Journal Log 8. 28/01/15. The Medication and the Dental Implant.

Hello there,
I have yet to locate a vitamin C or licorice topical that is affordable, or visit Polish shops for kefir, or locate a tougher chewing gum. The chewing gum is currently irrelevant as I won’t be chewing much for a while anyway. I have however dyed my hair, which upon fading looks a lot more appropriate. Additionally I have acquired the antidepressant Celexa  which has reduced my periodic flushing substantially. I also acquired some Skinoren (azelaic acid 20%) which is a little drying so far, and  seems to exacerbate the facial redness, but I have only being using it for 5 days. It occurs to me that the context of the how the flushing started is extraordinarily unusual, and I will be revisiting my GP in the hopes of gaining some insight and initiating some further tests. Perhaps I have hormonal imbalances, a thyroid disorder, allergies or have suffered some sort of unusual infection.

Just to recap, I posted this in the rosaceagroup too, but as of yet I have acquired no insight.

“Here’s the story. I had some flushing on accutane, and this was mostly transient, and went into a sort of remission a short time after my last dose. I was using the accutane as a treatment for severe cystic acne, and I was on a low dose at 20mg for 6 months. The flushing generally happened in response to heat and the sun. I think the accutane may have contributed, perhaps via vascular and sun damage, to what was about to happen.

Some months after this remission I trained to run 5km, one day I took a protein powder, and felt a bit sick and bloated and was unable to complete my run. After I got home my face began to burn, even swell a little, all over. So my entire face was red/purple, and it settled down very slowly over three days, but I was left with recurrent flushing. Soon, I developed symptoms of anemia like dizziness, prolonged headaches, lightheadedness, and exhaustion. I lost a lot of weight really fast and I had no appetite. I also had a weird change in how my gut works, it’s not necessarily bad, but its weird and is still the same now. I also had palpitations, abnormal moods and sleep disturbances too. After this I acquired about 3 colds in a row. I put some weight back on with some iron tablets and metatone, but my gut is still ‘different’, my face still flushes some, and I still have residual anxiety. I sleep like I did before.

You don’t have to be a GP to say, that this is not medically normal. Unfortunately my GPs do not yet understand just how weird the events prior to Christmas were. I think I’ll be visiting them again very soon.

Up until very recently I was experiencing a lot of blushing in response to heat, nervousness, and flushing after every meal but breakfast. My face was burning and tingly. Soon I developed facial erythema, mostly on the right side, and some dilated surface blood vessels. It became socially unbearable. I began to stay indoors. ”

I also posted this too, regarding yesterday. It was unpleasant, I also had to run to the bathroom unfortunately.

“If anyone is thinking of using Celexa to dampen the flushing response, you should be aware that people have some unpleasant side effects, including me. Today I had hot/cold feelings, aches in my legs, sweating hands, jitteriness, palpitations, dizziness, breathlessness and later in the day, these effects settled and were replaced with slight elation. It has been a weird and unpleasant day. I hear most of the side effects attenuate after two weeks, I am on day five of Celexa, so there is not too long to go. It really helps with my flushing so I want to continue if possible. You were warned. Hopefully while the flushing is limited it won’t get too much worse while I get tests and attempt to unravel what has happened.”

As you might have guessed, according to the title, I have had a little bit of dental implant work done. The screw is inserted, and in 6 months after the bone has healed about it, the cap will be fitted. Upon entering the surgery I was given some codeine and made to drink a fairly gross amoxicillin  drink.  This morning and yesterday morning I took 10mg of prednisolone in preparation for  the surgery. I had an xray or two, had my blood pressure taken, a surgical drape, surgical hat and some light block glasses too. I had a lot of local anesthetic injections, which were somewhat uncomfortable, and I did not feel much if anything after that. Dr V. cut my gum a little bit, and used a sort twistable screwdriver to insert the implant into my mandible. She then closed the cut with two stitches. During the surgery I had a little bit of involuntary shaking, felt a little heavy and drowsy, After the surgery I was disorientated. The implant was successful, and the post-surgery xray showed that the vagus nerve had been evaded. No bone graft was needed which saves me around £900. There were no complications.I have an impressive collection of painkillers in preparation for when the local anesthetic wears off. Additionally I have a wisdom tooth on the right side that hasn’t emerged yet, which is good news for the right side of my face! Plus, I have £95 on my points card which is almost enough to pay for the post-implant hygiene treatment!

It would appear that things are looking up. My skin and dental situation are improving.

Me with dark blonde hair.

Me with dark blonde hair.

me with reddish brown hair.

me with reddish brown hair.

My everyday flushing., before Celexa.

My everyday flushing., before Celexa.

My everyday flushing, after Celexa...

My everyday flushing, after Celexa…

Me enjoying Celexa side effects, yesterday.

Me enjoying Celexa side effects, yesterday.

Me enjoying Celexa side effects, yesterday.

Me enjoying Celexa side effects, yesterday.

Celexa side effects: dilated pupils.

Celexa side effects: dilated pupils.

Post dental implant selfie, if you zoom in you can see blood in the corner of my mouth.

Post dental implant selfie, if you zoom in you can see blood in the corner of my mouth.

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Journal Log 7. 17/01/15. The Little Things that Matter a Lot.

Hello there,
I am still alive, and finished my last university exam yesterday. The exam was fine, very easy, and much easier than the statistics exam. Two and a half years of university life to go, assuming I don’t take a PhD loan. Anyway, let’s get down to business:

  • My GI symptoms are much reduced, having removed all the obvious sources of wheat from my diet, and I exist in a way that is similar to how normal people exist. Perhaps, I have a sort of cyclical allergy to wheat, or rather it is a main trigger for something else that is wrong with me. Despite this, there are improvements to be made, and I still experience symptoms if I engage in any sort of exercise.
  • My rosacea-like situation is mostly unchanged, the flushing is still short lived and generally temperature dependent, but I seem to have developed permanent erythema on the right side of my face. There are still many angles to approach the matter, and so as it is early on in its progression, I am not worried and instead determined. My GP stated that I had rosacea, but she did not conduct a skin biopsy, or examine my facial redness. She seems to think I have type two rosacea, which I believe is incorrect. My skin is essentially clear of lesions of all kinds, I have post hyper-inflammatory pigmentation from previous acne lesions, and flushing is my main symptom. I fit the first subtype of rosacea description.
  • My GP prescribed Duac, that is a topical treatment containing 1% clindamycin and 5% benzoyl peroxide, which having had a reaction to benzoyl peroxide before is useless to me. I do not intend to use it. She offered me broadspectrum antibiotics of the tetracycline variety, which I declined, as they offer temporary relief followed by a worsening of GI symptoms after cessation. Not only that, but antibiotics permanently reduce gut flora diversity, and I will only use antibiotics specific to the treatment of SIBO as part of a longer SIBO treatment protocol, so that antibiotics help the GI issues rather than worsen them.
  • That said, I am currently looking into other topicals that might help with facial redness. Benzoyl peroxide and oral antibiotics are my only real no-gos, and therefore anything else is fine.
  • I have been referred to hospital for tests, including a SIBO breath test, my GP said SIBO is a possibility, but that there is an innate overlap in my conditions and that the conditions might be manifesting as separate entities.  I am awaiting a letter from the hospital detailing my appointment.
  • I have found that EGCG, that is the main polyphenol in green tea, may enter the skin in useful amounts if around 1 teaspoon of quadruple concentrated green tea is applied to the face (according to this AcneEinstein article: http://www.acneeinstein.com/fresh-green-tea-topical-acne-treatment/). A small number of studies concerning EGCG and rosacea have been done, one study introduction states that EGCG has immunomodulatory, anti-oxidant, photoprotective, anti-angiogenic and anti inflammatory properties (see here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933390/). In this particular study EGCG topical treatment over the course of six weeks, was found to inhibit HIF-1α induction and VEGF (vascular endothelial growth factor) expression, which play a role in angiogenesis, in treated skin. However, no significant difference in erythema was found after six weeks of treatment. It was concluded that topical EGCG may help prevent telangiectasias and erythema. Another study, sponsored by Syed Skincare, was reported by WebMD and concerns type two rosacea. A significant reduction in skin lesions and inflammation was noted in participants who received the green tea extract cream, in comparison to the placebo (see here: http://www.webmd.com/skin-problems-and-treatments/news/20050223/green-tea-helps-reduce-red-in-rosacea). I am applying quadruple concentrated Clipper loose green tea, that has been left to brew for about 5 minutes, to my face using cotton wool pads every morning after washing my face. It is too early to tell whether it has helped with the rosacea, but as it seems more like a preventative move to me, I may never know whether it has helped or not. But it has given me a nice golden glow that looks quite natural at no extra cost to me, as I have been drinking very concentrated green tea every morning for about two years. This golden glow has helped offset some of the acne mark redness and seems to make flushing episodes more psychologically bearable. Interestingly despite the child neglect dental scenario, when I visited the dental hygienist privately of my own accord for the first time last year, she was shocked at how clean my teeth were. I believe this was in part because I have been drinking the equivalent of 3-6 cups of green tea  every day for the last 2 years. Green tea helps prevent periodontal disease and dental caries. I would also like to add that daily consumption of green tea made a notable dent in my severe acne in 2013.
  • I tried the Maybelline Baby Lips Strike a Rose lip balm, and as a person who doesn’t like bright makeup, was impressed. However it did not have great staying power. At about £3 from Boots it is an easy way to subtly enhance your appearance. It isn’t that moisturising, but it has a nice texture.
  • Thinking about my own personal experiences, having alternated between ash brown, auburn, and blonde hair colours, I can say that redish and red hair colours can help offset facial redness. The opposite is true of ash shades. I have also seen my observations manifest in my friends. This tendency is also supported by The Beauty Department and its articles on hair colour (http://thebeautydepartment.com/2013/10/hair-color-guide-hint-of-red/). In my view patterns in recommendations based on skin tone are not reliable, and some of them may even be faulty. I have a cool or neutral skin tone and I look better with a neutral to warm hair colour and look quite drab in cool ashy colours. In terms of hair colour recommendations I think people with more severe facial redness should move towards red hair as much as they can stand and is appropriate for them. People with mild or moderate rosacea should stick to hair colours with a hint of red like copper blonde, strawberry blonde, honey blonde, honey brown, auburn, chestnut brown, mahogany brown, and cherry black. Or, they can go straight to red. Generally, I find that blonde hair looks more attractive on people with naturally fair skin, and it may accompany financial benefits statistically in terms of employment. Blonde hair can suit individuals with pinker complexions too. I do not consider red hair to be ideal as cultural stigma regarding it, just as there is a certain distaste towards curly hair, is still alive and well. Be prepared to get less views on online dating sites and be spoken to less in clubs. The image below serves to demonstrate the rosacea hair colour ballpark in my view. Dyeing your hair is an easy way to make erythema look less troublesome, and I am going to dye my hair auburn soon, but after that I will look into honey blonde, reddish brown, chestnut brown and mahogany brown. The first one is ideal to me, but I would like to experiment with the other colours.
  • In terms of easy over the counter rosacea treatment I found the following “Topical vitamin C preparations have recently been studied in the reduction of the erythema of rosacea.18 Daily use of an over-the-counter cosmetic 5.0% vitamin C (L-ascorbic acid) preparation was used in an observer-blinded and placebocontrolled study. Nine of the 12 participants experienced both objective and subjective improvement in their erythema.18 It was suggested that free-radical production might play a role in the inflammatory reaction of rosacea, and that the antioxidant
    effect of L-ascorbic acid might be responsible for its effect. These promising preliminary results still need to be confirmed in larger, long term studies.” (see here: http://www.jabfm.org/content/15/3/214.full.pdf+html).
  • I have my pre-surgery dental implant appointment on the 21st of January.
  • I have been drinking a double concentrated ginger infusion with every meal. Ginger is anti-H Pylori, anti-angiogenic in vivo and vitro, a broad anti-inflammatory, and helps release digestive secretions including enzyme lipase and gallbladder secretions. ( see here for antigenesis: http://www.sciencedirect.com/science/article/pii/S0006291X05014543, here for anti-inflammatory action: http://online.liebertpub.com/doi/abs/10.1089/jmf.2005.8.125?src=recsys, here and here regarding digestion: http://informahealthcare.com/doi/abs/10.3109/09637486.2011.627841http://informahealthcare.com/doi/abs/10.3109/09637489609028561and here regarding H Pylori http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761965/) It seems to help with the GI symptoms and make me feel better somehow in a very general way.
  • In terms of general good news Simple Skin Care has reformulated its line, and notable amounts of vitamin E and vitamin B3 can be found in its extremely cheap products.

