Guide

Logo of the Human Microbiome Project, a program of the NIH Common Fund, National Institutes of Health, image courtesy of Wikimedia Commons This subject of microbiome-based therapeutic strategies for rosacea is one of my favorite subjects which I have done a great deal of research on. You may want to read the latest article I have written on this subject of the human microbiome.

The GUT - BRAIN - SKIN axis has now been clearly established. Three Types of Gut Bacteria They have now discovered that humans might be divided into three types of gut bacteria: Bacteroides, Prevotella and Ruminococcus, which may lead to personalizing medical treatment based upon which type gut microbes you predominantly have. "The three gut types can explain why the uptake of medicines and nutrients varies from person to person," [1] and may develop into a new ‘biological fingerprint’ on the same level as blood types and tissue types, akin to the 'blood type' diet and treatments. That is why probiotic treatment for rosacea is as valid, if not much better, as antibiotic treatment. Bacteroides Bacteroides is a genus of Gram-negative, obligate anaerobic bacteria. Bacteroides species are non endospore-forming bacilli, and may be either motile or nonmotile, depending on the species. The DNA base composition is 40–48% GC. Unusual in bacterial organisms, Bacteroides membranes contain sphingolipids. They also contain meso-diaminopimelic acid in their peptidoglycan layer. Bacteroides species are normally mutualistic, making up the most substantial portion of the mammalian gastrointestinal microbiota, where they play a fundamental role in processing of complex molecules to simpler ones in the host intestine. As many as 1010–1011 cells per gram of human feces have been reported. They can use simple sugars when available; however, the main sources of energy for Bacteroides species in the gut are complex host-derived and plant glycans.[8] Studies indicate that long-term diet is strongly associated with the gut microbiome composition—those who eat plenty of protein and animal fats have predominantly Bacteroides bacteria, while for those who consume more carbohydrates the Prevotella species dominate.[2] Prevotella Prevotella is a genus of Gram-negative bacteria. Prevotella spp. are members of the oral, vaginal, and gut microbiota and are often recovered from anaerobic infections of the respiratory tract. These infections include aspiration pneumonia, lung abscess, pulmonary empyema, and chronic otitis media and sinusitis. They have been isolated from abscesses and burns in the vicinity of the mouth, bites, paronychia, urinary tract infection, brain abscesses, osteomyelitis, and bacteremia associated with upper respiratory tract infections. Prevotella spp. predominate in periodontal disease and periodontal abscesses. Research of human microbiota show that human gut is mainly inhabited by two phyla of bacteria – Firmicutes and Bacteroidetes, the latter mostly dominated by Bacteroides and Prevotella genera. Prevotella and Bacteroides are thought to have had a common ancestor. Formally, the two genera were differentiated in 1990. [3] Ruminococcus Ruminococcus is a genus of bacteria in the class Clostridia. They are anaerobic, Gram-positive gut microbes. One or more species in this genus are found in significant numbers in the intestines of humans. The type species is R. flavefaciens. As usual, bacteria taxonomy is in flux, with Clostridia being paraphyletic, and some erroneous members of Ruminococcus being reassigned to a new genus Blautia on the basis of 16S rRNA gene sequences. [4] For more information: Do You Have A Gut Feeling About Your Rosacea? End Notes [1] What’s in your gut? Microbiota categories might help simplify personalized medicineBy Katherine Harmon | April 20, 2011, Scientific American [2] Bacteroides, Wikipedia [3] Prevotella, Wikipedia [4] Ruminococcus, Wikipedia

A poster Facebook reported that Egg Whites applied topically on her rosacea works for her. If you try this treatment, please post in this thread your results.

Dirk Bruere has a website where he has tried various formulas using DMSO with green tea, aspirin, alternating with a mixture of Copper Salicylate, Methyl Salicylate and Caffeine. He has tried other drugs/substances with DMSO which he lists that didn't work, and says he has totally cleared his rosacea for a good length of time. If you try this, please post your results in this thread.

violentred26 at Reddit (scroll down to find her post) reports, "All I did was buy a big thing of 99% pure aloe Vera gel from Whole Foods (their brand) and a bottle of Jarrow Formulas Curcumin 95. I then opened one capsule of curcumin and dumped it into like two tablespoons of aloe (approximate, I didn’t measure). Then I spread the mixture all over my face and left on for 15 minutes. Oh, I also keep the aloe refrigerated so it’s nice and cold when I put it on. I did this mask once per day starting last Saturday through Tuesday, and I **** you not, it completely killed the rosacea flare up."

