Skinoren

Rosacea is not induced by bacteria, antibiotics is not preferred drug in treatment of rosacea. The following article may help you improve rosacea treatment.Rosacea patients have to avoid drinking beer and alcohol, as well as some food such as milk, beef, and chilli and fried food.

Niren NM. Pharmacologic doses of nicotinamide in the treatment of inflammatory skin conditions: a review. Cutis. 2006 Jan;77(1 Suppl):11-6.

Dos S K, Barbhuiya J N, Jana S, Dey S K. Comparative evaluation of clindamycin phosphate 1% and clindamycin phosphate 1% with nicotinamide gel 4% in the treatment of acne vulgaris. Indian J Dermatol Venereol Leprol 2003;69:8-9

Otte N, Borelli C, Korting HC. Nicotinamide - biologic actions of an emerging cosmetic ingredient. Int J Cosmet Sci. 2005 Oct;27(5):255-61. doi:

Niren NM, Torok HM. The Nicomide Improvement in Clinical Outcomes Study (NICOS): results of an 8-week trial. Cutis. 2006 Jan;77(1 Suppl):17-28.

Oracea (doxycycline) is used for its anti-inflammatory properties in rosacea.

http://www.ncbi.nlm.nih.gov/pubmed/17315050

The inflammation of rosacea is not induced by bacteria, antibiotics is not preferred drug in treatment of rosacea. Many people think that only the bacteria is the main cause of inflammation, but it is not. I can not advocate the misuse of antibiotics, treatment of rosacea should be focus on the cause of the disease.There are many articles have revealed the pathogenesis of acne vulgaris and rosacea. but the following articles suggest some therapeutics different from the past should be taken in treatment of acne and rosacea.

1. Burkhart CN, Gottwald L. Assessment of etiologic agents in acne pathogenesis. Skinmed. 2003 Jul-Aug;2(4):222-8.

2. Bowe WP, Logan AC. Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles. Lipids Health Dis. 2010 Dec 9;9:141.

3. Ozer Arican, Ergul Belge Kurutas, Sezai Sasmaz.Oxidative Stress in Patients With Acne Vulgaris. Mediators Inflamm. 2005 December 14; 2005(6): 380–384.

4. Bowe WP, Patel N, Logan AC. Acne vulgaris: the role of oxidative stress and the potential therapeutic value of local and systemic antioxidants. J Drugs Dermatol. 2012 Jun;11(6):742-6.

5. Sarici G, Cinar S, Armutcu F, Altinyazar C, Koca R, Tekin NS. Oxidative stress in acne vulgaris. J Eur Acad Dermatol Venereol. 2010 Jul;24(7):763-7.

6. Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003 Jul;121(1):20-7.

7. Ottaviani M, Camera E, Picardo M. Lipid mediators in acne. Mediators Inflamm. 2010;2010. pii: 858176.

In some rosacea patients the skin is very sensitive even to routine available topical gels & creams for rosacea. I have tested a topical solution made by adding 1 gram metronidazole powder to 100 ml of Bioderma Sensibio solution . It is tolerated by almost all patients. Low dose Doxycycline po has beneficial effects by a mechanism different from its antibacterial effects, it seems to have some anti-inflammatory effects!

Rosacea is chronic diseases relapse easily. Doxycycline is an antibiotic, not a vitamin. It can not be a long-term oral medicine in treatment of rosacea. Children and young adolescent should not use doxycycline. Long-term oral Doxycycline in treatment of acne and rosacea can cause permanent graying or yellowing of the teeth not only in children younger than 8 years old, but also adolescent and young adult. ......Plenty of Doxycycline side-effects can be listed here. Doxycycline po should not be used to treat rosacea and acne even obviously bacteria infection

In some rosacea patients the skin is very sensitive even to routine available topical gels & creams for rosacea，in the begin,he should use doxycyclineor Metronidazole.

Rosacea is a disease of middle aged persons. It is not seen in children and adolescents , so lt ls obvious that we use doxycycline in patients with rosasea (usually older than 30 years) not in children and adolescents.

Rosacea is well recognized as a chronic cutaneous inflammatory disease with characteristic sign as flushing, erythema, telangiectasia, edema, papules, pustules, ocular lesions, and rhinophyma on the central face skin (cheeks, chin, nose, and central forehead), often characterized by remissions and exacerbations. Rosacea occurs in both men and women and, although the onset typically begins at any time after age 30, it may occur at any age of life. Doctors use Doxycycline and tetracycline po to treat acne and rosacea without consider the pathogenesis of rosacea and acne, nor the side effect of these medicine.

Some medical doctors always think that inflammation associated with bacteria infection, but it is absolutely not. No evidence was found that bacteria are implicated as a factor in papular rosacea and acne in earl stage.

There are so many questions about rosacea, for example, why Rosacea is a disease frequently found in middle aged persons?The prevalence of many diseases is increasing after the age of 30. What cause the severe inflammation of acne and Rosacea? what is the pathogen of acne and rosacea?What is the name of the disease should be considered by medical doctors when the erythema of rosacea extend from truck to bilateral cheeks like butterfly?......

Oxidative stress involve in pathogenesis of many diseases including acne, rosacea, psoriasis, atherosclerosis, cancer, depression, Alzheimer’s disease, schizophrenia, and diabetes mellitus, and so on. Do rosacea patients have high risk of suffering all these diseases?......

Doxycycline and tetracycline po in treatment of acne and rosacea is really not safe!

I usually treat rosacea with systemic metronidazole for 14 days in combination with topicals. Topical i prefer benzoyl peroxide 2.5% gel. After that topical metronidazole give. If patient not improved than in low dose systemic isotretinoin considered.

Dear Adashiata singh:

Thank you for your reply.

One of pathological features of acne and rosacea is apoptosis, necrosis and desquamated of the epidermal cell around rosacea and acne lesion. A significant side effect of topical isotretinoin is apoptosis and desquamates of epidermal cells increasing on skin. The pathological changes after treatment of topical isotretinoin include chapped lips, apoptosis, desquamating, keratosis and Peeling on face skin of rosacea and acne patients.

Oral isotretinoin can lead to apoptosis of epithelial cells and intestinal epithelial cells, gastrointestinal mucosal dysfunction and abnormal gastrointestinal symptoms; liver cells apoptosis result in abnormal liver function; isotretinoin is not a vitamin, it is a byproduct of metabolism has no physiologic function, it inhibits cell metabolism and interfere with growth of the body and increase the depression and suicidal tendencies. It inhibits and interferes with the normal development of the embryo and results in teratogenicity. Isotretinoin cause hyperlipidemia makes patients susceptible to atherosclerosis.

Although some article report no any depressive symptoms or suicide risk caused by isotretinoin, isotretinoin can not improve depression and suicidal tendencies of rosacea and acne patients.

Isotretinoin is not safe in the treatment of psoriasis, acne vulgaris and rosacea.

Thank you sir for opinion about isotretinoin . What you said everything is correct . But isotretinoin is not first line drug of treatment for rosacea, but if other drugs are not giving relief at that time considering isotretinoin in low dose is not that much harmful for short duration.All those side effects are common when we consider higher dose for long duration.

Dear Adarshlata Singh:

Thank you for your reply!

1. Most mild to moderate Rosacea and acne patients can be improved and heal by change their diet habits. Rosacea and acne patients have to avoid alcohol drinking, fry food and milk, beef and spicy food. If other drugs are not giving relief at that time considering diet habit changing can improve Rosacea and acne. Doing exercise is recommanded.

2. Rosacea and acne patients who are in dyslipidemia (hyperlipemia) should be treated.

3. isotretinoin is not necessary.

4.......

My view point about pathogenesis of acne and rosacea and therapeutic principle of these diseases is something different from other dermatologist. I am very sorry that I can not explain too much here.

Dear All,

Rosacea is a problem which many have described above and is easy to treat difficult to cure.

I have tried these medication and have been successful in all (hundreds) but one or two.

Tab Azythromycin in pulse therapy

Local Metronidazole gel therapy

Apply calamine at day time

Strict avoidance of sunlight,beer ,alcohol,radiant heat or any factor which triggers flushing of face .

If all fails PO metrogly or some hormonal therapy.Damage due to long standing Rosacea is only cured by laser or dermaabrasion

Benzoyl Peroxide 5%

I've personally used azelaic acid (15%) which is available as a topical treatment. The trade name in the US is Finacea. It makes my skin feel like ant stings, but it's not bad. Metronidazole doesn't help me much at all.

Avoid alcool and trigger foods. Advise of outdoor living and greater exercise. Metronidazole 250mg BID for four 4weeks, or metronidazole topical Cream At the concentration of 1%

Azytromicin 500 mg in tab formulation in pulse therapy (2weeks of therapy).

Isotretionin 0,5 /mg/day for 6-8weeks.

Doxiciclin 40mg/day for 6-8weeks

Dear Paolo Borrelli：

I do not agree with your point of view

Dear Mathew Alex

I do not agree with your point of view

I believe that many of the suggestions can be and are helpful in specific patients.

The protocol we find most helpful includes a mild cleanser in place of a bar soap. Overall in both adults and children the body or facial washes (synthetic detergents or syndets) which foam and some contain ceramides are superior to bar soaps.

The stages of rosacea especially the erythematotelangiectatic and papular/papulopustular can be mild and static or aggressive and advancing. For those that are mild , 1% metronidazole gel or 15 % azelaic acid gel can be used qd. Often one of the TCIs can be used adjunctively to reduce inflammation.

Systemic rx is not always needed in the mild static stages noted above. However systemic rx is required in the phymatous stage as well as with ophthalmic rosacea which is recognized both in pediatric and adult medicine.

Current systemic rx choice is doxycycline 40 mg qd. This is a sub antimicrobial dosage and works as an anti-inflammatory with 10 mg rapid release and 30 mg sustained or slow release. It has a significant anti-MMP action.

Important for pt. to understand that this is a chronic condition and we don't cure it but only control it and hopefully help it into remission. There is electrosurgery and laser rx for the phymatous and erythematotelangiectatic stages that can help dramatically

Acne vulgaris, acne rosacea, psoriasis and lupus Erythematosus share common pathogenesis. The therapeutic principle of acne rosacea should refer to that of atherosclerosis : high dose of niacin(800~3000mg/d, 20~50mg/kg/d), so as to upgrade plasma levels of HDL cholesterol and/or improve HDL function to inhibit inflammation of acne and rosacea.

Dear Hao your view is interesting, If niacin could treat rosacea, on the line of atherosclerosis, then why is the single medicine not being used to treat blocks and save millions from heart attack and strokes. we find statins being used for cholesterol control,. Rosacea is an immunologically mediated alteration of the skin of face worsened by alcohol, sun, stress, seen in young females and males resistant to treatment sometimes but not always.I believe sensitive skin has little bearing for rosacea.

Dear Hao,

I have not tried naicin in acne or rosacea.Can you quote some some reliable studies to substantiate.

i give tab metrogyl 400 mg bd for 14 days . Topical metrogyl in the morning and in the night with topical benzoyl peroxide . i advice not take drinks which gives hot flusess and avoid direct sun light .

I may not be able to advise on a treatment for Rosacea, but the work of Prof. Richard L. Gallo, a leading dermatologist at the University of California, is definitely worth following. I don't think he is not on researchgate but many of his papers and co-authors are.

Prof. Gallo does a lot of research into cathelicidins and our other innate antimicrobial peptide (AMP) defenses. I recall that he discovered that rosacea was due to an OVERPRODUCTION of cathelicidin, and a subsequent immune response to that.

Apparently certain antibiotics have been useful for rosacea, but again it was Prof. Gallo who figured out that they didn't work as antimicrobials but rather against an enzyme that influenced cathelicidin production.

http://en.wikipedia.org/wiki/Richard_Gallo

My dermatologist colleagues report that Soolantra cream can be very effective in pustular rosacea. This cream's active ingredient is directed towards killing the mite demodex folliculorum that commonly lives on the skin. Although it is undecided in the literature how much this mite is responsible for pathology, it  would tend to support at the very least that the mite is implicated in some aspects of rosacea. Whether the mite is causing an allergic response or is implicated in a mediating a secondary infection remains to be seen. Either way, it seems a useful tool and is easy to prescribe....

I have a question here that perhaps people will respond to in passing... I have noted that topical estriol may help with mild rosacea, possibly by reducing the inflammatory response. Has anybody else noticed this?