Guide

Could it be possible for a non profit organization for rosacea to sponsor cell and gene therapy for rosacea?  Could 10K rosacea sufferers get together and each donate one dollar to sponsor an investigation into this type of therapy for rosacea?  Only if you and 9,999 other rosacea sufferers decided to do this. What is cell and gene therapy? Watch this video by Novartis: 

If you are interested in sponsoring such an investigation into such research, read this post. 

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*image - Robert Plutchik's Wheel of Emotions.

A recent study came to the conclusion that "The emotions of Anger and Disgust have been poorly explored in empirical studies, despite they could be theoretically considered a vulnerability factor for the development of skin disorders and the dermatological extreme consequences, as negative emotionality toward self and the pathological skin condition." [1]

Most clinical studies have focused on sadness, fear and anxiety which are the negative emotions related to skin disorders. However this paper concludes that "For most of the theories, anger is the typical reaction to both physical and psychological frustration and constriction." 

As for disgust, the paper mentions, "Over the years, not many authors have given their contribution to the empirical study of the emotion of disgust, but several studies show that disgust has the function to keep us away from situations or substances which could be dangerous, or from anything that is abhorrent and dirty, including values, thoughts, people, and, in some cases, even the self." [1]

Do you feel that emotions such as anger, disgust, depression, anxiety, apprehension, sadness, or other negative emotions should be investigated more with research?  Could rosaceans come together in a non profit organization and sponsor such research?  If you want to learn more read this post. 

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End notes 

*image courtesy to wikimedia commons

[1] Int J Psychol Res (Medellin). 2020 Jan-Jul; 13(1): 71–86. doi: 10.21500/20112084.4078
Negative Emotions in Skin Disorders: A Systematic Review
Carmela Mento, Amelia Rizzo, Maria Rosaria Anna Muscatello, Rocco Antonio Zoccali, and Antonio Bruno

Isotrexin is a topical gel containing 0.05% isotretinoin and 2% erythromycin indicated for the treatment of moderate acne vulgaris and is manufactured by GlaxoSmithKline (Ireland) which is owned by Stiefel Laboratories (Ireland) Ltd. - see product insert

2209530.PA1077_123_001.14879f44-cc4d-45fe-9d4e-a5a95f9374b8.000001Isotrexin PIL.180822.pdf

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In England, an article published in the British Journal of General Practioners, concludes that "Skin problems are the most common reason for a new presentation in primary care, and most patients with skin problems are managed exclusively in primary care" by general practitioners (GPs). Furthermore, "skin problems were usually presented alongside other complaints and resulted in a medication recommendation." This means that more patients in the UK apparently are being treated by GPs rather than dermatologists and the authors of the paper are concerned that "Shared decision making was uncommon and self-management advice not consistently given, with re-attendance for the same problem common. GPs’ training should reflect how frequently skin problems are seen and seek to improve patient involvement in decision making and support self-management."  

Another concern expressed by the authors regarding long term treatment of skin conditions is that  "Long-term skin problems can place a heavy burden on patients, including impaired health-related quality of life, reduced occupational productivity, and a high socioeconomic and psychological impact." The patients "treatment failure in long-term conditions is common as a result of low adherence with treatments."

"Most skin problems were not referred to dermatology specialist care, with GPs offering planned or contingent followup arrangements in two-thirds of cases, which was documented for only half of the problems. Although most skin problems were not referred, re-attendance within 3 months of the index consultation was common."

The paper never mentions rosacea in the list of skin conditions treated. 

Br J Gen Pract. 2020 Sep 8 : bjgp20X712577. doi: 10.3399/bjgp20X712577 
The content and conduct of GP consultations for dermatology problems: a cross-sectional study
Emma Le Roux et al  

Diagnosis of rosacea has traditionally been done with a physical examination, history and 'qualitative human assessment [which] is often subjective and suffers from a relatively high intra- and inter-observer variability in evaluating patient outcomes,' [1] sometimes resulting in misdiagnosis. [2] A team of seven researchers at Ohio State University’s Department of Dermatology and the Wake Forest School of Medicine have developed an algorithm using AI, dubbed “Ros-NET,” that relies on digital images of rosacea patients to diagnose patients which according to the team works 88% to 90% correctly. The team used the same algorithm similar to one they had previously developed for acne. We may be hearing more about Ros-NET. [1]

End Notes

[1] Skin Res Technol 2020 May;26(3):413-421. doi:10.1111/srt.12817
Ros-NET: A deep convolutional neural network for automatic identification of rosacea lesions. 
Binol H, Plotner A, et al.

