Guide

April 29, 2020

"In addition, excessive cleansing can lead to disruption of the epidermal barrier, increased transepidermal water loss (TEWL), roughened and irritated skin, increased bacterial colonization, increased comedonal formation, secondary irritant contact dermatitis, and burning and stinging. These negative effects caused by harsh soaps and aggressive cleansing make many prescription topical AV medications less tolerable."

Maedica (Buchar). 2018 Jun; 13(2): 89–94.
Butterfly Effect – the Concept and the Implications in Dermatology, Acne, and Rosacea
Victor Gabriel

April 29, 2020

Another anecdotal report:

"After only 5 days of using it it sent my skin crazy. I stopped using it and the symptoms persisted for about another 5 days, then returned back to how it was previously thankfully (still terrible though)."

Lac_77 Rosacea Forum

April 27, 2020

"Healing my gut has been a long journey and is still not completely healed. Both of my naturopath doctors are convinced that my overuse of antibiotic (in particular two years of Oracea) cause me serious gut issues. I understand this will be controversial here, but I would strongly advise against anyone considering Oracea or any antibiotic long-term. Even this low dose can cause serious imbalance in your gut that can surface years later and the results are not fun." Matt [MP1985 4th June 2019 02:59 AM Post no 19] Rosacea Forum

April 27, 2020

Oxygen, ROS and Pathogens

“A paradox in metabolism is that, while the vast majority of complex life on Earth requires oxygen for its existence, oxygen is a highly reactive molecule that damages living organisms by producing reactive oxygen species." [1]

"However, reactive oxygen species can be beneficial, as they are used by the immune system as a way to attack and kill pathogens." [2]

The human body composition can be "analyzed in various ways," either by chemical elements present, or by molecular type. "Almost 99% of the mass of the human body is made up of six elements: oxygen (65%), carbon (18.5%), hydrogen (9.5%), nitrogen (3.2%), calcium (1.5%), and phosphorus (1%)." [3] Oxygen makes up 65% of the chemical element in the human body, while water makes up 65% of the molecular mass. Another method to analyze the human body is by cell type. "Traditionally, non human microorganisms in the human body have been estimated to be way more than human organisims, depending on what you designate is actually 'human', but more recent estimates put this number at a 50/50 ratio, so, this subject is debated among biologists" [4]

So oxygen is important in human metabolism and comprises the majority of the composition of the body. However, sometimes oxygen can cause negative reaction in disease as this thread is pointing out with ROS and its connection to rosacea. If you have a pathogen issue causing rosacea, I.e., demodex, virus, or bacteria, ROS activates the immune system response, which may cascade an inflammatory reaction.

End Notes

[1] Antioxidant, Wikipedia

[2] Oxidative stress, Wikipedia

[3] Composition of the Human Body, Wikipedia

[4] Human Microbiome, Brady Barrows

April 22, 2020

Azithromycin, a treatment for rosacea, is being investigated as a treatment for COVID-19. One study states, "Studies suggest beneficial effects of azithromycin in reducing viral load of hospitalized patients, possibly interfering with ligand/CD147 receptor interactions; however, its possible effects on SARS-CoV-2 invasion has not yet been evaluated. In addition to the possible effect in invasion, azithromycin decreases the expression of some metalloproteinases (downstream to CD147), induces anti-viral responses in primary human bronchial epithelial infected with rhinovirus, decreasing viral replication and release." [1]

MedScape reports, "This small open-label study of hydroxychloroquine in France included azithromycin in 6 patients for potential bacterial superinfection (500 mg once, then 250 mg PO daily for 4 days). These patients were reported to have 100% clearance of SARS-CoV-2. While intriguing, these results warrant further analysis. The patients receiving combination therapy had initially lower viral loads, and, when compared with patients receiving hydroxychloroquine alone with similar viral burden, the results are fairly similar (6/6 vs 7/9)." [2]

"Though azithromycin is an antibiotic and thus ineffective alone against viruses, some clinicians have seen limited success in COVID-19 coronavirus disease patients when adding it to chloroquine (Aralen) and/or hydroxycholoroquine (Plaquenil) in the sickest patients." [3]

Coronavirus and Rosacea

Azithromycin for Rosacea

End Notes

[1] Stem Cell Rev Rep. 2020 Apr 20 : 1–7.
CD147 as a Target for COVID-19 Treatment: Suggested Effects of Azithromycin and Stem Cell Engagement
Henning Ulrich and Micheli M. Pillat

[2] What is the role of hydroxychloroquine plus azithromycin in the treatment of coronavirus disease 2019 (COVID-19)?, David J Cennimo, MD, Scott J Bergman, Keith M Olsen, MedScape

[3] azithromycin (Zithromax): Potential COVID-19 Combo Drug, Omudhome Ogbru, Jay W. Marks, MD, MedicineNet

April 21, 2020

Chloroquine, a treatment for rosacea, is now being investigated as a treatment for the coronavirus. One report states, "Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome." [1]

Another report states, "Chloroquine is effective in preventing the spread of SARS CoV in cell culture. [2]

"But it is not yet clear how well hydroxychloroquine and chloroquine work in patients with COVID-19." [3]

"Chloroquine seems to block the coronavirus in lab studies. There's some anecdotal evidence from doctors saying it has appeared to help," says James Gallagher, BBC health correspondent. [4]

"A research trial of coronavirus patients in Brazil ended after patients taking a higher dose of chloroquine, one of the drugs President Trump has promoted, developed irregular heart rates." [5]

"So until these or any drugs have been shown to be effective against SARS-CoV-2 in clinical trials and have been approved by the FDA, no one should be self-medicating." [6]

More on Coronavirus and Rosacea

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End Notes

[1] Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-188. doi: 10.3760/cma.j.issn.1001-0939.2020.03.009.
[Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia].

