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Rosacea: Diagnosis and Management

PDF Ebook Rosacea: Diagnosis and Management

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Product details

Hardcover: 200 pages

Publisher: CRC Press; 1 edition (December 22, 2008)

Language: English

ISBN-10: 1420072587

ISBN-13: 978-1420072587

Product Dimensions:

6.2 x 0.5 x 9 inches

Shipping Weight: 14.9 ounces (View shipping rates and policies)

Average Customer Review:

2.9 out of 5 stars

3 customer reviews

Amazon Best Sellers Rank:

#1,661,146 in Books (See Top 100 in Books)

This is not an up to date resource; I requested a return

This book was so helpful,especially when I needed to do additional research on Roseaca. It was full of descriptive information and pictures.. I give it a strong recommendation !!!

This book is designed with physicians in mind and is full of a wonderful mixture of color illustrations of nineteenth century artists along with the author's own modern color photographs of his patients. Powell points out the 'great detail that the dermatologists of a former era paid to describing and illustrating this condition."Even though this book is not designed for laymen like myself, I found the book fairly easy to understand and insightful and learned a great deal which I will detail in this review. Dr. Powell's book is, as he says, "not intended to be an in-depth study of this disease," but to "fill the gap that texbooks leave in the provisions of solutions for individual patients with rosacea who often require their clinicians to be innovative in the approach to the management of their skin conditions."Powell confirms how rosacea's definition has been vague, that the etiology is unknown, yet suggests that ultraviolet light may be the culprit underlying the various pathogenic theories surrounding rosacea. He lauds the new NRS classification of rosacea into subsets and discusses details of rosacea into these subsets using a grading system to select therapies, devoting a chapter on this subject.One new thought to me is his mention of the `lactic acid test' for skin sensitivity to assess and grade a patient using this tool. A whole chapter is devoted to skin structure and function. His chapter on Flushing and Blushing confirms what other clinicians have fund that while both are seen 'sufficiently often enough' in rosacea patients and both flushing and/or blushing are the `first features of rosacea to appear in some patients," nevertheless, "flushing and blushing are not necessarily a component of the clinical picture in all patients with rosacea." He explains the only difference between flushing and blushing are the "different conditions which disparate initiating factors." Flushing may be initiated by many factors other than emotional or psychological. Blushing is initiated by emotional and psychological factors. He does admit that there are `crossovers in the distribution of flushing and blushing' and that flushing is more widespread. He goes into some detail how Charles Darwin wrote much about the subject of blushing which resulted in the public psyche associating `facial reddening and emotions' leading to 'some curious theories relating to the etiology of rosacea.'One matter Dr. Powell clears up is the notion that individuals with sensitive skin and who flush frequently should be classified as `pre-rosacea.' He points out that the evidence is lacking for this theory mainly because of the `lack of [a] clear definition of both rosacea and the type of facial reaction that constitute[s] facial flushing or blushing.' Powell makes the point that rosacea may be the result of irritating effects of the environment rather than the effects of frequent flushing.A whole chapter is devoted on the classification and grading the severity of rosacea. He points out the benefits of clinicians accepting a `common recognition of which subtype within the rosacea spectrum' and how this classificaion also facilitates management of treatment which is `largely dictated by which subtype of rosacea' the patient represents. One clarification worth noting is how he explains that the NRS `expert committee' did not imply `a pathogenesis or progression of the disorder through various stages.'The chapter on Subtype 1 (Erythematotelangiectatic [ETTR] Rosacea) shows the difficulty for differentiating it from rosacea mimics, in particular, heliodermatitis. He says that some clinicians use the terms heliodermatitis and ETTR interchangeably. He thus focuses on differentiating the two conditions. There is much detail also differentiating ETTR with systemic lupus erythematosus (SLE), dermatomyositis, seborrheic dermatitis, atopic dermatitis, other dermatitis, and other rarer conditions. He states that subtype 1 is the most difficult to treat and offers suggestions on its management.In his chapter on Subtype 2 (Papulopustular [PPR] Rosacea) he says this subtype `corresponds most closely to the original concept of rosacea' and goes into detail about the definition and concludes that this subtype is `the easiest type to treat' and `apart from rhinophyma, PPR is the most easily recognized rosacea.' He gives an interesting short history on past treatments used to treat PPR, for example, `reducing he intake of carbohydrates,' and `increasing the quantity of meat.' He devotes attention to the `presence of Demodex folliculorum mites in the facial skin of some patients with rosacea and how `these mites are greatly increased in number.' With many color photos (24 - more than any other chapter) he devotes details about PPR's clinical features and then spends a third of the chapter discussing `differential diagnosis and investigations.' First he explains rosaceiform dermatitis (RD) in which `D. folliculorum mites are found in abundance in some individuals affected with this disorder.' Sometimes RD can be "seen in persons who have applied potent topical steroid creams to their faces over prolonged periods and is referred to as 'steroid induced rosacea-like dermatitis.' " These patients `have also been shown to have a major increase in the demodex mite count on heir facial skin using the cyanoacrylate skin biopsy technique.' Other differential diagnosis is discussed differentiating PPR from acne vulgaris, perioral dermatitis, seborrheic dermatitis, and