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    • Related ArticlesStatPearls Book. 2020 01 Authors: Abstract Rosacea is a common chronic inflammatory disease that presents with recurrent flushing, erythema, telangiectasia, papules, or pustules on nose, chin, cheeks, and forehead. There are four clinical subtypes of rosacea based on the predominant signs and symptoms: erythematotelangiectatic, papulopustular, phymatous, and ocular. The subtypes are not mutually exclusive. Patients can present with features of multiple subtypes, and the predominant features and areas of involvement can change over time. Fifty to seventy-five percent of patients with rosacea have eye involvement with symptoms including dryness, redness, tearing, tingling/burning sensation, foreign-body sensation, light sensitivity, and blurred vision. In addition to the skin and eye symptoms, rosacea can cause anxiety, embarrassment, and depression and can have a significant impact on the quality of life. Although usually limited to the skin, an association of rosacea with systemic comorbidities such as neurologic diseases, inflammatory bowel disease, and cardiovascular diseases has been reported.[1][2][3][4] PMID: 32491506 {url} = URL to article
    • Related ArticlesAssessment of the abdominal fat index by ultrasonography in patients with rosacea. Australas J Dermatol. 2020 Jun 03;: Authors: Özkur E, Bülbün G, Karataş D, Kıvanç Altunay İ PMID: 32491195 [PubMed - as supplied by publisher] {url} = URL to article
    • "A variety of repurposed drugs and investigational drugs such as remdesivir, chloroquine, hydroxychloroquine, ritonavir, lopinavir, interferon‐beta, and other potential drugs have been studied for COVID19 treatment. We reviewed the potential dermatological side‐effects of these drugs." Dermatol Ther. 2020 May 22 : e13476.doi: 10.1111/dth.13476 [Epub ahead of print] Cutaneous sıde‐effects of the potential COVID‐19 drugs Ümit Türsen, Belma Türsen, Torello Lotti 
    • There are different approaches offered by the various 'authorities' on rosacea diagnosis into phenotypes. [1] However, they all agree that the phenotype classification is superior to the subtype classification that has been used since 2002 initially proposed by the NRS 'expert' panel. [2] The general consensus is "at least one diagnostic or two major phenotypes are required in order to diagnose a patient with rosacea." [3] {1} Diagnostic Cutaneous Signs (only one required) The ROSCO panel list includes persistent centrofacial erythema associated with periodic intensification by potential trigger factors as a minimum diagnostic feature of rosacea and phymatous changes are individually diagnostic of rosacea.  Fixed centrofacial erythema, papules and pustules, flushing or blushing, phymatous changes are included in the NRS panel diagnostic list.  Dr. Tan with the ROSCO panel, as well as the NRS Panel, and Dr. Del Rosso with the AARS panel both concur that facial erythema is essential to a diagnosis of rosacea. [4] OR {2} RRDi Phenotypes (two required) (1) Flushing (2) Persistent Erythema (3) Telangiectasia (4) Papulopustular (Papules/pustules Lesion Counts) (5) Phymatous (6) Ocular Manifestations Variances in Phenotype Listings The ROSCO panel has no numbering phenotype system but lists the above phenotypes.  The NRS 'expert' committee's approach has no numbering system and divides four phenotypes with three secondary phenotypes. [5] Galderma tweets four major phenotypes and four minor phenotypes.  The AAD follows the NRS expert panel recommendations.  The AARS has its own way of acknowledging the phenotype classification into six phenotypes:  "central facial erythema without papulopustular (PP) lesions;"  "central facial erythema with PP lesions;"  "the presence of phymatous changes," "ocular signs, and symptoms;"  "extensive presence of facial telangiectasias;"  "and marked, persistent, nontransient facial erythema that remains between flares of rosacea and might exhibit severe intermittent flares of acute vasodilation (flushing of rosacea)"  Medscape recognizes four major phenotypes and three secondary phenotypes following the NRS recommendations End Notes [1] ROSCOE Panel • NRS Expert Panel • Galderma • AAD • AARS • Medscape [2] Phenotype Treatment is Superior [3]  Clinical, Cosmetic and Investigational Dermatology February 2020 [4] Phenotype Classification Uses Signs and Symptoms Better [5] The four phenotypes the NRS lists are Papules and Pustules, Flushing, Telangiectasia, and  Ocular manifestations. The secondary phenotypes are  Burning or stinging, Edema, and Dry Appearance.  Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. 
    • Related ArticlesStudy of Clinical Profile of Patients Presenting with Topical Steroid-Induced Facial Dermatosis to a Tertiary Care Hospital. Indian Dermatol Online J. 2020 Mar-Apr;11(2):208-211 Authors: Jain S, Mohapatra L, Mohanty P, Jena S, Behera B Abstract Background: Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately. Aim: The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population. Materials and Methods: This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded. Results: A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form "No-Scar" preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone. Conclusion: Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse. PMID: 32477980 [PubMed] {url} = URL to article
    • Stem cell colonies that are not yet differentiated. Image courtesy of Wikimedia Commons One of the many theories on the cause of rosacea is that it is caused by sun damaged skin. A paper published by Wolters Kluwer Health according to Science Daily states, "Some plastic surgeons have been using stem cells to treat aging, sun-damaged skin. But while they've been getting good results, it's been unclear exactly how these treatments work to rejuvenate 'photoaged' facial skin. A new study finds that within a few weeks, stem cell treatment eliminates the sun-damaged elastin network and replacing them with normal, undamaged tissues and structures." [1] Controversial "Stem-cell therapy has become controversial following developments such as the ability of scientists to isolate and culture embryonic stem cells, to create stem cells using somatic cell nuclear transfer and their use of techniques to create induced pluripotent stem cells. This controversy is often related to abortion politics and to human cloning. Additionally, efforts to market treatments based on transplant of stored umbilical cord blood have been controversial." [2] Regenerative Medicine Stem-cell therapy is what is called regenerative medicine. To understand the basics of this therapy watch this short TED video: How much does it cost? That is usually what most want to know the answer about before considering this treatment. The doctor from this clinic actually gives you a range of the cost since it depends on what your chief complaint issue is and various factors.  Could 10K members of the RRDi get together and each donate a dollar to sponsor a stem cell therapy for rosacea clinical study? That would be less than  the cost of a cup of coffee at Starbucks. Why not donate now? End Notes [1] Stem cell treatments 'go deep' to regenerate sun-damaged skin, Science Daily [2] Stem-cell Therapy, Wikipedia
    • Zilxi is a minocycline topical foam that has been going through clinical trials for some time now. It has been announced recently as FDA approved for rosacea (see fifth post in this thread). Minocycline, a tetracycline drug, has been shown to be just as effective as doxycycline for rosacea. If you are using Zilxi please find the green reply button and post your experience using this new treatment for rosacea. 
    • Menlo Therapeutics Inc. announced that the U.S. Food and Drug Administration (FDA) has approved ZILXI™ (minocycline) topical foam, 1.5%, for the treatment of inflammatory lesions of rosacea in adults. ZILXI, developed as FMX103 by Menlo’s wholly-owned subsidiary Foamix Pharmaceuticals Ltd. (“Foamix”), is the first minocycline product of any kind to be approved by the FDA for use in rosacea. Official Announcement Zilzi is a tetracycline what has done well in clinical trials. You will need to ask your physician for a prescription.  Product Insert  
    • Update "A massive study that raised health concerns over hydroxychloroquine, the anti-malaria drug touted by President Trump as a coronavirus treatment, is coming under scrutiny from scientists who are demanding to see the data behind it." Massive hydroxychloroquine study raising health concerns about the drug under scrutiny from scientists, Tal Axelrod, The Hill, MSN "After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure." N Engl J Med DOI: 10.1056/NEJMoa2016638 A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 David R. Boulware, M.D., M.P.H., Matthew F. Pullen, M.D., Ananta S. Bangdiwala, M.S., Katelyn A. Pastick, B.Sc., Sarah M. Lofgren, M.D., Elizabeth C. Okafor, B.Sc., Caleb P. Skipper, M.D., Alanna A. Nascene, B.A., Melanie R. Nicol, Pharm.D., Ph.D., Mahsa Abassi, D.O., M.P.H., Nicole W. Engen, M.S., Matthew P. Cheng, M.D., et al.
    • Related ArticlesOut of the Blue: A Case of Blue Subungual Discoloration Associated with Prolonged Tetracycline Use. Cureus. 2020 Apr 24;12(4):e7810 Authors: Ahmad Y, Boutros H, Hanna K Abstract Tetracycline derivatives are antibiotics such as minocycline and doxycycline that have been commonly utilized for inflammatory dermatological conditions such as acne and rosacea. Hyperpigmentation of the skin, nails, thyroid, oral mucosa, teeth, and bones is a known but rare side effect of prolonged tetracycline use. The hyperpigmentation typically takes months to years to develop. There may also be residual changes to the skin after discontinuation of the medication. For this reason, the time tetracyclines are used should be minimized and patients should be monitored for the skin findings. Subungual discoloration carries a broad differential including infectious, inflammatory, metabolic, malignant or systemic diseases. Knowledge of this side effect is crucial in order to avoid unnecessary testing in determining the etiology of the subungual discoloration. We report on a case of a patient who has been on long-term minocycline use for adult acne management. He was initially on minocycline for six years, but due to minocycline-induced hyperpigmentation of his ears and fingernails, he had switched to doxycycline. One year later, the skin hyperpigmentation of the ears regressed; however, the blue subungual hyperpigmentation of his hands progressively become more prominent without any other significant symptoms. PMID: 32467786 [PubMed] {url} = URL to article
    • Related ArticlesSurgical mask dermatitis caused by formaldehyde (releasers) during the COVID-19 pandemic. Contact Dermatitis. 2020 May 28;: Authors: Aerts O, Dendooven E, Foubert K, Stappers S, Ulicki M, Lambert J PMID: 32468589 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesRosacea and perioral dermatitis: a single-center retrospective analysis of the clinical presentation of 1032 patients. J Dtsch Dermatol Ges. 2020 May 29;: Authors: Hoepfner A, Marsela E, Clanner-Engelshofen BM, Horvath ON, Sardy M, French LE, Reinholz M Abstract BACKGROUND: Rosacea is a common chronic inflammatory cutaneous disorder affecting nearly 5.5 % of the adult population. Our aim was to evaluate the prevalence and epidemiology of rosacea and perioral dermatitis (POD) in an ambulatory care setting. METHODS: We retrospectively analyzed medical data of patients with a confirmed diagnosis of rosacea or perioral dermatitis (POD) presenting at our university hospital outpatient clinic during a 3-year period. RESULTS: Out of 1032 patients, 81.5 % were diagnosed with rosacea and 18.5 % with POD. Overall prevalence was 1.4 % for rosacea and 0.3 % for POD. 69.3 % of the analyzed patients were female. Overall mean age was 49.3 ± 7.7 (1-92) years; the women's average age was less than the men's. Patients with POD were younger and predominantly female, whereas patients with phymatous rosacea were older and predominantly male. The most common phenotypes were papulopustular rosacea (68.4 %), erythematotelangiectatic rosacea (22.5 %), and phymatous rosacea (8.0 %). Special forms of rosacea were diagnosed in 15.8 % of the patients; the most frequent were ocular rosacea (6.9 %) and steroid-induced rosacea (5.4 %). CONCLUSIONS: The large patient cohort analyzed in our study provides a good estimate of the frequency of the rosacea subtypes, special forms and of perioral dermatitis in a hospital-based outpatient care setting. PMID: 32469453 [PubMed - as supplied by publisher] {url} = URL to article
    • Update "In this study, a high-dosage of CQ (12 g) given for 10 days concurrently with azithromycin and oseltamivir was not sufficiently safe to warrant continuation of that study group. Age was an important confounder and might be associated with the unfavorable outcomes. We recommend that similar dosages no longer be used for the treatment of severe COVID-19, especially because treatment based on older patients with previous cardiac diseases who are receiving concomitant cardiotoxic drugs should be the rule. No apparent benefit of CQ was seen regarding lethality in our patients so far. To better understand the role of CQ or HCQ in the treatment of COVID-19, we recommend the following next steps: (1) randomized clinical trials evaluating its role as a prophylactic drug and (2) randomized clinical trials evaluating its efficacy against the progression of COVID-19 when administered to patients with mild or moderate disease. Even if we fail to generate good evidence in time to control the current pandemic, the information will affect how we deal with coronavirus outbreaks in the future." JAMA Netw Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857 Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) InfectionA Randomized Clinical Trial Mayla Gabriel, Silva Borba, MD; Fernando Fonseca Almeida Val, PhD, Vanderson Souza Sampaio, PhD
    • A treatment for rosacea is being considered to treat coronavirus. "The second-generation tetracycline Dox has an anti-inflammatory and broad spectrum antimicrobial activity...It has minimal side effects and it is routinely prescribed for acne and rosacea...In ophthalmology, Dox is usually administered in patients affected by ocular rosacea and posterior blepharitis...Dox also has anti-angiogenic properties... It regulates cytokines and diminishes neutrophil chemotaxis too...Besides its well-known use in treating bacterial infections, some studies in the literature report that Dox possesses a broad activity against viral infection too...The first who described the Dox antiviral effect was Sturtz in 1998 (29), and this suggestion has been confirmed in several followed-up studies...In 2007, Suzuki et al. identified that coronavirus could be associated with anosmia,..." "In our preliminary observation, the administration of Dox 200 mg once daily seems to improve respiratory symptoms and anosmia under Dox treatment in six patients completely recover after only 2 days of treatment. From our experience, it seems reasonable to continue the treatment at least 8 days. The mean patients' age was 35.8 ± 6.8 years, and 4 (66.7%) were females. One patient reported anosmia as the only COVID-19 manifestation; instead of the other five patients who complained about the loss of smell, in which it appeared 5–7 days after mild fever, dry cough, and malaise. The average time of the recovery COVID-19-linked anosmia after the administration of Dox in these patients was 2.5 ± 0.5 days. We noticed a sudden improvement in all symptoms after the administration of Dox, but our most exciting insight is about the rapid recovery of the smell." Front Med (Lausanne). 2020; 7: 200. Doxycycline: From Ocular Rosacea to COVID-19 Anosmia. New Insight Into the Coronavirus Outbreak Chiara Bonzano, Davide Borroni, Andrea Lancia, and Elisabetta Bonzano  Virus and rosacea has never, ever been ruled out.
    • Related ArticlesTopical ivermectin-metronidazole gel therapy in the treatment of blepharitis caused by Demodex spp.: A randomized clinical trial. Cont Lens Anterior Eye. 2020 May 24;: Authors: Ávila MY, Martínez-Pulgarín DF, Rizo Madrid C Abstract PURPOSE: To evaluate the efficacy of topical ivermectin-metronidazole combined therapy in the management of Demodex-associatedblepharitis. METHODS: Sixty patients with a diagnosis of Demodex-associatedblepharitis were recruited in a randomized clinical trial. Thirty receiving topical ivermectin (0.1%)-metronidazole (1%) gel treatment on days 0, 15 and 30. Thirty additional patients were used as a control group receiving vehicle on days 0, 15 and 30. The primary efficacy measure was the number of Demodex spp. mitesin the eyelashes of patients. The secondary outcomes included clinical improvement of signs and adverse events. RESULTS: Complete eradication of Demodex spp. was found in 96.6% of patients in the treatment group. Furthermore, a significant reduction of inflammation signs were found in all treated patients versus controls. None of the patients experienced any adverse effects associated with the treatment. CONCLUSION: Demodex infection was controlled satisfactorily with the ivermectin (0.1%)-metronidazole (1%) gel, and no adverse effects were observed. Application of this gel for the treatment of different parasitic infections of the eyelids could be feasible, and this requires further exploration. PMID: 32461053 [PubMed - as supplied by publisher] {url} = URL to article
    • Related ArticlesCutaneous Exophiala oligosperma infection presenting with multiple, rosacea-like papules on the cheek in a healthy individual. J Dermatol. 2020 May 28;: Authors: Demitsu T, Umemoto N, Maeda T, Kakurai M, Harada K PMID: 32463524 [PubMed - as supplied by publisher] {url} = URL to article
    • Coconut Oil image courtesy of Wikimedia Commons "There is anecdotal evidence to support the use of coconut oil as a home remedy to treat rosacea." [1] There are a number of anecdotal reports at RF of using coconut oil as a moisturizer after cleansing with a raw honey mask. [2] Virgin Coconut Oil (VCO) vs Refined Coconut Oil (RCO) "The two main types of coconut oil you will come across are virgin coconut oil (VCO) and refined coconut oil (RCO). To make VCO, oil is cold pressed from the meat of the coconut. VCO has both the flavor and smell of coconut, and is often creamier. RCO is a mass produced oil obtained from dried coconut and is usually chemically treated. If you open a jar of RCO it will have no coconut aroma or flavor." [3] This same source says there is no such thing as extra virgin coconut oil since there is only one cold pressed 'virgin' version processed so any product that states this on its label is actually a misleading advertisement. Wikipedia explains there are two processes used to make coconut oil, the dry and the wet process. The wet process is more costly. Wikipedia also refers to the Virgin Coconut Oil (VCO) but calls the refined oil as Refined, bleached, and deodorized (RBD) oil. [4] RBD coconut oil can be processed further into partially or fully hydrogenated oil. Some RBD coconut oil can be fractionated into different fatty acids to isolate caprylic acid and capric acid (or to remove lauric acid). Caprylic acid and capric acid are medium-chain triglycerides, thus producing MCT Oil.  The benefit of VCO  over RBD oil is further shown with its use in medicine and cosmetics. Be sure to use VCO if you are using it to treat rosacea or as a moisturizer. You may want to put a test amount on your inside wrist and wait several hours to see if you have an allergic reaction to coconut oil before putting it on your face.  Coconut Oil as Medicine "Coconut oil has been shown to be as effective and safe as mineral oil when applied as moisturizers for mild to moderate xerosis." This same paper reports that coconut oil helps atopic dermatitis, improves skin barrier function, promotes wound healing through faster epithelization, increased neovascularization, fibroblast proliferation, pepsin-soluble collagen synthesis, and turnover of collagen in wounds, increases the expression of specialized cornified envelope and protects the skin from UV radiation. Coconut oil contains monolaurin, a monoglyceride derived from lauric acid, that comprises nearly 50% of coconut’s fat content. Monolaurin displays antimicrobial activity as well as exhibits antiviral and antifungal activity. [5] Another paper reports that virgin coconut oil has anti-inflammatory, analgesic, and antipyretic activities. [6] Coconut oil is among a list of plant oils that have antimicrobial, antioxidant, anti-inflammatory, and anti-itch properties. [7] Coconut Oil is listed as one of the Biologic Treatments for Rosacea.  Virgin Coconut Oil (VCO) Treatments Garden of Life Virgin Coconut Oil Parachute Naturalz 100% Organic Virgin Coconut Oil Premium Virgin Organic Coconut Oil Proudly Pure Virgin Coconut Oil End Notes [1] Using Coconut Oil to Treat Rosacea, Healthline [2] Anecdotal Reports on Using Raw Honey, see first subheading, Coconut Oil Not the Focus [3] This is How Coconut Oil for Skin Saved Me Time, Cash, and Face, Liz Thompson, Organic Authority [4] Coconut Oil, Wikipedia [5] Int J Mol Sci. 2018 Jan; 19(1): 70. Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils Tzu-Kai Lin, Lily Zhong,2, Juan Luis Santiago Agero A.L., Verallo-Rowell V.M. A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis. 2004;15:109–116. doi: 10.2310/6620.2004.040 ]6] Journal Pharmaceutical Biology Anti-inflammatory, analgesic, and antipyretic activities of virgin coconut oil S. Intahphuak, P. Khonsung & A. Panthong [7] Am J Clin Dermatol. 2018 Feb;19(1):103-117.  doi: 10.1007/s40257-017-0301-1. Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science Alexandra R Vaughn, Ashley K Clark, Raja K Sivamani, Vivian Y Shi 
    • <What is the butterfly effect in rosacea?>  click to read article Image courtesy of Wikimedia Commons
    • William Beaumont Hospitals is sponsoring two treatments used for rosacea, Naltrezone and Ketamine, in a clinical trial to treat coronavirus. [1] Low Dose Naltrezone is used for rosacea in this post about flushing avoidance and in other prescriptions.  Ketamine 0.5% and Amitriptyline 1% in a Lipoderm cream used for Erythomelalgia has been reported anecdotally to improve rosacea in this post.  These two treatments above are included in a growing list of rosacea treatments considered to treat coronavirus. End Notes [1] Study of Immunomodulation Using Naltrexone and Ketamine for COVID-19 (SINK COVID-19), NIH, Clinical Trials
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