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Guide

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  1. A paper written in 2017 about diet and rosacea never once mentions sugar/carbohydrate as a rosacea trigger and parrots the diet triggers promoted by the NRS while admitting that "Dietary triggers are also frequently cited by patients, although there is a lack of research in this area. In one survey by the National Rosacea Society of over 400 patients, 78% had altered their diet due to rosacea. Of this group, 95% reported a subsequent reduction in flares." The NRS has never listed sugar/carbohydrate as a rosacea trigger, even though the number of anecdotal reports continue to grow that indeed sugar/carbohydrate is just as valid a rosacea trigger as any of the other NRS proposed triggers. The paper about diet and rosacea is cited below: 

    Dermatol Pract Concept. 2017;7(4):31–37. Published 2017 Oct 31. doi:10.5826/dpc.0704a08
    Diet and rosacea: the role of dietary change in the management of rosacea
    Emma Weiss and Rajani Katta

  2. Welcome to the RRDi community support. If you are suffering from rosacea plus gastatory face flushing* and erythromelagia, we can only empathize with your situation. Your condition is extreme and quite unusual. Not many rosaceans are suffering as much as you are suffering. Have you tried avoiding sugar and carbohydrate or at the very least reduced your intake to see if this improves your situation? Sugar is the fire that burns rosacea. It is not expensive to avoid sugar, in fact, you will save money avoiding sugar. Basically, all you do it eat high protein/fat for thirty days to see if your skin improves. Eating high protein/fat for just thirty days and drinking lots of water is not a health risk since it is only temporary. You may learn that you need more protein/fat instead of the high sugar/carbohydrate to control your rosacea. For example, you may not know how eating macaroni and cheese is a high carbohydrate meal. Our bodies are mostly water, protein and fat and carbohydrate only takes a very small percentage of our body mass. It is simply something that you can rule out to see if this helps your skin. 

    In order to recommend topicals, we would need to know what topicals you have tried. Also what oral medications or vitamins/supplements or any other oral treatments have you tried? 

    How long have you been suffering from this? 

    * "Gustatory flushing affects both sides of the face and is associated with excessive salivation, tear production and nasal secretion with no history of parotid gland injury. This may be reproduced by chewing a chilli pepper and holding it in the mouth for 5 minutes." Flushing, DermNet NZ

  3. 305px-Malaria_Parasite_Connecting_to_Human_Red_Blood_Cell_(34034143483).jpg
    Colorized electron micrograph showing malaria parasite [protozoa]
    Image courtesy of Wikimedia Commons

    Protozoa and rosacea has not been considered in any clinical paper known to date. However, there is a "link between protozoa, vitamin B12 deficiency, acne and depression" according to at least one clinical paper. [1] This same source states the following about rosacea: 

    "Rosacea is another inflammatory skin disease that causes facial redness but it is different from acne, the common denomination being inflammation. Metronidazole, a synthetic antibacterial and antiprotozoal agent of the nitroimidazole class, is used against protozoa such as Trichomonas vaginalis,  amebiasis, and giardiasis. Metronidazole is extremely effective against anaerobic bacterial infections and is also used to treat Crohn’s disease, antibiotic-associated diarrhea and rosacea. The nitroimidazoles class of agents used to treat G. lamblia infection includes metronidazole, tinidazole, ornidazole, and secnidazole. This class was discovered in 1955 and was found to be highly effective against several protozoan infections." [1]

    "Protozoa constitute a group of microorganisms, also known as protists, some of which are responsible for serious diseases in humans, such as malaria and Chagas' disease and inflammatory disease conditions." [1] A significant number of worldwide deaths due to diarrhea are caused by three protozoas - Entamoeba, Cryptosporidium, and Giardia. 

    The human microbiome includes a number of different microbes, including protozoa. The NRS substantiates that protozoa are included in the human microbiome by publishing this statement,  "Microbes include bacteria, fungi, protozoa [bold added] and others, and may be found in greatest concentrations in the ears, nose, mouth, vagina, digestive tract, anus and the skin." [2] Very little is known about protozoa and rosacea. What exactly are protozoa?

    "Protozoa (also protozoan, plural protozoans) is an informal term for single-celled eukaryotes, either free-living or parasitic, which feed on organic matter such as other microorganisms or organic tissues and debris. Historically, the protozoa were regarded as "one-celled animals", because they often possess animal-like behaviors, such as motility and predation, and lack a cell wall, as found in plants and many algae.  Although the traditional practice of grouping protozoa with animals is no longer considered valid, the term continues to be used in a loose way to identify single-celled organisms that can move independently and feed by heterotrophy." Wikipedia

    Treatment Used for Malaria Has Proved Successful in Rosacea
    There has been some treatments for malaria [protozoa] that have been used to treat rosacea such as mepacrine, artemisinin, artesunate, chloroquine, and hydroxychloroquine that have proved successful in some rosacea patients.  

    Protozoa has never been ruled out as having a connection with rosacea. There simply isn't data on this subject. 

    There needs to be a clinical study done on protozoa and rosacea. Who would fund such a study? Since protozoa has never been ruled out in causing rosacea, who would support such an investigation? Would you? Just think if 10K members of the RRDi each donated one dollar and insisted on supporting a reputable clinician to study protozoa and rosacea, what might be discovered? If you have a comment about this, please find the green reply button and let us know your comment. 

    End Notes

    [1] Research, September 2015; DOI: 10.13140/RG.2.1.1087.9200
    PROTOZOAL LINK BETWEEN SEVERE ACNE, RISK OF ATTEMPTED SUICIDE AND IMMUNE SUPPRESSION:
    A direct peripheral blood test to confirm microparasitic infections, 
    Beldeu Singh

    [2] The Ecology Of Your Face: Demodex, Rosacea And You, National Rosacea Society

  4. 6 hours ago, Apurva Tathe said:

    Yes I know this very well it has its medicinal properties and used for food and pharmaceutical industry considering its compounds but not much research has been done on this plant when it comes to skin diseases especially for rosacea and the link you provided It is already mentioned in my articles reference note. Yes you can not find the essential oil online that is why how I made this concoction oil I have explained this in my article.

    I hope others try this. I was just pointing out I couldn't find any essential oil available. Are the leaves available for purchase somewhere?

  5. mepacrine.jpg

    Mepacrine is one of the Anti-parasitic Prescription Agents.

    There are some papers indicating using mepacrine (Quinacrine) for the treatment of rosacea. One paper published in The Lancet, May 1952 written by Borrie Peter and another paper published in 1955.  [1]

    Another paper mentions using mepacrine and chloroquine in combination to treat rosacea. [2] 

    Anecdotal Reports
    Here are some anecdotal reports using Mepacrine:

    lucy_nic87 reports, "i have now been on mepacrine for about 5 weeks and this last week particularly my flushing has been much reduced. my redness is still there, if anything perhaps a bit worse, but i have not had any of that hot feeling, burning, flushing i was having. my skin in general feels calmer. i am however turning rather yellow which can be a side effect for some. if it doesnt get too much worse i can handle it, but it if increases im not sure." 

    lamarr in October 2008 started a thread about Mepacrine. 