Mastic Gum Tears - image Wikimedia Commons What is Mastic Gum? costcogoldmember at Reddit reports, "Took Mastic Gum for four weeks and HCL supplement (still to this day). This was the best my skin has ever looked in four years and it cleared up within a couple weeks. It's now March 2019 and I have clear skin." If you try this, please post in this thread your results. Jarrow Mastic Gum. Amazing Formulas Betaine HCL. Nutricost Betaine HCL Mastic Gum 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.

Wish I could help but don't really know. You may want to know about Jamie Kern Lima, IT Cosmetics, who a rosacea sufferer. Our affiliate store carries some of her line of products.

Rebound according to Medicine.net is "The production of increased negative symptoms when the effect of a drug has passed or the patient no longer responds to the drug. If a drug produces a rebound effect, the condition it was used to treat may come back even stronger when the drug is discontinued or loses effectiveness." This can happen with any drug, but with rosacea the reports of rebound most often are with Mirvaso (Brimonidine) and to a lesser extent with Rhofade (Oxymetazoline Hydrochloride). The RRDi began collecting negative anecdotal reports of Mirvaso Rebound and stopped at 242. Here are the positive anecdotal reports. Rhofade has less negative reports than Mirvaso. Both of these drugs are vasoconstrictors. You should be aware of this side effect or risk associated with these two drugs. However, it has been reported that those who use antibiotics for rosacea long term find that their rosacea returns rather quickly and is worse when antibiotic treatment is stopped, which is also a type of rebound. Rebound vs Allergic Reaction

The Daily Mail reports of an ex-model, Rebecca Morrison, who was able to stop her antibiotic treatment she was using for her rosacea and successfully used Kalme Day Defence SPF 25. Rebecca is reported to say, "I've now been using Kalme for a year and have been more or less free from all the symptoms for the majority of that time. Since using product I've seen almost 100 per cent improvement in my skin. I still get a few pimples now and then when I'm especially stressed and get a little flush if I'm out in the sun but zero flaking skin, painful irritation or furious redness! It has truly changed my life!" Kalme Day Defence SPF 25 is sold in the United Kingdom and you can review the ingredients. Mother whose rosacea left her skin a 'furious' mess during pregnancy reveals she improved her skin in just four weeks WITHOUT medication - and it was all thanks to a £19.95 cream, By Chloe Morgan for MailOnline, Daily Mail

Keep us posted on your progress. Taking probiotics (there is a lot of discussion on what brand to buy, but I think the main thing is your taking some kind of probiotic) along with Efracea can only help your gut and skin. I personally take bunch of vitamins and minerals. If you are interested in this subject, read this article on this FAQ: Do Rosacea Sufferers have Nutritional Deficiencies?

Hi Jesse, Thanks for joining the RRDi and posting. The Efracea (European version of Oracea) and Soolantra are the gold standard for rosacea treatment currently, the state of the art. It has been reported that using Soolantra it does get worse before it gets better, but some report no worsening of the skin, only improvement. The Efracea should improve your skin since you responded so well with doxycycline before. You may want to look into probiotic treatment since this is now a medically acceptable treatment for rosacea. After you skin improves, you may want to consider the long term effects of antibiotic treatment and opt out for probiotics. There are many who report successful treatment of the gut, which the RRDi recognizes as GUT Rosacea when rosacea responds to intestinal treatment. Not all rosacea is demodectic rosacea and the RRDi is the only non profit for rosacea that recognizes thirteen variants of rosacea. Since you have dry skin you may want to consider the new cosmetic ZZ cream which will be released in April 2019 and is designed for dry skin manufactured in China by the Zhongzhou Pharmaceutical Company, the company that manufactures the original famous ZZ Cream. The Cosmetic ZZ cream has already been released in Europe as Demoderm. You may respond well to it so it may be worth your effort to try it since you are so close to the source. You will know in thirty days whether the ZZ cream works for you. Since you live in Hong Kong you may find is easy to drop by Demodex Solutions, a sponsor of the RRDi, at this address: Demodex Solutions limited 1450 Chun Shing Factory Estate 85-89 Kwai Fuk Road Kwai Chung NT Hong Kong Tel: (852) 81916262 Mobile: (852) 85267369688 Fax: (852) 67369688 Email: info@demodex.com Skype name: demodexsolutions

