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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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    • Diagram depicting the major determinants of gastric acid secretion, with inclusion of drug targets for peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). Image courtesy of Wikimedia Commons.  Proton Pump Inhibitors Theory One of the systemic cormorbidities in rosacea is the use of Proton Pump Inhibitors (PPIs). What are PPIs?  "Proton-pump inhibitors (PPIs) are members of a class of medications whose main action is a profound and prolonged reduction of stomach acid production." [1] Why are they called proton pump inhibitor? "They are called 'proton pump inhibitors' because they work by blocking (inhibiting) a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the 'proton pump'). This chemical system is found in the cells in the stomach lining that make stomach acid." [2] What do PPIs do that is related to causing rosacea?  One of the related rosacea theories is the Low Gastric Acid and Rosacea which has been around for sometime now, back to a paper in 1931 by Epstein and Susnow. [3]  PPIs inhibit gastric acid production.  What happens in the stomach without a doubt is related to what happens in the gut. There are a number of rosacea theories related to the gut, i.e, IBD and Rosacea, IBS and Rosacea,  SIBO and Rosacea, and Rosacea and the Gut. GUT Rosacea is listed as a variant of rosacea. H Pylori (Helicobacter Pylori) in the gut has been a subject of investigation with rosacea for sometime now and continues to be investigated in clinical papers.  Antibiotics have been the mainstay of medical treatment for rosacea, particularly those medicines derived from tetracycline, i.e., doxycycline, which work in the gut and has an effect on the stomach and bowel microbiota. The vast majority of rosacea patients have taken antibiotics, usually high dose for a significant period of time or low dose for even much longer periods. There is evidence that PPIs may even contribute to antibiotic resistance. [4] PPIs Systemic Cormorbidity in Rosacea Related to Gastric Acid Reduction One paper concluded, "In conclusion, prolonged PPI use was associated with an increased risk of rosacea, particularly in women and patients with peptic ulcers." [5] Theory Therefore, the theory that the use of PPIs may have a relationship in causing rosacea. Obviously not all rosacea sufferers have used PPIs so this is just one theory among the long list. For example, one theory is that rosacea is caused by demodex mites, but not all rosacea sufferers have any increase in demodex mites and treatment for demodex doesn't improve the rosacea, nevertheless, the theory is still listed since some rosacea sufferers respond well to treatment for demodectic rosacea. Ergo, the PPI and rosacea theory stands. A theory.  End Notes [1] Proton-pump inhibitors, Wikipedia [2] Proton Pump Inhibitors, Dr Laurence Knott, Patient [3] Cal West Med. 1931 Aug;35(2):118-20.ACNE ROSACEA: WITH PARTICULAR REFERENCE TO GASTRIC SECRETION.Epstein N, Susnow D.ACNE_ROSACEA_GASTRIC_SECRETION_Hypochlorhydria_Acid_Epstein_1931.pdf  [4] JAMA Intern Med 2020 Feb 24 Does Gastric Acid Suppression Encourage Antibiotic Resistance? Abigail Zuger, MD reviewing Willems RPJ et al. JAMA Intern Med 2020 Feb 24 Lee TC and McDonald EG.  J Clin Microbiol. 2005 Jul; 43(7): 3059–3065.doi: 10.1128/JCM.43.7.3059-3065.2005 Effect of pH and Antibiotics on Microbial Overgrowth in the Stomachs and Duodena of Patients Undergoing Percutaneous Endoscopic Gastrostomy Feeding Graeme A. O'May, Nigel Reynolds, Aileen R. Smith, Aileen Kennedy, and George T. Macfarlane [5] J Dermatol. 2020 Jul 01;: Use of proton pump inhibitors and risk of rosacea: A nationwide population-based study. Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH
    • Related ArticlesUse of proton pump inhibitors and risk of rosacea: A nationwide population-based study. J Dermatol. 2020 Jul 01;: Authors: Dai YX, Tai YH, Chen CC, Chang YT, Chen TJ, Chen MH Abstract Proton pump inhibitors (PPI) are commonly used drugs. However, little is known about the association between PPI use and rosacea. This study aimed to investigate the association between PPI use and rosacea risk. Patients with prior PPI therapy, including 1067 rosacea cases and 4268 matched controls, were identified from the National Health Insurance Research Database in Taiwan. The cumulative defined daily dose (cDDD) was used to quantify the PPI use. Logistic regression was used for the analyses. After adjustment for potential confounders, PPI use with cDDD of more than 365 was significantly associated with an increased risk of rosacea (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.10-2.15). Rosacea risk was significantly associated with PPI use of cDDD of more than 365 in women (OR, 1.62; 95% CI, 1.08-2.46) but not in men. Stratified by PPI indications, risk of rosacea was significantly associated with PPI use of cDDD of more than 365 for peptic ulcer (OR, 1.58; 95% CI, 1.12-2.21). In conclusion, prolonged PPI use was associated with an increased risk of rosacea, particularly in women and patients with peptic ulcers. PMID: 32613686 [PubMed - as supplied by publisher] {url} = URL to article
