Guide

So, we suggest that the combined therapy works better than ivermectin alone on cases with different skin lesions and anterior blepharitis.

In conclusion, the combined therapy was superior in decreasing the D. folliculorum count in all groups and in reducing the mite count to the normal level in rosacea and in blepharitis lesions, while the two regimens were comparable in reducing the mite count to the normal level in acne and peri-oral dermatitis lesions.

International Journal of Infectious Diseases
Volume 17, Issue 5, May 2013, Pages e343-e347
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 Salema, Atef El-shazly, Nairmen Nabih, Youssef El-Bayoumy, Sameh Salehc

I just checked this post today, May 6, which has not been a month since I initially posted this vent I am still on, and there has been 68 views of this post totaled up today. So since Apurva Tathe is the only one who replied to this thread (just in case you don't know how to reply to this thread there is a green button at the top of the thread to the right - see below) I thought maybe some of you need some help understanding how a forum works with replying to a post?

Or you can scroll all the way to the bottom of the thread and you will see 'Reply to this topic' and just start typing (in both cases you need to be registered and logged in).

Anyway, I thought I would continue my vent. I have been browsing Reddit and Facebook to see where all the rosaceans have gone and have discovered that there are some huge rosacea groups formed and how these are extremely popular to use. For example, at Reddit r/rosacea has 7.9K members (I tried posting there and one of the moderators was extremely rude and would not reason with me and denigrated the RRDi repeatedly so I simply left this group). I joined Reddit r/SkincareAddition (954K members) and am appalled that anyone can try to sort through this group for help with rosacea since it covers so many different skin conditions. Facebook Rosacea (in English) has 6.6K members, while Rosacea Tips and Support Group has 7.4K members. Facebook to me has a friendlier atmosphere over Reddit (for example, I simply recommended that in one of the many inquiries, IS THIS ROSACEA?, to see a dermatologist I was chastised and rudely told to mind my own business). So far, in Facebook the rosaceans there are more respectful and kindlier than the Reddit rosaceans. The most appalling discovery in all this is the lack of rosacea knowledge. Most rosacea newbies, of course, haven't a clue what rosacea is, and the vast majority are trying to learn about it through Reddit or Facebook and the search feature at either one is dreadful. Of course, they don't know what to search for in the first place, but the most FAQs are, Is this Rosacea?, What Moisturizer?, Should I get Laser? (or LED or IPL, etc.), What is Horse Paste?, Asking about Rosacea Triggers, especially IS COFFEE A TRIGGER?, and usually asking about a particularly over the counter treatment for rosacea or a particular prescription treatment. As you can see, the RRDi has been answering these questions since 2004 and has grouped all these questions into logical categories and areas in the member forum or in the research articles. Why rosaceans prefer Facebook and Reddit over having all these questions in a forum in categories boggles my mind. What is it about Facebook and Reddit that appeals to these rosacea newbies?  It is so difficult to find what you are looking for in either one. Total chaos yet rosaceans love it. Your thoughts on all this?  

Second, is the fact that since the 1200 plus members of the RRDi simply don't want to volunteer and post or do anything that the RRDi funds are dwindling (and since our non profit is so transparent you can view the financial situation that the RRDi is in).

At the present rate of spending, we have enough to last a little over a year. I am hoping for a donation from Demodex Solutions, but Walter apparently hasn't had the success he used to have when the ZZ cream was one of the more popular demodectic rosacea treatment around (horse paste has taken over), so I can't count on his support. There simply isn't enough members purchasing our Amazon Affiliate items to keep the RRDi afloat.

There simply are no donations to speak of in the last few years. Members don't donate. If the 1200+ members each donated a dollar that would keep us going for over a year and half. 

Going through the hoops to get a Galderma Education Grant is a huge amount of volunteer time and I may try going through the hoops again but you should try it and see how difficult Galderma makes this process and they only offer the RRDi a $2K grant if you qualify. Would anyone of you want to volunteer to do this and keep half the money (the RRDi has to keep half to keep this ship afloat!!!). However, if you can get one of these education grants from Galderma through the RRDi you can keep half the money which means $1K in your pocket! We have been offering this for a long time and some volunteers have tried and given up rather quickly because you really have to be patient and meticulous to follow all the instructions from Galderma, not to mention the multiple forms and bureaucratic steps required to get the grant. All you do is contact me and I will set you on course on how to do this. 

So the handwriting is on the wall. The days of the RRDi are numbered since volunteering is just not popular anymore as it was in 2004 when the RRDi started. There are no Warren Stuarts or other helpful volunteers. The other board members are busy and involved with their own responsibilities to be able to volunteer very much at all. The MAC Members are the same. Actually the MAC Members are one of the Crown Jewels of the RRDi, however, I cannot really bother them since when I do some quit and want their name removed so I have learned to not bother them unless I have something pertinent to their speciality like asking them a question I know they know the answer. It is amazing they have offered to volunteer for the RRDi and give me their personal contact information and I can ask them rosacea questions. What a resource!  

Then there is the wealth of rosacea data on this website. Huge amount of rosacea data. All this will be gone unless we either (1) get volunteers to keep this going, (2) get some donations to keep this going, or, (3) you come up with another solution. 

This is not to mention why the RRDi was formed in the first place, which a lot of you rosacea newbies haven't a clue about. We do have a history of the RRDi if you are interested. So since I did mention this, yes, this is still a venting session for me, you may need to understand rosacea research and get a perspective on this. First read the post, Rosacea Research in Perspective of Funding and then read Rosacea Research in Perspective of Idiopathic Diseases. Do you really want the NRS and the AARS to keep the status quo rosacea research that the pharmaceutical companies keep funding?  Do you want a non profit organization for rosacea patient advocacy to fund some novel rosacea research? Unless you form another non profit organization for rosacea that is better than the RRDi, at this point, the RRDi is the only choice. So please consider what is in this entire thread, about what I just vented about and please post a comment in this thread. Do you have any thoughts on this? 

image courtesy of WikiMedia Commons

Rosacea has been associated with other diseases and the list just keeps growing. This is referred to in medicine as systemic comorbidities. What this means for you to understand is this requires even more research needed to understand why rosacea is associated with these diseases and knowing how confounding factors are used in the investigation. For further investigation and seeing the list, put on your diving cap for a deep dive investigation and click here. 

Rosacea has been associated with a number of other diseases and the list keeps growing. Another paper shows an association of chronic kidney disease and rosacea which we just added to the list of Systemic Cormorbidities in Rosacea.

To learn more about associated diseases with rosacea, read the article, Rosacea Theories Revisited and scroll down to the subheading, Associated Diseases. 