image courtesy of Wikipedia Over the years it has amazed me how the public has so little knowledge of the three basic food groups, i.e., protein, fat and carbohydrate. Yes, a significant number of the public can name the three basic food groups, but that is as far as it goes and where the confusion begins. This leads to confusion to rosaceans who know so little about what should be included in a diet to control their rosacea. The public receives a lot of nutrition recommendations by not only their teachers, physicians, and the government, but also the incredible amount of data on the internet which appears to further confuse everyone. For example, the USDA Center for Nutrition Policy and Promotion lists five food groups in the MyPlate program, while the National Institute of Health proposes the Dietary Approaches to Stop Hypertension (DASH) diet lists eight food groups, and Pass My Exams lists seven nutrition food groups. If you google this subject, you will get so many different recommendations on what constitutes the food groups and how many there should be. Nutrition Facts Label However, in most countries in the world, there is now mandated a Nutrition Facts Label that is prominently displayed on food and drink products that can really clear up all this confusion. In the USA, the "label was mandated for most food products under the provisions of the 1990 Nutrition Labeling and Education Act (NLEA), per the recommendations of the U.S. Food and Drug Administration." [1] Technically, the Pass My Exams that lists the seven nutrition food groups is closer to what is required for proper nutrition [2], and is true to survive and live healthy one needs all seven food groups listed but technically, carbohydrate is not an essential nutrient since you can obtain glucose, which is an essential carbohydrate nutrient required to survive that can be obtained from protein or fat. [3] Nevertheless, most humans obtain glucose from consuming carbohydrate and you do need the other six food groups and the Nutrition Facts Label can help sort through the confusion. For example, in the image at the top of this post is an example of the Nutrition Facts Label on a package of macaroni and cheese. The three basic food groups are in bold letters, Fat, Carbohydrate and Protein. Depending on the food or drink item the label may also include other nutrients such as Vitamins or minerals. However, if you note, water is never mentioned as a nutrition since everyone usually knows that water is essential for human survival and to maintain a healthy status, even though most food and drink contains some water. In this example, macaroni and cheese contains mostly carbohydrate (31 gram), fat (12 grams) and protein (5 grams) making a total of 48 grams. If you look at the total serving in this example it is 228 grams. If you subtract the basic three food groups from the total serving size you have 180 grams. So how do you account for the 180 grams? The Nutrition Facts Label acknowledges some of the essential nutrients such as sodium which amounts to 470 mg (less than half a gram). The other essential nutrients listed such as Vitamin A, Vitamin C, Calcium and Iron only take up such a trace amount of milligrams that it is not even listed. Water takes up most of the 180 grams unaccounted for. The label gives you information at the bottom concerning 'daily values' that is supposed to be helpful but can also be very confusing to the average reader, which if you want to clear up this confusion, you will have to do some more research. What is the most helpful information about the Nutrition Facts Label is that it lists the three basic food groups, protein, fat and carbohydrate. You can determine the amount or the percentage of each of these food groups. To determine the percentage is simple math. Take our example of macaroni and cheese which contains a total of 48 grams (total fat, protein, carbohydrate). To determine the percentage of carbohydrate contained in this food serving you simply divide 31 grams (carbohydrate) into 48 grams (total fat, protein, carbohydrate) and the result is 64.5% which is the total percentage of carbohydrate in a 228 gram serving of this item. This is why the label is so helpful, you can determine what the primary amount or percentage of a food or drink in terms of the three basic food groups. This helps you know how to see what you are consuming each day in terms of these basic three food groups. To repeat, if you eat the macaroni and cheese serving of 228 grams you will be consuming primarily (64.5%) carbohydrate (not to mention you are also consuming mostly water, remember the 180 grams of unaccounted serving). Food Groups, Body Mass and Rosacea For rosaceans who are concerned about diet triggers, particularly sugar and carbohydrate diet triggers, understanding that the human body is mostly made up of water (62%), protein (16%), fat (16%), minerals (6%), and how little is comprised of carbohydrate (1%), this should clear up some of the confusion on how over consuming carbohydrate can be an issue for rosacea sufferers. [4] If you body only has a mass of 1% carbohydrate do you really need to be ingesting primarily carbohydrate? Shouldn't you be ingesting more protein and fat instead? And if you have rosacea, if you are primarily ingesting carbohydrate, you could learn how to control your rosacea by simply reducing the amount or percentage of carbohydrate in your diet to control your rosacea. [5] One other point about all this is since your body is mostly water, what should you be drinking instead of drinks containing sugar? [5] If you are drinking a high percentage of drinks containing sugar, you may find you can control your rosacea by simply substituting all those sugary drinks with just water and see if your rosacea improves. Conclusion Using the Nutrition Facts Label to gain proper data on what you are consuming will help you see how your high carbohydrate diet is a factor in triggering your rosacea. [5] You can then decide what you want to do about this using the information you just read. Reply to this TopicThere is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Nutrition facts label, Wikipedia [2] The seven essential nutrients are the following: Carbohydrate Protein Fat Fibre Vitamins Mineral Water Source: Why We Need Food, Pass My Exams [3] Carbohydrate Not Essential For Human Survival [4] “The body of a healthy lean man is composed of roughly 62 percent water, 16 percent fat, 16 percent protein, 6 percent minerals, and less than 1 percent carbohydrate, along with very small amounts of vitamins and other miscellaneous substances. Females usually carry more fat (about 22 percent in a healthy lean woman) and slightly less of the other components than do males of comparable weight.” Carbohydrate Body Mass Percentage Obviously this subject is debatable since another source lists this: "The average human body is made up of 60% water, 17% fat and only 5% carbohydrate." Volac Obviously each human will have a different body mass distribution since each individual is unique, but generally speaking any human body has a body mass of primarily water which comprises the majority of the body's mass, then the next highest percentage of body mass would be either protein or fat, followed by minerals (including vitamins) and without a doubt carbohydrate would comprise an even smaller percentage of the body mass. If carbohydrate is on the bottom of the list of your total weight, why would you primarily eat carbohydrate in your diet? [5] Carbohydrate & Sugar Avoidance Sugar and Rosacea Sugar = Rosacea Fire