    • An interesting title to an article, "Eating black raspberries might reduce inflammation associated with skin allergies, a new study indicates" [1] intrigued me into an investigation. My wife commented that blackberries are the same. A cursory Google search said otherwise. [2] Wikipedia shows after entering 'black raspberry,' "Not to be confused with blackberry. Black raspberry is a common name for three species of the genus Rubus." Ironically, Rubus is part of the Rosaceae family. The one used in this clinical study was Rubus occidentalis (above image courtesy of Wikimedia Commons).  The article refers to a clinical investigation paper that was "funded by National Cancer Institute (NCI/NIH), grant number K01CA207599 awarded to S.O., and the Ohio State University Foods for Health (FFH) Discovery Theme & Food Innovation Center (FIC) Seed Grant awarded to S.O. and USDA Hatch Funds (OHO01470) awarded to J.L.C." [3] Currently I am noticing where authors are getting the money to study such novel investigations like 'black raspberries,' since the RRDi would love to research novel studies like this for rosacea but can't drum up the money and rosaceans are not donating and have left for all the social media private rosacea groups chattering the same as they did twenty years ago about rosacea and doing nothing constructive about researching rosacea. Why they continue to support the status quo rosacea research mostly sponsored by pharmaceutical companies baffles my mind. [4] This isn't an easy read nor for the novice so you may want to stick to what Emily Henderson wrote about this subject. [2] But if you want to deep dive into this a little more I noticed some facts that Emily doesn't mention. For example, the authors state, "Recent studies have shown that diet plays a significant role in mitigating the development of allergic illnesses, with the consumption of antioxidant rich foods shown to be particularly efficacious in reducing allergic responses." [3] If you search you will find that there are a number of foods considered rich in antioxidant besides black raspberries, but it sounds way more interesting to eat black raspberries than say kale or spinach, not to mention the fun of it.  Emily failed to mention that the authors of the study supplemented Protocatechuic acid (PCA), a 'gut microbial metabolite of anthocyanins' with not the fresh fruit black raspberries, but instead used "5% w/w freeze-dried black raspberry (BRB) powder sensitized with DNFB (n = 5), or AIN-76A."  The authors seem more interested in the synergistic effect of PCA with BRB. PCA occurs in nature, i.e., green tea has lots of it. Here are some tidbits Emily didn't detail:  (1) Used 2.4-dinitrofluorobenze (DNFB) to recapitulate the human disease Contact hypersensitivity (CHS). (2) Four groups of mice were used for the study, all female, in groups of five mice. Each group had different diets, first group had 'standardized minimal nutrient rodent chow AIN-76A sensitized with vehicle only (n = 5),' second group had 'minimal nutrient rodent chow AIN-76A sensitized with DNFB (n = 5),' third group had 'AIN-76A supplemented with 5% w/w freeze-dried black raspberry (BRB) powder sensitized with DNFB (n = 5),' and the fourth group 'AIN-76A supplemented with 500 ppm protocatechuic acid (PCA.'  The authors conclude, "In summary, we demonstrate that the dietary intake of BRB and its anthocyanin metabolite PCA have an inhibitory effect on CHS. We also distinguish between PCA specific immunomodulatory effects and the global effects of the complex mixture of BRB phytochemicals on the pathways associated with CHS." So while this is an interesting subject, I would be careful eating a lot of black raspberries since the fructose in fresh berries can initiate a rosacea trigger, notwithstanding the antioxidant effect. [5] Maybe if you skin is clear, you may have a small bowl which would be nice and who knows, maybe fresh black raspberries might be good for rosacea? Maybe a little. Just watch out for the fructose! End Notes [1] Eating black raspberries might reduce inflammation associated with skin allergies, a new study indicates, Emily Henderson, B.Sc., News-Medical.Net [2] THE DIFFERENCE BETWEEN BLACK RASPBERRIES AND BLACKBERRIES, Black Raspberry Buzz Huff Post concurs:  Blackberry vs Black Raspberry: What's The Difference?, By Julie R. Thomson, Huff Post [3] Nutrients. 2020 Jun 6;12(6):E1701.  doi: 10.3390/nu12061701. Full Text Black Raspberries and Protocatechuic Acid Mitigate DNFB-Induced Contact Hypersensitivity by Down-Regulating Dendritic Cell Activation and Inhibiting Mediators of Effector Responses Kelvin Anderson, Nathan Ryan, Arham Siddiqui, Travis Pero, Greta Volpedo, Jessica L Cooperstone, Steve Oghumu  [4] Rosacea Research in Perspective of Funding [5] Sugar = Rosacea Fire