    Halfpipe101 in May 2009 started a thread that his flushing is almost cured using Mepacrine. 

    kev711216 in May 2011 started a thread on success using Mepacrine. 

     Ray at RF [post no 14 on 5/22/2011] wrote, "I've been on quinacrine now for 3 months and I'm happy to report I havent flushed once in almost a month.

    Scarlet Letters has an interesting article discussing using mepacrine and plaquenil in treating rosacea.

    End Notes

    [1] The Lancet
    Volume 259, Issue 6718, 31 May 1952, Page 1113, Letters to the Editor
    TREATMENT OF ROSACEA WITH MEPACRINE
    Borrie Peter
    Science Direct

    Acta Derm Venereol. 1955;35(6):446-52.
    Mepacrine in rosacea.
    INMAN PM, GORDON B.

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

  6. A recent study published by International Immunopharmacology states that hydroxychloroquine "improved rosacea in rosacea-like mice and mast cells (MCs)" and investigated "the effects of HCQ treatment for rosacea patients". The paper concludes, "In vitro, HCQ suppresses LL37-induced MCs activation in vitro, including the release of inflammatory factors, chemotaxis, degranulation and calcium influx. Moreover, HCQ attenuated LL37-mediated MCs activation partly via inhibiting KCa3.1-mediated calcium signaling. Thus, these evidences suggest HCQ ameliorated rosacea-like dermatitis may be by regulating immune response of MCs. Finally, the 8-week HCQ treatment exerted satisfactory therapeutic effects on erythema and inflammatory lesions of rosacea patients, indicating that it is a promising drug for rosacea in clinical treatment."

    Since hydroxychloroquine is available worldwide in generic form we should hear more reports from rosaceans who will ask their physician for a prescription to confirm these results. Duff Man reported in 2017 that this worked for him. Another thread at RF in 2010/2011 has a few others who have tried it discuss their experience. antwantsclear [post no 240 and post no 243] reports taking hydroxychloroquine starting in 2011 and continues to use it for flushing. 

    One paper published in the Archives of Dermatology, January 2011, indicates that 3 out of 5 patients with neurogenic rosacea were successful using hydroxychloroquine. 

    More Info
    Hydroxychloroquine is a novel therapeutic approach for rosacea.

    Plaquenil (Hydroxychloroquine)

    Mast Cell Stabilizers in the Treatment of Rosacea: A Review of Existing and Emerging Therapies
     

  7. A paper published in the British Journal of Dermatology concluded that after treatment with 1% and 3% Minocycline Topical Gel, this resulted with a "significantly decreased inflammatory lesion counts and a significantly larger proportion of subjects achieved IGA success at week 12 in the 3% topical minocycline group. These findings support further evaluation of minocycline gel for the treatment of inflammatory lesions associated with papulopustular rosacea."

    Metronidazole will be having some competition. 

  8. skin.png*

    Dry skin (Xeroderma) can be a co-existing condition with rosacea. When treating rosacea with topicals or oral treatments, a common side effect is dry skin, and if one already has dry skin, this complicates and exacerbates the dry skin issue further. "Symptoms most associated with xeroderma are scaling (the visible peeling of the outer skin layer), itching, and skin cracking." Wikipedia

    "Repeated application (typically over a few days) of emollients or skin lotions/creams to the affected area will likely result in quick alleviation of xeroderma. In particular, application of highly occlusive barriers to moisture, such as petrolatum, vegetable oils/butters, and mineral oil have been shown to provide excellent results. Many individuals find specific commercial skin creams and lotions (often comprising oils, butters, and or waxes emulsified in water) quite effective (although individual preferences and results vary among the wide array of commercially available creams)." Wikipedia

    Skin Hydration Sensor (SHS) might be used to measure your skin moisture. 

    Treatments

    The Merck Manual recommends the following: 

    "Frequency of bathing should decrease and tepid, rather than hot, water should be used.

    Skin moisturizers should be used frequently, particularly immediately after bathing, to decrease transepidermal water loss. Thicker moisturizers such as petrolatum- or oil-based moisturizers are more effective than water-based lotions, although water-based lotions may be better tolerated in warmer climates. Moisturizers with additives such as ceramides, alpha-glycolic acids (eg, lactic, glycolic, and pyruvic acids), and beta-glycolic acids (eg, salicylic acid) are very commonly used.

    Increasing fluid intake and using humidifiers also help."
    Xeroderma, Merck Manual

    Women's Health has an article on treating dry skin using The Inkey List treatments and has this to say about the subject: 

    "Dry skin needs – you guessed it – serious hydration."  

    Adex Gel

    The following four treatments are recommended: 

    (1) Polyglutamic Acid [1]

    (2) Squalane Oil [2]

    (3) Rosehip Oil [3]

    (4) Lactic Acid [4]

    "Oral hydration is key but directly hydrating the skin with a solid moisturizer is just as important. You must pick a moisturizer based on your skin type. If you have dry skin use a cream with greater oil content." [5]

    End Notes

    [1] Polyglutamic Acid

    THE INKEY LIST Polyglutamic Acid

    Polyglutamic Acid Serum

    [2] Squalane Oil

    Amara Beauty Squalane Oil

    The Ordinary 100% Plant-derived Squalane

    [3] Rosehip Oil

    Bvokey recommends rosehip oil for rosacea.

    Eva Naturals Rosehip Seed Oil

    Kate Blanc Rosehip Seed Oil

    Leven Rose Rosehip Oil

    Radha Rosehip Oil

    Teddie Organics Rosehip Seed Essential Oil

    The Inkey List Rosehip Oil

    The Ordinary 100% Organic Cold-Pressed Rose Hip Seed Oil

    Trilogy Certified Organic Rosehip Oil

    [4] Lactic Acid

    The Inkey List Lactic Acid

    Measurable Difference Lactic Acid Face Serum

    [5] My skin is as dry as the Mojave, what do I do? 
    By Dr. Ali Tehrani, For the Daily Press

    Etcetera (Moisturizers)

    There are a number of other moisturizers to consider in our affiliate store. You may also want to check our forum category on moisturizers

    Coconut Oil for Rosacea (as a moisturizer)

    Bio-Oil 

    *Image [The distribution of the bloodvessels in the skin of the sole of the foot. (Spalteholz.)] Courtesy of Wikimedia Commons

  9. Time to review the 2018 Form 990 the NRS publishes on their website or you can read for yourself below (click to open pdf): 

    nrs_990_2018.pdf

    Review

    Let's first try to concentrate on the positive aspects of this report. The NRS is the leading non profit organization for rosacea that supports research grants for rosacea. In 2018 a total of $12,500 was spent on research grants if you read Form 990, Part IX, Line 1. How can you figure out who received the $12,500?  You definitely have to do some digging since the Form 990 doesn't disclose this. The NRS website in its Awarded Grants page shows Dr. Anna Di Nardo and colleagues were awarded $25,000 in 2018. In reviewing the Form 990 it does indeed show that $25,000 was awarded to the Regents of UCSD shown below: 

    regentsUCSD.png

    So let's give the NRS a benefit of doubt and instead of $12,500 which is shown on Form 990, Part IX, Line 1, and commend the NRS for spending $25K for rosacea research grants. This means that the NRS spent 5.37% of its donations in 2018 on rosacea research. 

    Putting into Perspective How the NRS Spends Donations

    2018 donations were down from previous years with a total revenue of $465,042 (in the 21 years I have been following the NRS Form 990s, 2001 was the only year lower in donations). While acknowledging above that the NRS spent $25K for rosacea research, putting this into perspective is the fact for every dollar donated to the NRS in 2018 only a little more than a nickel (5 cents) was actually spent on rosacea research. What was the rest of the donations spent on? Answer: 

    93% of the donations were spent on two private contractors that are owned by the president/director of the NRS Sam Huff. Here is a screen shot of the names of the two private contractors shown on Form 990: 

    glendalepark2018.png

    How do we know that Glendale Communications Group, Inc and Park Mailing and Fulfillment, Inc belong to Sam Huff?  The Illinois Secretary of State gives the proof. As you can see from the screen shot above, Form 990, Schedule R, Line 2 shows the amount sent to these two corporations which is $432,408. Is this legal? Yes, of course. You didn't know that NON profit corporations can do this? If you want an education, read this post

    Here is a screen shot of Form 990, Part VII, Section A, Compensation which is interesting: 

    boardincome2018.png

    I didn't know that Zoe Draelos, MD who also serves on the RRDi MAC is now serving on the board of directors for the NRS. She received $2500 from the NRS in compensation. Good for her! Also Dr. Gallo who I have tried to contact to serve on the RRDi MAC to no avail also received $2500. Good for him!  Did you note how much Sam Huff receives? The RRDi would love to give Dr. Draelos $2500 but we didn't even receive half that amount in donations so all we can do is keep our website going and keep the RRDi afloat since our donations are quite meager compared to the donations given to the NRS.  

    One other very interesting item on the 2018 Form 990 the NRS has released is the amount of Excessive Contributions which has never been revealed in the twenty years I have been following NRS Form 990s. See below: 

    excesscontributions2018.png

     

    If you note the screen shot above it says **Do Not File** ***Not Open to Public Inspection*** which if I had paid accounting fees of $26,691 to my accountant as shown on the NRS Form 990 for 2018, Part IX, Statement of Functional Expenses, Line 11, c, it would pose a question why is this made public? We have never before had any indication the amount of donations the pharmaceutical companies give to the NRS. And if you note in Form 990, Part VI, Governance, Section B, Policies, Line 11a, please note the question, "Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?" and also note that 'yes' was checked. This is also restated in Form 990, Schedule O, where it shows the following line: 

    reviewedBoD2018.png

    If the pharmaceutical companies discover that the NRS has disclosed its Schedule A,  IDENTIFICATION OF EXCESS CONTRIBUTIONS, what might the consequences of this be?  I find it odd in the first place that 501 c 3 non profits are not required to disclose the identification of who is donating when it is obvious they are private contributions and not pubic donations. However, you know who makes the IRS rules for non profits? Probably nothing will become of this disclosure but I find it really interesting. 

    The only other interesting item I found was that the NRS reports an expense of advertising in the amount of $74,814 (Form 990, Part IX, Statement of Functional Expenses, Line 12. It also reports on Form 990, Part VIII, Statement of Revenue, Line 2a, Advertising Income in the amount of $85,000. I don't recall seeing any advertisements on the NRS website, but maybe I am missing something?  I wish I could figure out how to get advertising income for the RRDi. Does anyone know how this is done? Sure could use some help. 

    For a spreadsheet of all the years reviewedclick here

  10.  

    submityourpaper.png

    We are accepting articles from novice rosacea sufferers or health professionals on rosacea subjects to be published in the next edition of the Journal of the RRDi. There are no charges for submitting your article. However you will be required to join the RRDi to submit your article by clicking on the Sign up button and membership is a minimum of $2/month (discount to $1/month for three or more months). Our privacy policy is second to none. We are the most private rosacea member forum on the internet with ample security in our member forum. 

    You may follow the two steps below to begin the process to have your article reviewed, approved and published (scroll all the way down to view the TWO STEPS required to submit your article):

    step1.png

    (1) Step One
    Sign in or Sign up (RRDi Members Only)

    Look at the top right corner of your browser and either Sign up (if you have NOT registered, we also now allow Sign in with Apple) or Sign in (if you have already registered) - See screen shots below to understand what to look for to learn how to SIGN UP or scroll further down to see how to SIGN IN:

    signin.png

    signup.png

    The Sign in process REQUIRES you to confirm your email address

    step2.png

    (2) Step Two
    NOVICE ONLY (Professionals skip this and scroll on down)
    After you have registered an account and you are a novice and you are logged in, in the same category forum you are in now, ROSACEA RESEARCH, POST your article on rosacea. You are currently in the following category forum: 

    rosacearesearchforum.png

    Look for the button START NEW TOPIC (currently a blue button now) and click on it (see screen shot below): 

    startnewtopic.png

    Post your rosacea article and this starts the review process for novices only by clicking on the START NEW TOPIC green button.

    Novices this is all that is required. Professionals follow the directions below.

    PROFESSIONALS Only follow this step:

    If you are a professional health care provider, please,

    Submit your paper using this form

    We only accept Google .doc or MS Office Word .docx files, or portable data files (pdf).adobe_pdf.jpg
    Please convert your paper to pdf when submitting your paper if you are not using MS Office Microsoft Word. 

    You will be required to have a Google account, either your own Gmail account, or the RRDi will provide a free G Suite account upon request. If you are volunteering on the RRDi MAC a Google Workspace account will automatically be provided for you. All RRDi MAC consultants have been issued a free Google Workspace account and if you need assistance logging into your account contact us for assistance

    ISSUES WITH THESE STEPS

    If you are having any issues with the above steps CONTACT us describing your issue so we can assist you.  

  11. There are four Human Herpes Virus known that may have implications with rosacea which should be considered. They are Varicella zoster virus (VZV) (HHV)-3, Epstein-Barr virus (EBV)/ HHV- 4, Cytomegalovirus (CMV)/HHV-5, and Human herpes virus type 6 (HHV-6). [8] If you are suffering with any of these viruses and also have rosacea you may want to ask your physician about antiviral treatment drugs.