This question comes up a lot since many who have dry skin want a moisturizer that doesn't exacerbate their rosacea, so which moisturizer? The RRDi has collected a number of moisturizers that have been reported to work for some and listed in our non profit store and also in: 

Forum Home >  Forums >  Public Forum >  Rosacea Topics > Non Prescription > Moisturizers 

Most of the ones listed are those who rosaceans report works for them. We hope if you find a moisturizer that works for you that you will post this in this thread by simply clicking the reply button and share it with fellow rosacea sufferers who are asking the same question. 

NOTE: The reports on using horse paste is to apply it TOPICALLY,  and NOT orally. 

However there is an anecdotal report posted on Facebook who requests anonymity (who gave permission for this screen shot) says her friend ingests horse paste for Lyme disease on the advice of her 'tropical disease consultant.'  Here is a screen shot of the post: 

We have a post on oral ivermectin. 

Naltrexone, a prescription drug, is "sold under the brand names ReVia and Vivitrol among others, is a medication primarily used to manage alcohol or opioid dependence." Wikipedia

There are anecdotal reports that it reduces flushing, neuropathic rosacea, neurogenic rosacea, and improves phenotype 1. 

Reduces Flushing
We have a post on LDN here to avoid flushing which has some additional information on that subject.  

There is a thread at RF that some are taking this for rosacea in low dose tablets, which you may want to follow. If you discovered this here at the RRDi and find low dose naltrexone helps your rosacea, can you please post in this thread this is where you learned about it and post your results here? 

Anecdotal Reports 

Judworth posts, "I have responded really well to LDN and knocked my flushing and nerve pain down by about 85%!"

Sineadrosy started a thread on this subject with others discussing their experience.

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

Image courtesy of Wikimedia Commons

Demodetic Rosacea has a long history. For example, note the following quote in a paper written in 1886:
"From these and other statements it is seen that in suggesting the thought that these minute forms of life are etiological factors in even some of the phases of acneform diseases, I shall be but little in accord with the highest authorities. In antagonism to these views, I may say that the results of my observations appear to indicate a close relationship of the parasites with the diseased condition."
Demodex Folliculorum in Diseased Conditions of the Human Face
Proceedings of the American Society of Microscopists, Vol. 8, 1886, page 123, Published by: Wiley-Blackwell

According to Google Scholar a paper, Simon 1842, is cited by at least 38 articles that mention demodex foliculorum. 
Simon G (1842), Ueber eine in den kranken und normalen haarsacken des menschen lebende milbe.
Arch Anat, Physiol u Wissensch Med 11: 218–237.

"D. folliculorum and D. brevis are typically found on humans. D. folliculorum was first described in 1842 by Simon; D. brevis was identified as separate in 1963 by Akbulatova. D. folliculorum is found in hair follicles, while D. brevis lives in sebaceous glands connected to hair follicles." Wikipedia

For more information on demodectic rosacea 

Crotamiton is used mainly to treat scabies which is caused by the Sarcoptes scabiei mite and there are a few articles showing Crotamiton improves rosacea. For more information click here. 

Crotamiton is used mainly to treat scabies which is caused by the Sarcoptes scabiei mite and there are a few articles showing Crotamiton improves rosacea. If you are using crotamiton or know of any other articles like the ones below, please post in this thread. That is what volunteering is all about. Share your rosacea knowledge with other rosaceans. 

"After clinical manifestations, the mites may be temporarily eradicated with topical insecticides, especially crotamiton cream, permethrin cream, and also with topical or systemic metronidazole. In severe cases, such as those with HIV infection, oral ivermectin may be recommended." [1]

"When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole." [2]

"The skin lesions resolved after treatment including systemic metronidazole, topical metronidazole, crotamiton, or gamma benzene hexachloride." [3]

"Patients with these skin conditions markedly improved with the use of topical crotamiton twice daily, regardless of results from a KOH test for the presence of Demodex mites. Crotamiton also possesses antipruritic properties, which may be helpful in cases associated with pruritis. Based on these findings, we recommend the use of topical crotamiton twice daily in patients with a chronic history of, or who present with, facial erythema, dryness, scaling, and roughness with or without papules/pustules." [4]

"A random sample of 16 female patients suffering from papulopustular rosacea (PPR) as well as (16) normal female healthy subjects as control group were adopted in this study to assess of Demodex folliculorum pathogenesis. It was done through determination of mite density using a standard skin surface biopsy 10.5 cm2 from different designated 6 areas on the face, and scanning electron microscopic study (SEM) as well as total IgE estimation. A trial of treatment using Crotamiton 10% cream with special program was also attempted. All subjects ranged between 35-55 years old. All patients with rosacea and 15 of the control group i.e. 75.93% were found to harbour mites. The mean mite counts by site distribution were 28.6 & 6.9 on the cheeks, followed by 14.5 & 3.0 on the forehead and lastly 6.8 & 0.8 on the chin in PPR and control groups respectively. The total mean mite count in patients was 49.9 initially and 7.9 after treatment. In the control group it was 10.7 & 10.6 respectively. The mean total IgE was 169.4 & 168.4 and 96.3 & 98.4 in PPR and control groups respectively Light and scanning electron microscopy revealed that all mites were pointing in one direction. Some of them were containing bacteria inside their gut and on their skin. After treatment 3 cases (18.75%) were completely cured, 10 cases (62.5%) gave moderate response while 3 cases (18.75) have no response. In conclusion, this study supports the pathogenic role of D. folliculorum in rosacea." [5]

"Crotamiton is marketed under the trade names Eurax, which is manufactured by Ranbaxy Laboratories in the United States, and GlaxoSmithKline in the United Kingdom, and Euracin, which is manufactured by Green Cross in South Korea. In Germany, it is marketed under the brand name Crotamitex. In India, it is sold as Eurax by Ranbaxy Laboratories." [6]

Crotamiton is included in with the Anti-parasitic Prescription Agents used to treat rosacea. 

Topical topical benzyl benzoate (BB) (+crotamiton) treatment for rosacea. 

End Notes

[1] Indian J Dermatol. 2014 Jan-Feb; 59(1): 60–66.
doi:  10.4103/0019-5154.123498
PMCID: PMC3884930
Human Demodex Mite: The Versatile Mite of Dermatological Importance
Parvaiz Anwar Rather and Iffat Hassan

[2] Ann Dermatol Venereol. 2011 Nov;138 Suppl 3:S211-4
Treatment of rosacea.
Parodi A, Drago F, Paolino S, Cozzani E, Gallo R

[3] J Am Acad Dermatol. 2009 Mar;60(3):453-62
Demodicosis: A clinicopathological study.
Hsu CK, Hsu MM, Lee JY

[4] J Clin Aesthet Dermatol. 2009 January; 2(1): 20–25.
Demodex Dermatitis, A Retrospective Analysis of Clinical Diagnosis and Successful Treatment with Topical Crotamiton
Joseph B. Bikowski and James Q. Del Rosso

[5] J Egypt Soc Parasitol. 1997 Apr;27(1):183-95.
 A study on Demodex folliculorum in rosacea.
Abd-El-Al AM, Bayoumy AM, Abou Salem EA.