[2] Misdiagnosed Rosacea 

Brad Goreski, a celebrity fashion stylist and television personality, has rosacea. He has worked with Galderma in producing the following video: 

On August 20, 2020, Brad announced he has rosacea on his Facebook page. 

Famous Rosaceans

Daubee,

So I see you explain how you achieved remission when you posted here. So what is your current regimen now?

Remission means different things to people. We have post on this subject that may help increase clarity on this subject. 

Similar to the VeinGogh device is another brand, Veinwave™, which uses "thermocoagulation to safely and effectively treat spider veins (telangiectasia) on the face and body. The procedure was developed by vascular surgeons to treat small spider veins that cannot be treated with sclerotherapy injections." [1] This is NOT photo dynamic therapy. You can watch a video how its done in the end note. [1]

"The Veinwave™ has been widely used outside the USA for rosacea, but has not yet been cleared by the FDA for this. The European physicians find the Veinwave™ is very successful at removing the symptoms of rosacea (removing the vascular areas), but not actually curing the disease. The number of treatment sessions depends on severity of the disease state." [1]

According to UAB Medicine, "The Veinwave™ system is a revolutionary, FDA-approved technique used by vein specialists around the world to eliminate spider veins on the legs through thermocoagulation (heat). The process involves using an ultra-fine insulated needle on the surface of the spider vein to deliver just enough heat to cause the vessel walls to collapse, but because of the insulation, the extra heat is not transmitted into the skin (similar to sucking the air out of a drinking straw and then gluing the inside walls together). Unlike lasers and other light-based therapies that use photocoagulation ("light") with variable penetration through the skin, Veinwave™ treatment usually is more precise and complete." [2]

Most sources insist that Veinwave has been FDA cleared for treating facial spider veins and telangiectasia. For example, "This FDA-cleared device is relatively new in the USA, but has been used in Europe for over nine years. It is the treatment of choice for spider veins that are too small to treat with injection sclerotherapy and it is particularly effective for the treatment of facial telangiectasias." [3]

In the past, "Radiofrequency thermocoagulation is a thermal pain treatment procedure." [4] "Thermocoagulation is a treatment that uses high-frequency current.  It’s effects is based on heat.  Heat is used to coagulate blood capillaries or skin anomalies.  The current is restricted to the target area. Thus making sure that the tissue damage caused by the thermocoagulation is limited. Its non-invasive process makes it a popular alternative to other options." [5]

There may be other brands of thermocoagulation devices available, i.e., ThermaVein. We are concentrating on the Veinwave device in this post and while many anecdotal reports are out there on physician websites who are using this device are positive, there are some who are not as happy with the results, so we are reporting some of these negative ones here. 

Negative Anecdotal Reports 

Thread no 1. 

Thread no 2. 

Thread no 3.

Thread no 4.

Thread no 5.  

If you have used Veinwave, please find the reply button and share your results. 

End Notes

[1] Veinwave Treatment for Spider Veins, Vein Directory

[2] Veinwave, UAB Medicine

[3] What is Veinwave?, Tennessee Vein Center

[4] Radiofrequency thermocoagulation, Wikipedia

[5] How does thermocoagulation work?, Timeless Electrolysis 

On 9/2/2020 at 9:15 AM, JohnIR said:

Hello.

I decided to try a home made batch of Ivermectin and Cetaphil so I followed the directions but got some odd results.
First, it looks like the mixture is not holding together. After mixing it and allowing it to sit in a container for awhile some (or all) of the yellowish Ivermectin comes out of the mixture and ‘floats’ separately in streaks. Each time I use it I have to remix it.

Second, the newly mixed substance doesn’t hold together to spread it on uniformly. As I spread it some of it forms small clumps and the rest of it becomes a clear paste/oil. It is not at all like Soolantra.