    Virus and Rosacea
    For more information

  12. Just an update on my venting in this thread, which started on April 8, 2019 (264 days this thread has been up and running) which now has 299 views as of this date (December 28, 2019). I have moved to Alabama and have begun going through the process of registering the RRDi in Alabama which is odd, because I recall one of the members of the board of directors for the Rosacea Research Foundation was a veterinarian living in Alabama. Very few rosaceans will recall all those events back in 2004 when two non profit organizations went in two separate directions. The RRF dissolved but David Pascoe still maintains its website and has now removed the names of those who served on the board of directors. 

    So I put out a request for any member of the RRDi who lives in Alabama to come forward and volunteer to sit on the board of directors and Johannes Schild has filled that spot so that we have two members on the board who are residents of Alabama. We could also continue to be registered in Hawaii if any RRDi member would volunteer to do that, but since volunteering is usually something that our RRDi members shy away from, I doubt if that would ever happen. I personally knew a friend in Hawaii who has rosacea and asked her to do that but she told me she was also leaving Hawaii next year and couldn't volunteer. So if anyone wants to keep the RRDi registered in Hawaii it would be good to contact me asap. 

    So this thread has had an average of just a little over 1 view a day since I initially posted my vent. Not too many care about reading my vent, and at least Apurva has replied to this thread (and I am happy for almost 300 views). However, I will continue my vent. Could one of you who reads this thread explain to me why you think hardly any of the RRDi members don't want to post in the public forum?  Why would 1200 plus members join the RRDi and then NEVER post? What is going on? 

    I thought since Facebook and Reddit were PRIVATE (social media groups for rosacea) and for some reason rosaceans prefer to be in private groups, the RRDi has sponsored a private rosaceans group but that has NOT been popular at all. We are spending $10/month to do this and it sure hasn't been used at all. I was thinking about making the public member forum we use through Invision Community into a PRIVATE forum. What are your thoughts about this?  

    The RRDi does have Facebook and Reddit groups but that hasn't proved popular at all. What are your thoughts about all this? Why the lack of posting by RRDi members?

  13. 314px-Demodex_mite_1.jpg
    Demodex Canis image courtesy of Wikimedia Commons

    Many 'authorities' say that mites on pets do not transfer to humans [1], but this is another example of the 'butterfly effect' in rosacea. While generally speaking mites on pets don't transfer to humans, we demonstrate with references that this myth is officially debunked. 

    mythdebunked.png.eac8ca5c06f8781410aed4e

    Most clinical papers on rosacea refer to only two demodex mite species found in humans, demodex folliculorum and demodex brevis. For example, Wired magazine in its article on demodex reports, "Our network of skin caverns offers food and shelter to two different species of mites: Demodex folliculorum and Demodex brevis." However, there are a large range of demodex mite species, one source says, "approximately 50,000 species have been described." [2] 

    In dogs there are at least three types of demodex, Demodex canis, D. injai and D. cornei. [3] There are different species of mites living on birds and rodents. In fact, just about all mammals have some species of demodex mites living on them. Can any of these mites, especially on pets transfer to humans? 

    The answer is yes. In rare cases this happens with various mites. In the case of scabies it is common.  

    "Humans occasionally become infested with zoonotic mites, which can cause discomfort and dermatitis. A few species can transmit diseases, such as human vesicular rickettsiosis. Mites from animals do not usually survive for very long on humans, and most zoonotic infestations are self-limiting...Some mites do not cause any apparent ill effects unless their population becomes unusually large. Other species, such as Sarcoptes scabiei, can result in clinical signs even when only a few mites are present...However, humans can be infested transiently by the scabies mites of a wide variety of domesticated and exotic animals, as well as by Notoedres cati. and Trixacarus caviae....Myobia musculi, Radfordia affinis and Radfordia ensifera (family Myobiidae) affect rodents. The eggs of myobiid mites are usually attached to the base of the hair on the host. These mites feed on tissue fluids, but can also feed on blood from capillaries at the surface of the skin. They are readily transmitted between hosts, and may also infest cats, dogs and people...Human infestations with mites such as Cheyletiella and Sarcoptes scabiei are reported occasionally. The transmission rate for S scabiei var canis from dogs to people is estimated to be 10-50%, and close, prolonged skin contact is the most important route of transmission. Cheyletiella mites from animals are also reported to bite humans readily; however, clinical signs may not be common, or possibly not recognized." [2]

    "A twenty-year-old girl student who feeds a Miniature Pinscher crossbred dog in her house for a while noticed common itchy papulopustular lesions, incrustation and some alopecic loci in her dog and admitted to Selçuk University Faculty of Veterinary Medicine, Department of Parasitology. Itchy papules and pustules were also observed in dog's owner face and arm about three or four weeks later. Skin scrapings and hair samples were taken from the patient and the dog and examined with light microscope. Adult and egg forms of Demodex spp. were detected in both patient and dog specimens in microscopic examination." [4]

    "Mange is a skin disease that is caused by two different species of mites. Sarcoptic mange is caused by Sarcoptes scabiei. Demodectic mange can be caused by several mites of the Demodex family. Sarcoptic mange is extremely itchy and highly contagious to other animals and humans. Demodectic mange is not as itchy, and while it can be transmitted to other dogs, it is not contagious to humans or cats." [5]

    "Scabies, an infestation by the itch or scabies mite, Sarcoptes scabiei var. hominis, remains a major public health problem worldwide and a common cause of PUO in returning travelers. The worldwide prevalence of scabies has been estimated to be about 300 million cases/y.  Although more often associated with crowding, homelessness, institutionalization, and immunodeficiency, scabies occurs worldwide in both sexes, at all ages, and among all ethnic and socioeconomic groups." [6]

    "Sarcoptes scabiei or the itch mite is a parasitic mite (an arthropod) that burrows into skin and causes scabies. The mite is found in all parts of the world. Humans are not the only mammals that can become infected. Other mammals, such as wild and domesticated dogs and cats (in which it is one cause of mange) as well as ungulates, wild boars, bovids, wombats, koalas, and great apes are affected." Wikipedia

    "Although host specific cross infections between humans and animals have been rarely reported, D. canis was determined to be more transmissible across species than the other Demodex mites as indicated in the literature. As a result, it is necessary and important to keep in mind about Demodex spp. infestation in patients with skin complaints and pet feeding." [7]

    "Two different mange mites cause skin disease in dogs. Although both share certain characteristics, it is important not to confuse the two types of mange, because they have different causes and treatments, and one can be passed to humans. The two types are demodectic mange, caused by the mite Demodex canis and sometimes just called demodex, and sarcoptic mange, caused by infestation of the mite Sarcoptes scabiei and sometimes called scabies...The sarcoptic mange mite can be transmitted to humans who come into contact with a dog infested with sarcoptes." [7]

    "The parasite [Sarcoptes scabiei] can be transmitted from dog to dog and can pass from dogs to humans, although it doesn’t thrive on non-canine hosts." [8]

    "Although dogs and humans live in close contact, there have beenfew reports suggesting transmission of dog mites to their own-ers, and to our knowledge, none that definitively confirmed that the mites found on the human patient were D. canis and not D. folliculorum or D. brevis. However, the patients involved were younger than would be expected for detectable Demodex presence. In addition, D. canis was found to survive and repro-duce in dog skin engrafted onto SCID mice, but did not spreadto the surrounding mouse skin. [9]

    Conclusion
    Generally speaking it is rare for humans to contact mites from pets, but it can happen as the above sources cited indicate. Usually, the only species of demodex mites found on humans are demodex folliculorum and demodex brevis, but in some rare cases cited above, other mite species are found, with the exception of scabies, as noted above, which effects millions of humans.  

