Guide

Sorry to hear that since I have enjoyed your posts. Dr. Cordain wrote the Paleo Diet, which is a high protein diet, similar to my Rosacea Diet, the Atkins Diet, Protein Power by Drs. Eades. I recall you wrote something in this thread about Dr. Cordain regarding his use of references? I invited him to volunteer on the RRDi MAC because there are many rosaceans who have posted that eating high protein and avoiding carbohydrate, especially sugar improves rosacea. Dr. Cordain rarely posts here, as you will find out, most of the MAC members rarely post since they are all living very busy lives.

I have tried the Soolantra and posted my results here. I have tried the Durvet horse paste and prefer it over Soolantra. I like the horse paste 'gel' better than the oily 'cetaphil' Basis for the Vehicle in Soolantra. Hope you have good results with Soolantra, since many do report it works for them. As for your eyes, many have reported that the Cliradex towels work. As for shampoo there are a number of tea tree oil shampoos that many have reported works for them, i.e., Ovante or DS Shampoo, and there are many others. Ivermectin generally takes 12 weeks for clearance, after that, you can figure out your own maintenance routine, hopefully, one or twice a week. As for the human microbiome, there are ten times as many virus in a human as there are bacteria. The Russians and Eastern Europeans have traditionally looked into using bacteriophage (virus) for over ninety years and are way ahead of Western Medicine into research on this subject, using bacteriophage as an 'antibiotic' in treatment of disease. The Western bias of focusing on bacteria as the culprit of everything and dismissing all the other microbes besides bacteria clouds the health issue. For more information on the human microbiome.

Global ROSacea COnsensus (ROSCO) 2019 In 2019 the ROSCO panel collaborated again with a paper published in the British Journal of Dermatology and concluded: "The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management." The original panel lost one member, Y Wu from China, and has gained five new members, J. Del Rosso, R.D. Granstein, G. Micali, E. Tanghetti and M. Zierhut. Here is the list of 2019 ROSCO Panel: L.M.C. Almeida, Brazil A. Bewley, United Kingdom B. Cribier, France J. Del Rosso, USA N.C. Dlova, South Africa R.L. Gallo, USA R.D. Granstein, USA G.Kautz, Germany M.J. Mannis, USA G. Micali, Italy H.H. Oon, Singapore M. Rajagopalan, India M Schaller, Germany M. Steinhoff, Ireland J. Tan, Canada E. Tanghetti, USA D.Thiboutot, USA P. Troielli, Argentina, E.J. van Zuuren, Netherlands G. Webster, USA M. Zierhut, Germany 2019 Total ROSCO Panel Members 21

The ivermectin apparently kills the mites. The metronidazole is an antibiotic and helps heal any bacterial infection that you may be experiencing. Sometimes dermatologists also prescribe taking oral antibiotics, i.e., doxycycline, along with the ivermectin, the gold standard that Galderma uses. I am happy for you that your ivermectin/metronidazole treatment is improving your skin. It usually takes twelve weeks for clearance and after that using a maintenance treatment, say two times a week or when you feel it is necessary. Thanks for the links to the TED talks. The Russian study on demodex is illuminating as well as the demodex update post. As for vaginal yeast infections, antibiotics don't work well on such, but anti-fungals do. There simply isn't much research on anti-fungals and rosacea, or for that matter the rest of the skin microbiome. Bacteria only takes up a small percentage of the human microbiome, yet research has been overwhelming in favor of looking at bacteria for over a hundred and fifty years which focuses on antibiotic treatment. This bias toward bacteria tends to ignore other microorganisms, i.e., virus, fungus, archea, protozoa, helminths, demodex, and the list continues to grow. Candida albicans (a fungus or yeast) and rosacea have been linked in at least one research paper.

Just posted something about the placebo/nocebo effect worth reading.