    • Related ArticlesExcessive cleansing: an underestimating risk factor of rosacea in Chinese population. Arch Dermatol Res. 2020 Jun 27;: Authors: Li G, Wang B, Zhao Z, Shi W, Jian D, Xie H, Huang Y, Li J Abstract Appropriate skincare is essential in the prevention and management of rosacea. We sought to investigate whether cleansing habits, the initial step of skin care, would influence the onset and progression of rosacea and their associations with clinical features of rosacea in the Chinese population. We analyzed the daily cleansing habits data collected from 999 rosacea cases and 1010 skin-healthy controls from China. Overall, the high frequency of cleansing (more than once daily) (OR = 1.450) and the large amount of cleansers (> 5 pieces/year) (OR = 1.612) presented a positive correlation with rosacea occurring. The cleansing duration and types of cleansers appeared not to be correlated with the onset of rosacea in this study. Significant risk factors also included the deep cleansing habits, such as the overuse of cleansing tool (more than four times/week) (OR 2.179) and oil control and exfoliating behaviors via daily used products (OR 2.435), facial mask (OR 1.459) or projects in beauty salons (OR 2.688). The analysis of the clinical features of rosacea showed that patients who prefer deep cleansing were more prone to present an initial symptom of papule and pustule (OR 1.63-3.15). What is more, using daily exfoliating products presented a positive correlation with the progression of the symptoms from flushing to erythema (OR = 2.01), papule and pustule (OR = 2.28) and telangiectasis (OR = 2.14), and the affected areas from a single area to pan facial (OR = 1.650). In conclusion, excessive cleansing habits were substantial risk factors for the incidence and progression of rosacea in the Chinese population. PMID: 32594335 [PubMed - as supplied by publisher] {url} = URL to article
    • Topical retinoids are mainly used for acne but there are some dermatologists prescribing Rx topical retinoids for rosacea, i.e., Differin (adapalene), Retin-A Micro (Tretinoin Microspheres), Tazret (Tazarotene), and others. "Also referred to as retinoic acid or vitamin A acid, topical retinoids are available as gels, ointments, creams, or foams to be applied directly to the skin. They work by promoting the exfoliation of dead skin cells as well as by boosting the production of new skin cells. The new cells then push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties." [1] "As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted." [2] "Expert groups and evidence-based guidelines agree that topical retinoids should be considered the foundation of acne therapy." So this article explains the increased use of retinoids by physicians over antibiotics since there is concern over antibiotic resistance. This article states, "The use of retinoids plus BPO targets multiple pathways and can often eliminate the need for antibiotics, reducing the likelihood of antibiotic resistance." [3] "Topical retinoids have clearly demonstrated benefit in rosacea. "Some dermatologists choose to avoid them, because they are more difficult to use, but over the long term, they really do make a difference for these patients," Dr. Pelle says. "In my experience, at one month you get an improved skin texture, at four months flushing is much less frequent, and at one year there is a normal flush response, substantially decreased redness and few to no flares requiring tetracyclines." " [4] There is a thread at RF that inspired this post. [5] There are a number of over the counter retinols available in our affiliate store. [6]  What is the difference between a retinol and a retinoid? "Essentially, retinol is just a specific type of retinoid." [7] End Notes [1] What to Know About Topical Retinoids for Acne, Heather L. Brannon, MD, very well health  [2] Topical tretinoin resolves inflammatory symptoms in rosacea, in small study [3] Increased Retinoid Therapy for Acne [4] 'Subtype-directed' approach targets rosacea, Jan 01, 2005, DermatologyTimes [5] Retinoid highly recommended by top-rated dermatologist on RRDi, beherenow [6] https://irosacea.org/search/?q=retinol&quick=1 [7] What’s the Difference Between Retinol and Retinoids, Marissa Laliberte, Reader's Digest
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