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Melatonin for Rosacea
One paper has stated, "Among the 113 predicted drugs, melatonin (MLT) was co-associated with both RORA and IFN-γ in AD and rosacea. Subsequently, network pharmacology analysis identified 19 pharmacological targets of MLT and demonstrated that MLT could help in treating AD/rosacea partly by modulating inflammatory and vascular signaling pathways. Finally, we verified the therapeutic role and mechanism of MLT on rosacea in vivo and in vitro. We found that MLT treatment significantly improved rosacea-like skin lesion by reducing keratinocyte-mediated inflammatory cytokine secretion and repressing the migration of HUVEC cells. In conclusion, this study contributes to common pathologies shared by rosacea and AD and identified MLT as an effective treatment strategy for rosacea and AD via regulating inflammation and angiogenesis."

Bioinformatics and Network Pharmacology Identify the Therapeutic Role and Potential Mechanism of Melatonin in AD and Rosacea

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'Current findings provide more evidence that rosacea is significantly associated with depression and anxiety, and rosacea may predispose patients to develop depression and anxiety. Clinicians should be aware of the psychological aspects of rosacea."

Association of rosacea with depression and anxiety: A systematic review and meta-analysis

 

'Retaron® is a new dietary supplement formulation on the market that has recently obtained the national safety standard identification in China. Its main ingredients include omega-3 free fatty acids, lutein, aronia extract, vitamin C, and vitamin E. It has potent antioxidant and anti-inflammatory effects, which play an important role in promoting retinal development and improving visual function (19). In this study, we investigated the effect of the dietary supplement as an adjunct treatment of MGD-related dry eye. Our hypothesis was that the use of dietary supplement can improve dry eye symptoms and signs, reduce the inflammatory reaction of MG, and restore the gland structure in patients with MGD.'

Front Med (Lausanne). 2021; 8: 769132.
Improved Dry Eye Symptoms and Signs of Patients With Meibomian Gland Dysfunction by a Dietary Supplement
Kangcheng Liu, Yau Kei Chan,  Xia Peng,  Ruolan Yuan,  Min Liao,  Jingwen Liang,  Xiangbo Tang,  Yi Xu,  Yingjun Cai,  Qiangxiang Li,  and Hua Wang 

"At present, the development of skin imaging technologies [dermoscopy, reflectance confocal microscopy (RCM), optical coherence tomography (OCT), etc.], teledermatology, and artificial intelligence (AI) has profoundly and comprehensively changed the nature, service model, and public recognition of dermatology (1). Skin imaging, as an important technical system in modern dermatology, continues to gain the attention of researchers and the wider community alike....n sum, this special Research Topic of skin imaging technology, teledermatology, and AI in dermatology collects the latest endeavors, progresses, experiences, and challenges in these fields and shows the successful integration of modern information technology into dermatology."

Front Med (Lausanne). 2021; 8: 757538.
Editorial: Progress and Prospects on Skin Imaging Technology, Teledermatology and Artificial Intelligence in Dermatology
Chengxu Li,  Je-Ho Mun,  Paola Pasquali,  Hang Li,  H. Peter Soyer, and Yong Cui 

'Face masks worn for at least 6 hours per day have resulted in allergic and irritant contact dermatitis, acneiform eruptions, atopy and seborrhoeic eczema, periorificial dermatitis, urticaria, rosacea, folliculitis, and pruritus...It is less clear how many hours or days that nonhealthcare individuals wear the same unsanitized face mask and whether exhaled, nasal, cutaneous, oral, oropharyngeal, and gastrointestinal organisms cultivated on the underside of the mask promote dysbiotic microbiomes and host illness."

Respir Med Res. 2021 Nov 27 : 100877.
PROLONGED FACIAL MASK WEAR IS A CONCERN FOR THE DEVELOPMENT OF DYSBIOTIC MICROBIOME
John K. Brooks, DDS, Clinical Professor, Ahmed S. Sultan, BDSPhD, Assistant Professor, and Mary Ann Jabra-Rizk, PhD, Associate Professor

"The role of the exposome in rosacea must be highlighted: UV light, air pollution, tobacco smoking, nutrition, and psychological stress can trigger or worsen rosacea. Although UV exposure is one of the most commonly reported triggers and UV radiation can play a significant role in the pathogenesis of rosacea, the literature on photoprotection in rosacea is relatively scarce."

"Among these factors, UV radiation is crucial in the pathogenesis of rosacea."

J Cosmet Dermatol. 2021 Nov; 20(11): 3415–3421.
Impact of ultraviolet radiation and exposome on rosacea: Key role of photoprotection in optimizing treatment
Daniel Morgado‐Carrasco, MD, Corinne Granger, MD,  Carles Trullas, MSc,  and Jaime Piquero‐Casals, MD 

UV Radiation from the sun has for many years been associated with rosacea which is a component of EM radiation. For more information learn more. 

