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Dr. Jerry Tan has an excellent video explaining Demodex Blepharitis.
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Jennifer Brown started Soolantra on December 16, 2015:
Ten Weeks Later
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Update today 92 days on Soolantra. Just a little improvement from a month ago. I will stay the course for one more month.
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The topical use of oxymetazoline 0.05% solution in the management of rosacea has been primarily limited to data from case series involving fewer than 10 patients and demonstrating sustained improvements in both erythema and flushing. Alhough oxymetazoline is not recognized in national guidelines, an international consensus statement recognizes the possible therapeutic role of oxymetazoline in the management of rosacea, despite the limited evidence.
Hosp Pharm. 2013 Jul-Aug; 48(7): 558–559.
Published online 2013 Jul 9. doi: 10.1310/hpj4807-558
PMCID: PMC3839519
Oxymetazoline (Topical): Rosacea
Joyce A. Generali, RPh, MS, FASHP, (Editor) and Dennis J. Cada, PharmD, FASHP, FASCP -
For more information on the prescription oxymetazoline hydrochloride cream (1 percent strength) known as Rhofade click here.
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The topical use of oxymetazoline 0.05% solution in the management of rosacea has been primarily limited to data from case series involving fewer than 10 patients and demonstrating sustained improvements in both erythema and flushing. Alhough oxymetazoline is not recognized in national guidelines, an international consensus statement recognizes the possible therapeutic role of oxymetazoline in the management of rosacea, despite the limited evidence.
Hosp Pharm. 2013 Jul-Aug; 48(7): 558–559.
Published online 2013 Jul 9. doi: 10.1310/hpj4807-558
PMCID: PMC3839519
Oxymetazoline (Topical): Rosacea
Joyce A. Generali, RPh, MS, FASHP, (Editor) and Dennis J. Cada, PharmD, FASHP, FASCP -
Oxymetazoline is a vasoconstrictor which is commonly used in nasal sprays as a nasal decongestant. It works by causing the smooth muscle around blood vessels to contract, making the vessels smaller and less dilated. Thus it would appear to be a good candidate for treating rosacea.
Indeed, the Rosacea International Expert Group has noted that topical oxymetazoline has a role in the treatment of rosacea and the group recommends its use.
Studies have found that after applying oxymetazoline to the skin once a day, a decrease in redness was noted in 1 hour and the effect was sustained throughout the day. Continued application once a day over several months was associated with a marked improvement of rosacea symptoms. These results were sustained after prolonged use at 17 months.
When compared to the other agents currently used, oxymetazoline presents fewer issues with potential side effects and its application results in a rapid improvement of symptoms.
Border Compounding Pharmacy in Australia has formulated a 0.075% w/w oxymetazoline cream in an elegant, lightweight hypoallergenic cream designed for the face.A doctor’s prescription is not required unlike Rhofade (1%) which is a prescription drug.
Border Compounding Pharmacy is able to customise the cream to your specifications (for example, to manage sensitivities or if you do not wish to use specific particular ingredients).
For More Information Click Here.
What is a compounding pharmacy?
This information was posted by Flugs in post #9 about an email received from Border Compounding Pharmacy:
We can indeed formulate an oxymetazoline cream or gel in a variety of strengths. Oxymetazoline works by constricting the blood vessels in the surface of the skin, thus reducing the red appearance of rosacea. It works quite quickly – generally within an hour – and the effects last for 24 hours. It is important to only apply the cream once daily.
There is quite a bit of evidence to suggest that strengths of as little as 0.05% oxymetazoline are effective in reducing the redness associated with rosacea. It is generally a good idea to start with a lower concentration as higher concentrations can constrict blood vessels too much, blood flow is restricted and this gives the areas of rosacea a white appearance .
We generally suggest a starting at 0.1% as this appears to give good results with minimal side effects.
