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Soolantra Review by Brady Barrows


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Sorry if I was off topic. I wish I could be one of those who could eat or drink anything. I read somewhere (can't find it now) that at a recent dermatologists convention a discussion of the mystery of how Soolanta improves Rosacea with no data on demodex density counts (whether the count is lowered). However there is data that it works better than Mirvaso or Metronidazole

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3 hours ago, Rory said:

Brady, from your last 2 posts would I be correct in saying you're not convinced that Soolantra kills demodex? 

 

Ivermectin is supposed to kill mites. I am simply not having the success that many have reported happens to them using Soolantra. I was hoping the fourth month would really be more of an improvement but so far I am not impressed. I am seeing the dermatologist on Feb 15 and get a professional evaluation on my progress. I can tell you that using the ZZ cream works way better for me than Soolantra. I guess I am one of those who responds better to sulphur treatment than Ivermectin. 

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I guess some could be sceptical about Soolantra's ability to kill demodex. Especially since there are no studies to prove it. Sometimes oral meds don't work as well, or even not at all, when transformed into a topical device. But I believe there is some proof that Soolantra is as effective as oral ivermectin. You may have read this study http://www.sciencedirect.com/science/article/pii/S120197121201315X

It compares oral ivermectin to oral ivermectin and metronidazole in the reduction of demodex and improvement of symptoms in 4 different skin conditions. The author of this study did make one observartion which is very much identical to so many testimonials we read about from users of Soolantra. Here is a paragraph from the study:

"In the cases who received ivermectin alone, there was a gradual reduction in the mean follicle mite count at the first week visit . However, rebound elevation in the mite count was evident in the third week in some patients with rosacea and those with anterior blepharitis lesions."

This was only a 4 week study so obviously there was no report of a 6th week rebound.

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Went to the dermatologist today and he advised me to stop Soolantra since I am not a candidate for this treatment. After 105 days, I was hoping Soolantra would work for me, but alas, as you can see below, my rosacea seems to inflamed too much from using Soolantra. My dermatologist prescribed a generic sulphur based cream for me to try since I have responded well in the past to similar treatment using the ZZ cream. I have to pick up the prescription and will start another review later. Here are my photos for today: 

Photo on 2-15-17 at 10.37 AM.jpg

Photo on 2-15-17 at 10.37 AM #2.jpg

Photo on 2-15-17 at 10.38 AM.jpg

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Brady, what if you have such a heavy infestation with demodex, that it makes it hard for your skin to deal with the die off by itself? I think you should try taking oral antibiotics along with Soolantra and push through this phase for another month. You have put such an effort to this, it would be a pity if you quit earlier.

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8 hours ago, MariaSt said:

Brady, what if you have such a heavy infestation with demodex, that it makes it hard for your skin to deal with the die off by itself? I think you should try taking oral antibiotics along with Soolantra and push through this phase for another month. You have put such an effort to this, it would be a pity if you quit earlier.

Maria, 

You are so kind. My face has been burning where I have been applying the Soolantra everynight, even when I wash it off in the am, the burning continues. I explained all this the dermatologist who said to stop using it. I really did give it a go. There must be something in the Soolantra that irritates my skin. It has been over 24 hours since I applied the Soolantra and my face has already started to calm down and cool off. The burning has almost completely gone. I am going to let my skin rest for a few days to recover from this and then apply the sulphur generic prescription my dermatologist prescribed since I have experienced good results from the sublimed sulphur in the ZZ cream. However, the ZZ cream costs more than my generic prescription since I have insurance. I am now convinced that Soolantra just isn't for me. My dermatologist says one out of four of his rosacea patients gets excellent results with Soolantra. I may in the future use a dab of Soolantra on a zit to see what happens, but no more night applications for me. 

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Well done Brady. I think you have given Soolantra a fair go. You should have seen something really good by now so I don't blame you for ditching it. I have a similar problem with it and at the moment I need to use Tacrolimus to keep the inflammation at bay. I don't think I'm going to last much longer. 

Anyway I'm curious. Your Derm doesn't seem to be having huge success with his patients on Soolantra. 25% is quite a low success rate, especially when compared to the 70% success rate in the one year study. Of course I accept that a certain percentage could have ditched it too early in their treatments, but 1 in 4 is still quite low. You told your Derm that you have good results with sulfur so obviously he prescribed what you wanted. But I'd love to know what your Derm is having most success with treating the 3 out of 4 who failed on Soolantra. 