What is happening?

Thanks

John

 

 

Hi John, 

Welcome to the RRDi. I am not an expert on this and immediately thought of Tom Busby who I asked what his advice would be for you. Tom is kind and immediately replied to my inquiry and here is his response: 

------------------begin Tom Busby response:

Hi Brady:
 
You could reply and advise that he would google ivermectin solubility.  This will show that ivermectin is soluble in methanol (rubbing alcohol) or 95% ethanol (EverClear).  However, he will need to determine the best way to dissolve it, which probably involves heating the alcohol/ivermectin mix, perhaps at a 50/50 ratio, to about 150F.  The problem is that heat and/or alcohol will probably break the emulsion in Cetaphil, which is weak to begin with.  The dump-in method is better than nothing, but barely. 
 
Or, he could try the double dump-in method, where the alcohol/ivermectin mix is poured into hot oil, perhaps MCT oil at 150F, and then the hot oil/ivermectin/alcohol mix is dummped into Cetaphil.  
 
It’s very difficult to teach this, and he’ll have to have plenty of ivermectin to experiment on what works via trial and error.
 
Sincerely,
Tom

----------------end Tom Busby response. 

I hope this helps you in your search on how to dissolve the Ivermectin correctly into Cetaphil. My personal advice is to find a compounding pharmacist who knows how to do this correctly. An easier and cheapest way is to simply get horse paste. 

Brady 

There is a unique device used to treat telangiectasia, spider veins or varicose veins called VeinGogh which is "a microwave-based therapy" according to Wave3 News. [1] This is NOT a photo dynamic therapy but instead uses 'energy pulses' rather than light. It is recommended that physicians use this device on patients and should receive training. [2] It is not a 'do it yourself' device. You can watch this video that explains more: 

It is not for the novice to use, since it costs over $14K US dollars. [3] There are other brands, i.e., Veinwave, etc. 

Not everyone is happy with the results. [4] 

Please post your results in this thread if you have experience with this device. Find the reply button. 

End Notes 

[1] A pen that erases spider veins
December 30, 2010 at 11:58 PM EST - Updated June 23 at 5:28 A, Wave3 News

[2] Physician Information, VeinGogh

[3] VeinGogh XL Vein Treatment System
veingogh.com Sites > US Site > Products > VeinGogh Supplies > VeinGogh XL Vein Treatment System

[4] "Anyway...4 weeks ago I had veingogh done on my nose for stubborn broken caps....worst mistake of my life." CONTACTMC

"I had the VeinGogh procedure done 2 months ago and it left me with red scars and a new vein. They look worse than when I started and I don't know how to get rid of them." Moonbeam [post no 4]

A new prescription topical treatment is in clinical trials and the results are impressive. The new topical is Rosazel by Alma Development.

The Rosazel website states, "REGULATORY STATUS Medical Device Class I (Marking in progress)."

A paper with ROSAZEL in the title, concludes, "This new GSH-C4, beta-glycyrrethic and azelaic acids cream has shown to be efficacious in mild to moderate rosacea subjects. Local tolerability is in line with other anti-rosacea treatments." [1]

Rosazel Ingredients (source)
Azeloglicina®: a combination between azelaic acid and glycine with soothing and moisturizing effect. 
- Hyaluronic Acid: a naturally-occurring polysaccharide that provides skin moisture and firmness.
- Vit. E: a free radical scavenger, a powerful anti oxidant vitamin with protective properties on the skin
- Solar Filters (SPF 15): to protect skin from UV-A and UV-B rays.

The active ingredient, Azeloglicina is according to Sinerga, the following:

"The chemical modification from Azelaic Acid to AZELOGLICINA® has led to an equally active ingredient, but much improved from a technical point of view. Indeed, Potassium Azeloyl Diglycinate (Trade Name: AZELOGLICINA®) is a water soluble derivative of Azelaic Acid, maintaining all the cosmetic properties of the original molecule, but improving its technical characteristics." Sinerga, Azeloglicina 

Mknlvi [2] flagged especially the "rather confusingly, the words (The Rosazel Trial) in the journal title" article [1] which does indeed mention another cream, "A daily cream (E-AR) containing GSH-C4 (0.1%) with beta-Glycyrrhetic (0.5%) and azelaic acids (10%), with an SPF of 30, is available." Mknlvi found possibly an over the counter treatment, Eutrosis AR sold on Amazon UK with similar ingredients. It is manufactured by Difa Cooper cantabria labs. The company website states that "Eutrosis AR cream is an ultra-soothing, anti-redness adjuvant treatment that, thanks to an active formula based on glutathione-C4, azelaic acid and 18 β glycyrrhetinic acid, performs antioxidant and soothing actions which contribute to visibly reduce skin blemishes skin blemishes due to rosacea and couperose."