In terms of plans regarding the next two weeks:

  • Chris Kresser offers a number of free ebooks, including one of skin health and another on gut health, and I believe that I can use these to help create a sort of alleviation of treatment protocol. I intend to cross references both ebooks with the FODMAP diet (very important)
  • I want to go back to the GP, claiming that the Duac caused a skin reaction, with a list of topicals I want to try and acquire something more appropriate (very important).
  • Find a Polish shop that sells kefir at a cheaper price than Asda, this will constitute the main part of my breakfast (quite important).
  • Locate more topical products containing licorice, or vitamin C, as to reach an investment (quite important).
  • Search foreign shops and the internet for tougher chewing gum, which is useful for giving your face more width (quite important).
  • Ideally I want to use Kathryn’s Marsden’s Good Gut Healing to produce a mindmap post on fibre, which might be useful to some people (bonus).
  • Obviously I want to dye my hair, and invest in my next dye, which will hopefully be more up my street (bonus I like the sound of)t.
  • I intend to pay more attention to fashion, and style, and may in time post research and ideas on that (bonus).
  • This is me before I started using the green tea as a toner, as you can see I look quite unattractive, I have just woken up and my face is in its natural format.

    This is me before I started using the green tea as a toner, as you can see I look quite unattractive, I have just woken up and my face is in its natural format.

    Another morning, after just waking up, having applied green tea as a toner for several days I looked like this.

    Another morning, after just waking up, having applied green tea as a toner for several days I looked like this.

    Again, before the usage of green tea as a toner.

    Again, before the usage of green tea as a toner.

    After the usage of green tea as a toner for a few days.

    After the usage of green tea as a toner for a few days.

    If you have acne, acne fade marks, acne rosacea, rosacea, or a naturally red skin tone this is your ideal hair colour ball-park in my opinion.

    If you have acne, acne fade marks, acne rosacea, rosacea, or a naturally red skin tone this is your ideal hair colour ball-park in my opinion.

    Before the application of Maybelline Baby Lips Strike a Rose tinted lip balm.

    Before the application of Maybelline Baby Lips Strike a Rose tinted lip balm.

    After the application of Maybelline Baby Lips Strike a Rose tinted lip balm.

    After the application of Maybelline Baby Lips Strike a Rose tinted lip balm.

Useful to Some: SCD Lifestyle Simplified Video Transcriptions III

SCD Lifestyle is essentially a business that creates profit by educating individuals about gut health. It makes sense to do such a thing, as the individuals who run the business have put a lot of effort and research into dealing with their gut issues, so they might as well profit right? Actually, I don’t think the answer to that question is so straightforward.

Nevertheless, I have written transcripts for a few of their videos. When I first watched the videos I found them pretty overwhelming and so I attempted to make sense of the information presented through writing. Hopefully someone will find this useful, and may even come up with ideas regarding what might be causing their gut issues. Remember, you can find your own answers.

Here is the third list of transcripts. It is worth noting these are only partial videos, as SCD Lifestyle sell the full videos alongside full transcripts. Despite this, I have found the partial videos  very useful as they have put into perspective just how important it is that I fix my gut issues to avoid further physical degeneration. It has also opened up a new realms of knowledge to explore, of particular interest to me, given my previously difficult existence is the concept of adrenal fatigue. I see now that it is also possible that I might be in danger of acquiring an autoimmune disease assuming that I don’t already have one.

The Exact Process of How Autoimmune Disease Starts:
Autoimmunity and autoimmune disease are separated by the quantity of damage and the symptoms it produces. Symptoms are caused when enough damage to tissues happens. The point at which autoimmunity leads to autoimmune disease varies from person to person, depending on the tissue being attacked, and the aggressiveness of the autoimmune disease. Symptoms can include more benign things such as fatigue, headaches, muscle pain, mood issues, skin conditions including rashes, dry skin and acne.
Two things have to happen to create an autoimmune disease, that is to move from a state of generalized inflammation, to a targeted attack on the part of the adaptive immune system. . The first thing is the production of a antibody, a protein. There are cells in the adaptive immune system that produce antibodies, which target specific entities, which are usually foreign invaders. Antibodies have a structure that resembles a Y. The of tips of the Y, have antigen binding sites on them, this is like a lock and therefore it acts to acquire the appropriate key. It is looking for a specific sequence of around 15-20 amino acids, as it does not recognise whole proteins, which it binds to. It follows that the antibody is looking for a specific protein fragment. In doing this the antibody signals to the adaptive and innate immune system that there is something that needs attacking. There are millions of antibodies in our immune system. Every cell produces a type of antibody which bonds a specific protein fragment.

When the cells of the innate immune system find something they tell production cells to produce antibodies specific to the invader. Other parts of the immune system decide whether the production of these antibodies is a good idea or not.

What can happen is that because antibodies are binding to very small protein fragments, they can bind to sites that are not specific to a forgein invader. This happens because there are structural similarities in cells and these similarities are necessary for life. Unfortunately this means that antibodies may attack the body.

There are certain things that make the autoimmune response more likely, including genetics, and infections. Some infections are more likely to lead to the production of antibodies that also recognise the body.

Antibodies attack the body in everyone. The body has a large number of fail-safe mechanisms to try to prevent the immune system from attacking the body. There are cells that exist to recognise autoimmune antibodies, and make sure that these autoantibodies are shutdown or killed. However in autoimmune diseases the fail-safes fail and so the production of autoantibodies is allowed to continue. So the immune system is simulated in a way that results in it attacking the body, it is unable to shut down autoantibodies, and will not cease their production. When enough damage results you have what is called an autoimmune disease.

Autoimmune reactions can result from chronic stress, leaky gut, infection or some kind of toxic exposure because they stimulate the immune system.

The Gut-Hormone Connection Stealing your Energy:

There is a direct correlation between how exhausted the adrenal glands are and how damaged the gut lining has become.

When you are first having adrenal fatigue, and increased cortisol levels, it can take a few years of stress before GI symptoms result. It is practically a prerequisite to have a gut problem if you have notable adrenal gland burnout. It is also the case that notable gut problems are usually accompanied by some level adrenal fatigue. They cannot be separated.