Many rosaceans complain of dry skin issues and want to find the perfect moisturizer. Those with oily skin usually don't complain about this issue. However, if you are treating your rosacea with sulphur based treatments, finding a perfect moisturizer can really be hard to find. You may want to ask your dermatologist for sample to try either the original formula emollient cream or the low sulphur emollient. This may be what the doctor ordered for your dry skin issues. AVAR-e® Emollient Cream Prescribing Information AVAR-e® LS Emollient Cream Prescribing Information

My dermatologist gave me some samples of Avar-e Green and I noticed that it does indeed help my rosacea and SD. You may want to ask your dermatologist for some samples to try out and see if it works for you. Please post in this thread your results. AVAR-e Green® Cream Prescribing Information 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.

image courtesy of Wikimedia Commons “The body of a healthy lean man is composed of roughly 62 percent water, 16 percent fat, 16 percent protein, 6 percent minerals, and less than 1 percent carbohydrate, along with very small amounts of vitamins and other miscellaneous substances. Females usually carry more fat (about 22 percent in a healthy lean woman) and slightly less of the other components than do males of comparable weight.” [1] Human Nutrition, Kenneth Carpenter A. Stewart Truswell Douglas W. Kent-Jones Jean Weininger, Encyclopedia Britannica So depending on the weight and sex, you can see that the majority of the human body is water (62%), and protein and fat make up about a 50/50 ratio comprising of about a third of the body mass, while carbohydrate only amounts to a tiny 1% of the body mass. Since there is so little carbohydrate making up your body mass, why is it that today's modern diet consists of more carbohydrate than protein and fat? For a significant number of humans living in the modern world, the diet consists of a mostly carbohydrate. [2] In times past, say a couple of hundred years ago, humans ate more protein and fat, or at the very least equal amounts of all three food groups. The increase of carbohydrate in the human diet, particularly sugar, whether as high fructose corn syrup or sucrose (or any other sugar) has only happened in the last couple of hundred years, particularly in the last one hundred years. What has the increased sugar intake in human consumption along with other carbohydrate done to health? The increased knowledge data of over consumption of sugar/carbohydrate continues to show the detrimental effect to human health and you are without a doubt aware you should limit your sugar/carbohydrate intake to improve your health. You know you are consuming too much sugar/carbohydrate in your diet and this is triggering your rosacea. If you are not convinced, why not try reducing sugar/carbohydrate for thirty days and see if your rosacea improves? This will probably be the hardest fast you have ever done since sugar/carbohydrate is embedded into the typical modern industrial diet and it is so difficult to avoid sugar/carbohydrate, mainly because you are addicted to sugar. But a clear face is worth it, isn’t it? Nutrition Facts Label Can Help You Understand the Basic Food Groups End Notes [1] “The body of a healthy lean man is composed of roughly 62 percent water, 16 percent fat, 16 percent protein, 6 percent minerals, and less than 1 percent carbohydrate, along with very small amounts of vitamins and other miscellaneous substances. Females usually carry more fat (about 22 percent in a healthy lean woman) and slightly less of the other components than do males of comparable weight.” Carbohydrate Body Mass Percentage Obviously this subject is debatable since another source lists this: "The average human body is made up of 60% water, 17% fat and only 5% carbohydrate." Volac Obviously each human will have a different body mass distribution since each individual is unique, but generally speaking any human body has a body mass of primarily water which comprises the majority of the body's mass, then the next highest percentage of body mass would be either protein or fat, followed by minerals (including vitamins) and without a doubt carbohydrate would comprise an even smaller percentage of the body mass. If carbohydrate is on the bottom of the list of your total weight, why would you primarily eat carbohydrate in your diet? [2] The modern diet Is sometimes referred to as the Standard American Diet (SAD) or the Western pattern diet

image courtesy of Wikimedia Commons You without a doubt have heard about body mass so let me ask you a question: Question What percentage of body mass is your protein, fat and carbohydrate? You think about this for a while and then after you have your answer ready click for the answer.

Cutera has announced "a significant leap forward in the Company’s current excel V laser platform' introducing the excel V+ with the following features: Fully-integrated 532/+ 1064 nm wavelengths, with the addition of ‘Green Genesis’ a micro-pulsed 532 nm procedure 50% more power with the 532 nm wavelength Large spot sizes up to 16 mm for 2X faster treatments New ‘Dermastat’ tracing handpiece to quickly treat small vascular and pigmented lesions on the face and body Cutera Announces Global Commercial Launch Of the excel V+® the Next Generation Laser Platform, Global Newswire The excel V+ laser platform is considered one of the top of the line machines. What you need to understand is anyone with a lot of money can purchase a top of the line racing car like a Lotus Formula One but its the driver that really counts if you are trying to win a race. The same is true with these high end laser machines, it is the dermatologist or the operator using the laser that make the difference if you are wanting excellent results in improving your skin. 2011 Lotus Elise SC image courtesy of Wikimedia Commons Reply to this TopicThere is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

Update "In the assessment of facial dermal tolerability at Week 52, more than 95% of patients had either no signs or symptoms, or signs/symptoms that were classified “mild” (burning/stinging, flushing/blushing, dryness, itching, peeling and hyperpigmentation). The severity of key clinical manifestations of rosacea - erythema and telangiectasia - had both significantly improved when compared to Baseline of the preceding double-blind studies. Patient satisfaction with FMX103 treatment remained high when re-assessed at Week 52 which was consistent with scores obtained at Week 12 (end of double-blind studies)." Foamix Announces Positive Results from Phase 3 Open-Label Safety Study Evaluating FMX103 Topical Minocycline Foam for Treatment up to 1 Year Long Term Data on FMX103 Demonstrated a Generally Favorable Safety Profile; 81.6% of Patients Achieved Clear or Almost Clear Skin at 52 Weeks Global Newswire Foamix Announces Dosing of Last Patient in Phase 3 Rosacea Studies for Minocycline Foam FMX103 For the latest update