As we are a compounding pharmacy and not a manufacturer, we are bound by a few restrictions(as is the case in the US/Uk/Ire). Firstly, we need to prepare the product specifically for the individual and it will have your name on a dispensing label. Secondly, we are only allowed to assign a one month expiry date to the product in line with Australian pharmacy law (manufactured products can have much longer expiry dates). However, it is formulated in line with commercially available products and we would suggest the product would be fine to use for a while after this.It is $49AUD for a 50g airless pump and international delivery is $30AUD. We can send an invoice via email, and when this is paid, we will compound the medication and send it off.
Regards
Lee McLoughlan
B.Pharm, Cert.Adv.Cos.Sci -
Rhofade Approved by FDA • Rhofade Official Web Site
"Topical oxymetazoline applied to the face once daily for 29 days was effective, safe, and well tolerated in the treatment of moderate to severe persistent facial erythema of rosacea." [1]
"Expert commentary: While assessment of available clinical trial data indicates that the medication is as effective as other available treatment for controlling rosacea-associated erythema with minimal risk of adverse effects, studies of long-term duration and direct comparison will be necessary to establish its place in treatment guidelines and clinical practice. As further evidence becomes available, the real-world clinical potential of topical oxymetazoline cream will become clearer." [2]
"For both QD and BID dosing, the efficacy of oxymetazoline 1.0% was greater than the 0.5% dose and comparable to the 1.5% dose. Safety and application-site tolerability were similar across groups." [3]
Rhofade, also known as oxymetazoline hydrochloride cream (1 percent strength), is a topical cream made to treat persistent facial erythema (redness). Ask your dermatologist for a sample.
The odds in the clinical trials of potential side effects using Rhofade for four weeks are 1% and go up to 3% using Rhofade for one year.
There is a non prescription oxymetazoline ( 0.075%) topical cream available by a compounding pharmacy in Australia.
Please post your experience using Rhofade in this thread.
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End Notes
[1] J Drugs Dermatol. 2018 Mar 01;17(3):290-298
Pivotal Trial of the Efficacy and Safety of Oxymetazoline Cream 1.0% for the Treatment of Persistent Facial Erythema Associated With Rosacea: Findings from the Second REVEAL Trial.
Baumann L, Goldberg DJ, Stein Gold L, Tanghetti EA, Lain E, Kaufman J, Weng E, Berk DR, Ahluwalia G[2] Expert Rev Clin Pharmacol. 2017 Oct;10(10):1049-1054. doi: 10.1080/17512433.2017.1370370. Epub 2017 Aug 24.
Oxymetazoline hydrochloride cream for facial erythema associated with rosacea.
Patel NU1, Shukla S1, Zaki J1, Feldman SR1,2,3.[3] J Drugs Dermatol. 2018 Mar 1;17(3):308-316.
Phase 2 Randomized, Dose-Ranging Study of Oxymetazoline Cream for Treatment of Persistent Facial Erythema Associated With Rosacea.
DuBois J, Dover JS, Jones TM, Weiss RA, Berk DR, Ahluwalia G. -
This report, Rosacea Pipeline Highlights - 2017, provides most up-to-date information on key pipeline products in the global
Rosacea market. It covers emerging therapies for Rosacea in active clinical development stages including early and late stage clinical trials. The pipeline data presented in this report helps executives for tracking competition, identifying partners, evaluating opportunities, formulating business development strategies, and executing in-licensing and out-licensing deals.
Research and Markets Report
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Tom Busby wrote this tip about washing off Soolantra:
"The base for Soolantra is Cetaphil Cream, according to the patents. This is not Cetaphil Lotion --- the Cream has a little petrolatum and as a result is slightly more occlusive, so it's slightly more difficult to wash off completely. You might find it useful to spend more time washing it off, or use the water stream of a shower to assist in washing it off. It's useful for general skin health to clean the skin completely at least once per day, and occlusive creams make this task a little more difficult. It may be useful for you to spend more time washing your face -- just an idea though.