Cortisol is in charge of the secretion of immunoglobulin A (SIgA). Immunoglobulins protect the intestinal lining against potential foods that could be reactive or cause a problem. It also protects you against potential pathogens like bacteria and parasites or yeast. So, if your adrenals are burned out they cannot produce enough cortisol and your SIgA drops. This is why there is a direct relationship between how stressed you are and your gut health.

If you’re doing something to inflame your gut, you drive cortisol up, because cortisol is an anti-inflammatory hormone. So damage to the gut makes the adrenals worse and damage to the adrenals makes the gut worse. NSAIDs, substances like alcohol and poor dietary decisions cause gut inflammation.

Physical stress can be equally as damaging as emotional stress. So, both physical stress and emotional stress do the same thing, they drive cortisol up and cause gut immunity to drop.

There is a process by which cortisol becomes high, and then later becomes low. Initially we react to stress in such a way that our cortisol levels go up. However if this goes on too long our cortisol levels drop. This process exemplifies the stages of adrenal fatigue.

In stage 1 of adrenal fatigue cortisol levels are high. In stage 2 cortisol levels start to drop. And finally, in stage 3 cortisol levels become very low. The lower the cortisol the more fatigued the adrenals are, and therefore the harder the problem is to fix. An individual with more adrenal fatigue will have more gut issues and their situation will be harder to fix.

Low cortisol also relates to the accumulation of body fat, fatigue, and low sex drive.

How Leaky Gut is Probably Causing All Your Skin Problems

You might have dysbiosis, SIBO, parasites, fungal overgrowth, intestinal permeability, or just a lack of beneficial bacteria. All of these things can directly and indirectly contribute towards a plethora of skin problems. Changes in the gut flora can be due to antibiotic use, not being breast-fed, being born via Caesarean section, eating a poor diet, chronic stress, sleep deprivation, exposure to environmental toxins, et cetera. Changes in gut fora then predispose people to intestinal permeability and inflammation, which as mentioned leads to an inflammatory skin response.
Substance P is a neuropeptide that is produced in the gut, the brain and the skin. Altered gut microbiom promotes the release of substance P in both the gut and the skin. Probiotics have been shown to attenuate or mitigate the situation regarding gut flora.

The gut microbiome also influence lipids and tissue fatty acid profiles, which in turn influence sebum production (an oily waxy substance produced by the sebaceous glands in the skin) and the fatty acid composition of the sebum itself. This can predispose individuals to acne.

There are have a myriad of studies that have noted a significant connection between gut and skin issues.

Two researchers Stokes and Pillsberry were talking about the gut skin axis, as far back as the early 1900s. They said that there is an important link between emotion and skin issues such as acne outbreaks, erythema, urticaria and dermatitis via the physiology and bacteriology of the gut. They noted research at the time that indicated that 40% of acne prone individuals in a given sample had low stomach acid. Low stomach acid can contribute towards SIBO and intestinal permeability. Low stomach acid can therefore contribute to the development of skin issues.

Stokes and Pillsberry suggested a number of remedies including probiotics and cod liver oil (a rich source of EPA and DHEA). EPA and DHEA are both anti-inflammatory. Additionally cod liver oil is a rich source of vitamin A (preformed vitamin A- retinol).

How Gut Inflammation Triggers Depression

There are systemic effects to anti-depressants and psychotropic medicines. In 2009 there were about 235 billion prescriptions written for anti-depressants. The effects of anti-depressants and psychotropic medicines are not completely understood in all cases. That said, they can be very helpful. They are not magic pills. In fact in some cases they may not be the right instrument compared to modulating the immune system and modulating pathology via managing diet, managing gut microbiome, and making sleep changes. Lifestyle changes are more in line with our very complicated pathophysiology than the usage of psychiatric medications.

Inflammatory cytokine model of depression: inflammatory cytokines could be crossing the blood/brain barrier suppressing activity in the frontal cortex which may lead to depression.

If the microbiome is off in your gut it will cause an inflammatory reaction. The immune system near the gut will release sorts of inflammatory cytokines including interleukin 1 (IL 1) and interleukin 6 (IL 6). They send a direct message to the hypothalamus, which in turn tells the pituitary gland to the signal the adrenal glands to release more cortisol. It follows that gut issues can lead to depression, or manifest as the straw that breaks the camel’s back.

How important is it for people to address the gut during the treatment of anxiety and depression?

Switching from a diet of highly processed food to a diet of less processed food will help the gut. Managing sleep is going to help the gut. All these things can affect the gut bacteria and the stress response.

In Victorian times they used to treat TB, depression and anxiety by visiting the seashore wherein they stay out in the sunshine and eat fish. Additionally individuals were taken to countryside mental institutions where they would be taken out in the early morning into the sunshine. When individuals were manic they would lock them in a dark room. Mania is characterised by immense energy, but also psychotic delusions. It happens in various disorders including bipolar and schizophrenia.

You can temporarily sleep deprive a depressed individual for half a night. Their depression will get immediately better, but once they sleep normally it will return as it was before.

Chronic sleep deprivation is a stressor that can cause depression. We are having around 20 less hours of sleep a week relative to 60-70 years ago.

Interestingly a 10,000 lux light box used before 10am in the morning from September to March can be as effective as an antidepressant. This is known as chronotherapy. However it is risky to use the light box after 10am, especially if you have a family history of bipolar.

If you have depression is it prudent to get up at 6:00am or 7:00am and go outside for some morning sun exposure. It is also a good idea to avoid night computer use. If you use your computer at night use blue blockers install Flux on your computer for use after sunset. This will help reset your circadian rhythm.

The blue light sends a signal to the hypothalamus saying “goodmorning”.

Journal Log 5. 15.12.14. Patterns in Flushing and Gut Issues.

Hello there,
I have noted a few little things, the significance of them is not yet known. I still haven’t had a serious flushing episode, it has been about 10 days now! There has been a slight change in  the flushing, until very recently my face would become progressively more flushed and red throughout the day, but it would not progress in such a way as to cause too much distress. For the last two days this has not happened, and I have instead had ‘micro flushes’. So, my face will go bright red, so red it will be practically luminous, and then return to normal in a few minutes. It did this a grand total of four times yesterday and so I flushed for maybe fifteen minutes at most throughout the day. Weird. I think this is significant in two ways. The first is that my face is returning to normal quickly which indicates that the vascular system in my face is not overly damaged. The second is that this may not qualify as rosacea flushing as my face is returning to normal very quickly. That said, there is definitely something wrong with me. It is also possible that I have another broken capillary but I can’t tell  for sure. But then again the flushes may simply be short lived because of my efforts in controlling them.

