Guide

Sugar image and Fire image courtesy of Wikimedia Commons The RRDi is the only non profit organization for rosacea that lists sugar and carbohydrate as rosacea triggers (see the RRDi Trigger Factor List). Search all you can and you won't find either one listed on the other non profits for rosacea trigger lists. Why do you think this is the case? There is ample anecdotal evidence from rosacea sufferers that reducing sugar and carbohydrate in the diet improves rosacea while ingesting huge amounts of sugar and carbohydrate triggers rosacea. Trigger factors are simply discovered by anecdotal reports from rosacea sufferers in surveys and polls. What many rosacea sufferers don't understand is that sugar is carbohydrate, which is simply carbon plus water. All carbohydrate is just different forms of sugar, i.e., glucose, fructose, lactose, etc. There are absolutely no essential nutrients in carbohydrate, none. Increasing sugar/carbohydrate into your diet is a rosacea trigger. Sugar is the fire that burns your rosacea, the fuel for your inflammation. High Sugar Content Leads to Inflammation. If you are skeptical about this why not try eliminating or reducing sugar/carbohydrate in your diet for 30 days and see if your rosacea improves. Then eat a significant amount of sugar/carbohydrate in the diet after this 30 day experiment and notice what happens. Most rosaceans will not try this simple experiment to see if sugar/carbohydrate is triggering rosacea because most are addicted to sugar. Yes, sugar is an addition. For those septics, they will have to find another way to control their rosacea. Trigger avoidance is an accepted medical treatment offered by most physicians who parrot the NRS Trigger Factor List. However, you will be hard pressed to find a physician who parrots the NRS Trigger Factor List to mention you should avoid sugar/carbohydrate. The RRDi Trigger Factor List is much more extensive and continues to grow as more anecdotal evidence comes in from rosacea sufferers. Just picture in your mind that sugar is the fuel that is burning your rosacea. If you reduce the fuel that is burning your rosacea, you will help put the rosacea fire out. Etcetera Sugar And Rosacea Sugars to Avoid Anecdotal Reports of Sugar/Carbohydrate Avoidance