Wikipedia

image courtesy of WikiMedia Commons

The National Institutes of Health (NIH) spent $31.3 billion in 2016 according to this report. You may see the list of diseases that the NIH funds research on and rosacea is NOT on the list. 

Dr. Kligman in a paper he wrote in 2003 mentions the "indifference of the National Institutes of Health, which with an annual budget of nearly 30 billion dollars, has not seen fit to fund a single grant for the investigation of rosacea." Dr. Kligman also says that most research done on rosacea is by the skin industry which is "voluminous literature, mainly focused on treatments sponsored by commercial interests; perhaps not the most credible source of unbiased research.'” 
A Personal Critique on the State of Knowledge of Rosacea32.48 kB · 2 downloads , Albert M. Kligman, M.D., Ph.D.
Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.

A typical example is this paper about three over the counter redness control treatments sponsored by a pharmaceutical company. 

Another example is this paper that states, "Of the 106 studies, 66 reported that they received funding, mainly by pharmaceutical companies. We were confident funding did not affect the results in 56 of these studies but had concerns about the remaining 10." [1]

The National Rosacea Society, who is heavily funded by pharmaceutical companies or skin industries, i.e., Galderma, Allergan, Bayer HealthCare, Rodan+Fields, Cutanea, has funded over $1.5 million on rosacea papers over a twenty year period. The AARS has funded a little research and notice who supports the AARS.  We could go on but you should understand who is supporting rosacea research primarily by these examples. 

One paper on demodex was funded by the Irish Health Research Board, which is an example of discovering who funded the research. You have to do some investigative digging on who is funding a research paper on rosacea. Are you into this?  That is what volunteering is all about. 

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.

Joel T. Bamford, M.D., wrote an article in the Journal of the RRDi, entitled, Is it possible for rosaceans to do research?

End Notes

[1] Cochrane Database Syst Rev. 2015 Apr; 2015(4): CD003262.
Published online 2015 Apr 28. doi: 10.1002/14651858.CD003262.pub5
Interventions for rosacea
Zbys Fedorowicz, Ben Carter, Mireille MD van der Linden, Lyn Charland, and Esther J van Zuuren

Etcetera

Related to the skin industry funding rosacea research are the following posts: 
Skin Industry Rosacea Research & Social Media
Dermatological Textbooks Conflict of Interests
Rosacea Research in Perspective of Idiopathic Diseases

One report from a poster at Facebook, posts spironolactone was prescribed for rosacea and it helps for pimples. 

When asked, "How much credence do you attribute Spironolactone as improving your skin? Are you still taking Spironolactone and, if so, how much do you take each day?" 

In the same thread, another poster posted a link to this article, THIS PILL (NOT *THE* PILL) HELPS TO BANISH HORMONAL ACNE—HERE’S WHAT TO KNOW, which is how spironolactone helps acne. 

Spironolactone is a potent antimineralocorticoid according to Wikipedia, and you need a prescription from your doctor. If you have experience with this drug, please post in this thread. 

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

Image courtesy of Wikimedia Commons

There are a huge number of articles on demodex and rosacea (the RRDi started a list sometime back and abandoned this project so if you are interested here is the link). If a volunteer wants to take on this project and update it contact us. It would be better to use Google Sheets for this project and you need a lot of time to gather all the demodex articles onto one Google Sheet. This is not for the faint of heart. If you want to volunteer for this project contact us. 

Demodex Update

We have browsed some of the most interesting articles on demodex since our last investigation and here are some interesting thoughts on this subject that has been gleaned and the highlights are shown below: 

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

Under the lash
"Because all adult mites have a limited life cycle, their ability to expand in numbers in a human host depends on successful copulation by adult male and female mites in the opening of the hair follicle (near the skin surface). Afterwards, the gravid female moves to the sebaceous gland to deposit eggs, each of which gives rise to a larva and then a protonymph in the sebaceous canal. A protonymph is brought to the opening of the hair follicle and matures into a deutonymph, which crawls on to the skin surface, then re-enters a hair follicle to become an adult. Therefore, during a life cycle, if adults can successfully copulate and produce the next generation, the extent of Demodex infestation will gradually increase in the host over time.

Scanning electron microscopy reveals the special piercing mouthparts of D. folliculorum as a sharp offensive weapon capable of destroying adipose tissue. Although it has also been proposed that mites feed on follicular and glandular epithelial cells, sebum is thought to be the mite’s main food source. As a result, both Demodex species often coexist at the same skin area and gather in the face, cheeks, forehead, nose and external ear tract, where active sebum excretion creates favourable habitats and breeding conditions. Because these mites are susceptible to desiccation, their lifespan is limited outside the living body, and direct contact is required for transmission of mites from one individual to another. Consequently, an effective regimen in eradicating Demodex infestation should include killing as well as prevention of their copulation and transmission.....

......To quantify the extent of Demodex infestation in the skin, a surface biopsy has been standardized as the main method. After cleaning the patient’s skin and a glass slide with ether to improve adherence, a spot of cyanoacrylate adhesive (superglue) is applied on the skin surface of interest before being overlaid with a slide. After approximately 1 minute on the skin, the slide is gently removed and covered by one drop of immersion oil before being mounted with a coverslip. The density of D. folliculorum is measured by counting the number of mites on the slide in a pre-marked surface area of 1 cm2 at a magnification of ×40 and ×100 under a microscope......

......It has been proposed that the pathogenic potential increases if a mite density is higher than five per cm2 1. Several studies have shown a higher mite density on the faces of rosacea patients than on those of age- and sex-matched non-rosacea controls. It is intriguing that Demodex numbers increase when the outside temperature elevates in spring and summer, coinciding with the time when rosacea is exacerbated......

.....Contiguous to the skin, the eye can also be infested by Demodex mites....As a matter of fact, the first disorder that was associated with Demodex, dated as early as 1899, was blepharitis (inflammation of the lid), a disease that has continued to be a subject of investigation ever since....Hence, we believe that one way of determining the pathogenic potential of Demodex infestation in blepharitis and other ocular diseases is to identify a treatment that can kill Demodex with a good safety profile.....