You may find it interesting why the RRDi, the first non profit organization for rosacea founded by rosacea sufferers, was formed. A post on rosacea research in respect to funding helps get a clearer perspective. Currently there are four active non profit organizations for rosacea: National Rosacea Society (NRS) 501 (c) (3) non-profit(Spends 60% of its donations on two private contractors owned by the director/president of the NRS, Sam Huff, and 10% of its donations on rosacea research) American Acne and Rosacea Society (AARS) 501 (c) (3) non-profit(Spends most of it donations on conventions for its prestigious members and very little on rosacea research) Acne and Rosacea Society of Canada(Absolutely no financial public records so we have no data on any rosacea research) The RRDi, which is where you are now. You mention cancer, which as you point out receives millions, if not billions of dollars in donations, and very little is spent on cancer research if you actually check how each non profit organization for cancer spends its donations. This post explains where a few cancer organizations actually do spend a significant amount on cancer research, such as Dana Farber and The Breast Cancer Research Foundation, but typically, most cancer non profits, i.e., The American Cancer Society (Group), spend very little on cancer research. For example the The American Cancer Society (Group) received almost a billion dollars in donations and spent less than one percent of this on cancer research. Most people don't care about any of this. The American Academy of Dermatology receives millions of dollars in donations and in 2015 spent 3% of the total on research, very little if any on rosacea research. The sad point of all this is that Rosaceans simply don't care how non profit organizations for rosacea should conduct themselves. They don't care about coming together and trying to do their own research. They continue to donate to the NRS who spends very little money of its donations on rosacea research, about ten percent, and spends the vast majority on private contractors owned by the president/director of the NRS. C'est la vie.

Yes, I think this is the best method you are trying. Try this for at least four weeks and post back your results.

You may want to try the Agri-Mectin gel on your face at night and let it dry before you put your face on the pillow or bed. In the am wash it off. See if this works for you?

Which brand are you using?

Soolantra at drugs.com costs $389/30 grams

Trillium, Tom Busby, SD poster extraordinare at RF, mentioned in a post on this subject at RF, "an alternative source of ivermectin, on eBay" which is ivermectin powder. I asked Tom whether this would be a good idea since it seems a lot safer to use the horse paste than have to concoct a paste with grain alcohol and his comment is, "horse paste is fairly expensive for a really tiny amount of product.... I have to assume that someone who has some experience formulating hot emulsions (oil in water) could make a non-greasy cream with this ivermectin powder." There is a formulae based upon weight how much ivermectin to use per pound of body weight. You mention using the Cetaphil base for your concoction. Have you used Cetaphil? No issues with Cetaphil? Some have reported they cannot tolerate Cetaphil, while others just love it. We have a post explaining the 'basis for vehicle' regarding the use of Cetaphil with Soolantra that should prove illuminating to you. Some prefer the smaller amount of inactive ingredients in horse paste over using the huge amount of inactive ingredients in Cetaphil based Soolantra. There are a significant number of brands of horse paste and each one has similar but different inactive ingredients which are discussed in this thread. We have found two brands that actually list the inactive ingredients, but most brands do not list the inactive ingredients since they are not required to do so. As for price of Soolantra have you contacted Galderma about the CareConnect program that you may qualify for? As for the high prices pharmaceutical companies charge in the USA which is related to the medical insurance conglomerate and the universal health insurance issue, yes, it is sad that medical treatment is for the rich, similar to the way justice is given. If you are rich you definitely have an advantage in the USA for justice and medical treatment. But there are some work arounds, where philanthropic organizations help the poor with the money donated by rich benefactors but obviously not enough is given to alleviate these issues. Our non profit organization tries to help in small ways by educating Rosaceans on alternative treatments like ElaineA has done in this thread. Hopefully, you will figure out your own ivermectin solution. Are you confident that using ivermectin actually controls your rosacea? Ivermectin doesn't work for every rosacean. Which brand of horse paste 'leaves a goopy mess on your face at night' ? Have you tried using the horse paste on at night and then washing it off in the AM? Most use Soolantra this way, only use at night. Horse paste is usually only put on at night and then washed off in the AM. Keep us posted.

