Guide

While the above study admitted the limit of a small sample size, as well as, 'The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation,' it doesn't mention that Light Microscopy Skin Scraping is Not as Reliable as 'Confocal laser scanning in vivo microscopy' which is more reliable. See item one in this post. What it does conclude is demodex mites are indeed in higher density in rosacea patients over the control group. 
Demodex Density Count - What are the Numbers?
 

"Oral ivermectin (200 micrograms/kg/day) is also a treatment alternative for PPR although it is supported with level D evidence. In patients with treatment resistant rosacea, combination of oral ivermectin and permethrin 5% cream can be considered since this combination was found to be effective in decreasing demodex density in immunocompromised patients as well."

Clin Cosmet Investig Dermatol. 2020; 13: 179–186.
Published online 2020 Feb 20. doi: 10.2147/CCID.S194074
PMCID: PMC7039055
PMID: 32110082
Conventional and Novel Treatment Modalities in Rosacea
Burhan Engin, Defne Özkoca, Zekayi Kutlubay, and Server Serdaroğlu

The February 2020 issue of the Clinical, Cosmetic and Investigational Dermatology reports, "Therefore, in 2017, there was a shift from subtypes to phenotypes in the diagnosis of rosacea and at least one diagnostic or two major phenotypes are required in order to diagnose a patient with rosacea."

Rosacea image Courtesy of Wikimedia Commons

Phenotype 4 used to be classified as Subtype 2 (Papules & Pustules), which looks similar to acne vulgaris with the exception that blackheads are not indicated in rosacea. 

Papule, Pustule, Pimple, Comedo, Lesion, Cyst & Abscess Explained

Treatment for Phenotype 4

"In this longitudinal cohort study of more than 82 000 participants with more than 1.1 million person-years of follow up, higher caffeine intake was associated with lower rosacea risk after adjustment for several confounders. Overall, participants who drank 4 cups of coffee per day were less likely to develop rosacea compared with participants who did not drink coffee. A dose-response association was found for both increasing caffeine and coffee intake. The authors hypothesized that caffeine’s vaso-constrictive and immune suppressive effects might decrease the risk of rosacea." Source

JAMA Dermatol. 2018 Dec 1; 154(12): 1385–1386.
doi: 10.1001/jamadermatol.2018.3300
PMCID: PMC6510488
NIHMSID: NIHMS1020506
PMID: 30347020
One More Reason to Continue Drinking Coffee–It May Be Good for Your Skin
Mackenzie R. Wehner, MD, MPhil and Eleni Linos, MD, MPH, DrPH, 

Here is a link to the entire article

image courtesy of Wikimedia Commons

There is a hypothesis that the 'cross reaction between the GroEl chaperonin antibodies against the B.oleronius and human GroEl chaperonin' 'will not fold normally the ALDH2, and then the enzyme will not metabolize the acetaldehyde' and therefore, 'As a result, high amounts of acetaldehyde will circulate for longer time in the blood, until the liver CYP2E1(p450) enzyme system finally metabilizes the acetaldehyde, during that period of time the patients will experience a flushing as well as the people with the "Asian flushing syndrome" suffer when they drink ethanol.'

Med Hypotheses, 84 (4), 408-12  Apr 2015
Hypothesis of Demodicidosis Rosacea Flushing Etiopathogenesis
Mary Ann Robledo, Mariana Orduz

Flushing avoidance is one of the chief concerns of Phenotype 1 rosaceans. For more information. 

Ball-and-stick model of cromolyn molecule gif image courtesy of Wikimedia Commons

"Cromolyn sodium or other MC stabilizers affect the release of histamine and other inflammatory mediators from MCs to ameliorate erythema in ETR. Drugs including brimonidine and BoNT can also reduce the recruitment of MCs and inhibit MC degranulation to improve inflammation associated with rosacea."

Front Med (Lausanne). 2019; 6: 324.
Published online 2020 Jan 28. doi: 10.3389/fmed.2019.00324
PMCID: PMC6997331
PMID: 32047752
The Theranostics Role of Mast Cells in the Pathophysiology of Rosacea
Lian Wang, Yu-Jia Wang, Dan Hao, Xiang Wen, Dan Du, Gu He, and Xian Jiang

Acuri reports using aspirin improves flushing (at RF).

I haven’t figured out how to get the full article. Sometimes in the author information it shows an email address and I ask for the full article and one of authors sometimes sends a copy. If anyone would volunteer to figure out how to get copies of articles like this (without paying for it!) that would be most helpful. We are searching for volunteers!

The RRDi financial report shows clearly how we are spending member donations. If the over 1300 members would each donate ONE DOLLAR that would keep us going for another year. If you appreciate the amount of rosacea data preserved on our website and forum would you consider donating one dollar so we can keep this non profit organization for rosacea patient advocacy going? If you have the volunteer spirit you could read our current financial situation and with some math figure out how long our current spending will last. As you can see our funds our meager compared to the other non profit organizations for rosacea which will be the only ones left if the RRDi doesn't receive donations to continue its operation. 

A new paper states the following, 'A Western diet rich in fat and sugar may lead to inflammatory skin diseases such as psoriasis, a study by UC Davis Health researchers has found."  The article mentions that "cholestyramine, a drug used to lower cholesterol levels by binding to bile acids in the intestine, helped reduce the risk of skin inflammation.'

Western diet rich in fat and sugar linked to skin inflammation, Science Daily, February 18, 2020

Trevi has a post that he says just using warm to hot water for three months and he has clearance. He does mention in the initial post he has been using some boric acid as well. We will follow up and see if anyone else confirms that this helps improve SD/Rosacea or not. 

Using just warm water to hot water is about as natural as it gets. 

You be judge whether boric acid is natural or not. 

Welcome Steven Zeigler to the RRDi. 

As Apurva points out you are correct in your research. You can take time in this forum category you posted in, PSYCHOLOGY AND ROSACEA, to continue your research by reading all the posts. One of the many theories on rosacea is the Nervous System Theory which is worth some of your time to investigate since it is related somewhat. 

However, your doctor isn't acquainted with the Gold Standard of treatment for rosacea and is old school prescribing [probably] topical metronidazole and doxycycline. What exactly did your doctor prescribe? 

There are a number of rosacea theories on the cause of rosacea, but this post is worth considering. 

If you want a free copy of Rosacea 101 which includes the Rosacea Diet, just use the contact form [request a copy]. Avoiding sugar and carbohydrate may improve your skin. You may want to read this post about alcohol and rosacea. The RRDi official trigger factor list has a number of environmental triggers. 

As for everyone being different with regard to rosacea, we have dubbed this the X-Factor in Rosacea. 

16 hours ago, Ruby said:

I’m taking it not had great results yet . But I got my sister on it who has fibromyalgia and it’s worked wonders for her. I’ve been up to 4.5 but i couldn’t sleep so I’m on my way back down. 

Thanks Ruby, keep us posted. 

Thanks ElaineA for your bath recipe. I have now been doing your bath recipe for about five days each evening and notice it does indeed help my scalp SD issues and I use a wash cloth and wash my face with the bath water and my face seems to really be better with this bath. I think totally soaking in your bath recipe is worth it and recommend others try it. I am using the Equate Brand Epsom Salt since it is cheaper than Dr. Teals. I do use the 20 Mule Team Borax soap. 

Addendum Post on NRS Form 990 2018

Since basically I am the lone watchdog of the NRS in how it spends its donations and generally speaking, the vast majority of rosaceans could care less how the NRS spends its donations, I will continue to raise red flags and point out some juicy facets of how the NRS spends its donations (i.e., in the second to last paragraph of the previous post in this thread did you notice how the NRS spends $74,814 on advertising just in the year 2018?). I thought it would be pertinent to point out how much the NRS spends on 'Information Technology' just in 2018 which was $60,377. Not sure what you think IT is but it could include the NRS website or possibly an IT geek who takes care of their computers and network in the office. You can find where this is listed in Form 990 for 2018 (available for your download and inspection at the beginning of the previous post) at Part IX, Statement of Functional Expenses, page 10 (see screen shot below). 

'

For a spreadsheet of all the years reviewed: click here. 

Now think about the amount spent on Information Technology ($60K) and then compare what the NRS spent for rosacea research ($25K) or as already pointed out $74K for advertising. What do you think about any of this? What do you think a non profit organization for rosacea should spend on rosacea research when considering 'functional expenses'? Any comments? 

it is quite odd that with over five hundred views of this post that no one has made one reply to this topic. To me this is a fascinating subject that should be investigated more and should be done by rosaceans independent of the pharmaceutical backed research which predominates the clinical papers on rosacea. Why rosaceans don't want to come together as a group and support their own independent research baffles my mind. If we could just get $1000, we could offer one of the RRDi MAC members to investigate a rosacea subject that the RRDi wants investigated and publish the results ourselves as an independent, non profit organization for rosacea. All it would take is for each member to donate ONE US DOLLAR. If you agree, please donate. 

image courtesy of Wikimedia Commons

"Mast cells are innate immune cells that can be found in virtually all tissues. Recently, increasing evidence has indicated that mast cells have important effects on the pathogenesis of rosacea." 

Front Med (Lausanne). 2019;6:324
The Theranostics Role of Mast Cells in the Pathophysiology of Rosacea.
Wang L, Wang YJ, Hao D, Wen X, Du D, He G, Jiang X

This is helpful information on the different ZZ creams available throughout the world:

Type 1
Original ZZ Cream

Type 2
Cosmetic ZZ Cream

Type 3
ZZ cream UK Version (Amazon UK)

Type 4
ZZ Cream European Version Cosmetic (Demoderm)

Apurva, 

My dermatologist told me that I have SD on my forehead and into the hair. For about three months I have now had some issues similar on the back of my head just above the neck that has not responded to my normal shampoo, Coal Tar (I usually use a generic T-Gel from Walmart or CVS), so I tried using Nizorol (Ketoconazole) brand shampoo which did improve the issue but it simply didn't go away. What really helped was using an old jar of Sulfur Butter from a tip Joanne Whitehead posted a while back. We do feature it in our affiliate store but when I tried to purchase another jar it wasn't available on Amazon. So I contacted the Braunfels Labs company website, and it is no longer listed. So I contacted the company asking what happened and got a response from DP Davidson, who explained that the Sulfur Butter is still available but on a different website, sulfursoap.com.  So I ordered another jar since this cream contains the following ingredients: 

Your experience and mine indicates that fungus and rosacea (yeast is a fungus) has not been ruled out and even though SD and rosacea can co-exist, there is probably some relationship between the two skin diseases. Not sure what ingredient in the Sulfur Butter is improving my fungus issue in my scalp but I think the Shea Butter, Hemp Oil, Avocado Oil and Jojoba Oil may have something to do with it along with the sulfur. 

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.  

image courtesy of Wikimedia Commons

"A 40-year-old Caucasian woman presented to our dermatology clinic with rosacea. She was prescribed oral doxycycline 50mg once daily and metronidazole lotion at bedtime. Seven weeks after starting this regimen without complaint, she contacted the office stating her teeth had become discolored “overnight.” "

The article explains that "Chemicals and medications associated with staining of teeth" should be reviewed with rosacea patients and "question patients about their oral hygiene regimen and develop cooperative relationships with our dental colleagues."

J Clin Aesthet Dermatol. 2019 Oct; 12(10): 12–13.
Published online 2019 Oct 1.
PMCID: PMC6937148
Sudden Onset of Tooth Discoloration
Brooke A. Jackson, MD, FAAD and Cierra D. Taylor, BA

The Journal of the American Academy of Dermatology, February 2020, mentions the new phenotype classification with this statement: 

"The new system is consequently based on phenotypes that link to this process, providing clear parameters for research and diagnosis, as well as encouraging clinicians to assess and treat the disorder as it may occur in each individual."

J Am Acad Dermatol. 2020 Feb 06;:
Standard Management Options for Rosacea: the 2019 Update by the National Rosacea Society Expert Committee.
Thiboutot D, Anderson R, Cook-Bolden F, Draelos Z, Gallo R, Granstein R, Kang S, Macsai M, Gold LS, Tan J

It is that time again, after five years, to nominate and approve the RRDi Board of Directors. If you are a voting member, you will be able to nominate or approve the board of directors by following the directions in this post. If you can't access the post, after you login, this means you are a member of the RRDi but do not have voting rights. If you want to change your membership from a member to a voting member follow the directions in this post.