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It could be the case that your demodex is resistant to ivermectin and after all these years of sulpur usage it's also resistant to sulfur, so I wouldn't expect much of this generic sulfur cream. I know you have the feeling that sulfur controls it, but obviously it's not a cure, otherwise you wouldn't search for other options, Brady. Maybe you could try the permethrin cream. I just read an article about permethrin being effective in ivermectin-resistant cases of scabies infection, the same should apply for demodex.

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20 hours ago, MariaSt said:

It could be the case that your demodex is resistant to ivermectin and after all these years of sulpur usage it's also resistant to sulfur, so I wouldn't expect much of this generic sulfur cream. I know you have the feeling that sulfur controls it, but obviously it's not a cure, otherwise you wouldn't search for other options, Brady. Maybe you could try the permethrin cream. I just read an article about permethrin being effective in ivermectin-resistant cases of scabies infection, the same should apply for demodex.

Maria, 
Actually I am cheap, since it costs me around $40/jar for the ZZ cream which I actually prefer. But since I have insurance in my old age now, I would prefer to pay a nominal fee for a sulphur treatment if it works reasonably well. I was using the sulphur butter due to a post made by Joanne Whitehead, PhD, (Assistant Director of the RRDi) since it was cheap and it works sort of ok, but I don't like the oily part of the formula since my skin is already oily. The ZZ cream is so different and it dries up my skin which is wonderful, and it feels cool when you put it on due to the menthol in it. I just love it and have one jar left as an emergency jar. So if the Americans can make a cheaper sulphur topical I am willing to give it a try and apparently there are a number of them. My insurance wouldn't approve the one my dermatologist prescribed yesterday (not sure of the exact Rx that was denied) and it takes days to do the documents to get it approved and my doctor doesn't like having his staff write up these letters (such are the woes of the American Medical System), so I heard he can write a Rx for a generic sulphur drug that my insurance will accept. Time will tell what Rx I get. 

As to the demodex population, I think I nuked all those little buggers with the ivermectin. My face is healing nicely each day now and I plan on doing nothing but washing with water for the next few days and then I will take photos of my face to show you the difference. I read a post in RF from Toen (post #684) how he only uses Soolantra occasionally which seems like a good idea to me, like if I get a pustule, since I noticed the Soolantra seems to work rather nicely on them and reduces them quickly, within a couple of days. I think I just over did the Soolantra. You would think that someone would mention this, that Soolantra is powerful, that more is not good sometimes. I can still get more tubes of Soolantra if I want. But I think the one I have which is half gone will last me months. 

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I haven't used the Soolantra since February 13, 2017 so for more than 72 hours my skin has been healing and I don't have the burning feeling I had, so I thought I would take three more photos to show my skin condition after using Soolantra for 105 days, just three days later. 

Photo on 2-17-17 at 5.12 PM.jpg

Photo on 2-17-17 at 5.12 PM #2.jpg

Photo on 2-17-17 at 5.12 PM #3.jpg

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For the past two weeks have not used Soolantra, even though I have a half tube left and purchased a brand new refill for March. This should last me a while with Soolantra. My insurance would not cover the brand name sulphur cream my dermatologist gave me a Rx for. Called the doctor's office and the girl said there is no generic or other Rx to write for the sulphur prescription (I forgot to write down the brand name). I will be seeing the doc on March 8 for a follow up visit and ask him about it. So, I can either use my last jar of the ZZ cream or the Sulphur butter I have on hand. So far I have been using a little dab of Neosporin Bacitracin Zinc-Neoycin Sulfate-Polymyxin B Sulfate-Pramoxine HCL ointment on some of the red spots left over from the Soolantra. My skin is not burning anymore and it seems a lot healed. See for yourself. I plan on trying the Soolantra again but rarely to see if this keeps the pustules at bay. I am convinced I have nuked all the mites and now only need a little maintenance now and then with this regimen. I do think the Soolantra did actually clear up my face but using it every day is way too much. Maybe once a week or so should suffice, but time will tell. I will keep my regimen in this thread and post more photos. This forum is an excellent format for rosacea sufferers to post photos. We even have a gallery that each one could use and members can create their own blog.. Adding photos in the forum like this is easy. And if you are worried about posting your photos you can always cover the eyes with a black bar or something or worried about posting you name you can put up a fake display name and no one will ever know who you are. This post explains how to change your display name to a cryptic one and any concerns you have about privacy. Can you beat this format that IPS offers? I don't think so. So come on, Join the RRDi

