Guide

The coronavirus-19 (COVID) pandemic has hindered health care provider operations, and its impact on patient willingness to seek in-person dermatologic care lacks extensive study. Understanding how a pandemic may influence patient motivation to consult a dermatologist may facilitate efficient allocation of health care provider resources both during and after COVID. Participants (n = 416) were recruited through Amazon Mechanical Turk, a web-based survey platform. Subjects were randomized to one of fourteen groups, each entailing a pre-COVID or during-COVID hypothetical scenario of a socially stigmatized skin condition: scalp psoriasis, herpes labialis, acne vulgaris, rosacea, tinea faciei, melanoma, or a benign nevus. Subjects rated their willingness to schedule an in-person dermatology appointment on a 5-point Likert scale (ie, willingness score). Sociodemographic data were collected. Herpes labialis, tinea faciei, and melanoma prompted higher willingness scores during COVID (3.94; 4.03; 3.54) compared with pre-COVID (3.81; 4.0; 3.32); scalp psoriasis, acne vulgaris, rosacea, and benign nevi prompted lower willingness scores during COVID (3.33; 2.88; 3.67; 3.07) compared with pre-COVID (3.93; 3.19; 4.21; 3.7). The benign nevus group displayed the largest decrease in willingness scores from pre-COVID (3.7) to during COVID (3.07). Patients reported higher willingness to seek in-person evaluation for conditions associated with stronger social stigmas, such as scalp psoriasis and herpes labialis, during COVID. We did not control for subject familiarity with each skin condition, and perceived degree of disfigurement was not measured. Patient willingness to seek treatment during COVID may be changing rapidly and, at this time, does not appear to be largely affected by the pandemic.

Impact of COVID-19 on patient willingness to seek in-person dermatologic care
J Am Acad Dermatol. 2021 Sep; 85(3): AB101.

There is evidence that demodex infestation primarily changed the dominant flora and relative abundance of ocular surface microbial communities and meibomian gland dysfunction (MGD) may play an important role in this process.

Ophthalmol Ther. 2021 Sep; 10(3): 601–617.
Demodex Infection Changes Ocular Surface Microbial Communities, in Which Meibomian Gland Dysfunction May Play a Role

"Keratinocytes are the primary type of cell found in the epidermis, the outermost layer of the skin. In humans, they constitute 90% of epidermal skin cells." [1]

"These findings reveal the specific epithelial differentiation in normal central facial skin, and epithelial–immune crosstalk in lesions providing insight into an initial keratinocyte pattern in the pathogenesis of rosacea." [2]

"In conclusion, we extensively and comprehensively investigated the characteristics of central facial skin and rosacea lesions in a stepwise manner. We potentially revealed the communication between the skin barrier and innate immune system, keratinocyte–immune crosstalk, and provided insights into the initial keratinocyte pattern for the pathogenesis of rosacea. Finally, our findings suggested STAT1 might be a potential therapeutic target for rosacea." [2]

"Epidermal RNA-seq and immunohistochemistry analysis further validated the epithelial-derived STAT1 signature in rosacea lesions." [2]

"Signal transducer and activator of transcription 1 (STAT1) is a transcription factor which in humans is encoded by the STAT1 gene. It is a member of the STAT protein family. " [3]

"Bacterial peptidoglycan (PGN) stimulates toll-like receptor 2 (TLR2) on the surface of keratinocytes (KCs), triggering signaling pathways that promote an innate immune response. " [4]

End Notes

[1] Keratinocyte, Wikipedia - image courtesty of Wikimedia Commons

[2] Front Immunol. 2021; 12: 674871.
Keratinocyte-Immune Cell Crosstalk in a STAT1-Mediated Pathway: Novel Insights Into Rosacea Pathogenesis

[3] STAT1, Wikipedia - STAT1 image courtesy of Wikimedia Commons

[4] AhR Regulates Peptidoglycan-Induced Inflammatory Gene Expression in Human Keratinocytes

"Most of the research performed has focused on bacteria. Bacteria are nonetheless not the only inhabitants of human skin. Additionally, fungi, phages and micro-eukaryotes are present on the skin and most likely play a role in normal skin homeostasis."

Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001
Skin microbiome transplantation and manipulation: Current state of the art
Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

 "Rosacea has also been linked to a dysbiosis of the skin microbiome. An increased abundance of Demodex mites are observed in this disease. An interesting suggestion was made by Parodi et al. who reported an interplay between the skin and bacterial overgrowth in the small intestine. Rosacea patients had a significantly higher overgrowth of gut bacteria than controls and elimination of the overgrowth, using an antibiotic, resulted in an almost complete regression of the skin pathology for a prolonged time. These findings support the pathogenetic role of the gut microbiome in rosacea lesions, although the exact relationship remains to be elucidated. Additionally, research even investigated the microbiota of the Demodex mites, but final conclusions are still outstanding."

Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001
Skin microbiome transplantation and manipulation: Current state of the art
Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"Rosacea has also been linked to a dysbiosis of the skin microbiome. An increased abundance of Demodex mites are observed in this disease. An interesting suggestion was made by Parodi et al. who reported an interplay between the skin and bacterial overgrowth in the small intestine. Rosacea patients had a significantly higher overgrowth of gut bacteria than controls and elimination of the overgrowth, using an antibiotic, resulted in an almost complete regression of the skin pathology for a prolonged time. These findings support the pathogenetic role of the gut microbiome in rosacea lesions, although the exact relationship remains to be elucidated. Additionally, research even investigated the microbiota of the Demodex mites, but final conclusions are still outstanding."

Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001
Skin microbiome transplantation and manipulation: Current state of the art
Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"Probiotics and diet manipulations have been successfully applied to (partly) restore skin disorders. The gut-skin axis is not only governed by diet, and even acts bidirectionally with UVB and topical allergies directly influencing the gut [19], [20], [21]. Therefore, the cross-talk between the gut and skin is an important factor to take into consideration in regard to skin disorders."

Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001
Skin microbiome transplantation and manipulation: Current state of the art
Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

"The Western diet, which is rich in fat and carbohydrates and low in fibre, has altered the gut microbiome, which can lead to an impaired mucus layer and, in further stages, an impaired intestinal barrier. This contributes to an inflammatory state in the body that can be expressed as a skin pathology."

Comput Struct Biotechnol J. 2021; 19: 624–631. Published online 2021 Jan 4. doi: 10.1016/j.csbj.2021.01.001
Skin microbiome transplantation and manipulation: Current state of the art
Chris Callewaert, Nastassia Knödlseder, Ante Karoglan, Marc Güell, Bernhard Paetzold

There are a number of papers indicating improvement with rosacea taking Carvedilol. Here is a growing list: 

RRDi List of Papers on Carvedilol for Rosacea

The RRDi is pleased to announce a new page, Rosacea Episodes. 

More Information

You may be having issues trying to navigate our website using a mobile device so here is a helpful tutorial to find Rosacea Topics. Watch Video. You will have to register as a member to view some of the content below. 

Step one - Finding the Menu on the Home page (iOS - hopefully Android users are similar) - Look for the three bars top right corner (click): 

You should then see the following menu: 

Just under the HOME button find the NAVIGATOR button and click on it and you should see the following menu: 

The first word 'Navigator' is simply the title of this menu (don't click on it). The menu choices are now shown below this word, 'Navigator,' and you should begin scrolling down till you see the following: 

The menu button ROSACEA TOPICS is the second to the last choice. Click on ROSACEA TOPICS which brings you to the following screen: 

You may want to turn your mobile device horizontally to view the videos and subforums and scroll down to see all the choices: 

Now you can view the subforums but you are not allowed to enter a subforum without being a member of the RRDi. Membership requires a subscription and all you do register and then you can view over 7K posts and over 5.4K rosacea topics. Learn more. Hope this helps mobile device users on how to navigate our website. If you have questions, find the reply to this topic button and ask. 

Melaleuca alternifolia image courtesy of Wikimedia Commons

There are a number of anecdotal reports of using Tea Tree oil (TTO) for rosacea, usually diluted at least 50/50 with some other oil, i.e., rose hip oil, most of these reports found at the Rosacea Forum. There are numerous over the counter treatments for acne containing TTO. [1] There are anecdotal reports that adding Tea Tree oil to baby shampoo has been used as a cleanser. [2]

There are a few clinical papers on using Tea Tree oil for medical uses showing it has antimicrobial and anti-inflammatory properties. [3]

"Australian tea tree oil (TTO) and its extract terpinen-4-ol (T4O) are found to be effective in moderating demodex-related diseases. Their possible effects are lowering the mite counts, relieving the demodex-related symptoms and modulating the immune system especially the inflammatory response."  [4]

TTO may cause an allergic reaction and may be too harsh for rosacea sensitive skin so be sure to dilute it. 

