Guide

Brady Barrows, March 2020 So I thought I would experiment with my blog to see if anyone is interested in what I am writing. With all the coronavirus news and having to stay at home, I have been spending more time with the RRDi writing posts and trying to get donations. It is mind boggling to me that with over 1300 members no one is posting and the donations are basically nothing to speak of and I wrote this post on March 20 explaining that if the RRDi doesn't get donations we will have to dissolve the non profit for rosacea and everyone will just have to live with the NRS, the AARS, the ARSC, or the AAD as what would be left since these organizations have lots of donations. Watch this video about the RRDi: So I thought I would write about what the RRDi has accomplished: (1) A website with a huge amount of rosacea data in the member forum. The subjects are organized in methodical categories on rosacea topics. (2) Received a total of three education grants from Galderma. Now if you want to help with this, it is a painstakingly arduous task and if you ever wonder why grant writers get paid for this, why not VOLUNTEER like two of our members did and see what hoops you have to go through to get an education grant. Right now, volunteers are basically down to two of us and I am keeping the website going and Apurva is helping. Basically we are it. There are no other volunteers, period. (3) We have done all this with volunteers. No one has a salary or is employed. Now check out the other non profit organizations and see if they do what they do for rosacea sufferers with only volunteers, and if you really investigate, what is the motive behind the other non profit organizations for rosacea? So today I discovered that the PayPal donation button wasn't working at all and discovered in the PayPal community that this is a common issue with the donate form button and changed how we use PayPal with the PayPal Giving Fund and using the PayPal.me/ link which seems to be mo'betta as they say in Hawaii. That took a while to figure out. RF still has some members that post, so I check out what's happening there and posted a bit over there. Yesterday I wrote an incredible post about the Risk-benefit Ratio in Rosacea Research & Development. I then checked what I did yesterday and it was a lot, adding several items to the RRDi affiliate store and calling Steve Johnson, D.O., who has served on the RRDi board of directors for many years and couldn't get ahold of him but managed to talk to his receptionist who after consulting with Steve tells me he is too busy to volunteer anymore for the RRDi and resigned so I posted all about this. If you note on Steve's website he shows he serves on our board of directors. I mentioned this to the receptionist. By the way, you can create your own blog and it will be controlled by you. Every member can have their own blog and it is included when you donate for a subscription. Besides that, we have galleries and everyone can have their own gallery. You would think that with over 1300 members we would have at least 1300 photos of rosacea from our members but alas, the members are not only silent, they are also shy. I won't even mention clubs, but I think I just did. I still haven't figured out the difference between a blog and a club. Maybe Invision Community might explain it. So a while back I experimented going over to Reddit and Facebook rosacea groups and discovered that the rules over there are completely different, like PRIVATE groups, that don't allow you to refer to anything they post since it is PRIVATE and by doing this I committed an unforgivable sin. I removed the links that some were so offended I referred to about their rosacea post from our RRDi website and they treated me like I was Adolph Hitler or Judas. Also, linking to any RRDi page or post is absolutely forbidden in these private groups, even though these same private groups allow links to the NRS or the AAD non profit organizations and frequently refer to these two non profits. To me, I just don't understand why rosaceans prefer Reddit or Facebook. It is so difficult to navigate through all the posts on a particular search on a topic. And what I found is that the ones in the 'private' groups are very opinionated and judgmental, and berated the RRDi, preferring the AAD or the NRS. So I decided to simply work more on the RRDi website and try to keep it going. Who knows, it may not work, and all the data on the RRDi website will be lost. Oh, I forgot, there is the wayback machine. However, sometimes even the wayback machine doesn't have what I am looking for. So how am I controlling my rosacea? I try to stay on my Rosacea Diet. However, I do cheat. I also take tons of vitamins and supplements. I take 12.5 mg of Carvedilol twice a day. I take ElaineA's salt/borax bath just about every day. If I get any pimples/pustules I dab on the ZZ cream. I have been having some issues with SD on the back part of my scalp near my neck so I sometimes use Sulfur Butter or Equate Coal Tar Shampoo, and recently I just purchased Yesto Tree Tea Scalp Treatment (too early to tell if it helps). My review of Soolantra and the ZZ cream. I will post in my blog what I am currently doing to treat my rosacea/SD. If you scroll to the last post you will see the latest treatment.