Photo on 3-1-17 at 4.46 PM.jpg

Photo on 3-1-17 at 4.47 PM.jpg

Photo on 3-1-17 at 4.48 PM.jpg

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On 2/7/2017 at 8:22 AM, Rory said:

Sorry Brady but I didn't say that those using Soolantra would notice a better improvement with a low carb diet. I was referring to the 30% of participants in the Soolantra study who failed to see any improvement. 70% of participants were clear/almost clear without any mention of a diet. Also, I have no idea what most of your last post has to do with my previous post. What exactly Soolantra does for Rosacea may very well still be a little up in the air. My previous post was specifically looking at your case, where it seems that Soolantra or ZZ cream will treat your secondary symptoms, and diet addresses the primary cause. Or maybe it's the other way round. I was hoping that Soolantra could have treated both aspects of your Rosacea, but that doesn't seem to be the case so far. 

Like I've said, there have been some people on the Soolantra thread who have reported being able to eat and drink whatever they want while using Soolantra. But I guess this may not apply to all of us.

 

I see. I know that low carb/high protein helps control my rosacea. I think that Soolantra works for some just like every other treatment for rosacea. I do think it is worth trying out since so many say it works for them. Soolantra is definitely one of the treatments in the armamentarium for rosacea. 

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Thought I would update my Soolantra thread. I stopped Soolantra as you can review on February 13. I then got some samples from my dermatologist with the following prescription  treatments: 

Avar-e Green Color Corrective Emolilent Cream (sodium sulfacetamide 10%, sulfur 5%)

Ovace Plus Cream (sodium sulfacetamide 10%)

Ovace Plus Lotion (sodium sulfacetamide 9.8%)

My dermatologist gave me a number of Soolantra samples too!

In March, April and through today I would try the above three samples alternatively as well as use Soolantra once in a while (about once a week). I have found that the Avar-e Green seems to work the best for me. However the other day I got a sunburn because I go to the beach and swim just about every day and really got burnt. Not good for rosacea. But I have enclosed some update photos. I will continue to use this thread to post my regimen since I include Soolantra once a week. 

Photo on 5-17-17 at 5.09 PM.jpg

Photo on 5-17-17 at 5.12 PM.jpg

Photo on 5-17-17 at 5.13 PM.jpg

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Thats a nice improvement Brady. I take it that Avar is a green coloured cream which masks the redness somewhat as well as being antibacterial and anti inflammatory? What about your diet. Do you still have to avoid carbs while using Avar?

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On 5/18/2017 at 3:04 AM, Rory said:

Thats a nice improvement Brady. I take it that Avar is a green coloured cream which masks the redness somewhat as well as being antibacterial and anti inflammatory? What about your diet. Do you still have to avoid carbs while using Avar?

Absolutely. Carbs trigger my rosacea big time. Sometimes I cheat like eating some Häagen-Dazs® Vanilla Ice Cream and zits appear and more redness. I try to keep on a low carb high protein/fat diet. But as anyone who has tried to do this, it is tough to never cheat. 

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9 hours ago, Rory said:

Did you suffer from mild, moderate or severe Acne as a teenager Brady?

Mild acne. 

Probably the other factor worth considering is sun damage. I was sun burnt many times when I was a kid and teenager. There is a lot of data suggesting that rosacea is a result of sun damage

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The research only found a connection between sun damage and subtype 1 rosacea, not papulopustular rosacea. Unfortunately the research on diet and Acne is pretty slim. So it looks like we will just have to suffer on with our insipid meals.

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12 hours ago, Rory said:

The research only found a connection between sun damage and subtype 1 rosacea, not papulopustular rosacea. Unfortunately the research on diet and Acne is pretty slim. So it looks like we will just have to suffer on with our insipid meals.

Rory, 

Have you seen the following?

There is evidence that sugar is connected to acne. A NY Time article discusses this connection. The article refers to the following study:

Journal of the American Academy of Dermatology
Volume 57, Issue 2, August 2007, Pages 247–256

The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial
Robyn N. Smith, BAppSc (Hons), Neil J. Mann, BSc (Hons), BAppSc, PhD, Anna Braue, MBBS, MMed, Henna Mäkeläinen, BAppSc, George A. Varigos, MBBS, FACD, PhD,

I posted the above here

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Yes I've seen a few studies which found a link between high carbs and Acne. The problem for me is the treatment. Its a pain in the ass trying to resist the temptations of a plethora of beautiful foods. Its only in the last decade that science has cautiously accepted  this acne subtype exists, after decades of denying a connection. For that reason, those of us in this subtype could be waiting a long time to find a treatment which will allow us to eat what we want without breaking out.

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9 hours ago, Rory said:

Yes I've seen a few studies which found a link between high carbs and Acne. The problem for me is the treatment. Its a pain in the ass trying to resist the temptations of a plethora of beautiful foods. Its only in the last decade that science has cautiously accepted  this acne subtype exists, after decades of denying a connection. For that reason, those of us in this subtype could be waiting a long time to find a treatment which will allow us to eat what we want without breaking out.

Rory, 

Once you have tasted sugar in all its different forms, whether high fructose corn syrup or sucrose, etc., it is a difficult habit to break. However, our ancestors before the 18th century never ate as much sugar as the average human does today. 

I like the way The Sugar Buster! authors put it this way on page 36–37 of their book, “… Pro-sugar lobbying by sugar growers, cola manufactures and the packaged-food industry has been very effective in influencing our government. What politician wants to tell his constituents they should no longer eat sugar ?” (I quote this in my book, Rosacea 101, Chapter 26, page 100, however, I have posted the entire chapter here for your enjoyment).

As I point out in my chapter about sugar and rosacea in my book, sugar is big business. Science is in bed with the sugar industry. However as you have pointed out, in the last ten years there are way more articles and data to substantiate that sugar is really bad for health and to limit its intake drastically to improve health. I have listed such articles in this area of the forum with links to such data: 

Carbohydrate & Sugar Avoidance
and in the articles section of the site here: 

Carbohydrate Trigger Avoidance

Also in my book, Rosacea 101, Appendix U. page 225, I wrote the following about Diet and Acne: 

Diet and Acne
There is evidence that diet plays a role in acne according to the following report two reports:
Report 1
“Although the pathogenesis of acne is currently unknown, recent epidemiologic studies of non-Westernized
populations suggest that dietary factors, including the glycemic load, may be involved,” write Robyn N.
Smith, MD, from RMIT University in Melbourne, Australia, and colleagues. “Recently, there has been a
reappraisal of the diet and acne connection because of a greater understanding of how diet may affect
endocrine factors involved in acne.… Hyperinsulinemia has been implicated in acne pathophysiology
because of its association with increased androgen bioavailability and free concentrations of insulin -like
growth factor I (IGF-I).…
… It has been postulated that the frequent consumption of high carbohydrates lead to hyperinsulinemia.
Hyperinsulinemia has been implicated in acne pathophysiology because of its association with increased
androgen bioavailability and free concentrations of IGF-I.”594
Report 2
“During the course of the last 30 to 40 years, a general consensus has emerged within the dermatology
community that diet has no role in the etiology of acne … Given the dogma in current dermatology textbooks,
it might be assumed that there has been a long and well-established literature conclusively demonstrating
that diet and acne are unrelated and that the 2 articles most frequently cited as definitive evidence
against the diet/acne hypothesis merely represent capstone studies that confirm previous observations and
conclusions. In actuality, both assumptions have little factual basis.
Two reviews of the diet/acne literature covering 80 references and spanning 66 years from 1906 to 1972
clearly demonstrate the inconclusive and conflicting nature of the historical literature. Examination of
many of these early studies shows them to be rife with contradictory results and conclusions due in part
to numerous limitations of study design, such as the lack of control groups, inadequate sample size, no
statistical treatment of data, the lack of blinding and/or placebos, and inadequate or no baseline diet data,
as well as imprecise and inconsistent measurement procedures commonly seen in early, developing technology.
Furthermore, most early investigators did not have the benefit of research elucidating the endocrine
mechanisms underlying acne’s pathogenesis, let alone its molecular underpinnings. Accordingly, they
commonly did not examine etiologic variables we now understand to be important. In summary, there is
little substantive evidence in the historical literature that conclusively supports or refutes the role of diet in
the etiology of acne.
page 226 
A MEDLINE search revealed that, since 1971, no single human study has been published examining the
role of diet in the etiology of acne …
Over the course of the past 50 years, the major proximate causes of acne have been well-described.
Despite this knowledge, the following quote is representative of the state of affairs regarding acne’s ultimate
cause: “despite years of research, the basic cause of acne remains unknown …” To understand how
diet may influence the development of acne, it may be useful to first review: (1) the range of lesions within
acne’s umbrella designation, (2) the epidemiology of the disease, and (3) the widely recognized proximate
causes of acne.…
Acne is believed to develop from the interplay of 5 major pathogenetic factors: (1) increased proliferation
of basal keratinocytes within the pilosebaceous duct, (2) incomplete separation of ductal corneocytes
from one another via impairment of apoptosis and subsequent obstruction of the pilosebaceous duct, (3)
androgen-mediated increases in sebum production, (4) colonization of the comedo by Propionibacterium
acnes, and (5) inflammation both within and adjacent to the comedo …
A significant body of evidence now exists demonstrating that diet influences a number of hormones
that regulate both keratinocyte proliferation and corneocyte apoptosis …
Highly glycemic and insulinemic foods are ubiquitous elements in western diets and comprise 47.7%
of the per capita energy intake in the United States … that high glycemic meals in normal male subjects
significantly (P 0.05) elevate day-long plasma insulin concentrations. Further, numerous studies as summarized
by Ludwig46 and Liu and co-workers47 establish that chronic consumption of high glycemic load
carbohydrates may cause long-term hyperinsulinemia and insulin resistance … Hence, elevations in the
free IGF-1/IGFBP-3 ratio promote keratinocyte proliferation through at least 2 primary pathways.
The development of hyperinsulinemia and insulin resistance elicits a pathological rise in serum concentrations
of nonesterified free fatty acids (NEFAs), which in turn has been shown to cause over expression
of the EGF receptor.
For acne patients, consumption of low glycemic index diets may be therapeutic not only because of their
beneficial effects on insulin metabolism but also because these diets are known to reduce plasma NEFA,
which may influence keratinocyte proliferation and differentiation via the EGF receptor pathway …
Sebum production is stimulated by androgens, and, when excessive, can be pathogenetically involved in
the development of acne. Accordingly, hyperinsulinemia may promote acne by its well-established androgenic
effect …
The final factor involved in the pathogenesis of acne is inflammation of the dermis surrounding the 3
types of inflammatory acne lesions (papules, pustules, and nodules). Inflammation of the dermis is primarily
thought to be caused by an immunological reaction to P. acnes, an anaerobic Grampositive bacterium,
which colonizes the sebum-rich environment of the closed comedo. Certain agents (peptidoglycan–polysaccharides)
within the cell wall of P. acnes may directly induce the expression of proinflammatory cytokines
(tumor necrosis factor alpha, interleukin [IL]-1, and IL-8) from peripheral blood monocytes (PBMs)
in a dose-dependent manner. Increased concentrations of these cytokines can stimulate other inflammatory
mediators, including prostanoids and leukotrienes. It has been suggested that overproduction of
inflammatory cytokines by PBMs in response to P. acnes may underlie the development severe inflammatory
acne …
Dietary interventions using low glycemic load carbohydrates may have therapeutic potential in the treatment
of acne because of the beneficial endocrine effects these diets possess. A large interventional study 
page 227

has demonstrated that diets rich in low glycemic foods reduced serum testosterone and fasting glucose
while improving insulin metabolism and increasing SHBG …”595
Since the role of diet in acne has now been clearly established there is without a doubt a clear connection
of diet playing a role in rosacea as well. Eventually similar studies will be published showing the role diet
plays in rosacea.

the endnotes refer to the reference the quote is taken from (if you need these, let me know)

I know this really isn't good news to a rosacea sufferer, but the fact is, sugar is really bad for your health and it is the fuel that is burning rosacea. Cut back the fuel and the fire reduces dramatically. 

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Thanks Brady for the info. I've never had much of a problem resisting sugar. As you know there are a host of high glycemic foods which we must also avoid which have nothing to do with sugar. This is where I have the problem.

In my opinion Acne is primarily a disorder of hyperkeratinization within and around the sebaceous follicle. This one event leads to the others. In my experience a low carb diet reduces the flakeyness of my face and in turn the breakouts also. Its nice to see from reading your last post that research recognizes a connection between diet and hyperkeratinization. But as you know low carb or even zero carb diets may not be the whole answer. Some of us also need an adjuvant topical treatment. I think the reason why we also need to topically treat the problem is because hyperkeratinization impairs the skins barrier and disables the skin's antimicrobial defense . Exactly how a low carb diet can slow down keratinization is the big unknown. I believe once science finds the answer to this, it will be a huge step forward in developing a new treatment for diet related Acne. Anyway, I'm going out for a beer. I don't care if I have a few new papules tomorrow as a result, I just want to have a beer. 

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Is it possible that the cetaphil base that the soolantra is in caused your redness?  I learned the hard way that I cannot tolerate the cetaphil cleanser as it turned my entire face bright red!  I hesitate even more to try the soolantra after discovering that and the reports of a flare or flares while using soolantra.

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