    Anecdotal Evidence
    This thread started by soapbubble1 is anecdotal evidence establishing demodectic transfer in humans. If you have further anecdotal evidence why not find the reply button and post your experience. 

    Etcetera
    What is the difference between demodex, dust mites, bed bugs and scabies?

    Demodex Update

    Why do demodex like human skin?

    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] There are several examples of this, for example the Miami Herald has an an article entitled, Mange mites not transmittable between dogs and humans.

    The Illinois Department of Public Health has an article on mites and states, "Most mites never come in contact with humans, but some that do can affect a person’s health." The article does not mention demodex mites. 
    Mites Affecting Humans

    "No, demodectic mange is not contagious to other animals or humans."
    Demodectic Mange in Dogs, Ernest Ward, DVM; Updated by Amy Panning, DVM, VCA Hospitals

    "Additionally, demodex mites found on cats and dogs do not spread to humans."
    Feline Demodex, Catherine Barnette, DVM, VCA Hospitals  

    [2] Acariasis, Mange and Other Mite Infestations, June 2012
    The Center for Food Security and Public Health, Institute for International Cooperation in Animal Biologics, College of Veterinary Medicine, Iowa State University

    [3] Demodex canis, Arachnida, Canine Parasites and Parasitic Diseases, Science Direct 

    [4] Mikrobiyol Bul. 2018 Apr;52(2):214-220. doi: 10.5578/mb.66410.
    [A dog related Demodex spp. infestation in a student: a rare Demodex case].
    Esenkaya Taşbent F, Dik B.

    [5] Mange in Dogs
    a.k.a. Sarcoptic mange, Demodectic mange, scabies, etc
    PETCOACH EDITORIAL

    [6] Journal of Travel Medicine, Volume 17, Issue 1, 1 January 2010, Pages 21–31,
    Mite‐Transmitted Dermatoses and Infectious Diseases in Returning Travelers 
    James H. Diaz, MD, MPH&TM, Dr PH

    [7] Dog mange called scabies can transfer to humans, Dr. Wes Borgman, Orlando Sentinel

    [8] Mange: What You Need to Know, Mar Bovsun, American Kennel Club

    [9] Journal of European Academy of Dermatology and Venereology [Full Text]
    Demodex: a skin resident in man and his best friend
    R. Foley, P. Kelly, S. Gatault, F. Powell

  14. sugarfire.png
    Sugar image and Fire image courtesy of Wikimedia Commons

    The RRDi is the only non profit organization for rosacea that lists sugar and carbohydrate as rosacea triggers (see the RRDi Trigger Factor List). Search all you can and you won't find either one listed on the other non profits for rosacea trigger lists. Why do you think this is the case? 

    There is ample anecdotal evidence from rosacea sufferers that reducing sugar and carbohydrate in the diet improves rosacea while ingesting huge amounts of sugar and carbohydrate triggers rosacea. Trigger factors are simply discovered by anecdotal reports from rosacea sufferers in surveys and polls. 

    What many rosacea sufferers don't understand is that sugar is carbohydrate, which is simply carbon plus water. All carbohydrate is just different forms of sugar, i.e., glucose, fructose, lactose, etc. 

    There are absolutely no essential nutrients in carbohydrate, none. Increasing sugar/carbohydrate into your diet is a rosacea trigger. Sugar is the fire that burns your rosacea, the fuel for your inflammation. High Sugar Content Leads to Inflammation.

    If you are skeptical about this why not try eliminating or reducing sugar/carbohydrate in your diet for 30 days and see if your rosacea improves. Then eat a significant amount of sugar/carbohydrate in the diet after this 30 day experiment and notice what happens. Most rosaceans will not try this simple experiment to see if sugar/carbohydrate is triggering rosacea because most are addicted to sugar. Yes, sugar is an addition. For those septics, they will have to find another way to control their rosacea. 

    Trigger avoidance is an accepted medical treatment offered by most physicians who parrot the NRS Trigger Factor List. However, you will be hard pressed to find a physician who parrots the NRS Trigger Factor List to mention you should avoid sugar/carbohydrate. The RRDi Trigger Factor List is much more extensive and continues to grow as more anecdotal evidence comes in from rosacea sufferers. Just picture in your mind that sugar is the fuel that is burning your rosacea. If you reduce the fuel that is burning your rosacea, you will help put the rosacea fire out.  

    Etcetera

    Sugar And Rosacea

    Sugars to Avoid

    Anecdotal Reports of Sugar/Carbohydrate Avoidance

     

  15. 274px-Rotavirus_Reconstruction.jpg
    Rotavirus image courtesy of Wikimedia Commons

    Virus and Rosacea has never, ever been ruled out as a cause. Cite one paper that concludes virus is not a cause of rosacea. Why can't you find any paper that states this?

    Bacteria has been implicated in rosacea with a huge amount of clinical papers on this subject. Demodex is now without a doubt linked to a significant number of rosacea cases. At least one fungus has been associated with rosacea [1], and we have papers indicating treatment for one particular protozoa improves rosacea, however viruses have not been ruled out in rosacea, nor archea, for that matter. The human microbiome includes the skin which contains a number of different microbes, including virus. 

    To help understand why virus should be considered in a differential diagnosis of rosacea which includes a very long list, take measles as an example, which most people do not associate with a virus. The medical name for measles is 'Measles Virus', [aka morbilli, rubeola, red measles, and English measles]. "Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses."  "A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms." [9] There are other diseases that you may not be aware of that are caused by virus such as smallpox, polio, cowpox, and influenza, all of these diseases can appear with facial erythema. "Viral infections are responsible for some of the most common dermatologic presentations in adults such as oral and genital herpes, warts, and a wide variety of exanthems." [10]

    There are other virus to consider that the symptoms include erythema or pimples on the facial skin, such as HIV, Herpes, Poxvirus, and this list continues. It is possible that a virus may be at the root of some cases of rosacea to consider and should be ruled out, but what physician considers ruling out virus in rosacea?  Without any doubt some virus diseases do indeed present with erythema as mentioned.  Could rosacea be caused by a virus? 