I have been mixing a pea sized amount of Adapalene cream (a fairly non-irritating retinoid generally used to treat acne) into my moisturiser for the last two nights and applying it to my face. The Adapalene seems to reduce overall background facial redness, probably because it is a fairly powerful anti-inflammatory. I have had no general negative reactions to it if anything my skin feels better. It is possible that because my flushing started during a course of accutane, Adapalene is a retinoid and therefore a derivative of vitamin A, Adapalene is having a peculiar twofold effect on my face. It was claimed by some individuals in the Post Accutane/Minocycline Facial Flushing thread on acne.org (see the very very long thread here: http://www.acne.org/messageboard/topic/193804-post-accutaneminocycline-facial-flushing/) that vitamin A in consumption and topical application can worsen post-accutane flushing. However, Adapalene is poorly absorbed to the point where any absorption may be undetectable in humans (see here: http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20748lbl.pdf). I wouldn’t necessarily say my flushing has worsened, just changed, and there are number of potential factors that might have contributed. For example it is a hormonal time for me as a female, I have been eating a lot of wheat as a negative experiment, and I forgot to apply my aspirin face mask yesterday. Overall I think Adapalene is fine to use in instances of acne rosacea, but some caution is required in cases of post-accutane flushing.

I have one additional point to make regarding skin. If anyone ever finds themselves in my situation, remember to use your aspirin face mask religiously every two days! Essentially, it  seems to reduce facial redness, limit the severity of facial flushing and may have antiangiogenic properties. Preventative measures need to be repeated to do just that, prevent something from happening.

I have been deliberately eating a lot of wheat for the past three days as some kind of really crude test to see how it affects me. Yes I know, I need to up my game. Anyway, having eaten flour slices of bread and two bowls of knock-off Shreddies everyday for the last three days, I have a headache, fatigue, and embarrassing bathroom delight. I feel like I am going to die, and unfortunately I am going to try to continue this for another four days. On reflection I think my symptoms were much worse when I was a vegetarian and ate a lot of carbohydrates. I think I have a number of sensitivities corresponding to different issues. However, I think it is not so clear cut, I have sensitivities to constituents rather than simply foods. The table below shows my limited understanding of the matter.

Problematic Foods

Acne

Gut Issues

Wheat

Sugar

Dairy

Oats

Rice

Bananas

Chocolate

Apples

Sorbitol

Eggs

Meat

It is very clear that I should not eat any form of sweet junk food, and that I seem to have issues with some sorts of fibre. Protein is normally harder to digest than other foods, and so perhaps it makes sense that if I have something wrong with me I might struggle. On the other hand, I might for some reason be easily satiated by it and not actually struggle with its digestion. Perhaps, I have low stomach acid or some such thing. Anyway, I will torture myself with knock-off Shreddies for long enough for me to definitively conclude that my malaise is because of it. Then, I will cease to eat wheat for a yet to be specified period of time.

I remember doing quite well on some kind of lazy Paleo FODMAP diet. I simply cross referenced FODMAP food lists with Paleo food lists and ate that way for around 70% of the time. However, I was undone by eggs. I will repeat this process but I make a number of adjustments:

  • Include probiotics
  • Include more probiotic foods
  • Remove wheat entirely
  • Eat rice porridge made with almond milk for breakfast*
  • Take licorice supplements*

*I used to eat rice porridge everyday for breakfast, but it seemed to make my acne worse. It may have done this in part because of the milk used to make it, and so I will experiment with milk alternatives. When I was eating rice porridge for breakfast I had symptom free days,

*I am currently writing a post on licorice supplementation for rosacea. In summary, but I assure you I have a myriad of references to back this up as you will see soon, licorice seems to make it difficult for H pylori to adhere to the stomach mucus lining and has anti-H pylori activity. It is also antiangiogenic. That said, it is a complicated substance with both good and bad side effects. It also interacts with a lot of medications. So, do not take it without thorough research in regards to dosages, side effects and interactions.

That’s it for now, I’ll keep you posted.

Useful to Some: Type One Rosacea, Angiogenesis, Treatment and Retinoids

Disclaimer: This post is referenced in APA style, and so I need to learn the standard referencing system in dermatology. I try!

Type One Rosacea, Angiogenesis, Treatment and Retinoids

Crawford, Pelle, and James (2004) note that rosacea has been historically divided into stages which corresponds with a statement or implication that the disease will progress through the stages. In 2002 members of an expert committee assembled by the National Rosacea Society who met to standardise rosacea diagnostic criteria, did not discuss the stages (Crawford, Pelle, and James, 2004). They recognised only separate variants of rosacea.

Crawford, Pelle, and James (2004) argue that the most important factor in diagnosing rosacea is persistent erythema in the central portion of the face which lasts for at least 3 months. Generally the periocular skin is spared. Indeed, they state it should be the sole factor in diagnosing rosacea. Other features such as telangiectasia are viewed as supporting the diagnosis, but unnecessary for the diagnosis to be made (Crawford, Pelle, and James, 2004). Secondary features such as burning or stinging are indicative of the patient’s subtype of rosacea (Crawford, Pelle, and James, 2004).

Rosacea flushing usually lasts longer than 10 minutes, and this tendency allows the differentiation between mere blushing and flushing. Generally the central portion of the face flushes the most but the ears, neck, peripheral face, and upper chest may be involved too (Crawford, Pelle, and James, 2004). The periocular skin is spared. Flushing may triggered by stimuli such as alcohol or emotions (Crawford, Pelle, and James, 2004). Other times there may be no known stimuli. Burning and stinging may accompany flushing but sweating, light-headedness or palpitations do not (Crawford, Pelle, and James, 2004). Generally there is no history of acne (Crawford, Pelle, and James, 2004).

