RRDi journal Issue 1 Review: an unfortunate mix

Written by on April 21, 2010 in research foundation, reviews with 4 Comments

The RRDi recently published the first issue of their journal. Rosacea News was given a pre-print version to review. Volume 1, Number 1 is 88 pages and is available for around $15.

I was quietly hopeful that a publication `produced by volunteers and written by dermatologists, physicians, researchers and patients’ could be something worthwhile and progressive for the field of rosacea. Sadly my hopes were dashed in the first few pages. Read on to find out why.

Before we do continue though, let me pose a question. Who would want to publish an article in the RRDi journal ? Would an acknowledged researcher offer original research ? Probably not. If original research was of sufficiently high enough quality, it would be submitted to an established Journal. Would it be helpful and kind professionals ? Would it be someone you found on the internet with views that are not helpful ?

The key question boils down to “Where in the scale from internet lunacy to original research should this journal set its sights ?” The answer, I fear, is that this journal isn’t quite sure and will publish anything.

Calling something a Journal already sets a certain expectation in people’s minds. Without a peer review process supported by a group of experts armed with a sensible selection criteria, any publication will struggle to get above the paper at the bottom of the bird cage.

What happens when you don’t have the fundamentals right to start with ? Well, any ridiculous internet theory from anyone with a keyboard is in danger of sitting right next to something of real cognitive value.

A publication that hasn’t helped its readers distinguish the difference between good and useless has failed.

I fear that the first issue of this journal amounts to an unfortunate mixed bag of articles that will both confuse and inform.

Introduction Disingenuous

I have to take issue with the Introduction first up. The introduction does a disservice to rosacea sufferers.

The Associate Editor, Brady Barrows, says that there is a “mystery and bewilderment surrounding rosacea that baffles not only the experts but also those suffering with this disease.” This is a tired statement that is regularly peddled by Barrows.

I find this egregious on 2 fronts. Firstly it is patently false and secondly this statement becomes self-fulfilling with the poor quality of some of the articles that follow in the journal.

Rosacea cannot honestly be characterised as a baffling condition. Rosacea as defined by the experts has a standard system of diagnosing the disease and standard severity of symptoms as well as a standard set of treatment options. Clinical trials for PPR and ETTR, Ocular rosacea as well as Phymatous rosacea show that the vast majority of participants enjoy excellent clearance for their symptoms.

Thus it is entirely reasonable to suggest that the population at large also in the vast majority gain measurable relief from their rosacea symptoms. Spend too much time with sick people and you start to think that everyone is sick, no ?

Now to the second part of my objection to the `Rosacea is all so mysterious and baffling’ statement. It seems so disingenuous to push this statement and then allow any theory, any therapy to be promoted unchallenged.

What should one do if they truly believe that rosacea is confusing ? Filtering out the junk and highlighting quality would be a good start. What you don’t write about is as important as what you do write about or promote.

Article Breakdown

The articles appear all together. In order to see whether the one you are reading is opinion, patient perspective, review or original you need to flip back to the front each time to consult the index page. It would have been more helpful if each article was clearly labelled as to what category the editors consider each item belonged to.


A new class of topical medications may soon be available to treat facial redness


Dr. Brodell is a member of the RRDi MAC.

The first in the opinion section is by Robert T. Brodell, M.D., on the new class of topical vasoconstrictors currently being investigated. It is short, snappy and populist enough to be a news item in the Dermatology Times. Brodell explains that these new topicals are radically different, asks can they possibly work and replies we don’t yet know.

Ocular rosacea, the number one contributor to poor ocular surface health


Dr. Latkany is a member of the RRDi MAC.

The second article is even shorter (just 273 words) and is by an eye specialist. Robert Latkany, M.D., believes that "Rosacea is far more common than suggested" and "ocular rosacea  is probably the number one contributor to poor ocular surface health".

Rheumatic autoimmunity as the cause of rosacea


"Rheumatic autoimmunity as the cause of rosacea" was written by Lance Christiansen, D.O., a retired general practitioner of osteopathic medicine. The article is full of sweeping claims and erroneous beliefs presented as if established fact, for example that rheumatism is now called fibromyalgia, and that "Most physicians know the word "autoimmune", but they do not understand it and they have no idea of how autoimmune diseases affect people (and other vertebrates)."

