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Author: Subject: HELP w/ diagnosis/treatment of skin condition
ThoughtsIControl
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[*] posted on 4-6-2020 at 14:29
HELP w/ diagnosis/treatment of skin condition


My close relative has been having flare-ups for about a year now. The flare-ups are random and come with heat flashes. The 53-year-old doesn't sweat on her face. Her ears and cheeks become swollen and inflamed. She is currently having stress. Also, she lives in a warm climate in North America.

She has seen doctors and has been unable to find any sort of treatment that works. It seems to be a type of rosacea although her previous doctor told her it was something neurological.

If any of you have any idea what this could be or any treatments that could be effective then it would be greatly appreciated.

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karlos³
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[*] posted on 4-6-2020 at 15:07


Rosacea can have psychological factors causing it, since stress weakens the immune system.
If that would be my patient, I would prescribe a few months of antibiotics combined with ivermectine(systemic use not topical) initially for 2-3 weeks.
If it would be gone after that, forever? You can't say that for sure, but during the treatment?
Yes definitely-
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violet sin
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[*] posted on 4-6-2020 at 15:49


My mom has rosacea and lupus... The medicine they out her on for indigestion/acid reflux, omeprosal(sp?) has complications with bringing out lupus more and will incite osteoarthritis. With further complication also for kidneys, eyes and heart... From the one medicine. Now they want to put her on a heart pill and something else like stacking pills against symptoms caused by the orig fix to her throat pain...

Stress, medication, sunlight all bring on flairups. My mom can't go out in the sun unless she wants face peeling, cracking and bleeding, there are no sulfate drugs taken.

Lower the stress, stay outta the sun, drink enough water and see if that helps. I'm no doctor, I just see and hear what my mother is going through. you friend is a decade younger, but it looks like rosacea for shizzle. Antibiotics probably a good idea with that much broken skin.
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ThoughtsIControl
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[*] posted on 8-6-2020 at 15:51


Thank you karlos for your expert opinion. She's gonna show that to her specialist sometime this week to see if he would like to put her on systemic ivermectin.

Thank you for your comment too violet. :)
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karlos³
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[*] posted on 8-6-2020 at 17:18


No expert opinion, keep that in mind!

Yeah well, if she can't get it you have to resort to OTC means... that stuff is possible to get in veterinary medicine for example.
Doctors will be very hesitant to prescribe that, despite it lacking any notable side effects.
But it will get rid of any mites populating the skin which worsen such conditions with themselves being an inflammation causing factor.
The antiakarizid is the key of that.
If it helps, it is plain rosacea combined with some sort of overreaction to the plain sort of mites that colonise the skin and also the bed.

Together with a strong antibiotic it should definitely result in an improvement.
It has to be the right one though, and I can't comment much on that issue.
Personally, I would stick to azithromycin or metronidazole, or maybe a combination of some others?
No expert on the latter either.

Immunisation then to plain dust mites will lead to a general improvement of that reaction.

This is why I always recommend to allow childs to get dirty and play in mud and whatnot.... you will never see a child with that experiences grow up to an allergic adult, no matter against what.
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ThoughtsIControl
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[*] posted on 8-6-2020 at 17:33


So I was told that she has already tried ivermectin and it didn't help at all. Also, she has been prescribed to antibiotics for a few months which haven't helped either.

If anyone has other treatment or diagnosis suggestions then I would love to hear them!



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violet sin
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[*] posted on 8-6-2020 at 22:24


Well, I was bored and chose to read, as some pertains to my family member. Some times it takes a few turns and ends up nowhere, but it's still learning.

On the rosacea I wondered what kicked it up from my mom's medication. It's a proton pump inhibitor, Omeprazole is used to treat certain stomach and esophagus problems (such as acid reflux, ulcers). It works by decreasing the amount of acid your stomach. Ok, why did that make it worse. Did a couple searches on rosacea, vitimin b-12 uptake, and it seemed vit-b12 is sometimes deficient in those with certain kinds of rosacea.
====================

Nutritional Deficiencies in Those With Rosacea
https://www.pulselightclinic.co.uk/rosacea/nutritional-defic...

"In Rosacea, where the microvascular system is inflamed and malfunctioning, it is very common to find lower than optimum levels of Hydrochloric Acid production (stomach acid or HCl)"

"Additional nutrients such as proteins, B-Complex vitamins, and Vitamin C are also reliant upon sufficient HCl for their absorption."

"Vitamin B6, Selenium and Magnesium deficiencies result in the dilation of blood vessels, especially on the cheeks and nose."