"The survival times of the six different TTO groups confirmed a dose-related pattern, all of which had survival times shorter than the negative control (immersion oil). TTO 25% had comparable efficacy to the positive control agent (permethrin 5%)." [5]

• Tea Tree Oil and Baby Shampoo •

End Notes

[1] Int J Antimicrob Agents. 2015 Feb;45(2):106-10
Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action
K A Hammer  

[2] Tea Tree Oil and Baby Shampoo

[3] Clin Microbiol Rev. 2006 Jan; 19(1): 50–62.
Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties
C. F. Carson, K. A. Hammer, and T. V. Riley

[4] Parasitology. 2018 Oct;145(12)
Can the tea tree oil (Australian native plant: Melaleuca alternifolia Cheel) be an alternative treatment for human demodicosis on skin?
Nelson Siu Kei Lam, Xin Xin Long, Robert C Griffin, Mu-Kai Chen, James Cg Doery 

[5] The comparative in vitro killing activity of tea tree oil versus permethrin on Demodex folliculorum of rosacea patients

Just to clarify, when a member doesn't post for 30 days, the active member is then is manually switched to the inactive member group. When an inactive member logs in they are given the opportunity to subscribe. 

However, anyone who subscribes and continues to donate each month does not have to be active or post as long as the subscription is active. 

A novel topical consisting of 15% Azelaic Acid and 1% Dihydro Avenanthramide D for rosacea is mentioned in a clinical paper posted in our member forum at this link.

You will need to join the RRDi to view this post. Membership is free. 

We happen to have the MOST private rosacea forum on the internet, if you join using Sign in with Apple and use Apple's Hide My Email. Android users can still join as well as Windows users are welcome. 

There is  "a novel formulation cream containing 15% AzA (anti‐inflammatory/anti‐oxidant/anti‐microbial agent) combined with 1% dihydroavenanthramide D (anti‐inflammatory/anti‐itch)" that was evaluated using an instrumental "erythema‐directed digital photography (EDDP)." The study concluded "that this new non‐irritating product represents a valid therapeutic option for mild/moderate inflammatory rosacea."

J Cosmet Dermatol. 2021 Apr; 20(Suppl 1): 28–31.
A novel azelaic acid formulation for the topical treatment of inflammatory rosacea: A multicentre, prospective clinical trial
Federica Dall’Oglio, MD, PhD,  Aurora Tedeschi, MD, PhD,  Francesco Lacarrubba, MD,  Gabriella Fabbrocini, MD, PhD,  Nevena Skroza, MD, PhD,  Paolo Chiodini, MS, Giuseppe Micali, MD

"It was found that the synthetic analog dihydroavenanthramide D (DHAvD) can interact with the neurokinin-1 receptor (NK1R) and inhibit mast cell degranulation."

Experimental Dermatology 26(8) November 2016
Dihydroavenanthramide D inhibits mast cell degranulation and exhibits anti-inflammatory effects through the activation of neurokinin 1 receptor
Tobias Lotts, Konstantin Agelopoulos, Ngoc Quan Phan, Karin Loser

"Avenanthramides (anthranilic acid amides, formerly called "avenalumins") are a group of phenolic alkaloids found mainly in oats (Avena sativa), but also present in white cabbage butterfly eggs (Pieris brassicae and P. rapae), and in fungus-infected carnation (Dianthus caryophyllus). A number of studies demonstrate that these natural products have anti-inflammatory, antioxidant, anti-itch, anti-irritant, and antiatherogenic activities." Wikipedia

Closeup of oat florets (small flowers) image courtesy of Wikimedia Commons

An article published at mgblifestyle, discusses 'cold and formaldehyde-containing foods' as well as 'a pretty fancy-sounding protein' (actually a couple of fancy sounding proteins) that 'sets off a chain reaction that ultimately results in the release of histamines and cathelicidins by your skin's immune system.' The two proteins discussed in the article are transient receptor potential vanilloid 4 (TRPV4) and transient receptor potential alkyrin 1 (TRPA1). 

New Research Shows How Certain Foods & Drinks Affect Rosacea, Alexandra Engler, mgblifestyle

Grapefruit image courtesy of Wikimedia Commons

"Although ivermectin has been shown to inhibit the replication of severe acute respiratory syndrome coronavirus (SARS‐CoV)‐2 at supratherapeutic doses in vitro, no benefit has been seen in real‐world treatment of COVID‐19." 

Clin Exp Dermatol. 2021 Jun 26 : 10.1111/ced.14704.
Ivermectin in dermatology: why it ‘mite’ be useless against COVID‐19
D. Roche,  C. O’Connor, M. Murphy

Received the 2020 Form 990 from the AARS. Total revenue received $258,366. Who contributed most of the revenue? The 'skin industry.'

