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There’s no doubting that a vasectomy is one of the most effective methods of birth control available. However, because its effects can be permanent, you and your partner really need to consider whether you are ready to take this step and ask yourselves if you are sure that children aren’t going to be a part of your relationship at any point. It’s true that vasectomy reversals can and are performed regularly these days; but they are expensive and there’s no guarantee that the patient will ever regain his fertility. Despite the success rate of the vasectomy, it is not impossible that you could still end up fathering a child. Firstly, your surgeon should make you aware of the fact that you are still able to father children after undergoing your vasectomy for a few months. Throughout this period, your doctor will continue to examine you to see if you still continue to have viable sperm. You will have to continue to use an alternative form of birth control during this time. The other scenario is if the vasa deferentia actually grows back and makes it possible for your sperm to reach your penis once again. This is known to happen, though it is very rare. The likelihood of it occurring is believed to be something around 1 in a 1000. Whilst a vasectomy is an effective method of birth control, it’s important that you realize that it can’t and won’t protect you from any sexually transmitted diseases. If you want some protection from sexually transmitted diseases then you will still have to use a condom. However, if you and your partner enjoy a monogamous relationship, then you and your partner can begin to enjoy unprotected sex without having to worry about pregnancy. A vasectomy isn’t for everyone and is certainly a big step. But as long as you and your partner are sure that children aren’t to play a part in your future together or if pregnancy is dangerous for your partner because of a medical condition then a vasectomy could be the perfect solution for you and your partner. penis enargement tip plastic surgery penis enlarement herbal penis enlargement pills cheap penile enlargement penis enlarement fact natural penis enlarement vigrx penis enlargement pill pennis enlargement pic before and after

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Genital wart signs vary from men and women, this article will explain the different genital wart signs on each person and where they appear. Genital wart signs in men tend to be more outright and seen as their genitals are completely outside the body. Genital wart signs in women seem to be more internal and not as easily seen. On women the most notable wart signs are hard dots on the outer edges of the genitals as well as on the cervix and between the vaginal opening and the anal cavity. These are the genital warts and they may not show up for a long time after contraction occurs. Men may notice that genital warts seem to show up on the head of the penis and around the anus as well as the scrotum. They may be gray or pink in color and will grow bigger over time. Another sign that a person has contracted genital warts is burning or bleeding in the genital area, especially during sexual intercourse. Genital warts may seem to appear as small white lumps which many say resemble cauliflower and can be as small as 2 millimeters. Women who have genital wart infections will notice that the warts are small, sometimes too small to see. Genital warts appear in the cervix in some cases where they cannot be seen and there are no real symptoms or signs. Except for genital warts that are internal but may bleed during sex as the warts are being torn open. Doctor’s tests will readily tell a person if she has genital warts inside her cervix. In most cases genital warts will cause no symptoms and not be noticed unless the outbreak of genital warts is big enough that a person sees or feels them. People really have to reply on the signs that genital warts gives. These are for the most part the bumps and cauliflower shapes as well as where the warts appear and how long ago a person thinks they may have gotten them. Genital warts are considered a sexually transmitted disease because they are spread during unprotected sex and in some cases protected sex. The only dangerous thing about having genital warts and not doing anything about them is if there is no discomfort, and someone chooses not to pay attention to the bumps they can lead to some cancers. best penile enlargement pills vimax compare penis enlargement pills penis enlargment pills product penile enlargment pic penile enlargment procedure penile enlargement photo penile enlargment surgery photo pnis enlargement excercises penis enlargement technique

Dial 1-800/AIDSNYC Every Monday and Wednesday morning, promptly at 10 a.m., I leave behind my daily life and turn to volunteering as an AIDS Hotline counselor at New York City’s GMHC [Gay Men’s Health Crisis], the nation’s largest social service agency for AIDS. For the next four hours, my co-volunteers and I sit in front of a bank of constantly-ringing telephones, talking to men, women, and teens who call in from across the nation with urgent questions about AIDS, the ravaging disease that has left 13.9 million people dead worldwide. After almost 20 years, a whole generation, families are still facing the heartache of tending the sick, while scientists continue to be confounded by this stubborn, ravaging virus. Although the federal government currently spends$4 billion per year on AIDS research, and $15 billion worldwide, there is no cure in sight for the viral infection and no vaccine available. Small wonder that the GMHC AIDS Hotline, the nation’s first, is flooded with more than 40,000 calls each year. Listening to callers 8 hours each week, I often think the Hotline is actually a direct link to the soul of callers--an anonymous forum that allows each to reveal secrets and fears that they might otherwise never discuss with anyone. A Morning in May This is the way it began: “Good morning, GMHC AIDS Hotline, can I help you?” “Yes...I have a question...[hesitantly] My son...he’s 21...and he just found out...he’s HIV-positive [voice breaking] I’m.....alone, divorced. And I need some help...someone to talk to...” “Of course....happy to talk to you...it sounds like this has been devastating for you....” “It’s terrible. He told me two nights ago....he’s...he’s so young....I don’t want him to die. He’s my only child....why did this have to happen?” [crying] Her son, she explains, had sometimes neglected using condoms, convinced he wouldn’t contract HIV infection from his female partners. “How could he be so stupid?” she now asks angrily. “Why didn’t he know how to protect himself? I don’t understand. What am I going to do?” We talk for 35 minutes, and by the end of the conversation, I notice I’m barely breathing. The distraught woman’s anguish is palpable. Her situation is every mother’s worst nightmare.The life of her child is in jeopardy and she feels helpless and afraid. I can’t imagine anything worse. During the call, I do my best to employ the GMHC Hotline protocol of “active listening,” which involves using silence, empathy and gentle probing with open-ended questions. I’m also having my own emotional reaction to the panic in her voice, and I’m worried about whether I’m doing enough. Toward the end of the clal, when she exclaims: “I don’t want my baby to die,” my heart plummets: “I know....I understand that, but there is hope,” I tell her. I find myself on the verge of tears. The Bad News This mother’s story is too common. According to the Centers for Disease Control in Atlanta, Ga., 40,000 Americans (half of them under 25) are newly infected with the AIDS virus each year. Unprotected sex and intravenous drug use remain the principal modes of transmission. “Teenagers,” notes AIDS activist Elizabeth Taylor, “are being very hard hit.” She refers to the three million adolescents who contract a sexually-transmitted disease annually. “Heterosexual teenage football players who are healthy and drink milk can get it too!” says the 71-year-old actress, who has singlehandedly raised $150 million for AIDS research. “But teens are very ignorant and feel invincible. They believe there’s an invisible shield protecting them from the virus, when it’s actually aimed right at them.” Taylor believes in addressing the problem head-on: “Tell your teenage son: ‘Maybe a condom doesn’t feel as good, but if it saves your life, it’s better than being six feet under.’ Intelligence must replace random sex.” Although a new generation of AIDS-fighting medications is prolonging the lives of thousands, nearly half of the 900,000 people infected with HIV in the U.S. cannot afford these drugs. Since the virus was discovered in l981, 410,800 Americans have died from AIDS-related complications, and the disease has left 13.9 million dead worldwide. Who Calls a Hotline? Not long ago I took a call from a 15-year-old boy living in a small town who said he feels guilty about his sexual attraction to other boys and is scared to discuss this with his parents. I ask him if there’s a school counselor or relative he might talk to, but he says he’s too afraid to confide in anyone. Being a teenager is hard enough, I thought, without the pressure of keeping this kind of secret. I felt angry and saddened that this child can’t comfortably discuss his feelings with his own parents. I encourage him to call the Gay Community Center Youth Program in a nearby city. In the meantime, I assured him that he could call our Hotline anytime, that we’d be there for him. This call was typical of the many we get from teenagers,whispering from their parents’ homes, confiding their blossoming sexual feelings and concerns. Our Hotline also receives calls from married men who phone from their offices, worried about extramarital sexual encounters; gay men suffering side effects from medications; mothers caring for a sick child or grieving for one lost to AIDS; even health care professionals themselves confused and requiring burnout support. One particular morning, I’m struck by the number of single women who turn to our hotline for help. At 10:15 a.m. a distraught young woman calls, explaining that she had been dating someone “very charismatic,” after a two- year period of sexual abstinence. “At first we used condoms and I was taking the pill to avoid pregnancy,” she says. But after her partner assured her he was HIV-negative, the couple began having unprotected sex. A few months into the relationship, she recounts, his behavior became “unpredictable,” until he finally admitted he was sleeping with other women and was addicted to heroin. Now she has to withstand the “terror” of waiting 3 months before getting an HIV antibody test. To help her cope, I give her the names of three terapists in her area. The call lasts 43 minutes. At 11:15 a.m. I take a call from a woman who is breathing heavily. She says that four months earlier she’d had a brief affair with a limousine driver, “not out of passion, but because I felt lonely. This was so totally unlike me,” she continues. “I come from a traditional Orthodox Jewish family...” Although they used condoms, and she has since tested negative for HIV, she feels deeply ashamed, and has stopped seeing him. And because she has both a persistent vaginal yeast infection and a rash on her neck, she’s convinced she must be infected by HIV. Although rashes, high fever, swollen lymph glands, heavy night sweats, sore throat, or other flu-like symptoms may indicate HIV, they can just as easily accompany the common cold or flu, or other type of infection. I encourage her to seek medical help and counseling, but the calls ends on a down note. “I must have it [AIDS],” she moans. I’m exasperated because it doesn’t sound that way to me, yet I can’t get through to her. The call lasts 22 minutes. It’s 11.38 a.m. when a well-spoken woman, who says she’s an attorney, calls from her office, asking for the names of anonymous testing sites. At first very businesslike, she calmly takes down all the information. I ask her why she’s considering a test. Total silence. Then she begins to cry: “I....I can’t talk....I’m sorry...you see, I have swollen lymph glands....[crying]....And my doctor wants to rule out HIV...I feel overwhelmed...” Then, abruptly: “Where can I send a donation?” She thanks me and hurries off the phone after just 3 minutes. These were one-time callers, but, as in any epidemic, an element of panic prevails, and our hotline also attracts an army of “chronic” or repeat callers who are intensely fearful no matter how benign their risk, many revealing continued misconceptions and paranoia about a disease that can be effectively prevented. We do our best to help them, but often they’re impervious to counseling. Most poignant are calls we get from AIDS patients, phoning from their hospital beds, attempting to navigate the exhausting labyrinth of insurance and health care matters. One man, in hospice care, said he craved companionship and missed the “good old days” when he was handsome and healthy. That call was a tough one for me as just the day before a close friend of mine, Joe, who had battled HIV for 16 years, had finally succumbed. Although at the end Joe was a mere skeleton, he was nonetheless at peace. “I’ve done what I wanted to,” he told me on our last visit. An avid gardener, he insisted on a final trip to his country house to see his garden one last time. For a moment the caller’s reality and the memory of my deceased friend blurred in my mind and I was overcome. Time for a break. Face to Face One of the most and unique services GMHC offers is called “A-Team Counseling,” a one-time, in-person session that’s free and anonymous. Recently, I was on an A-Team counselling a 26-year-old HIV-infected mother from the Midwest. She had traveled to Manhattan by bus to find her estranged boyfriend, who, she recounted tearfully, had kidnapped her 7-year- old son. Disheveled, painfully thin, the woman was a disturbing sight. She’s learned that the two had already returned home where the boyfriend was, and the child put in his grandmother’s custory. custody