EM radiation from lighting, copiers, computer monitors etc.

Image courtesy of Wikimedia Commons

"All radiation is a form of energy, most of which is invisible to the human eye. UV radiation is only one form of radiation and it is measured on a scientific scale called the electromagnetic (EM) spectrum. UV radiation is only one type of EM energy you may be familiar with." 
Ultraviolet (UV) Radiation, FDA

"i have one of those backlight led monitors....anyone notice they flush while looking at it for long time?" bbillcee Thread,

FlushingQueen posts:

“I have spent the past 5 hours researching this strange phenomenon and it turns out I am not the only one out there. Several people in this forum and other experience burning from computer use. The biggest explanation has been electromagnetic fields hypersensitivity:

http://www.science20.com/florilegium...persensitivity 

All the symptoms are explained here. Some people are more sensitive than others, and things like mercury dental fillings (I have FOUR) make people more susceptible...

Could I not have rosacea but just really sensitive to today’s modern technology?”

"All fluorescent lamps emit some UV. Typical fluorescent lamps, including CFLs, which consumers would encounter, emit very low levels of UV. In order to measure any UV radiation from these lamps, very sensitive measuring equipment must be used." 
Compact Fluorescent Lamps (CFLs) – Fact Sheet/FAQ, FDA

The above is related to florescent lights which you may find interesting. 

"Some in the lighting business have stated that LEDs do not produce UV radiation. However studies have shown that standard LEDs do create a small amount of UV. That said, the amount of UV they actually emit is even less."
Do LED Lights Produce UV?, Premier Lighting

If you have a comment on this subject, please find the reply to this topic button and post!

"We assessed the efficacy of the Kleresca® biophotonic platform (KLOX Technologies Inc., Laval, Canada), which creates fluorescent light energy (FLE), to induce a novel form of photobiomodulation for treating rosacea. We also assessed patient satisfaction with their facial appearance and concerns about perceptions of others before and after treatment...FLE significantly reduced the inflammatory erythematous reaction of the face, improved flushing and erythema associated with rosacea, and had a positive impact on patients' self-perception and emotional wellbeing....Our results support FLE as an effective, noninvasive treatment modality for rosacea."

Biophotonic Therapy with Fluorescent Light Energy Decreases Facial Erythema, Improves Signs and Symptoms of Rosacea, and Increases Patient Satisfaction: A Postmarket Study

More on FLE

"Rosacea and scurvy, however, are described by Shakespeare before they become named entities. Bardolph's skin characterizes his alcohol addiction and thievery, and Caliban's "monstrous" form mirrors his state as an untouchable in society."

On Shakespeare and cutaneous diseases

"It is Bardolph’s big, red nose that commands our attention. He has what modern physicians call rosacea, a skin disorder of the face that causes redness, inflammation, and rhinophyma, the pimply growths that enlarge, harden, and crack the nose."

Bardolph’s Rosacea, Jeffrey R. Wilson
Preceptor in Expository Writing
Harvard College Writing Program

A "a plaster/bandage" comprised of probiotics has been developed in treating diseased skin, focusing mostly on acne (Acne vulgaris), infected atopic eczema lesions, venous leg ulcers, and (burn) wound infections, so that "the probiotic containing pads may be topically applied for the treatment of skin disorders without the need for a regular antibiotic treatment or as an adjunctive therapy."

Whether these probiotic dressings could be used for rosacea remains to be seen. 

Probiotics Antimicrob Proteins. 2021; 13(6): 1557–1571.
A New Approach to Harness Probiotics Against Common Bacterial Skin Pathogens: Towards Living Antimicrobials
Ghazi Khalfallah, Rita Gartzen, Martin Möller, Elisabeth Heine, and Rudolf Lütticken

"Ivermectin is approved by the Food and Drug Administration as an oral treatment for intestinal strongyloidiasis and onchocerciasis and as a topical treatment for pediculosis and rosacea. It is also used as a treatment for parasites in pets and livestock. Ivermectin may decrease severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in vitro, but randomized, controlled trials have shown no clinical benefit in the prevention or treatment of coronavirus disease 2019 (Covid-19). Veterinary use of ivermectin has increased, and the number of prescriptions for use by humans in the United States is 24 times as high as the number before the pandemic. Moreover, the number of such prescriptions in August 2021 was 4 times as high as the number in July 2021....These cases illustrate the potential toxic effects of ivermectin, including severe episodes of confusion, ataxia, seizures, and hypotension, and the increasing frequency of inappropriate use. There is insufficient evidence to support the use of ivermectin to treat or prevent Covid-19, and improper use, as well as the possible occurrence of medication interactions, may result in serious side effects requiring hospitalization."