It is common for patients who request a diagnosis and treatment for rosacea to only have severe sun damage (Crawford, Pelle, and James, 2004). As is the case with rosacea sun damage can produce erythema which generally spares the periocular skin, and notable telangiectases. However these features are found on most sun exposed surfaces such as the neck and the upper part of the chest, mostly in women (Crawford, Pelle, and James, 2004). This is because sun damage is a mildly inflammatory process. Dyspigmentation is present in the majority of patients (Crawford, Pelle, and James, 2004).
Individuals with erythematotelangiectatic rosacea, are unfortunate, in that their symptoms are difficult to treat (Korting, & Schöllmann, 2009). Often they respond poorly to topical or oral medications. However there is evidence to suggest that isotretinoin may improve inflammation caused erythema for some time (Korting, & Schöllmann, 2009). Light therapy, vascular laser and medications that help prevent flushing have proven beneficial in controlling the condition (Korting, & Schöllmann, 2009).

In regards to the general use of antibiotics in treating rosacea, it is generally agreed by researchers that it the non-antibiotic properties of the tetracyclines that are responsible for their usefulness in treating skin diseases, including rosacea (Korting, & Schöllmann, 2009). These non-antibiotic properties include the inhibition of angiogenesis, the inhibition of pro-inflammatory cytokines, the inhibition of neutrophil chemotaxis, and the inhibition of matrix metalloproteineses. It follows that because antibiotics have various non-antibiotic effects, which can be used to treat a myriad of conditions including autoimmune disorders such as rheumatoid arthritis, sarcoidosis, and aortic aneurysms (Korting, & Schöllmann, 2009). The ability of tetracyclines to reduce the inflammatory response is particularly relevant to the treatment of rosacea (Greewald et al, as cited in Korting, & Schöllmann, 2009).

Second generation tetracyclines offer advantages in the treatment of rosacea in comparison to their classic variants (Korting, & Schöllmann, 2009). These include minocycline and doxycycline (Korting, & Schöllmann, 2009). They have improved bioavailability, can be taken with food to reduce gastrointestinal side effects, and have a longer elimination half-life. They are helpful in treating rosacea at a sub-antimicrobial dose, which also exerts anti-inflammatory effects (Korting, & Schöllmann, 2009). This allows for the evasion of the disadvantages associated with long term antibiotic use including candial vulvovaginitis, gastrointestinal distress, and the development of bacterial resistance (Korting, & Schöllmann, 2009). It follows that when microbial pathogenesis is not indicated that such treatments as low dose doxycycline should constitute a preferred treatment in dealing with rosacea (Korting, & Schöllmann, 2009).

It could be argued that the anti-angiogenic and anti- inflammatory function of antibiotics might be useful in alleviating erythematotelangiectatic rosacea to some degree.

Isotretinoin is useful in treating several rosacea subtypes, however the studies concerning its use are generally poor (Korting, & Schöllmann, 2009). Only small poor studies are available. In one study isotretinoin was effective in treating both erythematotelangiectatic and papulopustular rosacea erythematotelangiectatic and papulopustular rosacea. Interestingly, reduced facial cutaneous blood flow was noted in isotretinoin treated individuals but not in the oxytetracycline treated comparison group (Irvine et al, as cited in Korting, & Schöllmann, 2009). Another study showed that four months of low dose isotretinoin therapy (10mg daily) was useful in treating 22 patients with therapy-resistant rosacea. Isotretinoin led to a reduction in inflammatory lesions, erythema and telangiectasia, however its effects manifested slower in comparison to the oral antibiotics used to treat the comparison group (Korting, & Schöllmann, 2009).

Because I have acne and mild rosacea like symptoms I have decided to find data on the use of topical retinoids which are often used to treating mild to moderate acne.  A few studies have shown that retinoids like tretinoin can be useful in treating rosacea, however the clinical response if often delayed (Korting, & Schöllmann, 2009). It can take 2 months or more until clinical response is evident. Generally topical retinoids are avoided because of the notion that retinoids can encourage angiogenesis (Korting, & Schöllmann, 2009). However an increase in cutaneous vascularity and the development of telangiectasia have not been observed (Korting, & Schöllmann, 2009). Indeed, a lessening of erythema coupled with a partial to complete disappearance of telangiectasia has been noted for patients treated with 0.025% tretinoin cream (Korting, & Schöllmann, 2009). Despite this the evidence is based on a trial situation which is relatively poor (Korting, & Schöllmann, 2009).

Relatedly Kligman (1993) treated nineteen adult women with persistent papulopustular rosacea. A low strength 0.025% tretinoin (Retin-A, Johnson & Johnson) cream was employed for a period of 6-12 months (Kligman, 1993). The dosage was well tolerated, and near half of the patients experienced complete clearing for 6 months after finishing treatment. Erythema lessened and there was at least a partial reduction in telangiectasia (Kligman, 1993). It is believed that the anti-inflammatory and photo damage ameliorating properties of tretinoin were at least partly responsible for the improvement (Kligman, 1993). That said tretinoin is indeed comedolytic which is not relevant to rosacea.

Adapalene is derived from naphthoic acid and has potent retinoid properties, it has demonstrated anti-inflammatory and antiproliferative activityin vitro and vivo studies (Altinyazer, Koca, Teken & EÍtürk , 2004). Acne patients tend to find it is less irritating than tretinoin gel.

Altinyazer et al (2004) treated 55 patients with papulopustular rosacea with either adapalene (0.1%) or metronidazole (0.75%) in an investigator blind comparison. Patients were randomly assigned to either condition after the initial sample was subject to a systematic process of exclusion. For examples patients using medications that might affect the adapalene or metronidazole were excluded (Altinyazer et al, 2004). Only patients diagnosed with papulopustular rosacea according to the Standards of the National Society Expert Committee and who had at least 10 papules or pustules were accepted into the study. Sun protection SPF 20 was used by all patients (Altinyazer et al, 2004). The nature and number of papules and pustules, erythema and telangiectasia were scored at baseline, and then after 2, 4, 8, and 12 weeks (Altinyazer et al, 2004). Additionally patient side effects were reported at each visit.

Altinyazer et al (2004) found that adapalene (0.1%) was useful in treating papules and pustules but had little effect on erythema and telangiectastic. Adapalene is less irritating than other retinoids, it was generally well tolerated in the study with some patients experiencing mild transitory irritation (Altinyazer et al, 2004). It found to be effective in treating the papules and pustules in patients with rosacea but not in reducing the erythema and telangiectasia (Altinyazer et al, 2004). However the study only lasted for 3 months, a vehicle control was not used, and the study was not double blinded.
As noted by Kligman (1993) Pharmacologic and preclinical studies have demonstrated that adapalene may reduce photo-aging which might explain its usefulness in treating rosacea (Altinyazer et al, 2004).