"Another common nutritional deficiency in Rosacea is vitamin B12, a large vitamin that requires a carrier molecule for transportation around the body"

"I strongly recommend being tested for Vitamin D status if you have two or more of these symptoms: Rosacea, Psoriasis, depression, memory problems, panic attacks, tooth decay, and/or joint pain."
=========================
Less HCl intentionally by medication, would tend to exacerbate a poor mineral uptake. Possibly block an uptake mechanism reliant on HCl chewing the salivary gland escort molecule for B-12
=========================

transcobalamin I
https://en.m.wikipedia.org/wiki/Transcobalamin

" haptocorrin, R-factor, and R-protein, is a glycoprotein produced by the salivary glands of the mouth. It primarily serves to protect cobalamin (Vitamin B12) from acid degradation in the stomach by producing a Haptocorrin-Vitamin B12 complex."

"pancreatic proteases degrade haptocorrin, releasing free cobalamin, which now binds to intrinsic factor for absorption
==================

https://en.m.wikipedia.org/wiki/Intrinsic_factor

"The intrinsic factor is secreted by the stomach, and so is present in the gastric juice as well as in the gastric mucous membrane.[8] The optimum pH for its action is approximately 7.[9] Its concentration does not correlate with the amount of HCl or pepsin in the gastric juice, e.g., intrinsic factor may be present even when pepsin is largely absent."

"The limited amount of normal human gastric intrinsic factor limits normal efficient absorption of B12 to about 2 μg per meal, a nominally adequate intake of B12."
=========
Less gastric juices, less IF from stomach to be in proximity to the haptocorin-b-12 complex in the shuttle molecule trade off after stomach leads to possible pernicious anemia.
=========

Vitamin B12 Transporters
https://pubmed.ncbi.nlm.nih.gov/10742986/

"The uptake of vitamin B12 from the intestine into the circulation is perhaps the most complex uptake mechanism of all the vitamins, involving no less than five separate VB12-binding molecules, receptors and transporters"
==========================

https://en.m.wikipedia.org/wiki/Megaloblastic_anemia

"Megaloblastic anemia has a rather slow onset, especially when compared to that of other anemias. The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency. Loss of micronutrients may also be a cause. Copper deficiency resulting from an excess of zinc from unusually high oral consumption of zinc-containing denture-fixation creams has been found to be a cause.["

"Biological competition for vitamin B12 by diverticulosis, fistula, intestinal anastomosis, or infection by the marine parasite Diphyllobothrium latum"
=============

Now a scary bit of random knowledge, for those with insufficient B-12

Severe Neurologic Deficit after Nitrous Oxide Anesthesia
https://anesthesiology.pubs.asahq.org/article.aspx?articleid...

"THE interaction of nitrous oxide and vitamin B12is well known from experimental studies in animals and anecdotal clinical reports. [1-4] Nitrous oxide oxidizes cobalamin in vitamin B12and disrupts several pathways involved in one-carbon chemistry. The result is an irreversible inactivation of the enzyme methionine synthase"

"The clinical syndrome associated with oxidation of vitamin B12develops after prolonged exposure to nitrous oxide and consists of megaloblastic erythropoiesis and subacute combined degeneration of the spinal cord. [2-4] We present the case of a patient who developed a severe neurologic deficit 6 weeks after anesthesia with nitrous oxide."
=========

https://en.m.wikipedia.org/wiki/Schilling_test

"The Schilling test is a medical investigation used for patients with vitamin B12 (cobalamin) deficiency.[1] The purpose of the test is to determine how well the patient is able to absorb B12 from their intestinal tract"
==================

And I'm done reading lol. It seems like there is a small possibility that limited B-12 intake can cause a number of health issues and some sever sideffects with nitrous oxide in otherwise normal seeming people. There seems to be a number of switching stations to get it in there,. Means more chance for dysfunction.

A shot of B-12 doesn't need the rigamaroll to get in and would be noticeable improvement over the possibly stammered influx normally present. I don't think anything I popped up here is a golden ticket, just my account if a couple hours reading stuff over my pay grade. But I know my grandmother had to have Vitamin B shots regularly... Maybe my mother does as well. She was also a little slow for a couple days after having a long dentist visit. Think that was not nitrous though.

Anyhow, best of luck, check you B-vit levels. The case study for some of the nitrous interactions said people were not in bad health, tested normal, and still had B-12 deficient issues. Seems like a cheap way to feel better if it does anything. I've no clue about possible interactions on your end, I'm no doctor... Just bored.
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FragranceLover89
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[*] posted on 29-10-2020 at 16:50


Have you tried TUDCA?
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symboom
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[*] posted on 29-10-2020 at 18:35


Only thing I heard of that is simular to tudca is NAC which is used in acetaminophen poisoning to protect the liver

[Edited on 30-10-2020 by symboom]




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[*] posted on 29-10-2020 at 18:54


Another option is change your diet to more good bacteria friendly foods. Anything that will ferment like cabbage, beans and legumes. As well as plants from the brassicaceae. Vinegars and things with short chain organic acids. It might take a while to get your digestive flora re-organised and you might be uncomfortable with gas and bloating until it settles down, but the protective anti-inflammatory response could very well be the trick.
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[*] posted on 29-10-2020 at 20:36


Rosacea can be autoimmune mediated.
That means stress will make it worse as it generally increases systemic inflammation.
Systemic inflammation increases mobility of various immune cells and causes them to attack more.
Determining if the rosacea is autoimmune mediated usually requires a lot of test.
If it is autoimmune, then drugs like methotrexate come into play.
It is relatively cheap but has horrible side effects.
The biologics have to be targeted to the specific type of autoimmune reaction.
And they are outrageously expensive.
$20k per month or more.
This is not medical advice.
An immunologist can help determine if it is autoimmune and appropriate treatment.
My wife has psoriasis and it can cause rosacea which she is starting to get.
Psoriasis can also cause a specific type of arthritis, which she has in her spine and hips and wrists.
And to top it off she has some type of neuropathy or myelitis that they are now trying to figure out.
Having one type of autoimmune reaction causes an increased likelihood of others.
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andy1988
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[*] posted on 29-10-2020 at 21:30


Disappointing that ivermectine didn't work. Demodex mites may be a cause of rosacea. One of many hypotheses it seems. A thought that comes to mind is if there are parallels between pine beetles and demodex mites, where it is not the burrowing itself which kills the tree, but the fungi introduced. The tree's sap acts not just as a physical means of pushing the intruder out, but an anti-fungal as well.

Topical and long term application of an ethanol patch maybe?

Another suggestion is to take tocopherol capsules. See if there are improvements after a couple weeks of daily supplementation. Targeting chronic inflammation and "nerve" cause mentioned by the previous doctor is my hypothesis here.

I wouldn't suggest a vasoconstrictive to remove redness. An eye doctor of mine was very critical of visine, as harmful to the health of eyes. Yes the redness goes away via the constriction of blood vessels, but the initial vasodialation was the body treating a real problem in the first place. Good luck.

[Edited on 30-10-2020 by andy1988]




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Deathunter88
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[*] posted on 30-10-2020 at 03:57


When did we become a forum for providing free medical diagnosis???
Not only does it set a bad precedent, no one should be looking for medical advice on an internet forum in the first place. There's a reason why other respected forums like laserpointerforums.com immediatly lock threads after suggesting the OP seek professional medical advice (even for issues directly related to the hobby such as getting hit in the eye with a laser), and I suggest we do the same.

[Edited on 30-10-2020 by Deathunter88]
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macckone
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[*] posted on 9-11-2020 at 08:18


Deathunter88,
Unfortunately the US has one of the crappiest health care systems on the planet when you weight the cost benefit analysis.
Many people cannot afford proper medical care, which is entirely different from proper medical care not being available (subsaharan africa or austrailian outback).
Many posters including myself suggested seeing a doctor, but that is not practical or available everywhere.
I understand the medical system in china allows anyone to see a doctor, but many of us do not live in china.
This would not be my first choice of location to get medical advise as there are many online medical resources run by actual doctors.
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[*] posted on 4-12-2020 at 16:13


Deadhunter, some of us are Doctors. And, moreover, we are scientists.

If we want to give free advice, that is our perogative.

OK.... One of my fellow Doctors was troubled by Rosacea, mites were at least part of the problem.

Frequent washing of face, her sheets and pillowcases, solved the problem. That, and frequently running clothing and bedsheets, through a hot clothes dryer.

Since, dust/skin mites are ever-present in our environment, a course of Ivermectine, won't kill all of the mites in the house. Just the ones in her body at the moment.

Try commercially made, copper impregnated pillow cases...Or, make your own.

If this condition improves, you are doing something right.

There may be other problems present. But at least, you will improve the mite aspect of the problem.

We used to use Ivermectine, to insure our Greyhounds against Heartworm. Only became aware of its effectiveness against Scabies, much later.

Even so, it is not immediately effective against the rashes and itching caused by Scabies. The Scabies' feces and body parts, imbedded in the skin, produce a prolonged allergic response.

The mites may be dead, but immunologically, they are NOT forgotten. Rashes and Itching may persist for weeks or months. Until, the effected skin has been replaced by fresh new skin, and the old stuff has sloughed off.

Try to eliminate mites. Consider other possibilities.

Zoster, is one. Perhaps not likely, but possible.

[Edited on 5-12-2020 by zed]
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