions with the result in rosacea chaos? Victor Gabriel's Butterfly Effect in Acne and Rosacea A paper written in 2018 by Victor Gabriel, et al., discusses the 'butterfly effect' not only in rosacea but also in acne. The concept of the butterfly effect "is associated with chaos theory, and it is a concept originated in meteorology, which represents the dependence on initial conditions." [2] "The butterfly effect (in chaos theory) represents the sensitive dependence on initial conditions, that is, a very small change in one state of a deterministic nonlinear system is associated with large differences in a later state." [2] Initial Conditions in Rosacea May Help Explain the Rosacea Chaos "Acne and Rosacea are chronic inflammatory skin diseases with an increasing frequency and an important negative impact on the quality of life, which are associated with a large number of false myths regarding causes and treatment." [2] The butterfly effect psychologically may have a profound result in finding a cure for rosacea considering the initial mental conditions (scroll below to the subheading, Butterfly Effect in Psychology). False Myths and Misconceptions in Acne "Acne represents the most common diagnosis made by dermatologists, and unfortunately, a common misconception among medical and lay communities is that acne is a self-limited teenage disease and thus, it deserves not the same attention as that paid to a chronic disease." [2] Actually, "acne occurs very frequently in adulthood." [2] The internet is replete with rosacea false myths, one paper indicates, "A total of 385 websites were included. About 44.7% of the shared content was rated as imprecise, 20% as confusing, and 35.3% as precise." [2a] "Misunderstanding and misinformation is associated with the beliefs that poor hygiene, hormones, diet, cosmetics, infection or stress are the factors that exacerbate acne in teenagers. Patients use ”acne treatments” (cleansers, acne pads, masks, cover-up products, acne lotions, etc.) before seeking medical attention. It was reported that 74% of such patients waited more than 1 year before medical consultation." [2] Butterfly Effect in Rosacea Gabriel explains the butterfly effect in rosacea is based upon the 'initial conditions' that are 'associated with a large number of false myths regarding causes and treatment.' Gabriel explains, "From the authors’ point of view, “the butterfly effect” associated with Acne and Rosacea is represented by education about these chronic inflammatory skin diseases, with emphasis on myths and skin care, because the power of false myths keep patients away from medical care; also, correct and individualized skin care is associated with a better adherence to treatment and results." [2] Similarly, it was reported in one large survey conducted by Galderma that it took on "average, women with rosacea waited at least seven months before receiving a correct diagnosis." [3] Male patients with telangiectasia tend to wait to seek treatment due to the false myth that the skin condition is not serious. [18] As with false myths in acne mentioned previously, similarly it could be said about rosacea that it is a 'cosmetic' issue that doesn't deserve serious medical attention, which is also a common misconception or false myth. Another false myth is that demodex mites on pets do not transfer to humans. [15] An example of a 'false myth' with rosacea initial conditions is the belief that rosacea progresses in stages which has been debunked. [19] Some rosaceans think that flushing is rosacea, a common misunderstanding that is an example of a false myth with rosacea. [16] Rosacea social media websites are replete with 'fake news.' [17] Butterfly Effect with Rosacea Research This is an important butterfly effect to consider for rosaceans. A paper by Elisabeth Pearson Waugarman, PhD, [9] emphasizes the need for rosaceans to unite in a patient advocacy non profit organization group to find the cure for rosacea. Dividing off into different social media private groups or forums is counter productive. Read the RRDi Mission Statement. If we could get enough rosaceans to unite into a giant butterfly with 10K members and each donated one dollar we could sponsor our own rosacea research. That would be an incredible butterfly effect. Butterfly Effect in Inflammation "We hypothesize that low-grade inflammation in early life (especially an imbalance between pro- and anti-inflammatory macrophages) triggers a "butterfly effect" within the arterial wall by initiating a sequence of processes that finally leads to atherosclerotic plaque development and progression." [6] Butterfly Effect in Healthcare Systems “When we look at the growing diversity of the populations our healthcare systems serve, we must ask ourselves this question: “What systemic by-product of yesterday is limiting our understanding of organizational needs today, pre-empting our competitive advantage?" The report concluded that, “the underestimated importance of diversity among healthcare leaders and care providers across the industry has limited our capacity for greater success.” [8] Butterfly Effect in Psychology "Recently, meterologists made a startling discovery about monarch butterflies—a discovery for which they have no explanation. Monarchs migrate in a gigantic cluster that forms the shape of a butterfly. The implications of this discovery are startling. Could it be that, like small fish, the monarchs gather together to form a large group that looks like a very large, inedible, butterfly? If this is the case, like small fish, butterflies have a sense of their identity. What is the message for us? If fish and butterflies unite for safety in numbers, surely humans have the same ability; but, instead, we divide ourselves into myriad groups that take precedence over our humanity. We need to relearn that to survive, we have to be united. With the butterfly effect, we can be." [9] Butterfly Effect in the Underrepresentation of Women The butterfly effect may explain why "the persistent underrepresentation of women is more likely to reflect unconscious bias, unequal family responsibilities, and gender stereotypes" in the economic gender gap. [4] image courtesy of Wikimedia Commons Edward Lorenz's Butterfly Effect Edward Lorenz, a MIT meteorology professor who proposed the 'butterfly effect' which has become popular in movies never envisioned that this would create so much attention. American Scientist explains, "The purpose of his provocative question, he said, was to illustrate the idea that some complex dynamical systems exhibit unpredictable behaviors such that small variances in the initial conditions could have profound and widely divergent effects on the system’s outcomes. Because of the sensitivity of these systems, outcomes are unpredictable. This idea became the basis for a branch of mathematics known as chaos theory, which has been applied in countless scenarios since its introduction." [5] “And the butterfly effect, also known as “sensitive dependence on initial conditions,” has a profound corollary: forecasting the future can be nearly impossible.” [1] Butterfly Effect in Popular Culture "The journalist Peter Dizikes, writing in The Boston Globe in 2008, notes that popular culture likes the idea of the butterfly effect, but gets it wrong. Whereas Lorenz suggested correctly with his butterfly metaphor that predictability 'is inherently limited', popular culture supposes that each event can be explained by finding the small reasons that caused it. Dizikes explains: "It speaks to our larger expectation that the world should be comprehensible – that everything happens for a reason, and that we can pinpoint all those reasons, however small they may be. But nature itself defies this expectation." [7] The Butterfly Effect in Groups "The corollary of the Butterfly Effect is that tiny changes you make do in fact make a difference." [10] A similar point is made by Tasha Wahl who is an artist, philanthropist and entrepreneur who formed the Wahl Foundation. Watch this one minute video: Butterfly Effect in What Really Counts Butterfly Effect with One Dollar So whether you believe in the butterfly effect that one random act can change the outcome of a much larger system of events, the RRDi appeals to you with our one dollar donation financial post. Can you donate one dollar for the RRDi butterfly to keep flying? Your one dollar would beautifully validate our butterfly logo as well as have a small part in the butterfly effect. Or buy one of our RRDi Tee Shirts with our butterfly logo on the front. Butterfly Effect in Disaster Scenarios Training Software "Similar to the famed "butterfly effect" in weather patterns -- the notion that the flapping of a butterfly's wings in California can have an impact on weather in China -- the disaster scenario evolves as participants make decisions. [11] Butterfly Effect in Creating Forms "In my job at JotForm, I sieve through forms built by our users almost every day, and I see first-hand what a difference a small decision can make. I’m often struck, for instance, by how tiny oversights can lead to significantly lowered conversion rates." [12] The Real Butterfly Effect "Historical evidence is reviewed to show that what Ed Lorenz meant by the iconic phrase 'the butterfly effect' is not at all captured by the notion of sensitive dependence on initial conditions in low-order chaos. Rather, as presented in his 1969 Tellus paper, Lorenz intended the phrase to describe the existence of an absolute finite-time predicability barrier in certain multi-scale fluid systems, implying a breakdown of continuous dependence on initial conditions for large enough forecast lead times. To distinguish from 'mere' sensitive dependence, the effect discussed in Lorenz's Tellus paper is referred to as 'the real butterfly effect'. Theoretical evidence for such a predictability barrier in a fluid described by the three-dimensional Navier–Stokes equations is discussed. Whilst it is still an open question whether the Navier–Stokes equation has this property, evidence from both idealized atmospheric simulators and analysis of operational weather forecasts suggests that the real butterfly effect exists in an asymptotic sense, i.e. for initial-time atmospheric perturbations that are small in scale and amplitude compared with (weather) scales of interest, but still large in scale and amplitude compared with variability in the viscous subrange. Despite this, the real butterfly effect is an intermittent phenomenon in the atmosphere, and its presence can be signalled a priori, and hence mitigated, by ensemble forecast methods." [13] The question, 'Is the Butterfly Effect Real?' is an interesting discussion amongst physicists in a blog. One answered this question 'almost certainly' while another answered, 'perhaps.' [14] Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] When the Butterfly Effect Took Flight, Peter Dizikes, MIT News magazine, Technology Review Journal of the Atmospheric Sciences, Volume 20: Issue 2, 01 Mar 1963 Deterministic Nonperiodic Flow Edward N. Lorenz [2] Maedica (Buchar). 2018 Jun; 13(2): 89–94. Butterfly Effect – the Concept and the Implications in Dermatology, Acne, and Rosacea Victor Gabriel, Francesca Satolli, Alin Laurentiu Tatatui, Cristiana Voicu, Ana Maria Veronica Draganita, Torello Lotti [2a] "A total of 385 websites were included. About 44.7% of the shared content was rated as imprecise, 20% as confusing, and 35.3% as precise." Int J Dermatol. 2020 Oct 23;: "Fake news" in dermatology. Results from an observational, cross-sectional study. Iglesias-Puzas Á, Conde-Taboada A, Aranegui-Arteaga B, López-Bran E [3] "The results, which are part of the national educational campaign Rosacea SKINsights sponsored by Galderma Laboratories, also reveal the lengths that women with rosacea would go to if they could get rid of their rosacea forever, and highlight the low awareness and complicated diagnosis path for this common condition. On average, women with rosacea waited at least seven months before receiving a correct diagnosis, and only half of respondents had ever heard of the condition upon the time of diagnosis. This reveals the high level of misunderstanding and confusion that surrounds rosacea, a chronic disorder primarily of the facial skin, often characterized by flare-ups and remissions." New Survey Reveals First Impressions May Not Always Be Rosy For People With The Widespread Skin Condition Rosacea, Medical News Today, 5 Apr 2010 [4] JAMA Netw Open. 2018 Dec 7;1(8):e186053. doi: 10.1001/jamanetworkopen.2018.6053. The Butterfly Effect in the Economic Gender Gap in Academia. Frangou S. [5] Understanding the Butterfly Effect BY JAMIE L. VERNON, American Scientist [6] Med Hypotheses. 2019 Jan;122:106-110. doi: 10.1016/j.mehy.2018.10.026. Epub 2018 Oct 30. Early-life inflammation pathways trigger a cascade leading to development of atherosclerotic plaque through the "butterfly effect" - An hypothesis. Kowara M, Kasarełło K, Czarzasta K, Opolski G, Cudnoch-Jędrzejewska A. [7] Butterfly effect, Wikipedia [8] J Healthc Manag. 2019 Sep-Oct;64(5):265-271. doi: 10.1097/JHM-D-19-00152. The Butterfly Effect in Healthcare: What Happens When an Organization Tackles Unconscious Bias and Promotes Diversity of Thought? Sadau EW, Capeles T. [9] What Does the Butterfly Effect Offer You? What matters most? The surprising answer, Elisabeth Pearson Waugarman, PhD, Psychology Today [10] The Butterfly Effect and the Environment: How Tiny Actions Can Save the World, Brian Clark, copyblogger [11] Butterfly Effect, BY SHANE PETERSON / AUGUST 3, 2004, Government Technology [12] The butterfly effect: how small changes make a huge difference, by Anil Ozsoy, JotForm [13] Nonlinearity, Volume 27, Number 9 The real butterfly effect T N Palmer, A Döring and G Seregin [14] Is the butterfly effect real?, Physics StackExchange [15] Can Mites Transfer From Pets to Humans? [16] Is Flushing Rosacea? [17] Fake Rosacea News? • Where have all the rosaceans gone? [18] Male Patients With Telangiectasia, Rosacea Tend To Wait To Seek Treatment [19] Does Rosacea Progress in Stages?

"In addition, excessive cleansing can lead to disruption of the epidermal barrier, increased transepidermal water loss (TEWL), roughened and irritated skin, increased bacterial colonization, increased comedonal formation, secondary irritant contact dermatitis, and burning and stinging. These negative effects caused by harsh soaps and aggressive cleansing make many prescription topical AV medications less tolerable." Maedica (Buchar). 2018 Jun; 13(2): 89–94. Butterfly Effect – the Concept and the Implications in Dermatology, Acne, and Rosacea Victor Gabriel

Another anecdotal report: "After only 5 days of using it it sent my skin crazy. I stopped using it and the symptoms persisted for about another 5 days, then returned back to how it was previously thankfully (still terrible though)." Lac_77 Rosacea Forum

"Healing my gut has been a long journey and is still not completely healed. Both of my naturopath doctors are convinced that my overuse of antibiotic (in particular two years of Oracea) cause me serious gut issues. I understand this will be controversial here, but I would strongly advise against anyone considering Oracea or any antibiotic long-term. Even this low dose can cause serious imbalance in your gut that can surface years later and the results are not fun." Matt [MP1985 4th June 2019 02:59 AM Post no 19] Rosacea Forum

Oxygen, ROS and Pathogens “A paradox in metabolism is that, while the vast majority of complex life on Earth requires oxygen for its existence, oxygen is a highly reactive molecule that damages living organisms by producing reactive oxygen species." [1] "However, reactive oxygen species can be beneficial, as they are used by the immune system as a way to attack and kill pathogens." [2] The human body composition can be "analyzed in various ways," either by chemical elements present, or by molecular type. "Almost 99% of the mass of the human body is made up of six elements: oxygen (65%), carbon (18.5%), hydrogen (9.5%), nitrogen (3.2%), calcium (1.5%), and phosphorus (1%)." [3] Oxygen makes up 65% of the chemical element in the human body, while water makes up 65% of the molecular mass. Another method to analyze the human body is by cell type. "Traditionally, non human microorganisms in the human body have been estimated to be way more than human organisims, depending on what you designate is actually 'human', but more recent estimates put this number at a 50/50 ratio, so, this subject is debated among biologists" [4] So oxygen is important in human metabolism and comprises the majority of the composition of the body. However, sometimes oxygen can cause negative reaction in disease as this thread is pointing out with ROS and its connection to rosacea. If you have a pathogen issue causing rosacea, I.e., demodex, virus, or bacteria, ROS activates the immune system response, which may cascade an inflammatory reaction. End Notes [1] Antioxidant, Wikipedia [2] Oxidative stress, Wikipedia [3] Composition of the Human Body, Wikipedia [4] Human Microbiome, Brady Barrows

Azithromycin, a treatment for rosacea, is being investigated as a treatment for COVID-19. One study states, "Studies suggest beneficial effects of azithromycin in reducing viral load of hospitalized patients, possibly interfering with ligand/CD147 receptor interactions; however, its possible effects on SARS-CoV-2 invasion has not yet been evaluated. In addition to the possible effect in invasion, azithromycin decreases the expression of some metalloproteinases (downstream to CD147), induces anti-viral responses in primary human bronchial epithelial infected with rhinovirus, decreasing viral replication and release." [1] MedScape reports, "This small open-label study of hydroxychloroquine in France included azithromycin in 6 patients for potential bacterial superinfection (500 mg once, then 250 mg PO daily for 4 days). These patients were reported to have 100% clearance of SARS-CoV-2. While intriguing, these results warrant further analysis. The patients receiving combination therapy had initially lower viral loads, and, when compared with patients receiving hydroxychloroquine alone with similar viral burden, the results are fairly similar (6/6 vs 7/9)." [2] "Though azithromycin is an antibiotic and thus ineffective alone against viruses, some clinicians have seen limited success in COVID-19 coronavirus disease patients when adding it to chloroquine (Aralen) and/or hydroxycholoroquine (Plaquenil) in the sickest patients." [3] Coronavirus and Rosacea Azithromycin for Rosacea End Notes [1] Stem Cell Rev Rep. 2020 Apr 20 : 1–7. CD147 as a Target for COVID-19 Treatment: Suggested Effects of Azithromycin and Stem Cell Engagement Henning Ulrich and Micheli M. Pillat [2] What is the role of hydroxychloroquine plus azithromycin in the treatment of coronavirus disease 2019 (COVID-19)?, David J Cennimo, MD, Scott J Bergman, Keith M Olsen, MedScape [3] azithromycin (Zithromax): Potential COVID-19 Combo Drug, Omudhome Ogbru, Jay W. Marks, MD, MedicineNet

Chloroquine, a treatment for rosacea, is now being investigated as a treatment for the coronavirus. One report states, "Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome." [1] Another report states, "Chloroquine is effective in preventing the spread of SARS CoV in cell culture. [2] "But it is not yet clear how well hydroxychloroquine and chloroquine work in patients with COVID-19." [3] "Chloroquine seems to block the coronavirus in lab studies. There's some anecdotal evidence from doctors saying it has appeared to help," says James Gallagher, BBC health correspondent. [4] "A research trial of coronavirus patients in Brazil ended after patients taking a higher dose of chloroquine, one of the drugs President Trump has promoted, developed irregular heart rates." [5] "So until these or any drugs have been shown to be effective against SARS-CoV-2 in clinical trials and have been approved by the FDA, no one should be self-medicating." [6] More on Coronavirus and Rosacea 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. End Notes [1] Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-188. doi: 10.3760/cma.j.issn.1001-0939.2020.03.009.[Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia]. [2]Virol J. 2005; 2: 69. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread Martin J Vincent,1 Eric Bergeron, Suzanne Benjannet, Bobbie R Erickson, Pierre E Rollin, Thomas G Ksiazek, Nabil G Seidah, and Stuart T [3] Treating Coronavirus With Plaquenil and Aralen, Reena Mukamal, American Academy of Ophthalmology [4] Coronavirus and chloroquine: Is there evidence it works? By Jack Goodman and Christopher Giles, BBC Reality Check, BBC News [5] Small Chloroquine Study Halted Over Risk of Fatal Heart Complications, By Katie Thomas and Knvul Sheikh, The New York Times [6] Could Chloroquine Treat Coronavirus?, By Katherine Seley-Radtke, The Conversation US on March 27, 2020, Scientific American

There is at least one paper that includes Chloroquine (Aralen, Chloroquine FNA, Resochin, Dawaquin, and Lariago) along with Mepacrine in the treatment of rosacea. [1] Chloroquine is listed with the other Anti-parasitic Prescription Agents For Rosacea. "Chloroquine is an aminoquinolone derivative first developed in the 1940s for the treatment of malaria. It was the drug of choice to treat malaria until the development of newer antimalarials such as pyrimethamine, artemisinin, and mefloquine. Chloroquine and its derivative hydroxychloroquine have since been repurposed for the treatment of a number of other conditions including HIV, systemic lupus erythematosus, and rheumatoid arthritis." [2] Chloroquine is also a treatment for rosacea that is being considered to treat coronavirus along with others which we are posting here. [3] A search for anecdotal reports of using chloroquine for rosacea found none. If you find any, please post in this thread. End Notes [1] Br J Dermatol. 1955 Dec;67(12):421-5. Mepacrine and chloroquine in the treatment of rosacea. BRODTHAGEN H. [2] DrugBank [3] Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-188. doi: 10.3760/cma.j.issn.1001-0939.2020.03.009. [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia].