pityriasis folliculorlum (PF). Dr. Powell goes into some details describing PF. "Pityriasis folliculorum is an often over-looked clinical entity" and cases are `mostly female.' He explains that there is `usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.' These individuals often apply moisturizers and complain of a burning or itcy sensation. He states that the diagnosis of PF is `facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.' This condition 'seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.'Another discussion focuses on Tinea Faciei and cutaneous sarcoid differentiating these from PPR. A very important note for clinicians is found on the last paragraph of page 82 in his book:"There is no laboratory test or investigation that will confirm the diagnosis of PPR. Specific investigations may be required to rule out similar appearing conditions (many of which will be identified by listening carefully to the patient's medical history and examining the skin lesions). These include skin swabs for bacterial culture, skin scrapings for the presence of demodex mites, scrapings for fungal KOH and fungal culture, skin biopsy for histologic examination, (and rarely culture) skin surface biopsy for demodex mite quantification, patch tests, photopatch tests, and very rarely systemic workup wih appropriate blood tests and radiological examinations."How many dermatologists do you know do such a detailed history and examination? When you were diagnosed with rosacea, did your physician come close to what is mentioned in the above paragraph? I would suggest buying this book and just having your dermatologist read the above paragraph by handing it to him at the end of your initial visit and insist on getting it back, also suggesting to the physician it is available at amazon and more rosacea patients are going to be walking in who have read this book. It might be an eye opener for some dermatologists. Keeping up with rosacea is what Dr. Powell's book is all about.Powell devotes the rest of the chapter with management of PPR with a cool algorithm figure for dermatologists to use.His chapter on Phymatous (Subtype 3) is also full of photos (14) and notes that while it is a rare malady with a `predilection for male patients' occurs `20 times more commonly in male patients.' He goes into detail abut six different types of rhinophyma and clearly states that while most literature in the past suggests this condition is the end stage of rosacea that this is not true. Rhinophyma can occur with `little (or even no) preceding inflammation.' He ends the chapter with the management of this subtype.He devotes another chapter on Ocular Rosacea (OR) or Subtype 4. He says that of all the dermatoses of rosacea OR is unique in that `it is often accompanied by ocular inflammation or dysfunction.' This frequency ranges from "20% to 60% depending on whether the findings are being recorded by `dermatologists or ophthalmologists.' " He goes into great detail with colorful illustrations and photos of the clinical features and makes the point that "most patients do not volunteer any specific complaint related to the their eyes when presenting with the skin changes of rosacea. This is because they are usually mild and they do not relate eye symptoms to their skin condition . It therefore behooves the clinician to specifically enquire about ocular symptoms." He says that dermatologists should refer the patient to an ophthalmologist to rule out any differential diagnosis since that falls into his speciality. Again he finishes with detail management treatment.In the last chapter, entitled, General Considerations, he suggests asking questions to the patient in taking a history, specifically:(1) Asking about polycythemia?(2) Whether the patient has been using a steroid cream?(3) Any other medication such as niacin or antacids?(4) Whether there has been any frequent flushing?(5) Any complementary or alternative medicines, i.e., herbal products?(6) Eye symptoms?(7) Any family history of rosacea?Did your physician ask you any or all these questions? He then goes into some suggestions when taking the physical examination and then some details for applying medications and skin care. For example, his advice is to tell the patient after cleansing with a gentle soap or soap free cleanser to wait 30 minutes before applying the medication and progressively reduce this proceedure as the patient acclimates to the therapy. He emphasizes to tell the patient that `drugs have priority - they go on first!' after sun block or moisturizers. He also encourages going over cosmetic advice with a table of Do's and Don'ts. He mentions caution to clinicians who treat pregnant patients and also a discussion about the rare patient with skin color (Fiztpatrick's Skin types 4 - 6) with some suggestions.One interesting suggestion in this chapter he points out that "it is courteous to discuss with the patient what their concept of rosacea is." He encourages clinicians to emphasize that rosacea is usually quite controllable and discusses lifestyle factors that may reduce the need for the chronic medication usage by discussing this with the patient. Many rosaceans are concerned about rhonophyma so he mentions it would be good to assure the patient that subtype 3 does not necessarily result from rosacea and this subtype mainly occurs in males which will no doubt relieve female patients. He says it is important to explain to the patient the reason for follow up visits and to reassure the patient that the association of alcohol with rosacea is not valid so as to reduce the stress associated with this misinformation. He concludes with addressing the social stigma of rosacea and the positive outlook that there is with ongoing research and organizations devoted to improve treatment.If every rosacean was armed with this book when he visits his dermatologist and with a respectful tone suggest that the dermatologist own a copy and read it that this would probably do more for rosacea patient treatment than anything else at this point in time. I highly recommend this book not only for physicians but if you are on a search to find physician treatment for rosacea this is the book that will help you the most. I predict Dr. Powell will become very popular with rosaceans.Brady BarrowsRRDi Director[...]

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Ebook Download Romania: Culture Smart and the description is for Culture

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Romania: Culture Smart and the description is for Culture

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About the Author

Debbie Stowe is a British author, travel writer, freelance journalist and the author of around twenty books. Her many travel guides, for Thomas Cook Publishing, range from the Maldives to Manchester to Mediterranean Cruising. Her work has appeared, in print and online, in publications including The Telegraph, The Times, The Independent, and Gay Times. She lives in Bucharest with her Romanian partner and son.

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Product details

Series: Culture Smart!

Paperback: 168 pages

Publisher: Kuperard; Second Edition, Second edition edition (May 1, 2017)

Language: English

ISBN-10: 1857338626

ISBN-13: 978-1857338621

Product Dimensions:

4.2 x 0.5 x 6.8 inches

Shipping Weight: 6.4 ounces (View shipping rates and policies)

Average Customer Review:

4.5 out of 5 stars

24 customer reviews

Amazon Best Sellers Rank:

#324,591 in Books (See Top 100 in Books)

I selected this book because we are visiting our three sponsored girls in Romania. I wanted something that covered all the bases without going into tedious detail, it's an overview,including things in everyday life. It also have a broader view of culture, addressing why they do the things they do while adjusting. From communism to western culture

Read it right before a 2-week trip to Romania. My trip was wonderful, and as a tourist all points made in the book didn't happen to be relevant, but it was a good primer about Romanian culture and history. I'm giving it 5* because it delivers what it intends. Not a page turner, not a book to read if you're not on your way to Romania, but worth reading if you are.

This should be required reading for anyone looking to visit the country. It gives a great overview of the people, the politics and the different cities and villages. I was happily surprised that it also gave an overview of the language and provided some basic vocabulary as well.

This book is a great guide to the Romanian culture. I purchase it as a gift for a family member and they love it. Great price and service, thank you

LOVE IT

I think this book will be the most helpful of the 2 books I purchased. I don't want to embarrass myself, so this is great for learning about the people and what they expect. I can't wait to travel and submerge myself in this interesting culture.

I'm planning a trip to Romania this summer. After reading this book I feel primed and have a good sense of what to expect when I arrive. This book is short and to the point. An easy read broken into topics that can be read one at a time when you have a few spare minuites.

This book gave me a good overview of the culture and history of Romania. It also highlighted cultural differences to be aware of when traveling through the different areas if the country. I have passed the book on to others in our travel group and plan in taking it with me on the trip. Very easy read.

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Ebook Download , by Sabrina Stark

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, by Sabrina Stark

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Product details

File Size: 645 KB

Print Length: 315 pages

Publication Date: February 9, 2019

Sold by: Amazon Digital Services LLC

Language: English

ASIN: B07NKTTN1J

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Amazon Best Sellers Rank:

#788 Paid in Kindle Store (See Top 100 Paid in Kindle Store)

See? This story is so hot that it's made my fingers stutter. It's felt like a long wait since the wowser end of "One Good Crash," and Sabrina Stark has delivered! You don't have to read OGC to understand "One Bad Idea," but you should because it adds even more color to this new book. For me, Allie almost stole the show in OGC because of her unforgettable personality, and waiting for her story was so worth it.No need to recap the story too much because other reviewers have that covered. What I can't say enough about is the chemistry between outspoken Allie and hunky Jaden. We're talking chemistry way outside the bedroom that turns blazin' hot between the sheets. Is Jaden a jerk? Sometimes, but you might call him a jerk with higher goals. Does Allie overthink everything? Sometimes, but Jaden needs a girl like her to challenge him and make him better. Their banter is some of the most sparkling that I've read and once or twice it even led me to mutter, "I guess she told YOU."I'm a long-time fan of Ms. Stark, and this may be the funniest book that she's written, which is saying something after the brothers in "Illegal Fortunes." Her villains are so realistic and so much fun to hate that you wonder what kind of psychotic people the author has encountered in her life. (This can't all be fiction, right?) Not to give anything away, but I literally lol'd at the running joke about the seat and whose *ss was supposed to be in it. It's hard to explain, but once you read the book, you'll laugh too. Highly recommended!

