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Because of spammers, we still approve each post before it goes live on our website, since guests still have to follow the RRDi rules when posting in the feedback forum of our website. 

To post in the community support of our website (the one you are currently in) you will have to register an account or in any other part of our website, for example, the major forums of rosacea topics, since this is one of the benefits of being a RRDi member (all that is required besides following the rules is to register your email address). 

Would anyone care to post why you don't want to register an account and post your comment on our website?  We get lots of traffic, but hardly any posts from guests or members. We would appreciate your comment. 

As Miracle Max said, it would take a miracle! We can only hope that rosaceans would come together into one group and accomplish this. Donate

Quantification for Demodex Density Counts

What are the numbers revealing? In normal humans demodex density is reported to be "1 or 2 per square centimetre of skin". In rosacea sufferers with demodectic rosacea "the number rises to 10 to 20." [1]

Methods and Tools Used to Quantify 

There are a number of methods or tools used to quantify demodex density counts. We will continue to update this page as we learn more. 

Cellophane Tape Method, Scraping, Plucking Eyelash and Eyebrow Hair

"Methods used to collect Demodex mites from humans include biopsy, the cellophane tape method (placing tape on the face to stick to the mites), scraping areas where mites are likely to reside, and plucking eyelash and eyebrow hairs." [2]

Confocal Laser Scanning Microscope (CLSM)

A paper published by the British Journal of Dermatology reports, "With the help of CLSM it is possible to non-invasively detect, image and quantify Demodex mites in facial skin of patients with rosacea." [3]

The Confocal Laser Scanning Microscope [CLSM] hopefully will be in every dermatologist's office so that we can get some data on how may sufferers have demodectic rosacea. [4]

Another paper discusses the Confocal LS Microscope and stated, "there are limitations to the use of this method to accurately detect absolute numbers of mites in human skin." [5]

According to a Russian study, the CLSM in vivo method is the best method of quantifying demodex density counts which needs to be validated by comparing the other tools used. 

Reflectance confocal microscopy (RCM) 

An article in 2014 says, "Reflectance confocal microscopy is a fast, direct and noninvasive method for Demodex-associated diseases and it is superior to SSSB for Demodex mite detection." [6]

"Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM." [16]

Cellophane Tape Method (CTP, Squeezing Method, Skin Scrapings, and the Standardized Skin Surface Biopsy (SSSB)

"To collect mites for further research, the cellophane tape method (CTP), squeezing method, or skin scrapings can be used. CTP seems to be more effective with a positive rate at 91%, whereas squeezing gives a 34% positive diagnosis. Standardized Skin Surface Biopsy (SSSB) is the most commonly used method for comparing densities of mites between patients with dermatoses and healthy controls." [7]

SNS [superficial needle-scraping] 

Direct Microscopic Examination (DME) & SSSB

Compound Microscope image courtesy of Wikimedia Commons

"Standardized skin surface biopsy (SSSB) and direct microscopic examination (DME) are commonly used to determine Demodex mites density (Dd)." [8]

Another paper in Thailand states that SSSB has been 'considered to be the gold standard technique' but after careful investigation that the Skin Scraping technique is just as valid. [9]

Microscope (simple)

Potassium Hydroxide (KOH)

"Potassium hydroxide (KOH) preparation of skin scrapings is a much simpler procedure that can be used to detect pathogens in the superficial skin...Potassium hydroxide preparation of skin scrapings is an effective, time saving and practical technique to detect Demodex mites with accuracy comparable to the standard biopsy method." [9]

SLI [scattered light intensity]

SSSB with DME Better Than CLSM?
According to one report,  if you use a skin scraping with a light microscope, no, which says, "The severity of the condition does not depend on the quantitative load of the mites in the scrape." However when using a 'Confocal laser scanning in vivo microscopy', yes, which this same report concludes, "Confocal laser scanning in vivo microscopy is an effective diagnostic method to detect Demodex mites that does not require preliminary preparation for analysis and allows detecting Demodex mites at the level of the spiky epidermis layer, which is not accessible for scarification, to identify the species belonging to the size of Demodex mites (from 100 up to 200 μm - Demodex brevis, 200 to 400 μm – Demodex folliculorum)." [10]

SSSB [standardized skin surface biopsy] 

DERMOSCOPY

The advantage of dermoscopy can be shown in a report by Friedman et al which states,"Our case is an example of how dermoscopy could have helped in demodicidosis recognition, since the patient was incorrectly treated with topical steroids possibly with the diagnosis of seborrheic dermatitis. However, when we evaluated the patient, dermoscopy did not reveal what would be expected for seborrheic dermatitis (dotted vessels in a patchy distribution and fine yellowish scales), but revealed, instead, features associated with demodicidosis (“Demodex tails” and “Demodex follicular openings”). [11]

"In 54 patients, the dermoscopy examination yielded a specific picture consisting of Demodex "tails" and Demodex follicular openings. In patients with an inflammatory variant of demodicidosis, reticular horizontal dilated blood vessels were also visualized. Microscopically, skin scrapings demonstrated Demodex in 52 patients. Overall, the dermoscopy findings showed excellent agreement with the microscopy findings (kappa value 0.86, 95% CI 0.72–0.99, P < 0.001)." Dermoscopy of demodicidosis shows the so-called "Demodex tails", which are visualised as creamy/whitish gelatinous threads protruding out of follicular openings (black arrow), and “Demodex follicular openings”, which appear as round and coarse follicular openings containing light brown/greyish plugs surrounded by an erythematous halo (black arrowhead) (f).  See Fig 4, Item f  [12]

A paper by Karabay et al shows photos of using SSSB. [13]