Rotavirus image courtesy of Wikimedia Commons Virus and Rosacea has never, ever been ruled out as a cause. Cite one paper that concludes virus is not a cause of rosacea. Why can't you find any paper that states this? Bacteria has been implicated in rosacea with a huge amount of clinical papers on this subject. Demodex is now without a doubt linked to a significant number of rosacea cases. At least one fungus has been associated with rosacea [1], and we have papers indicating treatment for one particular protozoa improves rosacea, however viruses have not been ruled out in rosacea, nor archea, for that matter. The human microbiome includes the skin which contains a number of different microbes, including virus. To help understand why virus should be considered in a differential diagnosis of rosacea which includes a very long list, take measles as an example, which most people do not associate with a virus. The medical name for measles is 'Measles Virus', [aka morbilli, rubeola, red measles, and English measles]. "Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses." "A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms." [9] There are other diseases that you may not be aware of that are caused by virus such as smallpox, polio, cowpox, and influenza, all of these diseases can appear with facial erythema. "Viral infections are responsible for some of the most common dermatologic presentations in adults such as oral and genital herpes, warts, and a wide variety of exanthems." [10] There are other virus to consider that the symptoms include erythema or pimples on the facial skin, such as HIV, Herpes, Poxvirus, and this list continues. It is possible that a virus may be at the root of some cases of rosacea to consider and should be ruled out, but what physician considers ruling out virus in rosacea? Without any doubt some virus diseases do indeed present with erythema as mentioned. Could rosacea be caused by a virus? Virus and Rosacea Virus are very tiny compared to other microbes, on average 100 times smaller than bacteria.* Viruses are in bacteria, demodex, fungus, archea, and throughout the human body in the blood, as well as human cells and comprise more number in the human body than bacteria by a factor of ten times. [2] Virus are in plants, animals, insects, fish, in the oceans, and comprise more number on planet earth than any other life form including all the animals on land or fish in the sea combined! [2] There are scant few, if any, clinical papers on virus and rosacea. There are a huge number of clinical papers on bacteria and rosacea and if you can find any paper on virus and rosacea, please find the reply button and give the link to the paper! Wouldn't you think that a microbe that numbers ten times more as the bacteria in the human body deserves some kind of investigation as to whether virus has anything to do with rosacea? One theory on the cause of rosacea involves a disorder of the innate immune system [3] and one paper explains what happens: "Recognition of bacteria and viruses [bold added] initiates the inflammatory cascade involving the release of cytokines, recruitment of immune cells, and production of AMPs and ISGs. AMPs and ISGs represent one of the most important and robust immune mechanisms in the skin. However, pathogenic bacteria—such as S. aureus—and cutaneous viruses [bold added] have evolved mechanisms to counteract innate immune mechanisms." [4] Cytokines and Rosacea are being investigated and cytokines are released due to a virus response. As you can see from the above example which is typical, the focus is usually, if not always, on bacteria with a token mention of virus. Most, if not all clinical papers on rosacea rarely mention the word virus and focus mostly on bacteria. Our investigation found scant few papers that mention virus and rosacea which we list in the next subheading. Coronavirus and Rosacea Clinical Papers Mentioning Virus Associated with Rosacea "Granulomatous rosacea has been reported in children as well as adults, and in association with infection with the human immunodeficiency virus (HIV)." [5] Herpes Simple, a virus, has been associated with granulomatous rosacea. [6] "Two months after the beginning of the anti-retroviral treatment, the patient developed a progressively extending facial eruption resembling rosacea." [7] Human Herpes Virus There are four Human Herpes Virus known that may have implications with rosacea which should be considered, since there are absolutely no papers ruling out human herpes virus and rosacea. They are Varicella zoster virus (VZV) (HHV)-3, Epstein-Barr virus (EBV)/ HHV- 4, Cytomegalovirus (CMV)/HHV-5, and Human herpes virus type 6 (HHV-6). [8] If you are suffering with any of these viruses and also have rosacea you may want to ask your physician about antiviral treatment drugs. [8] Bacteriophage Scoll below for information on bacteriophage, a virus (third post). Anti-viral Treatments Shown Successful in Treating Rosacea Ivermectin (also shown effective in treating rosacea) Acylovir (papers about treating rosacea with Acylovir} Hydroxychloroquine is a novel therapeutic approach for rosacea (see also the fifth post in the current thread you are reading now). Hydroxychloroquine Suppresses LL37-induced Mast Cells Imiquimod Cream [possible anti-viral treatment] (read the fourth post in the current thread you are reading). Conclusion There are numerous clinical papers discussing the innate immune system reaction to rosacea and without a doubt, information about this subject enhances our knowledge on rosacea. However, because of a scientific bias towards bacteria ignoring virus (when virus has ten times more number in the human body than bacteria), this bias continues to influence and support more bacteria research on rosacea than researching virus. There needs to be more clinical studies done on virus and rosacea. Since virus has never been ruled out in causing rosacea, who would support such an investigation? Would you? Just think if 10K members of the RRDi each donated one dollar and insisted on supporting a reputable clinician to study virus and rosacea, what might be discovered? Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Candida Albicans [2] Number of different virus "There are 219 virus species that are known to be able to infect humans." Philos Trans R Soc Lond B Biol Sci. 2012 Oct 19; 367(1604): 2864–2871. Human viruses: discovery and emergence Mark Woolhouse, Fiona Scott, Zoe Hudson, Richard Howey, and Margo Chase-Topping "The results of a new study suggest that at least 320,000 different viruses infect mammals." How many viruses on Earth?, Vincent Racaniello, virology blog "...more than 6,000 virus species have been described in detail of the millions of types of viruses in the environment. Viruses are found in almost every ecosystem on Earth and are the most numerous type of biological entity." Virus, Wikipedia "There are more viruses than stars in the universe..." National Geographic, April 15, 2020 Human Microbiome, Brady Barrows [3] Immune System Disorder Theory [4] PLoS Pathog. 2018 Dec; 14(12): e1007353. Innate antimicrobial immunity in the skin: A protective barrier against bacteria, viruses, and fungi Margaret Coates, Sarah Blanchard, and Amanda S. MacLeod Deborah A. Hogan, Editor [5] The granulomatous reaction pattern David Weedon AO MD FRCPA FCAP(HON), in Weedon's Skin Pathology (Third Edition), 2010 [6] JAAD, January 2015Volume 72, Issue 1, Pages e36–e37 Granulomatous rosacea manifesting after herpes simplex 2 infection: A case of Wolf's isotopic response Kaitlyn N. Mula, DO, Nicole M. Cassler, MD, Jeffrey N. Lackey, MD [7] Dermatology 2002;205:394-397 Ivermectin-Responsive Demodex Infestation during Human Immunodeficiency Virus Infection, A Case Report and Literature Review C. Aquilina, R. Viraben, S. Sire [8] Four Human Herpes Virus May be Implicated in Rosacea The 4 Common Viruses That Can Trigger Thyroid, Autoimmune, and Brain Problems, Dr. Will Cole [9] Measles, Wikipedia [10] Curr Dermatol Rep. 2020; 9(2): 152–165.New Developments in Bacterial, Viral, and Fungal Cutaneous InfectionsSamuel Yeroushalmi, Joshua Yoseph Shirazi, Adam Friedman ------------------------------------------- *How Tiny Are Virus? Some authorities say ever smaller. "Personally, I always liked the metaphor that if a cell was a baseball stadium, a virus is the size of the ball..." So Just How Tiny Is a Virus? By Stuart Fox "Viruses are usually 20 to 300 nm. That is as tiny as we- an average human being are to the Earth." How tiny is tiny?, Neha Patil, The University of Melbourne "Named after the Latin word for small – parvus – viruses in the Parvoviridae family are just 23-28 nanometres (nm) in diameter." KEEPING UP WITH VIRUS TAXONOMY: SMALL VIRUSES, EXTRA SMALL VIRUSES AND A VIRUS USED TO PROTECT AGAINST FUNGAL DISEASE, by Laura Cox, Microbiology Society "Most viruses vary in diameter from 20 nanometres (nm; 0.0000008 inch) to 250–400 nm; the largest, however, measure about 500 nm in diameter and are about 700–1,000 nm in length." Virus, Size and shape, Encyclopedia Britanica ________________________________ 1 Millimeter (mm) = 0.1 Centimeter [or 1000 Micrometers (μm)] (one thousandth of meter) 1 Centimeter (cm) = 0.01 meter (one hundredth of a meter) [ or 10 Millimeters (mm)] 1 Micrometer (μm) = 0.0001 Centimeter [or 0.001 Millimeter (mm)] (or one millionth of a meter) 1 Nanometer (nm) = 0.001 Micrometer (μm) (or one billionth of a meter)

image courtesy of Wikimedia Commons Acne Vulgaris is a completely different disease from rosacea, however some authoritative sources report that acne vulgaris can co-exist with rosacea.[1] In past literature, 'acne rosacea' was the term used to describe adult acne, and, this term is sometimes still used. [2] However, rosacea is generally confined to the facial area while acne vulgaris can be not only on the facial area but also on the trunk (chest and back). Treatments for acne usually irritate or exacerbate rosacea and is one of the differentiating diagnostic marker for a rosacea diagnosis. [3] According to the American Academy of Dermatology, acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent, but can also affect adults in the 20s, 30s and 40s. [4] Usually when pimples and pustules are present physicians treat acne vulgaris with acne (condition) treatments. [5] Acne is technically a condition while acne vulgaris is a disease. When acne treatments exacerbate the condition usually this indicates Rosacea Phenotype 4, changing the diagnosis in the patient and switching the treatment to rosacea. [6] This naturally begs the question, what is the difference between acne and rosacea? [3] A proper diagnosis needs to be from a physician. [7] "The infiltration of γδT cells was significantly increased in rosacea and acne lesions and positively linked with almost all hub genes. These identified hub genes and immune cells may play a crucial role in the development of rosacea and acne." [8] End Notes [1] "It should be noted, however, that it is possible for acne vulgaris and rosacea to appear at the same time in the same patient." Medscape [2] “It is interesting that the original term for rosacea was “acne rosacea”, which has more features in common with acne than currently realized. If the “acne” portion had been retained in the later works, rosacea might have received much greater investigative attention.” 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. [3] What is the difference between acne and rosacea? Diagnosing Acne vs. Rosacea (Stanford Medicine 25) [4] Rosacea 101: Includes the Rosacea Diet, page 2, Brady Barrows [5] "If self-care remedies don't clear your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist)." Acne, Symptoms and Causes, Mayo Clinic [6] "Your doctor may prescribe an oral antibiotic such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acnelike lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects." Rosacea, Symptoms and Causes, Mayo Clinic [7] Diagnosing Rosacea [8] PubMed RSS Feed - -Exploring the association between rosacea and acne by integrated bioinformatics analysis

There has been at least three pharmaceutical companies researching and testing a topical minocycline foam or gel for rosacea. We await to see the results of these clinical trials and if these are effective and which one will be released first. It looks like Foamix, a subsidiary of Menlo Therapeutics, has announced Amzeeq (for acne) and Zilxi (for rosacea) as the front runners if you scroll past this post and go to post number five in this thread. We will continue to follow the other 'horses' in this race. (1) FMX103 Topical Minocycline Foam, Foamix Ltd (2) BPX-04 Minocycline Topical Gel 1%, BioPharmX, Inc. (3) HY-01 Minocycline Gel 3%, Hovione

image courtesy of Wikimedia Commons A genome-wide association study (GWAS) of rosacea symptom severity was conducted by Aponte et al [1] that concluded "All associations with rosacea were novel except for the HLA locus. Two of these loci (HERC-OCA2 and SLC45A2) and another precedented variant (rs1805007 in melanocortin 1 receptor) with an association P value just below the significance threshold (P = 1.3 × 10-7) have been previously associated with skin phenotypes and pigmentation, two of these loci are linked to immuno-inflammation phenotypes (IL13 and PSMB9-HLA-DMA) and one has been associated with both categories (IRF4). Genes within three loci (PSMB9-HLA-DMA, HERC-OCA2 and NRX3-DIO2) were differentially expressed in a previously published clinical rosacea transcriptomics study that compared lesional to non-lesional samples. The identified loci provide specificity of inflammatory mechanisms in rosacea, and identify potential pathways for therapeutic intervention." "In genetics, a locus (plural loci) is a specific, fixed position on a chromosome where a particular gene or genetic marker is located." Wikipedia "With the completion of the Human Genome Project in 2003 and the International HapMap Project in 2005, researchers now have a set of research tools that make it possible to find the genetic contributions to common diseases." [2] "Genome wide association studies (GWAS) are a relatively new approach to analyzing genetic sequence and have quickly become a fundamental part of modern genetic studies. Their purpose is to determine alleles that correlate to different diseases and traits." [3] "Despite clear successes in identifying novel disease susceptibility genes and biological pathways and in translating these findings into clinical care, GWAS have not been without controversy. Prominent criticisms include concerns that GWAS will eventually implicate the entire genome in disease predisposition and that most association signals reflect variants and genes with no direct biological relevance to disease." [4] End Notes [1] Hum Mol Genet. 2018 Aug 1;27(15):2762-2772. doi: 10.1093/hmg/ddy184. Assessment of rosacea symptom severity by genome-wide association study and expression analysis highlights immuno-inflammatory and skin pigmentation genes. Aponte JL, Chiano MN, Yerges-Armstrong LM, Hinds DA, Tian C, Gupta A, Guo C, Fraser DJ, Freudenberg JM, Rajpal DK, Ehm MG, Waterworth DM. [2] Genome-Wide Association Studies Fact Sheet, NHGRI, NIH [3] Genome Wide Association Studies (GWAS), Genetics Generation [4] Nature Reviews Genetics, ISSN 1471-0064 (online) Benefits and limitations of genome-wide association studies Vivian Tam, Nikunj Patel, Michelle Turcotte, Yohan Bossé, Guillaume Paré & David Meyre

Image of Demodex Folliculorum courtesy of National Geographic - by Darlyne A. Murawski Galderma reports that treatment with Soolantra improves rosacea. This is usually the same with treatment using the ZZ cream. There are substantial anecdotal reports that treatment for demodectic rosacea by reducing the number of mites shows it gets worse before it gets better. The Theory Behind This Logic The logic behind this is that killing the demodex mites causes a die-off of the mites that takes weeks to accomplish since new eggs are being hatched each day and the "life cycle of demodex mites consists of five phases of development and lasts from 14 to 18 days". [1] Furthermore because the movement of the mites has been shown to be "at a speed of 8-16 mm/h" [2] they may leave the area being treated and return later while planting eggs along the route. During the initial treatment which may take weeks some of the mites are reported to be killed which may cause inflammation and worsen the skin. One explanation of this is the "Jarisch–Herxheimer reaction" (JHR) which has been "traditionally associated with antimicrobial treatment of syphilis." [3] The principle of JHR may indicate a reason why it gets worse before it gets better. One source comments on this by stating, "And while the JHR only technically relates to spirochetal infections (spiral-shaped bacteria) and antibiotics, the concept of symptom-onset or worsening after starting treatment with antimicrobials has been seen to apply more broadly in clinical practice. This is why you’ll often hear practitioners talk about a Herx-reaction, even if it isn’t scientifically accurate. But, what we call ‘die-off symptoms’ is certainly something we see commonly when clients begin addressing bacteria, parasites and yeast pathogens using natural antimicrobials." [4] Most reports indicate that it takes eight to twelve weeks to achieve clearance. It is not uncommon in medical treatment that 'it gets worse before it gets better,' such as in treating acne, which the Mayo Clinic states, "With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely," or in immunotherapy, 'it gets worse before it gets better.' In fact, immunosuppressive treatments may actually increase demodex mites! [11] When treated with isotretinoin for acne, one reports states, "Some patients experience an initial worsening of their acne in the first month of treatment; less commonly, isotretinoin can induce acne fulminans." [13] One article explains, how this might happen when treatment is for demodex mites: "Rosacea often improves with antibacterial drugs that don’t affect the mites, such as tetracyclines. Kavanagh thinks this is because rosacea is caused by a reaction to bacteria in the mite’s faeces." Antibiotics do not kill demodex mites but likely treats the bacteria the mites carry. [5] Furthermore, there are at least six types of bacteria that have been associated with demodex mites, and bacteria has been implicated for a long time with rosacea. [6] At least one fungus has been associated with rosacea [7]. Viruses have not been ruled out in rosacea. There are very little, if any, clinical studies done on virus and rosacea. Viruses are in bacteria and throughout the human body and comprise more in number in the human body than bacteria by a factor of ten times. [8] For that matter, other microbes haven't been studied either, such as protozoa or archea. There is much to learn about the human microbiome and as more research is done, new insights are learned. Ivermectin, the active ingredient in Soolantra and in horse paste is an insecticide that kills parasites, including mites. There is evidence that data suggests it does indeed get worse before it gets better. [14] Sulfur in the ZZ cream has been used for decades to treat rosacea and kill the mites as well. [12] More study should be done on why treatment for demodectic rosacea seems in many cases to get worse before it gets better. Nevertheless, reducing demodex density counts in rosacea improves the patient with rosacea. [9] Just think if 10K members of the RRDi each donated one dollar and insisted on supporting a reputable clinician to study what they wanted, supporting their own research, what might be discovered? This can only happen if you want it to happen. Or you can continue to do nothing and let the status quo research continue on. [10] Rosacea Forum Severe-die-off-from-zz-after-first-use In the above thread, Mothinrust had an initial immediate reaction of getting worse and then one month (1/18/2020 post no 35) later posts, "But I do think it helping my skin so much....So I take the vast improvement as a sign of better things to come...." He posted a total of eleven posts in the thread. 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] Demodex Update Subheading, The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea, third paragraph [2] Russian Study on Demodex Mites and Rosacea Illuminating, (2) The report confirms the size and movement of demodex, second paragraph [3] Jarisch–Herxheimer reaction, Wikipedia [4] Pathogen & Parasite Die-Off Symptoms: How to manage detox side-effects, Bella Lindemann, June 24, 2019 [5] Rosacea may be caused by mite faeces in your pores, Debora MacKenzie, New Scientist [6] Bacteria Associated with Rosacea and Demodex Mites Bacteria Theory [7] Candida Albicans [8] Human Microbiome, Brady Barrows [9] Decreasing Demodex Density Count Improves Rosacea What are the numbers? [10] Rosacea Research in Perspective of Idiopathic Diseases Rosacea Research in Perspective of Funding [11] Immunosuppressive Treatments May Increase Demodex Mites [12] The Health Benefits of Sulfur, Cathy Wong, VeryWellHealth [13] Clin Cosmet Investig Dermatol. 2019; 12: 943–951. Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience Vincenzo Bettoli, Aurora Guerra-Tapia, Maria Isabel Herane, and Jaime Piquero-Martín [14] Continuous Improvement With Ivermectin Long-term Use - Gets Worse Before it Gets Better

Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. Image courtesy of Wikimedia Commons Chronic Mucocutaneous Candidiasis (CMC) "is an immune disorder of T cells, it is characterized by chronic infections with Candida that are limited to mucosal surfaces, skin, and nails." [1] One report states, "Heterozygous STAT1 gain-of-function (GOF) mutations result in a combined form of immunodeficiency which is the most common genetic cause of chronic mucocutaneous candidiasis (CMC)." [2] This same report connects "chronic demodicosis in the form of a facial papulopustular eruption, blepharitis, and chalazion" with CMC. This could also be described as demodectic rosacea. Candida has been connected to rosacea in at least one paper. [3] End Notes [1] Wikipedia [2] Pediatr Dermatol. 2019 Oct 21; STAT1 gain-of-function and chronic demodicosis. Molho-Pessach V, Meltser A, Kamshov A, Ramot Y, Zlotogorski A [3] Candida Albicans

The skeleton structure of the SNRI venlafaxine, a typical example of an antidepressant. image courtesy of Wikimedia Commons "I’d never heard of antidepressants causing any issues with skin, which made me wonder if anyone else was having the same issue and just putting up with it in silence – or if the whole thing was in my head. I chatted with Dr Zubair Ahmed, the CEO of MedicSpot digital clinics, who confirmed that yes, antidepressants can absolutely cause or worsen skin conditions. ‘These skin issues range from innocent facial flushing to life threatening systemic rashes such as Stevens-Johnson syndrome,’ Dr Ahmed told metro.co.uk. ‘You may also notice purple dots on your skin (Purpura) or a condition called urticaria which is often due to an allergic reaction. ‘Eczema is also associated with antidepressant medication.’ " How your antidepressants might be messing with your skin, Ellen Scott, Metro Chai reports a serious rosacea flareup after withdrawing from mirtazapine. Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post.

image courtesy of Wikimedia Commons There are a number of anti-flushing prescriptions reported by rosaceans and we have an exhaustive list here (also includes a list of non prescription treatments as well).

Aclaris has now sold Rhofade to EPI Health, LLC.

"Aclaris Therapeutics, Inc. (Nasdaq: ACRS), a physician-led biopharmaceutical company focused on immuno-inflammatory diseases, today announced it has divested RHOFADE® (oxymetazoline hydrochloride) cream, 1% (RHOFADE) and related intellectual property assets to EPI Health, LLC (EPI Health). The divestiture of RHOFADE is a key component of Aclaris’ recently announced strategic plan to refocus resources on the development of its immuno-inflammatory development programs." GlobalNewswire, Inc, October 10, 2019 "Allergan developed and brought RHOFADE to market in 2017 after acquiring the drug as part of its 2011 acquisition of Vicept Therapeutics, Inc., a company established by certain members of the current senior management team of Aclaris." Business Insider, October 15. 2018 Aclaris owned Rhofade and sold it to Allergan and bought it back on October 2018. AP REPORTS The new owner, EPI Health, states on its website, "EPI Health is continually expanding our prescription product line to offer healthcare professionals and patients new and better options to treat skin conditions." EPI Health's president, John A. Donofrio, joined EPI Health in March of 2019. image courtesy of EPI Health, LLC

"All the cases, spreading rose petals on their face, at the end of the treatment show a decrease of the redness as well, and their “facies” exhibit a dark pinkish colour, that correspond to a real flesh-coloured appearance, that reveals a complete status of good health and remission of the syndrome." Our Dermatology Online, Letter to the Editor Rosacea treated with rose petals: a calembour that affffords intriguing results Piotr Brzezinski, Lorenzo Martini It is ironic that rose petals reduces redness? Since obtaining rose petals is without a doubt an easy task for most rosaceans worldwide, we should be able to easily confirm if this treatment works. You can order 50 fresh roses from Amazon right now delivered to your door. Please post your results in this thread. Rose Flowers-A Delicate Perfume or a Natural Healer? If you are not into getting the actual rose petals you may want to try one or more of the following: JAYJUN Rose Blossom Mask Thayers Alcohol-free Rose Petal Witch Hazel with Aloe Vera Thayers Natural Remedies Alcohol-Free Rose Petal Witch Hazel Facial Mist Toner Teddie Organics Rose Water amcfarland41 [post no 232] writes, "A product that I use alongside the books knowledge is a type of water called "Rose Water". This is the only thing I put on my face now and it is completely natural. Most importantly, it has one ingredient. It allows your face to breathe and remain cool when you would usually get hot. Also, it is a great value, as it will last you for a year. Instead of spending your hard earned money on various products that promise to treat your Rosacea,..."

There is a new cosmetic version of the ZZ cream now available on Amazon which is priced at $39 with free shipping until November 16, 2019. After this date the price goes up to $49. To learn more about this and what the difference is between the cosmetic ZZ cream and the original ZZ click here. I haven't used the ZZ cream for probably around nine months. I tried the horse paste because there were so many who raved about the success they were having with it and I must say, it is just as good or better than Soolantra. I just received a new shipment of the Cosmetic ZZ cream and must say this is an improved version and works much better and I have always preferred using the original ZZ cream over any other topical treatment for rosacea. Within a week my red spots have cleared up. I highly recommend you try a three month supply of the Cosmetic ZZ cream or at the very least one jar to see if your rosacea improves. If it does, you have demodectic rosacea. Product Insert

No mention of ivermectin in the abstract. Wonder if these authors have heard of Soolantra?

One report on 50 patients with rosacea using topical ivermectin concluded, "Ivermectin is an effective treatment not only in moderate-severe papulopustular rosacea but also in almost clear/mild rosacea." [bold added] Dermatol Ther. 2019 Oct 03;:e13093 Real life experience on effectiveness and tolerability of topical ivermectin in papulopustular rosacea and anti-parasitic effect on Demodex mites. Trave I, Merlo G, Cozzani E, Parodi A

A recent report concluded, "As a result, the Demodex count was significantly higher in the primary demodicosis and rosacea patients than the control group. We think that every Demodex-positive patients should be evaluated for also eyelash mites to prevent a possible chronic blepharitis."

The RRDi has been using the Invision Community forum for many years. It has been announced that there will are beta versions of Invision Community Apps for iOS & Android. We look forward to using these new apps when completed, however, the development of this has dragged on for sometime now and apparently unless we pay a developer to do this, it will not be done. If you need assistance in learning about how this platform works click here.

I was intrigued when I heard about The Planetary Society and requested the latest Form 990 from this 501 c 3 non profit organization, which means that any donation to this non profit is tax deductible for the donor. I received the following pdf: 2018 TPS 990 without Schedule B.PDF You can review this above yourself and save yourself the time requesting it for yourself. A cursory review of the above Form 990 shows some interesting facts. For example, total revenue (donations) in tax year 2017 was $4,945,266.00 and total expenses were $4,885,055.00 so they spent just about all the donations except for about $60K. See the summary below: What did they spend most of the money on? What about 'planetary' things? Actually most of the donations for 2017 were spent on salaries and employees if you go through the expense details which amounted to $2,682,000.00 if you look above. If you will note in the summary, line 5, there are 29 employees of The Planetary Society. That means if you average it out, each employee cost The Planetary Society $92,482.75. Would you like to work for The Planetary Society? Remember that each employee is paid with donations from the public. However, you should note that the six board of directors received the highest amount in salaries and compensation. The salaries for six of the board of directors amounted to $911,122 which is 34% of the total expenses on salaries listed on 15 above which you can view below in detail: I challenge any of you to find in the Form 990 provided for free from The Planetary Society to find what this non profit organization spent on 'planetary' or 'space' items? I found one grant they spent in the amount of $98,759 (line 13 in the summary above) and for its Lightsail Project which is listed below in the amount of $123,000 spent on an independent contractor, Ecliptic Enterprise Corporation (see below). So the only two items I could find that remotely relates to 'space' are one grant and its one project which totals $221,759.00. That means for every dollar donated to The Planetary Society about 4 cents is actually spent on what its mission statement is about. The other 96 cents of a donated dollar is spent on operating the organization and most of the expense is on salaries and employees (54%). This is not uncommon practices for non profit organizations which is the theme of this entire thread. If you take the time and effort to receive a Form 990 from any 501 c 3 that is required to publish one that makes it available to anyone who asks, you will find that most non profits spend very little on its 'mission.' One other item of note are the assets listed by this non profit organization. When you bring in millions of donations each year, it is possible that the non profit organization accumulates assets. Note below what is listed in the Form 990: The total assets are significant. In other words, if this organization ever decided to dissolve, it could sell the assets and the organization is required to disclose where all the money from those assets went. But most people simply don't care how non profit organizations spend their donations. Especially when it comes to rosacea non profits. Are you surprised or do you even care about any of this?

Thanks Erin for your post. Many, many others have reported great success with horse paste (gel). Without a doubt, Galderma and other pharmaceutical companies will note this success and start producing 1.87% ivermectin in a gel form without as many inactive ingredients to compete with the success you and others are having, especially a cheap version that could get FDA approved for human treatment. As for taking ivermectin orally, we have a thread on using ORAL IVERMECTIN FOR ROSACEA which is separate from the one you are posting in here which is about topical horse paste treatment. Really appreciate your post very much.

A new paper published in the September 2019 issue of The Journal of the European Academy of Dermatology and Venereology states that treatment using benzyl benzoate and crotamiton has been shown to decrease demodex density counts and improve demodectic rosacea. Benzyl Benzoate is a medication and insect repellent also used to treat scabies and lice. Crotamiton has been used to treat rosacea for sometime now and has traditionally been used to treat scabies. For more information.

There are a number of papers warning about allergic contact dermatitis to topical brimonidine (Mirvaso): Case Report: Allergic Contact Dermatitis to Topical Brimonidine Demonstrated With Patch Testing: Insights on Evaluation of Brimonidine Sensitization. Allergic contact dermatitis caused by Mirvaso®, brimonidine tartrate gel 0.33%, a new topical treatment for rosaceal erythema. [Allergic contact dermatitis to Mirvaso® (brimonidine tartrate)]. Allergic contact dermatitis to topical brimonidine. Sensitization to and allergic contact dermatitis caused by Mirvaso(®) (brimonidine tartrate) for treatment of rosacea - 2 cases.

Private Rosacea Forum We are pleased to announce that the RRDi is sponsoring a PRIVATE Tapatalk Rosaceans Forum at the following url: http://rosacea-control.com We hope you enjoy using the new forum. The Tapatalk Rosaceans Forum is a private forum if your prefer privacy over our Invision Community Forum (the forum you are currently using) which is a public forum for GUESTS (5% of the site is public). Guests may post without registering in the Invision Community Public Guest Forum. Learn more about our Invision Community private member forum (the most private rosacea forum on the internet). Tapatalk Rosaceans Forum The private rosacean Tapatalk forum uses Tapatalk Gold Points for those who so choose to use this reward system, but you are not required to purchase gold points. You may purchase gold points only if you prefer to do so and are under no obligation to do so since we are sponsoring this new Tapatalk Forum. Let us know how you feel about this Tapatalk PRIVATE forum by posting in this thread or post in the Tapatalk forum. We sponsored this for a limited time to see if the private Tapatalk forum is popular and it has not proved popular. We have switched to the free Tapatalk basic version since we cannot afford to pay for the tiered monthly fee version. We have paid for this for over a year and there are few registrations and no engagement with the members, even though it is totally private. We will keep it going as long as it is free. Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post.

Andy, You can learn about oral ivermectin with this post. You should be able to view demodex with the naked eye but dermoscopy or a cheap microscope makes viewing easier. This post explains about viewing demodex. A Russian paper on demodex had this point concerning demodex brevis: Demodex brevis not as significant as Demodex Folliculorum "In patients with severe manifestations of the condition (pustulous and infiltrative- productive forms of rosacea), the species of the mites Demodex folliculorum (P<0.01) is more often detected. Demodex brevis is found in mild forms of the condition and in healthy people, without showing signs of parasitism." "When Demodex brevis is found, given its weak possibility of parasitism, treatment with antiparasitic drugs is not indicated." More information

image courtesy of Wikimedia Commons What is Tripterygium wilfordii? Wikipedia says, it is "a vine used in traditional Chinese medicine." More info on Morbihan disease

Watch this less than one minute trailer Watch the longer ten minute version below What is your idea of what a rosacea non profit organization or a not for profit organization should be doing? Many have a poor understanding of what a non profit or not for profit organization is or how it operates and usually have a misunderstanding or very fuzzy concept of what these type of organizations should be doing. This post is to help clear up the confusion. If you are a rosacean who is interested in volunteering this is a good post for you to educate yourself on how non profits function or operate. If you note the title of this post it is asked to stimulate your thinking and and reply to this topic. What are your thoughts on this subject? So lets focus first on what you think a ROSACEA non profit organization should be doing and then we can discuss the nuances and caveats of non profit vs not for profit organizations. Rosacea Non Profit Organizations Rosaceans have changed over the years. In 2004 when the RRDi was founded, the rosaceans in 2004 really wanted to become united and do something about rosacea. Today, current rosaceans want to gather together in social media private groups like Facebook, Instagram, Twitter, and Reddit and discuss what they do about rosacea and do absolutely nothing about uniting together into a non profit organization for rosacea to sponsor research or have any influence on the medical community as patients suffering from this affliction (a patient advocacy organization). There are basically four currently active non profit organizations for rosacea (see Other Non Profit Rosacea Organizations). The RRDi is the only grassroots non profit organization out of the four founded by rosacea sufferers. The other three non profit rosacea organizations are top down non profits organized by non rosaceans who are businessmen or dermatologists with a small percentage spent on rosacea research. Since the RRDi is the only current and active rosacea non profit founded by those who suffer from rosacea in contrast to the other rosacea non profit organizations founded by businessmen and dermatologists, have you ever really investigated how the three other spend the donation/revenue? The RRDi has investigated the AARS, the NRS, and the ARSC. These three rosacea non profit organizations spend the majority of the donations/revenue primarily to benefit businessmen and dermatologists. Do you think that rosacea sufferers should unite together and sponsor their own rosacea research and have a voice that speaks for those who suffer from rosacea to speak to the medical community in a rosacea non profit organization? So does anybody care what a rosacea non profit organization should be doing about rosacea? What are your thoughts? Do you know anything about what the four rosacea non profit organizations are doing about rosacea? Could you discuss this or if you have questions about any of this? If you carefully look, you will find a REPLY TO THIS TOPIC button to comment or ask a question. Non Profit vs Not for Profit Organizations For example, what is the difference between a nonprofit and a not-for-profit organization? Yes, there is a difference. Wikipedia explains, "Nonprofit and not-for-profit are terms that are used similarly, but do not mean the same thing. Both are organizations that do not make a profit, but may receive an income to sustain their missions. The income that nonprofit and not-for-profit organizations generate is used differently. Nonprofit organizations return their income back to the organization if they generate extra income. Not-for-profits use their excess money to pay their members who do work for them. Another difference between nonprofit organizations and not-for-profit organizations is their membership. Nonprofits have volunteers or employees who do not receive any money from the organization's fundraising efforts. They may earn a salary for their work that is independent from the money the organization has fundraised. Not-for-profit members have the opportunity to benefit from the organization's fundraising efforts." However, whether an organization is a nonprofit or a not-for-profit based upon the above paragraph can get really fuzzy and the lines are not easily drawn. Sometimes the information on the internet offered to explain the differences between a non profit and a not for profit organization is conflicting, so the bottom line is what the Internal Revenue Service has to say on this subject or in a court of law. But we can discuss this subject here in this post and hope you are stimulated enough to enter the discussion. Could you please reply to this topic by hitting the REPLY TO THIS TOPIC button and post your comment on this subject? It would be incredible if volunteers would take the time to investigate how non profits work and input some thoughts on this subject. In the meantime, here are some investigative material for your consideration to meditate on when it comes to the subject, Non Profit vs Not for Profit. Non Profit Organization "A nonprofit organization is one that qualifies for tax-exempt status by the IRS because its mission and purpose are to further a social cause and provide a public benefit. Nonprofit organizations include hospitals, universities, national charities and foundations. To qualify as a nonprofit, your business must serve the public good in some way. Nonprofits do not distribute profit to anything other than furthering the advancement of the organization. As such, you will be required to make your financial and operating information public so that donors can see how their contributions are being used. An individual or business that makes a donation to a nonprofit is allowed to deduct their donation from their tax return. The nonprofit, likewise, pays no taxes on any money received through fundraising." [1] One websites says, "a nonprofit company can, in fact, operate as a not-for-profit organization." [2] An example of a non profit organization is any non profit designated 501 c 3. [3] Not for Profit Organization "Similar to a nonprofit, a not-for-profit organization (NFPO) is one that does not earn profit for its owners. All money earned through pursuing business activities or through donations goes right back into running the organization. However, not-for-profits are not required to operate for the benefit of the public good. A not-for-profit can simply serve the goals of its members. A good example is a sports club; the purpose of the club is to exist for its members’ enjoyment. These organizations must apply for tax-exempt status from the IRS, including exemptions from sales tax and property taxes. That also means that money donated by an individual to an NFPO cannot be deducted on that person’s tax return." [1] One website says, "a not for profit company can't function as a non-profit company." [2] An example of a not for profit organization is any non profit designated 501 c 6. [4] Common Interests Both non profit and not for profit organizations are referred to as NGOs. "Both types of organizations are operated with the intent to raise money or awareness for a particular cause or group rather than to increase profits and money for the business's shareholders...Not-for-profit and nonprofit companies both use their income to help those in need." [2] "The IRS classifies various types of organizations, events, and activities as either nonprofit or not-for-profit." [2] "Although both companies can make money from their various activities and fundraising initiatives, these funds must [be] used for additional charity work or reinvested to further the company's operations. No profits will be distributed to any members, directors, or trustees." [2] Et Cetera How Non Profits Work Comparing Non Profit Organizations with their Mission Reply to this TopicThere is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Nonprofit vs. Not-for-Profit vs. For-Profit: What's the Difference?, Emily Heaslip, U.S. Chamber of Commerce [2] Not for Profit vs Nonprofit: Everything You Need to Know, UpCounsel [3] "An organization will be regarded as operated exclusively for one or more exempt purposes only if it engages primarily in activities which accomplish one or more of such exempt purposes specified in section 501(c)(3). An organization will not be so regarded if more than an insubstantial part of its activities is not in furtherance of an exempt purpose." Comparing 501(c)(3) vs. 501(c)(6) for Nonprofit Startups, Gene Takagi, NEO Law Group, Non Profit Law Blog Well known non profit organizations are the United Way, The American Cancer Society (Group), Dana-Farber Cancer Institute, Red Cross, and the list goes on and on. [4] "A [501(c)(6)] business league is an association of persons having some common business interest, the purpose of which is to promote such common interest and not to engage in a regular business of a kind ordinarily carried on for profit. It is an organization of the same general class as a chamber of commerce or board of trade. Thus, its activities should be directed to the improvement of business conditions of one or more lines of business as distinguished from the performance of particular services for individual persons." Comparing 501(c)(3) vs. 501(c)(6) for Nonprofit Startups, Gene Takagi, NEO Law Group, Non Profit Law Blog The more famous 501 (c) 6 organizations are the American Medical Association, the PGA Tour (over $1 Billion in Revenue), the Professional Golfers Association, and some sports organizations like the US Polo Association, and the National Football League (the NFL was a 501 (c) 6 from 1942 through 2015 and announced that it would henceforth be a for profit organization), as well as Major League Baseball, which dropped it's long history as a non profit in 2007. Other 501 (c) 6 non profit organizations include the American Dental Association, American Petroleum Institute, Edison Electric Institute, American Beverage Association, National Association of Home Builders of the United States, Aerospace Industries Association of America, Inc., the Association of Pool and Spa Professionals, American Nurses Association, Inc., and Association of American Railroads. There are hundreds of others you can browse through.