of his grandmother. Meanwhile she’d run out of money for the return trip, been refused a loan by her family, lost her ID, gone hungry and spent two nights on the street. Fortunately, this woman was registered at a local AIDS organization in her town. I telephoned her caseworker and persuaded him to buy her a one-way Greyhound bus ticket for $115.00. I also gave her subway tokens, a basket of food, juice and coffee. Smiling shyly, she thanked me for caring. Shaking hands good-bye with this woman was a bittersweet farewell. What will happen to her? I wondered will her health deteriorate or improve? Will she gain control of her life and be able to provide for her son? I’ll never know. One thing I do know: She’d appeared with the sorrow of a difficult life in her eyes, but when she left, she was elated at the thought of being reunited with her child. It seems that with faith and a helping hand, almost anything is possible. * * * * * 10 BIGGEST MISCONCEPTIONS ABOUT AIDS AND HIV (This list would probably be most effective when presented in a vertical chart, the misconception on the left, the correct answer on the right.) 1)The AIDS virus can be transmitted through saliva, sweat, tears, urine or feces; also through deep kissing. 1) HIV can ONLY be transmitted through four bodily fluids: blood, semen, vaginal secretions and breast milk--and can also be transmitted from a mother to her child before birth, during birth, or while breast feeding. The exchange of saliva through kissing is no-risk, unless the saliva has blood in it and both you and your partner are bleeding in the mouth simultaneously. 2) HIV may also be transmitted through casual contact with an infected person. 2) You can’t get infected from toilet seats, phones or water fountains. The virus can’t be transmitted in the air through sneezing or coughing. You can’t get HIV from sharing utensils or food or from touching, or hugging. HIV dies after being exposed to the air. Therefore, touching dried blood on a shaving blade, a toothbrush or a bathroom counter top is no risk. In any case, unbroken skin is impermeable, like a rubber raincoat, and cannot absorb the virus whether it’s alive or dead. Blood transfusions and medical procedures in the U.S. are safe. Giving blood is completely risk-free. The chance of getting HIV from dentists or other health care providers is too low even to measure.You can’t get it from mosquitoes or other insect or animal bites. 3) Oral sex is just as risky as vaginal or anal intercourse. 3) Although not 100% risk-free, oral sex is considered a low-risk activity,except if: you have bleeding gums, recent dental work, open sores such as a herpes lesion, any cut, blister, or burn in the mouth, or if you’ve just brushed or flossed your teeth. Also, oral sex with an infected woman is riskier if she is having her period, since menstrual blood can contain HIV. Overall, latex barriers, (such as condoms or dental dams) used during oral sex reduce the transmission of not just HIV, but other sexual transmitted diseases. 4) Animal skin, latex and polyurethane condoms are all equally effective in preventing HIV infection and you can use ANY lubrication on the condom desired. 4)Only latex or polyurethane condoms may be used, as HIV can pass through an animal skin condom. With latex condoms, only water-based lubricants--like K-Y jelly or H-R jelly--may be used. No lubricants with oil, alcohol, or grease are safe.Petroleum jelly,Vaseline, Crisco, mineral oil, baby oil, massage oil, butter and most hand creams can weaken the condom and cause it to split. However, with polyurethane condoms, petroleum-based lubricants can be used. 5) Women have to rely on men using condoms during intercourse to protect themselves against HIV. 5) Women may employ the “female condom,” a plastic sheath that can be inserted in their vaginas and used for protection against HIV. It can be inserted up to 8 hours before sex, has rings at both ends to hold it in place and can be lubricated with oil-based lubricants that stay wet longer. In addition, women can carry conventional condoms for their male partners’ use. 6) If a woman is HIV-positive, her offspring will automatically be born infected with HIV. 6) With no medical treatment taken, about 25% of HIV-positive women will give birth to infants who are also infected. However, the use of anti-HIV medications has resulted in a significant decrease of mother-to-child transmission of HIV in utero and during delivery to less than 5%. (NYT 10/19/ 99]. 7) AIDS is fundamentally a gay disease contracted by white males. 