Guide

While there’s no way to cure rosacea, New York City dermatologist Dr. Amy Wechsler knows a few simple ways to help control it in winter. She noted that in addition to seasonal changes, flareups can be triggered by a wide variety of factors like stress, sleep deprivation, spicy food, drinking too much alcohol, travel, trying new products, having a cold or being sick in any way. “People with rosacea often have sensitive skin, so dry, cold weather can exacerbate this,” she said. In addition to whatever medication or regimen your dermatologist recommends, here are three simple ways to manage your redness in the wintertime, according to Wechsler: 3 Tips And Tricks For Defeating Rosacea In The Winter, Carly Ledbetter, Lifestyle Editor, The Huffington Post

Sorry if I was off topic. I wish I could be one of those who could eat or drink anything. I read somewhere (can't find it now) that at a recent dermatologists convention a discussion of the mystery of how Soolanta improves Rosacea with no data on demodex density counts (whether the count is lowered). However there is data that it works better than Mirvaso or Metronidazole. Note: There is data on this now: Decreasing Demodex Density Count Improves Rosacea

Rory, It has never been proven whether killing the mites improves the rosacea or if the density count is different when using Soolantra. Do the numbers actually go down after using Soolantra? We really don't know for sure. There are no studies done on this. A paper published by the American Journal of Clinical Dermatology in April 2015 succinctly clarifies the controversy: “According to Rothman’s model of causality, Demodex mites are probably a non-necessary and non-sufficient cause of rosacea.” [Note added 2/23/2021 that one week after this post there is now evidence that reducing the mite count improves rosacea. Read this post, Decreasing Demodex Density Count Improves Rosacea] What we do know is that Soolantra use with improvement of rosacea implies that treating for demodectic rosacea is warranted. In other words, if it works for some then it is a valid treatment. As for sugar/carbohydrate avoidance, you will note that physicians rarely if ever mention this as a rosacea trigger. Only the RRDi recognizes sugar/carbohydrate as a rosacea trigger. There are few, if any, clinical papers on this subject. I do agree with you that if those who use Soolantra also avoided sugar/carbohydrate they would notice better improvement.

Not sure, but most reports say demodex folliculorum is the culprit. Never have tested for demodex.

Rory, Basically I controlled my rosacea with my Rosacea Diet and the ZZ cream all those years. This didn't cure it, but it works to control it. If I went off my diet I would get a zit or two or even more depending on how far I strayed from my diet. My rosacea really shows up quickly after I eat sugar/carbohydrate whether on the ZZ cream or Soolantra. For the past year I was using the Sulphur Butter to save some money and see if it works, which it does but not as good as the ZZ cream since my skin is oily and I prefer the way the ZZ cream dries up my skin. I read all those incredible results of those who say Soolantra works for them and simply wanted to try it. Today Soolantra seems to be improving my skin so I am hoping after four months it works. Most reports from users say they have to keep using it on a maintenance basis dabbing it on a flareup to keep it under control. With my insurance Soolantra is cheaper than the Sulphur Butter. My understanding is that if demodex is the culprit, demodex simply keep coming back, hence, the need to keep using Soolantra. The only way to know if a rosacea treatment works is to try it. And we know that it takes time, usually months, to know for sure.

I would say the ZZ cream works better. However, the ZZ cream is more expensive than Soolantra since my insurance pays for it.

"Almost a decade and a half has elapsed since the initial proposition of criteria for rosacea diagnosis and grouping into common presentations or subtypes. Reappraisal of these items suggests shortcomings in case-finding and diagnostic accuracy that require revision to facilitate rather than undermine future investigation. Subtyping of rosacea, a post-hoc means of grouping more common presentations, can be and has been subverted inappropriately to imply strict categories without adequate consideration of the varying phenotypic presentation of individuals and the potential for temporal variation. Scales for rosacea severity are also confounded by similar multidimensional aspects represented in subtyping. In clinical investigation, this can interfere with study of the course of singular features of rosacea and their measurement." Br J Dermatol. 2017 Jan;176(1):197-199. doi: 10.1111/bjd.14819. Shortcomings in rosacea diagnosis and classification. Tan J, Steinhoff M, Berg M, Del Rosso J, Layton A, Leyden J, Schauber J, Schaller M, Cribier B, Thiboutot D, Webster G; Rosacea International Study Group. The Phenotype Classification of rosacea is superior to the subtype classification.

Rosacea is a chronic skin condition whose symptoms are a persistent redness of the skin of the cheeks, nose, chin and forehead, excessive blushing, and small, dilated blood vessels. There can also be swelling and pimple-like bumps on the skin. More extreme cases can involve the eyes and swelling and disfigurement of the nose. It can begin at any age, and seems to have a hereditary component, as fair-skinned people of northwestern European descent are most affected. Women are three times as likely to develop Rosacea, and the incidence increases at menopause. Its cause is unknown. Rosacea: Diagnosis and treatment, Niagara This Week - St. Catharines, Sponsored Content, In Your Neighbourhood, METROLAND MEDIA GROUP

image courtesy of @talontedlex / Instagram The brave blogger took to Instagram to share her story of rosacea with a selfie showing half of her face with makeup and half without. Lex expressed her difficulty in posting the photo - which shows the rosacea on her face - at first: "This photo was hard to take and is even harder to post. Every single time I take a photo of my bare skin I am still shocked, because this is not how I picture myself." She then goes on to explain how she feels it was important to share the image in order to show how much of a positive impact makeup can have on our confidence and the way we feel about ourselves. Blogger and rosacea sufferer Lex Gillies shares brave before & after Instagram post, By Rebecca Fearn, Glamour Lex Gillies, Beauty Blogger, and Rosacea British Skin Foundation Ambassador Twitter (the classic butterfly) Lucy Abbersteen Interviews Lex Gillies About Rosacea Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

The phenotype classification uses signs and symptoms better than the subtype classification and particularly focuses on erythema as a pivotal diagnostic feature. Dr. Jerry Tan, ROSCO Panel and NRS Expert Committee “Practically, in our current phenotypic-led classification, it’s not important to be grouping into subtypes. It’s more important to be categorizing based on patients’ presentation in terms of signs and symptoms,” he says. “So, if they simply presented with centrofacial erythema that would be diagnostic of rosacea, but we wouldn’t go onto subtype. We would just leave them as is, as that predominant phenotype. Then, we would manage them based on that, with various treatment options that are indicated for background centrofacial erythema.” Dr. Jerry Tan, Updated guidelines for diagnosis, treatment of rosacea Focus on phenotype-led diagnosis, classification By Lisette Hilton, Dermatology Times ---------------------------------------------------------- Dr. James Q Del Rosso, AARS Panel and the ROSCO Panel (2019) Dr. Del Rosso concurs that 'persistent facial erythema' (PFE) "is the pivotal diagnostic feature of cutaneous rosacea, including in both the presence or absence of papulopustular lesions...that dermatologists...Consider the role of PFE in essentially all patients with cutaneous rosacea." Journal of drugs in dermatology: JDDJune 2019 | Volume 18 | Issue 6 | Editorials | 503 | Copyright © June 2019What Is “PFE”? It May Just Be Time You Found Out….Del Rosso Q. James DOJDR Dermatology Research/Thomas Dermatology Las Vegas, NV More Information on Phenotypes

image courtesy of wikipedia "President Trump takes medication for three ailments, including a prostate-related drug to promote hair growth, Mr. Trump’s longtime physician, Dr. Harold N. Bornstein, said in a series of recent interviews. The other drugs are antibiotics to control rosacea, a common skin problem, and a statin for elevated blood cholesterol and lipids." Donald Trump’s Longtime Doctor Says President Takes Hair-Growth Drug, By LAWRENCE K. ALTMAN, M.D., FEBRUARY 1, 2017, New York Times Doctor claims Trump takes medication for hair growth, rosacea, cholesterol by: Michelle Ewing, KIRO7, Cox Media Group National Content Desk Updated: Feb 2, 2017 - 12:45 AM Doctor claims Trump takes medication for hair growth, rosacea, cholesterol Michelle Ewing, The Atlanta Journal Constitution, Cox Media Group National Content Desk Famous Rosaceans

Dr. Jerry Tan has an excellent video explaining Demodex Blepharitis. 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.

Jennifer Brown started Soolantra on December 16, 2015: Ten Weeks Later

Update today 92 days on Soolantra. Just a little improvement from a month ago. I will stay the course for one more month.

The topical use of oxymetazoline 0.05% solution in the management of rosacea has been primarily limited to data from case series involving fewer than 10 patients and demonstrating sustained improvements in both erythema and flushing. Alhough oxymetazoline is not recognized in national guidelines, an international consensus statement recognizes the possible therapeutic role of oxymetazoline in the management of rosacea, despite the limited evidence. Hosp Pharm. 2013 Jul-Aug; 48(7): 558–559. Published online 2013 Jul 9. doi: 10.1310/hpj4807-558 PMCID: PMC3839519 Oxymetazoline (Topical): Rosacea Joyce A. Generali, RPh, MS, FASHP, (Editor) and Dennis J. Cada, PharmD, FASHP, FASCP Non Prescription Oxymetazoline

For more information on the prescription oxymetazoline hydrochloride cream (1 percent strength) known as Rhofade click here.

The topical use of oxymetazoline 0.05% solution in the management of rosacea has been primarily limited to data from case series involving fewer than 10 patients and demonstrating sustained improvements in both erythema and flushing. Alhough oxymetazoline is not recognized in national guidelines, an international consensus statement recognizes the possible therapeutic role of oxymetazoline in the management of rosacea, despite the limited evidence. Hosp Pharm. 2013 Jul-Aug; 48(7): 558–559. Published online 2013 Jul 9. doi: 10.1310/hpj4807-558 PMCID: PMC3839519 Oxymetazoline (Topical): Rosacea Joyce A. Generali, RPh, MS, FASHP, (Editor) and Dennis J. Cada, PharmD, FASHP, FASCP

Oxymetazoline is a vasoconstrictor which is commonly used in nasal sprays as a nasal decongestant. It works by causing the smooth muscle around blood vessels to contract, making the vessels smaller and less dilated. Thus it would appear to be a good candidate for treating rosacea. Indeed, the Rosacea International Expert Group has noted that topical oxymetazoline has a role in the treatment of rosacea and the group recommends its use. Studies have found that after applying oxymetazoline to the skin once a day, a decrease in redness was noted in 1 hour and the effect was sustained throughout the day. Continued application once a day over several months was associated with a marked improvement of rosacea symptoms. These results were sustained after prolonged use at 17 months. When compared to the other agents currently used, oxymetazoline presents fewer issues with potential side effects and its application results in a rapid improvement of symptoms. Border Compounding Pharmacy in Australia has formulated a 0.075% w/w oxymetazoline cream in an elegant, lightweight hypoallergenic cream designed for the face. A doctor’s prescription is not required unlike Rhofade (1%) which is a prescription drug. Border Compounding Pharmacy is able to customise the cream to your specifications (for example, to manage sensitivities or if you do not wish to use specific particular ingredients). For More Information Click Here. What is a compounding pharmacy? This information was posted by Flugs in post #9 about an email received from Border Compounding Pharmacy: We can indeed formulate an oxymetazoline cream or gel in a variety of strengths. Oxymetazoline works by constricting the blood vessels in the surface of the skin, thus reducing the red appearance of rosacea. It works quite quickly – generally within an hour – and the effects last for 24 hours. It is important to only apply the cream once daily. There is quite a bit of evidence to suggest that strengths of as little as 0.05% oxymetazoline are effective in reducing the redness associated with rosacea. It is generally a good idea to start with a lower concentration as higher concentrations can constrict blood vessels too much, blood flow is restricted and this gives the areas of rosacea a white appearance . We generally suggest a starting at 0.1% as this appears to give good results with minimal side effects. As we are a compounding pharmacy and not a manufacturer, we are bound by a few restrictions(as is the case in the US/Uk/Ire). Firstly, we need to prepare the product specifically for the individual and it will have your name on a dispensing label. Secondly, we are only allowed to assign a one month expiry date to the product in line with Australian pharmacy law (manufactured products can have much longer expiry dates). However, it is formulated in line with commercially available products and we would suggest the product would be fine to use for a while after this. It is $49AUD for a 50g airless pump and international delivery is $30AUD. We can send an invoice via email, and when this is paid, we will compound the medication and send it off. Regards Lee McLoughlan B.Pharm, Cert.Adv.Cos.Sci