Watch the video Rosacea Research Every medical student learns about the risk-benefit ratio in medical research and in treatment. "For research that involves more than minimal risk of harm to the subjects, the investigator must assure that the amount of benefit clearly outweighs the amount of risk. Only if there is a favorable risk–benefit ratio may a study be considered ethical. The Declaration of Helsinki, adopted by the World Medical Association, states that biomedical research cannot be done legitimately unless the importance of the objective is in proportion to the risk to the subject. The Helsinki Declaration and the CONSORT Statement stress a favorable risk–benefit ratio." [1] Rosacea Treatment For a rosacean, it would be prudent to understand what the risk-benefit data is for any rosacea treatment being considered. If you are seeking medical treatment from a physician, legally the risk/benefit ratio should be provided to the patient clearly in terms that the patient can understand. What are the risks involved and what are the benefits for a particular rosacea treatment? Clearly the benefits should outweigh the risks, however, because the Benefit-risk assessment (BRA) mainly relies on a qualitative assessment of quantitative data, there is sometimes subjective or qualitative bias involved in the presentation of the data by the medical practitioner and also in the decision of the rosacea patient. Also the placebo/nocebo effect may be involved as well, which is a factor not only in the outcome of the treatment, but also in the decision of the patient in the process of accepting or rejecting the treatment . [2] Bias For an example, take the common bias in the perception of risk in flying vs driving. Some feel that flying is more risky than driving, however, statistics show otherwise. The bias in this case is subjective or qualitative on the quantitive data. "In the end in any given situation, the acceptable risk-to-benefit balance is an individual judgement on the part of the patient or the prescriber." [3] Double-Blind Due to this bias, clinical research studies use 'double-blinded' techniques. "In a blind or blinded experiment, information which may influence the participants of the experiment is withheld (masked or blinded) until after the experiment is complete. Good blinding can reduce or eliminate experimental biases that arise from a participants' expectations, observer's effect on the participants, observer bias, confirmation bias, and other sources." [4] "Most often, single-blind studies blind patients to their treatment allocation, double-blind studies blind both patients and researchers to treatment allocations, and triple-blinded studies blind patients, researcher, and some other third party (such as a monitoring committee) to treatment allocations. However, the meaning of these terms can vary from study to study." [4] "The double-blind randomized controlled trial (RCT) is accepted by medicine as objective scientific methodology that, when ideally performed, produces knowledge untainted by bias. The validity of the RCT rests not just on theoretical arguments, but also on the discrepancy between the RCT and less rigorous evidence (the difference is sometimes considered an objective measure of bias)." [7] Placebo/Nocebo Effect "Evidence for the relevance of placebo and nocebo effects in dermatology is also increasing...A large proportion of the success or failure of dermatological treatment can be explained by factors other than the treatment mechanisms themselves. Placebo and nocebo effects, in particular, strongly contribute to treatment outcomes, with explained variances comparable to, for example, effects of analgesics or antidepressants....the placebo responses and positive expectations of patients will only endure if they are based on trust in a long‐term authentic relationship. Highly optimistic promises followed by limited effects will probably result in nocebo instead of placebo effects." The placebo/noebo effect is a significant factor in whether a rosacean decides to accept a treatment or reject it as well as a huge factor in the outcome of the treatment. [5] Criteria for Assessing Risk-Benefit "The concept of risk is generally understood to refer to the combination of the probability and magnitude of some future harm. According to this understanding, risks are considered "high" or "low" depending on whether they are more (or less) likely to occur, and whether the harm is more (or less) serious." [6] Benefit-risk Assessment Of course, there are a number of rosaceans who give absolutely no consideration to the risk-benefits of any given rosacea treatment (rely totally on what a physician proposes without hesitation, inquiry or investigation into this subject), while others investigate these risks-benefits in methodical and incredible details. For example, what is involved in investigating PDT for rosacea? One other assessment is understanding the X-Factor in rosacea. Informed Consent Informed consent is the right of each patient and the responsibility of the medical practitioner. However, in over the counter or non prescription treatments for rosacea the responsibility of gathering the risk-benefit data relies totally on the rosacean, who relies heavily on anecdotal reports and very little scientific data, if any, probably in both cases provided by the promoter of the rosacea treatment under consideration. Independent verified anecdotal reports are highly valued, but as many have discovered, anecdotal reports can be faked. What can help in making an assessment with a proposed rosacea treatment? A principle to consider is, 'a treatment causes benefit in many at the cost of serious injury in some.' Obviously if this principle is reversed, 'a treatment causes serious injury in many at the cost of benefit in some' would you accept the treatment? That would depend on how bad your rosacea is, now wouldn't it? The dilemma in this decision is understanding whether the data that is presented is valid or biased. That is what research and development is all about and why the RRDi was formed and a principle found in our mission statement (see Goal #4). Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Risk-benefit ratio, Wikipedia [2] Dialogues Clin Neurosci. 2011 Jun; 13(2): 183–190. Assessing the benefit:risk ratio of a drug - randomized and naturalistic evidence François Curtin, MD and Pierre Schulz, MD [3] Drug Saf. 1996 Jul;15(1):1-7. Concepts in risk-benefit assessment. A simple merit analysis of a medicine? Edwards R, Wiholm BE, Martinez C. [4] Blinded Experiment, Wikipedia Blinded Experiment, Terminology, Wikipedia [5] Placebo/Nocebo Effect in Rosacea [6] The Assessment of Risk and Potential Benefit, Chapter 4, Biotech Archive, Georgetown University [7] J Clin Epidemiol. 2001 Jun;54(6):541-9. doi: 10.1016/s0895-4356(00)00347-4. The double-blind, randomized, placebo-controlled trial: gold standard or golden calf? T J Kaptchuk

Artemisia Image Courtesy of Wikimedia Commons "Artemisinin (ART), an anti-malaria drug, was reported to have several effects including anti-inflammation and anti-angiogenesis activities. However, the role of ART on rosacea remains unclear....ART ameliorated rosacea-like dermatitis by regulating immune response and angiogenesis, indicating that it could represent an effective therapeutic option for patients with rosacea." Biomedicine & Pharmacotherapy Volume 117, September 2019, 109181 Artemisinin, a potential option to inhibit inflammation and angiogenesis in rosacea Xin Yuan, Ji Li, Yangfan Li, Zhili Deng, Lei Zhou, Juan Long,Yan Tang, Zhihong Zuo, Yiya Zhang, Hongfu Xie Artemesinin is on the list of anti-malaria treatments used for successful rosacea treatment. Technically, artemisinin is not an anti-viral, but an anti-malaria treatment used on Plasmodium falciparum, a protozoa. Hopefully, we will hear of anecdotal reports of Rosaceans using artemisinin for rosacea with positive results. "Artemisinin derivatives are known for their ability to suppress immune reactions such as inflammation." Wikipedia "Artemisinin is extracted from the plant Artemisia annua, sweet wormwood, a herb employed in Chinese traditional medicine. A precursor compound can be produced using a genetically-engineered yeast, which is much more efficient than using the plant." Wikipedia Nicholas Bogosian posted about this treatment with a link. Artemisinin is available over the counter and considered one of the Anti-parasitic Prescription Agents. More information on artemisinin Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post.