Update “Sol-Gel anticipates that building a portfolio of generic product candidates with favorable commercial agreements can supplement its branded pipeline and potentially have a meaningful contribution to the Company’s operating income,” stated Alon Seri-Levy, Chief Executive Officer of Sol-Gel. “This strategy first came to fruition last January when Perrigo received tentative approval from the FDA for ivermectin cream, 1%, developed in collaboration with Sol-Gel. Perrigo was second to file and, as of today, has the only reported tentative approval for ivermectin cream, 1%, and there is no public disclosure of a third filer to the FDA," added Dr. Seri-Levy." Sol-Gel Technologies Announces Sixth Agreement for a Generic Product Candidate with Perrigo, Globe Newswire Update from Sol-Gel

image courtesy of Royal Queen Seeds "A study recently showed the efficacy of hemp seed oil to control the symptoms of dermatitis. Hemp seed oil contains stearidonic acid, gamma-linoleic acid, and oleic acid, which help reduce skin inflammation in conditions such as eczema and rosacea. Its content of polyunsaturated fatty acids, such as omega-6 and omega-3, improves blood circulation and vascular functionality even in the thin capillaries of our face. Plus, hemp seed oil contains vitamins that are essential for the skin, synergising with the other compounds to produce a more pronounced effect." How Cannabis And Hemp Can Reduce Symptoms Of Rosacea, Cannabis Blog, Royal Queen Seeds

If you have been treating your rosacea and the treatments are not responding to the standard treatments offered by your dermatologist, this is an old article, written in 2008, which doesn't even mention the gold standard of treatment for rosacea, but you may find it helpful if you haven't heard of any of these treatments. All these treatments are mentioned in the category: Forum Home > Forums > Public Forum > Rosacea Topics > Prescription Treatments "As you’re already aware, standard FDA-approved therapies for rosacea include topical preparations: metronidazole, clindamycin, azelaic acid, sulfur, sodium sulfacetamide and oral medications: tetracycline, doxycycline and minocycline. As all dermatologists know, these therapies sometimes do not work, so an awareness of off-label uses of other medication groups and approaches is useful to avoid treatment failure, patient frustration and dermatologist exasperation. I will focus on four groups and approaches: retinoids, anti-parasitic agents, Helicobacter pylori treatment and second-generation macrolides." The Dermatologist Short Term Steroid Treatment Sometimes if your rosacea is severe your physician may prescribe short term steroid treatment, usually an oral systemic steroid like Prednisone or in some cases a topical prescription steroid. For short term, steroids are impressive in attenuating intractable rosacea. [1] Just be forewarned, that long term steroid treatment for rosacea is a disaster waiting to happen. Other Treatments There are other options or alternatives also reported using Immunosuppressants, i.e., Topical Calcineurin Inhibitors (TCIs), anti-inflammatory treatments, anti-parasitic agent treatments, oral ivermectin and metronidazole, secondary therapy, Timolol Maleate 0.5%, Artesunate, the ZZ Cream, other prescriptions, demodex treatments (non prescription), other demodectic prescription treatments, (i.e., Benzyl Benzoate and Crotamiton, Permethrin), Azithromycin [2], probiotics (probiotic therapy), or a growing list of non prescription or over the counter treatments (our affiliate store). The RRDi is an armamentarium database of rosacea treatment options and will continue as such as long as donations continue to keep our non profit organization going. Low Dose Isotretinoin "For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective." [3] Natural Treatments Some prefer natural or holistic treatments for rosacea. Our forum on those proposed can be found here: Forum Home > Forums > Member Forum > Rosacea Topics > Non Prescription > Natural Treatments Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] Prednisone "A patient with severe papulopustular rosacea (PPR) and severe background erythema responded well to a treatment regimen consisting of a short course of antibiotics in combination with a corticosteroid, followed by monotherapy with isotretinoin." Drugs R D. 2016 Sep; 16(3): 279–283. Published online 2016 Sep 13. doi: 10.1007/s40268-016-0141-0 A Tailored Approach to the Treatment of a Patient with a Severe Dynamic Manifestation of Rosacea: A Case Report Martin Schaller and Lena Gonser [2] "Oral azithromycin dosing 500 mg/day for 2 weeks is effective for treatment of intractable rosacea." J Korean Med Sci. 2011 May; 26(5): 694–696.Published online 2011 Apr 21. doi: 10.3346/jkms.2011.26.5.694 Oral Azithromycin for Treatment of Intractable Rosacea Jae-Hong Kim, Yoon Seok Oh, and Eung Ho Choi [3] Low-dose isotretinoin vs. minocycline in the treatment of rosacea

The gold standard for rosacea treatment is Oracea and Soolantra, both Rx(s) from Galderma (yes, Galderma has sponsored three RRDi education grants). If your physician hands you these two prescription treatments for rosacea your physician is keeping up with the latest state of the art for rosacea! ""For improving outcomes and facilitating academic exchanges, a well-validated gold standard evaluation tool is still needed." [1] However, until such a standard is generally accepted, the RRDi advocates Oracea and Soolantra as the gold standard until proven otherwise. A report states, "First randomized clinical trial comparing the efficacy and safety of combined doxycycline 40 mg modified release (DMR) and ivermectin 1% cream (IVM), versus ivermectin 1% cream plus placebo in adults with severe papulopustular rosacea, reveals more than double the number of patients reach 'clear' (100% lesion clearance) at 12 weeks." Galderma: New Data Reveals Benefits of Combining Oral and Topical Treatment in Patients With Severe Papulopustular Rosacea, Press Release, P&T Community "Combining IVM and DMR can produce faster responses, improve response rates, and increase patient satisfaction in severe rosacea." A randomized phase 3b/4 study to evaluate concomitant use of topical ivermectin 1% cream and doxycycline 40 mg modified-release capsules versus topical ivermectin 1% cream and placebo in the treatment of severe rosacea. Soolantra "In comparing topical ivermectin and metronidazole, ivermectin was more effective; this treatment modality boasted more improved quality of life, reduced lesion counts, and more favorable participant and physician assessment of disease severity. Patients who received ivermectin 1% cream had an acceptable safety profile. Ivermectin is efficacious in decreasing inflammatory lesion counts and erythema." Ivermectin More Effective Than Metronidazole Oracea Oracea is 40 mg (10 mg is timed released doxycycline while the other 30 mg is immediate release) taken orally and Soolantra contains 1% Ivermectin applied topically. Some physicians also recommend using the Soolantra at night and then washing it off and applying metronidazole topical in the am. "In addition, there were significant differences in the distribution of baseline and week 12 IGA scores in the PP group (P = .0012). At week 12, most participants (63.6%) had mild CEA scores; the distribution was significantly different from baseline (P = .0407). Only 7% of participants had treatment-related adverse events (AEs), mostly mild or moderate in severity. Thus the 40-mg formulation of doxycycline proved to be effective and well-tolerated in a real-world setting in participants with rosacea who were receiving topical therapy but still experiencing symptoms." Effectiveness and safety of doxycycline 40 mg (30-mg immediate-release and 10-mg delayed-release beads) once daily as add-on therapy to existing topical regimens for the treatment of papulopustular rosacea: results from a community-based trial. General Silver Treatment Used for Many Years Some physicians who are not keeping up with the gold standard are still prescribing topical metronidazole gel or cream along with oral doxycycline 100 mg twice a day (or even higher doses) which treatment has been around for many, many years. However, they are not keeping up since recent studies show that azelaic acid 15% has been shown superior to topical metronidazole and low dose doxycycline (40 mg a day) has been shown just as effective as Oracea. Furthermore, minocycline has been shown just as effective as doxycycline. The Gold Standard Treatment If your physician (hopefully a dermatologist) hasn't treated you with the gold standard, then, your physician simply isn't keeping up with the latest information on rosacea treatment. So if you received a prescription for doxycycline and metronidazole, your physician simply isn't keeping up with the latest state of art medical treatment for rosacea, the 'gold standard'. However, if your physician has prescribed the gold standard treatment, some may also give you a topical to use during the day (use the Soolantra at night) like metronidazole or azelic acid or recommend a moisturizer for the day, especially if you have dry skin. There are reports that some physicians are also giving metronidazole cream or gel for their patients to use during the day after applying the Soolantra at night, washing off the Soolantra in the AM and applying metronidazole during the day, repeating this regimen each night, along with taking Oracea orally each day. Zilxi Included in the Gold Standard Treatment The latest state of the art treatment is using Zilxi 1.5% Minocycline Foam topical treatment for rosacea. Your dermatologist might give you a Rx for xilxi along with Soolantra and Oracea. Three Months Required If Oracea and Soolantra does not improve your rosacea within a month, then you obviously have some other rosacea variant, rosacea mimic, or some other possible co-existing condition or another skin condition. Usually it takes 12 weeks for clearance, then after that a reduced maintenance treatment may be required, since the demodex mites do come back. Also, if your physician diagnoses you with a subtype of rosacea, your physician hasn't been keeping up with the new phenotype classification of rosacea, so you may want to find one who is keeping up with the latest information on rosacea. Once you are on the gold standard of treatment for rosacea you should improve within thirty days. Some may take longer, say sixty to ninety days, but usually you will know whether this treatment improves your rosacea within this time period. If not, you simply go back to your physician (hopefully a dermatologist) who will prescribe a different treatment if you don't respond to the gold standard. Not everyone will respond well to the gold standard, but it is worth trying since many do improve their rosacea with this treatment. If you are suffering from demodectic rosacea the gold standard will either improve your rosacea or rule out demodectic rosacea. Gets Worse Before it Gets Better As with most treatments for rosacea, it is important to note that it is common for a treatment for rosacea to get worse before it gets better and usually takes three months. Gold Standard Expensive Because the gold standard is so expensive (hence the gold designation), in many social media groups, i.e., Facebook, Twitter, Reddit, there are reports that many have been trying an inexpensive horse paste and rave about the success. 50 mg generic doxycycline is also available which is not as expensive (or 20 mg generic doxycycline twice a day). There are other options or alternatives also reported using oral ivermectin and metronidazole, benzyl benzoate and crotamiton, other demodectic treatments, other prescriptions, secondary therapy, the ZZ Cream, demodex treatments, probiotics (probiotic therapy), or when rosacea doesn't respond to standard therapies. Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. End Notes [1] The therapeutic effects in patients with rosacea: how do we evaluate them?

At the Hilton Waikoloa Resort on the Big Island of Hawaii, the Skin Disease Education Foundation is holding its 43rd annual seminar, February 17 - 22, 2019. Linda Stein Gold, MD, RRDi MAC Member spoke on how to manage rosacea patients.

A June 2018 article published at Bustle adds more confusion to rosaceans who read this and believe there are '9 unexpected causes of rosacea' when such a title is very misleading and so untrue. What the article is actually discussing is common rosacea triggers which are found on many rosacea trigger lists and there has never been a rosacea trigger connected with causing rosacea. Triggers are only causing a rosacea flare up or flush. While the article starts out clearly stating that the "causes of rosacea are infuriatingly elusive," and clearly states there are "numerous unexpected factors that could be triggering your rosacea," the title suggests otherwise. The 'causes' in the title of the article should have read, 'triggers.' Ms Dixon does refer to the NHS website article on the web, Causes of Rosacea, stating "The NHS offers an exhaustive (and exhausting) list of theories surrounding the origins of rosacea." The NHS article in the first paragraph states, "The exact cause of rosacea is unknown, although a number of potential factors have been suggested." 9 Unexpected Causes Of Rosacea, Because Changing These Everyday Things Could Have A Huge Impact, Emily Dxon, Bustle By EMILY DIXON

Acne and Rosacea Society of Canada