"Besides diagnostic purposes, dermoscopic assessment in erythro-telangiectatic rosacea may also be helpful in monitoring post-treatment changes (with reduction of vascular and non-vascular findings, especially when treated with lasers) and predicting therapeutic response to topical treatments [32]. Indeed, according to a preliminary analysis on 20 patients suffering from erythro-telangiectatic rosacea, the presence of protruding follicular plugs is associated with a better response to an 8-week course of ivermectin 10 mg/g cream compared to metronidazole 1% gel used for the same time span (personal observations). This would be due to the possible active effect of the former therapy on Demodex folliculorum as there is a correlation between protruding follicular plugs on dermoscopy and a higher mite density that may be seen in rosacea (typically less than 5 mites/cm2)." [15]

"Papulopustular rosacea has specific dermoscopic findings. In our opinion, dermoscopy is not the best method for the diagnosis of Demodex mites proliferation in rosacea." [17]

"A thorough knowledge of entodermoscopy will empower dermatologists to promptly, non-invasively, and confidently diagnose and manage cutaneous infections and infestations, both as a lone modality, as well as in facilitating patient approval for an invasive diagnostic test, if required." [18]

"As dermoscopy is a fast, inexpensive, and noninvasive method, it can be used for the diagnosis and monitoring of inflammatory dermatoses (such as rosacea)." [19]

Dermatoscopy

Fluorescence-advanced videodermatoscopy

What is Dermatoscopy?

"Improvements with dermatoscope attachments to mobile devices enable dermatoscopic images to be easily uploaded into patients’ medical records. Dermatoscopes will continue to become smaller. Hopefully, image uploading capabilities will become integrated into these devices. Eventually, dermatoscopes will utilize MBL algorithms to offer diagnostic suggestions." [14]

Do It Yourself (DIY)

Supereyes Macro Lens-Disposable Dermatoscope

Supereyes Smartphone Microscope Camera Adapter

Thumbnail-squeezing method

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End Notes

[1] Demodex Density Count - What are the Numbers?

[2] Plos | One
Ubiquity and Diversity of Human-Associated Demodex Mites
Megan S. Thoemmes , Daniel J. Fergus, Julie Urban, Michelle Trautwein, Robert R. Dunn

[3] Br J Dermatol. 2012 Jun 20. doi: 10.1111/j.1365-2133.2012.11096.x.
 Non-invasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy.
Sattler EC, Maier T, Hoffmann VS, Hegyi J, Ruzicka T, Berking C.

[4] Counting Demodex Mites with a Confocal Laser Microscope
David Pascoe, Rosacea Support Group

[5] Br J Dermatol. 2013 Feb 16. doi: 10.1111/bjd.12280. 
Demodex quantification methods: Limitations of Confocal Laser Scanning Microscopy (CLSM).
Lacey N, Forton FM, Powell FC.

[6] Skin Res Technol. 2014 Feb 13.
Reflectance confocal microscopy vs. standardized skin surface biopsy for measuring the density of Demodex mites.
Turgut Erdemir A, Gurel MS, Koku Aksu AE, Bilgin Karahalli F, Incel P, Kutlu Haytoğlu NS, Falay T.

[7] Iran J Parasitol. 2017 Jan-Mar; 12(1): 12–21. PMCID: PMC5522688
Human Permanent Ectoparasites; Recent Advances on Biology and Clinical Significance of Demodex Mites: Narrative Review Article
Dorota LITWIN,  WenChieh CHEN, Ewa DZIKA, and Joanna KORYCIŃSKA

[8] Ann Dermatol. 2017 Apr; 29(2): 137–142.
Demodex Mite Density Determinations by Standardized Skin Surface Biopsy and Direct Microscopic Examination and Their Relations with Clinical Types and Distribution Patterns
Chul Hyun Yun, Jeong Hwan Yun, Jin Ok Baek, Joo Young Roh, and Jong Rok Lee

[9] Indian J Dermatol Venereol Leprol [View Image]
Skin scrapings versus standardized skin surface biopsy to detect Demodex mites in patients with facial erythema of uncertain cause – a comparative study
Sumanas Bunyaratavej, Chuda Rujitharanawong, Pranee Kasemsarn, Waranya Boonchai, Chanai Muanprasert, Lalita Matthapan, Charussi Leeyaphan

[10] Dermatol Reports. 2019 Jan 23; 11(1): 7675.
Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites
Alexey Kubanov, Yuliya Gallyamova, and Anzhela Kravchenko

[11] Dermatol Pract Concept. 2017 Jan; 7(1): 35–38.
Usefulness of dermoscopy in the diagnosis and monitoring treatment of demodicidosis
Paula Friedman, Emilia Cohen Sabban, and Horacio Cabo

[12] Int J Dermatol. 2010 Sep;49(9):1018-23.
Dermoscopy as a diagnostic tool in demodicidosis.
Segal R, Mimouni D, Feuerman H, Pagovitz O, David M.

[13] An Bras Dermatol. 2020 Mar-Apr; 95(2): 187–193.
Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis
Ezgi Aktaş Karabay and Aslı Aksu Çerman

[14] J Am Acad Dermatol. 2019 Apr; 80(4): 1121–1131.
Emerging imaging technologies in dermatologyPart II: Applications and limitations
Samantha L. Schneider, MD, Indermeet Kohli, PhD, Iltefat H. Hamzavi, MD, M. Laurin Council, MD, Anthony M. Rossi, MD, and David M. Ozog, MD

[15] Dermatol Ther (Heidelb). 2020 Oct 08;:
Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview.
Errichetti E

[16] Br J Dermatol. 2015 Jul;173(1):69-75.  doi: 10.1111/bjd.13783.  Epub 2015 May 29.
Reflectance confocal microscopy for monitoring the density of Demodex mites in patients with rosacea before and after treatment
EC Sattler, VS Hoffmann, T Ruzicka, TV Braunmühl, C Berking 

[17] Dermoscopy of papulopustular rosacea and comparison of dermoscopic features in patients with or without concomitant Demodex folliculorum

[18] Indian Dermatol Online J. 2021 Mar-Apr; 12(2): 220–236.
Entodermoscopy Update: A Contemporary Review on Dermoscopy of Cutaneous Infections and Infestations
Sidharth Sonthalia, Mahima Agrawal, Jushya Bhatia, Md Zeeshan, Solwan Elsamanoudy, Pankaj Tiwary, Yasmeen Jabeen Bhat, Abhijeet Jha, and Manal Bosseila

[19] Indian J Dermatol. 2021 Mar-Apr; 66(2): 165–168.
Dermoscopic Findings of Rosacea and Demodicosis
Yesim Akpinar Kara and Hatice Kaya Özden1

Soolantra prices may vary but a 45 gram tube costs approximately $12.91/gram if you don't have insurance to cover it. Check with your insurance provider for your actual cost. The price below is a screen shot from GoodRx. 

Differential Diagnosis from Rosacea?
An article published in the Chinese Medical Journal states that Sensitive Skin (SS) should be a differential diagnosis from Rosacea, concluding, “The pathogenesis, medication, and prognosis of rosacea and SS are quite different, so it is necessary to find reliable non-invasive method to differentiate between the two conditions.” [1]

However, another paper states the following: 
"Cosmetics were the most frequent source of sensitization, followed by topical medications-notably corticosteroids and antifungal agents." [13]

Are you aware there is such a thin line between sensitive skin and rosacea? 

Skin Condition or Syndrome? 
"A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder." Wikipedia

"Sensitive skin is a skin condition in which skin is prone to itching and irritation experienced as a subjective sensation when using cosmetics and toiletries. When questioned, over 50% of women in the UK and US, and 38% of men, report that they have sensitive skin." [2]

"Using the Delphi method, sensitive skin was defined as 'A syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. These unpleasant sensations cannot be explained by lesions attributable to any skin disease. The skin can appear normal or be accompanied by erythema. Sensitive skin can affect all body locations, especially the face'." [3]. 

Some authorities propose listing SS as a syndrome, stating, "Moreover, the presence of erythema in patients with sensitive skin does not imply that the erythema is due to sensitive skin, as sensitive skin is sometimes associated with skin diseases, particularly atopic dermatitis (AD). AD is not the only dermatosis that can be associated with sensitive skin; in fact, some authors propose to define a subcategory of sensitive skin associated with dermatological diseases (for example: AD, rosacea, psoriasis, seborrhoeic dermatitis, acne, etc.)." [3]

"SS is defined as a syndrome defined by the appearance of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that would not normally cause such sensations..." [4]

"Sensitive skin syndrome (SSS) is a common and challenging condition, yet little is known about its underlying pathophysiology. Patients with SSS often present with subjective complaints of severe facial irritation, burning, and/or stinging after application of cosmetic products. These complaints are out of proportion to the objective clinical findings. Defined as a self-diagnosed condition lacking any specific objective findings, SSS is by definition difficult to quantify and, therefore, the scientific community has yet to identify an acceptable objective screening test...Defined as a self-diagnosed condition, SSS is by definition difficult to quantify. Some of the contradictions between investigators could be explained by flawed methodologies since the scientific community has yet to identify an acceptable objective screening test for sensitive skin...SSS is very common and poses a challenge to physicians and patients alike. We are still far from understanding the underlying mechanisms involved. Therefore, more basic science research is warranted. " [5]

Sensitive Skin vs Rosacea
It is common for rosaceans to complain of sensitive skin and the line between sensitive skin and rosacea is very thin. Do you want the RRDi to sponsor some investigative clinical research into sensitive skin and rosacea? Could 10K members of the RRDi each donate one dollar to sponsor such research?  

"A still unanswered question is whether improper formulations could also prove to be counterproductive in other types of sensitive skin, such as rosacea."

Tests for Sensitive Skin

Lactic acid sting test (LAST) [11]

Treatment

"A bakuchiol nature-based anti-aging moisturizer is well tolerated and effective in individuals with sensitive skin." [6]

Differin Detox + Soothe 2Step Face Mask [10]

Eau Thermale Avene Hypersensitive Skin Regimen Kit for Sensitive and Irritated Skin [7]

Eau Thermale Avene XeraCalm A.D Lipid-Replenishing Cream, Atopic Dermatitis, Eczema-Prone, Fragrance-Free, Pump [7]

Eau Thermale Avène Cicalfate+ Restorative Protective Cream [7]

Eau Thermale Avene Cicalfate Post- Procedure, Soothing Skin Recovery Lotion [7]

Flushing Avoidance Treatments 

REN Clean Skincare - Evercalm Anti-Redness Serum [8]

REN Clean Skincare - Evercalm Gentle Cleansing Milk [8]

REN Clean Skincare Stop Being So Sensitive Evercalm Value 3-Piece Set [8]

PCA SKIN Anti-Redness Serum [9]

PCA SKIN ReBalance Face Cream [9]

Rose Hip Oil 

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End Notes

[1] Chin Med J (Engl). 2020 Aug 5.  doi: 10.1097/CM9.0000000000001001. 
A predictive model for differential diagnosis between rosacea and sensitive skin: a cross-sectional study
Xiao-Yan Wang, Yun-Yi Liu, Yi-Xuan Liu, Wei-Wei Ma, Jia-Wen Zhang, Zi-Jing Liu, Juan Liu, Bing-Rong Zhou, Yang Xu

[2] Sensitive Skin, Wikipedia

Allergic Dermatitis Image Courtesy of Wikimedia Commons

[3] ActaDV
Definition of Sensitive Skin: An Expert Position Paper from the Special Interest Group on Sensitive Skin of the International Forum for the Study of Itch 
Laurent Misery, Sonja Ständer, Jacek C. Szepietowski, Adam Reich, Joanna Wallengren, Andrea W. M. Evers, Kenji Takamori, Emilie Brenaut, Christelle Le Gal-Ianotto, Joachim Fluhr, Enzo Berardesca, Elke Weisshaar

[4] Sensitive Skin and Rosacea

[5] Indian J Dermatol. 2012 Nov-Dec; 57(6): 419–423.doi: 10.4103/0019-5154.103059
The Sensitive Skin Syndrome
Hadar Lev-Tov and Howard I Maibach

[6] J Drugs Dermatol. 2020 Dec 01;19(12):1181-1183
Clinical Evaluation of a Nature-Based Bakuchiol Anti-Aging Moisturizer for Sensitive Skin.
Draelos ZD, Gunt H, Zeichner J, Levy S

[7]

[8]

[9]

[10]

[11] Clin Cosmet Investig Dermatol. 2021; 14: 1215–1225.
Questionnaire and Lactic Acid Sting Test Play Different Role on the Assessment of Sensitive Skin: A Cross-sectional Study
Yao Pan, Xue Ma, Yanqing Song, Jinfeng Zhao, and Shiyu Yan 

[12] Optimizing Emollient Therapy for Skin Barrier Repair in Atopic Dermatiti

[13] "We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications." Contact Allergy in Patients With Rosacea

This is odd to me that a 2020 article is discussing a 'Cross-sectional study of Finnish adults aged 70 to 93 as part of the Norther Finland Cohort 1966 Study.'' Why not examine adults the same age today?

In the spirit of posting 'everything rosacea' the RRDi is announcing this 'natural' treatment which the official website states, "Grahams Natural Rosacea Cream is a natural formula which includes clinically tested ingredients to reduce redness. Designed to reduce inflammation and soothe sensitive skin, our rosacea cream will hydrate and calm the skin." It is made in Australia and here are the ingredients:

Water Purified, Medium-chain Triglycerides, Cetostearyl Alcohol, Simmondsia chinensis (Jojoba) Seed Oil, Coconut Oil, Macrogol Cetostearyl Ether / Polyoxyl 20 Cetostearyl Ether, Tocopherol, Gluconolactone, Niacinamide, Taurine, Phenoxyethanol, Glyceryl Monocaprylate, Ethyl Ascorbic Acid, Retinyl Palmitate, Lactic Acid.

If you have used this treatment please find the green reply button and post your experience. 

"We compiled a comprehensive list of candidate medicinal herbs for skincare by analyzing terms employed in the Donguibogam and identified the characteristics of 52 such herbs using SRKs. Each herb exhibited a different skincare function. Our findings will guide the development of new skincare products via experimental and clinical studies....Further in-depth experimental studies are needed, though our work reduces the time required for future experimentation and product development. Our results enhance the understanding of the previously unknown characteristics of medicinal herbs used for skincare and facilitate the discovering additional novel herbs." [1]

The Dongui Bogam (동의보감) is a Korean book compiled by the royal physician, Heo Jun (1539 – 1615) and was first published in 1613 during the Joseon Dynasty of Korea. The title literally means “a priceless book about medicines of an Eastern Country”. [2]

Wouldn't it be novel of a grassroots rosacea non profit organization to sponsor clinical studies on this? What if 10K members of the RRDi each donated one dollar and sponsored these kind of studies into medicinal herbs for skincare?  Why not donate a dollar now to start the process?

End Notes

[1] Integr Med Res. 2020 Dec; 9(4): 100436.
Identification of candidate medicinal herbs for skincare via data mining of the classic Donguibogam text on Korean medicine
Gayoung Cho, Hyo-Min Park, Won-Mo Jung, Woong-Seok Cha, Donghun Lee, Younbyoung Chae

[2] Dongui Bogam, Wikipedia
image courtesy of Wikimedia Commons

The RRDi is sponsoring free rosacea blogs so you can have your own private or public blog. That way you can direct your friends to your own blog and discuss what you are doing to control your rosacea. These blogs are usually public but you may want your own private blog. 

If you want your own private rosacea blog here are the steps: 

PRIVATE BLOG

The default blog is public so all you do is change it to private and only invite your friends to view your blog. 

(1) To setup your blog you first need to be a member of the RRDi by registering with just your email address. 

(2) Go to Blogs and look for the CREATE A BLOG button:

(3) Look for the ONLY THE MEMBERS I CHOOSE CAN READ THIS BLOG radio button:

Then click continue to setup your blog. If you need assistance, use the Invision Community help center or use the RRDi support center (only available for members of the RRDi). 

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There are a number of co-existing conditions associated with rosacea that are not uncommon. Some are uncommon. Here is the list to consider: 

Acne Vulgaris  

Blepharitis 

Blepharokeratoconjunctivitis (BKC)

Dry Skin (Xeroderma)

Eczema 

Frontal fibrosing alopecia 

Hyperkeratosis 

Lupus

Melasma

Ocular Cicatricial Pemphigoid (OCP)

Periorol Dermatitis

Seborrheic Dermatitis

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"Blepharokeratoconjunctivitis (BKC) is a chronic inflammatory disease of the lid margin with secondary conjunctival and corneal involvement..."

"This is a retrospective review of 14 patients with the history of chronic red eyes with corneal involvement. All patients were diagnosed with ocular demodicosis based on the results of eyelash sampling. All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg)....Rosacea was present in only three patients."

Indian J Ophthalmol. 2020 May; 68(5): 745–749.
Demodex blepharokeratoconjunctivitis affecting young patients: A case series
Nikunj Vinodbhai Patel, Umang Mathur, Arpan Gandhi, and Manisha Singh

image courtesy of PMC

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.  

This a a FAQ. 

This post has been promoted as an article. 

A case of Demodex-induced Lupus miliaris disseminatus faciei was treated with "ornidazole tablets (500 mg twice a day) and recombinant bovine basic fibroblast growth factor gel (0.2 g/cm twice a day) for an 8-week period" and the results showed "the facial erythematous papules were improved, and no new skin lesions were observed. The patient showed no signs of recurrence during the 6-month follow-up."

Medicine (Baltimore). 2020 Jul 02;99(27):e21112
Demodex-induced Lupus miliaris disseminatus faciei: A case report.
Luo Y, Wu LX, Zhang JH, Zhou N, Luan XL

AARS 2018 Form 990 Review

Total Contributions from public support (99.25%) in the amount of $304,583.
Total Expenses were $207,657.
At the end of the 2016 the AARS reports 'net assets or fund balances' totaling $462,175.

The AARS spent most of the expenses on 'conferences, meetings and conventions' in the amount of $148,728 for its prestigious members who are comprised mostly of dermatologists. The next largest expense was on 'management' in the amount of $48,000. The third largest expense was on its website which amounted to $4,473.  In 2018 the AARS didn't spend any of its donations on research grants.

Schedule B, page 2 reveals the top contributors: 

Galderma $50,000
L'oreal $35,000
Cutanea Life Sciences $15,000
Ortho Dermatologics $35,000
Bayer Healthcare $20,000
Allergan USA $35,000

Total $190,000

The six skin care industry corporations above contributed 62% of the total donations. 

You can read the Form 990 yourself: 

2018_AARS Form 990 signed by JHarper 8.6.19.pdf

You can read for yourself the mission of the AARS and what they did in 2018 in the screenshot below of Form 990 Part III: 

image courtesy of Nutrients

A report concluded, "Overall, probiotics and prebiotics are promising in protecting the skin against UVR-induced skin damage."

Nutrients. 2020 Jun; 12(6): 1795.
Published online 2020 Jun 17. doi: 10.3390/nu12061795
PMCID: PMC7353315
PMID: 32560310
Potential of Skin Microbiome, Pro- and/or Pre-Biotics to Affect Local Cutaneous Responses to UV Exposure
VijayKumar Patra,1,2 Irène Gallais Sérézal,3,4 and Peter Wolf2,*

UPDATE

"Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19." 

Annals of Internal Medicine, 16 Jul 2020
Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19
A Randomized Trial
Caleb P. Skipper, MD et al

"Hydroxychloroquine did not lead to faster symptom improvement among patients who had Covid-19 symptoms and were not hospitalized, according to a new study published Thursday in the Annals of Internal Medicine." 
New Covid-19 study, despite flaws, adds to case against hydroxychloroquine
By MATTHEW HERPER, STAT

"Hydroxychloroquine does not appear to keep people from getting the disease after they’ve been exposed to someone who has it. It does not change how many people hospitalized with Covid-19 die of the disease. It does not reduce symptoms for people with milder cases who aren’t in the hospital."
Hydroxychloroquine Still Doesn’t Do Anything, New Data Shows, Wired

"The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized."
Hydroxychloroquine studies show drug is not effective for early treatment of mild covid-19
Laurie McGinley, The Washington Post, MSN 

3D medical animation still of Cytokines that are important in cell signaling. Image courtesy of Wikimedia Commons

While more rosacea research has been focused since 2007 on Cathelicidin, another cytokine is emerging as a possible link to rosacea, interleukin 17A (IL17A), with a report of using a biologic treatment for rosacea, secukinumab. [1] For several years the cytokine, cathlecidin, has been considered linked to rosacea because it is found in high levels with rosacea patients. [2] The following animated video explains how this works in treatment for psoriasis (using secukinumab) which is now being used to treat rosacea: 

Cytokines
"Cytokines are a broad and loose category of small proteins (~5–20 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrine, paracrine and endocrine signaling as immunomodulating agents." [3] 

"Their definite distinction from hormones is still part of ongoing research." [3]

Therefore, cytokines are important in health and in disease prevention and when working properly everything is fine. However, just like the hormone insulin, when in proper amount secreted it works like a charm. If you are too low on insulin or too high things get a bit tricky when it comes to health. The same is true with cytokines. Cytokines in the right amount, everything is hunky dory, but when too many are present it can create quite a storm, or if not enough, things can get worse. The theory is that cytokines need to be investigated more in what role they play in rosacea inflammation. "At the heart of the inflammatory response are the mechanisms that stimulate the production of inflammatory mediators and cytokines." [16]

A Cytokine storm is associated with Covid 19 deaths as well as with the 1918 Spanish Flu epidemic. 

One research paper "provided a comprehensive and objective analysis of the main studies on the influence of cytokines in ocular inflammatory diseases." [22]

Cytokines and the Rosacea Immune System Disorder Theory
Cytokines are related to the theory that rosacea is an immune system disorder. [4] Mast cells have important effects on the pathogenesis of rosacea and produce cytokines.  Both interleukin 17A and cathlecidin are cytokines that are related to inflammation in disease. 

What is interesting is that "Cytokines also play a role in anti-inflammatory pathways and are a possible therapeutic treatment for pathological pain from inflammation or peripheral nerve injury. There are both pro-inflammatory and anti-inflammatory cytokines that regulate this pathway." [3] The first cytokine discovered was Interferon-alpha, an interferon type I, identified in 1957 as a protein that interfered with viral replication. [5]

Could it be possible that the cytokine response in rosacea sufferers is somehow related to virus? [7] For over sixty years the focus has been on bacteria or demodex. Could it be that the investigation should focus more on virus as the culprit why the cytokines are reacting? Virus are so tiny that the bacteria or demodex may carry a pathogen virus that is triggering the cytokine response. Has anyone even looked into this?  Have you seen any paper that has ruled out virus in rosacea?

"Cathelicidin antimicrobial peptides (CAMP) LL-37 and FALL-39 are polypeptides...serve a critical role in mammalian innate immune defense against invasive bacterial infection..." [2] "These peptides are potent, broad spectrum antibiotics which demonstrate potential as novel therapeutic agents.  Antimicrobial peptides have been demonstrated to kill Gram negative and Gram positive bacteria, enveloped viruses, fungi and even transformed or cancerous cells." [10]

Dr. Gallo, et al, has applied for a patent, PREVENTION OF ROSACEA INFLAMMATION, United States Patent Application 20160030386, related to this. [11]

"Toll-like receptor 2 (TLR2) and TLR4 signaling may induce differential secretion of T helper 1 (Th1) and Th2 cytokines, potentially influencing the development of autoimmune or atopic diseases....TLR proteins mediate cellular activation, including the expression of cytokines induced by a variety of bacterial products..." [14]

IL-17
Interleukin 17A is an inflammatory cytokine. "Inflammatory cytokines are predominantly produced by and involved in the upregulation of inflammatory reactions. Excessive chronic production of inflammatory cytokines contribute to inflammatory diseases, that have been linked to different diseases...A balance between proinflammatory and anti-inflammatory cytokines is necessary to maintain health. Aging and exercise also play a role in the amount of inflammation from the release of proinflammatory cytokines." [9]

"Our study showed increased serum IL-17 levels in rosacea patients and a significant correlation between IL-17 concentrations and secondary features of the disease suggesting IL-17 may contribute to pathogenesis of rosacea and may be a new target for rosacea treatment." [19]

Other Cytokines and Rosacea
"Additionally, we identified the upregulation of IL-5 and IL-13 in PPR conditioned culture medium. IL-5 and IL-13 are type 2 cytokines that play important roles in the pathophysiology of allergic diseases. Although the elevation of these cytokines in PPR has not been previously reported, PPR has been associated with airborne allergies (Rainer et al. 2015). A recent publication identified IL4l1 and IL4R as differentially expressed genes in PPR lesional tissue compared to NLS, suggesting the type 2 axis may play a role in PPR pathology (Shih et al. 2019)." [12]

Without a doubt we will be learning more on further research with interleukin 17A (IL17A) and possible other cytokines that are involved in the inflammation of rosacea. 

"...adipokines may contribute to various aspects of the homeostasis of the skin, e.g., melanogenesis, hair growth, or wound healing, just as to the pathogenesis of dermatological diseases such as psoriasis, atopic dermatitis, acne, rosacea, and melanoma." [15] [bold added] Adipokines are cytokines. 

Bradykinin, another cytokine, has long been associated with rosacea. [17]

"Besides, aspirin administration decreased the microvessels density and the VEGF expression in rosacea-like skin. We further demonstrated that aspirin inhibited the activation of NF-κB signaling and the release of its downstream pro-inflammatory cytokines."

Pro-inflammatory cytokine CCL20 "stimulates inflammation by recruiting Th17 T-lymphocytes and dendritic cells and is elevated in papulopustular rosacea." [20]

"Taken together, our findings revealed that mTORC1-mediated angiogenesis responding to LL37 might be essential for the development of rosacea and targeting angiogenesis might be a novel potential therapy." [21]

"In this study, we aimed at examining the serum levels of a series of chemokines (including CCL2, CCL3, CCL20, CXCL1, CXCL8, CXCL9, CXCL10, and CXCL12) implicated in rosacea and their correlation with disease severity." [23] [24]

"In conclusion, our results showed that the destruction of the skin barrier aggravates the inflammation levels and immune infiltration of rosacea partly by activating STAT3-mediated cytokine signal pathways in keratinocytes." [25]

Treatment
Magnesium decreases inflammatory cytokine production by modulation of the immune system. [8]

Secukinumab (Cosentyx) [1]

"Treatment of patients with isotretinoin significantly decreased monocyte TLR-2 expression and subsequent inflammatory cytokine response to P. acnes by one week of therapy. This effect was sustained six months following cessation of therapy, indicating that TLR-2 modulation may be involved in the durable therapeutic response to isotretinoin...Disorders characterized by inflammation such as acne, rosacea, psoriasis, psoriatic arthritis, and Behcet’s disease have been linked to dysregulation of innate immune signaling...Isotretinoin’s mechanism of action in inducing long-term remissions of acne is unknown....The mechanism by which retinoids affect TLR expression is unknown." [bold added] [13]

Topical ivermectin has been found effective in the treatment of T‐cell‐mediated skin inflammatory diseases. [6]

Independent Rosacea Research
Could a group of rosacea sufferers in a non profit organization like the RRDi collectively get together and sponsor their own research on rosacea? For example, if 10K members each donated a dollar, could it be possible that this money could be used to sponsor their own independent rosacea research on cytokines?  What do you think? If you want to do something about this read this post. 

Reply to this Topic
There is a reply to this topic button somewhere on the device you are reading this post. 

End Notes

[1] Secukinumab (Cosentyx)

[2] Cathelicidin

[3] Cytokine, Wikipedia

[4] Innate Immune Response Disorder

[5] Proc R Soc Lond B Biol Sci. 1957 Sep 12;147(927):258-67.  doi: 10.1098/rspb.1957.0048.
Virus interference. I. The interferon
A ISAACS, J LINDENMANN

[6] Ivermectin Anti-Inflammatory Properties

[7] Virus and Rosacea

[8] J Immunol. 2012 Jun 15;188(12):6338-46.  doi: 10.4049/jimmunol.1101765.  Epub 2012 May 18.
Magnesium decreases inflammatory cytokine production: a novel innate immunomodulatory mechanism
Jun Sugimoto, Andrea M Romani, Alice M Valentin-Torres, Angel A Luciano, Christina M Ramirez Kitchen, Nicholas Funderburg, Sam Mesiano, Helene B Bernstein

J Inflamm Res. 2018 Jan 18;11:25-34.  doi: 10.2147/JIR.S136742.  eCollection 2018.
Magnesium deficiency and increased inflammation: current perspectives
Forrest H Nielsen 

[9] Inflammatory cytokine, Wikipedia

[10] Antimicrobial peptides (AMPs), Wikipedia

[11] Gallo Patent for the 'Prevention of Rosacea Inflammation'

[12] J Invest Dermatol. 2020 Sep 14;:
Paired Transcriptomic and Proteomic Analysis Implicates IL-1β in the Pathogenesis of Papulopustular Rosacea Explants.
Harden JL, Shih YH, Xu J, Li R, Rajendran D, Hofland H, Chang ALS

[13] J Invest Dermatol. 2012 Sep; 132(9): 2198–2205.
Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients
Melanie C. Dispenza, Ellen B. Wolpert, Kathryn L. Gilliland, Pingqi Dai, Zhaoyuan Cong, Amanda M. Nelson, Diane M. Thiboutot

[14] J Interferon Cytokine Res. Author manuscript; available in PMC 2007 Nov 2.
TLR2 and TLR4 Stimulation Differentially Induce Cytokine Secretion in Human Neonatal, Adult, and Murine Mononuclear Cells
BIANCA SCHAUB, ABDELOUAHAB BELLOU, FIONA K. GIBBONS, GERMAN VELASCO, MONICA CAMPO, HONGZHEN HE, YURONG LIANG, MATTHEW W. GILLMAN, DIANE GOLD, SCOTT T. WEISS, DAVID L. PERKINS, and PATRICIA W. FINN1

[15] Int J Mol Sci. 2020 Nov 28;21(23):
Adipokines in the Skin and in Dermatological Diseases.
Kovács D, Fazekas F, Oláh A, Törőcsik D

[16] Int J Mol Sci. 2021 Jan; 22(2): 721.
The Role of Endogenous Antimicrobial Peptides in Modulating Innate Immunity of the Ocular Surface in Dry Eye Diseases
Youssof Eshac, Rachel L. Redfern, and Vinay Kumar Aakalu

[17] Bradykinin Rosacea Theory

[18] Aspirin alleviates skin inflammation and angiogenesis in rosacea

[19] Serum IL-17 levels in Patients with Rosacea

[20] Glucocorticoids Promote CCL20 Expression in Keratinocytes

[21] PubMed RSS Feed - -mTORC1-Mediated Angiogenesis is Required for the Development of Rosacea

[22] J Clin Med. 2022 Feb; 11(3): 661.
Influence of Cytokines on Inflammatory Eye Diseases: A Citation Network Study
Beatriz G. Gálvez, Clara Martinez-Perez, Cesar Villa-Collar, Cristina Alvarez-Peregrina, Miguel Ángel Sánchez-Tena

[23] "Chemokines (from Ancient Greek χῠμείᾱ (khumeíā) 'alchemy', and κῑ́νησῐς (kī́nēsis) 'movement'), or chemotactic cytokines, are a family of small cytokines or signaling proteins secreted by cells that induce directional movement of leukocytes, as well as other cell types, including endothelial and epithelial cells." Wikipedia

[24] Increased serum levels of CCL3, CXCL8, CXCL9, and CXCL10 in rosacea patients and their correlation with disease severity

[25] PubMed RSS Feed - -Multi-Transcriptomic Analysis and Experimental Validation Implicate a Central Role of STAT3 in Skin Barrier Dysfunction Induced Aggravation of Rosacea

A rare condition involving SD is eyebrow hairloss. Sickening started an interesting thread on this subject if you are suffering from this disorder. A similar thread was started by angelstar. Sometimes it can be confused with Frontal Fibrosis Alopecia.

The RRDi has been around for quite a while and we publish on our website for free what rosacea sufferers all over the world have said works to control their rosacea. A significant number of rosaceans say this simple method to control rosacea using this two step regimen does indeed work which is non prescription. We have added a third step for those of you considering using prescription treatment from a dermatologist. 

Will it work for you?  The only way to know is to try it. There is no rosacea treatment regimen that works for every rosacea sufferer, not one. We have dubbed this the Rosacea X-Factor. However, this is what we recommend you try and we hope you will reply in this thread your results. 

(1) Diet
First, keep in mind this recommendation is only for thirty days. After the thirty days, go back to eating whatever you want. What you are probably eating is mostly carbohydrate since the typical American diet is high carbohydrate. Carbohydrate is simply different forms of sugar. There are absolutely no nutrients in carbohydrate, none. Carbohydrate is simply carbon, hydrogen and oxygen (absolutely no vitamins, minerals, or any nutrients). Sugar is the fire that inflames rosacea. 

For example, oats, brown rice, fruit, sweet potato have significant carbohydrate. It is extremely difficult to cut out all carbohydrate. But if you can reduce your carbohydrate to no more than 30 grams a day for 30 days to see if this improves your rosacea, then you will know. What will you learn?

Sugar/carbohydrate is a rosacea trigger. 

If you do see improvement within the thirty days, at the end of the thirty days go back to your oats, brown rice, fruit, sweet potato or whatever you are eating and see what happens. This simple diet just for thirty days will either work or it won't in improving your rosacea. Please read a list of anecdotal reports that this actually works.  

To help you understand how to figure out how many grams of carbohydrate you may be eating, just take a bowl of oats which contains 27 grams of carbohydrate in a half a cup. So if you decide to eat that half a cup of oats, you now only have 3 grams of carbohydrate to your 30 gram limit for the day. The only way you can do this is stick to broccoli since one cup (91 grams) of raw broccoli contains 6 grams of carbs. Kale is ok too, since one cup (67 grams) of raw kale contains 7 grams of carbs. You can have a lot of broccoli and kale in your day and still keep within the 30 gram limit. So anything that goes into your mouth that you digest, simply watch how many grams of carbohydrate and limit it to 30 grams a day. And watch how many carbohydrate is in anything you drink! Liquid or any food, 30 gram carbohydrate limit. Only for 30 days. 30 grams/30 days. Dr. Atkin's Carb Counter book helps you understand how to count carbs. 

So what do you eat? Protein and Fat, as much as you want, no limit. And remember, when someone or some authority says eating high protein/fat is bad, the reply is, 'this is just for thirty days.' Thirty days on a high protein/diet is not bad. No one can cite any clinical paper that eating high protein/fat for just thirty days is any health risk. Remember, just thirty days. No risk. And if you like meat, fish, and chicken it will be easier. If you are a vegan, it will be more difficult to find the protein/fat to eat but it can be done. The Rosacea Diet has a vegan 30 day diet. 

Remember, this is only for thirty days. At the end of the thirty days you can then eat whatever you want (sugar and carbohydrate), as much as you want and see what happens. Does your rosacea return when you eat high sugar/carbohydate? If so, you have learned something. Then you decide what to do about this. Not everyone chooses this course since it is so difficult. Why? Because sugar is addictive. Your choice. You obviously can keep eating whatever you want. This is just a recommendation, just like the following topical. 

(2) Topical
As for a topical, recommend the ZZ cream. Before you use, be sure to apply a dab of the ZZ cream on your inner wrist and see if your skin turns red? If so, you are allergic to the ZZ cream. Remember that if you use the ZZ cream it gets worse before it gets better.  It takes at least a month to see any improvement with the ZZ cream and three to four months for clearance. 'Getting worse before it gets better' is a common occurrence in medicine, not just in using the ZZ cream. 

(3) Rx Treatments

Gold Prescription Standard Treatment for Rosacea

More Information on Rx Treatments

Conclusion
These two simple treatments may work to control your rosacea if you reduce your sugar/carbohydrate to 30 grams a day for 30 days and use the ZZ cream as a topical. Third, if you opt for Rx treatments, watch the above video so you will have some questions for your dermtologist when you visit. 

It will take at least 30 days to see improvement with step one, and 90 to 120 days for clearance in step two. If you opt for step three is usually takes two to three MONTHS for clearance. 

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.  

Hi Kara, 

Welcome to the RRDi. It would be good to know if your partner did get a diagnosis of rosacea (or what exactly) and what particular antibiotic and how much, whether low dose or high dose, I.e., how many milligrams per day? Is your partner applying any topical(s)? 

The laser mentioned in the article in this thread, pulsed dye, has been around for years.

By the way, the article is an abstract made available through an RSS feed from PubMed published in Dermatologic Therapy. So this pulsed dye laser is usually in either a dermatology or cosmetic surgeon clinic and as you can imagine expensive. One treatment with an experienced practitioner as you can imagine is expensive, between $350 to $600 US Dollars and usually three or more treatments are required. Most insurance companies in the USA will cover such treatment if they are designated a medical diagnosis but usually such treatments are considered cosmetic and are not covered. I imagine the same conditions exist in the UK regarding whether insurance covers such laser treatments or not. You would have to ask. Most Rosaceans who rave about Laser treatment have to spend the money out of pocket. There are others who have negative experience with laser. By the way, some Rosaceans have now purchased their own light device, sometimes laser, others purchase LED or IPL devices since they are now available to the pubic. There is a learning curve using these devices and you can easily damage your skin so if you decide to go that route take care. Our store has some listed in broad band light. Using laser is just one of the many light devices under the treatment called photo dynamic therapy. 

The article in this thread used the pulsed dye laser along with intradermal botulinum toxin type-A, a particular botulinum used in cosmetics. This treatment is also expensive and the practitioner should have experience using it since you can imagine if you were his first patient you might feel uneasy.  The article concludes this combination of treatment “demonstrated high efficacy and satisfaction rate with this combined approach and a low side-effect profile.”  If it cost several thousand dollars, you would expect such results. Just remember that you sign off on a lot of waivers and notices that you are warned of the risks and side effects of laser and botulinum treatment. 

There are clinical papers showing improvement in rosacea using Botox, I.e., Botox for Rosacea.

Depending on what your partner is suffering with, recommend your partner read our welcome page or our newbies page. Some have found that simply reducing sugar/carbohydrate in the diet improves rosacea or whatever skin issue along with the topical ZZ cream.

To give you an idea of the prescription rosacea market you can view the number of prescriptions for the four leading rosacea prescription treatments shown below in two graphs the first one in surrogates, and the second one in market size as revealed in a Menlo Therapeutics investor presentation dated March 2020.

Before/after photos released by an investor presentation dated March 2020

. 

"Dry Eye Disease (DED) is a common ocular condition that needs prompt diagnosis and careful treatment interventions....In this review, we demonstrated the mechanism of action of IPL, including its benefits on DED. The emerging evidence shows that the role of IPL in DED is novel and therapeutic. These results direct us to conclude that IPL is a potentially beneficial tool and essential future therapy for dry eye disease."

Int J Med Sci. 2020; 17(10): 1385–1392.Published online 2020 Jun 1. doi: 10.7150/ijms.44288
Use of Intense Pulsed Light to Mitigate Meibomian Gland Dysfunction for Dry Eye Disease
Abhishek Suwal, Ji-long Hao, Dan-dan Zhou, Xiu-fen Liu, Raja Suwal, and Cheng-wei Lu

Image [Diffuse lissamine green staining in a person with severe keratoconjunctivitis sicca.] Courtesy of Wikimedia Commons

Just received the TEA Form 990 for 2019, which this non profit is not required to file Form 990 EZ for 2019 since donations were less than $50K (only received $21,578.00 in donations in 2019) and could have filed Form 990 N. 

TEA spent $18K on 'printing, publications, postage, shipping and other expenses.' So no research grants were sponsored in 2019. No money spent on staff or 'conventions' for members. 

Considering TEA has over 2000 members who donated $21K, this non profit gets high marks for what is being accomplished according to the mission statement and still has over $125K in the bank in net assets. 

Read the Form 990 yourself. We could only wish that RRDi members would donate half as much as TEA members do.  

TEA 990 . 2019.pdf