More has been uncovered in a report published in Cell Reports, April 7, 2020 by Balka et al. who report, "We further demonstrate that TBK1 acts redundantly with IkB kinase ε (IKKε) to drive NF- kB upon STING activation." While this may be daunting to understand for a layman, James Ives, News Medical Net, explains the significance of this, "The two signalling arms of the cGAS-STING pathway were thought to be mediated by a single upstream kinase, TANK binding kinase (TBK1)...."That basically told us that the mechanism that drives the second cytokine pathway depends on both proteins, but that they act redundantly - if one's missing the other one does the job,"..." Read the clinical paper below: PIIS2211124720303703.pdf

It is with sad hearts that Steve Johnson, D.O., who has served for many years on the RRDi board of directors has resigned due to his busy work at his clinic. Steve will be missed.

One more differential diagnosis with rosacea is ruling out Demodex-induced follicular mucinosis (FM) from demodectic rosacea or for that matter, rosacea in general or of its variants. A report on this states, "Higher densities of mites correlate with increased perifollicular inflammation and clinical manifestations of disease. These cases support the hypothesis that a subset of idiopathic FM arises secondary to an aberrant immune response to Demodex. Given the typically robust response of Demodex to treatment with ivermectin, identification of this subset of patients would potentially provide significant clinical benefit." JAAD Case Rep. 2020 Apr; 6(4): 266–272.Published online 2020 Mar 24. doi: 10.1016/j.jdcr.2020.01.014. PMCID: PMC7109359Demodex-induced follicular mucinosis of the head and neck mimicking folliculotropic mycosis fungoidesMegan H. Trager, BA, Dawn Queen, BA, Diane Chen, MD, Emmilia Hodak, MD, Larisa J. Geskin, MD

Metronidazole (brand name Flagyl) has been used to treat rosacea for many years, not chiefly for its antibacterial component but more importantly for its anti-inflammatory treatment component. Metronidazole is also classified as an antiprotozoal treatment along with the larger category of anti-parasitic agents. Recently due to the coronavirus pandemic, metronidazole is being investigated to treat coronavirus. A paper published March 30, 2020 online in the Archives of Academic Emergency Medicine concluded, "Metronidazole, owing to its immunopharmacological behavior, plays a pivotal role in several essential biological processes. Based on the reported immunological manifestations of COVID-19 infection, it could serve as a potential candidate to counteract majority of the immunopathological features of the disease. Therefore, clinical trials with a large sample size are necessary to determine its efficacy in the treatment of COVID-19 infection." [1] Virus and rosacea has never, ever been ruled out. Metronidazole is just one treatment for rosacea that is being investigated along with other rosacea treatments. More on Coronavirus and Rosacea End notes [1] Arch Acad Emerg Med. 2020; 8(1): e40. Published online 2020 Mar 30. PMCID: PMC7114714 Metronidazole; a Potential Novel Addition to the COVID-19 Treatment Regimen Reza Gharebaghi, Fatemeh Heidary, Mohammad Moradi, Maryam Parvizi

Image courtesy of Wikimedia Commons Image courtesy of Wikimedia Commons A "study demonstrated a significant impact of the COVID-19 pandemic on the public interest in dermatology." This same report stated that in some periods during 2020 that "An initial decrease in interest was followed by a significant increase for acne, comedones, melasma, rosacea, botox, dermaroller, and peeling." [1] "Of note, some patients with COVID-19 with previous skin conditions such as rosacea, acne, eczema, and atopic dermatitis experienced a flare during the course of their disease." [2] "In some COVID-19 patients, preexisting skin diseases, such as atopic dermatitis, psoriasis, and rosacea have been exacerbated." Treatments for Rosacea and for Covid-19 These are the list of treatments for rosacea that are being investigated to treat the coronavirus: Azithromycin for Coronavirus Chloroquine for Coronavirus Doxycycline for Coronavirus Hydroxychloroquine for Coronavirus Ivermectin for Coronavirus Metronidazole and Coronavirus Naltrexone and Ketamine for COVID-19 Tetracycline for Coronavirus We will keep you updated on these treatments in the above posts. If you have anything to add to these treatments we are not aware of, please volunteer and post by finding the 'reply to this topic' button what you know. Scrolling through the posts in this thread will keep you updated on this subject. Virus and rosacea has never, ever been ruled out. Cross-sectional model of a coronavirus, Image courtesy of Wikimedia Commons Etcetera Protection of skin barrier for Coronavirus with Personal Protective Equipment Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Dermatol Ther. 2021 Feb 17;: Public Interest in Dermatologic Symptoms, Conditions, Treatments, and Procedures during the COVID-19 Pandemic: Insights from Google Trends. Esen-Salman K, Akın-Çakıcı Ö, KardeŞ S, Salman A [2] Am J Clin Dermatol. 2020 Aug 31 : 1–13.doi: 10.1007/s40257-020-00558-4 Cutaneous Manifestations of COVID-19: An Evidence-Based Review Giulia Daneshgaran, Danielle P. Dubin, and Daniel J. Gould [3] Clin Dermatol. 2021 Feb 16 Immunosuppressive/Immunomodulatory Therapies in Dermatology and COVID-19 Parvin Mansouri, MD, Susan Farshi, MD, MPH, Nahid Nickhah, MD, Niloufar Najar Nobari, MD, Reza Chalangari, MD, and Mohammad Ali Nilforoushzadeh, MD