Frontal fibrosing alopecia may be a co-existing condition with rosacea, as well as, a systemic comorbidity in rosacea. One cross-sectional study including 99 women with Frontal fibrosing alopecia presented a higher prevalence of rosacea than did controls. [1] "Frontal Fibrosing Alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline. It is considered to be a clinical variant of lichen planopilaris. Frontal Fibrosing Alopecia has been most often reported in post-menopausal women with higher levels of affluence and a negative smoking history. Autoimmune disease is found in 30% of patients." Wikipedia "Most of the patients in this series of FFA were postmenopausal women. The prevalence of oral and genital lichen planus was higher than that observed in the general population. Patients with a linear pattern had less severe disease. Facial papules were more common in younger patients and both facial papules and rosacea were associated with a greater need for oral treatment." [2] "FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia." [3] "The association with moisturizers, odinary facial soap, and hair straightening with formalin and the negative association with anti-residue / clarifying shampoo reinforce the possibility of an exogenous particle triggering FFA." [4] Genetic and Rare Diseases Information Center (GARD) End notes [1] A Cross-sectional Study of Rosacea and Risk Factors in Women with Frontal Fibrosing Alopecia. J Acad Dermatol.VOLUME 78, ISSUE 3, P596-597.E1, MARCH 01, 2018 Frontal fibrosing alopecia and cutaneous comorbidities: A potential relationship with rosacea Cristina Pindado-Ortega, MD, David Saceda-Corralo, MD, Diego Buendía-Castaño, MD, Ana R. Rodrigues-Barata, MD [2] Frontal Fibrosing Alopecia: A Retrospective Study of 75 Patients. [3] Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study. [4] J Am Acad Dermatol. 2020 Aug 21;: Risk Factors for Frontal Fibrosing Alopecia: a case-control study in a multiracial population. Ramos PM, Anzai A, Duque-Estrada B, Farias DC, Melo DF, Mulinari-Brenner F, Pinto GM, Abraham LS, Nogueira Santos LD, Pirmez R, Miot HA Etcetera Hair loss and rosacea Eyebrows hairloss! Fixed the symptoms but no regrowth

Medscape has recognized the phenotype classification of rosacea with the following: In 2016, the global rosacea consensus panel recommended a new classification: at least one diagnostic or two major phenotypes are required for the diagnosis of rosacea. Diagnostic phenotypes A diagnosis of rosacea may be considered in the presence of one of the following diagnostic cutaneous signs: Fixed centrofacial erythema in a characteristic pattern that may periodically intensify Phymatous changes: Patulous follicles, skin thickening or fibrosis, glandular hyperplasia, and bulbous appearance of the nose (rhinophyma is the most common form) Major phenotypes Without a diagnostic phenotype, the presence of two or more of the following major features may be considered diagnostic: Papules and pustules Flushing: Frequent and typically prolonged Telangiectasia: Predominantly centrofacial in phenotypes I-IV, rarely seen in darker phenotypes Ocular manifestations Secondary phenotypes The following secondary signs and symptoms may appear with one or more diagnostic or major phenotypes: Burning and stinging Edema: Facial edema Dry appearance: Central facial skin may be rough and scaly Ocular rosacea Major features of ocular rosacea are as follows: Lid margin telangiectasia Interpalpebral conjunctival injection Spade-shaped infiltrates in the cornea Scleritis and sclerokeratitis Secondary features of ocular rosacea are as follows: "Honey crust" and collarette accumulation at the base of the lashes Irregularity of the lid margin Evaporative tear dysfunction (rapid tear breakup time) Although ocular manifestations may precede the cutaneous signs by years, in many cases they develop concurrently with dermatologic manifestations. The diagnosis of rosacea is made clinically, based on the 2016 global rosacea consensus that one diagnostic or two major phenotypes are required for the diagnosis of rosacea. A skin biopsy is sometimes performed to exclude other cutaneous diseases, such as lupus or sarcoidosis. Agnieszka Kupiec Banasikowska, MD Consulting Staff, Georgetown Dermatology, PLLC Medscape > Drugs & Diseases > Dermatology > Rosacea

A recent paper on the subject of probiotics for skin conditions states, "Unfortunately, very few studies have looked how probiotic supplementation influence inflammatory skin disorders. The results of probiotic use, although beneficial, are difficult to implement into clinical practice due to the heterogeneity of the applied supplemental regimen. In this Viewpoint we aim to encourage the conduction of more research in that direction to explore unambiguously the therapeutic potential of oral probiotics in dermatology." [1] Wouldn't it be incredible if a non profit for rosacea got 10K members each to donate one dollar to fund a peer reviewed, double blind, placebo controlled clinical study on probiotics and rosacea? Could that be possible? Only you can be a part of such a miracle. Why not donate your dollar? End Notes [1] Exp Dermatol. 2019 Aug 06;: Targeting the gut-skin axis - probiotics as new tools for skin disorder management? Szántó M, Dózsa A, Antal D, Szabó K, Kemény L, Bai P