Interestingly Dr Pelle uses topical retinoids to treat rosacea on the basis that it can help repair the dermal anatomy by decreasingly abnormal elastin, increase collagen, increase glycosamonoglycans and decrease telangiectasias (Heymann, 2004). That said, Dr Pelle recommends preparing the skin with a moisturiser first. Relatedly Lachgar et al demonstrated that the quantity of cell-associated and secreted VEGF decreased strongly with retinoid concentration (Heymann, 2004). It was concluded that the decrease in VEGF expression by keratinocytes caused by retinoids might prevent skin angiogenesis in diseases like rosacea (Heymann, 2004). Furthermore retinoid is recognised by the Angiogenesis Foundation as a known angiogenesis inhibitor (2014).

The evidence, even though there it is limited and not of quality, seems to suggest that topical retinoids would be acceptable to treating acne rosacea. However there appear to be differences in the effectiveness of the sorts of topical retinoids available. At face value, it would seem that Retin A is more effective than adapalene, however adapalene is much less irritating than Retin A. I do not think there is not enough evidence to suggest conclusively state that Retin A should be employed over adapalene. I note that the Retin A in Kligman’s (1993) study was created by Johnson & Johnson, and I wonder why the name of the company was mentioned in the abstract.

What’s really interesting is the possibility that topical retinoids can be antiangiogenic as noted by Korting and Schöllmann (2009) and Heymann (2004). Their photo-damage reducing properties also appear useful (Altinyazer et al, 2004; Kligman, 1993; Heymann, 2004). Naturally the antiangiogenic properties also apply to oral antibiotics (Korting & Schöllmann, 2009). That said I do not believe topical retinoids are the best topical treatment for the most forms of rosacea.  In my case it could be especially risky as it not yet known whether my rosacea like symptoms were mediated by Accutane. If you were to use topical retinoids in treating rosacea I would use a cream version as it acts as a buffer, use a weaker retinoid to start, use the retinoid sparingly, and perhaps mix it into your moisturiser. As a final note, I think it is possible that topical retinoids have a unique role in slowing down the early signs of rosacea due to their antiangiogenic properties.

References
Altinyazer, H., Koca, R., Tekin, N., & EÍtürk, E. (2004). Adapalene vs. Metronidazole Gel for the Treatment of Rosacea. International Journal of Dermatology. 44 (3), 252-255.
Crawford, G., Pelle, M., & James, W. (2004). Rosacea: I. Etiology, pathogenesis, and subtype classification. Journal of the American Academy of Dermatology. 51 (3), 327–341.

Heymann, R. (2004). Rosacea Subtype Directed Therapy. Journal of the American Academy for Dermatology. 51 (1), 90-92.

Kligman, A. (1993). Topical tretinoin for rosacea: a preliminary report. Journal of Dermatological Treatment. 4 (2), 71-73.

Korting, H., & Schöllmann C. (2009). Current Topical and Systematic Approaches to Treatment of Rosacea. Journal of the European Academy of Dermatology and Venereology. 23 (8), 876-882.

The Angiogenesis Foundation, (2014). Growth Factors & Inhibitors. Retrieved from http://www.angio.org/learn/angiogenesis/

Reflection 2. 11.12.14. The Concept of ‘Just Be’.

Hello there,
Humans are remarkably poor at dealing with bad news, despite the possibility of unexpected disaster. In this world a mere bout of norovirus or rotavirus, can leave you with chronic skin and gut issues. That can happen to almost anyone. You and me. It might have already happened to me. The Center of Disease Control and Prevention stated that as of 2012 around half of adults in the US, around 117 million people, have one chronic illness. One in four adults were cited as having two or more chronic health problems (see here: http://www.cdc.gov/chronicdisease/overview/index.htm). That said these statistics may not even consider the prevalence of gut and autoimmune diseases. Naturally, such chronic illnesses are more likely to occur in the old, but survival in young people who would have ordinarily succumbed to chronic illness is on the rise. It follows that because of this, and other reasons, the number of young people suffering from chronic illness is on the increase. Essentially there are many common diseases regarding which many feel isolated and misunderstood. At face value, it doesn’t make a lot of sense.

I am under the impression that when I state that I have an illness, even if in my case it is mild, that individuals think less of me on some level, and that guilt is an appropriate response on my part. This is perfectly understandable, and if I lost partners or friends because of it I wouldn’t be surprised. Sure, it’s not the most altruistic of actions, and in some circumstances it is nought but destructive. In the end we all want the same thing, to live life. At the end of the day I don’t want to be in my office most of the day reading about the gut-skin axis at the age of 20. I don’t expect anyone to join me in my activities, all I want is faith, especially from my dad. Trust that there are many ways of solving and managing my body left to be explored. Trust that there is the possibly for me to embody life in a fuller form. The idea that the body is a complex machine, regarding which we don’t have all the answers, seems to indicate that many illnesses can be solved and controlled. Despite this knowledge, illness can still be a social death sentence. Apparently humans can’t wait for you to reach a plateau in terms of treatment.

What irritates and intrigues me is the lack of knowledge and understanding regarding the sorts of chronic illness that exist. My dad is so funny, I must have told him 20 times by now that if I don’t stop the flushing it might progress very slowly over years and eventually become a more disfiguring manifestation. He still says I look rosy. A girl in my Psychology degree, lovely as she is, keeps inviting me to social events despite knowing I am chronically ill. Sometimes humans are in denial regarding the frailty of existence and at other times they are not acting rationally. They put too much money on their self awareness and knowledge. Of course, if I had the audacity to challenge the comments pedestrians make about me during flushing episodes they would probably deny the situation by insulting me, deny making the comments, or deny that I have rosacea or otherwise. Oftentimes denial is a form of self defense, both direct as in the above scenario, and indirectly through the denial of knowledge regarding the self and the situation.

Living is easy, and difficult. It is easy in that to end your life takes pain beyond any comprehensible measure. Tomorrow you could be struck down by a car, your face might be disfigured, you might become paralyzed and experience agonising neuropathic pain.  Your partner might leave you, you might lose your job, lose your independence and everything might change for the worse. You will live like this for years, probably decades, and even then you might not intentionally face the end. Because living is easy, and living is difficult.