Allie and Jaden’s story had me from the very beginning; their personality’s are great. I love Sabrina Stark’s books, she never fails to let me down. I highly recommend this book! 5 star read.

I had the pleasure of reading the book prior to One Bad Idea, One Good Crash. If you have the opportunity to read that book, then you received a different perspective in this book. It isn’t necessary to read One Good Crash, but this book makes more sense if you had. This book follows Cassidy’s (the h from One Good Crash) best friend, Allie. Allie has come to rescue Cassidy in Florida after a disconcerting call. On arriving to the house where Cassidy was last found, Allie meets Jaden, the brother of the H from One Good Crash. Jaden is odd and exasperates Allie from the start. He is brash, confusing, and odd. Unfortunately, they are forced to continue to confront each other because Jaden’s brother, Jax, offers Allie a job as a personal assistant...to Jaden. From there, sparks fly. And an arrangement is made. Can two people who seem to detest each other fall for each other? That is the premise of One Bad Idea.When you read a Sabrina Stark book, you are reading a dialogue book. I know when I read One Good Crash I found myself overwhelmed by the back and forth of the characters. However, it is part of Stark’s charm as a writer. This continues in this book.There is a constant push and pull between Allie and Jaden. At times, it can be frustrating because you don’t feel “let in” to the exchange. However, if you stick with you, you eventually see the chemistry between the two characters.Jaden is seemingly annoying from the outset. In fact, no one except maybe his brother Jax seem to like him. However, it’s a bit of a front, and his true nature is revealed eventually. Once it’s revealed, you will fall in love with him. You will have to read for quite a bit before it’s revealed, but once it is, it’s one of the best parts of the book.Allie is a typical h in an enemies-to-lovers tale. Her feelings change at the spur of the moment, and the reader must wait for the revelation of Jaden’s true character for her to finally accept him. It can be frustrating at times waiting for her to figure it. However, Allie is an amazing friend to Cassidy, and she’s the perfect match for Jaden. She is the “yin to his yang.”If you like the enemies to lovers trope or a love-hate relationship that ends with an HEA, then you will enjoy One Bad Idea. Just remember that you’re reading a dialogue heavy romance with this book.

When Allie races to save her friend Cassidy after she receives Cassidy's panicked phone call, she must deal with the aftermath. She 'borrows' a car from her ex-boyfriend and races to the rescue, only to find out that Cassidy is fine. However, in looking for Cassidy, she meets the unpleasant bad boy, Jaden. Little does she know that the tattooed hunk is actually a well-to-do alcohol manufacturer.With no money and little left to go back to, Allie accepts a job at Jaden's executive assistant. The two drive each other crazy - until they don't. They begin a physical relationship that starts to morph into something more, at least for Allie. Jaden is so jaded that he won't consider a true relationship.The first third of this book was a bit muddled, and was filled with a lot of hints and unexplained coincidences to drive the story forward. Many of those coincidences were explained later and pulled the story together a bit, but throughout Jaden's personality is off-putting and while he secretly does some kind things for Allie, his blunt and seemingly uncaring attitude and speech toward Allie is really unforgivable at times.While Jaden turns out to be devoted, protective and loving, getting his character to that place takes some time and his behavior early in the book is unattractive. Allie, for being in her mid-twenties, seems to be a bit of a doormat where Jaden is concerned and too naïve for her own good. The two together seem to improve each other somewhat, leading to their HEA.Overall a moderately good romance read.This is a voluntary review of an ARC of the story.

This book just wasn't for me. It started straight off confusing. I even searched online to make sure there wasn't a book before this one that would explain things. I didn't care for the characters because I felt they were a bit too immature all the time. Some of the time is fine but it just went on and on. I normally hate leaving low star ratings on books but since I voluntarily read this book to give my honest opinion, that's just what I am doing. It seemed to drag on forever and I found I could barely stay focused on the story. If I had bought the book myself, I wouldn't have finished it. I voluntarily reviewed an advance reader copy of this book

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