We are also told that rosacea is common on the palms and soles of the feet.

Christiansen claims that rosacea is "an autoimmune disease caused by a common microorganism, Streptococcus pyogenes" which also causes strep throat, rheumatic fever, scarlet fever, erysepilas, streptococcal impetigo, and puerperal fever.

He then, with no evidence, lists a vast range of conditions including rheumatoid arthritis, scleroderma, Sjogren’s syndrome, ulcerative colitis, Crohn’s disease, allergies, asthma, Addison’s disease, Cushing’s syndrome, pancreatitis, and Tourette’s syndrome as being more likely to occur "in patients with demonstrated rosacea".

To decrease inflammation, he recommends a routine daily cocktail of aspirin, Prilosec, Indocin, Benadryl, Zyrtec, Omega 3 and penicillin.

Anyone googling the author’s name immediately learns that Christiansen’s retirement from the three clinics he ran in Washington state came after his license was suspended in 2005 by his regulating board and the Department of Health on the grounds that he posed "a serious danger to the health, safety, and welfare of the public". After six of his patients died of drug overdoses, Christiansen was accused of prescribing excessive amounts of medication, failing to examine patients before making his diagnosis, failing to maintain adequate records, and failing to consult with specialists and/or follow the recommendations of specialists. His license was permanently surrendered with no right to reapply.

( Suspended Lewis County physician to surrender license permanently,
Doctor Suspended, Accused Of Over-Prescribing )

Christiansen has churned out his theories for years and been ignored, as he explains in the 9,829 word comment he attached to a biotechnology blog in October 2008 in an attempt to find a research organization somewhere in the world that might give him access to patients in a hospital setting. He was, he wrote, struggling "because I am semi-retired, sixty-eight, an osteopathic general practitioner, and not an allopathic physician, because I have never worked in a research organization and I have not had any research published."

Christiansen is on the RRDi’s Board of Directors, and does mention that he doesn’t hold a license to practice medicine after retiring `under pressure’ from the DOH. This pressure, we are told by Christiansen, was as a result of a conspiracy to remove him from his position.

His claim of seeing 230,000 patients as a GP is truly staggering. This would equate to 21 patients a day, 6 days a week, 50 weeks a year for his 36 years. Impressive, but believable ?

Inside rosacea


Dr. Johnson is a member of RRDi MAC.

The last of the four articles in the Opinion section is ‘Inside Rosacea’ by Ben Johnson, M.D., CEO of Osmosis LLC, which sells health and beauty products including skincare, herbs and ‘natural remedies’.  For Johnson "Digestion is the key to this condition" whether through candida, low levels of hydrochloric acid, H. Pylori, or IBS. He encourages the consumption of aloe vera juice without warning of the increased risk of colorectal cancer, melanosis coli or hepatitis, or mentioning any of the medical conditions for which it is contraindicated.

(See Aloe vera Safety)

In the article Johnson twice plugs the health benefits of ‘Harmonized Water’ without letting on that he runs the company that sells it @ $30 per half-litre. On Harmonized Water’s web site the product is described as "a combination of waters that contain different vibrational frequencies". "Water has the ability to carry "frequency messages" for extended periods of time and we have found that some of these messages harmonize internal imbalances in our body."

Anti-quackery sites warn "Talk about "vibrations" is usually a dead giveaway that snake oil is being flogged. "Balance" and "harmony" are other words that have no physiological meaning, and so are widely employed to mislead the credulous."

(See Energized Water: pseudoscientific snake oil)

Harmonized Water LLC warns against trusting rival waters such as structured water – "There is little evidence that any of the handfuls of claims of frequency enhanced waters actually maintain their frequencies. In addition, most waters are not actually frequency enhanced with beneficial frequencies. By definition, frequency enhanced water could be enhanced by being; "prayed over", "put next to music", "treated with light". because all of these methods emanate frequencies. You will find that Harmonized Water is different." "Unfortunately, the effects of structured water are temporary and likely to "re-cluster" by the time consumers get these beverages at the store. Harmonized water enhances the outer shell of the protons/electrons of all the water molecules and its effects on water molecules lasts for several years." http://www.harmonizedwater.com/FAQ_css.html

Rosacea Control

Optimizing redness reduction, part I: Rosacea and skin care


Dr. Draelos is well known to rosacea sufferers from being on the expert panel that recently published the Standard Rosacea Management Options and is a member of the RRDi MAC.

In this article Dr. Draelos discusses the importance of the correct selection of a facial cleanser and moisturizer. The article describes how and why a particular formulation of cleanser and moisturizer might suit a skin type and things for rosacea sufferers to avoid. Oily skin may be suited to Ivory, `normal skin’ to Oil of Olay, Dove and Cetaphil Bar, and dry skin to Cetaphil Cleanser, CeraVe and Aquanil. The theory of cleansing cloths and how facial moisturizers work are detailed. Several recommendations for moisturizers with sunscreen for daytime and also moisturizers for night wear are listed.

The importance of essential fatty acids for rosacea


Laura Kopec is known to rosacea sufferers via the Rosacea Relief product from Kopec Naturals and is a member of the RRDi MAC.

This article poses the question `Can an understanding of the importance of essential fatty acids fill in the missing gaps for rosacea sufferers and allow one to take personal action toward better health and clearer skin?’

After discussing the benefits of the essential fatty acids to general health Kopec tells us that `it is unclear exactly how much essential fatty acid is important to overcome certain skin conditions such as rosacea’.

Some research is available that shows EFAs are necessary for good health, and as an example the supplementation for cardiovascular and Alzheimer’s disease are worthwhile.

The conclusion is that future considerations should be given to explore the possibility of a link between a deficiency in EFAs and rosacea.

Food choices for rosacea immunity


This article explores how, if one accepts that rosacea is an immune disorder, the selection of food can have an effect on our immune system and thus assist in overcoming rosacea.

Amongst other advice, we are told to avoid white flour and sugar, eat brown rice and quinoa.

One bold statement is that “Processed food may some day be linked to every known illness.”

The conclusion is that the important foods to avoid while overcoming rosacea are white flour, cow’s milk, sugar and processed food. Additionally we are implored to consume hormone free meat, aloe vera juice and green food and EFA supplements – in a diet rich in whole foods.

Review Articles

Rosacea, inflammation, and aging: The inefficiency of stress


Dr. Peat is a member of the RRDi MAC.

Despite this article being marked as Editor’s Choice, I just couldn’t grasp what the author was trying to get at.

Even the Editor’s recommendation –

Dr Peat makes the remarkable observation that rosacea has the potential to act as a model system for the study of other diseases which share the processes of neovascularization and fibrosis.

This insight should promote a renewed interest in rosacea research, which in turn has the potential to advance our understanding of debilitating chronic illnesses such as diabetes, kidney disease and cancer

still left me wondering what the paper was actually trying to say.

There are several pages of statements about cellular stress and at least a dozen other topics, but I can’t fuse them into something meaningful. The paper’s tightly packed paragraphs, lack of any sections or titles (or a single blank line!) or a discernable conclusion ensures that the reader is left foundering.

Psychological stress and rosacea


Professor Drummond is a member of the RRDi MAC and supervised the PhD program of Daphne Su, which I believe is the first doctoral dissertation on the topic of rosacea. I have met both of the authors.

In this article Su and Drummond lay out their thoughts under the headings:

  • The Relationship between Stress and Skin Disorders
  • Physiological Mechanisms of Facial Flushing and Blushing
  • Emotional Factors associated with Blushing and Flushing
  • The Function of Blushing, Blushing Studies
  • Emotional Influences on Flushing in Rosacea
  • Psychological Well-being and Skin Disorders
  • Rosacea and Mental Health
  • Psychological Intervention.

The article leads to the following summary:

As the experience of having a skin condition can be distressing, it is not surprising that psychological disorders such as anxiety and depression are prevalent in dermatological settings. While research in the area of rosacea is limited, the few papers published appear to indicate that rosacea sufferers, particularly individuals with severe symptoms, may experience psychological distress. Furthermore, while psychological intervention appears to be helpful for dermatological patients in general to better cope with their condition, more studies are needed to understand and evaluate the role of psychological intervention specifically for rosacea.

The role of Demodex mites in the pathogenesis of rosacea and blepharitis and their control


Dr. Mumcuoglu is a member of the RRDi MAC.

Whilst the title of this article suggests that the role of demodex in rosacea will be discussed, my reading would suggest that something along the lines of the “The role of demodex in demodicosis and blepharitis” would be a more descriptive title. Rosacea is discussed only sparingly in the paper.

Was it really 1925 that the possibility of a link between rosacea and demodex folliculorum was first raised ? 85 years later we are still talking about a possible link.

The paper outlines how demodex infestation may be visible as ocular and facial symptoms (and thus demodicosis can be diagnosed), how the mites can be detected and also detailed treatment options.

Anyone seeing the title of this paper would think that there is an establish role for demodex in how rosacea progresses, but this is not the case. This paper needs to be re-titled.

A molecular link between rosacea and gastrointestinal disease


Joanne Whitehead is the Editor in Chief of the Journal of the RRDi.

Dr. Whitehead explores the possibility of an enzyme known as Intestinal Alkaline Phosphatase (IAP) being a link between intestinal bacteria and rosacea symptoms.

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

More importantly, the safe and long term control of rosacea could be undertaken by patients themselves through dietary modification to naturally increase IAP activity.

This paper appears to be a copy of a previously published paper: Intestinal alkaline phosphatase: the molecular link between rosacea and gastrointestinal disease?, Med Hypotheses. Whitehead J., 2009 Dec;73(6):1019-22. Epub 2009 Jul 1.

According to the description of the Journal Medical Hypotheses, it doesn’t appear to a peer reviewed journal but somewhere that a hypothesis can be explored.

The papers chosen may contain radical ideas, but may be judged acceptable so long as they are coherent and clearly expressed. The authors’ responsibility for the integrity, precision and accuracy of their work is paramount.

Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations

Original Research

Signal Transduction Modulators to treat rosacea


Signum Biosciences featured recently in Rosacea News (Signum Biosciences developing SIG990 for Rosacea). Dr. Stock is the chairman of Signum Biosciences.

The article introduces a class of topicals known as Signal Transduction Modulators (STMs), which are said to attack the redness of rosacea.

We are told that this article has been published as Supplement to Volume 129, Journal of Investigative Dermatology,  1 April 2009 and also Society for Investigative Dermatology meeting in Montreal, 2009 (poster 126):

This class of anti-inflammatory STMs inhibits inflammation by reducing the release of critical inflammatory mediators that underlie rosacea pathogenesis, including tumor necrosis factor alpha, interleukins IL-1, IL-6, and IL-8. This leads to a dramatic reduction in neutrophil infiltration and the consequent production of toxic reactive oxygen species.

We are told that STMs have been shown to have superior activity in reducing erythema compared to metronidazole, azelaic acid and brimonidine. This is quite exciting because if this technology leads to a product that can be tested against rosacea then there may be another option for the treatment of the red face of rosacea.

A first-generation STM known as Arazine is to be released to the Japanese market in early 2010.

Patient Perspectives

The effect of dietary salt on rosacea


Helen Cooper is listed as a RRDi Corporate Member.

This article suggests that a condition known as Hypochloryhydria (the lack of stomach acid) causes the poor digestion of food which leads to flushing and rosacea. The trigger for this condition is said to be a lack of salt in our diet.

One can read all sorts of rosacea cures on the internet. Many of the cures are partnered with a conspiracy theory about how large pharmaceutical companies are responsible for suppressing the flow of information.

As to why my salt cure had never been discovered, the most alarming idea is that perhaps it has — but remains unrevealed. There are products on the market that treat rosacea with varying degrees of success and keeping this salt cure a secret would protect profits.

I doubt, however, that there is a collusion to hide valuable information. It’s just that the solution cannot be found in the laboratory.

It is unclear to me whether the author really wants a global conspiracy to exist or not. Certainly it would help the author answer the question as to why the method by simply increasing our salt intake isn’t taking off as a rosacea cure.

Perhaps a better answer to this question is that with such a large number of rosacea sufferers out there, one is bound to find a handful (at least) of fellow sufferers who share any particular experience or unsupported theory.

Is it possible for rosaceans to do research?


Dr. Bamford is a member of the RRDi MAC.

Dr. Bamford wants to encourage rosacea sufferers to consider that they could be responsible for some research themselves. He cites two studies that were presented as poster sessions but never progressed to academic papers. These studies looked at the correlation between “extra facial lesions” and the diagnosis of rosacea. The studies were not controlled so could not be considered for publication. The suggestion is put that with volunteer effort a controlled study could be achieved.


2009 Research Highlights


Dr. Whitehead mentions updates that the NRS Expert Committee published in 2009 on the overview of rosacea care and recommended treatment for each subtype.

A survey on rosacea treatment in the USA was mentioned along with a paper discussing the prevalence of rosacea in India.

The review ends with a brief comment of the unifying theory emerging from the research into cathelicidins.

Books and articles to be published in the future


Professor Plewig is a member of the RRDi MAC.

Plewig doesn’t appear to have contributed to the journal but is mentioned as being involved in 3 upcoming books.

Second Edition Next Year ?

There has been a call for papers for the next volume of this journal. The editors have said that this volume will be subject to peer review, but so far it isn’t clear what that actually means.

Related Articles

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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4 Reader Comments

  1. tessa says:

    I bought the journal also and I must say I was also kind of disappointed. It’s a great idea in theory to use the proceeds for a journal to further rosacea research, and I don’t mind supporting it if they are truly using the money for good. I was excited to read the topical redness relief (because I knew it would be about sansrosa), and the laser article, but was surprised that each one was only a couple paragraphs long! Maybe it’s just the nature of this disease that any article will hold some level of disappointment because there are so few definitive answers.

    Anyway, I had to do a double take on the salt intake article. The way I understand it, in the United States at least, we eat WAY too much sodium! In fact, there was a news report out yesterday about how the FDA is considering regulating the sodium levels in our food supply because of all the preventable diseases that are occurring in the population that can be tied to sodium intake. Eh, who knows. All I can say is, I hope my $15 went to something useful!

  2. andrew says:

    Putting money into this, even though it supposedly helps the cause would only encourage this kind of un-scientific based lazy effort.

  3. Peter says:


    It’s disappointing but I can’t say I am surprised that this publication appears to be a dud. Maybe people who want to donate towards rosacea research would be better off just sending $15 off the NRS instead?

    Brady no doubt has some genuine people on his RRDi but surely by now he can recognise the conmen and quacks, especially when there has been such adverse publicity about them in the past. He was caught out by Syed and then up until fairly recently he was also advertising Nase’s latest product from his website. Given that there is a whole website out there dedicated to warning the public about the infamous Dr Nase and those of us (including Brady) involved in the rosacea forums know his history, then it’s just plain dumb for Brady to be caught out promoting his products.

    You only have to read the profile of Mr Christiansen to realise he falls in the same category as Syed and Nase, so why risk damaging your own reputation by allowing an obvious quack to be involved in your organisation?

    Regarding your statement:
    The Associate Editor, Brady Barrows, says that there is a “mystery and bewilderment surrounding rosacea that baffles not only the experts but also those suffering with this disease.” This is a tired statement that is regularly peddled by Barrows.

    I couldn’t agree with you more and as I have continually pointed out with others on the Rosacea Forum, this just isn’t true and is just total miss-information which will confuse newly diagnosed people. I have formed the opinion now that Brady prefers it this way because it helps him to promote and justify himself together with his organisation. A recent RF post really hit the nail on the head:




  4. James L says:

    Thanks for this. I also purchased this and was disappointed. I found a couple of the articles, such as the one about skin care products, to be practical, informative and reasonable. Most of the rest seemed like internet nonsense or advertisements.

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