Artesunate is another anti-parasitic agent used to treat rosacea. A paper published June 2018 in Molecular Medicine Reports concluded, "In conclusion, the therapeutic and antimicrobial effect of artesunate on rosacea caused by D. folliculorum infection was demonstrated. The present study provided reliable data for future animal experimentation and clinical research. Artesunate may be a promising novel therapeutic method for the treatment of rosacea." Mol Med Rep. 2018 Jun;17(6):8385-8390. doi: 10.3892/mmr.2018.8887. Epub 2018 Apr 16. The therapeutic effect of artesunate on rosacea through the inhibition of the JAK/STAT signaling pathway. Li T, Zeng Q, Chen X, Wang G, Zhang H, Yu A, Wang H, Hu Y. Full text "Artesunate is part of the artemisinin group of drugs that treat malaria. It is a semi-synthetic derivative of artemisinin that is water-soluble and may therefore be given by injection." DrugBank

Johns Hopkins University is sponsoring a clinical trial of using Timolol for the Treatment of Acne and Rosacea which started in March 2016, with an Estimated Primary Completion Date of March 2019 and an Estimated Study Completion Date of March 2021. [1] Timolol (brand names Betimol, Istalol) is "a nonselective beta-adrenergic antagonist given in an eye drop solution to reduce intraocular pressure, or pressure in the eyes. It is also used in tablet form as a drug to treat hypertension." DrugBank A study concluded that topical timolol maleate 0.5% is 'expected to be beneficial' in improving 'both acne and rosacea': "In our study, topical timolol maleate 0.5% demonstrated effectiveness in the treatment of acne, especially in noninflammatory lesions, but seems to be more effective in erythematotelangiectatic rosacea than papulopustular rosacea lesions, with insignificant side effects. The addition of topical timolol to the standard treatment protocol for acne and rosacea is expected to be beneficial, especially by way of improving comedones of acne and resistant inflammatory erythema of both acne and rosacea." J Clin Aesthet Dermatol. 2020 Mar; 13(3): 22–27. Efficacy of Topical Timolol 0.5% in the Treatment of Acne and Rosacea: A Multicentric Study Sahar M. Al Mokadem, MD, Al-Shimaa M. Ibrahim, MD, and Abeer M. El Sayed, MBChB -------------------------------------------------------------------------------------------------- J Am Acad Dermatol. 2021 Feb 03;: Topical Timolol 0.5% Gel-Forming Solution for Erythema in Rosacea: A Quantitative, Split-Face, Randomized, and Rater-Masked Pilot Clinical Trial. Tsai J, Chien AL, Kim N, Rachidi S, Connolly BM, Lim H, Alessi César SS, Kang S, Garza LA End Notes [1] Timolol for the Treatment of Rosacea

No, the RRDi doesn't have an Instagram account. I will send you a private email but if you are willing to volunteer for this that would be much appreciated. RedVelvet, why don't you create your own blog and monitor it?

* Sulphur or Sulfur* has been used to treat rosacea for over a hundred years. One patient with 'rosy drops' "was ordered Aug. 6, 1878, a mixture containing sulphate of iron and sulphate of magnesia, and for local application an ointment of sulphur, four parts, cosmoline, ninety-two parts. This was followed by rapid improvement, and when seen again on Sept. 17, all trace of the eruption had disappeared, and she felt much stronger and better." [1] "Sulfur acts as a keratolytic agent and also it has antibacterial activity. It also kills fungi, scabies mites, and other parasites. Precipitated sulfur and colloidal sulfur are used, in form of lotions, creams, powders, soaps, and bath additives, for the treatment of acne vulgaris, acne rosacea, and seborrhoeic dermatitis." [2] "Sulfur is a chemical element that is present in all living tissues. The most commonly used form of pharmaceutical sulfur is Octasulfur. After calcium and phosphorus, it is the third most abundant mineral in the human body. Sulfur is also found in garlic, onions and broccoli." [2] [also see end note 4 about sulphur's percentage in the human body] "Sulfur is converted to hydrogen sulfide (H2S) through reduction, partly by bacteria. H2S has a lethal action on bacteria (possibly including Propionibacterium acnes) which plays a role in acne, fungi, and parasites such as scabies mites. Sulfur acts as a keratolytic agent and also it has antibacterial activity. It also kills fungi, scabies mites and other parasites. Precipitated sulfur and colloidal sulfur are used, in form of lotions, creams, powders, soaps, and bath additives, for the treatment of acne vulgaris, acne rosacea, and seborrhoeic dermatitis." [2] "Sulfur is the tenth most common element by mass in the universe, and the fifth most common on Earth." [3] "Sulfur is the third most abundant chemical in the human body. The element is also found in a number of foods such as garlic, onions, eggs, and protein-rich foods. Sulfur is necessary for the synthesis of the essential amino acids cysteine and methionine." [4] [also see end note 4 about sulphur's percentage in the human body] Sulfur is available in non prescription and prescription [5] treatments. "Sulfur helps dry out the surface of your skin to help absorb excess oil (sebum) that may contribute to acne breakouts. It also dries out dead skin cells to help unclog your pores." [6] If you suffer from Dry Skin (Xeroderma) using sulfur exacerbates this issue. Sublimed sulfur is sulfur that has been purified through sublimation and is contained in the ZZ cream. Prescription Some of the prescription sulfur treatments are: Avar-e Green, Avar-e Emollient Creams for Moisturizing, Avar, Plexion, Plexion SCT, Plexion TS, Rosanil, Rosac, Rosula, Rosula NS Non Prescription The RRDi affiliate store has numerous sulfur treatments below: One of the RRDi's sponsors, Demodex Solutions, offers a treatment with sublimed sulfur, the ZZ cream. 3 PACK- 10%Sulfur & Ointment + (2) 10% Sulfur Soap, Amazing Formulas OptiMSM, Ancient Minerals Magnesium Gel Ultra with OptiMSM, Ancient Minerals Magnesium Oil Ultra with OptiMSM, Clearogen Acne Lotion -Sulfur, De La Cruz 10% SULPHUR OINTMENT, Gold Standard Organic Sulfur Crystals, Sulfur Butter, Dr. Berry's Multi-Purpose Mite Cream, Dr. Berry's Multi-Purpose Sulfur Creme, Dr. Berry's Starter Sulfur Pack, Zudiafu Soap, Mite-B-Gone 10% Sulfur Cream, Mitesil MultipurposeSulfur Cream, Ovante Scabiesun, Mite S Pack - Sulphur Wash, Cream, Ointments & Essential Oils Kit, PC NetwoRx Pure OptiMSM, Rugby Zinc Oxide Ointment, San Marcus 10% Sulfur & Ointment + (2) 10% Sulfur Soap (3 PACK), Scabisil Topical 10% Sulfur & Ointment, Sodium Bituminosulfonate Sulphur Soap (4 bars) by Braunfels Labs, Sunfood MSM Aloe Gel, 15% OptiMSM, Sunfood MSM Lotion/Cream with 12% OptiMSM, Yiganerjing Sulfur Soap, Zudaifu Soap, Zudaifu Sulphur Soap 3 Pack, Zudaifu Soap 6 Pack, 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. Footnotes *Sulfur sample image courtesy of Wikimedia Commons "Sulphur is an alternative spelling of the same word used in British English....In American English, sulfur has become standard." Sulfur or Sulphur: What’s the Difference?, Writing Explained "Brimstone, an archaic term synonymous with sulfur, evokes the acrid odor of sulphur dioxide given off by lightning strikes." Wikipedia Smoke rising from a volcano, which the phrase "fire and brimstone" is intended to evoke. Image courtesy of Wikimedia Commons End Notes [1] Gastrointestinal Rosacea [GR], aka, Gut Rosacea [2] Sulfur, DrugBank [3] Sulfur, Wikipedia [4] The Health Benefits of Sulfur, Cathy Wong, VeryWellHealth, states in her article that sulfur is "the third most abundant chemical in the human body", however, Wikipedia lists sulfur way down on its list of the Composition of the human body, showing that sulfur only comprises 0.3% of body mass. image courtesy of Wikimedia Commons [5] Cutis. 2004 Jan;73(1 Suppl):29-33. Evaluating the role of topical therapies in the management of rosacea: focus on combination sodium sulfacetamide and sulfur formulations. Del Rosso JQ [6] Can You Use Sulfur for Acne Spots and Scars?, Healthline