[2]Virol J. 2005; 2: 69.
Chloroquine is a potent inhibitor of SARS coronavirus infection and spread
Martin J Vincent,1 Eric Bergeron, Suzanne Benjannet, Bobbie R Erickson, Pierre E Rollin, Thomas G Ksiazek, Nabil G Seidah, and Stuart T

[3] Treating Coronavirus With Plaquenil and Aralen, Reena Mukamal, American Academy of Ophthalmology

[4] Coronavirus and chloroquine: Is there evidence it works?
By Jack Goodman and Christopher Giles, BBC Reality Check, BBC News

[5] Small Chloroquine Study Halted Over Risk of Fatal Heart Complications, By Katie Thomas and Knvul Sheikh, The New York Times

[6] Could Chloroquine Treat Coronavirus?, By Katherine Seley-Radtke, The Conversation US on March 27, 2020, Scientific American

April 20, 2020

There is at least one paper that includes Chloroquine (Aralen, Chloroquine FNA, Resochin, Dawaquin, and Lariago) along with Mepacrine in the treatment of rosacea. [1]

Chloroquine is listed with the other Anti-parasitic Prescription Agents For Rosacea.

"Chloroquine is an aminoquinolone derivative first developed in the 1940s for the treatment of malaria. It was the drug of choice to treat malaria until the development of newer antimalarials such as pyrimethamine, artemisinin, and mefloquine. Chloroquine and its derivative hydroxychloroquine have since been repurposed for the treatment of a number of other conditions including HIV, systemic lupus erythematosus, and rheumatoid arthritis." [2]

Chloroquine is also a treatment for rosacea that is being considered to treat coronavirus along with others which we are posting here. [3]

A search for anecdotal reports of using chloroquine for rosacea found none. If you find any, please post in this thread.

End Notes

[1] Br J Dermatol. 1955 Dec;67(12):421-5.
Mepacrine and chloroquine in the treatment of rosacea.
BRODTHAGEN H.

[2] DrugBank

[3] Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-188. doi: 10.3760/cma.j.issn.1001-0939.2020.03.009.
[Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia].

April 20, 2020

Artesunate is another anti-parasitic agent used to treat rosacea. A paper published June 2018 in Molecular Medicine Reports concluded, "In conclusion, the therapeutic and antimicrobial effect of artesunate on rosacea caused by D. folliculorum infection was demonstrated. The present study provided reliable data for future animal experimentation and clinical research. Artesunate may be a promising novel therapeutic method for the treatment of rosacea."

Mol Med Rep. 2018 Jun;17(6):8385-8390. doi: 10.3892/mmr.2018.8887. Epub 2018 Apr 16.
The therapeutic effect of artesunate on rosacea through the inhibition of the JAK/STAT signaling pathway.
Li T, Zeng Q, Chen X, Wang G, Zhang H, Yu A, Wang H, Hu Y.
Full text

"Artesunate is part of the artemisinin group of drugs that treat malaria. It is a semi-synthetic derivative of artemisinin that is water-soluble and may therefore be given by injection." DrugBank

April 20, 2020

Johns Hopkins University is sponsoring a clinical trial of using Timolol for the Treatment of Acne and Rosacea which started in March 2016, with an Estimated Primary Completion Date of March 2019 and an Estimated Study Completion Date of March 2021. [1]

Timolol (brand names Betimol, Istalol) is "a nonselective beta-adrenergic antagonist given in an eye drop solution to reduce intraocular pressure, or pressure in the eyes. It is also used in tablet form as a drug to treat hypertension." DrugBank

A study concluded that topical timolol maleate 0.5% is 'expected to be beneficial' in improving 'both acne and rosacea':

"In our study, topical timolol maleate 0.5% demonstrated effectiveness in the treatment of acne, especially in noninflammatory lesions, but seems to be more effective in erythematotelangiectatic rosacea than papulopustular rosacea lesions, with insignificant side effects. The addition of topical timolol to the standard treatment protocol for acne and rosacea is expected to be beneficial, especially by way of improving comedones of acne and resistant inflammatory erythema of both acne and rosacea."

J Clin Aesthet Dermatol. 2020 Mar; 13(3): 22–27.
Efficacy of Topical Timolol 0.5% in the Treatment of Acne and Rosacea: A Multicentric Study
Sahar M. Al Mokadem, MD, Al-Shimaa M. Ibrahim, MD, and Abeer M. El Sayed, MBChB

--------------------------------------------------------------------------------------------------

J Am Acad Dermatol. 2021 Feb 03;:
Topical Timolol 0.5% Gel-Forming Solution for Erythema in Rosacea: A Quantitative, Split-Face, Randomized, and Rater-Masked Pilot Clinical Trial.
Tsai J, Chien AL, Kim N, Rachidi S, Connolly BM, Lim H, Alessi César SS, Kang S, Garza LA

End Notes

[1] Timolol for the Treatment of Rosacea

April 18, 2020

*

Sulphur or Sulfur* has been used to treat rosacea for over a hundred years. One patient with 'rosy drops' "was ordered Aug. 6, 1878, a mixture containing sulphate of iron and sulphate of magnesia, and for local application an ointment of sulphur, four parts, cosmoline, ninety-two parts. This was followed by rapid improvement, and when seen again on Sept. 17, all trace of the eruption had disappeared, and she felt much stronger and better." [1]

"Sulfur acts as a keratolytic agent and also it has antibacterial activity. It also kills fungi, scabies mites, and other parasites. Precipitated sulfur and colloidal sulfur are used, in form of lotions, creams, powders, soaps, and bath additives, for the treatment of acne vulgaris, acne rosacea, and seborrhoeic dermatitis." [2]

"Sulfur is a chemical element that is present in all living tissues. The most commonly used form of pharmaceutical sulfur is Octasulfur. After calcium and phosphorus, it is the third most abundant mineral in the human body. Sulfur is also found in garlic, onions and broccoli." [2] [also see end note 4 about sulphur's percentage in the human body]

"Sulfur is converted to hydrogen sulfide (H2S) through reduction, partly by bacteria. H2S has a lethal action on bacteria (possibly including Propionibacterium acnes) which plays a role in acne, fungi, and parasites such as scabies mites. Sulfur acts as a keratolytic agent and also it has antibacterial activity. It also kills fungi, scabies mites and other parasites. Precipitated sulfur and colloidal sulfur are used, in form of lotions, creams, powders, soaps, and bath additives, for the treatment of acne vulgaris, acne rosacea, and seborrhoeic dermatitis." [2]

"Sulfur is the tenth most common element by mass in the universe, and the fifth most common on Earth." [3]

"Sulfur is the third most abundant chemical in the human body. The element is also found in a number of foods such as garlic, onions, eggs, and protein-rich foods. Sulfur is necessary for the synthesis of the essential amino acids cysteine and methionine." [4] [also see end note 4 about sulphur's percentage in the human body]

Sulfur is available in non prescription and prescription [5] treatments.

"Sulfur helps dry out the surface of your skin to help absorb excess oil (sebum) that may contribute to acne breakouts. It also dries out dead skin cells to help unclog your pores." [6] If you suffer from Dry Skin (Xeroderma) using sulfur exacerbates this issue.

Sublimed sulfur is sulfur that has been purified through sublimation and is contained in the ZZ cream.

Prescription
Some of the prescription sulfur treatments are:

Avar-e Green,
Avar-e Emollient Creams for Moisturizing,
Avar, Plexion, Plexion SCT, Plexion TS, Rosanil, Rosac, Rosula, Rosula NS

Non Prescription
The RRDi affiliate store has numerous sulfur treatments below:

One of the RRDi's sponsors, Demodex Solutions, offers a treatment with sublimed sulfur, the ZZ cream.

3 PACK- 10%Sulfur & Ointment + (2) 10% Sulfur Soap,
Amazing Formulas OptiMSM,
Ancient Minerals Magnesium Gel Ultra with OptiMSM,
Ancient Minerals Magnesium Oil Ultra with OptiMSM,
Clearogen Acne Lotion -Sulfur,
De La Cruz 10% SULPHUR OINTMENT,
Gold Standard Organic Sulfur Crystals,
Sulfur Butter, Dr. Berry's Multi-Purpose Mite Cream,
Dr. Berry's Multi-Purpose Sulfur Creme,
Dr. Berry's Starter Sulfur Pack, Zudiafu Soap,
Mite-B-Gone 10% Sulfur Cream,
Mitesil MultipurposeSulfur Cream, Ovante Scabiesun,
Mite S Pack - Sulphur Wash, Cream, Ointments & Essential Oils Kit,
PC NetwoRx Pure OptiMSM,
Rugby Zinc Oxide Ointment,
San Marcus 10% Sulfur & Ointment + (2) 10% Sulfur Soap (3 PACK),
Scabisil Topical 10% Sulfur & Ointment,
Sodium Bituminosulfonate
Sulphur Soap (4 bars) by Braunfels Labs,
Sunfood MSM Aloe Gel, 15% OptiMSM,
Sunfood MSM Lotion/Cream with 12% OptiMSM,
Yiganerjing Sulfur Soap,
Zudaifu Soap,
Zudaifu Sulphur Soap 3 Pack,
Zudaifu Soap 6 Pack,

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.

Footnotes

*Sulfur sample image courtesy of Wikimedia Commons

"Sulphur is an alternative spelling of the same word used in British English....In American English, sulfur has become standard." Sulfur or Sulphur: What’s the Difference?, Writing Explained

"Brimstone, an archaic term synonymous with sulfur, evokes the acrid odor of sulphur dioxide given off by lightning strikes." Wikipedia

Smoke rising from a volcano, which the phrase "fire and brimstone" is intended to evoke. Image courtesy of Wikimedia Commons

End Notes

[1] Gastrointestinal Rosacea [GR], aka, Gut Rosacea

[2] Sulfur, DrugBank

[3] Sulfur, Wikipedia

[4] The Health Benefits of Sulfur, Cathy Wong, VeryWellHealth, states in her article that sulfur is "the third most abundant chemical in the human body", however, Wikipedia lists sulfur way down on its list of the Composition of the human body, showing that sulfur only comprises 0.3% of body mass.

image courtesy of Wikimedia Commons

[5] Cutis. 2004 Jan;73(1 Suppl):29-33.
Evaluating the role of topical therapies in the management of rosacea: focus on combination sodium sulfacetamide and sulfur formulations.
Del Rosso JQ

[6] Can You Use Sulfur for Acne Spots and Scars?, Healthline

April 17, 2020

1 hour ago, Ralar said:

gosh, I have all three of these issues - only starting to make all the connections (new to this site) I have had (very minor) rosacea since my 20's but gradually becoming worse - i think, scrolling the internet, i still probably have a mild case but i find it so sore when it flares up and worried about how quickly it seems to be getting worse now im nearly 40.. I have been struggling with my scalp which im pretty sure is seborrheic dermatitis (also v.sore when it flares up) and have been getting really sore itchy eyes, mildly bloodshot and now blepharitis!

I do believe (in my case) there is a link between all of this and my gut - currently working with a naturopathic practitoner as i'm determined not to take meds - I feel like a lot of my issues are to do with heavy doses of antibiotics earlier in life, poor diet and extreme stress..

Thank you - I wish you luck on your journey with this & hope you find results soon.

Rylar, keep us posted on your progress. Might want to read this post on GUT Rosacea. One treatment that may help which is natural and inexpensive is ElaineA's borax bath. Probiotics are another subject to consider.

April 17, 2020

Azathioprine image courtesy of Wikimedia Commons

A study has determined that if you are undergoing any immunosuppressive treatments, i.e., Tacrolimus, pimecrolimus, cyclosporine, systemic steroid, chemotherapy, systemic glucocorticoids, cyclosporine, methotrexate, or azathioprine treatments, or have an immunocompromised condition, i.e. HIV, chronic renal failure, acquired immunodeficiency syndrome, that this "might increase the number of mites and demodicidosis should be kept in mind in patients on immunosuppressive treatment."

In those in the tested group treated with immunosuppressive therapy "there was a statistically significant difference in Demodex density in patients treated with immunosuppressive therapy in the first and third months when compared with the control group (p < 0.05)."

"The results of our study suggest that there is an association between immunosuppressive treatment and the number of Demodex mites."

Medicina (Kaunas). 2020 Mar; 56(3): 107.
Pre-Treatment and Post-Treatment Demodex Densities in Patients under Immunosuppressive Treatments
Hacer Keles, Esra Pancar Yuksel, Fatma Aydin, and Nilgun Senturk

"Non-deliberate immunosuppression can occur in, for example, ataxia–telangiectasia, complement deficiencies, many types of cancer, and certain chronic infections such as human immunodeficiency virus (HIV). The unwanted effect in non-deliberate immunosuppression is immunodeficiency that results in increased susceptibility to pathogens such as bacteria, and viruses." Wikipedia

April 14, 2020

When rosaceans use drugs, whether prescription or non prescription, drug interactions are a concern when you take more than one drug to treat your rosacea. Whether the drug is oral, topical, tincture, toner, injection, or in whatever other form there can be drug interactions with other drugs, food or drink or some other unknown factor. First, let's be sure we agree on what a drug is so we are all on the same page and what a drug interaction is as well.

Drug
"A drug is any substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via inhalation, injection, smoking, ingestion, absorption via a patch on the skin, or dissolution under the tongue." [1].

Drug Interaction
So when taking a drug according to the definition above a drug interaction is defined as, "A drug interaction is a change in the action or side effects of a drug caused by concomitant administration with a food, beverage, supplement, or another drug." [2]

Treating Rosacea with Drugs
So the ideal setting is using one drug treatment for rosacea, i.e., topical metronidazole, the only drug interactions are with food, drink, and any other environmental factors to consider when using this treatment if you are not taking any other drugs at the same time. If, for example, you are taking aspirin or ibuprofen, what are the drug interactions to consider when applying the topical metronidazole? Also, what are the food and drink interactions to consider when taking topical metronidazole including any vitamins and supplements (considered food) you may be taking at the same time? For example, did you know that grapefruit juice can act as an enzyme inhibitor? St John's wort can act as an enzyme inductor. Garlic increases antiplatelet activity. Therefore, food or drink can interact with a drug. However, if you are only using one drug to treat your rosacea you don't have to consider whether another drug is interacting with the topical metronidazole which is an ideal situation. If you are taking other drugs at the same time no matter what the reason you are taking the drug, these other drugs or food can interact with the topical metronidazole. [3]

When you take more than one drug treatment for rosacea at the same time, the drug interactions to consider are multiplied, and this increases when you add a third rosacea treatment and the complexity of the considerations of drug interactions increases with additional rosacea treatments. To sort out what is causing a particular drug interaction can be complex and difficult to resolve as you can imagine, when you should rule out all these different factors to consider.

Synergism and Antagonism Factors
Synergism in medicine is the creation of a whole that is greater than the simple sum of its parts, i.e., the combined effect of taking two barbiturates is greater than taking each one at a time (combining the drugs leads to a larger effect than expected). The gold standard treatment for rosacea is a typical example of using synergism to treat rosacea. Another example is topical metronidazole and oral doxycycline together has a synergistic effect in treating rosacea. This is due to the synergistic effect of the two drugs interacting with each other. Sometimes synergism works out to the patient's benefit, but in some cases synergism can be negative which is what is termed Antagonism, "when synergy occurs at a cellular receptor level this is termed agonism, and the substances involved are termed agonists. On the other hand, in the case of antagonism, the substances involved are known as inverse agonists. The different responses of a receptor to the action of a drug has resulted in a number of classifications, such as "partial agonist", "competitive agonist" etc. These concepts have fundamental applications in the pharmacodynamics of these interactions." [2]

Pharmacodynamics and Pharmacokinetics
"Pharmacodynamics is the study of how a drug affects an organism, whereas pharmacokinetics is the study of how the organism affects the drug. Both together influence dosing, benefit, and adverse effects." [4] Pharmacists are trained in these two subjects and can answer more questions about any of your drug interaction questions better than most physicians.

Drug Interactions to Consider When Treating Rosacea
In this section we will be considering what drug interactions need to be considered in treating rosacea, and this is a work in progress. If you have something to consider, why not volunteer and reply to this post.

Antibiotics
If you are using antibiotics to treat your rosacea, whether low dose or high dose, particularly one of the tetracycline class treatments, i.e., Oracea, doxycycline, minocycline, if you are taking at the same time as calcium, iron, antacids like Tums or Maalox, or foods such as milk, cheese, nuts, or medications or supplements that contain calcium or iron these are factors to consider whether the antibiotic will be successful or interfere with the treatment side effects. [5]

more to come....

End Notes

[1] Drug, Wikipedia

[2] Drug Interaction, Wikipedia

[3] A partial list of drug interactions to consider with topical metronidazole are Antabuse (disulfiram), Anticoagulants, Dilantin (phenytoin), Hismanal (astemizole), Lithobid (lithium), Phenobarbital (Luminal and Solfoton), Tagamet (cimetidine), Vitamins, Alcohol, and the list continues. See Everyday Health Interaction with Metronidazole

[4] Pharmacodynamics, Wikipedia

[5] Antibiotics, Interactions, Everyday Health

April 14, 2020

"South Dakota Gov. Kristi Noem on Monday announced a statewide clinical trial of hydroxychloroquine for the possible treatment of COVID-19, making her state the first in the country to institute a program exploring the potential effectiveness of the drug in treating and preventing coronavirus."

South Dakota implements statewide hydroxychloroquine clinical trial for potential coronavirus treatment, Fox News

April 14, 2020

Skin Manifestations in Coronavirus

"The novel coronavirus may cause dermatological symptoms such as pseudo-frostbite, hives and persistent, sometimes painful redness, as symptoms that affect the body outside the respiratory system continue to be found that may be associated with coronavirus infections, according to the French National Union of Dermatologists-Venereologists (SNDV – skin and sexually transmitted disease doctors)."

Dermatological symptoms may be the latest new coronavirus symptom
Pseudo-frostbite, hives and redness may appear with or without respiratory symptoms.
By TZVI JOFFRE APRIL 12, 2020 17:54, The Jerusalem Post

-------------------------------------------------------

"The symptoms range from hives to measles-like rashes to a condition resembling frostbite."

Coronavirus News: Skin rashes emerge as possible symptom of COVID-19, dermatologists say, April 18, 2020, Jory Rand, Eyewitness News, WABC-TV 7

------------------------------------------------------

"There have been increasing reports of dermatologic manifestations of coronavirus disease 2019 (COVID-19). The first case series of dermatologic manifestations included 18 Italian patients with erythematous, urticarial, and vesicular rashes, often on the trunk. Other reports include drug hypersensitivity, urticaria, apetechial rash mimicking dengue, and acro-ischemia. It is important to further characterize dermatologic manifestations of COVID-19 in order to understand the relationship between the virus and skin, and determine whether cutaneous manifestations of COVID-19 may assist with early disease detection. To date, collecting cases of dermatologic manifestations of COVID-19 has been challenging given their relative infrequency and the rapid spread of COVID-19."

Freeman EE, McMahon DE, Fitzgerald ME, Fox LP, Rosenbach M, Takeshita J, French LE, Thiers BH, Hruza GJ, The AAD COVID-19 Registry: Crowdsourcing Dermatology in the Age of COVID-19, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/ j.jaad.2020.04.045.

Other dermatological papers related to this subject are cited at the University of Nottingham

The Science Times reports, "Two different Chinese doctors who were both critically ill from the coronavirus have actually seen their skin turn dark right after being brought back to life from the brink of death. Dr. Hu Weifeng and Dr. Yi Fan, had previously caught the virus when they were treating patients at the Wuhan Central Hospital back in January." - Another report about this from the New York Post.

"Skin manifestations were observed in about one-fifth of a group of patients with COVID-19 in the Alessandro Manzoni Hospital in Lecco, in northern Italy.",
Skin manifestations are emerging in the coronavirus pandemic, The Hospitalist

April 13, 2020

FREE jar of the ZZ cream!

Below are anecdotal reports of ZZ cream use collected over a great deal of investigative time for your benefit and the end notes show the source of the report usually found at RF since members at the RRDi are reluctant to post. The ones below are positive, and if you have the time you could post your investigation on the negative ones which I don't have the time for (maybe you do?). You may review my post on the ZZ cream and for a more recent update visit my blog (scroll down to my first comment) for a recent photo. I stumbled upon a negative post about the ZZ cream started by tatejones [6] on September 11, 2013 that has a significant number of positive reports which I am listing below. Starlite tried to explain to tatejones in the second post that it might be caused by the mite die off (Gets Worse Before it Gets Better) issue. Note the positive reports from different threads about the ZZ cream mostly at RF:

akas
akas started a thread on January 2, 2007 with the first post stating, "Based on how it's worked on my nose so far in 12 days, I'm slightly encouraged and will continue to use it and have a little hope it can return my nose to normal-ish levels (but I've been disappointed many times before so expectations aren't really exactly high either). " [7]

anemicroyalty
"Almost finished 7 weeks and my skin is actually looking pretty good right now." [9]

antwantsclear
"I used Soolantra initially and it was a little helpful, but I've found Zhongzhou cream a lot more helpful." [12]

beherenow
beherenow started a thread on the ZZ cream January 15, 2020 and gave up after three days, however, I am listing this because beherenow wanted to know if the ZZ cream helps erythema. [4]

chchchanging
chchchanging started a thread about the ZZ cream on July 7, 2011 with his first post stating he had been using for 1.5 weeks [8]

chchchanging posted on November 5, 2011, "...I think its been about 4 months since I started. Things are still going really well. Not 100% perfect but its progressed enough that I don't think much about the condition of my face anymore...." post #17 [8]

DukeCity
"I wasn't a believer either until I decided to try the ZZ cream, now after using it since about May 1st, I believe! I have no rosacea, after 15+ years of dealing with this crap, my skin is clear and normal." - DukeCity post no 6 [6]

Faith1989
"I have been using ZZ cream for a while now (not consistently) just because sometimes I forget. It has helped my skin a lot, I only had flushing. Like last night I didn't use it and flushed today and my eyes burn. I think it helps for sure." Faith1989 4/27/2016 post #39 [8]

guest
"Hey guys, the z cream works.... I am living proof and you can see my pictures on the rosacea support group under the photos section. The best advice I can give you is give it at least 6 monhs minimum to see marked improvement, you must have alot of patience, its like a roller coaster ride, there will be alot of ups and downs along the way but keep going, you can itch, look worse, break out, skin is dry, ....but it will get better with time and patience and I used the z cream nightly (not too late though) this is when the mites are most active, put water, and then a thin layer of z cream dont over do it!" guest 1/13/2007 post #46 [7]

hencloud1
"I am still using the Z cream which does seem to have helped but still getting a few P&Ps and still some deep ones." post no 41 [10]

"I put the improvement down to the zz cream. I haven't been using anything else... " post no 71 Simon [10]

Kirk
In the fifth post of chchchanging's thread, Kirk posts, "...Its an ongoing battle, and the ZZ can only do so much. I feel its important to change/wash your pillow cases frequently.... probably every 3rd or every other day at the minimum. Ive also started using the ZZ during the day, where I was only using it at night. If I have any p&ps anywhere on my face when I wake up, I dab just a little bit of ZZ on those areas, but I dont use it all over my face like I do at night. I feel like this has kept the stubborn areas under control throughout the day. 2 months ago I never thought Id be able to put it on more than once, but your skin become more tolerable to the harshness of the ZZ (at least mine did and I have SUPER sensitive skin). So dont be afraid to fiddle with your routine and find something that works for you..." [8]

"Im 7 weeks into using ZZ and my skin is finally starting to be a little more consistant." post no 7 [8]

Judworth
Judworth posted his report on the ZZ cream starting December 8, 2019 and posted after nearly two months on February 3, 2020, "I have been more than happy with the results, use 5 out of 7 nights and often over an oil-based night product (which really helps to reduce dryness). The face that now looks back at me is pale and although I obviously will never lose those pesky thread veins, they are much paler! All-in-all a real success for me!" [2]

KSD69
"The ZZ has helped ... soothing, seems to reduce the redness and really helps to keep the oiliness down..." KSD69 post no 18 [2]

Libby2018
"I've been using the zz cream for 8 days now (once a day at night). The overall redness has subsided by over 55-60%, my skin is much smoother where it used to feel like sandpaper before, it's far less itchy, papules and postules have shrunk, bumps have greatly shrunk in a week (incl. those that appeared a couple of days ago) whereas before it would have taken weeks, the skin looks calmer and not angry or as inflamed as it did before and, finally, the spots and redness along the jawline have almost disappeared." Libby2018 post no 148 [6]

Lobster222222
"...I have used the zcream for around 5 months now and at about 2-3 months of using it the mites started to come back after being gone for awhile, I mean my rosacea was under controll and my skin was smooth, and then out of the blue I was getting breakouts again and redness (especially after I ate) granted the pustules and papules would go away quickly, but they were a pain nonetheless. You have to add more to the zcream treatment to really get rid of the mites for good, and I have found using the zcream for at least a month or two gets your face prepared for this more aggressive treatment..." Lobster222222 1/13/2007 post #45 [7]

mapleleaves
"yes, zz cream really works! at least it did for me. zz cream every night and within two months my skin was almost clear. after the initial breakout from the dying mites my skin was already noticeably improving after a week. I highly recommend it. This stuff makes a big difference! " mapleleaves 11/30/2015 post #33 [8]

MariaSt
"Asm, keep going. It seems that you are going to be benefited by the zz cream. The dryness and redness are only temporary.
I have been using the zz cream twice a day for quicker results. When the dryness was at its worst and zz cream would be visible on my skin, I applied it only in the evenings. In the mornings I used boric acid 2%, it lessened the flakes without worsening the dryness and I was 100% sure it wouldn’t feed demodex or any other bacteria." MariaSt post no 63 [6]

Mikhala
"This stuff absolutely works. I've been dealing with acne/rosacea for years. I WISH I had the ZZ cream all those years ago.
After 3 weeks, my face is almost completely clear." Mikhala post no 162 [6]

Millie
"Day 19...Then, I applied the zzcream and went to bed, woke up, had my coffee, looked in the mirror......AND NO FLUSHING!!!!!!!! NO REDNESS!!!!!!! Just little red broken cappillaries. Did I mention that I am having PMS as well? Think it is a result of the ZZ cream?" January 31, 2007,post no 66 [7]

Mistica
"I too use ZZ cream along with other things, and find it a very useful tool in my toolbox, but for most people, a multi approach is necessary." Mistica post no 157 [6]

"...I'd like to add, btw, that zz cream is the most effective product I have used against p&p, they fade in two days..." MariaSt 6/17/2018 post #99 [7]

"I would advise any rosacean or flusher to give ZZ Cream a whirl and if necessary mix it with a topical you can tolerate." Mistica, post no 16, Rosacea Forum

Mothinrust
Mothinrust started a thread on the ZZ cream on December 16, 2019 and posted after two months on January 18, 2020, "I'm sure you've read my updates. My face is so soft and smooth from using ZZ cream. All flakiness and dryness gone. And to be honest with you that alone is worth using it. All traces of Seb derm are gone and I havent seen any P&Ps in weeks now." [5]

red-hotoz
"I've been applying the ZZ for just over 7 weeks now and believe there has been some improvement with the p&ps." Jen, October 11, 2006, post no 91 [10]

"I'm glad there is a new thread now running on ZZ. I hesitated for a long time before trying it but really pleased that I finally gave it a go. I don't really care if I have excess Demodex Mites or not...what I do know is that it helps to keep my p&p's at bay. Not perfect but better than anything else I've tried! What I have learnt though is that when I am stressed out, it doesn't matter what I'm doing for the control of my Rosacea beast...a breakout will happen! Urgh! Well, at least they are not nearly as severe as before and at least no more swelling on my face! YEAY!!! I mean, to be able to count or to 'work on' a few p&p's is not so bad!...Oh, one last thing. I don't work for Demodex Solutions nor do I have any monetary connection with them. I decided to try ZZ after reading about it from other's posts over a long period of time. Then my final 'hand in pocket' was after watching Simon's progress over several months. I'm glad I did though." redhotoz post no 26 on 7th January 2007 [7]

RedRecluse
RedRecluse ordered the ZZ cream on May 5, 2017 who became an avid fan of its use and posts his detailed treatment with lots of daily photos and wrote on Septeber 8, 2017, "I really do believe ZZ Cream is a miracle product for many skin conditions (it cured my Seborrhoeic Dermatitis and Eczema too)." You can view his clearance which took approximately four months progressively with his photos in the thread. There are others who report their use of the ZZ cream in this 21 page thread (as of this date). [1]

redvelvet
redvelvet started her thread on the ZZ cream on December 1, 2019 and posted on April 7, 2020 (over four months later), " I only used ZZ cream as my external form of treatment because I'd had it with medications that made it so much worse, and I was afraid to try lasers. I know meds and lasers help many people, but I wanted to try natural treatments first to address demodex. Luckily ZZ is quite remarkable and I had amazing success treating the marks, bumps, pustules, papules, enlarged pores and sandpaper like feel of my skin. It helped quite a lot with the redness too, but I'm pretty convinced that the flushing was due to gut and liver issues, as well as spleen. I'm happy to say I haven't flushed in quite sometime now, maybe months." By the way redvelvet is a doctor of chiropractor and volunteers on the RRDi MAC. [3]

Tioh2001
"In September 2004 I began using the ZZ ointment, which got me clear of p&p's in just a few days. Then in February 2005, after I had been using the ZZ ointment for about 6 months, I decided to take a break from it." Heather, June 21, 2006, post no 26 [10]

"I have personally found nothing better than the ZZ ointment." Heather, July 21, 2006, post no 59 [10]

"Once you have completed the 120 days, you should the try using the ZZ ointment every other day....then every 3rd day....until you find the right maintenance schedule for yourself." Heather, July 31, 2006, post no 61 [10]

"The ZhongZhou ointment from www.demodexsolutions.com eliminated this problem. My pores are no longer plugged, are signficantly smaller looking, and the greasiness has been reduced by about 95%. My nose no longer swells and no longer gets skin buildup/flakiness." Heather, January 2, 2008, post no 3 [11]

----------------------
Note: The above anecdotal reports are in alphabetical order according to their display name. This is still under construction and will be updated with more reports. If you have an experience using the ZZ cream why not post in this thread your comment. Find the reply button and volunteer to help other rosacea sufferers.

Reply to this Topic

There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.

End Notes

[1] RedRecluse - URGENT help please, I've never woken up with it this bad. Desperate! (w/ pics)

[2] Judworth - Zhongzhou Cream

Judworth started another thread on the ZZ cream on January 29, 2020 and states on post no 34 (February 12, 2020), " I am using only about 4 times a week now, still with the same great results!"

[3] redvelvet - Started ZZ Cream today (with Pic)

At post no 72 she reports, "It's been a while since I posted an update, but wanted to let you all know I'm still a huge fan of ZZ Cream. My skin continues to lighten and I really don't even feel "red" anymore. Thank you redrecluse for sharing your story, because that was the first post I read which inspired me. I really think I should buy a lifetime supply of ZZ incase, God forbid, they ever stop making it. It has changed my life. Actually, this website has, because this is where I first heard of demodex mites and ZZ cream. Thank you Brady Barrows!! I have been so inspired to share what I've learned with other rosaceans who are walking around completely unaware of demodex mites and the fact that there might be a cure to their rosacea. Some people on this forum have asked me for more specifics about the gut cleanse/detox I did and the products I used. (All Standard Process). So I started a blog/website, www.rosaceahelp.org which goes into much more detail about gut health, cleanses, diet, facial products, this amazing website, the RRDI, and of course Zhong Zhou cream. I am hoping to add more content as I learn more, and hoping others will share their success stories there as well."

[4] beherenow - ZZ cream for Type 1 or am I wasting my time?

[5] Mothinrust - Severe die off from zz after first use?

[6] tatejones - zz cream - so scared my face is ruined forever...

[7] skas - My experiences with the infamous ZZ cream so far

[8] chchchanging - My Story with ZZ Cream] [July 7, 2011, post no 1]

[9] anemicroyalty [post no 33]

[10] hencloud1 (Simon) - My photos (photos there now!)

[11] Bonefish - Any "purifying" ointment?

[12] antwantsclear [post no 14]

April 11, 2020

I have experimented using the Blog tool that is provided for free for our members and posted a comment. Maybe members would like to create their own blog?

April 9, 2020

Watch the video

Rosacea Research
Every medical student learns about the risk-benefit ratio in medical research and in treatment. "For research that involves more than minimal risk of harm to the subjects, the investigator must assure that the amount of benefit clearly outweighs the amount of risk. Only if there is a favorable risk–benefit ratio may a study be considered ethical. The Declaration of Helsinki, adopted by the World Medical Association, states that biomedical research cannot be done legitimately unless the importance of the objective is in proportion to the risk to the subject. The Helsinki Declaration and the CONSORT Statement stress a favorable risk–benefit ratio." [1]

Rosacea Treatment
For a rosacean, it would be prudent to understand what the risk-benefit data is for any rosacea treatment being considered. If you are seeking medical treatment from a physician, legally the risk/benefit ratio should be provided to the patient clearly in terms that the patient can understand. What are the risks involved and what are the benefits for a particular rosacea treatment? Clearly the benefits should outweigh the risks, however, because the Benefit-risk assessment (BRA) mainly relies on a qualitative assessment of quantitative data, there is sometimes subjective or qualitative bias involved in the presentation of the data by the medical practitioner and also in the decision of the rosacea patient. Also the placebo/nocebo effect may be involved as well, which is a factor not only in the outcome of the treatment, but also in the decision of the patient in the process of accepting or rejecting the treatment . [2]

Bias
For an example, take the common bias in the perception of risk in flying vs driving. Some feel that flying is more risky than driving, however, statistics show otherwise. The bias in this case is subjective or qualitative on the quantitive data. "In the end in any given situation, the acceptable risk-to-benefit balance is an individual judgement on the part of the patient or the prescriber." [3]

Double-Blind
Due to this bias, clinical research studies use 'double-blinded' techniques. "In a blind or blinded experiment, information which may influence the participants of the experiment is withheld (masked or blinded) until after the experiment is complete. Good blinding can reduce or eliminate experimental biases that arise from a participants' expectations, observer's effect on the participants, observer bias, confirmation bias, and other sources." [4] "Most often, single-blind studies blind patients to their treatment allocation, double-blind studies blind both patients and researchers to treatment allocations, and triple-blinded studies blind patients, researcher, and some other third party (such as a monitoring committee) to treatment allocations. However, the meaning of these terms can vary from study to study." [4]

"The double-blind randomized controlled trial (RCT) is accepted by medicine as objective scientific methodology that, when ideally performed, produces knowledge untainted by bias. The validity of the RCT rests not just on theoretical arguments, but also on the discrepancy between the RCT and less rigorous evidence (the difference is sometimes considered an objective measure of bias)." [7]

Placebo/Nocebo Effect
"Evidence for the relevance of placebo and nocebo effects in dermatology is also increasing...A large proportion of the success or failure of dermatological treatment can be explained by factors other than the treatment mechanisms themselves. Placebo and nocebo effects, in particular, strongly contribute to treatment outcomes, with explained variances comparable to, for example, effects of analgesics or antidepressants....the placebo responses and positive expectations of patients will only endure if they are based on trust in a long‐term authentic relationship. Highly optimistic promises followed by limited effects will probably result in nocebo instead of placebo effects."

The placebo/noebo effect is a significant factor in whether a rosacean decides to accept a treatment or reject it as well as a huge factor in the outcome of the treatment. [5]

Criteria for Assessing Risk-Benefit
"The concept of risk is generally understood to refer to the combination of the probability and magnitude of some future harm. According to this understanding, risks are considered "high" or "low" depending on whether they are more (or less) likely to occur, and whether the harm is more (or less) serious." [6]

Benefit-risk Assessment
Of course, there are a number of rosaceans who give absolutely no consideration to the risk-benefits of any given rosacea treatment (rely totally on what a physician proposes without hesitation, inquiry or investigation into this subject), while others investigate these risks-benefits in methodical and incredible details. For example, what is involved in investigating PDT for rosacea? One other assessment is understanding the X-Factor in rosacea.

Informed Consent
Informed consent is the right of each patient and the responsibility of the medical practitioner. However, in over the counter or non prescription treatments for rosacea the responsibility of gathering the risk-benefit data relies totally on the rosacean, who relies heavily on anecdotal reports and very little scientific data, if any, probably in both cases provided by the promoter of the rosacea treatment under consideration. Independent verified anecdotal reports are highly valued, but as many have discovered, anecdotal reports can be faked.

What can help in making an assessment with a proposed rosacea treatment?
A principle to consider is, 'a treatment causes benefit in many at the cost of serious injury in some.' Obviously if this principle is reversed, 'a treatment causes serious injury in many at the cost of benefit in some' would you accept the treatment? That would depend on how bad your rosacea is, now wouldn't it? The dilemma in this decision is understanding whether the data that is presented is valid or biased. That is what research and development is all about and why the RRDi was formed and a principle found in our mission statement (see Goal #4).

Reply to this Topic
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End Notes

[1] Risk-benefit ratio, Wikipedia

[2] Dialogues Clin Neurosci. 2011 Jun; 13(2): 183–190.
Assessing the benefit:risk ratio of a drug - randomized and naturalistic evidence
François Curtin, MD and Pierre Schulz, MD

[3] Drug Saf. 1996 Jul;15(1):1-7.
Concepts in risk-benefit assessment. A simple merit analysis of a medicine?
Edwards R, Wiholm BE, Martinez C.

[4] Blinded Experiment, Wikipedia

Blinded Experiment, Terminology, Wikipedia

[5] Placebo/Nocebo Effect in Rosacea

[6] The Assessment of Risk and Potential Benefit, Chapter 4, Biotech Archive, Georgetown University

[7] J Clin Epidemiol. 2001 Jun;54(6):541-9. doi: 10.1016/s0895-4356(00)00347-4.
The double-blind, randomized, placebo-controlled trial: gold standard or golden calf?
T J Kaptchuk

April 8, 2020

Artemisia Image Courtesy of Wikimedia Commons

"Artemisinin (ART), an anti-malaria drug, was reported to have several effects including anti-inflammation and anti-angiogenesis activities. However, the role of ART on rosacea remains unclear....ART ameliorated rosacea-like dermatitis by regulating immune response and angiogenesis, indicating that it could represent an effective therapeutic option for patients with rosacea."

Biomedicine & Pharmacotherapy
Volume 117, September 2019, 109181
Artemisinin, a potential option to inhibit inflammation and angiogenesis in rosacea
Xin Yuan, Ji Li, Yangfan Li, Zhili Deng, Lei Zhou, Juan Long,Yan Tang, Zhihong Zuo, Yiya Zhang, Hongfu Xie

Artemesinin is on the list of anti-malaria treatments used for successful rosacea treatment. Technically, artemisinin is not an anti-viral, but an anti-malaria treatment used on Plasmodium falciparum, a protozoa. Hopefully, we will hear of anecdotal reports of Rosaceans using artemisinin for rosacea with positive results. "Artemisinin derivatives are known for their ability to suppress immune reactions such as inflammation." Wikipedia

"Artemisinin is extracted from the plant Artemisia annua, sweet wormwood, a herb employed in Chinese traditional medicine. A precursor compound can be produced using a genetically-engineered yeast, which is much more efficient than using the plant." Wikipedia

Nicholas Bogosian posted about this treatment with a link.

Artemisinin is available over the counter and considered one of the Anti-parasitic Prescription Agents.

More information on artemisinin

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April 8, 2020

More has been uncovered in a report published in Cell Reports, April 7, 2020 by Balka et al. who report, "We further demonstrate that TBK1 acts redundantly with IkB kinase ε (IKKε) to drive NF- kB upon STING activation." While this may be daunting to understand for a layman, James Ives, News Medical Net, explains the significance of this, "The two signalling arms of the cGAS-STING pathway were thought to be mediated by a single upstream kinase, TANK binding kinase (TBK1)...."That basically told us that the mechanism that drives the second cytokine pathway depends on both proteins, but that they act redundantly - if one's missing the other one does the job,"..."

Read the clinical paper below:

PIIS2211124720303703.pdf

April 8, 2020

It is with sad hearts that Steve Johnson, D.O., who has served for many years on the RRDi board of directors has resigned due to his busy work at his clinic. Steve will be missed.

April 7, 2020

One more differential diagnosis with rosacea is ruling out Demodex-induced follicular mucinosis (FM) from demodectic rosacea or for that matter, rosacea in general or of its variants. A report on this states, "Higher densities of mites correlate with increased perifollicular inflammation and clinical manifestations of disease. These cases support the hypothesis that a subset of idiopathic FM arises secondary to an aberrant immune response to Demodex. Given the typically robust response of Demodex to treatment with ivermectin, identification of this subset of patients would potentially provide significant clinical benefit."

JAAD Case Rep. 2020 Apr; 6(4): 266–272.
Published online 2020 Mar 24. doi: 10.1016/j.jdcr.2020.01.014. PMCID: PMC7109359
Demodex-induced follicular mucinosis of the head and neck mimicking folliculotropic mycosis fungoides
Megan H. Trager, BA, Dawn Queen, BA, Diane Chen, MD, Emmilia Hodak, MD, Larisa J. Geskin, MD

April 7, 2020

Metronidazole (brand name Flagyl) has been used to treat rosacea for many years, not chiefly for its antibacterial component but more importantly for its anti-inflammatory treatment component. Metronidazole is also classified as an antiprotozoal treatment along with the larger category of anti-parasitic agents. Recently due to the coronavirus pandemic, metronidazole is being investigated to treat coronavirus. A paper published March 30, 2020 online in the Archives of Academic Emergency Medicine concluded, "Metronidazole, owing to its immunopharmacological behavior, plays a pivotal role in several essential biological processes. Based on the reported immunological manifestations of COVID-19 infection, it could serve as a potential candidate to counteract majority of the immunopathological features of the disease. Therefore, clinical trials with a large sample size are necessary to determine its efficacy in the treatment of COVID-19 infection." [1] Virus and rosacea has never, ever been ruled out. Metronidazole is just one treatment for rosacea that is being investigated along with other rosacea treatments.

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