Rhofade Approved by FDA • Rhofade Official Web Site "Topical oxymetazoline applied to the face once daily for 29 days was effective, safe, and well tolerated in the treatment of moderate to severe persistent facial erythema of rosacea." [1] "Expert commentary: While assessment of available clinical trial data indicates that the medication is as effective as other available treatment for controlling rosacea-associated erythema with minimal risk of adverse effects, studies of long-term duration and direct comparison will be necessary to establish its place in treatment guidelines and clinical practice. As further evidence becomes available, the real-world clinical potential of topical oxymetazoline cream will become clearer." [2] "For both QD and BID dosing, the efficacy of oxymetazoline 1.0% was greater than the 0.5% dose and comparable to the 1.5% dose. Safety and application-site tolerability were similar across groups." [3] Rhofade, also known as oxymetazoline hydrochloride cream (1 percent strength), is a topical cream made to treat persistent facial erythema (redness). Ask your dermatologist for a sample. The odds in the clinical trials of potential side effects using Rhofade for four weeks are 1% and go up to 3% using Rhofade for one year. There is a non prescription oxymetazoline ( 0.075%) topical cream available by a compounding pharmacy in Australia. Please post your experience using Rhofade in this 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] J Drugs Dermatol. 2018 Mar 01;17(3):290-298 Pivotal Trial of the Efficacy and Safety of Oxymetazoline Cream 1.0% for the Treatment of Persistent Facial Erythema Associated With Rosacea: Findings from the Second REVEAL Trial. Baumann L, Goldberg DJ, Stein Gold L, Tanghetti EA, Lain E, Kaufman J, Weng E, Berk DR, Ahluwalia G [2] Expert Rev Clin Pharmacol. 2017 Oct;10(10):1049-1054. doi: 10.1080/17512433.2017.1370370. Epub 2017 Aug 24. Oxymetazoline hydrochloride cream for facial erythema associated with rosacea. Patel NU1, Shukla S1, Zaki J1, Feldman SR1,2,3. [3] J Drugs Dermatol. 2018 Mar 1;17(3):308-316. Phase 2 Randomized, Dose-Ranging Study of Oxymetazoline Cream for Treatment of Persistent Facial Erythema Associated With Rosacea. DuBois J, Dover JS, Jones TM, Weiss RA, Berk DR, Ahluwalia G.

This report, Rosacea Pipeline Highlights - 2017, provides most up-to-date information on key pipeline products in the global Rosacea market. It covers emerging therapies for Rosacea in active clinical development stages including early and late stage clinical trials. The pipeline data presented in this report helps executives for tracking competition, identifying partners, evaluating opportunities, formulating business development strategies, and executing in-licensing and out-licensing deals. Research and Markets Report

Tom Busby wrote this tip about washing off Soolantra: "The base for Soolantra is Cetaphil Cream, according to the patents. This is not Cetaphil Lotion --- the Cream has a little petrolatum and as a result is slightly more occlusive, so it's slightly more difficult to wash off completely. You might find it useful to spend more time washing it off, or use the water stream of a shower to assist in washing it off. It's useful for general skin health to clean the skin completely at least once per day, and occlusive creams make this task a little more difficult. It may be useful for you to spend more time washing your face -- just an idea though. People with very dry skin like occlusive creams more than other people. Since you asked about comedogenic, I guess you don't have very dry skin. Here are the ingredients in the Cream, if it's any help -- the () comments are mine: Purified Water, Polyglycerylmethacrylate (hydrogel), Propylene Glycol (increases penetration), Petrolatum (long chain carbon-oil), Dicaprylyl Ether (emollient), PEG-5 Glyceryl Stearate (emulsifier and stabilizer), Glycerin (humectant), Dimethicone (silicone), Dimethiconol (silicone), Cetyl Alcohol (emulsifier), Sweet Almond Oil (medium chain carbon-oil), Acrylates/C10-30 Alkyl Acrylate Crosspolymer (hydrogel), Tocopheryl Acetate (synthetic Vitamin E), Phenoxyethanol (preservative), Benzyl Alcohol, Disodium EDTA (chelation), Sodium Hydroxide (activates 1st hydrogel by raising pH during the manufacturing process), Lactic Acid (lowers final pH) I speculate that the "1% line" in the ingredients comes after petrolatum, and that the petrolatum is about 1.5% to 2%. Both silicones aren't soluble in oil or water, and they also make any cream more resistant to washing off." Rosacea Forum, Tom Busby, post #3 See also: Soolantra Mechanism of Action & Basis for the Vehicle