Rylar, keep us posted on your progress. Might want to read this post on GUT Rosacea. One treatment that may help which is natural and inexpensive is ElaineA's borax bath. Probiotics are another subject to consider.

Azathioprine image courtesy of Wikimedia Commons A study has determined that if you are undergoing any immunosuppressive treatments, i.e., Tacrolimus, pimecrolimus, cyclosporine, systemic steroid, chemotherapy, systemic glucocorticoids, cyclosporine, methotrexate, or azathioprine treatments, or have an immunocompromised condition, i.e. HIV, chronic renal failure, acquired immunodeficiency syndrome, that this "might increase the number of mites and demodicidosis should be kept in mind in patients on immunosuppressive treatment." In those in the tested group treated with immunosuppressive therapy "there was a statistically significant difference in Demodex density in patients treated with immunosuppressive therapy in the first and third months when compared with the control group (p < 0.05)." "The results of our study suggest that there is an association between immunosuppressive treatment and the number of Demodex mites." Medicina (Kaunas). 2020 Mar; 56(3): 107. Pre-Treatment and Post-Treatment Demodex Densities in Patients under Immunosuppressive Treatments Hacer Keles, Esra Pancar Yuksel, Fatma Aydin, and Nilgun Senturk "Non-deliberate immunosuppression can occur in, for example, ataxia–telangiectasia, complement deficiencies, many types of cancer, and certain chronic infections such as human immunodeficiency virus (HIV). The unwanted effect in non-deliberate immunosuppression is immunodeficiency that results in increased susceptibility to pathogens such as bacteria, and viruses." Wikipedia

When rosaceans use drugs, whether prescription or non prescription, drug interactions are a concern when you take more than one drug to treat your rosacea. Whether the drug is oral, topical, tincture, toner, injection, or in whatever other form there can be drug interactions with other drugs, food or drink or some other unknown factor. First, let's be sure we agree on what a drug is so we are all on the same page and what a drug interaction is as well. Drug "A drug is any substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via inhalation, injection, smoking, ingestion, absorption via a patch on the skin, or dissolution under the tongue." [1]. Drug Interaction So when taking a drug according to the definition above a drug interaction is defined as, "A drug interaction is a change in the action or side effects of a drug caused by concomitant administration with a food, beverage, supplement, or another drug." [2] Treating Rosacea with Drugs So the ideal setting is using one drug treatment for rosacea, i.e., topical metronidazole, the only drug interactions are with food, drink, and any other environmental factors to consider when using this treatment if you are not taking any other drugs at the same time. If, for example, you are taking aspirin or ibuprofen, what are the drug interactions to consider when applying the topical metronidazole? Also, what are the food and drink interactions to consider when taking topical metronidazole including any vitamins and supplements (considered food) you may be taking at the same time? For example, did you know that grapefruit juice can act as an enzyme inhibitor? St John's wort can act as an enzyme inductor. Garlic increases antiplatelet activity. Therefore, food or drink can interact with a drug. However, if you are only using one drug to treat your rosacea you don't have to consider whether another drug is interacting with the topical metronidazole which is an ideal situation. If you are taking other drugs at the same time no matter what the reason you are taking the drug, these other drugs or food can interact with the topical metronidazole. [3] When you take more than one drug treatment for rosacea at the same time, the drug interactions to consider are multiplied, and this increases when you add a third rosacea treatment and the complexity of the considerations of drug interactions increases with additional rosacea treatments. To sort out what is causing a particular drug interaction can be complex and difficult to resolve as you can imagine, when you should rule out all these different factors to consider. Synergism and Antagonism Factors Synergism in medicine is the creation of a whole that is greater than the simple sum of its parts, i.e., the combined effect of taking two barbiturates is greater than taking each one at a time (combining the drugs leads to a larger effect than expected). The gold standard treatment for rosacea is a typical example of using synergism to treat rosacea. Another example is topical metronidazole and oral doxycycline together has a synergistic effect in treating rosacea. This is due to the synergistic effect of the two drugs interacting with each other. Sometimes synergism works out to the patient's benefit, but in some cases synergism can be negative which is what is termed Antagonism, "when synergy occurs at a cellular receptor level this is termed agonism, and the substances involved are termed agonists. On the other hand, in the case of antagonism, the substances involved are known as inverse agonists. The different responses of a receptor to the action of a drug has resulted in a number of classifications, such as "partial agonist", "competitive agonist" etc. These concepts have fundamental applications in the pharmacodynamics of these interactions." [2] Pharmacodynamics and Pharmacokinetics "Pharmacodynamics is the study of how a drug affects an organism, whereas pharmacokinetics is the study of how the organism affects the drug. Both together influence dosing, benefit, and adverse effects." [4] Pharmacists are trained in these two subjects and can answer more questions about any of your drug interaction questions better than most physicians. Drug Interactions to Consider When Treating Rosacea In this section we will be considering what drug interactions need to be considered in treating rosacea, and this is a work in progress. If you have something to consider, why not volunteer and reply to this post. Antibiotics If you are using antibiotics to treat your rosacea, whether low dose or high dose, particularly one of the tetracycline class treatments, i.e., Oracea, doxycycline, minocycline, if you are taking at the same time as calcium, iron, antacids like Tums or Maalox, or foods such as milk, cheese, nuts, or medications or supplements that contain calcium or iron these are factors to consider whether the antibiotic will be successful or interfere with the treatment side effects. [5] more to come.... End Notes [1] Drug, Wikipedia [2] Drug Interaction, Wikipedia [3] A partial list of drug interactions to consider with topical metronidazole are Antabuse (disulfiram), Anticoagulants, Dilantin (phenytoin), Hismanal (astemizole), Lithobid (lithium), Phenobarbital (Luminal and Solfoton), Tagamet (cimetidine), Vitamins, Alcohol, and the list continues. See Everyday Health Interaction with Metronidazole [4] Pharmacodynamics, Wikipedia [5] Antibiotics, Interactions, Everyday Health

