Guide

Diffuse lissamine green staining in a person with severe dry eye. 
Image Wikimedia Commons

A paper published in the Journal of Women's Health addresses the prevalence of DED in women and highlights a significant opportunity for action if earlier diagnosis and treatment of this common but burdensome condition is obtained that could significantly improve a woman's quality of life. As the Mayo Clinic observes, "Ocular rosacea may affect the surface of your eye (cornea), particularly when you have dry eyes from a deficiency of tears."

The comprehensive paper concludes, "Women are diagnosed with DED at earlier ages, and progression to severe forms of the disease is more prevalent in women than men. Thus, earlier diagnosis of DED in women may result in a significant improvement in their quality of life."

If you have rosacea and DED it would be prudent to see your dermatologist as soon as possible. 

J Womens Health (Larchmt). 2019 Apr 1; 28(4): 502–514.
Dry Eye Disease: Consideration for Women's Health
Cynthia Matossian, MD, FACS, Marguerite McDonald, MD, FACS, Kendall E. Donaldson, MD, MS, Kelly K. Nichols, OD, MPH, PhD, Sarah MacIver, OD, and Preeya K. Gupta, MD

image Wikimedia Commons

Someone at RF posted a subject, 'Random flareup from steak alleviated with propranolol?' and here was my response: 

beherenow, glad the propranolol helped your flareup. 

It is important to eliminate what actual food is triggering your flareup, as well as defining the flareup, whether you mean a rosacea flareup or a flushing flareup, since flareup means different things to Rosaceans. For example, while you mention celery juice and a lot of water, understanding what an elimination diet is all about will help, since not everyone agrees what an elimination diet is. For example, there are a number of lists proposed what food/drink triggers rosacea, the most known list is the NRS list. Steak/hambuger is not on the list, and you would be hard pressed to find any rosacea trigger list or anecdotal report with steak/hamburger mentioned, but I urge you to find some to substantiate your suggestion. However, LIVER is at the top of the the NRS list. 

Trigger factors that are listed are all anecdotal or taken from patient histories and therefore possibly helpful, but extremely subjective. There has never been one rosacea diet trigger factor that produces a rosacea flareup in every rosacean, not one. Any proposed rosacea diet trigger is just that, a proposed factor. It may be helpful to others to read about such diet triggers to see if avoiding 'steak/hamburger' or whatever improves their rosacea flareups or it may not. For example, on the NRS list rosaceans have reported that Liver, Yogurt, Sour Cream, Cheese, Eggplant, and Spinach are "Factors That May Trigger Rosacea Flare-Ups," however, you will be hard pressed to find any clinical study indicating scientific proof, and the key word is MAY. 

Another factor to consider is that rosacea diet triggers may be cumulative over a certain number of days. You have to consider what you have been eating/drinking cumulatively over the last three to five days. For example, let's say you have been eating/drinking fruit smoothies as well as celery juice over the past three to five days and have accumulated a huge amount of fructose (which is converted to glucose) in your blood. Fructose, as well as any other sugar is also a rosacea diet trigger proposed by the RRDi which the NRS totally ignores. So there is a lot to consider in determining what is actually triggering your flareup when it comes to rosacea diet triggers. Drugs, and as you mentioned the environment, stress, and a lot other factors are proposed to be rosacea trigger factors.

Ivermectin treatment for rosacea was first announced by Galderma in its February 2015 release of Soolantra. Since then this prescription topical treatment for rosacea has had much success. Sometime around 2017 the first reports of using horse paste topically for rosacea containing 1.87% ivermectin began circulating in rosacea social media groups and this has spread further so that thousands have reported success in treating their rosacea. There are some reports of using oral ivermectin to treat rosacea. There are reports that oral ivermectin along with oral metronidazole is more effective than oral ivermectin alone. The RRDi recommends that if you decide to treat your rosacea with ivermectin to discuss this with your physician, preferably a dermatologist, since not only is ivermectin prescribed as a prescription medication for rosacea, it is easily available online without a prescription, i.e., horse paste. One of the problems with posters on this subject of using topical horse paste is that it is common for the poster to not reveal what brand of horse paste (gel) they are using so we wanted to know what brand is the most popular one being used to treat rosacea which, hopefully, if enough rosaceans take this poll, we can get an idea which brands are the more popular. 

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Found this discussion pertinent to this thread. If anyone has anything to post about using any of the Kiss products for rosacea other than mchatham, please share. 

Autosensitization dermatitis when it appears on the face can be indistinguishable from rosacea, hence a rosacea mimic. 

"Autosensitization dermatitis presents with the development of widespread dermatitis or dermatitis distant from a local inflammatory focus, a process referred to as autoeczematization." Wikipedia

"The term autosensitization dermatitis was coined in 1921 by Whitfield to describe reaction patterns ranging from a generalized, erythematous, morbilliform, and urticarial eruption after blunt trauma to a generalized, petechial, papulovesicular dermatitis after the acute irritation of chronic stasis dermatitis."
Chapter 17. Autosensitization Dermatitis, Fitzpatrick's Dermatology in General Medicine, Donald V. Belsito

A case in point is recorded in the Journal of the American Academy of Dermatology  about a 46 year old woman who was initially diagnosed with rosacea and later diagnosed with Autosensitization dermatitis. 

A new rosacea mimic has emerged called Autosensitization dermatitis which is indistinguishable from rosacea when it appears on the face. It is now added to the list of skin conditions that need to be differentiated from rosacea, which list keeps growing. So what is it?

"Autosensitization dermatitis, or id reaction, is a cutaneous phenomenon in which an acute secondary dermatitis develops at a location distant from a primary inflammatory focus." [1] This also called 'Autoeczematization.'

The case of a 46-year-old woman (with photos) published in the Journal of the American Academy of Dermatology was initially diagnosed as papulopustular rosacea but resistant to all usual treatments for this disease which included topical and oral metronidazole, several oral tetracyclines, isotretinoin, ivermectin, topical dapsone with oral metronidazole. Later, she was found to have a rosacea-like id reaction in response to an oral infection after treatment with amoxicillin-clavulanate.

This case indicates that there are difficult cases to treat due to not obtaining a correct diagnosis initially. 

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End Notes 
[1] JAAD Case Rep. 2019 May; 5(5): 410–412.
Autosensitization dermatitis: A case of rosacea-like id reaction
Sarah D. Ferree, BA, Connie Yang, BA, and Arianne Shadi Kourosh, MD, MPH

"Our results demonstrate that in eyelashes with CD, the prevalence of Demodex brevis is higher than that of Demodex folliculorum. We also found that the number of Demodex spp. increases with age and that females are attacked more easily than males by Demodex spp. In patients with CD eyelashes, the severity of eyelid congestion was exacerbated by the prevalence and number of Demodex spp."

J Ophthalmol. 2019; 2019: 8949683.
The Prevalence of Demodex folliculorum and Demodex brevis in Cylindrical Dandruff Patients
Jing Zhong, Yiwei Tan, Saiqun Li, Lulu Peng, Bowen Wang, Yuqing Deng, and Jin Yuan

"Sarecycline (trade name Seysara; development code WC-3035) is a tetracycline-derived antibiotic. In the United States, it was approved by the FDA in October 2018 for the treatment of moderate to severe acne vulgaris". Wikipedia

"Sarecycline (Seysara™) is an oral, once-daily, tetracycline-class drug for which a tablet formulation is approved in the USA for the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris in patients aged ≥ 9 years. The drug was developed by Paratek and Allergen and later acquired by Almirall S.A. (a Barcelona-based pharmaceutical company focused on medical dermatology). Sarceycline tablets were approved in early October 2018 and are planned to be available for patients in January 2019. Sarecycline capsules have also been studied in the USA, but no recent reports of development have been identified for this formulation. There are currently no clinical trials underway assessing sarecycline in rosacea."

"There are currently no clinical trials underway assessing sarecycline in rosacea.....For moderate to severe and inflammatory acne vulgaris, oral antibacterials are standard care components, with tetracyclines and macrolides usually preferred. However, these agents have certain limitations, among which are photosensitivity (tetracyclines), adverse vestibular effects (minocycline), gastrointestinal disturbances (particularly with macrolides and doxycycline), dysbiosis and microbial resistance concerns." 

Drugs. 2019; 79(3): 325–329.
Sarecycline: First Global Approval
Emma D. Deeks

There is now a paper showing the results of "pharmacokinetics and safety studies": 

"14 Phase I pharmacokinetics and safety studies were performed on 378 patients with moderate-to-severe acne vulgaris exposed to sarecycline, with and without food (tablets and capsules)."

Future Microbiol. 2019 Sep; 14(14): 1235–1242.
Sarecycline: a narrow spectrum tetracycline for the treatment of moderate-to-severe acne vulgaris
Angela Yen Moore, Jean Elizze M Charles, and Stephen Moore

"Concurrent improvement of ocular surface conditions observed in patients treated for rosacea of their face, led to the potential implementation of intense pulsed light (IPL) for the treatment of MGD (meibomian gland dysfunction). IPL has been widely used in dermatology to treat various conditions such as rosacea, benign vascular lesions, and pigmented lesions....Patients with low meibum expressibility and tear film instability experienced greater improvement in symptoms after IPL treatment. The improvement in meibum expressibility was also associated with a decrease in tear inflammatory cytokine levels. Therefore, meibum expressibility improvement might be a good therapeutic target of IPL treatment in patients with MGD and DED, and could be an indicator of ocular surface inflammation during IPL treatment."

Sci Rep. 2019; 9: 7648.
Meibum Expressibility Improvement as a Therapeutic Target of Intense Pulsed Light Treatment in Meibomian Gland Dysfunction and Its Association with Tear Inflammatory Cytokines
Moonjung Choi, Soo Jung Han, Yong Woo Ji, Young Joon Choi, Ikhyun Jun, Mutlaq Hamad Alotaibi, Byung Yi Ko, Eung Kweon Kim, Tae-im Kim, Sang Min Nam, and Kyoung Yul Seo

Lex Gillies, Beauty Blogger, has a new article published in Refinery29,  Have Chronic Rosacea – This Is The Only Skincare Routine That Helps.

Her official website: 
https://talontedlex.co.uk

image courtesy of WikiMedia Commons

A clinical study has confirmed that the most common allergens rosacea patients suffer contact dermatitis are the following ingredients: 

Octyl Gallate

Dodecyl Gallate

tert-Butylhydroquinone

Thimerosal

Euxyl K400 (Methyldibromo glutaronitrile)

Cocamidopropyl betaine (CAPB)

2,6-Di-tert-butyl-4-cresol (Butylated hydroxytoluene)

The study concluded, "This study shows that rosacea patients show a strikingly high prevalence of contact sensitization to cosmetic allergens. We recommend the additional use of cosmetic series for patch testing, and the careful use of cosmetics in rosacea patients if cosmetic contact sensitivity is suspected." [1]

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End Notes

[1] J Cosmet Dermatol. 2019 May 20;:
Contact sensitization to cosmetic series of allergens in patients with rosacea: A prospective controlled study.
Ozbagcivan O, Akarsu S, Dolas N, Fetil E

The RRDi has collected a number of cosmetics to consider in your search by using our affiliate store. 

Thanks for your clearer explanation. If I understand correctly the steps would be the following in your case: 

(1) Demodex are living in normal numbers without any indication of rosacea. These mites secrete bioactive molecules that inhibit TLR2 expression in sebocytes. 

(2) You have immunocompromised cellular immunity, due to whatever, i.e., stress, poor diet, lack of exercise, virus, flu, and the list goes on and on....

(3) The mites increase in number 

(4) The immune system goes into hyperdrive due to the higher density of mites resulting in inflammation (reciprocal correlation) further increasing the mites density numbers

Please correct me if I got this wrong. 

For years, the RRDi has quoted posts of rosacea sufferers from other websites, particularly RF. We never have received any complaints. Recently the RRDi posted some quotes of rosacea sufferers from Facebook with the names to acknowledge the source of the quote and discovered that some of the posts at Facebook groups are in a private exclusive group and you have to get permission to quote these particular posts. The RRDi did not know that private Facebook groups are different from public Facebook groups. 

Our intent was to help rosacea sufferers. One particular project was to get a list of the positive posts about using horse paste and some negative posts. We didn't realize that this offended the posters who gladly posted in their private, exclusive group that either the horse paste worked for them or it was a negative post about horse paste. So upon request, we have removed all these posts. There are other interesting posts in these private, exclusive Facebook groups that we gleaned by browsing these groups and posted and quoted these helpful items here and have removed the names of the posters upon request. Our intent was not to hurt or embarrass any rosacea sufferer. Our intent is to help rosacea sufferers. 

The RRDi complies with requests for removal of certain published material on the internet from our website. Our legal disclaimer clearly outlines the step for takedown procedures. We have a solid privacy policy and respect everyone's privacy. 

However, for those of you who may not understand the legality of this issue, you may want to read these two answers to the following two questions: 

Can You Quote or Use Someone Else’s Facebook Posting?

Question: Is it illegal to quote someone without permission?

On 5/17/2019 at 1:49 AM, Apurva Tathe said:

In my view, normal skin also has demodex mites but less in number so they can't activate pro-inflammatory cytokines but when the number is more they activate it. so logically when the normal skin flora has demodex before rosacea has occured so demodex apparently came first and because demodex mites cause inflammatory immune response and inflammatory immune response is not just related to mites but self-antigen presentation to immune cells rather than non-self which is false immune response or we call it autoimmune response and attacks to healthy cells and so the false immune response might be the cause of increasing number of demodex .So demodex and rosacea have reciprocity with each other to increase its effects and outcomes.

That is difficult to follow. In a paper by Powell, et al, it is stated that the mites "secrete bioactive molecules that reduced TLR2 expression in Sebocytes." The 'bioactive molecules' that the mites secrete keep the innate immune system from reacting to the mites when in normal numbers on normal skin, so my question is what causes the demodex to proliferate in greater numbers to what you say,  "cause inflammatory immune response" ?  

Could you better explain what you mean by "self-antigen presentation to immune cells rather than non-self which is false immune response? ?

While it has been reported that topical ivermectin has better results than topical metronidazole for rosacea, there is at least one paper you should consider reading if you are considering taking oral ivermectin and metronidazole for rosacea.  There are other papers showing the safety of using oral ivermectin which has safely been administered to adults and children all over the world. 

Oral Ivermectin for Rosacea
A paper published by the International Journal of Infectious Diseases that compared taking 200 micro-grams Ivermectin per Kilogram of body weight of oral ivermectin once a week in one group (1) of sixty rosacea patients with another group (2) of sixty rosacea patients who received a combined therapy of the same amount of ivermectin along with 250 mg of oral metronidazole three times a day. The results were that the second group (2) improved better than the first group (1).  For more information

There are other papers published mentioning oral ivermectin which are listed below in the subheading, Oral Ivermectin for Demodectic Rosacea, which will be updated as more papers are discovered. If you know of any other papers, please post your findings in this thread. Click the REPLY button and add your finding. 

Ivermectin History
Some may be concerned about taking ivermectin orally. It is interesting to note that ivermectin has been around since the late 1970s and half "of the 2015 Nobel Prize in Physiology or Medicine was awarded jointly to Campbell and Ōmura for discovering avermectin, 'the derivatives of which have radically lowered the incidence of river blindness and lymphatic filariasis, as well as showing efficacy against an expanding number of other parasitic diseases' " Wikipedia

Ivermectin is "a dihydro derivative of avermectin—originating solely from a single microorganism isolated at the Kitasato Intitute, Tokyo, Japan from Japanese soil...originally introduced as a veterinary drug...has led many to describe it as a “wonder” drug....few drugs that can seriously lay claim to the title of ‘Wonder drug’, penicillin and aspirin being two that have perhaps had greatest beneficial impact on the health and wellbeing of Mankind....But ivermectin can also be considered alongside those worthy contenders, based on its versatility, safety and the beneficial impact that it has had, and continues to have, worldwide—especially on hundreds of millions of the world’s poorest people....Despite decades of searching around the world, the Japanese microorganism remains the only source of avermectin ever found. Originating from a single Japanese soil sample and the outcome of the innovative, international collaborative research partnership to find new antiparasitics, the extremely safe and more effective avermectin derivative, ivermectin, was initially introduced as a commercial product for Animal Health in 1981." [1]

While there are no long term clinical studies done on ivermectin use with rosacea, there are papers showing the long term effects of oral ivermectin in school-age and pre-school children treated for helminths. [2] There are also papers written about the long term effects of treating humans with ivermectin on other parasites, i.e., scabies.  

'Intriguingly, IVM has a diverse range of effects in many different organisms, far beyond the endoparasites and ectoparasites it was developed to control. For example, IVM has been shown to regulate glucose and cholesterol levels in diabetic mice, to suppress malignant cell proliferation in various cancers, to inhibit viral replication in several flaviviruses, and to reduce survival in major insect vectors of malaria and trypanosomiasis. Clearly, much remains to be learned about this versatile drug, but the promise of more sustainable strategies for current helminth-control programmes and novel applications to improve and democratise human health, are compelling arguments to pursue this cause." [3]

"Evidence suggests that oral ivermectin may be a safe and effective treatment for scabies". One article says "A Single, Oral Dose of Ivermectin Cures Scabies". [4] Two oral doses of ivermectin was found to be just as effective as a single topical application of permethrin in treating scabies. [5]

"When given orally, ivermectin can be used for treating head or pubic lice and scabies (an itchy, highly contagious skin disease caused by mites burrowing in the skin). Oral ivermectin is useful to control outbreaks of scabies in nursing homes where whole-body application of topical agents is difficult. Ivermectin's greatest impact on human health has been in Africa. Since 1987, in addition to its use for other parasitic infestations, ivermectin has been used extensively to control onchocerciasis with 1.4 billion treatments so far. Onchocerciasis is also called "river blindness" because the blackfly that transmits the disease breeds in fast-moving streams and rivers." [6]

In an article in The New York Times, Scabies Means Misery. This Pill Can End It., it states, "Nonetheless, the drug is considered safe enough to give to almost everyone except the youngest infants and pregnant women."

"This meta-analysis gives strong evidence that IVM 1% cream is the most effective topical treatment above other alternatives and it satisfies the impairment of social and working life with a sustained better QoL." [13]

A brand name for ivermectin is Stromectol. "Never take ivermectin in larger amounts, or for longer than recommended by your doctor. Follow all directions on your prescription label. Take ivermectin on an empty stomach, at least 1 hour before or 2 hours after a meal. Ivermectin is usually given as a single dose. Take this medicine with a full glass of water. To effectively treat your infection, you may need to take ivermectin again several months to a year after your first dose." [15]

"Studies conducted in children or infants have shown good tolerance of ivermectin." [17]

"Presently ivermectin is used to treat strongyloidiasis, scabies, pediculosis, gnathostomiasis, myiasis, and leishmaniasis. In addition, other studies have shown that ivermectin can be used to reduce the prevalence and spread of other infectious diseases linked to a helminthic parasites transmitted through soil such as strongyloidiasis, ascariasis, trichuriasis, and enterobiasis hookworm, Trichuris and Ascaris. These diseases have been identified as major cause of death for underdeveloped children with poor nutrition and retarded growth. Topical administration of ivermectin to children also reduced the prevalence of head lice and scabies. Moreover, ivermectin has also been shown to be effective in the treatment of Papulopustular rosacea (PPR), a human skin disease characterized by transient pustules and facial erythema." [19]

"Treatment with oral ivermectin and topical metronidazole cream resulted in a symptom-free period of 22 months. This case represents an unusual presentation of symptomatic Demodex infestation." [20]

Oral Ivermectin for Demodectic Rosacea

"A diagnosis of Demodex folliculitis was made, and the patient was prescribed 2 doses of oral ivermectin, 200 μg/kg, spaced 1 week apart. All pustules, swelling, and erythema resolved 2 weeks after the start of the first dose of ivermectin (Fig 3), and all scaling resolved after an additional week without further treatment. She did not require use of any topical medications and did not have any further facial rashes after treatment." [9]

"We report the case of a 12-year-old girl who presented with severe ocular and cutaneous rosacea unresponsive to oral doxycycline, oral isotretinoin, and topical tacrolimus. A biopsy specimen showed numerous mites within the folliculosebaceous unit. Treatment with a single dose of oral ivermectin achieved resolution of her symptoms." [10]

"The aim of this retrospective study was to assess the benefit and tolerability of oral and topical ivermectin therapy in pediatric PPR and POD....In conclusion, both oral and topical ivermectin were well tolerated and beneficial for treatment of both PPR and POD in this small group of children." [11]

"Ivermectin, both oral and topical, has been effective in treating rosacea of various subtypes. In particular, a case of recalcitrant oculocutaneous rosacea in an immunocompetent patient with Demodex folliculorum colonization achieved resolution with a single dose of oral ivermectin. An individual with recalcitrant papulopustular rosacea and evidence of numerous Demodex organisms on histologic examination benefited from oral ivermectin and topical permethrin cream.34 Gnatophyma, a rare variant of phymatous rosacea involving the chin, was treated with oral ivermectin, oral tetracycline, and metronidazole cream with satisfactory results (Table 1)." [12]

"All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg)." [14]

One paper in noting the efficacy of oral ivermectin alone in comparison with oral ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of demodex folliculorum concluded the oral ivermectin-metronidazole combined therapy was superior. [16]

"However, this patient still had a very good response to oral ivermectin and metronidazole gel, and all clinical symptoms disappeared within 4 weeks after treatment." [21]

Oral Ivermectin Safely Administered

"Over one billion treatments of ivermectin alone or co-administered with albendazole have been delivered in large-scale preventive chemotherapy programmes against lymphatic filariasis and onchocerciasis since 2000." [18]

Cost
"The wholesale cost in the developing world for the tablets is about US$0.12 for a course of treatment. In the United States, the costs is less than US$50." Wikipedia

"The direct cost of a pack of 100mg tablets of ivermectin is approximately $2.90 with a unit price of 0.029 per tablet. These costs are subject to variations in different countries." [18]

Conclusion
The above facts show there are a substantial number of humans globally who have taken oral ivermectin, including children.  

Horse Paste
With the craze of rosaceans using horse paste to treat rosacea topically (containing 1.87% ivermectin), there is at least one report of oral horse paste treatment for Lyme disease in Facebook by a poster. [7] Another website suggests taking oral ivermectin and using topical horse paste to treat scabies. [8]

Anecdotal Reports
ElaineA has a post worth reading on this subject, Oral Ivermectin, getting diagnosed and a prescription. Another poster, eringael, reports success using oral ivermectin/metronidazole. She also has some incredible photos in this thread worth looking at. She has updated her results in this post. 

BPRMFC at RF started a thread of using oral Ivermectin and Moxidectin. 

More information on oral ivermectin.

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End Notes

[1] Proc Jpn Acad Ser B Phys Biol Sci. 2011 Feb 10; 87(2): 13–28.
doi: 10.2183/pjab.87.13
PMCID: PMC3043740; PMID: 21321478
Ivermectin, ‘Wonder drug’ from Japan: the human use perspective
Andy CRUMP and Satoshi ŌMURA

"When doctors in the USA prescribe ivermectin for scabies that is called an "off-label" use. This is not unusual and it is generally legal.   Once a drug has been FDA approved for one disease or use, a doctor can prescribe it for any other use they choose to. Read more about "off-label use" in Wikipedia here. Wikipedia says "Off-label use is generally legal unless it violates specific ethical guidelines or safety regulations, but it does carry health risks and differences in legal liability." In other words, if the doctor thinks it is unethical to prescribe ivermectin or that he might get sued for prescribing it, he probably won't." In Depth Information On Ivermectin, MaximPulse, Green Dept

[2] PLoS Negl Trop Dis. 2008 Sep; 2(9): e293.
Published online 2008 Sep 10. doi: 10.1371/journal.pntd.0000293
PMCID: PMC2553482; PMID: 18820741
Impact of Long-Term Treatment with Ivermectin on the Prevalence and Intensity of Soil-Transmitted Helminth Infections
Ana Lucia Moncayo,  Maritza Vaca,  Leila Amorim,  Alejandro Rodriguez,  Silvia Erazo,  Gisela Oviedo,  Isabel Quinzo,  Margarita Padilla,  Martha Chico,  Raquel Lovato,  Eduardo Gomez,  Mauricio L. Barreto,  and Philip J. Cooper  

[3] Trends in Parasitology
Volume 33, Issue 6, June 2017, Pages 463-472
Ivermectin – Old Drug, New Tricks?
Roz Laing. Victoria Gillan. Eileen Devaney

[4] CDC, Scabies, Medications

A Single, Oral Dose of Ivermectin Cures Scabies
NEJM Journal Watch, September 1, 1995

[5] Ann Parasitol. 2013;59(4):189-94.
The efficacy of permethrin 5% vs. oral ivermectin for the treatment of scabies.
Ranjkesh MR, Naghili B, Goldust M, Rezaee E.

Difficult-to-treat scabies: oral ivermectin

[6] Oops! I Just Took My Dog's Heartworm Medicine
Ivermectin Safety, National Capitol Poison Control 

[7] Post number five in this thread (posted May 2, 2019)

[8] Ivermectin to cure scabies, Maximpulse, Green Dept

[9] JAAD Case Rep. 2019 Jul; 5(7): 639–641.
Perioral Demodex folliculitis masquerading as perioral dermatitis in the peripartum period
Dema T. Alniemi, MD and David L. Chen, MD

[10] JAMA Dermatol. 2014 Jan;150(1):61-3. doi: 10.1001/jamadermatol.2013.7688.
Severe demodexfolliculorum-associated oculocutaneous rosacea in a girl successfully treated with ivermectin.
Brown M, Hernández-Martín A, Clement A, Colmenero I, Torrelo A.

[11] JAAD, March 2017, Volume 76, Issue 3, Pages 567–570
Ivermectin therapy for papulopustular rosacea and periorificial dermatitis in children: A series of 15 cases
Lucero Noguera-Morel, MD, Paula Gerlero, MD, Antonio Torrelo, MD, Ángela Hernández-Martín, MD

[12] Clin Cosmet Investig Dermatol. 2016; 9: 71–77.
Published online 2016 Mar 18. doi: 10.2147/CCID.S98091
PMCID: PMC4807898
PMID: 27051311
New developments in the treatment of rosacea – role of once-daily ivermectin cream
Leah A Cardwell, Hossein Alinia, Sara Moradi Tuchayi, and Steven R Feldman

[13] Dermatol Ther. 2019 Dec 20;:e13203
Efficacy of topical ivermectin and impact on quality of life in patients with papulopustular rosacea: A systematic review and meta-analysis.
Husein-ElAhmed H, Steinhoff M

[14] Indian J Ophthalmol. 2020 May;68(5):745-749
Demodex blepharokeratoconjunctivitis affecting young patients: A case series.
Patel NV, Mathur U, Gandhi A, Singh M

[15] Ivermectin, drugs.com

[16] Int J Infect Dis. 2013 May;17(5):e343-7. doi: 10.1016/j.ijid.2012.11.022.  Epub 2013 Jan 5.
Evaluation of the Efficacy of Oral Ivermectin in Comparison With Ivermectin-Metronidazole Combined Therapy in the Treatment of Ocular and Skin Lesions of Demodex Folliculorum
Doaa Abdel-Badie Salem , Atef El-Shazly, Nairmen Nabih, Youssef El-Bayoumy, Sameh Saleh

[17] Arch Pediatr. 2016 Feb;23(2):204-9.  doi: 10.1016/j.arcped.2015.11.002. Epub 2015 Dec 14.
Safety of Oral Ivermectin in Children
A Chosidow, D Gendrel 

[18] WHO Expert Committee on the Selection and Use of Essential Medicines: Application for inclusion of ivermectin on the WHO Model List of Essential Medicines (EML) and Model List of Essential Medicines for Children (EMLc)for the indication of Scabies
Submitted: December 2018

[19] Pharmaceuticals (Basel). 2020 Aug; 13(8): 196.
Avermectin Derivatives, Pharmacokinetics, Therapeutic and Toxic Dosages, Mechanism of Action, and Their Biological Effects
Gaber El-Saber Batiha,1, Ali Alqahtani, Omotayo B. Ilesanmi, Abdullah A. Saati, Amany El-Mleeh, Helal F. Hetta, and Amany Magdy Beshbishy

[20] J Cutan Pathol. 2020 Nov;47(11):1063-1066
Aymptomatic vulvar demodicosis: A case report and review of the literature.
Hedberg ML, Chibnall RJ, Compton LA

[21] PubMed RSS Feed - -Demodicosis Imitating Acne Vulgaris: A Case Report

This post has been promoted to an article. 

Thanks Apurva for your research and investigation into this. Hope some substantiate your findings. 

"Melaleuca viminalis, commonly known as weeping bottlebrush, or creek bottlebrush is a plant in the myrtle family..." Redirect for Callistemon viminalis

Melaleuca viminalis image courtesy of Wikimedia Commons

Hi Peter, 

This question comes up a lot about coffee and is a FAQ answered here. We hope you continue to post and ask questions. As for cigars, we have no data on cigars and rosacea but obviously is probably not a healthy habit to keep. As for creams for rosacea, suggest you search our non prescription forum or check out our online store. 

    Find a dermatologist!
Image courtesy of Wikimedia Commons

The American Academy of Dermatologists is one of the premier, most distinguished organizations that produces a medical journal and sponsors conventions for their prestigious members each year. The AAD is a 501 c 3 non profit organization that in 2015 received $33 million dollars in revenue (donations) and spent $34 million dollars in expenses. If you carefully review the total amount of research grants spent in 2015 in its Form 990 you will see it spent a little over $1 million dollars so that amounts to 3 percent of its revenue. What that means, to put this into perspective about research, is that for every dollar received by the AAD three cents is spent on research! What amount went to rosacea research is anyone's guess, but if you have the volunteer spirit you could figure that out and report what you find in this thread. If you have the heart to figure out how much was spent on actual rosacea research by the AAD in 2015 you would probably find that the amount was not very much. The AAD focuses a lot on many other skin diseases, but sometimes has articles on rosacea in its journal, and a lot more articles on acne rather than rosacea. AAD rosacea research would be a tiny, tiny part of the one million dollars spent in 2015, so tiny that it would be difficult at best to obtain a figure. 

What does the AAD spend most of its donations on?

The AAD spent approximately $17.3 million on salaries, employees, employee benefits, and payroll taxes. $5.6 million was spent on conferences, conventions and meetings. You can read below how the AAD spent the rest of the donations. The point is that 97% of the money spent by the AAD was NOT spent on research and what was spent benefited dermatologists, not the general public. 

Read the Form 990 for 2015:
410793046_201512_990.pdf

Do you have any comments on the AAD and how this non profit spends its donations?

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

The skin industry, of course, is the primary sponsor of rosacea research papers published in the medical journals, as Dr. Kligman points out and who commented that such papers are "perhaps not the most credible source of unbiased research.' It takes a lot of deep investigation to find the source of funding of a clinical paper published in a medical journal but if you have the time and patience you can discover who funded the research paper published. For example if you check out this article published in the Dermatology Online Journal you can find that one of the authors, Eckert M. Mendieta works at the Department of Dermatology, Clínica Dermitek, which is part of the 'skin industry.'