.....Nevertheless, one cannot rule out the pathogenic role of microbial agents that may be associated with Demodex infestation. The notion that microbes are involved in pathogenesis of mite-infested diseases has long been suggested because the skin inflammation in rosacea can be markedly improved by topical metronidazole or oral antibiotics including tetracycline, i.e. treatments that do not kill mites......

.....In short, the co-morbidity based on a symbiotic relationship of B. oleronius in Demodex mites also justifies the consideration of a therapeutic strategy directed to killing the symbiotic bacterium via oral antibiotics such as tetracycline and to killing and preventing mating/reinfestation of Demodex mites, e.g. lid scrub with TTO and general hygiene at the same time...."

Biochem (Lond). 2009;31(4):2-6
Under the lash
Demodex mites in human diseases
Noreen Lacey, Kevin Kavanagh, and Scheffer C.G. Tseng

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

The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea.

".....Over a significant period of time, there have been numerous attempts to connect the etiopathogenesis of rosacea with the presence of some micro-organisms on or within the skin (Lazaridou et al., 2011), including Demodex mites and bacteria. It is well established that there is a higher density of Demodex mites in the skin of rosacea patients than control patients but the significance of this has been disputed (Vance, 1986; Bonnar et al., 1993; Erbağci & Ozgöztaşi, 1998). This review will explore the current understanding of the role of these organisms in the induction of rosacea....

.....Demodex mites use the chelicerae to cut the epithelial cells of the host skin, secrete lytic enzymes for pre-oral digestion and evacuate liquid cytoplasm components (Desch & Nutting, 1972). In the process of destroying the epithelial cells, the epithelial barrier is often disturbed and the mite penetrates into the dermis stimulating Toll-like receptors (TLR) (Schauber et al., 2007). Proteolytic enzymes (proteases) are among the digestive enzymes secreted by Demodex mites. Concrements of serum immunoglobulin IgD and two inhibitors of serum proteases (α-1-antitrypsin and α-1-antichymotrypsin), which might be a specific defensive reaction of the host against mites, have been detected on the surface of Demodex mites (Tsutsumi, 2004). In atopic dermatitis, proteases produced by house dust mites have been identified as the factor responsible for local skin irritation (Deleuran et al., 1998)......

....In all phases of their life cycle, Demodex mites avoid sunlight. They emerge from the pilosebaceous units at night and migrate across the surface of the skin to find a mating partner, travelling at a speed of about 16 mm h−1 (Lacey et al., 2011). The life cycle of Demodex mites consists of five phases of development and lasts from 14 to 18 days. The copulation takes place near the entry of the hair follicle. Afterwards, the gravid female moves to the inside of the sebaceous gland, where she deposits eggs, from which the larvae will emerge about 60 h later. Protonymphs and nymphs are the next phases of the Demodex life cycle (Lacey et al., 2009; Spickett, 1961)
Due to the fact that Demodex mites are obligate parasites of the pilosebaceous units and highly susceptible to desiccation, they are not capable of surviving for long periods outside the host. Routes of transmission are not fully known but it may occur by direct contact as well as through dust. While the skin of new-borns is free of Demodex folliculorum, colonization of the skin in humans takes place in childhood or early adulthood. Demodex mites are found in representatives of all human races and in all geographical areas (Lacey et al., 2009).....

....Demodex mites were originally perceived to be commensals, having a symbiotic relationship with the human host. However the opinion about the role of Demodex in pathogenesis of many diseases, including rosacea has been changing (Lacey et al., 2009). In some specific conditions in the host system, Demodex mites may become potential pathogens. This may happen when the immunological conditions of the host change and new environmental conditions on the skin facilitate the development of Demodex mites (Dahl et al., 2004; Whitfeld et al., 2011).....

.....The extent of Demodex colonization in the human population is high (20–80%), reaching 100% in elderly people (Elston, 2010). Mite density starts to rise in the sixth decade of life and stays at the same level until the eight decade of life. Mite density is very low in young adults, even though their levels of sebum production, a potential source of food for mites, are very high (Ozdemir et al., 2005; Aylesworth & Vance, 1982). Patients with papulopustular rosacea produce sebum with an altered fatty acid profile, suggesting that the nature of the sebum, rather than its quantity, may favour the development of Demodex mites (Ní Raghallaigh et al., 2012). This finding raises the possibility that non-antibiotic therapies to restore the normal fatty acid composition of sebum may improve skin integrity and inhibit the proliferation of Demodex mites

Due to the fact that Demodex mites are commonly found in healthy individuals and the density of mites is generally low, the presence of mites on the skin is not enough to determine pathogenicity. An increase in mite density on facial skin is observed in perioral dermatitis, caused by long-term use of local steroids or other immunomodulating drugs (Fujiwara et al., 2010). Higher numbers of Demodex mites have been noted in patients undergoing immunosuppressive therapy, for example children receiving chemotherapy for leukaemia (Ivy et al., 1995), patients with HIV-infection or AIDS (Aquilina et al., 2002; Dominey et al., 1989) and chronic dialysis patients (Karincaoglu et al., 2005).....

....Most probably, when Demodex mites breach the epithelial barrier, their antigens influence the immune system of the host and induce a type IV hypersensitivity reaction. Demodex mites may then be attacked by giant cells giving rise to dermal granulomas, which are most often observed in granulomatous acne rosacea. Granulomas are also found in skin biopsies of patients with papulopustular rosacea and even in patients with erythematous rosacea (Hsu et al., 2009).

The causal relationship of Demodex mites in skin lesions has been suspected to occur through several mechanisms. They may mechanically block the follicles, leading to distension and causing intra-follicular hyperkeratosis. The presence of mite’s chitinous external skeleton may act like a foreign body and contribute to the formation of granulomas. The waste products of Demodex mites and/or associated bacteria may activate the elements of innate immune system or stimulate the immune system through the mechanism of delayed hypersensitivity reaction (Bevins & Liu, 2007).....

....One hypothesis concerning the role of Demodex mites in the induction of rosacea assumes that Demodex are vectors for micro-organisms that causes and exacerbates skin lesions (Hsu et al., 2009). The theory has its roots in the fact that clinical improvement was noted in patients with rosacea who were administered tetracycline antibiotics, although these antibiotics neither demonstrate activity against D. folliculorum nor reduce their numbers on the skin. It has been suggested that the beneficial activity of antibiotics was due to their anti-inflammatory properties; however, other anti-inflammatory agents, such as steroids or tacrolimus, intensify the symptoms of rosacea or even induce its development (Antille et al., 2004). The fact that only some drugs proved to be effective in the treatment of rosacea suggested that that an unknown bacterium may have a role in the pathogenesis of the disease.....