"The FDA approval of RHOFADE™ exemplifies Allergan's commitment to continuing to address unmet patient needs through innovation in medical dermatology," said David Nicholson, Chief R&D Officer of Allergan plc. "We know persistent facial erythema associated with rosacea is a challenge for patients and physicians and having options can help in treating the disease. RHOFADE™ is the first and only alpha1A adrenoceptor agonist approved for persistent facial erythema associated with rosacea in adults. The FDA approval of RHOFADE™ represents a new prescription treatment that can effectively help physicians and their patients manage this condition." Allergan Announces FDA Approval Of RHOFADE™ (Oxymetazoline Hydrochloride) Cream, 1% For The Topical Treatment Of Persistent Facial Erythema Associated With Rosacea In Adults, Allegan Prescribing Information "Rhofade will be available commercially from May 2017 in the U.S. Allergan claims that Rhofade is the first and only alpha1A adrenoceptor agonist approved for persistent facial erythema associated with rosacea in adults.,,The approval was based on two clinical studies both of which met the primary efficacy endpoint. The clinical trials, which enrolled a total of 885 patients, were identical, multi-centered, randomized, double-blinded, parallel-group and vehicle-controlled in moderate or severe patients aged 18 years or older. Both the studies demonstrated that Rhofade was more effective than vehicle in reducing persistent facial erythema associated with rosacea in adults." Allergan (AGN) Rhofade Cream for Rosacea Approved in U.S., Zacks Equity Research, Yahoo Finance Rhofade, also known as oxymetazoline hydrochloride cream (1 percent strength), is a topical cream made to treat persistent facial erythema (redness), as opposed to the other symptoms of rosacea, like easy flushing, red bumps and pus pimples, skin burning, and sensitivity, explains Joshua Zeichner, a New York City dermatologist. FDA Approves Rhofade Rosacea Treatment, by Sarah Kinonenat, Allure The US Food and Drug Administration (FDA) has approved oxymetazoline hydrochloride 1% cream (Rhofade, Allergan) for the topical treatment of persistent facial erythema associated with rosacea in adults. Persistent facial erythema associated with rosacea is "a challenge for patients and physicians, and having options can help in treating the disease," David Nicholson, Allergan's head of research and development, said in a news release announcing approval. FDA OKs New Cream for Facial Erythema in Rosacea in Adults, Megan Brooks Medscape Rhofade, also known as oxymetazoline hydrochloride cream (1 percent strength), is a topical cream made to treat persistent facial erythema (redness), as opposed to the other symptoms of rosacea, like easy flushing, red bumps and pus pimples, skin burning, and sensitivity, explains Joshua Zeichner, a New York City dermatologist. How does Rhofade work? Rosacea sufferers experience an overactivity of blood vessels in the face, which is why those with rosacea flush easier than others. Over time, the persistent flushing can lead to what Zeichner likens to fixed background redness. "Rhofade directly addresses this redness by constricting the blood vessels," he explains. teenvogue David Pascoe has an excellent article on Who Should NOT Use Rhofade. In another article, David reports, "Going on the published clinical data, basically one in 6 or 7 users of RHOFADE will have a 2-grade improvement in their facial redness, typically for 12 hours, and continuing for 29 once-daily uses." "Apparently, the entry of the RHOFADE, which will be commercially available from May 2017, may just be timely. For a while now physicians have not been able to efficiently address the facial erythema for lack of treatment options. The best they have been doing is helping their patients manage the triggers. That means the availability of RHOFADE is a plus to the delivery of their goals." The FDA’s Approval Of RHOFADE Cream From Allergan Plc (NYSE:AGN): Will It Match The Market Competition? By Andy Parker - Market Exclusive, January 20, 2017

DMT210 is a topical gel specifically developed to downregulate the proinflammatory cytokines in the skin responsible for the inflammation and redness seen in acne rosacea. PRNewswire According to the Dermata web site, "DMT210 has the potential to be the first topical treatment to reduce both the erythema and the inflammation (papules and pustules) of rosacea." Reply to this Topic There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

Why is the phenotype classification superior to the subtype classification? Answer. What distinguishes the phenotype classification from the subtype classification? Answer.