Please note: This thread has continued to be updated and recommend you scroll to the last one to note that hydrooxychoroquine for coronavirus has been debunked and it not effective. You may read the history below and if you keep scrolling through all the posts. Hydroxychloroquine (brand name Plaquenil), a treatment for rosacea, [and the related drug, chloroquine (brand name Arelene)] has been in the news for its alleged ability to treat coronavirus, mostly due to President Trump’s advocacy on its use during the pandemic. President Trump suffers from rosacea. This subject has ‘divided the medical community’ according to The New York Times. The American Society for Biochemisty and Molecular Biology reports that there are few published papers on this subject, acknowledging that one small study in France was 'encouraging,' however, other reports indicate that hydroxychloroquine are 'not effective for treating coronavirus.' [1] According to Forbes, "The Food and Drug Administration on Sunday issued an emergency authorization for experimental coronavirus treatments using chloroquine and hydroxychloroquine, anti-malaria drugs touted by President Donald Trump despite inconclusive clinical proof of their efficacy." Hydroxychloroquine for Rosacea Hydroxychloroquine is also classified as an antiprotozoal treatment along with the larger category of anti-parasitic agents and is just one treatment for rosacea that is being investigated along with other rosacea treatments, with clinical papers indicating its use in improving rosacea. [3] Hydroxychloroquine has been shown to be effective in treating rosacea. [2] Duffman reported in April 2017, "The only thing that finally worked for me with long lasting, real remission, is plaquenil." [3] Virus and rosacea has never, ever been ruled out. Hydroxychloroquine for Coronavirus Dan Charles, on April 3, 2020, NPR reports, "Dr. Anthony Fauci of the National Institutes of Health was asked March 24 whether the drug was considered a treatment for the novel coronavirus."The answer is no," he said, "and the evidence that you're talking about ... is anecdotal evidence." " James Hamblin, MD, staff writer for The Atlantic, wrote an article on the history of this subject on April 6, 2020 explaining in detail how the president has been advocating the use of this drug for the coronavirus epidemic, and concludes, "It is unclear how hydroxychloroquine would work to treat COVID-19, but the drug is one of many now being urgently studied for the treatment of the disease." [4] Two other anti-parasitic drugs being studied are ivermectin and metronidazole, both treatments are used for rosacea. [5] The American Academy of Ophthalmology states on its website concerning hydroxychloroquine and chloroquine that, "These drugs may stop the immune system from going overboard in its attack on the virus." [6] If you are interested in a clinical trial with hydroxychloroquine you may want to contact Elizabeth Oelsner, Columbia University. Of course, you won't be able to know whether you actually receive hydrochloroquine or the placebo. The CDC lists on it's Information for Clinicians on Therapeutic Options for COVID-19 Patients that "Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19." A Chinese clinical study published in Cell Discovery concluded, "In conclusion, our results show that HCQ can efficiently inhibit SARS-CoV-2 infection in vitro. In combination with its anti-inflammatory function, we predict that the drug has a good potential to combat the disease. This possibility awaits confirmation by clinical trials." [7] Another Chinese study states, "In this study, hydroxychloroquine exhibited better in vitro anti-SARS-CoV-2 activity than chloroquine." [8] The French study that may have started all this states, "In conclusion, we confirm the efficacy of hydroxychloroquine associated with azithromycin in the treatment of COVID-19 and its potential effectiveness in the early impairment of contagiousness. Given the urgent therapeutic need to manage this disease with effective and safe drugs and given the negligible cost of both hydroxychloroquine and azithromycin, we believe that other teams should urgently evaluate this therapeutic strategy both to avoid the spread of the disease and to treat patients before severe irreversible respiratory complications take hold." [9] 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." [10] 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." [10] More on Coronavirus and Rosacea End notes [1] A small trial finds that hydroxychloroquine is not effective for treating coronavirus, Katherine Seley-Radtke, April 05, 2020, ASBMBTODAY [2] Int Immunopharmacol. 2020 Jan 06;79:106178 Hydroxychloroquine is a novel therapeutic approach for rosacea. Li J, Yuan X, Tang Y, Wang B, Deng Z, Huang Y, Liu F, Zhao Z, Zhang Y [3] Plaquenil (Hydroxychloroquine) [4] Why Does the President Keep Pushing a Malaria Drug?, The Atlantic The Guardian also has its version of the history of this subject. [5] Ivermectin Treats Coronavirus [6] Treating Coronavirus With Plaquenil and Aralen, Reena Mukamal, AAO [7] Cell Discov 6, 16 (2020). Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro Jia Liu, Ruiyuan Cao, Mingyue Xu, Xi Wang, Huanyu Zhang, Hengrui Hu, Yufeng Li, Zhihong Hu, Wu Zhong & Manli Wang [8] ciaa237.pdf [9] COVID-IHU-2-1.pdf ]10] Hydroxychloroquine is not dead yet, Lisa Cavazuti, NBC News

In a related news item, Ivermectin, another anti-parasitic drug, has been purported to treat coronavirus.

In a related news item, Plaquenil (Hydroxychloroquine), another anti-parasitic drug, has been purported to treat coronavirus. Read the third post in this thread.

"It’s still not clear exactly how Ivermectin works. But it appears to stop the processes that allow proteins to move within the virus. These proteins would normally dampen the body’s antiviral response, allowing the virus to replicate and enhance the infection." Head lice drug Ivermectin is being tested as a possible coronavirus treatment, but that’s no reason to buy it, April 6, 2020, Andrew McLachlan, The Conversation ----------------------------------------------------- "Wagstaff cautions that these are very early test results and much more will need to be done, including clinical trials and human testing and will be necessary before any action can be taken. But, he says, it’s a sign of hope." Researchers discover anti-parasite drug kills coronavirus in lab, Chris Patrick, Sunday, April 5, 2020, Trib ------------------------------------------------------ "The team worked with the Peter Doherty Institute of Infection and Immunity. They showed that Ivermectin reduced COVID-19 viral RNA present in cell culture by as much as 93 percent after 24 hours and by 99.8 percent after 48 hours, at around a 5,000-fold reduction in coronavirus RNA, hinting that the medicine can potentially eradicate the virus." Antiparasitic drug Ivermectin kills coronavirus in 48 hours, Angela Betsaida B. Laguipo, BSN, Apr 6 2020, News Medical

Please Note: The RRDi does not endorse ivermectin for treating Covid 19. Since ivermectin has been used to treat rosacea, we are interested in any of the treatments for rosacea that are also being considered in treating Covid 19. Treating Covid 19 with ivermectin is controversial. The RRDi has simply collected a list of articles for your consideration. This thread continues to be updated so scroll through the entire thread to the latest post on this subject. Add your thought by finding the REPLY TO THIS TOPIC button. -------------------------------------------------- There are multiple news reports that ivermectin, a common drug used to treat rosacea orally and topically, has been found effective in treating the coronavirus (scoll down for more reports). Virus and rosacea has never, ever been ruled out. Ivermectin is just one treatment for rosacea that is being investigated along with other rosacea treatments. "Taken together, the concerns associated with ivermectin's application in clinical settings may be adequately addressed to declare it as a safe anti-viral drug at a safe dosage." [1] A collaborative study led by the Monash Biomedicine Discovery Institute and the Doherty Institute found the drug Ivermectin stops coronavirus growing in cell culture." Warning issued as researchers reveal another potential treatment for coronavirus, ABC News Australia "Researchers at Monash University in Melbourne, Australia have discovered that the antiparasitic drug Ivermectin can inhibit replication of SARS-CoV-2, the virus the causes COVID-19, according to a study published Friday in the journal Antiviral Research....Ivermectin has been widely used since the 1980s to treat head lice, scabies and several other infections caused by parasites. The drug is also used to treat the skin condition rosacea." [bold added] "Researchers from Biomedicine Discovery Institute (BDI) at Monash University in Australia have found that an anti-parasitic drug called Ivermectin could kill the novel coronavirus, SARS-CoV-2, within 48 hours in a laboratory setting." Study finds anti-parasitic drug could kill coronavirus in 48 hours, Pharmceutical Technology ANTI-PARASITE DRUG USED SINCE 1980S MAY HELP STOP CORONAVIRUS, NEW STUDY SAYS BY AILA SLISCO ON 4/3/20 AT 10:46 PM EDT, 3 April 2020, Newsweek The report by Caly et al is published in Antiviral Research, funded by a National Breast Cancer Foundation Fellowship, is cited below: Antiviral Research Available online 3 April 2020 The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro Leon Caly, Julian D.Druce, Mike G.Catton, David A.Jans, Kylie M.Wagstaff Science Daily • Drugs.com • Nature World News • EurekaAlert! • Futureism/Neoscope • Pharmaceutical Technology • SciTechDaily • PHARMAfield • The US Sun • Archyde • Metro News • MoneyControl • The Tecake • Coronavirus and Rosacea End Notes [1] J Mol Struct. 2021 Jun 12 : 130808. COVID-19 and Ivermectin: Potential threats associated with human use Tean Zaheer, Kaushik Pal, Rao Zahid Abbas, María del Pilar Rodríguez Torres

There appears to be a shortage of Hydroxychloroquine (HCQ) according to several news sources. So if you somehow receive Hydroxychloroquine (HCQ) treatment for covid19 and your rosacea improves, please find the green reply button in this thead to post your results. Furthermore, virus has never, ever been ruled out in rosacea. End notes Physicians Seek to Reassure Amid Hydroxychloroquine Shortage, Jeff Evans, March 27, 2020, Medscape FDA SAYS THERE'S A SHORTAGE OF HYDROXYCHLOROQUINE AND CHLOROQUINE 'DUE TO A SIGNIFICANT SURGE IN DEMAND, BY KASHMIRA GANDER ON 4/1/20 AT 11:58 AM EDT, Newsweek As Trump touts an unproven coronavirus treatment, supplies evaporate for patients who need those drugs, By Christopher Rowland , March 23, 2020 at 1:02 p.m. CDT, The Washington Post Update Now there appears to be plenty of stock and absolutely no shortage. "The US now has more hydroxychloroquine than it knows what to do with following a series of studies that concluded the drug is an ineffective and potentially dangerous treatment for COVID-19. The federal government, which started stockpiling the drug in March, now has 63 million surplus doses of the drug, donated by companies including Novartis, and another 2 million doses of chloroquine, the New York Times reports. Some 31 million doses from the Strategic National Stockpile were distributed before the FDA withdrew its emergency authorization of the drug to treat the coronavirus. President Trump championed the drug for months, hailing it as a possible "game-changer" and announcing that he was taking it himself." US Is Stuck With 63M Doses of Hydroxychloroquine, Rob Quinn, Newser

Frequently some are concerned that if they have a red nose that they will end up like WC Fields, the rosacea poster boy. This is due to a misunderstanding that rosacea progresses in stages which has been debunked. While it is possible if you don't treat your rosacea (or your red nose) it may get worse, it certainly does not mean that it will necessarily get worse or progress into 'stages'. Obviously WC Fields didn't care about whether his nose got redder or turned into rhinophyma, so it is good you are concerned about your red nose. The good thing about rhinophyma or what is more recently classified as Phenotype 5 is that this is the most successfully treated rosacea phenotype (scroll to the subheading TREATMENT in this post for the list).

Coffee Extracts Protect Cells Against Oxidative Stress One of the many theories on the cause of rosacea is the Antioxidant System Defect Hypothesis which is related to Oxidative Stress, Ferritin and Rosacea. One paper concluded the following; "Further experiments using LPS-induced murine macrophages revealed that coffee extracts protect cells against oxidative stress by enhancing the content of the antioxidant GSH and stimulating expressions of the genes related with the cellular antioxidation system. Also, coffee extracts decreased the expression of proinflammatory cytokines and inflammatory mediators in LPS-stimulated RAW 264.7 cells. However, different roasting levels may dilute those effects by decreasing the concentrations of key compounds during the roasting procedures." Journal of Medicinal Food Cellular Antioxidant and Anti-Inflammatory Effects of Coffee Extracts with Different Roasting Levels Jung Soohan, Kim Min Hyung, Park Jae Hee, Jeong Yoonhwa, and Ko Kwang Suk. Journal of Medicinal Food. June 2017, 20(6): 626-635. https://doi.org/10.1089/jmf.2017.3935 Online Ahead of Print: June 5, 2017 Published in Volume: 20 Issue 6: June 1, 2017

Is rosacea a condition or a disease? Technically, it depends on how you are referring to rosacea in a statement. Condition "A medical condition is a broad term that includes all diseases, lesions, disorders, or nonpathologic condition that normally receives medical treatment, such as pregnancy or childbirth." [1] One report says, “rosacea is not actually a disease, but rather a chronic dermatologic condition that predominantly affects the convexities of the central aspect of the face.” [2] “Francis Wilkin of the FDA, whose serious studies have given us impressive insights into the nature and mechanisms of flushing, has proposed some concepts, which are inexplicable to most of us. He avers that rosacea is not a disease but a “condition”. He labels rosacea an ideotype, a cluster of signs and symptoms, apparently not a pathologic entity warranting a specific nosologic status. To be sure, rosacea is a multifactional disorder with many different clinical expressions. Nonetheless, it meets all the classical requirements of a pathologic process, most obviously the presence of chronic inflammation, both clinically and histologically. Calling rosacea a ‘condition’ downgrades the seriousness of the disorder, perhaps implying that it is only a cosmetic nuisance.” [3] Disease "A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury....The term disease broadly refers to any condition that impairs the normal functioning of the body." [1] Disorder “Rosacea is a common and chronic disorder characterized by flushing, erythema, papules, pustules, and telangiectasia on the central part of the face. Because the facial skin of individuals with rosacea is particularly sensitive, irritants can trigger a worsening of the signs and symptoms of the disease.” [4] “Once considered a variant of acne, this common skin disorder seems fairly well entrenched as a disease sui generis.” [5] Terms Condition/Disease Used Interchangeably “Most words of this type in medicine rooted in Latin from thousands of years ago do not have precise definitions!” [6] “The terms disease & condition are often used interchangeably in the literature.” [7] “…this is semantics: disease, affliction or condition all refer to the same meaning.” [8] Conclusion While both Dr. Millikan and Dr. Wilkin refer to rosacea as a 'condition' and not a 'disease’, there is no need to feel that somehow makes rosacea less important since the two words are used in most medical literature interchangeably. End Notes [1] Disease, Wikipedia [2] Skinmed 2003;2(1) The Proposed Inflammatory Pathophysiology of Rosacea: Implications for Treatment Larry Millikan, MD [3] A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman , M.D., Ph.D. Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A. The William J. Cunliffe Lectureship 2003—Manuscript publikation_kligman.pdf [4] J Dermatolog Treat. 2007;18(3):158-62. Beneficial use of Cetaphil(R) Moisturizing Cream as part of a daily skin care regimen for individuals with rosacea Laquieze S, Czernielewski J, Baltas E. [5] Postgrad Med. 2002 Dec;112(6):51-8, 82; quiz 9. Unraveling the mystery of rosacea, Keys to getting the red out Ken Landow, MD [6] Robert T. Brodell, MD, RRDi MAC, post no 2 [7] Sandra Cremers, M.D., RRDi MAC, post no 3 [8] Marianne Boes, PhD, RRDi MAC (former member), post no 3

There are several acne treatments used to treat rosacea, i.e., Dapsone, Sarecycline, Azithromycin, Minocycline, and the list continues, not to mention the plethora of over the counter acne treatments to consider. A typical example of an acne treatment, Benzaclin, that is also used to treat rosacea is discussed in the following paper: “Based on the theory that rosacea shares the same inflammatory features of acne, a recent study showed that, just as the combination of benzoyl peroxide 1 percent and clindamycin 5 percent gel is a powerful treatment modality for reducing Propionibacterium acnes levels, it also significantly reduces the papules and pustules of rosacea, according to Debra L. Breneman, M.D..… ‘Benzaclin, once daily, was found to be well tolerated and effective in the reduction of papules and pustules in patients with rosacea,’ said Dr. Breneman. ‘This lends credence to the theory that P. acnes is a potential aggravating factor in rosacea. This gives dermatologists a very effective treatment for rosacea.’ ” [1] Herbal Extracts for Acne One report on the 'clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris' concludes, "This herbal extracts can be a new therapeutic option for patients with mild to moderate acne vulgaris who are reluctant to use drugs." [2] The herbal extracts include: Mangosteen extract Lithospermum officinale extract Tribulus terrestris L. extract Houttuynia cordata Thunb extract End Notes [1] Dermatology Times Publish date: Apr 1, 2003 P. Acnes Possible Factor in Rosacea BenzaClin a significant Tx in lesion reduction Beth Kapes Another example similar to above paper discussing topical benzoyl peroxide 5%/clindamycin 1% (BP/C) gel (BenzaClin) concluded, "These results showed that BP/C was significantly more effective than vehicle in improving papules and pustules associated with rosacea.' Cutis. 2004 Jun;73(6 Suppl):11-7. Photographic review of results from a clinical study comparing benzoyl peroxide 5%/clindamycin 1% topical gel with vehicle in the treatment of rosacea. Leyden JJ, Thiboutot D, Shalita A. [2] J Dermatolog Treat. 2019 Oct 16:1-5. doi: 10.1080/09546634.2019.1657792. [Epub ahead of print] Clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris: an 8-week, double-blinded, randomized, controlled trial. Yang JH, Hwang EJ, Moon J, Yoon JY, Kim JW, Choi S, Cho SI, Suh DH.

image courtesy of WikiMedia Commons The RRDi financial situation is continuously posted at this url and as of this date, March 30, 2020, we have $771.42 in the bank. Based upon how we are spending donations (the income includes the small amount of affiliate fees we receive from Amazon) we will run out of funds in several months. So we are concerned about this and decided to first post this on our website before using the newsletter tool and send this same announcement to the members who have opted to receive our newsletter. You may wonder how much we are spending in donations currently and for the first three months of 2020 we averaged our expenses to $164/month. You can view how we spent donations for last year here. So you can see our current funds will only last us several months at the present rate of expenditure. Comparison of the RRDi Expenses vs NRS Expenses So let's compare this with how much money the National Rosacea Society [NRS] spends its donations (who is one of the other non profit organizations for rosacea). The only way we can get an idea how the NRS spends its donations is to look at the last financial report filed by the NRS as shown on Form 990 that the NRS files with the Internal Revenue Service for 2018 which is available for public viewing (the NRS releases its 2019 Form 990 much later and when it does we always review it since we have been reviewing how the NRS spends its donations since 1998). So let's compare how the NRS spends it donations, that is, the amount each month is spent with what the RRDi spends each month. For 2018, the NRS received in donations a total of $465,042. During this same period the NRS spent a total of $601,532 (yes the NRS can spend more than it takes in because of the assets they own which the NRS draws upon when the expenses are greater than donations). So on average, in 2018 the NRS spent over $50,000 each month! What did the NRS spend most of it donations on? The answer if you investigate is $432,408 was spent for the year (over $36,000 each month on average) on two private contractors owned by the director/president of the NRS, Sam Huff. So if you are happy with how the NRS is spending its donations that is just one of the other non profit organizations for rosacea that will continue if the RRDi runs out of funds and can't pay our monthly expenses. So the comparison is: RRDi spends NRS spends $164/month $50,000/month (of this amount $36,000 is spent on two private contractors owned by Sam Huff) Just for the record, the NRS claims on its Form 990 for 2018 that 25.31% of the total donations received in 2018 were from public support. What is one of the most interesting revelations found on the from its Form 990 for 2018 report is that it reveals how much money was received from the pharmaceutical companies in 'excess contributions' which is shown in a screen shot below: The above screen shot doesn't reveal for how long a period each of the above pharmaceutical companies have been giving the NRS 'excess contributions' but it does reveal the amounts. So if you are happy the way these pharmaceutical companies are contributing to the NRS and the way the NRS is spending its contributions and if the RRDi runs out of funds to keep going, you will surely have the NRS since it has lots of money to spend, especially on two private contractors owned by Sam Huff, the director/president of the NRS. Conclusion So it is simply up to you whether you want the RRDi to keep going or simply dissolve because of lack of funds. If you want to help out the RRDi here are two options: (1) donate (if the 1300+ members each donated just one dollar we could last way over a year! Do you think the RRDi is worth one dollar?) (2) volunteer (and help us get donations). If you have any questions or concerns, why not find the reply button and post?

image courtesy of Free paper chain v.2 Stock Photo We obviously aren't sure of what community support means to you, but we are trying to figure that out by forming a NON PROFIT organization for rosacea patient advocacy and encouraging rosaceans to come together by joining the RRDi and taking steps to obtain and disseminate community support for those who are suffering from rosacea. What has the RRDi done in this regard? (1) Creating a website with pages of information, a public forum of rosacea topics, a community support category, a private forum, member driven rosacea blogs, galleries and clubs, as well as the tools discussed in the article, RRDi and the Medical Digital Revolution. (2) Journal of the RRDi and the ability for anyone (amateur or professional) to submit a paper on rosacea to be published. (3) A legal non profit organization to allow donations to be tax deductible. (4) Education grants and the ability to volunteer as a grant writer as a non profit organization grant writer (possibly being reimbursed for your effort). (5) A way for you to volunteer to help rosacea sufferers. (6) Attracting sponsors to support our non profit organization. (7) Instructions on how to use our forum. (8) Our charter allows members to be compensated for services if we have the funds to do this. So, what does community support mean to you? Please find the green reply button and post what it means to you? We would love to understand what you think community support means to you or what you think a non profit for rosacea should be doing? You may think that posting in a community of rosacea sufferers your experience with rosacea and getting some feedback is what community support means to you? If so, this is the correct forum category to do that by finding the green reply button and post your concern.

"In a statement released Sunday night, the U.S. Department of Health and Human Services announced it had received 30 million doses of hydroxychloroquine sulfate and one million doses of hloroquine phosphate donated to a national stockpile of potentially life-saving pharmaceuticals and medical supplies. Hydroxychloroquine and chloroquine, which are oral prescription drugs used primarily to prevent and treat malaria, are both being investigated as potential therapeutics for COVID-19." Coronavirus live updates: FDA gives anti-malaria drugs emergency approval to treat COVID-19 The two drugs are being investigated as potential treatments for COVID-19., By Morgan Winsor and Emily Shapiro, March 30, 2020, 8:05 AM, ABC News FDA Letter Virus has never been ruled out in rosacea.

Image of Demodex Folliculorum courtesy of National Geographic - by Darlyne A. Murawski This question was asked may later be listed in our FAQs. Basically everyone has demodex mites and it has been thought that the mites have some sort of symbiotic or commensal relationship with humans, i.e., the mites eat sebum which helps the mites and helps the humans keep sebum stasis. One report states, "....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host." - See Jarmuda et al published in the Journal of Medical Microbiology (second article mentioned in this post). While this same report says that 'most human populations' have NOT been sampled for demodex mites the general belief is that demodex are common throughout humanity and pose no problem as a pathogen except in the case of demodectic rosacea as far as known. A Russian study on the mites says, "Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte." It is comparable to bacteria which humans have a relationship with, there is good bacteria and bad bacteria. The probiotic bacteria and the pathogen bacteria. The demodex mites usually pose no problem with the vast majority of humans since they are possibly, or probably, on everyone. Why they become more numerous seems to be of more importance. What are the numbers showing? For some unknown reason the mites are in higher density in rosacea patients. We don't know if the rosacea cause this increase in mites or does the increase in mites cause the rosacea, the old chicken or egg conundrum? There is evidence that reducing the mite density count improves rosacea. It is clear that the mites like human skin since they consume sebum. One report states, "Demodex mites feed on the sebum and cellular proteins that are obtained by protease containing the salivary enzymes of the mites. The lipase enzymes of Demodex are also thought to play a role in digesting bacteria or other microorganisms in addition to the digestion of lipid material." [1] Dr. Frank C. Powell who wrote the book on rosacea said at the 72nd annual meeting of the American Academy of Dermatology in Denver which was quoted in the NRS Rosacea Review (Spring 2014) the following and is related to this subject: “The presence of Demodex is likely to confer some sort of benefit on us, because human physiology is such that we wouldn’t tolerate something like this unless there was something to be gained for us,” he said. Whatever benefit that might be, in rosacea patients something causes the mites to proliferate, possibly triggering an inflammatory response. Large quantities of mites have been found in biopsies of rosacea papules and pustules, leading Dr. Powell to wonder whether the papules and pustules might not be 'gravestones to dead Demodex.' ” [2] Maybe the increase of sugar/carbohydrate in the diet increases sebum which in turn increases the mite population, and voila, the inflammation of rosacea? Not all rosacea is demodectic. GUT Rosacea is a different variant, but may be connected or associated. The list of systemic comorbidities with rosacea keeps growing. The gut microbiome is obviously connected with skin microbiome (see post on this). Could it be that H Pylori has a symbiotic relationship with humans and at times runs amuck and causes issues? Could demodex have this same symbiotic relationship in principle with humans that sometimes runs amuck? Or is demodex a parasite? [2] "Our results suggest close interactions between the mite, sebaceous gland size and function, and subtle variations of immune status." [3] 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] An Bras Dermatol. 2020 Mar-Apr; 95(2): 187–193.Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitisEzgi Aktaş Karabay and Aslı Aksu Çerman [2] "Parasitism is a non-mutual symbiotic relationship between species, where one species, the parasite, benefits at the expense of the other, the host." Symbiosis is a controversial subject, but it is generally accepted that the definition is "the living together of unlike organisms." Wikipedia The classic example is Helicobacter Pylori which has been reported to be in 50% of the human population. Why the other half the human population doesn't have H Pylori is an intriguing question. And this is interesting, "Over 80% of individuals infected with the bacterium are asymptomatic." * *Am J Clin Dermatol. 2002;3(4):273-82. Helicobacter pylori infection in skin diseases: a critical appraisal. Wedi B, Kapp A. [3] Which factors influence Demodex proliferation? A retrospective pilot study highlighting a possible role of subtle immune variations and sebaceous gland status

The president announced on March 19, 2020 that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19. Virus has never been ruled out in rosacea. CNN has a followup report on this. There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him. Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea? If you do take hydroxycholoroquine and your rosacea improves, please let us know.

"Webster et al. report a multicentre, randomized, double‐masked, parallel‐group, vehicle‐controlled study to evaluate the safety and efficacy of minocycline gel 1% and 3%. Topical minocycline had insignificant systemic absorption but produced significant reductions in mean inflammatory lesion counts with both the 1% and 3% concentrations. The response rate in the vehicle group was quite high, as is often the case in diseases with fluctuating inflammation. However, the 3% concentration of minocycline showed a significantly greater proportion of patients achieving Investigator's Global Assessment success at week 12 compared with vehicle. A topical minocycline foam formulation is in development, and this may provide a further useful option for treating papulopustular rosacea. How topical minocycline compares with other topical rosacea treatments is as yet unclear." Br J Dermatol. 2020 Mar 18;: Expanding treatment options for rosacea. Hampton PJ

The president announced on March 19,2020 that hydroxychloroquine (Plaquenil) has been approved by the FDA to treat COVID-19. As mentioned in the initial post in this thread, virus has never been ruled out in rosacea. CNN has a followup report on this. There is a paper that indicates using Hydroxychloroquine (HCQ) to treat rosacea "exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment." Duff Man told us about this a while back that it worked for him. Wouldn't it be incredible if any rosaceans who are treated with hydroxycholoroquine for COVID-19 also discovered that their rosacea improves or clears up! Is virus involved in rosacea? If you do take hydroxycholoroquine and your rosacea improves, please let us know. Coronavirus and Rosacea