.....Bacillus oleronius was isolated from a Demodex mite, obtained from a patient with papulopustular rosacea (Lacey et al., 2007)......

....Staphylococcus epidermidis has been isolated from the pustules of 9 out of 15 patients with papulopustular rosacea, whereas this bacterium was not detected on unaffected areas of the skin (Whitfeld et al., 2011). S. epidermidis was also isolated from the eyelid margins of 4 out of 15 patients with papulopustular rosacea, whereas no pure growth was isolated from the eyelids of age- and sex-matched control subjects. The same study also found that this bacterium was susceptible to antibiotics commonly used to treat rosacea.....

.....It is believed that B. oleronius forms a symbiotic relationship with Demodex, as it does in the termite (Kuhnigk et al., 1995). On the skin of humans, this bacterium may occur in the endospore form, which enters the digestive tract of Demodex mites when they consume epithelial cells. The dead mites then decompose inside the hair follicles, where they release significant numbers of bacterial antigens, which have the potential to stimulate a strong immune response (O’Reilly et al., 2012). Thus, the intensification of blepharitis and rosacea, especially the papulopustular variant, may not be induced so much by the presence of the mites alone but by the presence of Demodex mites that carry B. oleronius in their digestive tract. Empirically confirmed sensitivity of B. oleronius to different antibiotics, especially doxycycline, (Lacey et al., 2007) might explain the favourable therapeutic effect of the drug in diseases such as rosacea and blepharitis.....

....The pathogenic role of Demodex mites, as well as B. oleronius and S. epidermidis, in the induction and persistence of rosacea remains an unresolved issue.....

Journal of Medical Microbiology, 61 (11 ). pp. 1504-1510. ISSN 0022-2615
The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea.  
Jarmuda, Stanislaw and O’Reilly, Niamh and Zaba, Ryszard and Jakubowicz, Oliwia and Szkaradkiewicz, Andrzej and Kavanagh, Kevin (2012) 

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

Ubiquity and Diversity of Human-Associated Demodex Mites
"Here we use a new molecular method to assess the occurrence of Demodex mites on humans.....A phylogenetic analysis of 18S rDNA reveals intraspecific structure within one of the two named human-associated Demodex species, D. brevis....While these mites are well known to dermatologists, ophthalmologists, and veterinarians and have been the subject of study for 172 years, their ubiquity, diversity and evolution are poorly understood....

....Methods used to collect Demodex mites from humans include biopsy, the cellophane tape method (placing tape on the face to stick to the mites), scraping areas where mites are likely to reside, and plucking eyelash and eyebrow hairs. Based on the visual observation of mites collected from healthy individuals by these methods, it appears that approximately 3–55% of humans harbor Demodex, with most studies falling in the range of 10–20%. However, because these mites may occur in patches around the body, as in dogs, and all existing collection methods sample just small patches of skin (and even incompletely sample those patches), it is difficult to know to what extent the absence of mites in a sample equates to the absence of mites on the body. Intriguingly, in postmortem studies, mites appear to be present on all adult cadavers. The ubiquity of mites on cadavers might indicate they are universally present on living, adult humans but missed by current sampling methods. Alternately, conditions in which cadavers are found might facilitate colonization by mites and, in doing so, artificially inflate estimates of their incidence......

.....Only recently have molecular studies begun to consider Demodex mites. Existing phylogenies and estimates of molecular divergence include very limited sampling of Demodex species, are based on few genetic markers, and include only minimal geographic representation......

.....Here we test a new molecular approach to detect the presence of mites on human bodies and assess the proportion of individuals in one population colonized by mites. We then use phylogenetic reconstruction based on the nuclear 18S rRNA gene (18S rDNA) to better understand the diversity of these mites.....

....All sample collections were performed in Raleigh, NC at either the North Carolina Museum of Natural Sciences or North Carolina State University. Each participant was gently scraped with a metal laboratory spatula along the creases of the nose and over the surrounding cheek area. The facial habitats were chosen based on their high levels of sebum production and ease of pore expression. In addition, Bonnar et al. (1993) found the greatest abundance of mites in the cheek area among rosacea patients.....

....DNA was extracted from the sebum of individual participants, regardless of the presence or absence of an observed mite,...

....The 16S rDNA PCR products were separated on 2% agarose gels to assess presence or absence of mite DNA within a sample.....

....The 18S rDNA PCR products were sequenced from four individuals and used for phylogenetic analyses.....

....Phylogenetic analyses were conducted using maximum likelihood (ML) and Bayesian inference (BI). Under both methods, gaps in the alignment were treated as missing data.....

.....Molecular evidence suggests Demodex prevalence is much higher than recognized through visual observation alone. Our results are in line with postmortem studies that find Demodex mites present on all adult cadavers....

.....Here we tested 29 people for the presence of Demodex mites and found that mites were much more common than expected in comparison to methods that rely solely on the visual confirmation of whole mite specimens taken from living humans. When we sampled individuals using traditional approaches, our results were similar to those of the many previous morphologically based studies....

.....Little is known about the transmission of mites among humans. Recent studies find that many symbiotic microbes are passed directly from mother to offspring during breast-feeding or during birth (especially if birth is vaginal), and dogs acquire their Demodex mites as nursing pups. In light of this, the same means of mite transmission seems possible in humans, supported by the fact that in one study, Demodex mites were found in 77% of nipple tissue from mastectomies.....

.....Mites could be more ubiquitous on children than noted in postmortem studies or herein but at levels or in locations that make the mites difficult to detect even with the use of molecular approaches. One study of Demodex mites on Tokelau islanders found that mites were present on a greater number of children than on adults. These conflicting findings highlight our limited understanding of how and when mites move onto and among human bodies....

....The evolutionary history of the two human-associated Demodex species is, at best, poorly understood. D. folliculorum was described by Simon in 1842, and as late as 1933, all human Demodex were regarded as one, albeit variable, species. It was only in 1963 that D. brevis was distinguished from D. folliculorum and described as a separate, but closely related, species. Yet de Rojas et al. (2012) have demonstrated that interpreting variation in the morphology of the two human-associated Demodex mite species is problematic, even when interpreted in light of molecular (16S rDNA) sequence data. The closest relatives for both human-associated species, D. folliculorum and D. brevis, remain unknown and are likely to remain unknown until these mites are much better sampled from other primates and mammalian hosts in general. Of the described Demodex species, only 13 have been sampled for molecular data and included in phylogenetic analyses....

.....Demodex are generally considered to be species specific, which would suggest there might be as many as 10,000 Demodex species on living mammals if there are two host specific mites per mammal species.....