    Virus and Rosacea

    Virus are very tiny compared to other microbes, on average 100 times smaller than bacteria.* Viruses are in bacteria, demodex, fungus, archea, and throughout the human body in the blood, as well as human cells and comprise more number in the human body than bacteria by a factor of ten times. [2] Virus are in plants, animals, insects, fish, in the oceans, and comprise more number on planet earth than any other life form including all the animals on land or fish in the sea combined! [2]

    There are scant few, if any, clinical papers on virus and rosacea. There are a huge number of clinical papers on bacteria and rosacea and if you can find any paper on virus and rosacea, please find the reply button and give the link to the paper! Wouldn't you think that a microbe that numbers ten times more as the bacteria in the human body deserves some kind of investigation as to whether virus has anything to do with rosacea? 

    One theory on the cause of rosacea involves a disorder of the innate immune system [3] and one paper explains what happens: 

    "Recognition of bacteria and viruses [bold added] initiates the inflammatory cascade involving the release of cytokines, recruitment of immune cells, and production of AMPs and ISGs. AMPs and ISGs represent one of the most important and robust immune mechanisms in the skin. However, pathogenic bacteria—such as S. aureus—and cutaneous viruses [bold added] have evolved mechanisms to counteract innate immune mechanisms."  [4]

    Cytokines and Rosacea are being investigated and cytokines are released due to a virus response. 

    As you can see from the above example which is typical, the focus is usually, if not always, on bacteria with a token mention of virus. Most, if not all clinical papers on rosacea rarely mention the word virus and focus mostly on bacteria. Our investigation found scant few papers that mention virus and rosacea which we list in the next subheading.  

    Coronavirus and Rosacea

    Clinical Papers Mentioning Virus Associated with Rosacea

    "Granulomatous rosacea has been reported in children as well as adults, and in association with infection with the human immunodeficiency virus (HIV)." [5] Herpes Simple, a virus, has been associated with granulomatous rosacea. [6]

    "Two months after the beginning of the anti-retroviral treatment, the patient developed a progressively extending facial eruption resembling rosacea." [7]

    Human Herpes Virus

    There are four Human Herpes Virus known that may have implications with rosacea which should be considered, since there are absolutely no papers ruling out human herpes virus and rosacea. They are Varicella zoster virus (VZV) (HHV)-3, Epstein-Barr virus (EBV)/ HHV- 4, Cytomegalovirus (CMV)/HHV-5, and Human herpes virus type 6 (HHV-6). [8] If you are suffering with any of these viruses and also have rosacea you may want to ask your physician about antiviral treatment drugs. [8]

    Bacteriophage

    Scoll below for information on bacteriophage, a virus (third post). 

    Anti-viral Treatments Shown Successful in Treating Rosacea

    Ivermectin (also shown effective in treating rosacea)

    Acylovir (papers about treating rosacea with Acylovir

    Hydroxychloroquine is a novel therapeutic approach for rosacea (see also the fifth post in the current thread you are reading now). 

    Hydroxychloroquine Suppresses LL37-induced Mast Cells

    Imiquimod Cream [possible anti-viral treatment]  (read the fourth post in the current thread you are reading).

    Conclusion

    There are numerous clinical papers discussing the innate immune system reaction to rosacea and without a doubt, information about this subject enhances our knowledge on rosacea. However, because of a scientific bias towards bacteria ignoring virus (when virus has ten times more number in the human body than bacteria), this bias continues to influence and support more bacteria research on rosacea than researching virus. There needs to be more clinical studies done on virus and rosacea. Since virus has never been ruled out in causing rosacea, who would support such an investigation? Would you? Just think if 10K members of the RRDi each donated one dollar and insisted on supporting a reputable clinician to study virus and rosacea, what might be discovered? 

    Reply to this Topic

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

    End Notes

    [1] Candida Albicans

    [2] Number of different virus

    "There are 219 virus species that are known to be able to infect humans."
    Philos Trans R Soc Lond B Biol Sci. 2012 Oct 19; 367(1604): 2864–2871.
    Human viruses: discovery and emergence
    Mark Woolhouse, Fiona Scott, Zoe Hudson, Richard Howey, and Margo Chase-Topping

    "The results of a new study suggest that at least 320,000 different viruses infect mammals."
    How many viruses on Earth?, Vincent Racaniello, virology blog

    "...more than 6,000 virus species have been described in detail of the millions of types of viruses in the environment. Viruses are found in almost every ecosystem on Earth and are the most numerous type of biological entity."
    Virus, Wikipedia

    "There are more viruses than stars in the universe..."
    National Geographic, April 15, 2020

     Human Microbiome, Brady Barrows

    [3] Immune System Disorder Theory

    [4] PLoS Pathog. 2018 Dec; 14(12): e1007353.
    Innate antimicrobial immunity in the skin: A protective barrier against bacteria, viruses, and fungi
    Margaret Coates, Sarah Blanchard, and Amanda S. MacLeod
    Deborah A. Hogan, Editor

    [5] The granulomatous reaction pattern
    David Weedon AO MD FRCPA FCAP(HON), in Weedon's Skin Pathology (Third Edition), 2010

    [6] JAAD, January 2015Volume 72, Issue 1, Pages e36–e37
    Granulomatous rosacea manifesting after herpes simplex 2 infection: A case of Wolf's isotopic response
    Kaitlyn N. Mula, DO, Nicole M. Cassler, MD, Jeffrey N. Lackey, MD

    [7] Dermatology 2002;205:394-397
    Ivermectin-Responsive Demodex Infestation during Human Immunodeficiency Virus Infection, A Case Report and Literature Review
    C. Aquilina, R. Viraben, S. Sire

    [8] Four Human Herpes Virus May be Implicated in Rosacea
    The 4 Common Viruses That Can Trigger Thyroid, Autoimmune, and Brain Problems, Dr. Will Cole

    [9] Measles, Wikipedia

    [10] Curr Dermatol Rep. 2020; 9(2): 152–165.
    New Developments in Bacterial, Viral, and Fungal Cutaneous Infections
    Samuel Yeroushalmi, Joshua Yoseph Shirazi, Adam Friedman

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

    *How Tiny Are Virus?
    Some authorities say ever smaller. "Personally, I always liked the metaphor that if a cell was a baseball stadium, a virus is the size of the ball..."
    So Just How Tiny Is a Virus? By Stuart Fox

    "Viruses are usually 20 to 300 nm. That is as tiny as we- an average human being are to the Earth."
    How tiny is tiny?, Neha Patil, The University of Melbourne

    "Named after the Latin word for small – parvus – viruses in the Parvoviridae family are just 23-28 nanometres (nm) in diameter."
    KEEPING UP WITH VIRUS TAXONOMY: SMALL VIRUSES, EXTRA SMALL VIRUSES AND A VIRUS USED TO PROTECT AGAINST FUNGAL DISEASE, by Laura Cox, Microbiology Society

    "Most viruses vary in diameter from 20 nanometres (nm; 0.0000008 inch) to 250–400 nm; the largest, however, measure about 500 nm in diameter and are about 700–1,000 nm in length." Virus, Size and shape, Encyclopedia Britanica

    ________________________________

    1 Millimeter (mm) = 0.1 Centimeter [or 1000 Micrometers (μm)] (one thousandth of meter)
    1 Centimeter (cm) =  0.01 meter (one hundredth of a meter) [ or 10 Millimeters (mm)]
    1 Micrometer (μm) = 0.0001 Centimeter [or 0.001 Millimeter (mm)] (or one millionth of a meter)
    1 Nanometer (nm) = 0.001 Micrometer (μm) (or one billionth of a meter)

  16. Acne_vulgaris_on_a_very_oily_skin.jpg
    image courtesy of Wikimedia Commons

    Acne Vulgaris is a completely different disease from rosacea, however some authoritative sources report that acne vulgaris can co-exist with rosacea.[1] In past literature, 'acne rosacea' was the term used to describe adult acne, and, this term is sometimes still used. [2] However, rosacea is generally confined to the facial area while acne vulgaris can be not only on the facial area but also on the trunk (chest and back). Treatments for acne usually irritate or exacerbate rosacea and is one of the differentiating diagnostic marker for a rosacea diagnosis. [3]

    According to the American Academy of Dermatology, acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent, but can also affect adults in the 20s, 30s and 40s. [4] Usually when pimples and pustules are present physicians treat acne vulgaris with acne (condition) treatments. [5] Acne is technically a condition while acne vulgaris is a disease.

    When acne treatments exacerbate the condition usually this indicates Rosacea Phenotype 4, changing the diagnosis in the patient and switching the treatment to rosacea. [6] This naturally begs the question, what is the difference between acne and rosacea? [3] 

    A proper diagnosis needs to be from a physician. [7]

    "The infiltration of γδT cells was significantly increased in rosacea and acne lesions and positively linked with almost all hub genes. These identified hub genes and immune cells may play a crucial role in the development of rosacea and acne." [8]

    End Notes

    [1] "It should be noted, however, that it is possible for acne vulgaris and rosacea to appear at the same time in the same patient." Medscape

    [2] “It is interesting that the original term for rosacea was “acne rosacea”, which has more features in common with acne than currently realized. If the “acne” portion had been retained in the later works, rosacea might have received much greater investigative attention.” A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman, M.D., Ph.D. Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.

    [3] What is the difference between acne and rosacea?

    Diagnosing Acne vs. Rosacea (Stanford Medicine 25)

    [4] Rosacea 101: Includes the Rosacea Diet, page 2, Brady Barrows

    [5] "If self-care remedies don't clear your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist)." Acne, Symptoms and Causes, Mayo Clinic

    [6] "Your doctor may prescribe an oral antibiotic such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acnelike lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects." Rosacea, Symptoms and Causes, Mayo Clinic

    [7] Diagnosing Rosacea

    [8] PubMed RSS Feed - -Exploring the association between rosacea and acne by integrated bioinformatics analysis

  17. There has been at least three pharmaceutical companies researching and testing a topical minocycline foam or gel for rosacea. We await to see the results of these clinical trials and if these are effective and which one will be released first. It looks like Foamix, a subsidiary of Menlo Therapeutics, has announced Amzeeq (for acne) and Zilxi (for rosacea) as the front runners if you scroll past this post and go to post number five in this thread. We will continue to follow the other 'horses' in this race. 

    foamix_logo.jpg.b7fe788391363851a7e3f0d3zilxi.png.648d89f1d21970bfb6af75e572886bamzeeq400.png

    (1) FMX103 Topical Minocycline FoamFoamix Ltd

    biopharmx.png.57cf68a03667e38a48ba57f675

    (2) BPX-04 Minocycline Topical Gel 1%BioPharmX, Inc.

    havione.png.ef67d02f6ce39fbda9782cac2d09

    (3) HY-01 Minocycline Gel 3%, Hovione

     

  18. 200px-Hybridogenesis_in_water_frogs_gametes.svg.png
    image courtesy of Wikimedia Commons

    A genome-wide association study (GWAS) of rosacea symptom severity was conducted by Aponte et al [1] that concluded "All associations with rosacea were novel except for the HLA locus. Two of these loci (HERC-OCA2 and SLC45A2) and another precedented variant (rs1805007 in melanocortin 1 receptor) with an association P value just below the significance threshold (P = 1.3 × 10-7) have been previously associated with skin phenotypes and pigmentation, two of these loci are linked to immuno-inflammation phenotypes (IL13 and PSMB9-HLA-DMA) and one has been associated with both categories (IRF4). Genes within three loci (PSMB9-HLA-DMA, HERC-OCA2 and NRX3-DIO2) were differentially expressed in a previously published clinical rosacea transcriptomics study that compared lesional to non-lesional samples. The identified loci provide specificity of inflammatory mechanisms in rosacea, and identify potential pathways for therapeutic intervention." 

    "In genetics, a locus (plural loci) is a specific, fixed position on a chromosome where a particular gene or genetic marker is located." Wikipedia

    "With the completion of the Human Genome Project in 2003 and the International HapMap Project in 2005, researchers now have a set of research tools that make it possible to find the genetic contributions to common diseases." [2]

    "Genome wide association studies (GWAS) are a relatively new approach to analyzing genetic sequence and have quickly become a fundamental part of modern genetic studies. Their purpose is to determine alleles that correlate to different diseases and traits." [3]

    "Despite clear successes in identifying novel disease susceptibility genes and biological pathways and in translating these findings into clinical care, GWAS have not been without controversy. Prominent criticisms include concerns that GWAS will eventually implicate the entire genome in disease predisposition and that most association signals reflect variants and genes with no direct biological relevance to disease." [4]

    End Notes

    [1] Hum Mol Genet. 2018 Aug 1;27(15):2762-2772. doi: 10.1093/hmg/ddy184.
    Assessment of rosacea symptom severity by genome-wide association study and expression analysis highlights immuno-inflammatory and skin pigmentation genes.
    Aponte JL, Chiano MN, Yerges-Armstrong LM, Hinds DA, Tian C, Gupta A, Guo C, Fraser DJ, Freudenberg JM, Rajpal DK, Ehm MG, Waterworth DM.

    [2] Genome-Wide Association Studies Fact Sheet, NHGRI, NIH

    [3] Genome Wide Association Studies (GWAS), Genetics Generation

    [4] Nature Reviews Genetics, ISSN 1471-0064 (online)
    Benefits and limitations of genome-wide association studies
    Vivian Tam, Nikunj Patel, Michelle Turcotte, Yohan Bossé, Guillaume Paré & David Meyre

     

  19. demodex.jpg
    Image of Demodex Folliculorum courtesy of National Geographic - by Darlyne A. Murawski

    Galderma reports that treatment with Soolantra improves rosacea. This is usually the same with treatment using the ZZ cream

    There are substantial anecdotal reports that treatment for demodectic rosacea by reducing the number of mites shows it gets worse before it gets better. 

    The Theory Behind This Logic
    The logic behind this is that killing the demodex mites causes a die-off of the mites that takes weeks to accomplish since new eggs are being hatched each day and the "life cycle of demodex mites consists of five phases of development and lasts from 14 to 18 days". [1] Furthermore because the movement of the mites has been shown to be "at a speed of 8-16 mm/h" [2] they may leave the area being treated and return later while planting eggs along the route. During the initial treatment which may take weeks some of the mites are reported to be killed which may cause inflammation and worsen the skin. One explanation of this is the "Jarisch–Herxheimer reaction" (JHR) which has been "traditionally associated with antimicrobial treatment of syphilis." [3] The principle of JHR may indicate a reason why it gets worse before it gets better. One source comments on this by stating, "And while the JHR only technically relates to spirochetal infections (spiral-shaped bacteria) and antibiotics, the concept of symptom-onset or worsening after starting treatment with antimicrobials has been seen to apply more broadly in clinical practice. This is why you’ll often hear practitioners talk about a Herx-reaction, even if it isn’t scientifically accurate. But, what we call ‘die-off symptoms’ is certainly something we see commonly when clients begin addressing bacteria, parasites and yeast pathogens using natural antimicrobials." [4] Most reports indicate that it takes eight to twelve weeks to achieve clearance. 

    It is not uncommon in medical treatment that 'it gets worse before it gets better,' such as in treating acne, which the Mayo Clinic states, "With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely," or in immunotherapy, 'it gets worse before it gets better.'  In fact, immunosuppressive treatments may actually increase demodex mites! [11] When treated with isotretinoin for acne, one reports states, "Some patients experience an initial worsening of their acne in the first month of treatment; less commonly, isotretinoin can induce acne fulminans." [13]

    One article explains, how this might happen when treatment is for demodex mites: 

    "Rosacea often improves with antibacterial drugs that don’t affect the mites, such as tetracyclines. Kavanagh thinks this is because rosacea is caused by a reaction to bacteria in the mite’s faeces." Antibiotics do not kill demodex mites but likely treats the bacteria the mites carry. [5]

    Furthermore, there are at least six types of bacteria that have been associated with demodex mites, and bacteria has been implicated for a long time with rosacea. [6] At least one fungus has been associated with rosacea [7]. Viruses have not been ruled out in rosacea. There are very little, if any, clinical studies done on virus and rosacea. Viruses are in bacteria and throughout the human body and comprise more in number in the human body than bacteria by a factor of ten times. [8] For that matter, other microbes haven't been studied either, such as protozoa or archea. There is much to learn about the human microbiome and as more research is done, new insights are learned. 

    Ivermectin, the active ingredient in Soolantra and in horse paste is an insecticide that kills parasites, including mites. There is evidence that data suggests it does indeed get worse before it gets better. [14]

    Sulfur in the ZZ cream has been used for decades to treat rosacea and kill the mites as well. [12] 

    More study should be done on why treatment for demodectic rosacea seems in many cases to get worse before it gets better.

    Nevertheless, reducing demodex density counts in rosacea improves the patient with rosacea. [9] Just think if 10K members of the RRDi each donated one dollar and insisted on supporting a reputable clinician to study what they wanted, supporting their own research, what might be discovered? This can only happen if you want it to happen. Or you can continue to do nothing and let the status quo research continue on. [10]

    Rosacea Forum
    Severe-die-off-from-zz-after-first-use

    In the above thread, Mothinrust had an initial immediate reaction of getting worse and then one month (1/18/2020 post no 35) later posts, "But I do think it helping my skin so much....So I take the vast improvement as a sign of better things to come...."  He posted a total of eleven posts in the thread.

    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] Demodex Update
    Subheading, The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea, third paragraph 

    [2] Russian Study on Demodex Mites and Rosacea Illuminating, (2) The report confirms the size and movement of demodex, second paragraph

    [3] Jarisch–Herxheimer reaction, Wikipedia

    [4] Pathogen & Parasite Die-Off Symptoms: How to manage detox side-effects, Bella Lindemann, June 24, 2019

    [5] Rosacea may be caused by mite faeces in your pores, Debora MacKenzie, New Scientist

    [6] Bacteria Associated with Rosacea and Demodex Mites

    Bacteria Theory

    [7] Candida Albicans

    [8] Human Microbiome, Brady Barrows 

    [9] Decreasing Demodex Density Count Improves Rosacea

    What are the numbers?

    [10] Rosacea Research in Perspective of Idiopathic Diseases
    Rosacea Research in Perspective of Funding

    [11] Immunosuppressive Treatments May Increase Demodex Mites

    [12] The Health Benefits of Sulfur, Cathy Wong, VeryWellHealth

    [13] Clin Cosmet Investig Dermatol. 2019; 12: 943–951.
    Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience
    Vincenzo Bettoli, Aurora Guerra-Tapia, Maria Isabel Herane, and Jaime Piquero-Martín

    [14] Continuous Improvement With Ivermectin Long-term Use - Gets Worse Before it Gets Better

  20. 240px-Healthy_Human_T_Cell.jpg
    Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor.
    Image courtesy of Wikimedia Commons

    Chronic Mucocutaneous Candidiasis (CMC) "is an immune disorder of T cells, it is characterized by chronic infections with Candida that are limited to mucosal surfaces, skin, and nails." [1] One report states, "Heterozygous STAT1 gain-of-function (GOF) mutations result in a combined form of immunodeficiency which is the most common genetic cause of chronic mucocutaneous candidiasis (CMC)." [2] This same report connects "chronic demodicosis in the form of a facial papulopustular eruption, blepharitis, and chalazion" with CMC. This could also be described as demodectic rosacea

    Candida has been connected to rosacea in at least one paper. [3]

    End Notes

    [1] Wikipedia

    [2] Pediatr Dermatol. 2019 Oct 21;
    STAT1 gain-of-function and chronic demodicosis.
    Molho-Pessach V, Meltser A, Kamshov A, Ramot Y, Zlotogorski A

    [3] Candida Albicans

  21. 233px-Venlafaxine_structure.svg.png
    The skeleton structure of the SNRI venlafaxine, a typical example of an antidepressant.
    image courtesy of Wikimedia Commons

    "I’d never heard of antidepressants causing any issues with skin, which made me wonder if anyone else was having the same issue and just putting up with it in silence – or if the whole thing was in my head. I chatted with Dr Zubair Ahmed, the CEO of MedicSpot digital clinics, who confirmed that yes, antidepressants can absolutely cause or worsen skin conditions. ‘These skin issues range from innocent facial flushing to life threatening systemic rashes such as Stevens-Johnson syndrome,’ Dr Ahmed told metro.co.uk. ‘You may also notice purple dots on your skin (Purpura) or a condition called urticaria which is often due to an allergic reaction. ‘Eczema is also associated with antidepressant medication.’ "

    How your antidepressants might be messing with your skin, Ellen Scott, Metro

    Chai reports a serious rosacea flareup after withdrawing from mirtazapine.

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