Eutrosis AR cream offers protection from UV radiation thanks to SPF 15 and immediately counteracts redness thanks to masking pigments. Eutrosis AR ultra-soothing, anti-redness cream provides the necessary daily protection for skin affected by rosacea and couperose.

Eutrosis AR Ingredients (source)
Ingredienti principali: Glutathione-C4, Azelaic acid and 18 β Glycyrrhetinic acid

What these two creams have in common is azelaic acid. However, the two are made by totally different companies and have different ingredients. Hopefully, we can unravel this mystery with some better clarification. What connection Rosazel has with Eutrosis AR may be resolved with further investigation. To add further to this confusion there is also Eutrosis 641 (does not contain azelaic acid) sold on Amazon for dry skin, as well as Eutrosis DS for SD. [3]  The RRDi has contacted one of the authors of the ROSAZEL trial paper for clarification. 

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End Notes

[1] J Cosmet Dermatol. 2020 Sep 03;: Full text pdf
Efficacy and tolerability of a cream containing modified glutathione (GSH-C4), beta-Glycyrrhetic and azelaic acids in mild-to-moderate rosacea: A pilot, assessor-blinded, VISIA and ANTERA 3-D analysis, two-center study (The "Rosazel" Trial).
Dall'Oglio F, Puviani M, Milani M, Micali G

[2] Efficacy and tolerability of a cream containing modified glutathione (GSH‐C4), Mknlvi, Rosacea Forum

[3] Seborrheic Dermatitis, see end note 30

Face shields and masks with exhalation valves were found to be less effective at protecting others from the coronavirus than normal face coverings, according to a study on Tuesday. 

New research, published in the journal Physics of Fluids, determined that the two options, which some wearers find more comfortable -- allowed ejected particles to escape, putting those around you in danger of being exposed to the virus.

The findings come amid an increasing trend of people replacing their regular cloth or surgical masks with clear plastic face shields, or masks equipped with exhalation valves.

Coronavirus: Face shields offer less protection for others than regular masks, study finds, FoxNews

A paper on Dye pulsed light (DPL) concluded, "DPL is not the optimal procedure for treating severe telangiectasia in patients with ETR, whereas the efficacy of the treatment for erythema was not affected by the severity of the condition."

Dermatol Ther (Heidelb). 2020 Aug 31;:
Retrospective Study of Factors Affecting Efficacy of Therapy with Dye Pulsed Light for Erythematotelangiectatic Rosacea.
Zhao L, You C, Chen H, Wang J, Cao J, Qi M, Hou S, Zheng X, Shao L, Liu Q

Sandoz has a generic Azelaic Acid Gel 15% which was announced on March 13, 2018. [1]

Product Information

More information on Azelaic Acid

Teva Generics also provides a generic version. [2]

Glenmark Pharmaceuticals Inc also makes a generic version. [3]

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End Notes 

[1] Finacea® (azelaic acid) – First-time generic, OptumRx

[2] Generic of Finacea® Gel, 15%, Teva Generics

[3] Glenmark Pharmaceuticals receives ANDA approval for Azelaic Acid Gel, 15%, Glenmark Press Release

"Adex Gel is a highly moisturising and protective skin emollient which has an ancillary anti-inflammatory medicinal substance. It helps in the treatment and routine management of dry and/or inflamed skin conditions such as mild to moderate atopic dermatitis, various forms of eczema, contact dermatitis and psoriasis in circumstances where ancillary anti-inflammatory action added to the primary emollient action may be beneficial (e.g. during flares). Such use may help reduce reliance on more potent anti-inflammatory treatments such as corticosteroids and immunomodulators." [1] It is available in the UK. 