Dermatol Online J. 2016 Aug 15;22(8). pii: 13030/qt9ks1c48n.
Treatment of rosacea with topical ivermectin cream: a series of 34 cases.
Mendieta Eckert M, Landa Gundin N. 

Another example is a paper discussing a SPF‐30 facial moisturizer for rosacea whose authors are employees of either Galderma, Bayer, L'Oreal and La Roche‐Posay published in the Journal of Cosmetic Dermatology. [1] 

While we have shown a couple of examples of who is funding rosacea research we are still grateful for ANY rosacea research funding and can glean useful information from these published papers. The status quo research papers are without a doubt funded primarily by the skin industry, included in this are the few non profit organizations for rosacea since with the exception of the RRDi, these non profits are heavily funded primarily by the pharmaceutical skin industry. Joel T. Bamford, MD, wrote an article in the Journal of the Rosacea Research & Development Institute, Is it possible for rosaceans to do research?, which encourages his recommendation that Rosaceans should get together and sponsor their own research independent of the skin industry. What a novel idea? And that is why the RRDi was formed so that a non profit organization for rosacea should be established by Rosaceans who suffer from rosacea, and not like the other non profit organizations for rosacea who are established and run by NON rosaceans. If enough rosaceans got together, say 10,000 members, and each donated one dollar, they could sponsor their own double blind, placebo controlled, peer-reviewed rosacea research clinical papers independent of the skin industry.

End Notes

[1] J Cosmet Dermatol. 2019 Dec; 18(6): 1686–1692.
Published online 2019 Feb 25. doi: 10.1111/jocd.12889
PMCID: PMC6916358
PMID: 30803131
A novel moisturizer with high sun protection factor improves cutaneous barrier function and the visible appearance of rosacea‐prone skin
Hilary Baldwin, MD,  Francine Santoro, MD, Nadege Lachmann, PhD,  and Sandrine Teissedre, MSc 

Positive Anecdotal Reports of Soolantra

MagnificenT, the Rosacea Forum, posts, "I have been using it for 4 weeks now, and I am literally shocked how my skin improved during this time. There are no more discolorations, redness decreased by 70% (I'm pinkish now, but it looks healthy), I can take a shower without going super red, and in general I no longer feel this discomfort, tightness, and dryness. After a disastrous experience with Mirvaso, I need to pay thanks to the creators of this drug, it gave me a relief I needed so much."

17 hours ago, Apurva Tathe said:

I never used horse paste or any ivermectin during my medications. I have type I followed by type 2 rosacea but most of the time type I only with the coexisting condition of seborrheic blepharitis and antibiotics work wonder if you take it orally and apply it topically as well and it completely cured me of seborrheic blepharitis and does not exacerbate the rosacea.

Thanks for you post. Never heard of seborrheic blepharitis. I have heard of seborrheic dermatitis. When I used the search feature at Wikipedia for seborrheic blepharitis, it redirected me to 'blepharitis' and I found this quote, "Different variations of blepharitis can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic." 

Anecdotal Reports of Using Horse Paste for Rosacea - You Decide Positive or Negative?

Found one neutral anecdotal report at Rosacea Tips and Support Group, Facebook but you will just have to find it. 

The RRDi complies with requests for removal of certain published material on the internet from our website. However, for those of you who may not understand the legality of this issue, you may want to read the following post:

The Legality of Quoting a Post at Facebook or Another Internet Source

Negative Anecdotal Reports of Using Horse Paste for Rosacea

There are a few negative reports at Facebook Groups, i.e., Rosacea (English), Rosacea (English), Rosacea Tips and Support Groups, as well as Reddit r/Rosacea,  but you will have to join these groups to find the negative anecdotal reports since they are few and far between, and very difficult to find. Of course, you will always find negative reports, just like you do with Soolantra and any other rosacea treatment. The negative posts are way less than the positive reports for horse paste. 

If there are more negative ones or a significant number of them then you should be wary. So far, with horse paste the negative ones are few. 

The RRDi complies with requests for removal of certain published material on the internet from our website. However, for those of you who may not understand the legality of this issue, you may want to read the following post:

The Legality of Quoting a Post at Facebook or Another Internet Source

Positive Anecdotal Reports of Using Horse Paste for Rosacea

There are many, many positive reports at Facebook Groups, i.e., Rosacea (English), Rosacea Tips and Support Groups, as well as Reddit r/Rosacea,  but you will have to join these groups to read the anecdotal reports. 

The RRDi complies with requests for removal of certain published material on the internet from our website. However, for those of you who may not understand the legality of this issue, you may want to read the following post:

The Legality of Quoting a Post at Facebook or Another Internet Source

Here are some public statements at Facebook about using horse paste for rosacea: