The journal has been produced by volunteer rosacea sufferers and consists of `articles by dermatologists, physicians, naturopaths, researchers and patients’.

This first edition is available for $15 from amazon.com and iUniverse. The purchase price is used to further the journal’s publication and lead to some novel rosacea research – although one can imagine that many thousands will need be sold to be able to fund research.

Volume 1, Number 1 Contents.

• A new class of topical medications may soon be available to treat facial redness
• Ocular rosacea, the number one contributor to poor ocular surface health
• Rheumatic autoimmunity as the cause of rosacea
• Inside rosacea
• Optimizing redness reduction, part I: Rosacea and skin care
• The importance of essential fatty acids for rosacea
• Food choices for rosacea immunity
• Rosacea, inflammation, and aging: The inefficiency of stress
• Psychological stress and rosacea
• The role of Demodex mites in the pathogenesis of rosacea and blepharitis and their control
• A molecular link between rosacea and gastrointestinal disease
• Signal Transduction Modulators to treat rosacea
• The effect of dietary salt on rosacea
• Is it possible for rosaceans to do research?
• Research Highlights
• Books and articles to be published in the future

When I am able to read a copy I’ll post a review of the contents. Congratulations to all who contributed to this publication.

Related Articles

• Book Review: Rosacea Diagnosis and Management
• My list of Rosacea Book Reviews

I have to admit that I hate shaving. It seems such a waste of time to me. Every morning I need to devote 10-15 minutes to scrape the dead wire-like hair off my face. Not only is it messy, but it hurts. I have tried an electric razor but it just doesn’t cut it. Only in recent years have I been able to shave with a blade razor. My facial skin has been too sensitive to cope with a razor blade. Any small cuts would turn into a pustule. Any small papule was in danger of being sliced open. The irritation from shaving certainly didn’t enhance the redness of my rosacea.

I have seen shaving oils talked about in the past. Surely they don’t work though right ? The best way to shave is to have a heap of creamy lather ? Well now I’m not sure. In fact I’m almost ready to discard shaving cream for good.

For the last 2 weeks I have been using Dermalogica Close Shave Oil. For the first time in as long as I can remember, I no longer cut myself during my early morning facial scraping. Not only do I emerge from the bathroom without several nicks (suggesting that I don’t know how to shave) I also have the closest and smoothest shave I can remember.

As the oil is clear and you apply so little, you can see exactly where you are shaving. Until you get used it actually working you won’t believe that something you can’t see actually does a good job.

The slight smell reminds me a bit of camphor oil, it is a little bit of an unusual smell, certainly not the perfume I used to.

The instructions say to shake a few drops into a wet palm and smooth over dampened area to be shaved. Rinse razor often. This last tip is important as the oil tends to cause the razor to become blocked with the accumulation of the stubble. If you don’t rinse often and vigorously, you will certainly clog the razor solid.

Afterwards I find that my usual cleanser – Cetaphil Gentle Skin Cleanser doesn’t give a great feeling of washing off the oil. I moisturize anyway with Cetaphil Moisturizer and so far I haven’t noticed any bad reaction from the oil.

The price may seem a little steep for a small bottle, but 4 drops is enough for a strong beard. I expect my bottle to last several months at least. The oil is perfect for travelling, the bottle is so much smaller and lighter than a can of shaving foam.

Hey one last tip – it is great for shaving your legs too.

Official Product Description

“This slick oil is perfect for shaving goatees, moustaches and sideburns, or for those who prefer maximum visibility while shaving. Formulated with a rich blend of botanicals, Close Shave Oil comforts and soothes the skin while lifting the hairs for an irritation-free finish. Silicones allow the razor to glide evenly over the skin to minimize the risk of nicks, cuts and razor burn. Camphor diminishes irritation while thyme, clove, lavender and tea tree condition and soften the skin. Free of artificial colorants and fragrances, and suitable for shaving the head.”

Ingredients

The first ingredients give a clue to why to works so well – lubricants that help the razor smooth across the skin.

Dimethicone, Cyclomethicone, Amodimethicone, Dimethiconol, Melaleuca Alternifolia (Tea Tree) Leaf Oil, Lavandula Angustifolia (Lavender) Oil, Citris Aurantium Dulcis (Orange) Oil, Ocimum Basililicum (Basil) Oil, Cananga Odorata (Ylang-Ylang) Flower Oil, Pinus Palustris (Pine) Oil, Thymus Vulgaris (Thyme) Oil, Eugenia Carypophyllus (Clove) Flower Oil, Pogostemon Cablin Oil, Cedrus Atlantica (Cedarwood) Bark Oil, Melaleuca Leucadendron Cajaput Oil, Glycine Soja (Soybean) Oil, Camphor, Limonene, Linalool.

Final Remarks

OK, I don’t think I have raved about a product in this way for a long time. It is nice to find a product that you really like, one that works as it is advertised. I think this oil will remain in my box of toiletries.

If you find shaving is causing you irritation, please let us know if this product helps you.

Featured Product

Dermalogica Close Shave Oil

Related Articles.

• `shaving’ via light lamp promises low irritation
• Dermalogica: close shave oil

According to Albert M. Kligman, 93, dermatology researcher, Dr. Kligman cowrote 14 books, beginning with Textbook on Dermatology, published by W.B. Saunders in Philadelphia in 1956, and ending with the third edition of Acne and Rosacea, published by Springer Verlag in Berlin in 2000.

Dr. Kligman passed away on Feb 9, 2010 aged 93.

Kligman’s 2004 Critique on the state of Knowledge of Rosacea was scathing about the poor State of the Art of Rosacea Research and Development.

This quote was quite insightful: “It seems that rosacea is a physician-friendly disorder in which everything works. This brings to mind the old clinical adage that when everything works, nothing works! Of course, we all understand how it happens that industry supported research is unlikely to yield negative results” and further “I hold that studies of papulo-pustular rosacea has brought in the marketplace too many drugs of marginal efficacy making it almost impossible for clinicians to make rational choices among the offerings, especially when these are backed up by heavy investments in marketing”

Kligman is credited in the Standard grading system for rosacea, the Standard classification of rosacea as well as the Standard Management Options for rosacea.

In his recently published book, Rosacea: Diagnosis and Management, Dr. Powell tells us that the 1993 book Acne & Rosacea by Plewig & Kligman is still the preferred authorative medical reference for rosacea. This is a bit of a shame because this book is out of print. You may be able to find a copy in your library, or you can also sometimes purchase a second hand copy via Amazon.com.

The good news is that an updated hardcover version, Pathogenesis and Treatment of Acne and Rosacea, edited in parth by Kligman is due to be released in August 2010.

Albert M. Kilgman is considered truly as one who was larger than life. A 2006 paper in the Journal of Investigative Dermatology said of him “Albert Kligman is among many other things, a dreamer.
Through his vision and its implementation he has been a major force in directing dermatology toward a better future. His dermatologic dreams have been well realized”

Related Articles

• Kligman on the state of Rosacea Knowledge

Author: Frank C. Powell
Review Date: December 2009
Available at Amazon.com

Some Background

First some background on Prof. Powell. Rosacea News has in the past published 3 articles that feature publications from Powell; rosacea sufferers less interested in alternative medicine, demodex mite bacteria causes the inflammation ? and rosacea: its all in the follicles !

Powell has been a consultant dermatologist at the Mater Private Hospital in Dublin, Ireland for 25 years. He has received rosacea research grants from the NRS, has been on the Medical Advisory Board of the NRS since 2000 and was also a co-author of the ground-breaking Standard Classification of Rosacea and the companion Standard Granding System for Rosacea.

Powell has an impressive list of peer reviewed publications: 18 chapters on Dermatology and related medical subjects, 18 Letters to the Editor and 98 publications in Medical and Dermatology journals. Additionally Powell is a reviewer for the Journal American Academy of Dermatology, Archives of Dermatology, British Journal of Dermatology and several others.

Even a cursory glance on PubMed shows dozens of papers published with several on rosacea.

How the book feels

My first thought when I first received my review copy, `wow it is small, it fits in my hand’.

The book is hardcover and consists of 140 gorgeous glossy pages. The high resolution colour photographs are crisp and detailed.

One thing I really liked about the book is that all of the photographs (around 64 of them) are all of Dr. Powell’s patients. This helps consolidate the authority of the text. These are real, genuine photographs of actual patients under the care of the book’s author. What an awesome body of clinical experience we can tap – simply by having access to this book.

As you will appreciate, this book must have been many years in the making.

The book also features a dozen wonderful drawings of rosacea from medical publications that existed before photographs were common. This gives us a good glimpse into how long people have been suffering from rosacea ! The cover of the book features an elegant 19th century gentleman with the erythema, papules and pustules of rosacea clearly visible.

Who is the book for ?

Dr. Powell targets the book at clinicians – `consisting of an overview of the subtypes, differential diagnosis with a practical approach to current therapeutic modalities’. We are told that the book intends to fill the gap that textbooks leave when devising solutions for individual patients. This is something that the book does well, it is not a dry medical text book steeped in theory, but also not a rambling collection of disjointed self-help styled thoughts.

We are also told that the 1993 book Acne & Rosacea by Plewig & Kligman is still the preferred authorative medical reference for rosacea. This is a bit of a shame because this book is out of print. You may be able to find a copy in your library, or you can also sometimes purchase a second hand copy via Amazon.com.

Powell thanks the Photographic Department of the Mater Misericordiae University Hospital in Dublin and also acknowledges Dr. Jonathan Wilkin’s help especially in the chapters on Flushing and `General Considerations’.

Lets look briefly at each chapter.

Chapter 1: Structure, Function, Type, and Sensitivity of Skin [14 pages]

Chapter 1 contains a description of skin structure, looking at the surface film, and the horny, granular, squamous and basal layers as well as meibomian glands, vascular plexuses and lymphatics. It concludes with a description of skin function, skin type and skin sensitivity.

Chapter 2: Flushing and Blushing [18 pages]

After defining the broad differences between flushing and blushing the book includes a detailed description of other conditions that may also cause flushing. Powell suggests that a detailed patient consultation is required to rule out other possible reasons for flushing. Powell suggests psychotherapy and cognitive behavior therapy may help desensitize social blushing and some patients may benefit from low dose beta-blockers. A table suggests other treatment options such as alpha-blockers, HRT, surgery and laser.

It was encouraging to see a mention of topical oxymetazoline with a refence to a 2007 paper. Even more encouraging is the mention of herbal possibilities like red clover, soy isoflavones, vitamin E, black cohosh and even acupuncture. Whilst the author cannot find conclusive studies in support of these supplementary therapies, it is great to see them at least given a mention.

Powell notes that even though there has been intense debate about the link between frequent facial flushing and the development of rosacea, the evidence is lacking. Prospective studies are required to unearth any link to the redness and blood vessels of rosacea, but those studies will be very difficult to execute. One patient note mentions a young man who suffered from a flushed face becoming anxious after viewing pictures of rhinophyma on the internet.

Suggested further reading includes a text from 1839 – seriously ! The Physiology or Mechanism of Blushing.

Chapter 3: The Classification and Grading of Severity of Rosacea [10 pages]

We learn in Chapter 3 that rosacea was first described in detail in 1813 by a former colleague of the English dermatologist Robert Willan. Willan was the first to call it acne rosacea. In those very early days rosacea was considered closely related to acne, perhaps sharing the same pathogenesis. As long ago as the early 20th century Radcliff-Crocker was proposing to drop acne from the name, postulating that rosacea was due to hyperreactivity of the facial blood vessels manifested by frequent flushing. Powell notes that the development of the classification of rosacea in 2002 was the first time that a widely accepted definition of rosacea was available since Willan in the early 1800s. The grading of severity of rosacea was then undertaken as a broad way of analysing the disease state and treatment progress.

Powell modestly drops his name from author listing when citing the Standard classification of rosacea and Standard grading system for rosacea at the end of this chapter.

Chapter 4: Erythematotelangiectatic Rosacea (Subtype 1) [17 pages]

A persistent facial redness, a tendency to frequent flushing, presence of multiple fixed dilated small blood vessels leads to the diagnosis of Erythematotelangiectatic Rosacea (ETTR).

A clinical example was offered for a classical case of ETTR, but also for someone diagnosed with the similar looking condition Heliodermatitis (chronic photodamage). Some clinicians use the terms ETTR and Heliodermatitis interchangeably as they appear similar and often respond to the same treatments. In this case the patient, a farmer, did not respond to metrogel or doxycycline so was told to use a sunscreen all year round and offered IPL.

An in interesting quote ;

Even though ETTR is classified as subtype 1 rosacea, this is not intended to suggest that it represents the first stage in the progressive development of the other subtypes of rosacea and many patients do not subsequently develop other manifestations of rosacea. The inflammatory papules and pustules of stage 2 (papulopustular) rosacea (PPR) do not develop as a consequence of the erythema and telangiecstasias in subtype 1 disease.

…

Typically the erythema associated with PPR is secondary to inflammatory changes in the skin rather than the presence of telangiectatic vessels.

We are told that the most important condition to rule out when diagnosis ETTR is systemic lupus erythematosus (SLE).

Treatments for ETTR include the usual suspects, but Powell does mention physical sunscreens containing Titanium Dixoide and Zinc Oxide and a moisturizer. Mention is also made of topical oxymetazoline as a recent possibility.

Chapter 5: Papulopustular Rosacea (Subtype 2) [30 pages]

One line appealed to me when describing PPR “New lesions appear as the older ones fade if effective treatment is not instituted”. This was so me ! I would look each morning to see where I was going to get the next red lump or pussy bump, having just seen on the current batch.

Powell mentions that it is possible for sufferers of male pattern baldness to have papulo pustular rosacea on their scalp. This is the first time I have read this.

A page is devoted to the the possible involvement of demodex mites in rosacea. Powell says that it is probably impossible to fully eradicate the mites from our skin as they see to recolonize rapidly following anti-mite therapy. Powell notes that some of the demodex related bacteria are susceptible to the antibiotics used to treat the papules and pustules of rosacea, perhaps suggesting a reason for the effectiveness of topical and systemic antibiotics in the management of rosacea.

Indeed the cause of rosacea is unknown so Powell also mentions the possible involvement of antimicrobial peptides, Vitamin D and sunlight as two interesting areas of research.

This chapter contains an excellent list of photographs and clinical notes for the several alternative diagnoses that may mimic papulopustular rosacea.

The therapy section contains all the well know topical and systemic therapies for the papules and pustules of rosacea.

Some treatments that caught my eye were Oxymetazolinea, Permethrin and Ivermectin. Yes it does indeed appear that demodex mite treatments are becoming mainstream for rosacea sufferers. Typically topical permethrin and systemic and topical ivermectin are used for mite infestation. Powell does note though that the use of these therapies is currently unproven.

A nice feature is the Algorithm management of PPR – a flow diagram on how to manage patients who present with PPR.

Chapter 6: Phymatous Rosacea (Subtype 3) [18 pages]

We are told that Rhinophyma is fortunately rare and often the most visible form of rosacea. It was first describe in the medical literature in 1845. Powell suggests that rhinophyma is more accurately designated as a condition of the skin that is closely associated with rosacea rather than a disorder that occurs as a consequence of the disease.

I wasn’t aware that there are actually several types of rhinophyma: glandular, angiomatous, actinic, acneform, fibrous and obstructive.

The management section details the use of isotretinoin for early stage glandular rhinophyma. Powell notes that there are conflicting reports about it’s efficacy, optimum dosage and long term outcomes. Dapsone  is also mentioned. The Pulse Dye and CO2 lasers are mentioned as possible treatments.

Chapter 7: Ocular Rosacea (Subtype 4) [14 pages]

This chapter starts with a great quote about ocular rosacea: “The Rabbit-eye of Rosacea” – Gerd Plewig.

In this chapter we learn that patients with PPR appear to be more likely to suffer from Ocular Rosacea (OR) but that OR symptoms may accompany, precede or follow skin symptoms of rosacea. The duration and severity of OR does not appear to parallel  the type, duration or severity of rosacea skin symptoms. The reason that ocular symptoms are associated with a dermatological condition is unknown.

Studies of sufferers of OR have shown that the normal tear breakup time of at least 10 seconds is reduced by half. The tear breakup time is the time after a blink when the tear dries and in some spot a dry area occurs.

System therapy used for PPR is effective for the inflammatory lesions of OR. Most patients present with mild symptoms so simple measure are often enough.

The table of treatments includes artificial tears, lid and lash hygiene, topical and systemic antibiotics.

Chapter 8: General Considerations [12 pages]

This final chapter implores doctors to seek to understand the psychological aspects of rosacea, be proactive in asking about ocular symptoms, be open to differential diagnosis. There is also some advice of general skin care and cosmetic advice. Powell does answer an old chestnut about whether prescription topicals should be used before or after other skincare. Drugs have priority-they go on first ! we are told in italics.

As far as pregnant patients are concerned, Powell states that topical erythromycin is a possible permissible treatment; with the agreement of the obstetrician and in extreme cases. All other prescription topicals and systemics are not advised.

Doctors are advised to reassure patients that progression to rhinophyma is rare, that `cure’ along the lines of pneumonia is not the case with rosacea, but that it can be episodic.

In the final chapters Powell encourages doctors to reassure their patients and support them. Powell suggests patients will appreciate being directed to web sites of the AAD, the EADV and BAD. A typo sadly directs sufferers to the National Rosacea Society as nrs.com instead of rosacea.org and indeed the AAD web address is wrong as well.

The book ends with a detailed 6 page index.

The Price

For those not used to medical texts, an asking price of $80 USD may seem a little shocking. Indeed the full price at the publisher’s web site: informa healthcare is $100 USD. Bearing in mind that the book is targeted primarily at physicians and taking in to account the authority of the writer and material presented, the book is reasonably priced. Whether that value will translate into something you as a rosacea sufferer will want to pay for I can’t say.

After reading the book I can say that Powell’s book does represent excellent value for rosacea sufferers to use in partnership with their doctor, especially if their doctor is not overly familiar with treating rosacea. Many doctors will want solid research-backed recommendations before embarking on a particular treatment path. This is the sort of text that you can use to convince a sceptical doctor.

Want to get more of an idea of what the book looks like before purchasing it ? You can see several actual pages via 2 routes. Firstly you can Search Inside the Book at Amazon and secondly you can see many of the colour plates via the very generous Google Book Search listing for this book.

Along with large chunks of the book being available to preview, you ought to have enough information to decide whether to invest in the book yourself.

Conclusion

This book gets off to an excellent start because the author is a genuine rosacea expert who is widely recognised. Professor Powell’s book is the sort of text that will see the understanding of rosacea symptoms, diagnosis and treatment increase world wide.

This book is by and far the best book on rosacea that you can get your hands on.

You can purchase the book at Amazon.com: Rosacea Diagnosis and Management.

See Also: other Rosacea Book Reviews

So please feel free to start your own Rosacea Community Blog.

Why would I want one of those ?

Your own blog will allow you post your thoughts, ideas, rants etc. in a part of the community site that you can call your own. Each post will be stored and given its own unique web address, stored underneath your Rosacea Support Community Username.

Getting Started

To get started, just login and look for the link titled “My Blog” near the top right hand side.

Writing a blog post feels very much like writing a forum posting. Just select “Post a Blog Entry’ and you are underway. Type a good descriptive Subject, your post text and hit Submit.

Once you have posted a blog entry, other users will be able to comment on your post.

Other Blogs

You can see what others are saying on their blog my taking the link to Blogs, also on the top right hand side.

You will also notice a new link above the forum index called “View blog posts” that will show you who has posted an entry recently.

Once a user has posted some blog entries, you’ll see a link below their profile.

What is allowed ?

Basically anything that is and isn’t allowed on the community forum, will also be allowed or frowned upon on the Community Blogs. Any post that seeks to build friendships and uplift rosacea sufferers will be fine.

How do I register ?

Not a member of the Rosacea Support Community ? No problem, just Register here.

Already registered ? Great, what are you waiting for ? Start your Rosacea Community Blog now.

Elidel no better than Metrogel for lumps and bumps of rosacea.

A comparison of metronidazole 1% cream and pimecrolimus 1% cream in the treatment of patients with papulopustular rosacea: a randomized open-label clinical trial. Clin Exp Dermatol. 2009 Jul 6

Patients were randomly assigned treatment with either pimecrolimus 1% cream or metronidazole 1% cream for 12 weeks. Pimecrolimus cream is no more efficacious than metronidazole cream in the treatment of PR.

Another bacterial link found ?

Is rosacea another disorder of gut microbes? Curr Gastroenterol Rep. 2009 Aug;11(4):253-4

This paper sounds like it might be heading in the direction to add to some research that looks at small intestinal bacterial overgrowth as a source of rosacea symptoms. Alas all we can see at the moment is the title. Also note that the author has published several other papers that at least in their title link intestinal disorders with diseases such as fibromyalgia as obesity.

Facial blood vessels correlate to Ocular Rosacea Symptoms

This paper, who’s full text is available via the link, suggests that the presence of facial visible blood (telangiectasia) is more of a clue that ocular rosacea may also be present, compared to other facial symptoms like papules and pustules.

Correlation of the severity of cutaneous rosacea with ocular rosacea,  Indian J Dermatol Venereol Leprol 2009;75:405-6.

In our series, ocular involvement did not correlate with the severity of papular, pustular, nodular lesions and flushing but, surprisingly, we found a significant relationship between the severity of telangiectasia and ocular involvement. This finding was not in agreement with the previous studies claiming that the ophthalmologic complications of rosacea are completely independent of the severity of facial rosacea. On the other hand, it seems that the significant relationship between the severity of telangiectasia and eye lesions in our study might be an incidental experience. We agree with the general assumption that skin and eye lesions in rosacea are separate al together.

IAP the link from intestine to Rosacea Skin ?

This paper is proposing that the activity of the enzyme intestinal alkaline phosphatase (IAP) could be the link between an inflammatory response to intestinal bacteria and rosacea skin symptoms.

Intestinal alkaline phosphatase: The molecular link between rosacea and gastrointestinal disease?, Med Hypotheses. 2009 Jun 30 (UMR 168 CNRS/Institut Curie, 11 rue Pierre et Marie Curie, 75005 Paris, France Rosacea Research and Development Institute, Pahala HI 96777, USA)

Rosacea is a common inflammatory condition of the facial skin of unknown etiology, which frequently occurs in combination with gastrointestinal disorders. Many dietary and hormonal factors are known to affect the severity of rosacea symptoms, several of which also modulate the activity of the enzyme intestinal alkaline phosphatase (IAP). The role of IAP in inhibiting an inflammatory response to intestinal bacteria suggests a mechanism by which intestinal pathologies may be linked to the skin inflammation characteristic of rosacea. Analysis of alkaline phosphatase activity is routinely performed on blood samples, and methods to quantify enzyme activity of the intestinal isoform specifically have been described. Correlations between IAP activity and rosacea symptoms in patients and controls can thus be screened by noninvasive and inexpensive means. If IAP activity is found to be low in rosacea patients, acute symptoms could be treated with oral IAP supplementation, and trials of IAP-activating medications currently used in gastrointestinal disease could be initiated in rosacea patients. More importantly, the safe and long-term control of rosacea could be undertaken by patients themselves through dietary modification to naturally increase IAP activity.

Related Articles

• SIBO eradication clears rosacea: are you serious ?
• SIBO diet/treatment
• treating ocular rosacea (from the AAO)
• elidel vs. protopic, does it work for rosacea bumps ?

It is good to see more published research backing topical cyclosporine (Restasis, Allergan) as a treatment for ocular rosacea. Restasis (cyclosporine ophthalmic emulsion 0.05%) has been shown to increase tear production and improve the quality of naturally produced tears and is the first approved therapeutic agent for the treatment of chronic dry eye.

Official Use of Restasis

The FDA has approved Restasis as a treatment to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with chronic dry eye. Note that increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs. Restasis is not appropriate for immediate relief for an uncomfortable irritated eye as it may take up to 6 months for maximum improvement. (source The Eye Digest)

Other Evidence

An article from 2006 in Ophthalmology Management Topical cyclosporine proves to be effective in treating rosacea whetted our appetite for this interesting new treatment.

The anti-inflammatory mechanisms of cyclosporine are highly appropriate for the treatment of ocular rosacea, as the condition has been shown to have an inflammatory etiology. Barton and associates conducted a study comparing tear fluid concentrations of interleukin-1alpha (IL-1alpha) and tumor necrosis factor-alpha (TNF-alpha) in ocular rosacea with those in control subjects. Tear turnover was lower in patients with rosacea than in controls, and Schirmer scores were also statistically lower in patients with rosacea than in controls.

After 6 months of use, topical cyclosporine was shown to decrease inflammatory cytokines in the conjunctival epithelium of dry eye patients with increased tear production.

…

Given the excellent side effect profile of topical cyclosporine and its lack of systemic absorption, ophthalmologists should consider utilizing topical cyclosporine in the treatment of patients with ocular rosacea.

Expert Opinion

The Rosacea Support Group asked Dr. Eric Jones, MD, the Medical Director of Devers Eye Institute in Portland, Oregon a related question about Restasis and ocular rosacea.

Q: Do you agree with the view that Restasis won’t help ocular rosacea or dry eye triggered by Accutane?

A: The drug rep was in for Restasis the other day and I asked her about it. We looked it up here and didn’t find any studies that checked on Restasis and ocular rosacea together. It’s a great question because, you know people with ocular rosacea have decreased tear production and, if Restasis can help that, I don’t see why it wouldn’t work.

Recent Abstract

Below is the abstract from the recently published paper, from the same author as the above article, but now appearing in a peer reviewed journal. The above link to Ophthalmology Management leads to a full article, which can be consulted for more details if you don’t have access to the full text of the journal article.

Efficacy of topical cyclosporine for the treatment of ocular rosacea, Adv Ther. 2009 Jun 23, Schechter BA, Katz RS, Friedman LS, Florida Eye Microsurgical Institute.

INTRODUCTION: This study was designed to compare the efficacy of cyclosporine ophthalmic emulsion 0.05% with an artificial tear solution for the treatment of rosacea-associated eyelid and corneal pathology.

METHODS: Double-masked, randomized, 3-month clinical trial of 37 patients with rosacea-associated eyelid and corneal changes (defined as lid margin telangiectasia, meibomian gland inspissation, and/or fullness of the lid margin). All findings were standardized and compared to photographs for grading.

RESULTS: There was a statistically significant increase in Schirmer (with anesthesia) scores of 2.7+/-2.2 mm after 3 months of treatment in the topical cyclosporine group (P<0.001), compared with a mean decrease of -1.4+/-4.6 mm (P=0.271) in the artificial tears group. The mean tear break-up time score significantly improved in the topical cyclosporine group (mean increase of 3.56+/-1.5 seconds, P<0.001), but worsened in the control group, although this change was not significantly significant (mean decrease of -0.04+/-1.6 seconds, P=0.929). The topical cyclosporine group exhibited a significantly greater mean reduction in corneal staining scores (-1.3+/-0.53) compared with the control group (-0.2+/-0.83; between groups P<0.001). The topical cyclosporine group had a greater improvement in Ocular Surface Disease Index scores than those using artificial tears (P=0.022). Limitations of the study included an older, predominantly Caucasian patient population and short trial length.

CONCLUSIONS: Topical cyclosporine 0.05% is more effective than artificial tears for the treatment of rosacea-associated lid and corneal changes.

Related Articles

• Official web site: Restasis
• cyclosporine (restasis) shows promise for ocular rosacea
• Ocular Rosacea: Dr. Eric Jones, MD
• trial: treating ocular rosacea with Cyclosporine (Restasis)

“Earlier this year, we announced that four important and popular rosacea products that had been unavailable for many months would thereafter, by special arrangement with the originator, be manufactured and distributed by the Rosacea Care Company. We are pleased to tell you that the first of these, the much-loved Vita-Oil, will be released and ready to ship this coming Thursday, June 25. On-line purchases can be made in advance of that date by visiting our website: rosaceacare.com.

We would remind you that this is exactly the same Vita-Oil that has helped so many rosaceans over the years. The formula is identical, and it is being manufactured by the same laboratory. As with previous packaging, an eye dropper and instruction sheet will be enclosed with every order. The price is $28 US.

We would also take this opportunity to announce that original Tinted ZincO will be available sometime in July. The exact release date will soon be posted on our website and on this Support Group page. We thank everyone for their patience and their enthusiasm for these products.”

disclosure: RosaceaCare is a site sponsor of rosacea-support.org

Related Articles

• ZincO, Vita-Oil and Oatmeal Cleanser available again soon
• lindasy.com is closing down
• jojoba oil has anti-inflammatory properties
• Vita Oil vs. Jojoba Oil

Calcium dobesilate (2,5-dihydroxybenzene sulfonate) is a vasoactive drug with presumed effects on endothelial integrity, capillary permeability and blood viscosity. It is often recommended for venous disorders, and also prescribed for diabetic retinopathy and other microvascular disorders.

rosacea and doxium (calcium dobesilate)

Just wanted to let others know that Dr. Cuevas accepted me as a participant in his clinical trial of the 2.5% Calcium dobesiliate cream. I had to arrange and pay for international shipping and managed to get the product into Canada (the product was described as a skin cream for customs purposes).

I have been using the skin cream for 2 weeks in the morning and evening. Redness has visibly decreased. My skin feels smooth and soft where there were small bumps previously. Spontaneous breakouts have also stopped. The study above was conducted over 4 weeks.

Anyone interested in participating in the clinical trial can submit photographs to Dr. Pedro Cuevas at:

pedro.cuevas@hrc.es

Dr. Pedro Cuevas
Servicio de Histología
Departamento de Investigación
Hospital Ramón y Cajal
Ctra. de Colmenar, km. 9.100
28034-Madrid-Spain

Tel. (0034) 913368290

Obviously rosacea sufferers have to be quite keen to pay for their own shipping, but it is only through research and trial and error that we will learn. Please do let us know if you too decide to try the calcium dobesilate cream.

Have a read of Laser & IPL: Dr. Peter Crouch, MB.BS, Dr Steve Johnson, MD, Dr. Nicholas Soldo, MD to find out more about the following questions;

• ACCUTANE WITH RED LIGHT THERAPY OR LLLT
• BEARDS
• BLUE & RED LIGHT THERAPY
• DIFFICULT DIAGNOSIS: POSSIBILITY OF DISCOID LUPUS
• DIFFICULT DIAGNOSIS: RED HANDS AND ARMS FROM MEDICATION
• FACIAL STINGING & V-BEAM
• IPL SETTINGS
• OCULAR ROSACEA
• TEENAGERS WITH ROSACEA
• THICKENING SKIN ON SIDE OF NOSE TIP
• WHICH IS THE BEST LASER FOR RED SKIN AND MANY BROKEN VEINS?

[update] the above links are now fixed.

Related Articles

• Ocular Rosacea: Dr. Eric Jones, MD
• Ocular Rosacea: Dr. Mark J. Mannis, MD
• Rosacea and the Sympathetic Nervous System: Dr. Peter D. Drummond, PhD
• Combining Light-Based Treatments and Topicals for Rosacea: Dr. David J. Goldberg, MD