You can think of yourself as intrinsically connected to a parasite. This parasite is so connected to you that you could never be separated, and if you were what makes you you would fade into nothing. The parasite controls you near infinitely, it will try to deny you truth, deny you friends, deny you self awareness and knowledge and deny you any notion of goodness you might have. Of course, you know that this parasite is life, all it wants is to be and it will push against anything that challenges it. I wouldn’t worry about finding the strength to go on, to perhaps conquer your obstacles and endure great pain. No, I worry about our capacity to deal with an increasingly sick world in the most logical way, to deny life when necessary, to avoid the excesses of life as part of future planning, and to accept ourselves and each other.

Disclaimer: Although there is certainly something wrong with my body in that I have a cluster of gut, skin and occasional psychological issues which are interconnected, I am NOT chronically ill in the sense that I am perpetual pain, housebound, on many many medications or otherwise. Furthermore, while I am managing symptoms of illness everyday, and find it difficult, my symptoms would not be seen as severe. So, I am in a sense on the outskirts of chronic illness looking in, and commenting on what I see. I hope that I have not offended anyone through my ignorance regarding the experience of having more severe forms of chronic illness. That said, my experiences might apply better to those who have chronic illnesses that distressing but not severe, or those who have managed to manage their symptoms up to an extent.

Useful to Some: Licorice in Skin Care Products for Rosacea

I scoured the Paula’s Choice Beautipedia, and came across a collection of products that are gentle, contain useful ingredients such as antioxidants, have a ‘best’ or ‘good’ rating in the Beautipedia, contain licorice extracts (usually root extracts) and are probably useful in dealing with rosacea. The sunscreen actives are generally zinc oxide based and decent for sensitive skin. These are affordable at anywhere between £6 and £15.

Unfortunately, they can be quite difficult to find in the UK. No, doubt I will be on the prowl today. I’ll keep you posted.

Check out Paula’s Choice Beautipedia: http://www.paulaschoice.com/beautypedia/

  • Face and Neck face factor 30 broad spectrum, Kiss my Face, price: $12.95“Face Factor Face + Neck SPF 30 is a truly outstanding product in the Kiss My Face line! This in-part zinc oxide sunscreen for normal to dry skin contains a very good array of antioxidants, soothing agents, emollients, and the cell-communicating ingredients. Well done, and it’s fragrance-free, too! That is a great change of pace! This formula should be suitable for those struggling with dry skin and occasional breakouts; however, as with any skin-care product, it takes experimentation to discover what works best for you.”

The presence of vitamin C in an affordable SPF is impressive.

Some its ingredients: “Aloe Barbadensis (Aloe Vera) Leaf Juice, Glycerin,  Helianthus Annuus (Sunflower) Seed Oil,  Carthamus Tinctorius (Safflower) Oleosomes, Camellia Sinensis (Green Tea) Leaf Extract, Alpha Lipoic Acid, Cucumis Sativus (Cucumber) Fruit Extract, Glycrrhiza Glabra (Licorice) Extract, Ascorbyl Palmitate (Vitamin C), Tocopheryl Acetate (Vitamin E), Sodium Chloride, Linoleic Acid”

  • NATURAL PROTECTION MINERAL BLOCK SUNSCREEN LOTION, SPF 30, Aveeno Price: $10.99

There are few active ingredients, but they are presence, it is a pity regarding the small amount of liquorice.

Contains: “Dipotassium Glycyrrhizate (Licorice Root), Avena Sativa (Oat) Kernel Extract (Oat)”
It leaves a slight white cast.

  • OAT PROTEIN COMPLEX SUN SCREEN SPF 18 by Kiss My Face ,Price: $11.95 (no longer recommended for rosacea skin due to a change in formulation- but worth a shot)

Some of its ingredients: “Aloe Barbadensis (Aloe Vera Gel) Leaf Juice, Helianthus Annuus (Sunflower Oil) Seed Oil, Glycerin, Carthamus Tinctorius (Safflower), Avena Sativa (Oat), Betaglucan, Avena Sativa (Oat) Proteins, Camellia Sinensis (Green Tea) Leaf Extract, Glycrrhiza Glabra (Licorice) Extract, Carota Sativa (Carrot) Extract, Cucumis Sativus (Cucumber) Extract”

  • AGE DEFYING CC CREAM COLOR CORRECTOR BROAD SPECTRUM SPF 30 by Revlon Price: $13.99

There are not so many active ingredients in the CC cream, but the quantity is notable.

Some of its ingredients: “Glycyrrhiza Glabra (Licorice) Root Extract, Vitis Vinifera (Grape) Fruit Extract, Saxifraga Sarmentosa (Strawberry Saxifrage) Extract,  Scutellaria Baicalensis (Balkal Skullcap) Extract, Morus Bombycis (Mulberry) Root Extract, Ascorbyl Glucoside, Niacinamide””

  • SMART SHADE CC CREAM COMPLEXION CORRECTOR SPF 35 BROAD SPECTRUM by Almay , Price: $9.99

Some of its ingredients: “Niacinamide, Ascorbyl Glucoside Glycyrrhiza Glabra (Licorice) Root Extract, Vitis Vinifera (Grape) Fruit Extract, Saxifraga Sarmentosa (Strawberry Saxifrage) Extract, Hydrolyzed Glycosaminoglycans, Scutellaria Baicalensis (Baikal Skullcap) Root Extract, Morus Bombycis (Chinese Mulberry) Root Extract”

  • LINE SMOOTHING MAKEUP SPF 15 by Almay ,Price:$13.99

The presence of vitamin C in an affordable foundation is extremely impressive.

Some of its ingredients: “Ginkgo Biloba Leaf Extract, Panax Ginseng Root Extract Sodium Hyaluronate, Camellia Sinensis Leaf Extract, Glycyrrhiza Glabra Root Extract (Licorice), Punica Granatum Extract, Centaurea Cyanus Flower Extract, Erythrulose, Algae Extract, Vitis Vinifera Seed Extract (Grape), Cucumis Sativus Flower Extract (Cucumber), Hydrolyzed Glycosaminoglycans, Sodium Ascorbyl Phosphate, Caffeine, Tocopheryl Acetate, Retinyl Palmitate, Aloe Barbadensis Leaf Juice, Anthemis Nobilis Flower Oil, Aspalathus Linearis Leaf Extract”