There are many published peer reviewed papers on rosacea and it is important enough to have this article mentioned in a post to be able to refer to it later, since this points out some of the negative aspects of those who rely on peer reviewed papers. An article, published in The Washington Post, states about the peer reviewed process that 'It’s too easy for bad actors to exploit the process and mislead the public.' [1] "Peer review is supposed to safeguard the quality of scientific research. When a journal receives a manuscript, the editors ask three or more experts in the field for comments. The reviewers’ written assessments may force revisions in a paper or prompt the journal to reject the work altogether. The system, widely adopted by medical journals in the middle of the 20th century, undergirds scientific discourse around the world...The reputation of these journals rests in large part on vigorous peer review. But the process is opaque and fallible: Journals generally do not disclose who reviewed a study, what they found, how long it took or even when a manuscript was submitted...Critics have long worried that the safeguards are cracking, and have called on medical journals to operate with greater transparency." [2] We will continue to add more articles as we find them. If you would care to volunteer for the RRDi and add your comment we would appreciate it. Find the reply to this topic button, post your comment, and all that is required is an email address to begin the process. If you prefer commenting about this article without registering an account with the RRDi you may refer to this article in your comment (providing a link to it would help those who may have difficulty finding it) and join the RRDi to post. Volunteers may waive the subscription fee. End Notes [1] Why we shouldn’t take peer review as the ‘gold standard’, by Paul D. Thacker and Jon Tennant, August 1, 2019, The Washington Post [2] The Pandemic Claims New Victims: Prestigious Medical Journals, Roni Caryn Rabin, The New York Times

Credit: INSTAGRAM / JO HOARE The writer, Jo Hoare, states clearly, "I was diagnosed in 2016" with rosacea in an article in The Sun, SEEING RED Writer dares to bare the truth about living with rosacea and how to manage its symptoms. Jo Hoare is a journalist based in London, UK. Linkedin • Jo Hoare has made the RRDi official list of famous rosaceans. That is what you do, get a diagnosis from a physician, preferably a dermatologist like Jo Hoare did. She complains of flushing so she may have Phenotype 1 and Phenotype 2 (you can have more than one phenotype of rosacea, there are actually six phenotypes). While Tom Busby makes a point that "Rosacea is so badly defined" it is important that anyone that presents with a red face should get a correct diagnosis since there are also at least thirteen variants of rosacea and a huge number of rosacea mimics, so a differential diagnosis is prudent. Just because one presents with a red face doesn't necessarily mean one has rosacea. I refer to Dr. Draelos statement about all this which is pertinent to this post, "Rosacea is probably a collection of many different diseases that are lumped together inappropriately." So while there is some confusion about presenting one self to a physician with a red face, there is a lot of information dermatologists have to find a correct diagnosis by taking a patient history, examination, and possibly some tests to rule out certain skin conditions that present with a red face. What everyone wants is to find the best dermatologist who does just that (finds the correct diagnosis), because misdiagnosis is not uncommon. Sometimes, the path to a correct diagnosis can get complicated. Famous Rosaceans

image courtesy of Wikimedia Commons Another rosacea mimic to rule out is Perioral Demodex folliculitis from Rosacea Perioral Dermatitis. See the following article: JAAD Case Rep. 2019 Jul; 5(7): 639–641.Perioral Demodex folliculitis masquerading as perioral dermatitis in the peripartum periodDema T. Alniemi, MD and David L. Chen, MD