N Engl J Med. 2021 Oct 20 : NEJMc2114907.
Toxic Effects from Ivermectin Use Associated with Prevention and Treatment of Covid-19
Courtney Temple, M.D., Ruby Hoang, D.O., and Robert G. Hendrickson, M.D.

"Consequently, a schema established on patient features that encompassed the diversity of clinical presentations was proposed by the global ROSacea COnsensus (ROSCO) panel in 2017. This phenotype approach was based on an “individual’s observable characteristics that can be influenced by genetic or environmental factors”. The ROSCO panel represented an international rosacea expert group of dermatologists and ophthalmologists from Asia, Africa, Europe, North America, and South America to ensure global representation. In this paradigm, subsequently endorsed by the National Rosacea Society, two features were independently diagnostic for rosacea. In their absence, the presence of two or more major features can establish the diagnosis. Furthermore, minor features might also present with diagnostic and/or major features (Table 1). The next step was to align the management strategies with the phenotype approach to enable optimization of patient outcomes and improve general well-being by targeting those features most bothersome to the patient."

American Journal of Clinical Dermatology volume 22, pages 457–465 (2021)
Rosacea: New Concepts in Classification and Treatment
Esther J. van Zuuren, Bernd W. M. Arents, Mireille M. D. van der Linden, Sofieke Vermeulen, Zbys Fedorowicz & Jerry Tan 

"Morbihan syndrome is characterised clinically by the slow appearance of erythematous and solid, non-pitting oedema localised exclusively on the forehead, glabella, eyelids and cheeks. The aetiopathogenesis of Morbihan syndrome is not completely known. Most authors propose that it is a clinical variety or a complication of acne or rosacea. Some authors hypothesise that Morbihan syndrome may be caused by lymph vessel abnormalities.6 Pathological examination, although non-specific, is characterised by perivascular dermal oedema with a lympho-histiocytic periadenexal infiltrate containing numerous mast cells and dilation of lymphatic vessels. Granulomas are sometimes present, and sebaceous gland hyperplasia can be observed in patients who have had or have associated rosacea.

The age, clinical picture (erythema, pustules and telangiectasia on the face) and histological features consistent with granulomatous rosacea (marked oedema and granulomas) are all supportive of the diagnosis of rosacea leading to Morbihan syndrome.

According to the current literature, treatment is challenging. Commonly used treatments are tetracycline group antibiotics and isotretinoin. Other treatment modalities include facial massage to improve drainage and steroids. Isotretinoin (10–20 mg/day) alone or in combination with ketotifen (1 mg two times per day) for 3–6 months has been reported to be effective. However, the response is unpredictable."

BMJ Case Rep. 2019; 12(10): e231074.
Rosacea causing unilateral Morbihan syndrome
Saliya Weeraman and Andrew Birnie

"The skin microbiome includes bacteria, fungi, viruses, micro-eukaryotes (mites), archaea, and phages. They can be found not only on the surface of the epidermis, but also in sweat, sebaceous glands and associated hair follicles. The composition of microbiome differs among different regions affected by numerous factors including age, gender, genetics, immunity, hormonal balance, sleep routine, stress, metabolic factors, hygiene and skin care routine, chemical or ultraviolet radiation exposure, physical activity, climate, environmental pollution and availability of nutrients."

"The studies have shown that probiotics and prebiotics both administered orally or applied topically may have a positive influence on the course of skin diseases. Despite the continuous increase in promising data on the effectiveness of the use of probiotics and prebiotics, further clinical trials are needed to assess the efficacy and long-term safety profile of probiotics and prebiotics in the treatment of patients with dermatological diseases."

Biomedicines. 2021 Oct; 9(10): 1436.
Microbiome Modulation as a Therapeutic Approach in Chronic Skin Diseases
Karina Polak, Antal Jobbágy, Tomasz Muszyński, Kamila Wojciechowska, Aleksandra Frątczak, András Bánvölgyi, Beata Bergler-Czop, and Norbert Kiss

"There has been a definite change in the lifestyle due to the current Covid-19 pandemic. People are compulsorily using face masks to avoid the spread of Covid-19 infection. This change in behavior has brought out a surge of rosacea like lesions on the covered area of face. Partly, it can be explained by change in innate immunity due to excessive sweating and change in microenvironment of skin."

Unusual Spurts of Rosacea Like Dermatoses, Posing a Diagnostic Dilemma During Covid-19 Pandemic: A Cross-Sectional, Observational Study From a Tertiary Care Centre

"In conclusion, our findings identified and verified metformin as a novel therapeutic candidate for rosacea, and it alleviates the pathological symptoms, possibly by suppressing inflammatory responses, angiogenesis in rosacea."