People with very dry skin like occlusive creams more than other people. Since you asked about comedogenic, I guess you don't have very dry skin.
Here are the ingredients in the Cream, if it's any help -- the () comments are mine: Purified Water, Polyglycerylmethacrylate (hydrogel), Propylene Glycol (increases penetration), Petrolatum (long chain carbon-oil), Dicaprylyl Ether (emollient), PEG-5 Glyceryl Stearate (emulsifier and stabilizer), Glycerin (humectant), Dimethicone (silicone), Dimethiconol (silicone), Cetyl Alcohol (emulsifier), Sweet Almond Oil (medium chain carbon-oil), Acrylates/C10-30 Alkyl Acrylate Crosspolymer (hydrogel), Tocopheryl Acetate (synthetic Vitamin E), Phenoxyethanol (preservative), Benzyl Alcohol, Disodium EDTA (chelation), Sodium Hydroxide (activates 1st hydrogel by raising pH during the manufacturing process), Lactic Acid (lowers final pH)
I speculate that the "1% line" in the ingredients comes after petrolatum, and that the petrolatum is about 1.5% to 2%.
Both silicones aren't soluble in oil or water, and they also make any cream more resistant to washing off."
Rosacea Forum, Tom Busby, post #3
See also:
Soolantra Mechanism of Action & Basis for the Vehicle -
"The FDA approval of RHOFADE™ exemplifies Allergan's commitment to continuing to address unmet patient needs through innovation in medical dermatology," said David Nicholson, Chief R&D Officer of Allergan plc. "We know persistent facial erythema associated with rosacea is a challenge for patients and physicians and having options can help in treating the disease. RHOFADE™ is the first and only alpha1A adrenoceptor agonist approved for persistent facial erythema associated with rosacea in adults. The FDA approval of RHOFADE™ represents a new prescription treatment that can effectively help physicians and their patients manage this condition."
"Rhofade will be available commercially from May 2017 in the U.S. Allergan claims that Rhofade is the first and only alpha1A adrenoceptor agonist approved for persistent facial erythema associated with rosacea in adults.,,The approval was based on two clinical studies both of which met the primary efficacy endpoint. The clinical trials, which enrolled a total of 885 patients, were identical, multi-centered, randomized, double-blinded, parallel-group and vehicle-controlled in moderate or severe patients aged 18 years or older. Both the studies demonstrated that Rhofade was more effective than vehicle in reducing persistent facial erythema associated with rosacea in adults."
Allergan (AGN) Rhofade Cream for Rosacea Approved in U.S., Zacks Equity Research, Yahoo Finance
Rhofade, also known as oxymetazoline hydrochloride cream (1 percent strength), is a topical cream made to treat persistent facial erythema (redness), as opposed to the other symptoms of rosacea, like easy flushing, red bumps and pus pimples, skin burning, and sensitivity, explains Joshua Zeichner, a New York City dermatologist.
FDA Approves Rhofade Rosacea Treatment, by Sarah Kinonenat, Allure
The US Food and Drug Administration (FDA) has approved oxymetazoline hydrochloride 1% cream (Rhofade, Allergan) for the topical treatment of persistent facial erythema associated with rosacea in adults. Persistent facial erythema associated with rosacea is "a challenge for patients and physicians, and having options can help in treating the disease," David Nicholson, Allergan's head of research and development, said in a news release announcing approval.
FDA OKs New Cream for Facial Erythema in Rosacea in Adults, Megan Brooks Medscape
Rhofade, also known as oxymetazoline hydrochloride cream (1 percent strength), is a topical cream made to treat persistent facial erythema (redness), as opposed to the other symptoms of rosacea, like easy flushing, red bumps and pus pimples, skin burning, and sensitivity, explains Joshua Zeichner, a New York City dermatologist.