The AARS in June 2019 has now officially at the very least, started to recognize the phenotype classification of rosacea with its published paper stating, "The classification of rosacea in both clinical practice and research previously utilized subtype designations as described by Wilkin et al in 2002 from the National Rosacea Society. However, the current recommendations from multiple organizations with interest in the diagnosis and treatment of rosacea suggest characterizing patients with rosacea by individual clinical manifestations and symptoms that are present at the time of examination. As rosacea is a phenotypically heterogeneous disease, this might include central facial erythema without papulopustular (PP) lesions; central facial erythema with PP lesions; the presence of phymatous changes, ocular signs, and symptoms; extensive presence of facial telangiectasias; and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea). Manifestations at various time points in a single patient might differ depending on whether the rosacea is flared or quiescent, the age of the patient, the duration of his or her disease, the frequency and magnitude of rosacea flares, and associated symptomatology." J Clin Aesthet Dermatol. 2019 Jun; 12(6): 17–24. Update on the Management of Rosacea from the American Acne & Rosacea Society (AARS) James Q. Del Rosso, DO, FAOCD, FAAD, Emil Tanghetti, MD, FAAD, Guy Webster, MD, PhD, FAAD, Linda Stein Gold, MD, FAAD, Diane Thiboutot, MD, FAAD, and Richard L. Gallo, MD, PhD, FAAD While this isn't exactly endorsing the phenotype classification 'officially' and it is odd that the AARS paper on the management of rosacea has such a cursory reference to phenotypes since the ROSCO panel, RRDi, NRS, and Galderma have endorsed the phenotype classification of rosacea. But notice the 'phenotypically' list quoted above how it follows the phenotype classification: "central facial erythema without papulopustular (PP) lesions;" (Phenotype 2) "central facial erythema with PP lesions;" (Phenotype 4) "the presence of phymatous changes," (Phenotype 5) "ocular signs, and symptoms;" (Phenotype 6) "extensive presence of facial telangiectasias;" (Phenotype 3) "and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea)" (Phenotype 1) The AARS is recognizing the phenotypes in its own way. This is typical of how rosacea non profit medical organizations have to be different yet basically say the same thing, just list in a different order with lots of words. You can probably see that the six phenotypes are an easier way to refer to these 'manifestations' especially in writing down a diagnosis on a patient's chart.

Quite right. There hasn't been any dog mites shown to be on human skin. Weird isn't it? Yet, dog mites can travel on human skin. But for some reason we never find dog mites on human skin. I haven't really done any serious investigation on this because all the papers say humans only have demodex folliculorum and brevis mites. The dog mites are indeed different mites as you have pointed out. We now have a post on this subject worth your consideration: Can Demodex Mites Transfer From Pets to Humans? 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.

Just about everyone on planet earth has Demodex mites since they are part of the human microbiome. They usually pose no issues in most humans having a symbiotic relationship, but for some unknown reason in some people, the mites increase in number and are associated with rosacea. While it is true that mites can be spread by human contact, not to mention you can get mites from dogs, most contact poses no issues. Your skin also has many other microbes besides demodex, i.e., bacteria, archea, and fungi. When humans interact with each other skin contact is normal and basically no one worries about skin contact unless there is some skin disease that warrants no skin contact. In rosacea patients with high numbers of demodex folliculorum they become a parasite while demodex brevis is a saprophyte. There are no clinical papers studying whether or not a demodectic rosacea sufferer can spread this to another human, but without a doubt mites do travel to another human with skin contact so the probability is without a doubt possible. However, your girl friend may have a skin metabolism that is able to handle the demodex mites. For more information you may want to read this paper by the Russians on demodex as wells as, the update post on our understanding of demodex. For all our posts on demodectic rosacea click here. As for your contact with your girl friend, it would be prudent to let her know about all this and let her decide. One other point to correct is not all rosacea is demodectic. There are some who do not respond well to treatments aimed at eliminating demodex mites. In those cases these rosaceans may simply have one or more of the phenotypes of rosacea or another rosacea variant, or possibly a completely different skin disease (see this page on misdiagnosed rosacea).

This post about horse paste is helpful regarding this thread: https://irosacea.org/forums/topic/4191-horse-paste-for-rosacea/ Sent from my iPhone using Tapatalk

If you are interested in this subject, there is an excellent post discussing demodex density numbers in rosacea and do these numbers really matter?

If the RRDi has the money, what would you prefer the RRDi spend its donated funds on what particular rosacea research? If you want something added in the above poll please post in this thread (find the green reply button) and tell us what rosacea research you want?

Please indicate what prescription drug treatment(s) you have taken to control your rosacea. You may choose as many as you have tried. This may indicate what prescription drugs we need more research on. If you prescription drug treatment for rosacea is not on the lists, please post it so we may add it to the poll. Thanks.