Could someone explain to me why rosaceans prefer donating to the the NRS, the AARS, the ARSC, or the AAD instead of the RRDi? Why do they think it is ok for Sam Huff's two private corporations to receive about 60% of all the National Rosacea Society donations received over a twenty year period which amounts to over $9.8 million dollars (see spreadsheet) and they CONTINUE to donate to the NRS. Why is it that with over 1300 members in the RRDi no one posts? No one really cares if the RRDi dissolves? Really? It is so sad. I have given a lot of what I do for rosacea sufferers for FREE to anyone who wants a copy of either of my two books, Rosacea 101 or the Rosacea Diet. All you do is request a copy when you join the RRDi. You at least have to join the RRDi before I give you a free copy. Is that too much to ask? Join the RRDi. All that is required is you donate for a subscription. Is that too much to ask? You may want to also read my review of Soolantra or my ZZ cream review. In the meantime, why not read all of my recent activity in behalf of the RRDi: I have written some posts that I think are worthy of reading: Cytokines and Rosacea Simple Regimen Controlling Rosacea IPL for DED Co-Existing Conditions with Rosacea Blepharokeratoconjunctivitis (BKC) and Rosacea Coronavirus and Rosacea Drug Interactions in Treating Rosacea ZZ Cream Anecdotal Reports Risk-benefit Ratio in Rosacea Research & Development Artemisinin (ART) Steve Johnson, D.O. Resigns from RRDi Board of Directors Demodex-induced follicular mucinosis Butterfly Effect in Rosacea Simple Regimen Controlling Rosacea Read my reply to Kara in the third post of this thread Proton Pump Inhibitors Theory Black Raspberries for Rosacea? Topical Retinoids Grassroots Non Profit Organization Azelaic Acid 15% Foam (AAF) vs Metronidazole Cream (MC) and Metronidazole Gel (MG) Using the Skin Microbiome to Clear Rosacea Rosacea Prescription Market Minocycline Topicals for Rosacea I also added a number of items to the affiliate store. You can review all the recent activity with this url: https://irosacea.org/discover/

"South Dakota Gov. Kristi Noem on Monday announced a statewide clinical trial of hydroxychloroquine for the possible treatment of COVID-19, making her state the first in the country to institute a program exploring the potential effectiveness of the drug in treating and preventing coronavirus." South Dakota implements statewide hydroxychloroquine clinical trial for potential coronavirus treatment, Fox News

Skin Manifestations in Coronavirus "The novel coronavirus may cause dermatological symptoms such as pseudo-frostbite, hives and persistent, sometimes painful redness, as symptoms that affect the body outside the respiratory system continue to be found that may be associated with coronavirus infections, according to the French National Union of Dermatologists-Venereologists (SNDV – skin and sexually transmitted disease doctors)." Dermatological symptoms may be the latest new coronavirus symptom Pseudo-frostbite, hives and redness may appear with or without respiratory symptoms. By TZVI JOFFRE APRIL 12, 2020 17:54, The Jerusalem Post ------------------------------------------------------- "The symptoms range from hives to measles-like rashes to a condition resembling frostbite." Coronavirus News: Skin rashes emerge as possible symptom of COVID-19, dermatologists say, April 18, 2020, Jory Rand, Eyewitness News, WABC-TV 7 ------------------------------------------------------ "There have been increasing reports of dermatologic manifestations of coronavirus disease 2019 (COVID-19). The first case series of dermatologic manifestations included 18 Italian patients with erythematous, urticarial, and vesicular rashes, often on the trunk. Other reports include drug hypersensitivity, urticaria, apetechial rash mimicking dengue, and acro-ischemia. It is important to further characterize dermatologic manifestations of COVID-19 in order to understand the relationship between the virus and skin, and determine whether cutaneous manifestations of COVID-19 may assist with early disease detection. To date, collecting cases of dermatologic manifestations of COVID-19 has been challenging given their relative infrequency and the rapid spread of COVID-19." Freeman EE, McMahon DE, Fitzgerald ME, Fox LP, Rosenbach M, Takeshita J, French LE, Thiers BH, Hruza GJ, The AAD COVID-19 Registry: Crowdsourcing Dermatology in the Age of COVID-19, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/ j.jaad.2020.04.045. Other dermatological papers related to this subject are cited at the University of Nottingham The Science Times reports, "Two different Chinese doctors who were both critically ill from the coronavirus have actually seen their skin turn dark right after being brought back to life from the brink of death. Dr. Hu Weifeng and Dr. Yi Fan, had previously caught the virus when they were treating patients at the Wuhan Central Hospital back in January." - Another report about this from the New York Post. "Skin manifestations were observed in about one-fifth of a group of patients with COVID-19 in the Alessandro Manzoni Hospital in Lecco, in northern Italy.", Skin manifestations are emerging in the coronavirus pandemic, The Hospitalist

FREE jar of the ZZ cream! Below are anecdotal reports of ZZ cream use collected over a great deal of investigative time for your benefit and the end notes show the source of the report usually found at RF since members at the RRDi are reluctant to post. The ones below are positive, and if you have the time you could post your investigation on the negative ones which I don't have the time for (maybe you do?). You may review my post on the ZZ cream and for a more recent update visit my blog (scroll down to my first comment) for a recent photo. I stumbled upon a negative post about the ZZ cream started by tatejones [6] on September 11, 2013 that has a significant number of positive reports which I am listing below. Starlite tried to explain to tatejones in the second post that it might be caused by the mite die off (Gets Worse Before it Gets Better) issue. Note the positive reports from different threads about the ZZ cream mostly at RF: akas akas started a thread on January 2, 2007 with the first post stating, "Based on how it's worked on my nose so far in 12 days, I'm slightly encouraged and will continue to use it and have a little hope it can return my nose to normal-ish levels (but I've been disappointed many times before so expectations aren't really exactly high either). " [7] anemicroyalty "Almost finished 7 weeks and my skin is actually looking pretty good right now." [9] antwantsclear "I used Soolantra initially and it was a little helpful, but I've found Zhongzhou cream a lot more helpful." [12] beherenow beherenow started a thread on the ZZ cream January 15, 2020 and gave up after three days, however, I am listing this because beherenow wanted to know if the ZZ cream helps erythema. [4] chchchanging chchchanging started a thread about the ZZ cream on July 7, 2011 with his first post stating he had been using for 1.5 weeks [8] chchchanging posted on November 5, 2011, "...I think its been about 4 months since I started. Things are still going really well. Not 100% perfect but its progressed enough that I don't think much about the condition of my face anymore...." post #17 [8] DukeCity "I wasn't a believer either until I decided to try the ZZ cream, now after using it since about May 1st, I believe! I have no rosacea, after 15+ years of dealing with this crap, my skin is clear and normal." - DukeCity post no 6 [6] Faith1989 "I have been using ZZ cream for a while now (not consistently) just because sometimes I forget. It has helped my skin a lot, I only had flushing. Like last night I didn't use it and flushed today and my eyes burn. I think it helps for sure." Faith1989 4/27/2016 post #39 [8] guest "Hey guys, the z cream works.... I am living proof and you can see my pictures on the rosacea support group under the photos section. The best advice I can give you is give it at least 6 monhs minimum to see marked improvement, you must have alot of patience, its like a roller coaster ride, there will be alot of ups and downs along the way but keep going, you can itch, look worse, break out, skin is dry, ....but it will get better with time and patience and I used the z cream nightly (not too late though) this is when the mites are most active, put water, and then a thin layer of z cream dont over do it!" guest 1/13/2007 post #46 [7] hencloud1 "I am still using the Z cream which does seem to have helped but still getting a few P&Ps and still some deep ones." post no 41 [10] "I put the improvement down to the zz cream. I haven't been using anything else... " post no 71 Simon [10] Kirk In the fifth post of chchchanging's thread, Kirk posts, "...Its an ongoing battle, and the ZZ can only do so much. I feel its important to change/wash your pillow cases frequently.... probably every 3rd or every other day at the minimum. Ive also started using the ZZ during the day, where I was only using it at night. If I have any p&ps anywhere on my face when I wake up, I dab just a little bit of ZZ on those areas, but I dont use it all over my face like I do at night. I feel like this has kept the stubborn areas under control throughout the day. 2 months ago I never thought Id be able to put it on more than once, but your skin become more tolerable to the harshness of the ZZ (at least mine did and I have SUPER sensitive skin). So dont be afraid to fiddle with your routine and find something that works for you..." [8] "Im 7 weeks into using ZZ and my skin is finally starting to be a little more consistant." post no 7 [8] Judworth Judworth posted his report on the ZZ cream starting December 8, 2019 and posted after nearly two months on February 3, 2020, "I have been more than happy with the results, use 5 out of 7 nights and often over an oil-based night product (which really helps to reduce dryness). The face that now looks back at me is pale and although I obviously will never lose those pesky thread veins, they are much paler! All-in-all a real success for me!" [2] KSD69 "The ZZ has helped ... soothing, seems to reduce the redness and really helps to keep the oiliness down..." KSD69 post no 18 [2] Libby2018 "I've been using the zz cream for 8 days now (once a day at night). The overall redness has subsided by over 55-60%, my skin is much smoother where it used to feel like sandpaper before, it's far less itchy, papules and postules have shrunk, bumps have greatly shrunk in a week (incl. those that appeared a couple of days ago) whereas before it would have taken weeks, the skin looks calmer and not angry or as inflamed as it did before and, finally, the spots and redness along the jawline have almost disappeared." Libby2018 post no 148 [6] Lobster222222 "...I have used the zcream for around 5 months now and at about 2-3 months of using it the mites started to come back after being gone for awhile, I mean my rosacea was under controll and my skin was smooth, and then out of the blue I was getting breakouts again and redness (especially after I ate) granted the pustules and papules would go away quickly, but they were a pain nonetheless. You have to add more to the zcream treatment to really get rid of the mites for good, and I have found using the zcream for at least a month or two gets your face prepared for this more aggressive treatment..." Lobster222222 1/13/2007 post #45 [7] mapleleaves "yes, zz cream really works! at least it did for me. zz cream every night and within two months my skin was almost clear. after the initial breakout from the dying mites my skin was already noticeably improving after a week. I highly recommend it. This stuff makes a big difference! " mapleleaves 11/30/2015 post #33 [8] MariaSt "Asm, keep going. It seems that you are going to be benefited by the zz cream. The dryness and redness are only temporary. I have been using the zz cream twice a day for quicker results. When the dryness was at its worst and zz cream would be visible on my skin, I applied it only in the evenings. In the mornings I used boric acid 2%, it lessened the flakes without worsening the dryness and I was 100% sure it wouldn’t feed demodex or any other bacteria." MariaSt post no 63 [6] Mikhala "This stuff absolutely works. I've been dealing with acne/rosacea for years. I WISH I had the ZZ cream all those years ago. After 3 weeks, my