.....Our phylogeny indicates that the two human-associated mite lineages do not share a recent common ancestor and likely have separate evolutionary histories of transmission to humans. The 18S rDNA sequence does not resolve the sister group to D. folliculorum, but places a paraphyletic group of dog-associated mites as the closest relative to D. brevis.....

.....Phylogenetic estimates based on 16S rDNA also find that dog-hosted Demodex mites share a recent common ancestor with a human-associated species, though in this case D. folliculorum and D. brevis are both more closely related to goat-associated mites,....

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

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

Etcetera
Russian Study on Demodex Mites and Rosacea Illuminating

Demodectic Rosacea (Variant)

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image courtesy of Wikimedia Commons

An article recommends that ‘rosacea‐like demodicosis’, the disease term, should be not used at all, and the rosacea subtype II, Papulopustular (PPR), should be ‘reconsidered and simplified to include all patients with central face papulopustules–with or without persistent erythema’. This article, authored by F.M.N. Forton and V. De Maertelaer, published in the Journal of the European Academy of Dermatology and Venereology in February 2018, was several months after the NRS endorsed the phenotype classification in October 2017* and does indeed mention the ‘global ROSacea COnsensus (ROSCO) panel [that] recently suggested a more phenotype‐based approach’ [1] which the RRDi endorsed in November 2016. The RRDi is the only non profit for rosacea organization that recognizes demodectic rosacea as a rosacea variant in 2016. The NRS endorsed the new phenotype classification a year later. [2]

The article recommends two phenotypes, one for PPR and another 'rosacea‐like demodicosis.' 

Below are some of the highlights of this paper that confirms demodectic rosacea as a valid concern. 

“Our findings therefore demonstrate that a disease usually considered as not being caused by Demodex (PPR) has similar (and perhaps even slightly higher) Dds than a disease in which the role of the mite is accepted (rosacea with papulopustules without persistent erythema). It is difficult to understand how the presence of mites at similar density in these two clinically similar diseases can be considered to have a causative role in one condition, but to be only an epiphenomenon in the other. A more probable hypothesis is that the numerous mites are responsible for both conditions and that these two ‘entities’ should therefore be considered as two phenotypes of a single disease.”

“All our observations therefore highlight the nosological confusion that persists between PPR and rosacea‐like demodicosis and the need to update the consensus concerning the definition and classification of rosacea. Moreover, they suggest that PPR and rosacea‐like demodicosis may be phenotypes of the same disease.”

“In conclusion, while our observations do not prove a causative role of Demodex in rosacea, they nevertheless support the idea that PPR and rosacea‐like demodicosis should no longer be considered as two separate entities, but rather as two phenotypes of the same disease. As such, the definition of rosacea subtype II (PPR) should be reconsidered and simplified to include all patients with central face papulopustules–with or without persistent erythema –and thus also patients with ‘rosacea‐like demodicosis’, which is a term that should therefore disappear.”

The RRDi recognizes and recommends that PPR be considered Phenotype 4 and that 'rosacea‐like demodicosis'  be classified as Demodectic Rosacea and be considered a rosacea variant. This will allow clinicians to diagnose Phenotype 4 and Demodectic Rosacea in the same individual if the diagnosis warrants or separate if treatment for demodex is unresponsive (or little evidence of demodex) allowing for a diagnosis of just Phenotype 4. 

Journal of the European Academy of Dermatology and Venereology
Papulopustular rosacea and rosacea‐like demodicosis: two phenotypes of the same disease?
F.M.N. Forton and V. De Maertelaer
https://dx.doi.org/10.1111/jdv.14885

*An article published in the Journal of the American Academy of Dermatology published in January 2018 [Epub 2017 Oct 28]
Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

End Notes

[1] The ROSCO panel published its recommendation for a phenotype classification of rosacea in October 2016 in the British Journal of Dermatology
ROSCO Panel Recommends New Approach on Rosacea Diagnosis by Phenotype

[2] Phenotype Updates

Image courtesy of Wily Online Library

A paper by Frank Powell, MD, The Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland, and three other authors*, Demodex mites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea, concludes, “Our results also show for the first time that Demodex mites secrete bioactive molecules that reduced TLR2 expression in sebocytes.” 

So let’s break this down since this is demodectic rosacea news and you want to understand what all this means for those who want to dive deeper into rosacea investigative research.

First off, what are sebocytes? 
Answer
Any of the cells that make up the sebaceous glands, and secrete sebum. Wiktionary

What is TLR2?
Answer
One of a class of proteins that are single, membrane-spanning, non-catalytic receptors that identify structurally preserved molecules acquired from microbes known as Toll-Like Receptor 2 that play a key role in the innate immune system.

What does this mean?
If you look at the image above which shows on the left normal skin and how only a normal amount of demodex are able to regulate a TLR2 response so that the innate immune system doesn’t go into overdrive and respond to the demodex. For some unknown reason, in the image on the right with rosacea, when the demodex are increased the demodex can’t regulate the TLR2 response which initiates a cascade of molecular innate immune system activity. 

Why do the mites increase?
This has been one of the long time questions that the jury is still out on. More information. 

Conclusion
The paper written by Lacey, et. al, about understanding this activity of the mites regulating a TLR2 response at the molecular level may help in treating rosacea and understanding that demodex may be the cause of the innate immune system response. 

* British Journal of Dermatology
Demodex mites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea
N. Lacey, A. Russell‐Hallinan, C.C. Zouboulis, F.C. Powell

A recent report states this about consumers using health apps on Android or iOS mobile devices: 

"Clinicians should be conscious about the choices they make in relation to their app use and, when recommending apps to consumers, explain the potential for loss of personal privacy as part of informed consent. Privacy regulators should consider that loss of privacy is not a fair cost for the use of digital health services."

BMJ. 2019; 364: l920.
Published online 2019 Mar 20. doi: 10.1136/bmj.l920
PMCID: PMC6425456
PMID: 30894349
Data sharing practices of medicines related apps and the mobile ecosystem: traffic, content, and network analysis
Quinn Grundy, assistant professor and honorary senior lecturer, Kellia Chiu, PhD candidate, Fabian Held, senior research fellow, Andrea Continella, postdoctoral fellow, Lisa Bero, professor, and Ralph Holz, lecturer in networks and security

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.  

A topical nanocrystal Azelaic acid (AZA)-loaded hydrogels composed of Pluronic® F127 and hyaluronic acid mixture that are able to deliver AZA into the stratum corneum and deeper skin layers was considered in a study and we await further outcome of this research. For More Information

Intense pulsed light therapy (IPL ) along with a topical skin care regimen "produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement."  For more information

Warning Concerning Brands of Horse Paste/Gel

There are a number of horse paste/gel brands that also contain praziquentel (PZQ), an anthelmintic, which Wikipedia reports "is a medication used to treat a number of types of parasitic worm infections." Some brands are Pfizer Equimax Horse Wormer, Merial Zimecterin Gold, Bimeda Equimax and others. Praziquantel as far as we know has never been used to treat rosacea. Another horse paste, UltraCruz Equine Bio-Absorb Paste contains dioctahedral smectite (dio) which is used to treat acute diarrhoea. There may be other horse pastes that contain other active ingredients that you should carefully read the label on the horse paste and know what you are buying. Using treatments for horses or other animals which have not been FDA approved for humans may have some serious risks. 

The horse paste that everyone is reporting using is horse paste that only contains 1.87% ivermectin as the active ingredient. Read the label of the brand you are buying and if the active ingredient includes ivermectin and ANYTHING else, you may be in serious health risk applying this topically. Stick to the brands that ONLY have 1.87% ivermectin as the active ingredient. Always check with your physician before using ivermectin for your rosacea. 

A study on 54 patients  who met eligibility criteria with azelaic acid reports, "The biggest concern was cost (11.1%), with a mean importance score (IS) on a 10-point scale of 9.3."  Other than this the report concludes, "Patient-reported side effects were rare. Minor patient-reported side effects and concerns do not appear to affect rosacea-related QoL and medication satisfaction. Compared to a previously conducted study of similar design with patients using metronidazole gel and metronidazole cream, more patients in the current study reported no concerns with their treatment, while the number of patients reporting no side effects, as well as mean SATMED-Q and DLQI scores, were similar."  For more information • Now there is a low cost generic

image courtesy Wikimedia Commons

The Russian Ministry of Health conducted a detailed study of demodex mites and rosacea on 212 men and women which is illuminating and confirms the effectiveness of using 1% ivermectin in treating rosacea is just as effective as using metronidazole combined therapy. Further, some new information about detecting a demodex mite density count is revealed that is significant news. While the paper is difficult to read, probably due to the translation, here are some of the jewels found in the report: 

(1) Light Microscopy Skin Scraping Not Reliable
According to the report,  if you use a skin scraping with a light microscope, there may be no reliable data on demodex density counts, which says, "The severity of the condition does not depend on the quantitative load of the mites in the scrape." The report states that "in the light microscopy of scrapes of Demodex mites in the number of 5 individuals per 1 cm2, only 6 healthy persons (n=6; 2.8%); in the remaining 66 healthy people (31.2%), the light microscopy of the scrapes was negative."

"As a result of the study, we found that it is difficult to detect the mite by light microscopy of scrape per 1 cm2 of skin."

However when using a 'Confocal laser scanning in vivo microscopy', there is a significantly more reliable data to count on, which this same report concludes, "Confocal laser scanning in vivo microscopy is an effective diagnostic method to detect Demodex mites that does not require preliminary preparation for analysis and allows detecting Demodex mites at the level of the spiky epidermis layer, which is not accessible for scarification, to identify the species belonging to the size of Demodex mites (from 100 up to 200 μm - Demodex brevis, 200 to 400 μm – Demodex folliculorum)."

"Comparing the results obtained by light microscopy and confocal laser scanning in vivo microscopy in patients with rosacea and healthy people, in more cases Demodex mites are detected by confocal laser scanning in vivo microscopy, whereas scrape in these patients were negative."

(2) The report confirms the size and movement of demodex 

"Using a confocal laser scanning in vivo microscope allowed determining the average size of Demodex mites. When determining the size of mites from 100 to 200 μm, it was believed that in this case Demodex brevis was observed, while the average length of the mite was 125 μm; from 200 to 400 μm – Demodex folliculorum with an average length of 293 μm. The average size of the width of Demodex mites was 24 μm." More information on the size of demodex.

"In the examination of healthy people by light microscopy, Demodex mites were detected in 6 cases (2.8%). Given the ability of the mites to move over the surface of the skin at a speed of 8-16 mm/h, as well as random selection of the study site, this fact does not prove the absence of mites." The method of scattered light intensity (SLI) is used as a new quantitative method of evaluating the viability of Demodex mites. 

(3) Topical 1% Ivermectin Just as Effective as Metronidazole
"Antiparasitic drug ivermectin, in the form of an external form (cream), at a concentration of 1% (1 time per day, the general course of 30 days) has a high therapeutic efficacy in patients with associated with Demodex mites (in 93.3% of cases). The effectiveness of external therapy with a drug containing 1% ivermectin (course of 30 days) is comparable to the combined treatment with the systemic drug metronidazole 250 mg per os 2 times a day and the external application of 1% metronidazole (gel) 1 time per day for 30 days."

"Thus, clinical observations demonstrated a lack of superiority in combined antiparasitic therapy using a systemic drug compared to external therapy using a preparation containing 1% ivertmectin as a cream, as confirmed by statistical analysis. Stein et al. showed that after 12 weeks of ivermectin treatment, the skin of patients was defined as clean or almost clean. There was a significant reduction in the percentage of inflammatory lesions in the ivermectin treatment group. The results of the study showed that 1% ivermectin is an effective and safe treatment for inflammatory lesions in patients with rosacea."

(4) No Demodex Mites Detected in Some Patients
This paper reveals that in some humans there are no demodex detected. The report states, "the fact that in 55-100% of cases, mites are detected, both in patients with face dermatosis and with patients having no clinical signs of dermatological illnesses......II group is a comparison group, which was composed of patients with a diagnosis of rosacea with no Demodex mites. In Group II patients, two methods of study of Demodex mites were not found."

What this means is the second comparison group demodex mites were not detected by two methods, light microscope by skin scraping and Confocal laser scanning in vivo microscopy. The study concluded that those in group two had no demodex mites. If this is true, then this is illuminating and definitely  news since most literature says demodex mites are on all humans except new born babies. 

"In 80 patients with rosacea (37.8%) with Demodex mites were detected in an amount of less than 5 individuals per 1 cm2 or were absent altogether with a developed clinical picture of the condition."

However, because of the ability of the mites to move, the report adds this caution: 
"In the examination of healthy people by light microscopy, Demodex mites were detected in 6 cases (2.8%). Given the ability of the mites to move over the surface of the skin at a speed of 8-16 mm/h, as well as random selection of the study site, this fact does not prove the absence of mites."

(5) Role of Demodex on Humans
"Demodex folliculorum shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte."

Most papers state that the role of demodex is not known. This is illuminating and definitely news. 

(6) Demodex Mites are Significantly Higher in Rosacea
"Our findings confirm the hypothesis of Turgut Erdemir et al., that the Demodex mites affect the severity of the disease and contribute to the progression of the pathological process. In addition, the authors have proved that the density of mites increases depending on the severity of the disease."

"The detection of Demodex mites is not only statistically more significant in patients with rosacea than in the rest of the population, but also as can be seen from the Table 2, Demodex mites were more often found in patients with more severe clinical forms of rosacea (pustulous, infiltrative- productive forms)."

(7) Demodex brevis not as significant as Demodex Folliculorum

"In patients with severe manifestations of the condition (pustulous and infiltrative- productive forms of rosacea), the species of the mites Demodex folliculorum (P<0.01) is more often detected. Demodex brevis is found in mild forms of the condition and in healthy people, without showing signs of parasitism."

"When Demodex brevis is found, given its weak possibility of parasitism, treatment with antiparasitic drugs is not indicated."

(8) After 30 days of Ivermectin Treatment there is an INCREASE of demodex mites
"Patients enrolled in subgroup A received only external therapy with a drug containing 1% ivermectin in the form of a cream 1 time per day for 30 days. Patients enrolled in subgroup B received a drug containing 250 mg of metronidazole systemically 2 times a day, externally 1% metronidazole in the form of a gel 1 time per day for 30 days. A repeat visit of the patients took place after 30 days of continuous therapy. Subjectively, treatment regimens of patients were well tolerated, no side effects were noted, no patient was excluded from the study. When comparing the efficacy of the therapy, it was found that statistically significantly more Demodex mites were found after treatment with confocal laser scanning in vivo microscopy (P≤0.05) (Table 7)."

The above is significant news. However, the patients nevertheless improved their rosacea in 30 days and the report concluded: 
"Analysis of the clinical picture showed a positive dynamics of therapy, which manifested itself in a significant decrease in the number of morphological elements characterizing the severity of inflammation (P≤0.05). The effectiveness of the therapy was confirmed by a reduction in subjective complaints of patients after the treatment, and patients who received only external therapy had no complaints of a feeling of lusters of skin and the appearance of greasy lusters, which is an additional advantage."

You can read the entire Russian paper yourself here: 
Dermatol Reports. 2019 Jan 23; 11(1): 7675.
Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites
Alexey Kubanov, Yuliya Gallyamova, and Anzhela Kravchenko

Etcetera

Demodectic Rosacea (Variant)

Demodex Update

The gold standard treatment for rosacea includes Soolantra (1% ivermectin) along with Oracea. Learn more. 

Sol-Gel Technologies LTD is continuing its clinical trial with its generic ivermectin cream and has also released information on Epsolay for papulopustular rosacea, which is the first micro-encapsulated single active benzoyl peroxide (5%)  prescription drug. For more information or download here: 

0001178913-19-000060.pdf

Image courtesy of Galderma

Itch Tracker is the first application in the world to measure and visualize itching. Nestlé Skin Health developed Itch Tracker using ResearchKit, which is an open source framework for medical research introduced by Apple. Nestlé Skin Health simultaneously launched Itch Tracker worldwide in April 2017. Wearing the Apple Watch on your arm, if you start the Itch Tracker app before you sleep, you can measure your scratching behavior during sleep and evaluate your itching objectively. Nestlé Skin Health developed Itch Tracker using ResearchKit, (an open source framework for medical research introduced by Apple), and released Itch Tracker worldwide as a clinical research project from April 2017 to May 2018.

Nestlé Skin Health and Maruho Release Renewed Itch Measurement App ‘Itch Tracker’ for Apple Watch on July 5, Maruho Receives Exclusive Rights in Japan, Nestlé Skin Health, Media Newsroom, July 5, 2018

Galderma is partnering with top rosacea influencers to launch an empowering social media awareness movement during Rosacea Awareness Month (April): #RosaceaNoFilter.
Led by popular online rosacea patient influencers, with the aim of continuing conversation about the true burden of rosacea, #RosaceaNoFilter will encourage patients to share their personal experiences of living with this common inflammatory skin disease, in the form of ‘selfie’ posts on social media, and to feel empowered to speak up about the beyond the visible impact.

Galderma marks Rosacea Awareness Month with new insights into why some patients are self-treating and launches social media campaign to reinforce hidden impact of the disease, Nestlé Skin Health, Media Newsroom, April 8, 2019

We are collecting the Negative Reports (if anyone has a positive report, please post in this thread). There are positive reports and you can find them. It is a lot of work collecting positive or negative reports on this. Volunteering is what the RRDi is all about. Are you up to volunteering and collecting positive Rhofade reports? Our cursory investigation shows that there as many positive reports on Rhofade or possibly more than negative ones. Rhofade surely doesn't cure rosacea but it manages it if you have to appear good for a wedding or job interview, etc. For an example of a positive Rhofade report, consider this one: 

Alba [post no 23-] "Hi all I have been using the rhofade now for a year. i dont get rebound. It has helped about 30% i still flush but when i do i get over it quicker. also my skin used to hurt alot 90% when i flushed now doesnt hurt about 10% it hurts. I put it on my cheeks where i flush the most. At times if nose flushing i put it on there. I can use it on my nose on and off and dont get rebound. I tried Mirvaso and that i got bad rebound."

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anon [post no 6] "I stopped taking the Rhofade almost 4 months ago and I still flush pretty badly, but less often..."

Aurora823 [post no 1] "I had a horrible reaction to Rhofade...."

Katie Kelly, Rosacea (in English), Facebook, posts,  "I had a really adverse reaction to Rhofade where I had intense flushing for about two weeks! I’m still experiencing some lingering redness. I only used it on a tiny spot twice. BUT your results may vary (my skin is extremely reactive and sensitive in general). Just be sure to spot test it before applying to your whole face!"

Lea77 [post no 202] "I tried Rhofade for 4 days. If started burning my face so I stopped using it. I am now back to daily flares that feel like my face is on fire. With a 1 in 7 benefit to users I wish I had never tried it!!!"

SR840910 [post no 227] "My doctor gave me Rhofade all nonshalantly. I began to use it once a day everyday for a few months. Well slowly I realized it was actually making my face more red. When I would not put it on, my face would be bright red, making me look ten times worse. I have completely stopped taking it now for about a month and my face is still very red."

toomuchblush [post no 132] "Since stopping rhofade, my face has calmed down dramatically. I think rhofade will have many, many mixed reviews..."

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If you have had an experience with Rhofade and rosacea, wouldn't it be gracious on your part to post in this thread your experience so that other rosaceans might benefit?  

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.