For a long time microorganisms of the skin microbiome have been suggested as a cause of rosacea. The list includes, bacteria, fungus, virus (including phages), and demodex mites. Further, there are some papers that suggest that the gut microbiome may be involved in rosacea. One article comparing identical twins and the skin microbiome reports "Microbial dysbiosis could be one of the factors associated with the pathogenesis of rosacea as well as its comorbidities." [1] This same study concluded, "Our data demonstrate a significant correlation between facial microbiome and severity of rosacea in genetically matched twins and importantly that overall microbiome composition is largely unchanged." Further the study states, "Specifically, we uncovered a positive and a negative association for Gordonia and Geobacillus with rosacea, respectively. Importantly, this was in the background of a largely unchanged microbiome landscape." Furthermore, the fecal microbiome shows an altered state in rosacea patients. [8] Research into the human microbiome has enhanced our understanding of the importance of this subject and one paper explains: "The analysis of 16S ribosomal RNA (rRNA) fragments from the human microbiome is emerging as a novel tool for understanding the pathogenesis of human disease. Metagenomic approaches for investigating microbial genomes are being used to determine the potential roles of the microbiotas of the gut, skin, blood, and other human derivatives in chronic inflammatory diseases." [6] "However, it is suspected that the community of microorganisms in and on the skin, rather than a single species, plays a more causative role in the disease." [9] While the vast majority of papers focus on bacteria, there is little if any papers investigating virus, archea, protozoa, or helminths associated in rosacea. There are a significant number of papers focusing on demodex. [13] A Bias With Bacteria as the Focus of Rosacea Research and the Human Microbiome The study mentioned previously [1], focuses primarily on bacteria, i.e., Gordonia, Blautia, Chryseobacterium, Wautersiella, Geobacillus and unknown genus (phylum Proteobacteria). Most rosacea research papers have a bias towards bacteria and largely ignore other microorganisms in the microbiome such as virus, archea, fungi, protozoa, helminths, and demodex (the article made a cursory mention of demodex, but little discussion on this subject). The human microbiome has a huge diversity and bacteria is simply only a very small part of it. [2] Such bias towards bacteria ignoring these other microorganisms with only a token mention of other microbes is found in most articles on rosacea since Western Medicine largely ignores these other microorganisms with very little research, usually only focusing on bacteria. This results with such a paltry knowledge of what might be some significant factors in rosacea other than focusing on bacteria. For example, there are more virus types in the human microbiome than bacteria by a factor of ten times yet very little research is done on virus and rosacea. The bias is that bacteria plays a chief role in rosacea resulting in mostly antibiotic treatments and more recently a little probiotic treatment. There are examples of clinical papers that have bias toward bacteria and only give token mention of other microbes on skin microbiome. For example, a "study [that] provides a glimpse into the skin microbiota in rosacea and its modulation by systemic antibiotics" clearly shows a bias toward bacteria and ignores any other microbes of the skin microbiota. [5] Another study into the blood microbiota in rosacea patients focused entirely on bacteria ignoring all other microbes in the blood. This bias continues in other papers on the skin microbiome. [6] Another example is a study comparing the skin microbiota between acne and rosacea which concluded, "Investigating the differences between the skin microbiota in acne and rosacea can provide important clues toward understanding the disease progression in each condition." [7] This study ignores virus, demodex, protozoa, archea and any other microbes except the article totally focuses entirely on bacteria. The focus of most studies on the skin microbiome is usually if not always on bacteria. "Therefore, to predict the complete metabolism of any molecule by skin microbiome, a curated database of metabolic enzymes (1,094,153), reactions, and substrates from ∼900 bacterial species from 19 different skin sites were used to develop “SkinBug.” [11] "SkinBug" focuses exclusively on bacteria. "Recent research has confirmed the increased presence of bacterial genera like Acidaminococcus and Megasphera in the intestinal microbiome and Rheinheimera and Sphingobium in the blood microbiome of rosacea patients." [12] A paper published in 2021, Microbiota in Rosacea, mentions bacteria, viruses, fungi, and mites, it ignores archea, protozoa or helminths and totally focuses on bacteria or demodex. [13] The following image is shown in this paper discussing the gut-brain-skin axis. [13] Image courtesy of the American Journal of Clinical Dermatology Research on Other Microbes Besides Bacteria in Rosacea? The role of the other microorganisms besides bacteria should warrant more attention but who will pay for such studies? Demodex has been an example of the most researched microorganism other than bacteria studies. [3] This is because there are now treatments for demodectic rosacea so there is motive to fund such studies, usually by pharmaceutical companies that market treatments aimed at eradicating the mites. We are grateful that pharmaceutical companies who treat demodectic rosacea fund studies on demodex and rosacea. However, could there be other microbes that could be investigated besides bacteria and demodex mites? What about research on the other microbes that are in the human microbiome such as virus or protozoa? What role does archea play in rosacea? Do you want to fund such a study? Could 10K members of the RRDi get together and each donate one dollar to fund such a study? Only with your help could we reach such a goal. Think about it. [4] image courtesy of the Journal of Clinical Laboratory Analysis "During normal skin homeostasis, the microbes inhabiting the microenvironment keep a balance; however, a disorder of the microenvironment may occur if factors affecting the growth or survival of microorganism change. In addition, changes in microbiota may be due to individual, environmental, or behavioral factors, such as age, gender, climate, hygiene, antibiotic consumption, humidity, temperature, pH, and lipid composition, which may cause dysbiosis. It is therefore of great importance to examine the correlation between microenvironments and rosacea, which may interact with each other....For the better understanding of the microbiology of rosacea, more studies are needed to help illustrate the mechanism of rosacea and contribute to providing more therapeutic approaches based on the controversial studies and opinions expressed in the literature." [10] Another study focusing on systemic lupus erythematosus (SLE) patients, 20 controls with rosacea and 20 healthy controls were selected as study subjects shows that the compositions and diversity of skin microbiota in SLE patients are changed and have a distinct structural and functional skin microbiota compared with controls. However, the study only focused on bacteria, ignoring all other skin microbiota. [14] Etcetera Microbiome-based therapeutic strategies Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Exp Dermatol. Author manuscript; available in PMC 2019 Jul 16. Published in final edited form as: Exp Dermatol. 2018 Mar; 27(3): 295–298. Characterization of the facial microbiome in twins discordant for rosacea Asifa K. Zaidi,1 Katrina Spaunhurst, Daniel Sprockett, Yolandas Thomason, Margaret W. Mann, Pingfu Fu, Christine Ammons, Meg Gerstenblith, Marie S. Tuttle, and Daniel L. Popkin The main focus of most clinical papers on the human microbiome focuses on bacteria and ignores other microbiota. A typical example is the following: Medicine (Baltimore). 2021 Apr 23; 100(16): e25623. Differences in microbiota between acute and chronic perianal eczema Ming Ma, BM, Hongmei Lu, MM, Zuozhen Yang, PhD, Li Chen, MM, Yingru Li, BM, and Xiu Zhang, MMe [2] Human Microbiome, Brady Barrows "Parasitic diseases are skin conditions caused by insects, worms, protozoa, or coelenterates that may or may not be parasitic." An Bras Dermatol. 2020 Jan-Feb; 95(1): 1–14. Published online 2019 Dec 31. doi: 10.1016/j.abd.2019.12.001 PMCID: PMC7058862 - PMID: 32001061 Update on parasitic dermatoses Alberto Eduardo Cox Cardoso, Alberto Eduardo Oiticica Cardoso, Carolina Talhari, and Monica Santose "In this review, we will discuss the relationship between the gut and skin microbiome and various dermatological diseases including acne, psoriasis, rosacea, and atopic dermatitis. In addition, we will discuss the impact of treatment on the microbiome and the role of probiotics." The Skin and Gut Microbiome and Its Role in Common Dermatologic Conditions. Microorganisms. 