face is almost completely clear." Mikhala post no 162 [6] Millie "Day 19...Then, I applied the zzcream and went to bed, woke up, had my coffee, looked in the mirror......AND NO FLUSHING!!!!!!!! NO REDNESS!!!!!!! Just little red broken cappillaries. Did I mention that I am having PMS as well? Think it is a result of the ZZ cream?" January 31, 2007,post no 66 [7] Mistica "I too use ZZ cream along with other things, and find it a very useful tool in my toolbox, but for most people, a multi approach is necessary." Mistica post no 157 [6] "...I'd like to add, btw, that zz cream is the most effective product I have used against p&p, they fade in two days..." MariaSt 6/17/2018 post #99 [7] "I would advise any rosacean or flusher to give ZZ Cream a whirl and if necessary mix it with a topical you can tolerate." Mistica, post no 16, Rosacea Forum Mothinrust Mothinrust started a thread on the ZZ cream on December 16, 2019 and posted after two months on January 18, 2020, "I'm sure you've read my updates. My face is so soft and smooth from using ZZ cream. All flakiness and dryness gone. And to be honest with you that alone is worth using it. All traces of Seb derm are gone and I havent seen any P&Ps in weeks now." [5] red-hotoz "I've been applying the ZZ for just over 7 weeks now and believe there has been some improvement with the p&ps." Jen, October 11, 2006, post no 91 [10] "I'm glad there is a new thread now running on ZZ. I hesitated for a long time before trying it but really pleased that I finally gave it a go. I don't really care if I have excess Demodex Mites or not...what I do know is that it helps to keep my p&p's at bay. Not perfect but better than anything else I've tried! What I have learnt though is that when I am stressed out, it doesn't matter what I'm doing for the control of my Rosacea beast...a breakout will happen! Urgh! Well, at least they are not nearly as severe as before and at least no more swelling on my face! YEAY!!! I mean, to be able to count or to 'work on' a few p&p's is not so bad!...Oh, one last thing. I don't work for Demodex Solutions nor do I have any monetary connection with them. I decided to try ZZ after reading about it from other's posts over a long period of time. Then my final 'hand in pocket' was after watching Simon's progress over several months. I'm glad I did though." redhotoz post no 26 on 7th January 2007 [7] RedRecluse RedRecluse ordered the ZZ cream on May 5, 2017 who became an avid fan of its use and posts his detailed treatment with lots of daily photos and wrote on Septeber 8, 2017, "I really do believe ZZ Cream is a miracle product for many skin conditions (it cured my Seborrhoeic Dermatitis and Eczema too)." You can view his clearance which took approximately four months progressively with his photos in the thread. There are others who report their use of the ZZ cream in this 21 page thread (as of this date). [1] redvelvet redvelvet started her thread on the ZZ cream on December 1, 2019 and posted on April 7, 2020 (over four months later), " I only used ZZ cream as my external form of treatment because I'd had it with medications that made it so much worse, and I was afraid to try lasers. I know meds and lasers help many people, but I wanted to try natural treatments first to address demodex. Luckily ZZ is quite remarkable and I had amazing success treating the marks, bumps, pustules, papules, enlarged pores and sandpaper like feel of my skin. It helped quite a lot with the redness too, but I'm pretty convinced that the flushing was due to gut and liver issues, as well as spleen. I'm happy to say I haven't flushed in quite sometime now, maybe months." By the way redvelvet is a doctor of chiropractor and volunteers on the RRDi MAC. [3] Tioh2001 "In September 2004 I began using the ZZ ointment, which got me clear of p&p's in just a few days. Then in February 2005, after I had been using the ZZ ointment for about 6 months, I decided to take a break from it." Heather, June 21, 2006, post no 26 [10] "I have personally found nothing better than the ZZ ointment." Heather, July 21, 2006, post no 59 [10] "Once you have completed the 120 days, you should the try using the ZZ ointment every other day....then every 3rd day....until you find the right maintenance schedule for yourself." Heather, July 31, 2006, post no 61 [10] "The ZhongZhou ointment from www.demodexsolutions.com eliminated this problem. My pores are no longer plugged, are signficantly smaller looking, and the greasiness has been reduced by about 95%. My nose no longer swells and no longer gets skin buildup/flakiness." Heather, January 2, 2008, post no 3 [11] ---------------------- Note: The above anecdotal reports are in alphabetical order according to their display name. This is still under construction and will be updated with more reports. If you have an experience using the ZZ cream why not post in this thread your comment. Find the reply button and volunteer to help other rosacea sufferers. 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. End Notes [1] RedRecluse - URGENT help please, I've never woken up with it this bad. Desperate! (w/ pics) [2] Judworth - Zhongzhou Cream Judworth started another thread on the ZZ cream on January 29, 2020 and states on post no 34 (February 12, 2020), " I am using only about 4 times a week now, still with the same great results!" [3] redvelvet - Started ZZ Cream today (with Pic) At post no 72 she reports, "It's been a while since I posted an update, but wanted to let you all know I'm still a huge fan of ZZ Cream. My skin continues to lighten and I really don't even feel "red" anymore. Thank you redrecluse for sharing your story, because that was the first post I read which inspired me. I really think I should buy a lifetime supply of ZZ incase, God forbid, they ever stop making it. It has changed my life. Actually, this website has, because this is where I first heard of demodex mites and ZZ cream. Thank you Brady Barrows!! I have been so inspired to share what I've learned with other rosaceans who are walking around completely unaware of demodex mites and the fact that there might be a cure to their rosacea. Some people on this forum have asked me for more specifics about the gut cleanse/detox I did and the products I used. (All Standard Process). So I started a blog/website, www.rosaceahelp.org which goes into much more detail about gut health, cleanses, diet, facial products, this amazing website, the RRDI, and of course Zhong Zhou cream. I am hoping to add more content as I learn more, and hoping others will share their success stories there as well." [4] beherenow - ZZ cream for Type 1 or am I wasting my time? [5] Mothinrust - Severe die off from zz after first use? [6] tatejones - zz cream - so scared my face is ruined forever... [7] skas - My experiences with the infamous ZZ cream so far [8] chchchanging - My Story with ZZ Cream] [July 7, 2011, post no 1] [9] anemicroyalty [post no 33] [10] hencloud1 (Simon) - My photos (photos there now!) [11] Bonefish - Any "purifying" ointment? [12] antwantsclear [post no 14]

I have experimented using the Blog tool that is provided for free for our members and posted a comment. Maybe members would like to create their own blog?