"Although Adex Gel is available on prescription, it can also be purchased from a pharmacy - but you may need to ask for Adex Gel at the Pharmacy counter where prescriptions are dispensed." [2]

Ingredients
Carbomer, glycerol, isopropyl myristate, liquid paraffin, nicotinamide, phenoxyethanol, sorbitan laurate, trolamine and purified water.

Adex Gel is free from topical steroids, SLS, perfumes and parabens. [3]

End Notes

[1] Information for the User, Adex Gel, Package Leaflet

[2] Adex Gel, FAQs, CAN ADEX GEL BE PURCHASED WITHOUT A PRESCRIPTION?

[3] Adex Gel, FAQs, WHAT ARE THE INGREDIENTS OF ADEX GEL?

Adex Essential Information.pdf

"However, shortcomings in these diagnostic criteria and subtyping have become apparent. This includes the lack of specificity of some primary features (flushing, papules/pustules, telangiectasia), the exclusion of phyma as a primary feature and the conflation of multiple features into subtypes. For example, the erythematotelangiectatic subtype comprises flushing and persistent central facial erythema with or without telangiectasia, whereas the papulopustular subtype comprises persistent central facial erythema with transient, central facial papules and/or pustules. Thus, both have persistent central facial erythema as a common feature. This has led to confusion in epidemiological research whereby some studies consider them as separate categories, while others aggregate all with central facial erythema as erythematotelangiectatic, a subgroup of which is papulopustular. Furthermore, it does not account for patients presenting with a solitary diagnostic criterion and absence of the others defining a specific subtype. For example, how would one classify a patient with persistent central facial erythema alone but without flushing and telangiectasia? In addition, severity determination of subtypes is complicated by the presence of multiple features each of which may vary in individual severity and responsivity to intervention. However, these individual features were not previously typically evaluated separately. Furthermore, in clinical practice, subtyping may inadequately capture the signs and symptoms of individual patients as some features can extend across subtypes.

Consequently, revised diagnostic criteria have been proposed and recommendations made to abandon the subtyping approach."

Br J Dermatol. 2019 Jul;181(1):65-79.  doi: 10.1111/bjd.17590.  Epub 2019 Mar 10. Pubmed
Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments
E J van Zuuren, Z Fedorowic, J Tan, M M D van der Linden, B W M Arents, B Carter, L Charland 

Tom Busby makes a lotion for SD which the RRDi is posting pro bono. You can read all about this lotion and how to purchase by reading the pdf below. If you have used this lotion you can find the reply button and post in this thread. Tom also makes a shampoo. 

Review of OTC Treatments for Malassezia skin conditions-for Square Space-2.pdf

Please tell Tom you heard about his AquaVive Lotion from the RRDi. 

Folliculitis - Rosacea Mimic

Histopathology of granulomatous folliculitis, image courtesy of Wikimedia Commons

Folliculitis is "the infection and inflammation of one or more hair follicles." [1]  A google image search shows some photos that mimic rosacea.

"Folliculitis is a common skin condition in which hair follicles become inflamed. It's usually caused by a bacterial or fungal infection." [2]

"Folliculitis is most often caused by an infection of hair follicles with Staphylococcus aureus (staph) bacteria. Folliculitis may also be caused by viruses, fungi and even an inflammation from ingrown hairs." [2]

"Folliculitis can appear anywhere on the skin, except for our palms and soles." [3] "You have hair follicles just about everywhere except your lips, your palms, and the soles of your feet. Folliculitis can make these hair follicles red and swollen." [4]

"Usually there is some itch, sometimes a little soreness. Folliculitis looks like acne pimples or non-healing, crusty sores." [5]

What does folliculitis look like? Google image search. 

It looks like acne [3] [4] (a rosacea mimic), so it is to be differentiated from the long list of skin conditions that appear with erythema and pimples. However, your folliculitis may be simply related to your rosacea or SD issues. If around your mouth it may be referred to as Perioral Demodex folliculitis. There are various types of folliculitis: 

Bacterial folliculitis [2]
Barber’s itch [4]
Boils (furuncles) and carbuncles [2] [4]
Deep folliculitis [4]
Eosinophilic folliculitis [2] [4]
Gram-negative folliculitis [2] [4]
Hot tub folliculitis (pseudomonas folliculitis) [2] [3]
Perioral Demodex Folliculitis
Pseudo folliculitis or razor bumps (pseudofolliculitis barbae) [2] [3]
Pityrosporum folliculitis [2]
Shaving rash [4]
Superficial folliculitis [4]
Sycosis barbae [2] [4]

Dr. Reagan Anderson, a board certified dermatologist and Mohs Micrographic Surgeon explains folliculitis and what to do about it. 

Found this interesting reddit you may want to check out. 

Pruritis and Rosacea

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End Notes 

[1] Folliculitis, Wikipedia

[2] Folliculitis, Mayo Clinic

[3] ACNE-LIKE BREAKOUTS COULD BE FOLLICULITIS, AAD

[4] Folliculitis, WebMD

[5] Folliculitis, AOCD

On 8/20/2020 at 11:16 AM, Apurva Tathe said:

Yes it would be a good idea to get the recommendation of another dermatologist and please share what did she recommend and prescribe you.

I always have this thing in winter season when the weather is chilled and automatically goes when the temperature goes normal and the rest of the year though I get rosacea flare ups but this seborrhea does not bother me. I think everyone has their own story to say with these things. If anyone has noticed this yeast overgrowth with their rosacea which causes flakiness and extremely disturbed skin barrier like rough sandy surface. please share your story.

Apurva, 

I have posted my results with the dermatologist visit in my blog. I have scheduled a followup visit with Dr. Harper for the end of September. 

On 6/21/2011 at 9:37 PM, eacarrington2 said:

finacea caused my mild case to be quite severe after one weeks use.

why are there no current members nor posts?

bizi

That is the question. Over 1300 members and hardly anyone posts. Maybe if we offered a RRDi tee shirt for each post there would be motivation to post?  You would think that these members would at least post once out of a volunteer spirit? I just got a Rx for the azeliac gel and foam versions and they should arrive next week in the mail. I will be posting my findings using these two on my face and scalp in my rosacea blog. 

Daubee, 

Thanks for starting your own club. So what do you do to treat your rosacea?  You didn't explain in detail what your current regimen is at this post. 

Brady

amzeeq (minocycline) topical foam, 4% is for acne which has been FDA approved and is available and Zilxi 1.5% for rosacea available. 

Apurva, 

I have been having scalp issues toward the back of my neck and sides of the scalp and have used the following treatments: 

Over the counter 
Equate Anti-Dandruff Therapeutic Shampoo (T Gel)
Baby Shampoo
Cotrimazole cream
Nizoral (ketoconazole 1%) shampoo
Braunfels Labs Sulfur Butter Cream 'n Ointment
Zhongzhou Cream
Sesderma Sebovalis Facial Gel (key ingredients 8% lithium gluconate -  0.5% Piroctone olamine - 4.5% glycolic acid - Calendula extract)
Yesto tea tree scalp treatment
Aqua Vive
 

Prescription 
Doxycycline 100 mg twice a day for twenty days 
Fluocinolone Acetonide Topical Oil

So far nothing has resolved the issue. On Wednesday I will be seeing a new dermatologist and hopefully will get her recommendation on this issue. 

Update on this dated January 16, 2021: 
I used Azelaic Acid on this issue which seems to help, then I tried putting a tablespoon of Tea Tree Oil into about six ounces of Baby Shampoo and used this up and sometimes putting full strength Tea Tree Oil on some of the itchy spots on my scalp and this seems to be working better than anything. I will be continuing the tea tree oil with baby shampoo treatment for a while. 

An article published by the Vice Media Group written by Carly Minsky, Scientists Have Shown There's No 'Butterfly Effect' in the Quantum World, in discussing quantum computers had this to say about the butterfly effect: 

"New research in quantum physics from Los Alamos National Laboratory has shown that the so-called butterfly effect can be overcome in the quantum realm in order to “unscramble” lost information by essentially reversing time."

"What this means is that a quantum system can effectively heal and even recover information that was scrambled in the past, without the chaos of the butterfly effect."