Pharmacol Res. 2021 Nov 8;105971.  doi: 10.1016/j.phrs.2021.105971.  Online ahead of print.
Exploring metformin as a candidate drug for rosacea through network pharmacology and experimental validation
Yangfan Li, Li Yang, Yaling Wang, Zhili Deng , San Xu, Hongfu Xie , Yiya Zhang, Ji Li  

"Metformin, sold under the brand name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight." Wikipedia

It still amazes me that rosaceans feel absolutely comfortable posting at social media sites like Facebook or Reddit and for some reason that doesn't seem logical to me can't even post a reply to this thread that doesn't require registration and can totally hide behind a cryptic display name of their own choosing so that no one knows who they are. Could someone out of the graciousness of their heart explain this to me? What are your thoughts on why the current state of rosacea sufferers are not posting here at the RRDi?  It would be helpful to understand this. If you know nothing about the RRDi click here. After you learn about the RRDi please join the conversation here by finding the reply to this topic button found on your device in this discussion thread about the RRDi. Or find the QuOTE button and post. Or you might find the join the conversation and post your thought. Usually there are at least two or more ways to post in this thread located somewhere on your device. 

"The majority of patients who had acne vulgaris (79.7%), vitiligo (79.3%), hair disorders (76.9%), or rosacea (71.5%) reported a small to no effects on their QoL."

Quality of life assessment among patients suffering from different dermatological diseases

"Using SF-36, rosacea patients were affected mentally the most as they reported the worst mental component scores, and the scores were significantly worse than that of melasma patients (rosacea vs. melisma = 46.5 vs. 52.7, p = 0.007)."

Impacts of skin disorders associated with facial discoloration on quality of life: Novel insights explaining discordance between life quality scores and willingness to pay

"After 52 weeks of once-daily treatment, subantibiotic dose doxycycline significantly reduced the relapse rate and inflammatory lesion counts in subjects with moderate-to-severe inflammatory rosacea."

Long-Term Inflammatory Rosacea Management with Subantibiotic Dose Oral Doxycycline 40 mg Modified-release Capsules Once Daily

It is of interest to note that an anti-depressant, fluvoxamine, brand name Luvox,  which is a selective serotonin reuptake inhibitor (SSRI) most often used to treat obsessive compulsive disorder (OCD) and depression is being considered to treat Covid 19. A CNN article states the following about this drug treating cytokines: 

" 'Fluvoxamine may reduce the production of inflammatory molecules called cytokines, that can be triggered by SARS-CoV-2 infection,' Reiersen said in a statement. The drug may also reduce blood platelets, which may affect the clotting effects of coronavirus infection."

Cheap, generic anti-depressant may reduce severe Covid-19 disease, study finds. Maggie Fox, CNN

"Skin, the largest organ in the human body, is exposed to air pollutants, including diesel exhaust fumes, ultraviolet rays, food, xenobiotics, drugs, and cosmetics, which promote the production of ROS. ROS exacerbate skin aging and inflammation, but also function as regulators of homeostasis in the human body, including epidermal keratinocyte proliferation. Although ROS have been implicated in various skin diseases, the underlying mechanisms have not yet been elucidated." [1]

"The regulation of free radical and ROS has been implicated in the development of various skin diseases; however, the underlying mechanisms have not yet been elucidated in detail, and proper usage of antioxidant drugs is still unknown now. In addition, there lacks studies concerning physiological roles of free radicals and ROS in skin homeostasis, and the information about duration of the generation, action and ratio of free radicals and ROS is still unclear in skin diseases.'

[1] What Are Reactive Oxygen Species, Free Radicals, and Oxidative Stress in Skin Diseases?

"Research has documented that stress has wide-ranging physiologic and clinical impacts on skin disease [1]. This has led to an interest in mind body therapies (MBTs) as potential adjunct therapies in the treatment of skin disease...

...MBTs may be considered as adjunct therapy in the treatment of several dermatologic conditions, including atopic dermatitis, psoriasis, self-induced skin conditions, and others. Other indications include during dermatologic procedures.

Further research is needed to confirm beneficial effects, to determine patient selection, and to delineate mechanisms of action. However, many of these therapies are low risk and referral to experienced practitioners or multidisciplinary clinics should be considered."

Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology

In addition to stress, Nocturnal Pruritus (NP) is mentioned in this post. 

"There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms...However, concepts such as topical steroid addiction (TSA) and topical steroid withdrawal (TSW) are controversial with majority of the dermatological community questioning this entity. Differences in opinion between dermatologists and patients who believe in TSA/TSW create challenges in treatment and a failure to acknowledge the patient’s concerns can result in a weakening of the patient-healthcare relationship (ongoing study)."

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal