Introduction to Rosacea

Rosacea is a relatively common skin disorder which can include:

1. Facial redness
2. Telangiectasia (dilated blood vessels which are red and can be thread-like in
appearance)
3. Unusually reactive skin
4. Uneven skin texture (lumps and bumps)
5. Flushing
6. Acne-like lesions (papules, pustules, and nodules)
7. Burning sensations
8. Swelling
9. Rhinophyma (a deformity more frequently occurring in men which is characterized
by redness, inflammation, and excess tissue growth around the nose)
10. Chronic ocular redness, scaling or crusting of the eyelids and lashes, and eye
irritation

The exact causes of rosacea are unknown, though genetics and environmental damage are thought to be factors. Some research indicates that the demodex mite could be responsible for rosacea symptoms, while other research suggests rosacea is caused by a chronic bacterial infection in the gastrointestinal system.
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Rosacea Subtypes

There are five different subtypes of rosacea. A person can have a combination of more than one subtype at a time.

1. Erythematotelangiectatic Rosacea:

Primarily involves facial redness in the central portion of the face and frequent flushing. Telangiectasia commonly can occur in those with this rosacea subtype. The skin tends to be unusually reactive and stinging and burning sensations often occur, as well as facial roughness.

2. Papulopustular Rosacea:

Involves chronic central facial redness and short-lived papules and/or pustules that tend to resemble acne. Stinging and burning sensations are not unusual.

3. Phymatous Rosacea:

Involves a thickening of the skin on the nose, nodules, and strange tissue growth. Although rhinophyma is the most common manifestation of this rosacea subtype, phymatous rosacea can be seen elsewhere such as on the chin, forehead, cheeks, and ears.

4. Ocular Rosacea:

A rosacea subtype occurring in the eye area which affects over half of those with other rosacea subtypes. Symptoms include watery, bloodshot eyes, the feeling that a foreign object has made its way into the eye, burning and/or stinging, dryness, itching, sensitivity to light, blurry vision, and telangiectasia of the eye and lid. Blepharitis (inflammation of one or both eyelids), conjuctivis (inflammation of the conjunctiva, the mucous membrane which covers the internal portion of the eyelid and is attached to the cornea), and irregularity of the eyelid margins can also sometimes be seen.

5. Neuropathic Rosacea:

A rosacea subtype which has yet to be officially recognized yet is thought to be the most severe. It involves fits of burning in the central facial region, often lasting for longer than a half hour, as well as pain following exposure to rosacea triggers (see below section). Severe cases can semi-permanently or permanently activate sensory nociceptors (pain receptors).

If you think you have rosacea, it is very important not to self-diagnose and to get a professional opinion from a dermatologist. The reason being is that some symptoms that appear to be caused by rosacea can actually be indicative of other, more serious conditions. For example, one symptom of lupus (an autoimmune disease) is what appears to be a red rash spread over the nose and cheeks that is often mistaken for rosacea. Also, many of the symptoms of rosacea cannot be addressed by over-the-counter products and require medical intervention.
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Rosacea Triggers:

Rosacea flare-ups are often worsened by various things (triggers) which are unfortunately not always easy, or even possible, to avoid. These triggers vary from person to person. Below some possible triggers are listed.

Emotional Triggers:

Anxiety
Concentration
Crying
Embarrassment
Excitement
Intimacy
Laughing
Stress

Environmental Triggers:

Cold Climates
Heat
Sun
Wind
Hormonal Triggers:
Birth control pills
Estrogen
Perimenopause
Premenstrual
Postmenopause

Foods:

Large meals
Spicy foods
Hot foods

Beverages:

Alcohol
Hot beverages

Physical Triggers:

Exertion (light or heavy)
Lying down
Migraines
Overheating
Pain

Oral Medications:

Vasodilating drugs (drugs which widen blood vessels and can therefore worsen rosacea) used for the treatment of cardiovascular disease

Topical Triggers:

Products containing skin irritants (see section below)
Exfoliants
Moisturizers
Sunscreens containing synthetic sunscreen agents

Other Triggers:

Spontaneous (if you suspect something is triggers a flare-up, avoid it if possible)
Fluorescent lighting
Computers
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Irritants Commonly Found in Cosmetics

Here is a list of common skin irritants you may wish to avoid:

Alcohols. Ethanol (grain alcohol), denatured alcohol, ethyl alcohol, methanol, benzyl alcohol, isopropyl, and SD alcohol should be avoided. (Exceptions: Ingredients like cetyl alcohol or stearyl alcohol are fatty alcohols. Some alcohols like SD alcohols can be used in small amounts. An ingredient is in a small amount if it appears at the end of an ingredients list).
Ammonia
Arnica
Balm mint
Balsam
Bar cleansers and soaps
Bentonite (can be used in the occasional clay mask, but avoid frequent use or formulations which contain other "actives")
Benzalkonium chloride (if it is one of the main ingredients)
Benzyl Alcohol (if it is one of the main ingredients)
Bergamot
Camphor
Cinnamon
Citrus juices and oils
Clove
Clover blossom
Coriander
Cornstarch
Essential Oils
Eucalyptus
Eugenol
Fennel
Fennel oil
Feverfew
Fir needle
Fragrance (may be listed as "Parfum")
Geranium
Ginger
Grapefruit
Horsetail
Jasmine
Lavender
Lemon
Lemongrass
Lime
Linalool
Marjoram
Melissa (lemon balm)
Menthol, Menthyl Acetate, and Menthyl PCA
Mint
Oak bark
Orange
Oregano
Papaya
Peppermint
Phenol
Rose
Sandalwood oil
Sodium C14-16 olefin sulfate
Sodium lauryl sulfate
TEA-lauryl sulfate
Thyme
Wintergreen
Witch hazel
Ylang-ylang

If you are uncertain about an ingredient, information about it might be found here in this online ingredients dictionary:

http://www.cosmeticscop.com/learn/dictionary.asp?TYPE=MAIN
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Treatment Options

Rosacea can be very difficult to treat for numerous reasons. First, rosacea is not very well-understood, so only the symptoms of the disease can be addressed. Second, because rosacea increases the reactiveness of one's skin, what may work for one rosacea patient may be much too irritating for you. Third, some popular rosacea treatments, like oral antibiotics, can only be used in the short-term. Fourth, products which claim to be designed for sensitive skin or to treat rosacea often contain skin irritants. If they do contain ingredients which would be beneficial to rosacea-prone skin, those ingredients are often found in minute concentrations. And lastly, there is much disagreement among dermatologists as to what should and should not be used for the treatment of rosacea. When treating rosacea, monitor how your skin reacts. If a treatment seems to worsen facial redness and cause irritation, don't use it.

Some Prescription-Only Treaments:

Standard treatment options for rosacea involve oral antibiotics and metronidazole (found in MetroGel), a topical antibiotic effective against anaerobic bacteria and some parasites. This can be effective, but keep in mind that bacteria can become resistant against oral antibiotics, making them effective only for the short-term, and metronidazole doesn’t work for everyone. Finacea, a 15% azelaic acid gel, was approved for the treatment of rosacea in 2002. It is an antimicrobial product which has some research indicating that it is more effective for rosacea treatment than MetroGel; however, other research indicates that it is more irritating, which can cause problems for many patients. Another popular rosacea treatment is a sodium sulfacetamide and sulfur lotion (such as Rosula). It has antimicrobial properties, though irritation can occur.

Isotretinoin, found in Accutane, can be a very effective rosacea treatment (I won't say "cure," but an Accutane course can solve rosacea problems for many), though it is not understood why.

Some Over-the Counter Treatments:

Some rosacea sufferers benefit from the use of benzoyl peroxide, an antibacterial treatment commonly used for acne sufferers that is effective against anaerobic bacteria. However, this is recommended with caution since benzoyl peroxide can be extremely irritating to rosacea patients and ultimately make the skin worse. Tea tree oil exhibits antimicrobial properties and is thought to be less irritating than benzoyl peroxide, but again is recommended with caution. One should use between a 5 and 15% concentration; anything more might be too irritating and anything less might be ineffective. The only leave-on tea tree oil treatment (I don't recommend medicated cleansers because the treatment gets rinsed away) I know of is Derma E Tea Tree and E Antiseptic Cream, which contains 5% tea tree oil. Salicylic acid, a chemical exfoliant, may be beneficial to rosacea sufferers as well since it has some antimicrobial and anti-inflammatory properties; however, most salicylic acid products are poorly formulated and contain unnecessary skin irritants like drying alcohols. Exfoliants of any kind can aggravate rosacea symptoms, so again approach the use of salicylic acid cautiously. The best and most economical salicylic acid products are those made by Paula's Choice. Topical hydrocortisone treatments can be beneficial for relieving rosacea-related irritation and inflammation, but these should be used sparingly as long-term use can thin the skin and actually exasperate rosacea symptoms.

Many skincare lines are coming out with products marketed to rosacea sufferers. They might be advertising that their products calm and cool the skin. Usually products claiming to cool the skin use ingredients like menthol and peppermint to produce the sensation of coolness. This cooling sensation is actually a sign of irritation, so it's best to avoid these products. You may have heard of the Aveeno Ultra-Calming and Eucerin Redness Relief lines. The Ultra-Calming line by Aveeno uses feverfew as its active ingredient, which acts as an anti-inflammatory agent when taken orally but a skin irritant when applied topically. The Ultra-Calming Foaming Cleanser is probably OK to use since the feverfew is in contact with the skin for only a short time, but otherwise one should avoid this line. Eucerin's Redness Relief line uses licorice extract, which does act as an anti-inflammatory agent when applied topically. However, Eucerin's products don't contain that much of it. Your best bet is to use products featuring anti-inflammatory ingredients without the use of unnecessary skin irritants like fragrance. You don't have to stick to just one product line.

Laser Treatments:

Although many of the above-mentioned treatments can help with some rosacea symptoms, particularly those which resemble acne, they tend to be ineffective against telangiectasia and facial redness overall. Avoiding rosacea triggers can help with these problems, they are usually inevitable in the long-run. Laser treatments, like V-Beam, can be very effective for treating telangiectasia and overall facial redness. Consult with your dermatologist on this matter if you are interested.

Additionally, combinations of laser treatments are being used in new ways to treat facial redness, flushing, swelling, and neuropathic pain that other treatment options have not been able to address. You can read more about this here:

http://www.drnase.com/rosacea_photoderm.htm

Ocular Rosacea Treaments:

Treating ocular rosacea can be tedious. Hygienic ocular care is essential. Many rosacea patients find the use of artificial tears beneficial (though don't use products like Visine, which will ultimately make the dryness and redness of the eye worse). You can read more about ocular rosacea treatments here:

http://lycos.cs.cmu.edu/info/rosacea--ocular-rosacea.html

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Other Important Information:

WEAR SUNSCREEN. Sun damage is thought to play a role in the development of rosacea because it is a vasodilator. Make sure your sunscreen is broad-spectrum, meaning that it provides sufficient protection from both UVA and UVB rays. If your sunscreen does not contain titanium dioxide, zinc oxide, avobenzone, mexoryl sx, and/or tinosorb, it does not provide sufficient UVA protection and is not broad-spectrum. Synthetic sunscreen ingredients can be irritating to those with rosacea, so look for sunscreens using the physical sunscreen ingredients of titanium dioxide and zinc oxide.

This article discusses the importance of sun protection and proper sunscreen application:

http://www.cosmeticscop.com/learn/sun.asp?ID=163
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Recommended Websites:

http://www.drnase.com/
http://www.rosacea.org/index.php
http://www.nlm.nih.gov/medlineplus/rosacea.html
http://www.about-rosacea.com/

I have been reading this forum for a year and half, and I have been a member for almost one year. I joined because I started Accutane therapy to control/stop steriod induced rosacea. Steriod induced rosacea is currently the only curable form of rosacea. I have also suffered from acne since puberty and today I am 43. It was in trying to fix my acne that I ended up with a form of rosacea.

Since I have been here I have seen what I think is a horrible trend. There have been several members of this board whose skin has developed rosacea like symptoms and they attribute this to oral and topical isotretinoin. I believe they are suffering greatly, I believe their suffering is related to isotretinoin, but I also believe their experiences are very uncommon. And now their posts have been leading many visitors to this board - terrified that if they use isotretinoin this will happen to them.

The fact remains that isotretinoin both oral and topical has helped many people over come acne. It has controlled rosacea for many as well. In my case it cured my rosacea and I was for the record taking 120 mg a day, 2mg per kg of my weight for the last three months of my therapy. If I believed what I read on here, than I should have a horrible rosacea and I don't.

The rosacea forum has three good stickies that contain awesome, well written information detailing rosacea. However, each day more and more people start posts asking if they have rosacea. These are people who have red skin, that is caused by one, several or all of the following: 1) inflammed acne, 2) topicals which are aggravating their skin, 3) topicals which naturally produce redness during the beginning of treatment until tolerance is built up, and or 4) the common side effect of redness that occurs during oral isotretinoin treatment and naturally subsides anywhere from 3 to 6 months after stopping treatment.

This forum is a godsend of information for many people. I for one have learned a lot on here and it helped my 7 month course of Accutane be a lot less scary. It is a shame that for all the good information on here, people are getting terrified by a few members whose experiences are uncommon and purely anecdotal. I am not asking for those who are having problems to stop posting. But, everytime I read this forum and I see a post by a terrified newbie, I want to comfort and inform them - but I don't have the time to do that with everyone. I really wish that one of the moderators on this board could put up a warning about this so that people are not unnecessarily alarmed by something they have no reason to be alarmed about.

Jessica,
I did a bit of online research last spring after someone here said his/her derm mentioned Demodex mites as a possible cause of his acneiform eruptions.

To show your hubby & make you feel better about those $100, here's a list of research papers I copied from a Rosacea site. The mites are implicated in the papulopustular form of Rosacea, the kind that looks very much like acne. The latest mite/Rosacea news is that the mites harbor a Gram negative bug of the bacillus genus (I've forgotten the exact name) that might be the actual irritant. The interesting thing about this is that the old sulfa drugs Bactrim and Septra, which many derms now consider the last resort/big guns before accutane, actually work best against Gram negative bugs.

I'll be reading your (and Queen's) journals with interest.

Quote
The clinical importance of demodex folliculorum presenting with nonspecific facial signs and symptoms.
Karincaoglu Y, Bayram N, Aycan O, Esrefoglu M.

In vitro and in vivo killing of ocular Demodex by tea tree oil.
Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC. MD, PhD, Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA. stseng@ocularsurface.com.

Topical application of 1-methylnicotinamide in the treatment of rosacea: a pilot study.
Wozniacka A, Wieczorkowska M, Gebicki J, Sysa-Jedrzejowska A.
Department of Dermatology, Medical University of Lodz, Poland. wozniacka@bmp.net.pl

Could matrix metalloproteinase-9 be a link between Demodex folliculorum and rosacea?
Bonamigo RR, Bakos L, Edelweiss M, Cartell A.


Density of Demodex folliculorum in perioral dermatitis.
Dolenc-Voljc M, Pohar M, Lunder T.
Department of Dermatovenereology, University Medical Centre Ljublana, Zaloska 2, SI-1525 Ljublana, Slovenia.

Demodecidosis in a patient infected by HIV: successful treatment with Ivermectin
Clyti E, Sayavong K, Chanthavisouk K.
Service de Dermatologie, Institut Guyanais de Dermatologie Tropicale, Hopital de Cayenne, Guyane Francaise.

The role of HLA A2 and Cw2 in the pathogenesis of human demodicosis.
Mumcuoglu KY, Akilov OE.
Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem, Israel. kostam@cc.huji.ac.il

Demodicosis and rosacea: epidemiology and significance in daily dermatologic practice.
Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, Sass U, Stene JJ, Thibaut S, Tytgat M, Seys B.

Studies of di-n-butyl phthalate-OP emulsion in the treatment of demodicidosis
Xia H, Hu SF, Ma WJ, Ge JH.
Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu 233003, China.

A clinico-pathological approach to the classification of human demodicosis.
Akilov OE, Butov YS, Mumcuoglu KY.
Department of Dermatology, Cosmetology Hospital "Aesthetics", Ekaterinburg, Russian Federation.

Efficiency of benzoyl peroxide-erythromycin gel in comparison with metronidazole gel in the treatment of acne rosacea.
Ozturkcan S, Ermertcan AT, Sahin MT, Afsar FS.
Department of Dermatology, Medical Faculty of Celal Bayar University, Manisa, Turkiye.

Rosacea: a clinicopathological approach.
Aroni K, Tsagroni E, Lazaris AC, Patsouris E, Agapitos E.
Department of Dermatopathology, School of Medicine, National and Kapodistrian University of Athens

Relationship between the Demodex and bacteria infection in human rosacea
Hu Q, Wang Y, Tong L.
Department of Parasitology, Medical college of Inner Mongolia National University, Tongliao 028041, China.

Facial demodicosis.
Zomorodian K, Geramishoar M, Saadat F, Tarazoie B, Norouzi M, Rezaie S.
Div. of Molecular Biology, Dept. of Medical Mycology & Parasitology, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, P.O. Box 14155, 64410 Tehran, Iran.

Immune response in demodicosis.
Akilov OE, Mumcuoglu KY.
Department of Dermatology, Cosmetology Hospital 'Aesthetics', Ekaterinburg, Russian Federation.

Treatment of human Demodex folliculorum by camphor oil and metronidazole.
El-Shazly AM, Hassan AA, Soliman M, Morsy GH, Morsy TA.
Departments of Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Demodex abscesses: clinical and therapeutic challenges.
Schaller M, Sander CA, Plewig G.
Department of Dermatology and Allergology, University of Munich, Germany

Eucalyptus globulus (camphor oil) in the treatment of human demodicidosis.
Morsy TA, Morsy GH, Sanad EM.
Department of Parasitology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt

Association between human demodicosis and HLA class I.
Akilov OE, Mumcuoglu KY.
Department of Dermatology, Cosmetology Hospital Aesthetics, Ekaterinburg, Russian Federation.

The management of rosacea.
Rebora A.
Department of Endocrinological and Metabolic Diseases, Section of Dermatology, University of Genoa, Genoa, Italy.

Demodicidosis revisited.
Baima B, Sticherling M.
Department of Dermatology, University of Leipzig, Germany

Rosacea and the pilosebaceous follicle.
Powell FC.
Regional Centre of Dermatology, Mater Misercordiae Hospital, Dublin, Ireland

Rosacea: I. Etiology, pathogenesis, and subtype classification.
Crawford GH, Pelle MT, James WD.
Department of Dermatology, University of Pennsylvania Medical Center, USA.

Facial demodicosis.
Zomorodian K, Geramishoar M, Saadat F, Tarazoie B, Norouzi M, Rezaie S.
Div. of Molecular Biology, Dept. of Medical Mycology & Parasitology, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, P.O. Box 14155, 64410 Tehran, Iran.

Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment.
Antille C, Saurat JH, Lubbe J.
Department of Dermatology, University Hospital, Geneva, Switzerland.

Is permethrin 5% cream effective for rosacea?
Swenor ME.
Harrisburg Family Practice, Residency Program, PinnacleHealth Hospitals, Pa, USA

Permethrin 5% cream versus metronidazole 0.75% gel for the treatment of papulopustular rosacea. A randomized double-blind placebo-controlled study.
Kocak M, Yagli S, Vahapoglu G, Eksioglu M.
Department of Dermatology, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.

Effects of intense pulsed light on sun-damaged human skin, routine, and ultrastructural analysis.
Prieto VG, Sadick NS, Lloreta J, Nicholson J, Shea CR.
Department of Pathology, UT-MD Anderson Cancer Center, Houston, Texas 77030, USA.

The pathogenesis of Demodex folliculorum (hair follicular mites) in females with and without rosacea.
el-Shazly AM, Ghaneum BM, Morsy TA, Aaty HE.
Department of Parasitology, Faculty of Medicine, Mansoura University, Egypt.

Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea.
Georgala S, Katoulis AC, Kylafis GD, Koumantaki-Mathioudaki E, Georgala C, Aroni K.
National University of Athens, Department of Dermatology and Venereology, A. Sygros' Hospital, Greece

Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome.
Jansen T, Kastner U, Kreuter A, Altmeyer P.
Department of Dermatology and Allergology, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.

Is demodex really non-pathogenic?
Pena GP, Andrade Filho JS.
Laboratorio Distrital Centro-Sul, Prefeitura de Belo Horizonte, Minas Gerais, Brasil

Rosacea, acne and other diseases of the seborrheic spectrum
Boni R.
Dermatologische Klinik, UniversitatsSpital Zurich.

Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream.
Forstinger C, Kittler H, Binder M.
Department of Dermatology, Division of General Dermatology, University of Vienna Medical School, Austria

Limitations of standardized skin surface biopsy in measurement of the density of Demodex folliculorum. A case report.
Forton F, Song M.
Clinic of Dermatology, Universite Libre de Bruxelles, Saint Pierre University Hospital, Brussels, Belgium

Demodex mites in acne rosacea.
Roihu T, Kariniemi AL.
Department of Dermatology, Helsinki University Central Hospital, Finland.

Unilateral demodicidosis.
Pallotta S, Cianchini G, Martelloni E, Ferranti G, Girardelli CR, Di Lella G, Puddu P.
Department of Immunoderma-tology, Istituto Dermopatico Dell Imma-colata, IRCCS, Via dei Monti di Creta 104, 00167 Rome, Italy.

The significance of Demodex folliculorum density in rosacea.
Erbagci Z, Ozgoztasi O.
Department of Dermatology, Faculty of Medicine, Gaziantep University, Turkey.

A study on Demodex folliculorum in rosacea.
Abd-El-Al AM, Bayoumy AM, Abou Salem EA.
Department of Dermatology, Faculty of Medicine, Al-Azhar University, Nasr City, Cairo

Pilocarpine gel for the treatment of demodicosis--a case series.
Fulk GW, Murphy B, Robins MD.
College of Optometry, Northeastern State University, Tahlequah, Oklahoma, USA.

Rosacea-like demodicosis in an HIV-positive child.
Barrio J, Lecona M, Hernanz JM, Sanchez M, Gurbindo MD, Lazaro P, Barrio JL.
Dermatology, Service, Hospital General Universitario Gregorio Maranon, Madrid, Spain.

Demodicidosis or rosacea: what did we treat?
Hoekzema R, Hulsebosch HJ, Bos JD.
Department of Dermatology, Academisch Medisch Centrum, University of Amsterdam, The Netherlands.

Acne rosacea complicated with demodicosis
Bobrov VM.

Demodex mites in rosacea.
Diaz-Perez JL.


Rosacea
Decauchy F, Beauvais L, Meunier L, Meynadier J.
Service de dermatologie allergologie et photobiologie, hopital Saint-Charles, Montpellier.

The Demodex mite population in rosacea.
Bonnar E, Eustace P, Powell FC.
University Department of Ophthalmology, Mater Misercordiae Hospital, Dublin, Ireland.

Granulomatous rosacea associated with Demodex folliculorum.
Amichai B, Grunwald MH, Avinoach I, Halevy S.
Department of Dermatology, Soroka Medical Center of Kupat Holim, Beer-Sheva, Israel.

Rosacea: a study of clinical patterns, blood flow, and the role of Demodex folliculorum.
Sibenge S, Gawkrodger DJ.
Department of Dermatology, University of Sheffield, Royal Hallamshire Hospital, U.K.

The possible role of skin surface lipid in rosacea with epitheloid granulomas.
Basta-Juzbasic A, Marinovic T, Dobric I, Bolanca-Bumber S, Sencar J.
University Department of Dermatology, Medical Faculty, University of Zagreb, Croatia.

Topical steroid induced chronic demodicidosis.
Sakuntabhai A, Timpatanapong P.
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Rosacea: histopathologic study of 75 cases
Ramelet AA, Perroulaz G.
Service de dermatologie et de venereologie, CHUV, (Centre Hospitalier universitaire vaudois), Lausanne, Suisse.

The hair follicle mites (Demodex spp.). Could they be vectors of pathogenic microorganisms?
Wolf R, Ophir J, Avigad J, Lengy J, Krakowski A.
Department of Dermatology, Ichilov Medical Center, Tel-Aviv, Israel.

T-cell subsets in acne rosacea lesions and the possible role of Demodex folliculorum.
Rufli T, Buchner SA.


Ultrastructural study of demodex infestation of the face in healthy subjects and acne rosacea patients
Crosti C, Menni S, Piccinno R, Sala F.

Nosologic position of demodicidosis in humans
Bardach HG, Raff M, Poitschek C.

Demodicosis of ophthalmic concern.
English FP, Nutting WB.

Metronidazole and Demodex folliculorum.
Persi A, Rebora A.

Demodex folliculorum and rosacea: experimental and immunological studies
Grosshans E, Dungler T, Kien TT, Kremer M.

Perioral dermatitis--an allergic disease?
Arutjunow V.


Pyroglyphid mites, xerophilic fungi and allergenic activity in dust from hospital mattresses.
v d Lustgraaf B, Jorde W.

Pathogenesis associated with hair follicle mites (Demodex spp.) in Australian Aborigines.
Nutting WB, Green AC.

Demodecidosis and rosaceiform dermatitis
Hojyo Tomoka MT, Dominguez Soto L.

Demodex folliculorum in rosacea.
Ayers S Jr, Mihan R, Marks R, Harcourt-Webster JN.


The role of the acarid Demodex folliculorum in ophthalmology.
English FP.

The role of demodex mites in the development of acne rosacea
Kiselev OA.

Demodex folliculorum in patients with rosacea
Baksht BP.

Demodex folliculorum and rosacea. A clinical and histological study.
Robinson TW.


Demodectic eruptions (demodicidosis) in the human. 30 years' experience with 2 commonly unrecognized entities: pityriasis folliculorum (Demodex) and acne rosacea (Demodex type).
AYRES S Jr, AYRES S 3rd.

Rosacea: the role of demodex folliculorum.
BRODIE RC.

Rosacea and the pilosebaceous follicle.
Powell FC.
Regional Centre of Dermatology, Mater Misercordiae Hospital, Dublin, Ireland. 1974

Unquote


Feel better now? :-)

Hi,

I don't quite have acne, but have this very bothersome redness. I went to a dermatologist, and he said I have SD and prescribed me Loprox cream (with 2% Hc powder, whatever that is... it came in a generic container). I applied it for about 2 months to the area, at night, but it didn't help much. I went back to the dermatologist, and he said that I basically got rid of SD, but that the redness will maybe disappear in the future, but that he cannot do anything about it other than laser.

That is not good enough for me. It makes it look very ugly because of where it is; it affects only the TOP half of my upper lip area (as well as some around my chin as in the picture). It looks better in the light, but still... Also, it's somewhat patchy: that area is not contiguously red. I don't know how it came to be. I am also slightly red around the nose (typical SD), but that doesn't bother me.

I have tried using Nizoral by applying it to the area, leaving it on for 10 minutes, and washing it off. I can't comment on whether this produces results, though.

I'd also like to say that I never experiences any flaking or dryness or anything. The redness is all I care about.

What should I do? Would BP daily help? Or experiment more with Nizoral? Or something else (currently, I'm using Dan's new SA twice daily as a moisturizer)? This is basically the only thing that really bothers me on my face.

Thanks.

Hi everyone, thanks for viewing my thread.

Like most of us here, I have battled acne since my early teens. I am 22 now, I recently bought my own house, work is heavy and demanding, and life is different to when I was living with my parents! My battle with acne has seemed to turn one problem into another.

At first it was bad on my back and neck and I had break-outs on my face from time to time. From the ages of 13 to 18 I had tried several medications. I was prescribed Accutane but never actually started the treatment. I think just through growing up and improvements in my diet, my acne faded naturally. That was all good until I developed eczema and very red-raw dermatitis on my face, neck and scalp. It started out as just a few blotches under my eyes, but it grew and grew until both cheeks were full of it, my top lip suffered, my chin got it and my forehead was covered with it. I tried several creams and prescribed emollients, but with little effect. My doctor even told me to use ketoconazole shampoo on my face. It seemed the only thing that would help it would be to live off fruit and veg and water!

I went on holiday to Greece a few years ago, and used this Nivea after-sun lotion, and surprise surprise, it cleared up my eczema rather well, and I still use it today. So, my acne kinda cleared up on its own, and my eczema is kept under control by this Nivea moisturiser I'm using, but I've slowly developed this redness on all my face.

First I noticed it on my cheeks and it has very slowly spread to all over my face. The only white bits of "normal" skin left are directly round my eyes. I look like a panda! And it stops exactly on my jaw bones. It is not red like eczema-red, it is more of a gentle red, like a pinkish colour. My face has a rather dry but oily feel to it and it is rough to the touch. I shed a lot of skin - I am always seeing flakes stuck to the side of my nose and if I rub my lips, my top lip flakes a lot. My cheeks are bad for flaking - I can gently slide my nail down my cheek and I pull off lots of skin.

I just don't know what it is. I've been to my doctor and he has prescribed me minocycline. After doing research on this product I don't think I need it, as it is a treatment for acne. Yes it keeps acne break-outs at a minimum (but so does a healthy diet in my opinion), but I don't think my doctor really understood what my problem was. After reading some posts on here, minocycline seems to worsen this red flushing of the face. I've been on minocycline for about 6 months now. The redness comes and goes but I don't think it has improved or got worse.

I just feel like I'm in a deep hole with no ladders to get out. I do try and forget about it because sometimes it isn't that bad, but sometimes I can catch myself in the mirror and I think "Geeze" because the front of my neck (throat) is white, then it's red from my chin upwards, with two white patches where my eyes are. I think I look so stupid lol.

Any suggestions on what to try next?

Hi has anyone used Paula's choice lightening products for red marks? I have a lot of them currently and quite a few whiteheads.

Which one is better the one with AHA or the one with BHA?

After reading many posts on this site I decided to purchase the lumiport Pen. But it appears to only be sold on the companies website. Many people had mentioned it being sold on drugstore.com. Am wondering if the pen has been discontinued or if something else is just about to come out?

Basically, I am very pale/freckly thin skinned and whenever I do something(yes basically anything e.g run for 20 seconds) My face goes pink and im sure its the blood showing through my thin skin, Even when Im normal in a normal room temprature my skin is still slightly seethrough and pink(I have permanent red cheeks too)

This is really starting to F*@K me off badly, Everything you try on the market just doesnt work, And it only seems to get worse.
I think im about to go on roaccutane also soon so would this make it worse/better?

Please some1 atleast reply if you have any ideas

Has anyone used it? Is it any good?

Thx!

Im an 18 year old male. I first started washing my face at age 15. Everything was good until I got cocky and didnt wash my face for a whole year. I never had a problem with acne I just washed my face to prevent getting it. So When I was 16 I started to wash my face again. I was using a new cleanser every few weeks. It was drying my skin out and I would apply a moisturizer to it. I was also not eating healthy and not wearing sunscreen. At that time I was in the sun a few hrs daily. I would also shave with just water on my face. So the combination of these things made my face worse. Now My face is like a light pink red color. Gradually I started to take better care of my self and stook to cleansers for longer times. When I turned 17 I started a whole new part of skin care. I started excersising and eating healthy. So for the past year ive been eating and drinking healthy. But my skin has shown little improvement. I dont do drugs,smoke or drink alcohol, and have little stress. So im not sure why my skin hasnt cleared up. So I decided to see the dermatologist.I went to the dermatolagist who told me I had acne scars. which I didnt get cause I never had acne to beging with. But w/e.So I was on Klaron Lotion for 3 months. That didnt work. Then I went back last week and he said I have Rosacea. So now im using metrogel once daily. And I would like any tips or help on how to achieve CLEAR SKIN! And if anyone knows of any good supplements or vitamins I can take orally that can help my skin id love to hear it!

After over 10 year with acne, I have finally managed to get it under control (thanks, in large part, to Naturally Clear Multivitamins and Aqua Glycolic products). But after my active acne went away, my naturally very pale skin was ravaged by very apparent bright red post acne marks and a tremendous amount of overall redness. After reading about other posters' successes with Sudocrem, I decided to pick up a container at the store and try it.

After the first few days, I was AMAZED at how well it was working. While there were no overnight miracles for me, every morning I woke up and washed it off, my face was substantially less red, many of my post-acne marks were fading, and the one active pimple I did have dried up. I was so happy, and was finally able to be substantially more confident about the overall appearance of my skin and optimistic about my skin's future.

And then, I did something stupid. Without thinking, I used my normal Glycolic acid toner after washing my face, along with an AHA nightly moisturizer. I put this on underneath my layer of Sudocrem. Previously, I had only used my AHA moisturizer on top of the Sudocrem with no problems. This turned out to be a huge mistake, and when I woke up this morning my skin had suffered a chemical burn and was bright red!!! All of my progress had been ruined, and I was so surprised, because my skin normally isn't sensitive to anything.
So do not use Sudocrem with AHA products! I have managed to get my redness down by a lot so far, thanks to an aspirin mask, aloe vera gel, and pycnogenol redness reducing serum, but my skin is still unfortunately feeling quite raw.

I will definitely go back to using Sudocrem once this passes, I definitely recommend it if you have excessive redness, but never in conjunction with AHA products!

How do i prepare? should i wash my face before I go? I wear makeup to cover up the redness of my face, so i assume I would have to take off the makeup somewhere along the line, but do i do it before i go or what?

Should i tell her i think i have rosacea, or should i just describe my symptoms?
How do you even pronounce rosacea? (lol)

I have little freaking annoying bumps all around my nose/cheek area, my cheeks and nose are ALWAYS pink (but they seem to have gotten a lot better over the past like 3 months? what the heck is that about, they've been red ever since i started having acne), and my face flushes at the tiniest most annoying thing.

I'm 18 years old.

I also have some minor acne in various spots around my face and I'm scared she might try to treat that instead of treating me for rosacea.

What should i tell her? everything i just told you guys?
This is my first dermatologist appointment EVER.

Anyone use this for red/uneven skin? does it work

I was thinking of ditching my compound and washing with my gentle cetaphil and adding this before bed.

But I Wanna know if anyone has tried this.

I had NO idea that this could effect your eyes!
I am finishing up Accutane and have all the redness and flushing, but another big problem I have had is my eyes being bloodshot all the time! Red, itchy, dry, bloodshot. Ive been googling this like crazy now! lol
Can anyone else relate?

I was on accutane for six months about a year ago and after getting off I was put on minocycline which I took from then on until about six weeks ago. Last November I started to get facial redness/flushing on the sides of my face and nowhere else. The main trigger that causes my redness/flushing is heat and my face seems to be extremely sensitive to any heat and I can even flush in temperatures of 65F. At first I thought it was just due to dry skin, but my skin hasn't been dry for months and I still suffer from this problem. My dermatologist had no idea what was wrong with me and she had me stop taking minocycline to see if that helped. I noticed a marked improvement once I stopped taking the minocycline, but I still have facial redness/flushing six weeks later. The minocycline was definitely making things worse, but the biggest change I have seen since stopping it is in the intensity of flushing I get. When I was on the minocycline my face felt like it was on fire and now, even though I still flush, it isn't to the same intensity as before. When my face starts to feel hot my cheeks feel sticky even though my skin still feels smooth to the touch so I guess it is like an internal problem. I am not sure what that means, but I think that maybe my skin doesn't produce enough oil after accutane or something? I used to have pretty oily skin and now I don't have oily skin at all. The only product I am using right now is klaron, but I don't think that it has any connection with flushing and it has been really effective in keeping me acne free. I was hoping to get some advice if anyone had any?

how can i make the flaking go faster so that i can meet the results because it looks like the more the flakings come off the better my skin starts to look help please read and reply if u do know how

how to get rid of the scar and the redness of the pimple???bcoz i really have it and so many especially in my forehead!!!pls help me guys!!

my dermatalogist told me yesterday i have both rosacea and acne vulgaris. At first i used to have only acne. i think some excessive use of acne products causes my rosacea. I have recently come to know that rosacea is not curable. This information makes me so depressed. I am only 19. And i am loosing all my hopes, aim ...... i have another problem. some times when i go out in the sun my chest , back, and forhead become red( almost blood colour) and i also have a burn feelin at that time. sometimes it happens when even i am just walking or doing something quickly. But after this situation when i go to a cool place my skin become normal again. Do any of you guys exprience it???? Please someone help me. This problem is killing me!!!!!!

Hey everyone!
Before i start rambling about the terrible side effect i got frm one of the topicals i used let me tell u a lil abt me. Im 21/m frm india. The climate out here is really hot and humid. I started gettin acne arnd 2004 i had got my acne nearly cleared by gettin glycolic peels and microdermabrasions done in 2005-6. In 2007 arnd march i went to my derm she prescribed me a cream called deriva-c gel (its got adapalene and clindamycin in it) was to be applied for every whole night. She said it'll make my skin smoother. Well im always in for clear n smooth skin. So i started the application 1st night when i applied it felt very cool as if ive applied ice on my face i kept it on my face for abt 15 mins 2nd night for 1hr and 3rd night i kept it for whole night. 4th day was terrible day in my life my face had become completely horrible with my skin peeled off like anything, rough rash burning itching scaling all over my cheeks and nose. It looked like someone spilt acid on my face! its been 6 months thinking tht things would get better with time but no major improvement. My present concern is tht my nose stays pink all the time ive got many white dead skin which is visible after my shower, in the day my face is quite dry by evening my face becomes very oily, ive got a lil redness on my cheeks too, i breakout into 2-3 pimples in a week or two but my pimples go away real fast. ive showed to many derms they say ive got seboherric dermatitis with mild rosacea and mild acne. Finally ive found the right derm after my visits to 7 derms. She has prescribed me mino 100mg, elidel cream and a hydrocortisone cream called fucidin-h. What do u guys say should i start with this ??? has any1 tired any of these medications plz let me know with details, thanks in advance and im really sorry for the long post hoping to get some replies....

So I pretty much have photodermatitis
http://www.umm.edu/altmed/articles/photode...itis-000155.htm

it said a on therapys that b5 could help but then it also said this at the end,im confused?

vitamin B3 (1 g three times per day) -- Nicotinamide (a form of niacin, or vitamin B3) may make a photosensitive reaction less likely. In a pilot study, it reduced reactions among people with polymorphous light eruptions. Vitamin B3 is an antioxidant, so it may be providing protection in the same way other antioxidants might. You should take this high a dose of vitamin B3 only under a doctor's supervision because of the risk of side effects such as flushing and liver damage

Im confused....

This doctor at a clinic gave me a perscription for minocin..

I never knew about it until I got it,thought it was that minocylin or wtf and she wrote it wrong but it seems to be different..says it for acne and redness/rosacea

has anyone took it?

has anyone heard about post redness after it?

please help i already have post redness from accutane..and if i get it again that would be fucking hell.

If your skin is pink and gets red from a bit of water but you dont have roseaca what isit classed as?
Im guessing its classed as flushing, well I have been these boards and see that it seems theres no treatment for flushing, everybody just says use a moistruizer or all of that BOLLOCKS, I dont even know why the F*** my skin has gone like this, I can look at a picture from when I was 8 and my skin is just 1 tone, Now its completly F****D, I dont want to use a moisturizer that calms the reddness by 15%, or stay in a cool enviroment, or not touch my face. All of this S*** I could do without worrying when i was younger.
I CANT do all this stuff for the rest of my life just to make my face not go pink, Their must be something that can stop it, If i tilt my head down for just 10 seconds my whole face goes pink, So I should not tilt me head for the rest of my life?? BS.

Their has to be something to just STOP it. Can anybody who has managed to post a drug they was prescribed here with the name of it?
And DONT post f****** **** creams that you have to apply every 35 minutes because obviuosly its impossible to do that for the rest of your life, Unless you want to sit in a box room, live in a box room, sleep in a box room, and die in a box room.

So far LEMARR posted about a drug called mepacrine, which seems to be worth looking into
Is there any others? or any other users who have stoped there flushing?

If your a derm and I offered you £8000, Can you help me?

Thanks

U said u found a cure to flushing/facial redness after accutane?

please help

I began experiencing facial flushing back in late November. Which is just after I started using a lot of new products. I started on Solodyn (minocycline), Yaz Birth Control, Differin Gel, and Duac. After about one month I stopped using the Solodyn. After two months I stopped using the Yaz Birth Control Pill and Duac. I continued with the differin gel until a few weeks ago.

I went back to the dermatologist after I stopped both the Solodyn and the Birth Control Pill in early January. I told her that I thought it was causing me to get really hot... I thought at the time that, that was all it was. Hot flashed or something. I thought the medicine caused it. So she perscribed me Bactrim. I used that for about two months. It worked great for break outs. However, I ended up getting a mild rash on my stomach from it. So I went back to the dermatologist about that and she toke me off it and put me on Spironolactone. Which I've been using now for two months and It is worked great for my break outs and my oily skin. Which I'm very happy about.

However the facial flushing has continued and gotten worse over time. I have only recently stopped using the differin gel. About three weeks now. I don't know what could have caused this facial flushing but... it's beginning to become impossible to live with. It mostly happens in any kind of heat or when I'm embarrsed/stressed. Although, sometimes it happens randomly for no apparant reason. It is very discomforting... my face feels like it is burning. When I touch my cheeks they are soooo hot. I can feel my face pulsing almost too. My ears also get very hot and red. It seems to be worse on the right side of my face than on my left side.

If I sit in front of a fan for a good 15-20 mins usually it will calm down. Also sometimes when I wake up in the morning my face is back to normal. Recently though even sitting in front of a fan or getting a good night's sleep isn't working anymore. I woke up today with my right cheek and ear very red... my left cheek was a little red too. My whole face felt so hot. I toke a cool shower and that helped. My face doesn't have that burning sensation anymore but my cheeks are still pretty rosy.

I don't know what caused this or what to do about it. I don't know what kind of treatment there may be. But if anyone knows please please please help me out. I would really appreciate any advice. I would love to hear about anything that may have worked for you.

I am going to the doctor tomorrow morning about this. I'm going to take a really warm shower and go right afterwards so she can see how bad this really is. Also I am going to try going to my dermatologist too if the doctor doesn't know what to do about it.

Please help me. I'm so depressed about this. This is effecting every day of my life. I don't want to go on forever dealing with this. What can I do about this?

Hey guys ive been using Green cream for 8 days now and have noticed a significant improvement in my facial redness.....before i would feel when my skin was red and now i rarely feel it red, it feels awesome.....has ne one else tried it, i tried googlin green cream and rosacea to see if other people were experiencing similar results but i couldnt find anything. Have any of you guys used it and experience good or bad result??.......ohh yea im using the 3% using it every night

My red marks are usually very noticable especially in the heat, they are from a bout of severe cystic acne some 2 years back and I almost consider them to be a form of rosacea.

Whenever I take a certain stimulant (which I wont mention the name of) I notice that my red marks completely fade, even in the heat and I have found that while on that certain stimulant my red mark problem is temporarily eradicated

So I was wondering today, caffeine is a weak form of stimulant, and most stimulants constrict blood vessels. Maybe it will have similar effects on red marks? I might try drinking coffee/red bull everyday and see if I notice any difference. Ive also looked at this website http://www.personahealth.com/Caffeine-lotion-pr-16145.html . Now it says nothing about the lotion helping rosacea or red marks but if you look at this website http://www.drnase.com/mini_studies.htm it says that a caffeine based moisturizer could do wonders?

Anyone tried fading their red marks/ rosacea by using caffeine based products?

Hi guys

I have had two goes at Accutane, both on very low does (20mg a day max) and for no longer than 2 months at a time. The first time I went on Accutane I was on 20mg a day and I couldn't cope with the side effects so I had to come off. The next time I tried a very low dose (5mg a day) to see if I could tolerate it better, however this was not the case and I had to give up after about a month because I was getting severe blushing everyday.

Once I stopped Accutane the blushing has gradually got slighty better, but I still blush very easily when I laugh, get emabarassed etc. I find I can't tolerate even slighty warm temperatures and it makes going to parties etc so horrible because I spend the whole night looking like a tomato and everyone looking at me and asking me if I'm alright. I don't blush everyday now but only when I get hot. I feel so depressed because I find myself avoiding social situations because I don't want to spend the whole night burning and trying to cool myself down. I wouldn't mind so much if it was a quick flush but sometimes it's hours before I return to a normal colour.

I feel so depressed becuase I never had any of the these problems before Accutane and I end up thinking if only I hadn't taken it. The worst thing is they say Rosacea only gets worse, can someone tell me if this is definately the case if your Rosacea was caused by Accutane? and will it gradually get better now I am off Accutane?

Please someone help me.

xx

I have some concerns and questions that hopefully someone in this forum can answer and explain.

I was offically diagnosed with SD about 2.5 months ago although I can remember having symptoms for about 1.5 years ago. Before I was diagnosed my doctor thought it might be Eczema and perscribed me 2% hydrocortisone. I used it about once day for 1.5 months. I found out it could cause dependency and quit using it all together. For about 2.5 weeks after quiting it and using no other products except mousiturizer after showering, my skin was mostly flawless and I don't remember having too much redness. Then once I got into the 3rd week of being off steroid cream I started to get a patch of little blemishes on my left cheek. I remember getting a little redness too. I was then able to finally get into the derm and this is when he diagnosed me with SD. He gave me ketoconzaloe cream which I started using about a week after the diagnosis when my SD flared a little bit. It has now been about 1 month since the derm visit and about 1.5 months since i quit the steroid cream. I am starting to get these little isolated blemish marks that aren't acne but instead are jsut little red spots that itch. After applying ketoconzaloe to them they seem to go away after 2-3 days for the most part. This is when I found out about steroid induced Rosacea and Withdrawal. I am starting to notice signifigant flushing of the skin on the upper half of my face and for the last week or so I have noticed some slight burning when I apply mouisturizer to my face. This morning when I woke up my face looked fine and there was minimal redness. But for about 6 hours after my shower and application of ketoconzaloe and eucirin mouisturizer I have been getting signifigant flushing and this kind of warm sensation in my face. What are your thoughts on all of this?

If anyone coudl also answer the following:

Is steroid rosacea permanent or is it jsut a withdrawal phase that will go away once the bodies natural cortisol levels are restored?

Should I go try and see a derm about this?

Do you think it might be an allergic reaction to the products I am using? I have used the moisturizer for many months without a reaction so it could be the ketoconzaloe.

Does this indeed sound like steroid-induced Rosacea?


I know these pictures don't really show the redness too well as I had to take them wtih my cell phone. But if you compare my face with the skin on my neck or my hand which I put in some of the pictures you can see that my face has a farily signifigant redness to it. I don't think any of the little blemish marks really showed up though.

Left Side of face - better side

Right Side - Worse Side

Front with hand to compare


Thanks for input.

So i know ALOT of people know this already,

bit i thoguht i had rosacea because my mother has it. and then i changed BP products and BAM no rosacea. just a thought in-case some people have this problem as well.

Also when i used certain products on my skin i suffered from emphysema. Which is basically blushing of this skin, but its when you blush without being stresses, embarassed and it makes your face feel quite hot. So mayeb change the products your using and it will go away. It used to happen to me ALL the time and now it never does.