7) Recent data compiled by the Centers for Disease Control and Prevention indicate that young gay Hispanic and African-American men and heterosexual women are the fastest growing segment of the population being infected with HIV. Women now account for 43% of all HIV infected people over age 15. [NYT 11/24/98] African-American and Hispanic women account for more than 76% of AIDS cases among women in the U.S. 8) Heterosexual men are not really at risk for contracting HIV, even if they don’t use condoms. 8) The inside opening of the penis is composed of highly-absorbent, sponge- like mucous membrane tissues, which can provide a route for HIV-infected vaginal secretions or blood to enter the bloodstream. Proper condom use protects men from infection. 9) The AIDS epidemic is largely over because new AIDS medications like protease inhibitors and others have turned AIDS into a chronic, not a terminal disease. 9) In the U.S., AIDS is the fifth leading cause of death for people 25-44 years old. Roughly half of all those infected with HIV in the U.S. are not receiving any medications or medical care. AIDS now kills more people worldwide than any other infection, including malaria and tuberculosis.[NYT 11/24/98] In 1998 alone, 2.5 million people died of AIDS worldwide. 13.9 million people have died since the virus was discovered in 1981. 10) If you think you’ve been exposed to HIV through unprotected sex, you can take an HIV antibody test 2 weeks later and get an accurate result. 10) The standard “window” or waiting period remains a full 3 months. However, because the widely-used HIV antibody tests (The ELISA and Western Blot) have become so sensitive, about 95% of people will procure an accurate result 4-6 weeks after a possible exposure to the virus. * * * * [Note:The information stated above was reviewed for medical accuracy by Dr. Todd J. Yancey, an infectious disease specialist practicing in New York City and affiliated with New York Presbyterian Hospital, NY, Cornell Campus.] THE CHILD LIFE PROGRAM “Mommy takes a lot of medicine and Mommy’s really tired sometimes and she can’t take you to the park as much as she used to. It’s not that I don’t love you...and that I don’t want to...but Uncle Jack’s going to take you to the park today.” --A mother living with AIDS, a client at GMHC, talking to her 6-year- old son. In New York City alone, 28,000 children have been orphaned by AIDS since the epidemic began [NYT 12/13/98] GMHC’s unique Child Life Program serves HIV-infected parents and their children--who may, or may not, be infected with the virus. “We help families strengthen their ability to cope, relieve the pressure of parenting with support services, and teach parents how to talk to their kids,” says Child Life Program Coordinator Alison Ferst. “Unfortunately, should a parent or child be sick enough to be facing death, we also help them walk through it with grace and dignity---as opposed to feeling alone, isolated and frightened. “We also encourage sick parents to make stable legal plans for their children who may be left behind,” adds Ferst, “and to have disclosure conversations with the children in advance, so you don’t have a child standing at her mother’s funeral, not sure where she’s going next.” When an HIV-infected Mom arrives at GMHC to have lunch, attend a support group, consult with a lawyer, or access the acupuncture clinic, she can leave her children in a spacious playroom, decorated with fanciful murals and a giant tree hand-painted by the famed children’s story writer and illustrator, Maurice Sendak, who donated his art. [see photos] The program provides: child- sitting, nutrition services, a food pantry, art and magic classes, and recreational trips--church picnics, seasonal apple-pumpkin picking, amusement parks, zoos, museums, beaches. Also: homework help sessions, holiday parties, hospital visits, summer sports and weekly support groups for HIV- positive parents and their HIV-negative children. This unique program also features: Cooking classes for kids who sometimes prepare meals for sick parents; Pediatric Buddies, GMHC adult volunteers who play with sick children and also assist with family chores; Fun With Feelings Support Group, Friday Evening Family Time, Birthday parties, and a Holiday Gift Drive. “Children infected or affected by AIDS,” concludes Ferst, “want to be like other kids: They want to play with their friends, want to know that someone will always take care of them, want to know they’re not alone, and often wonder if it’s their fault when Mom or Dad gets sick.” These children need a helping hand and any of us can provide one. vimax herbal penile enlargement pills vimax guide to penis enlargement penis enlargement information penis enhancement exercise cheap vigrx cheap penis enlagement vimax penis enlargement technique

The bracketing feature on most DSLR and EVF digital cameras is sometimes unfairly ignored. Bracketing the exposure is not to be confused with the continuous feature that takes three or more exposures at the same value. The automatic exposure sensor in the camera does its best to supply the correct exposure, but since the window of good exposure is fairly narrow in digital cameras, a better exposure could be made. The light sensor must rely on either average information across a representative section of image or in the case of a spot reading, a small area that may or may not be close to a mid range density. By exposing a subject one half or one third stop under exposed and one half or one third stop over exposed, an obvious difference in image quality will help you decide which one to keep for future enlargement. Most cases of poor image quality can be traced to an original under or over exposure. While it is true that the average image editor can correct for density mistakes, the end result will be a compromised version of the image, even though it is improved from the original. A properly exposed image will show better skin tones, whiter whites, deeper blacks and a more subtle range of tones in pastel colors. Years of shooting with exposure forgiving negative color film has spoiled us with the fact that two under exposure or three stops over exposure will be corrected in the printing. There is some correlation to slide film, especially the characteristics of Kodachrome. Transparencies often required the exposure to be within one half stop of the correct exposure to look at all good when projected. Few photographers carry around a gray card to check the color balance or take a spot reading of a face close up before taking the shot. The bracketing feature can save the day. best enlarement exercise penis free penile enlargment technique penile girth enlargement vimax free natural penis enlargement natural penis enargement penis enhancement procedure pennis enlargement before and after penis enlargement technique penis enlargement technique

KNOWING ROSACEA Rosacea is a disorder of the blood vessels. It is a common skin disorder. Approximately 48 percent of the world population suffers from Rosacea. However, Rosacea is one of the most misunderstood states of the skin. FAMOUS PERSONS SUFFERING FROM ROSACEA If you are having Rosacea, you are then in the august company of eminent persons. A few of the noted personalities suffering from Rosacea are JP Morgan, WC Fields, Cameron Diaz, Bill Clinton, Prince Harry of England, besides the late princess of Wales and mother of Prince Harry – Diana. ROSACEA SYMPTOMS The common symptom of rosacea is transformation of the skin color into red. The body portions most affected by rosacea are the cheeks, nose and forehead. At times, such redness and flushing of skin can also spread to the ears, scalp, chest or the neck. As Rosacea progresses, the reddish tinge can turn into a permanent condition. There can also be a marked visibility of the small blood vessels particularly at the skin surface, stinging or burning skin sensation, eyes turning gritty and reddish, and pus-filled or simple bumps that appear red. Among these severe symptoms are bulbous noses. The maiden rosacea symptoms are nagging redness which is often wrongly attributed to cleansing, exercising or temperature changes. SIMILAR SKIN DISORDERS Many confuse rosacea with seborrheic dermatitis or/and acne vulgaris. Mentionably, rosacea can co-exist with acne vulgaris and seborrheic dermatitis. THE ROSACEA VULNERABLE SECTION It has been generally noticed that the people with fair skin are the most vulnerable section with reference to rosacea. Therefore, rosacea does have a hereditary strain. Those having a descent from the Celtic or the fair-skinned European stocks are genetically inclined to suffer from rosacea. Notably, both the sexes can fall prey to rosacea. People of all ages can be affected by rosacea. It has also been noticed that people in the age group of 30-50 are easily affected by rosacea. Nonetheless, women in their middle ages are the most vulnerable section of the populace. The reason is, of course, menopause-abetted hot flushes. However, rosacea symptoms are more severe with reference to men. CAUSES OF ROSACEA There is no unanimity among the medical researchers as to the exact rosacea pathogenesis. Nonetheless, there is a concurrence in views insofar as to the cause of rosacea. Rosacea occurs when stimuli repeatedly dilate the blood vessels, and as a result of which the blood vessels get damaged. The damaged blood vessels dilate rather easily. Besides they either remain permanently dilated or stay dilated for a considerably long time. The consequence is redness of the affected portion and its flushing. ROSACEA PAPULES OR INFLAMMATORY PUSTULES The papule or inflammatory pustule can be I the form of a boil, or a pimple, or an eruption for that matter. In rosacea (papulopustular), the mediators (inflammatory ones) as well as immune cells ooze out from the skin bed that is basically micro-vascular by nature. This, in turn, leads to the inflammatory pustule or papule. OTHER CAUSES OF ROSACEA Various conditions can also lead to rosacea. One thing is for sure: strenuous movements cause blushing and flushing. A few of the situations where such flushing or blushing can be formed are as follows: Stress, cold weather, acute sunburn, and extreme heat exposure especially from the sun. Rosacea can also be caused by sudden changes in temperatures while traveling, or in heated rooms especially in winter. FOODS CAN ALSO CAUSE ROSACEA Certain food items that contain very high quantity of histamine have been identified as responsible for the eruption of rosacea symptoms in many people. Similarly, spicy food besides alcoholic substances can definitely trigger off rosacea. MEDICATIONS TOO CAN LEAD TO ROSACEA Several topical irritants and medications may at times cause rosacea. Take for example several drugs people take to hide wrinkles or to deal with acnes. Among these chemicals those particularly responsible for causing rosacea are tretinoin, benzoyl peroxide, isotretinoin, microdermabrasion, and certain chemical peels. Obviously, one should immediately stop the use of any such irritants the moment any rosacea symptoms appear. INDUCED (STEROID) ROSACEA The term ‘steroid induced rosacea’ points to such rosacea symptoms that are caused by steroids, particularly nasal and topical. Notably, these types of steroids are generally prescribed for patients suffering from seborrheic dermatitis. First aid: In such circumstances, immediately consult the physician. Moreover, one should begin the medication discontinuing process over a period of time. Decrease the dosages slowly. Else there may be a flare up of the rosacea symptoms. MITES & BACTERIA CAN CAUSE ROSACEA AS WELL A considerable number of rosacea people have been found to possess the species of mites known as demodex. This is more so the case with those people who have rosacea from steroids. Mentionably, the presence of a large number of these demodex mites can only cause rosacea. But, they cannot by themselves cause the rosacea condition. The demodex mites will have tom act in conjunction with other factors to be able to trigger off the rosacea states. Bacteria, especially the intestinal bacteria, can cause rosacea. These intestinal bacteria reside in our digestive highways. This is a neurological dysfunction. Such rosacea conditions can erupt after the intestinal bacteria activate the plasma kakllikrein-kinin system. THE KAKLLIKREIN-KININ SYSTEM The kakllikrein-kinin system or the kinin-kallikrein system or just the kinin system is a not well delineated structure of blood proteins. The blood proteins have a major role to play in causing pain, coagulation, control of blood pressure and inflammation. Mentionably, the major mediators of the kinin system are bradykinin and kallidin. Both of them act on different cell types. Both are vasodilators DIFFERENT FORMS OF ROSACEA Researchers have identified four forms of rosacea. Each of these subtypes can have its typical symptoms. More importantly, one person can have more then one of the subtypes at the same time. THE ROSACEA SUBTYPES The four rosacea subtypes are Ocular rosacea, Phymatous rosacea, Papulopustular rosacea and Erythematotelangiectatic rosacea. OCULAR ROSACEA Ocular rosacea mainly affects the eyes. The Ocular rosacea symptoms are burning and itching besides sensations as if there are foreign bodies within the eyes. When anyone is affected by ocular rosacea, the eyes and the eyelids turn dry and red. Irritation of the eyes and the eyelids is also very common. PHYMATOUS ROSACEA Phymatous rosacea affects the nose, ears, cheeks, forehead, chin and the eyes. Phymatous rosacea is also linked with the nose enlargement dysfunction called rhinophyma. Another disorder closely connected with phymatous rosacea is the visibility of small blood vessels near the skin surface. Other symptoms of phymatous rosacea are appearance of irregular surfaces on the skin and which may be also accompanied by nodularities. The skin can get thick as well. PAPULOPUSTULAR ROSACEA Many confuse Papulopustular rosacea with acne. However, Papulopustular rosacea remain reddish while acne do not. The common Papulopustular rosacea symptoms are papules (red bumps) filled with pus. Such bumps are called pustules. Papulopustular rosacea papules with or without pustules generally dissolve within five days. People having Papulopustular rosacea usually have permanent redness of their skin. This state is described medically as erythema. Another symptom of Papulopustular rosacea is they tend to flush or blush quite easily. Moreover, the patient can also have burning or itching sensations. ERYTHEMATOTELANGIECTATIC ROSACEA Erythematotelangiectatic rosacea causes the small blood vessels to appear rather prominently near the surface of the skin. This typical state is known as telangiectasias. TREATING ROASAEA There are various treatments for rosacea people. The strategies vary depending on the acuteness and the rosacea subtype that a particular person may be suffering from. Hence, there can be different treatments for different persons suffering from the rosacea symptoms. Hence, the dermatologists opt for the sub-type-directed method to diagnose, analyze and treat rosacea. LASER TREATMENT Laser treatment in dermatology is variously known as Broad spectrum (Intense Pulsed Light), or Single wavelength (Vascular laser). Laser treatment is one of the most popular treatment methods of rosacea. In laser treatment, light is made to infiltrate the epidermis. The light hits the skin’s dermis layer. It targets the dermis capillaries. The oxy-haemoglobin gets heated up after it absorbs the light. The process heats up the capillary walls till 70 degree centigrade. This heat destroys the capillary walls. The damaged walls are then absorbed by the body via its defence mechanism. CO2 LASER TREATMENT Focused thin beams of CO2 laser are manipulated to defocus or cut (as scalpels) the tissues. Then these tissues are vaporized. CO2 lasers are used to get rid of the excessive tissues formed by phymatous rosacea. In this method, our skin directly absorbs the CO2 lasers wavelength. SIMPLE STEPS TO TACKLE ROSACEA (i) Gentle skin cleansing regime Always deal with the skin gently and lovingly. Go for only those cleansers that are non-irritating. (ii) Shielding skin from sun Never venture out in the sun-bated beach sans protection shields. Regularly use sunscreens. Choose such a sunscreen that consists of a physical blocker agent. Such active blockers are titanium dioxide or zinc oxide. (iii) Trigger avoidance It is important to maintain a diary of the foods and the climatic or other factors that generally lead to rosacea. In fact, The National Rosacea Society promotes this habit. This approach also goes a long way in identification and reduction of the triggers. Moreover, trigger avoidance is ideal to control the onset frequency of rosacea. But, all alone it cannot check rosacea. Nonetheless, the mild rosacea attacks can be effectively checked if a patient avoids the factors that triggered off the rosacea symptoms. One can get flushing after consuming red wine or food items having high quantities of histamine. Then, go for antihistamines. Some common antihistamines are loratadine or cetirizine. (iv) Eyelid hygiene Eyelid hygiene is especially recommended for persons complaining of eyelid infections. Practice eyelid hygiene frequently. Here are some easy eyelid hygiene steps. Gently scrub the eyelids daily; You can use baby shampoo in a diluted form; Or, you can also opt for any across-the-counter eyelid cleaner. Apply the cleaner in warm compresses. But, mind you, never should it be hot. Carry on the practice several times in a day. MEDICATIONS (ii) Topical & Oral Antibiotics To get instant relief from the rash, redness, inflammation, pustules and papules, you can go for topical and oral antibiotics. An effective topical antibiotic is metronidazole. Similarly, ideal oral antibiotics are the tetracycline antibiotics. Some examples of tetracycline antibiotics are minocycline, doxycycline, and tetracycline. The oral antibiotics are rather effective in treating ocular rosacea symptoms. Isotretinoin is generally given to patients who complain of persistent pustules or papules. However, there are several side effects of isotretinoin. Therefore, isotretinoin is prescribed only in acute situations. It is also given to treat acute acne. Nevertheless, for patients suffering from phymatous and papulopustular rosacea, low dosages of isotretinoin have been delivering the goods. BETA BLOCKERS OR α-2 AGONIST The commonly used α-2 agonist is clonidine. It is helpful to deal with blushing and flushing. But it has side effects. One can feel drowsy or/and one’s blood pressure may also plummet. So, to neutralize this effect, one can use monoxidine as an alternative. Monoxidine has lesser side effects. But many do not find it as effective as clonidine. Propanolol is an ideal beta blocker. It is akin to α-2 agonists. And, it has been found to be effective in dealing with recurrent social blushing rather than the general rosacea flushing. It is also ideal to tackle anxiety.