How does Rhofade work? Rosacea sufferers experience an overactivity of blood vessels in the face, which is why those with rosacea flush easier than others. Over time, the persistent flushing can lead to what Zeichner likens to fixed background redness. "Rhofade directly addresses this redness by constricting the blood vessels," he explains. teenvogue
David Pascoe has an excellent article on Who Should NOT Use Rhofade. In another article, David reports, "Going on the published clinical data, basically one in 6 or 7 users of RHOFADE will have a 2-grade improvement in their facial redness, typically for 12 hours, and continuing for 29 once-daily uses."
"Apparently, the entry of the RHOFADE, which will be commercially available from May 2017, may just be timely. For a while now physicians have not been able to efficiently address the facial erythema for lack of treatment options. The best they have been doing is helping their patients manage the triggers. That means the availability of RHOFADE is a plus to the delivery of their goals."
The FDA’s Approval Of RHOFADE Cream From Allergan Plc (NYSE:AGN): Will It Match The Market Competition?
By Andy Parker - Market Exclusive, January 20, 2017 -
DMT210 is a topical gel specifically developed to downregulate the proinflammatory cytokines in the skin responsible for the inflammation and redness seen in acne rosacea. PRNewswire
According to the Dermata web site, "DMT210 has the potential to be the first topical treatment to reduce both the erythema and the inflammation (papules and pustules) of rosacea."
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"Terpinen-4-ol is used in multiple skin related diseases including blepharitis, rosacea, Demodex, meibomian gland dysfunction, chalazion and dry eye., as well as lid margin diseases. The compound exhibits miticidal, anti-inflammatory, antibacterial and antifungal effects. Terpinen-4-ol is the main component of tea tree oil,[2] which is steam-distilled from the leaves of the Australian native plant Melaleuca alternifolia. Because of its beneficial effects, the oil has long been used by the Aborigines for wounds and minor skin infections."
Wikipedia"Using a reported in vitro killing assay to measure the survival time of adult Demodex folliculorum up to 150 minutes, we have screened serial concentrations of 13 of the 15 known ingredients of TTO [Tea Tree Oil] (ISO4730:2004) that were soluble in mineral oil and examined their synergistic relationships in killing mites. The most potent ingredient was then tested for its efficacy in killing Demodex in vivo.
Results
All ingredients exhibited a dose-dependent killing effect. Besides Terpinen-4-ol, the order of relative potency did not correlate with the order of relative abundance in TTO for the remaining 12 ingredients. Terpinen-4-ol was the most potent ingredient followed by α-Terpineol, 1,8-Cineole and Sabinene. Terpinen-4-ol, the most abundant ingredient in TTO, was more potent than TTO at equivalent concentrations and its killing effect was even observable at a mere concentration of 1%. Terpinen-4-ol exhibited a significant synergistic effect with Terpinolene, but an antagonistic effect with α-Terpineol in killing mites (both P < 0.05). In vivo, Terpinen-4-ol was shown to eradicate mites.
Conclusions
The above finding suggests that deployment of Terpinen-4-ol alone should enhance its potency in killing Demodex mites by reducing the adverse and antagonistic effects from other ingredients in TTO."
Transl Vis Sci Technol. 2013 Nov; 2(7): 2.
Published online 2013 Nov 13. doi: 10.1167/tvst.2.7.2
PMCID: PMC3860352
Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill Demodex Mites
Sean Tighe, Ying-Ying Gao, and Scheffer C. G. Tseng"When these components were examined individually, only terpinen-4-ol suppressed the production after 40 h of TNFalpha, IL-1beta, IL-8, IL-10 and PGE2 by LPS-activated monocytes.
CONCLUSION:
The water-soluble components of tea tree oil can suppress pro-inflammatory mediator production by activated human monocytes."
Inflamm Res. 2000 Nov;49(11):619-26.
Terpinen-4-ol, the main component of the essential oil of Melaleuca alternifolia (tea tree oil), suppresses inflammatory mediator production by activated human monocytes.
Hart PH, Brand C, Carson CF, Riley TV, Prager RH, Finlay-Jones JJ."Terpinen-4-ol suppresses inflammatory mediator production by activating human monocytes. Monocytes are a type of white blood cell–part of the human body’s immune system."
Loving Terpinen-4-ol by ANDREA"Not all tea tree oils are created equal and as George Orwell might say, some tea tree oils 'are created more equal than others.' ”
Confessions Of A Tea Tree Oil Snob, Michelle Glover -
This is a forum to share your experiences of living with rosacea with fellow sufferers and those interested to learn more.
As a condition where many suffer in silence, here we encourage you to share your thoughts, fears, hopes, frustrations and advice amongst a community of those who understand. Through the support of our community and the sharing of one united voice, together we can raise awareness of the impact of living with rosacea and breakdown the common and often damaging misconceptions surrounding the conditionExperience My Rosacea UK Campaign Sponsored by Galderma
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Before you go in with a heavy camouflage, soothe skin from the outset to create a smoother, more uniform base for makeup. Dr Anthony Bewley, Consultant Dermatologist at Whipps Cross and Barts Hospitals, London, recommends taking five with a redness reducing treatment to help both skin and mind cool off (incidentally, stress is thought to trigger 79% of flare-ups, which has more of the touch of the ‘vicious circle’ about it).
THE MAKEUP MANIAC: MAKEUP FOR ROSACEA, Anna Hunter, Get the Gloss
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Altogether, our results show that IVM is endowed with topical anti-inflammatory properties that could have important applications for the treatment of T-cell mediated skin inflammatory diseases.
Experimental Allergy and Immunology doi: 10.1111/all.13118
Topical ivermectin improves allergic skin inflammation
Erwan Ventre, Aurore Rozières, Vanina Lenief, Floriane Albert, Patricia Rossio, Léo Laoubi, David Dombrowicz, Bart Staels, Lauriane Ulmann, Valerie Julia, Emmanuel Vial, André Jomard, Fériel Hacini-Rachinel, Jean-François Nicolas, Marc Vocanson -
So how long were you on Soolantra total Rory?
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"Pharmaceutical compounding (done in compounding pharmacies) is the creation of a particular pharmaceutical product to fit the unique need of a patient. To do this, compounding pharmacists combine or process appropriate ingredients using various tools. This may be done for medically necessary reasons, such as to change the form of the medication from a solid pill to a liquid, to avoid a non-essential ingredient that the patient is allergic to, or to obtain the exact dose(s) needed or deemed best of particular active pharmaceutical ingredient(s). It may also be done for more optional reasons, such as adding flavors to a medication or otherwise altering taste or texture. Compounding is most routine in the case of intravenous/parenteral medication, typically by hospital pharmacists, but is also offered by privately owned compounding pharmacies and certain retail pharmacies for various forms of medication. Whether routine or rare, intravenous or oral, etc., when a given drug product is made or modified to have characteristics that are specifically prescribed for an individual patient, it is known as "traditional" compounding." Wikipedia
There is a difference between a pharmacist and a compounding pharmacist. Whether your insurance covers a compounding pharmacist is another matter you will need to investigate. A prescription from a medical doctor is usually required for the compounding pharmacy to make the prescription. The base ointment can be any type the pharmacist has available or prescribed by the physician. This is like the old fashioned pharmacist who has a motar and pestal.
image courtesy of Wikipedia commonsLinks
Professional Compounding Centers of AmericaFind a Local Compounding Pharmacy Near You
Walgreens Pharmacy Compounding Services
How do I Find a Compounding Pharmacy Near Me?
FDA Registered Outsourcing Facilities
Reply to this Topic
There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post? And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register? We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.
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Kalamazoo reports that her dermatologist in Spain prescribed a compounding pharmacist formula for rosacea that includes the following:
30 gram 'crema glucidica' (Spanish) for sensitive skin containing:
1% metronidazol
1% ivermectin
0.5% hyaluronic acid
5% vitamin PP (pellagra-preventive factor - vitamin B3 [niacin])
0.5% glyceral acidApply 1 to 2 times a day.