GALDERMA LABORATORIES L.P. $87.5K
LA ROCHE POSAY $15K
ORTHO DERMATOLOGICS $35K
SOL-GEL TECHNOLOGIES INC. $15K
SUN PHARMACEUTICALS $36K
ALMIRALL, LLC (FORMERLY AQUA PHARMA) $35K
BOTANIX PHARMACEUTICALS $5K
EPI HEALTH, LLC $5K

Total donations from the skin industry is $233.5K. The AARS was refunded one of the grants given out last year in the amount of $10K and also received $10,150 in membership dues from dermatologists.  See below: 

What did the AARS spend most of its donations on? Again, the largest amount was on 'Conferences, conventions, and meetings' in the amount of $167,836. Two other large expenses was $48K on 'management' and $12,280 on 'website expenses.' See below: 

Is this the way you think a non profit organization for rosacea should be run?  If you are a dermatologist it seems appropriate to run this non profit the way it is run. However, if you are a rosacea sufferer, is this the rosacea non profit organization you want to support?  Why should there be a rosacea non profit run by rosaceans?

You can read the Form 990 below: 

AARS-2020Form990.pdf
 

Received the 2019 Form 990 from the AARS. Total revenue received $195,638 and here is the breakdown of the top contributors who donate at least $5K: 

ACLARIS THERAPEUTICS $10K
CUTANEA LIFE SCIENCES (NOW OWNED BY BIOFRONTERA) $35K
CASSIOPEA S.P.A. $10K
FOAMIX PHARMACEUTICALS $10K
GALDERMA LABORATORIES L.P. $50K
RODAN AND FIELDS, LLC $35K
THE PROACTIV COMPANY $35K

Total from 'skin industry' $185K

It would be safe to say that the vast majority of donations are from the 'skin industry.'  In addition to this, $10,450.00 revenue came from membership dues (dermatologists). 

It would be prudent to note that there is little, if any, public support donations to the AARS. This organization operates more like a 501 6 c which is a business league. 

What did the AARS spend most of the 'donations' on? $234,961 on "Conferences, conventions, and meetings."  You ask, how can the AARS spend more than it received in revenue? Answer: carry over assets. One expense worth noting is how the AARS spent $3,830.00 on its website. Here is a screen shot of all the expenses: 

The AARS did spend $40K on research grants in 2019 and you can review below who received the money: 

Your can read the form 990 yourself below: 

AARS-2019-Form990.pdf

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One paper discusses granulomatous rosacea (GR) and and cutaneous lupus erythematosus (CLE) with "the codiagnoses of GR and CLE later confirmed with clinicopathological correlation." 

Severe Granulomatous Rosacea with Cutaneous Lupus Erythematosus

"Prior studies have revealed the adverse effects (AEs) of PPE on healthcare workers (HCWs); however, no review has focused on the AEs of PPE on HCWs in intensive care units (ICUs). This review aimed to identify the AEs of PPE on HCWs working in ICUs during the COVID-19 pandemic."

SAGE Open Nurs. 2021 Jan-Dec; 7: 23779608211026164.
Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review
Takeshi Unoki, PhD, RN, Hideaki Sakuramoto, PhD, RN, Ryuhei Sato, PhD, RN,3 Akira Ouchi, PhD, RN, Tomoki Kuribara, MSN, RN, Tomomi Furumaya, MSN, RN, CCNS, Junko Tatsuno, PhD, RN, CCNS, Yuki Wakabayashi, MSN, RN, Asami Tado, PhD, RN, CCNS,8 Naoya Hashimoto, BSN, RN, Noriko Inagaki, MSN, RN, CCNS, Yoshiko Sasaki, PhD, RN,

"In conclusion, the proportion of rosacea patients who have anxiety or depression is large. However, the psychological distress experienced by these patients is usually neglected by clinicians. Our study revealed that younger age, more severe self-reported symptoms, and higher disease burden may indicate the possibility of anxiety or depression, especially when clinical signs and self-reported symptoms are inconsistent or if patients have apparently impaired quality of life. Psychological intervention should be taken into consideration when prescribing atreatment regimen."

Front Psychiatry. 2021; 12: 659171.
Prevalence and Risk Factors of Anxiety and Depression in Rosacea Patients: A Cross-Sectional Study in China
Mengting Chen, Zhili Deng, Yingxue Huang, and Ji Li1