2019 Nov 11;7(11): Ellis SR, Nguyen M, Vaughn AR, Notay M, Burney WA, Sandhu S, Sivamani RK [3] Demodectic Rosacea [4] More thoughts on this subject to think about: Rosacea Research in Perspective of Funding Rosacea Research in Perspective of Idiopathic Diseases [5] J Clin Med. 2020 Jan 09;9(1): Characterization and Analysis of the Skin Microbiota in Rosacea: Impact of Systemic Antibiotics. Woo YR, Lee SH, Cho SH, Lee JD, Kim HS Another study on the skin microbiome states, "The collection of all the microorganisms (bacteria, archaea, fungi, protozoa and viruses) that live in a particular environment or biome, their genomes and the surrounding environmental conditions including microbial metabolites (RNA, proteins, short‐chain fatty acids)," but totally focuses on bacteria with no other mention of 'archea, fungi, protozoa or viruses.' Int J Cosmet Sci. 2020 Apr; 42(2): 116–126. Revealing the secret life of skin ‐ with the microbiome you never walk alone R. Sfriso, M. Egert, M. Gempeler, R. Voegeli, R. Campiche Another paper admits to its bias toward bacteria with statement while acknowledging other microbes: "Consortia of microbes are found in many niches of the earth, like on various sites of animals and plants, in soil, in water and in the atmosphere, but also in industrial fermentations and biofilms. In this review, we will focus on the human skin microbiota (mainly on bacteria), their currently known relevance in health and disease, and provide an overview of main sequencing‐based methods and bioinformatic tools to measure them." J Dermatol. 2020 Oct; 47(10): 1110–1118. Skin microbiota in health and disease: From sequencing to biology Thomas H. A. Ederveen, Jos P. H. Smits, Jos Boekhorst, Joost Schalkwijk, Ellen H. van den Bogaard, Patrick L. J. M. Zeeuwen [6] Dermatology 2019;235:255–259 DOI: 10.1159/000496968Characterization of the Blood Microbiota in Korean Females with RosaceaYeojun Yun, Han-Na Kim, Yoosoo Chang, Yunho Lee, Seungho Ryu, Hocheol Shin, Won-Serk Kim, Hyung- Lae Kim, Jae-Hui Nam Another example of a bias toward bacteria with a token mention of fungus and virus in the skin microbiome dysbiosis: Am J Clin Dermatol. 2020; 21(Suppl 1): 18–24. The Skin Microbiome: A New Actor in Inflammatory Acne Brigitte Dréno, Marie Ange Dagnelie, Amir Khammari, and Stéphane Corvec This paper focuses mainly on bacteria with a mention of demodex: Microorganisms. 2020 Nov 08;8(11):Diversity and Composition of the Skin, Blood and Gut Microbiome in Rosacea-A Systematic Review of the Literature.Tutka K, Żychowska M, Reich A [7] Exp Dermatol. 2020 Apr 11;: Comparison of the skin microbiota in acne and rosacea. Thompson KG, Rainer BM, Antonescu C, Florea L, Mongodin EF, Kang S, Chien AL [8] J Formos Med Assoc. 2020 May 20;:An altered fecal microbial profiling in rosacea patients compared to matched controls.Chen YJ, Lee WH, Ho HJ, Tseng CH, Wu CY [see the third post in this thread by scrolling down past this first post] [9] Br J Dermatol. 2020 Jun 13;: Bacterial and fungal microbiome characterization in patients with rosacea and healthy controls. Wang R, Farhat M, Na J, Li R, Wu Y [10] Clin Lab Anal. 2020 Sep; 34(9): e23363. Rosacea is associated with conjoined interactions between physical barrier of the skin and microorganisms: A pilot study Chao Yuan, Yafeng Ma, Yinjuan Wang, Xiuli Wang, Chunyan Qian, Didier Hocquet, Shuli Zheng, Sophie Mac‐Mary, and Philippe Humbert [11] iScience. 2021 Jan 22; 24(1): 101925. SkinBug: an artificial intelligence approach to predict human skin microbiome-mediated metabolism of biotics and xenobiotics Shubham K. Jaiswal, Shitij Manojkumar Agarwal, Parikshit Thodum, and Vineet K. Sharma [12] Acta Microbiol Immunol Hung. 2021 Jan 29;:Interactions between immune system and the microbiome of skin, blood and gut in pathogenesis of rosacea.Joura MI, Brunner A, Nemes-Nikodém É, Sárdy M, Ostorházi E [13] American Journal of Clinical Dermatology volume 21, pages 25–35 (2020) Microbiota in Rosacea Hei Sung Kim [14] Systemic lupus erythematosus patients have a distinct structural and functional skin microbiota compared with controls