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    1. RRDi members must be polite and respectful to fellow members taking into consideration the individual fellow member's religious, ethical, and cultural values, as well as age, race and sex. The institute determines what is polite and respectful and may or may not give warnings for violating this rule. Removal from the membership is possible for violating this rule. It is a privilege to be a member of the RRDi and not a right.

    2. To be a legal corporate voting member a name, mailing address, two email addresses, and a statement of whether the member is a rosacean or not a rosacean is required. Non voting members are only required to provide a valid email address. 

    3. Members may not profit from the institute; however, any Medical Advisory Consultants (or Committee) member or any other member may be compensated for services rendered to the institute.

    4. Members who sell items or services for rosacea may comment on a treatment, product, book or service sold by the member when another member asks for information. However, the institute may at any time stop the discussion, delete the posts or ban the member at the sole discretion of the institute. Warnings may or may not be given to the member by the institute. Profiting from contacts of fellow members through the institute is not the purpose of this non profit institute. However, information is acceptable to post when asked and appropriate comments are allowed subject to the approval by the institute. The RRDi determines if the post is appropriate or not and you agree to this decision.

    5. Voting members should state if they have a diagnosis of rosacea from a physician and failure to discuss this may be grounds for dismissal as a member. The institute needs to know which voting members are rosaceans to determine the percentage of voting members who have a diagnosis of rosacea from a physician and which voting members are not rosacea sufferers. Non voting members are also required to state if they have a diagnosis of rosacea if another member inquires.  

    6. Privacy is of concern to the institute. Names, mailing and email addresses are not given out to the public or to fellow members by the institute. Your public profile is available to anyone to view but only shows your location, country, and whether you are a rosacean if you put data into these public profile boxes. Your personal profile like first and last name, etc., is never shown to the public and only RRDi staff members can view your personal profile. You agree to allow your public profile to be shown. Members should not release names, mailing or email addresses of fellow members if you are aware of the personal contact information of a fellow member without the consent of the fellow member. A Privacy Policy is available for the public. Members who donate to the institute will be listed with their name and the amount unless the donor requests anonymity. If you want to remain anonymous please let the institute know when you donate otherwise your name will be posted without any address, phone, or email address.

    7. Members will adhere, agree to and obey the Guidelines, Charter, Articles of Incorporation, the Bylaws, the Conflict of Interest Policy and these Rules of the Institute. Violation of any of these rules may be grounds for being removed as a corporate voting member or non voting member. You may view these documents by request or check the site index.

    8. A 'rosacean' is a rosacea sufferer. 'Institute' refers to the RRDi. RRDi refers to the Rosacea Research & Development Institute. You accept these terms.

    9. Anyone can join as a non voting member and post in the forum without providing any contact information other than a valid email address. 

       10.  The Rules of the Institute may be changed at any time at the sole discretion of the institute. 

     

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    • Image of Demodex Folliculorum courtesy of National Geographic - by Darlyne A. Murawski There are substantial anecdotal reports that treatment for demodectic rosacea gets worse before it gets better. The logic behind this is that killing the demodex mites causes a die-off of the mites that takes weeks to accomplish since new eggs are being hatched each day and the "life cycle of demodex mites consists of five phases of development and lasts from 14 to 18 days". [1] Furthermore because the movement of the mites has been shown to be "at a speed of 8-16 mm/h" [2] they may leave the area being treated and return later while planting eggs along the route. During the initial treatment which may take weeks some of the mites are reported to be killed which may cause inflammation and worsen the skin. One explanation of this is the "Jarisch–Herxheimer reaction" (JHR) which has been "traditionally associated with antimicrobial treatment of syphilis." [3] The principle of JHR may indicate a reason why it gets worse before it gets better. One source comments on this by stating, "And while the JHR only technically relates to spirochetal infections (spiral-shaped bacteria) and antibiotics, the concept of symptom-onset or worsening after starting treatment with antimicrobials has been seen to apply more broadly in clinical practice. This is why you’ll often hear practitioners talk about a Herx-reaction, even if it isn’t scientifically accurate. But, what we call ‘die-off symptoms’ is certainly something we see commonly when clients begin addressing bacteria, parasites and yeast pathogens using natural antimicrobials." Furthermore, there are at least six types of bacteria that have been associated with demodex mites. [5] At least one virus has been associated with rosacea [6] and viruses have not been ruled out in demodectic rosacea. There are very little clinical studies done on virus and rosacea. Viruses are in bacteria and comprise more weight in the human body than bacteria by a factor of ten times. [7] More study should be done on why treatment for demodectic rosacea seems in many cases to get worse before it gets better. Nevertheless, reducing demodex density counts in rosacea improves the patient with rosacea. [8] End Notes [1] Demodex Update Subheading, The potential role of Demodex folliculorum mites and bacteria in the induction of rosacea, third paragraph  [2] Russian Study on Demodex Mites and Rosacea Illuminating, (2) The report confirms the size and movement of demodex, second paragraph [3] Jarisch–Herxheimer reaction, Wikipedia [4] Pathogen & Parasite Die-Off Symptoms: How to manage detox side-effects, Bella Lindemann, June 24, 2019 [5] Bacteria Associated with Rosacea and Demodex Mites [6] Candida Albicans [7] Human Microbiome, Brady Barrows  [8] Decreasing Demodex Density Count Improves Rosacea  
    • Related Articles Intense pulsed light for improving dry eye disease in rosacea. J Am Acad Dermatol. 2019 Dec 03;: Authors: Vazirnia A, Wat H, Danesh MJ, Anderson RR PMID: 31809814 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Rosacea-like acute reaction after hyaluronic acid dermal filler. G Ital Dermatol Venereol. 2019 Dec 04;: Authors: Valenti M, Guanziroli E, Mancini LL, Costanzo A PMID: 31804049 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles Rosacea associated with increased risk of generalized anxiety disorder: a case-control study of prevalence and risk of anxiety in patients with rosacea. An Bras Dermatol. 2019 Oct 26;: Authors: Incel Uysal P, Akdogan N, Hayran Y, Oktem A, Yalcin B Abstract BACKGROUND: Rosacea may result in emotional distress and anxiety. However, data on the presence of generalized anxiety disorder in rosacea patients are scarce. OBJECTIVE: The aim of the study was to detect the frequency and level of anxiety and depression in patients with rosacea. METHODS: A total of 194 consecutive rosacea patients and 194 age- and sex-matched controls were enrolled. Severity of rosacea was assessed in patients according to the criteria of the National Rosacea Society Ethics Committee. Both patients and controls were evaluated by the Generalized Anxiety Disorder 7-item scale, and severity was measured by the Generalized Anxiety Disorder-Adult. RESULTS: Individuals who were diagnosed with an anxiety and/or depressive disorder were more common in patient group (24.7% vs. 7.2%, p<0,01). Female patients were particularly at risk for having generalized anxiety disorder (OR=2.8; 95% CI 1.15-7.37; p=0.02). STUDY LIMITATIONS: Single center study and limited sample size. CONCLUSIONS: Rosacea patients show greater risk of having anxiety disorders, including generalized anxiety disorder. Female patients, those with lower educational levels, those with phymatous subtype, untreated patients, and patients with prior psychiatric morbidity may be at particular risk for anxiety. It is essential to consider the psychological characteristics of patients to improve their well-being. PMID: 31789266 [PubMed - as supplied by publisher] {url} = URL to article
    • Related Articles ACTH-dependent Hypercortisolemia in a Patient with a Pituitary Microadenoma and an Atypical Carcinoid Tumour of the Thymus. Medicina (Kaunas). 2019 Nov 27;55(12): Authors: Baranowska-Jurkun A, Szychlińska M, Matuszewski W, Modzelewski R, Bandurska-Stankiewicz E Abstract Cushing's syndrome (CS) is a set of clinical symptoms which occur as a result of hypercortisolemia. Endogenous ACTH-dependent CS related to an ectopic ACTH-secreting tumour constitutes 12%-17% of CS cases and is one of the most common causes of paraneoplastic syndromes. This study presents a case of a 31 year-old man with diabetes, hypertension, rosacea, purple stretch marks and hypokalemia. Findings of diagnostic procedures include high concentrations of cortisol and ACTH, pituitary microadenoma and a tumour in the anterior mediastinum. Dynamic hormone tests determined the source of excess hormone secretion and ectopic ACTH-dependent CS was diagnosed. Due to increasing symptoms of superior vena cava syndrome, an emergency resection of almost the whole tumour was performed, with only a small part of the upper pole left because of the proximity of large vessels and a risk of damaging them. On the basis of histopathological tests, an atypical carcinoid tumour of the thymus was identified. Immediately after the surgical procedure, there was a significant reduction of clinical and laboratory traits of hypercortisolemia, yet, during the 46 weeks of postoperative observation, despite chemotherapy, the progression of residual masses of the tumour occurred with metastases and increased hormone indices. The presented case shows and discusses the differentiation of ACTH-dependent hypercortisolemia and its causes, difficulties in surgical therapy and chemotherapy, as well as prognosis for atypical carcinoid of the thymus, which is a rare disease. PMID: 31783507 [PubMed - in process] {url} = URL to article
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