In addition to the compounding formula above the dermatologist prescribed the following:
7 milligrams of isotretinoin taken orally once a day
metronidazole drops for ocular rosacea
SPF 50 topical in gel format to prevent sunburn
If any member tries this please post here.
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The impact of other potential pathogens remains unsettled. For example, said Dr. Webster, European physicians accept completely that the Demodex folliculorum mite is the root of rosacea. "If you ask me, or many American dermatologists, it's less decided." Although D. folliculorum levels are elevated in rosacea, he explained, people can have heavy D. folliculorum colonization, but no rosacea, and vice versa. The fact that Demodex levels are highest in ETT rosacea counters the assumption that mites attack the hair follicles, causing inflammation and pimple formation, he added.
"The issue is confounded by the fact that the anti-mite drug Soolantra (topical ivermectin, Galderma) works well in rosacea. But no one has fulfilled Koch's postulates by showing that killing the Demodex improves rosacea; that Soolantra lowers Demodex levels; and that patients who resist Soolantra have Demodex levels that don't decrease with treatment." One cannot assume that topical ivermectin works in rosacea by killing Demodex, he said, because antibiotics such as doxycycline work in rosacea through many non-antibiotic effects. Topical ivermectin also has anti-inflammatory activity, he noted.
Also unclear, he said, is the contribution of Bacillus oleronius. This bacterium has been found to have antigens (chaperonin GroEL and aconitate hydratase) that excited the lymphocytes of patients with rosacea, but not in normal subjects.6 "It sounds like something's going on there. Also, the immune response to B. oleronius was found to be especially elevated in ocular rosacea. But we don't know that the antigens in this bug are unique to this bug. Much remains to be worked out. It's a stretch to conclude that the bug isolated from one mite of 40 studied is relevant. I'd be more convinced if these antigens are in Propionibacterium acnes or some known skin resident" that causes disease.
Factors in rosacea pathogenesis clearer
By John Jesitus
Dermatology Times, Dermatology, Clinical dermatology -
While there has been in the past discussion about classifying demodicosis as a disease sui generis or demodectic rosacea as a rosacea variant, there is overwhelming evidence that demodex mites are involved in some cases of rosacea. Therefore, the RRDi has now recognized demodectic rosacea as a rosacea variant.
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On the horizon, another α-adrenergic agonist, oxymetazoline 1% cream, likely will earn FDA approval in early 2017, predicted Drs. Harper and Webster. Allergan submitted the drug for FDA approval in mid-2016 and expects its Prescription Drug User Fee Act date in the first half of 2017, according to the company.
12th Annual Women's & Pediatric Dermatology Symposium 2016, Dermatology Times
Rosacea treatments
Dermatologists welcome antibiotics, α-adrenergic agonists and more
This report, 
Donald Trump Reported to Have Rosacea
in Rosacea in the News
Posted
image courtesy of wikipedia
"President Trump takes medication for three ailments, including a prostate-related drug to promote hair growth, Mr. Trump’s longtime physician, Dr. Harold N. Bornstein, said in a series of recent interviews.
The other drugs are antibiotics to control rosacea, a common skin problem, and a statin for elevated blood cholesterol and lipids."
Donald Trump’s Longtime Doctor Says President Takes Hair-Growth Drug, By LAWRENCE K. ALTMAN, M.D., FEBRUARY 1, 2017, New York Times
Doctor claims Trump takes medication for hair growth, rosacea, cholesterol
by: Michelle Ewing, KIRO7, Cox Media Group National Content Desk Updated: Feb 2, 2017 - 12:45 AM
Doctor claims Trump takes medication for hair growth, rosacea, cholesterol
Michelle Ewing, The Atlanta Journal Constitution, Cox Media Group National Content Desk
Famous Rosaceans