Recently the manufacturers of Finacea, Intendis, and Coria Laboratories, have begun promoting a new combination package it is calling Finacea plus. This package encourages rosacea sufferers to combine a tube of Finacea with CeraVe Hydrating Cleanser and/or CeraVe Moisturizing Lotion. In theory this sounds like a good idea. Many rosacea sufferers have discovered that a gentle cleansing and moisturizing combination is a key part of their rosacea beating rosacea.

Official Web Site Comments

According to the official CeraVe web site, CeraVe is suitable for rosacea sufferers; “If you are taking a prescription medication for a skin condition, CeraVe Skin Care products are designed to enhance a medication’s therapeutic effect. That’s why many dermatologists recommend CeraVe Skin Care products as part of their therapeutic regimen. The gentle and moisturizing ingredients in CeraVe Skin Care products can also help offset the drying effects of certain prescription medications used to treat conditions such as eczema, psoriasis, acne, and rosacea.”

So the manufacturers are convinced, then.

Medical Opinions

From Rosacea: No laughing matter, Dr. Bikowski stresses skin care to make sure the outer layer, called the stratum corneum, is healthy. "That stops water from leaving, the skin from drying out, and stops things like microbes from getting in, also irritants and allergens." He advises the use of the over-the-counter cleanser, moisturizer lotion and/or moisturizer cream marketed under the name CeraVe. …

"There is nothing over the counter that is of any medical value for treating rosacea except for the skin products [CeraVe]," he said.

Hmmm, Dr. Bikowski sounds convinced too.

Paula Begoun seems to be generally happy with the CeraVe range;

“Hydrating Cleanser deserves serious consideration by anyone with normal to dry skin that’s also sensitive, including those dealing with rosacea. It is an exceptionally gentle, soothing cleanser that contains several ingredients that mimic the structure and function of healthy skin …”

“Moisturizing Lotion is the lotion version of the Moisturizing Cream, and other than having a lighter texture and smoother dry-down, the same formulary comments apply. The blend of glycerin, ceramides, cholesterol, and hyaluronic acid will help normal to dry skin look and feel very good …”

How To Use

Instructions that accompany Finacea Plus recommend that rosacea patients wash their skin with lukewarm water and CeraVe Hydrating Cleanser. This should be followed by an application of Finacea. Finally, it recommends applying CeraVe Moisturizing Lotion to the entire face.

What is the special offer ?

Well perhaps the package is slightly less than exciting. The prescription for Finacea Plus offers patients a $10 coupon towards the prescription cost of Finacea and a $2 coupon toward the purchase of either CeraVe Moisturizing Lotion or CeraVe Hydrating Cleanser. A fairly modest discount scheme indeed.

User Reviews

For more information on Finacea itself, see the Rosacea Support Group page containing Finacea User Reviews.

Here are some comments from rosacea sufferers who have tried the CeraVe range of products;

Artist said: I had also started using Finacea, a topical medication for rosacea, while still using the Cerave (the last few days using it.) I distinctly remember that the Finacea was extremely irritating to my skin, as if my face were on FIRE, when combined with the Cerave. Cerave is known to release moisture throughout the day due to microbeads or some such technology. It also contains ceramides, so maybe that has something to do with it. Who knows. I think this kept re-activating the finacea or just did not combine well with it. I then switched from Cerave moisturizer to Vanicream Lite Lotion

Carol, Brooklyn, Ohio said: (They) mentioned CeraVe Hydrating Cleanser. I tried it and i hope coria labs never stop making it! In three days, my face looks like it did so long ago. I am in love with my skin on my face! I knew from the first night i used it. It was not greasy, it washed off very quick, no residue, no redness, no drying, no itching! I love it!!!!!! I have not had to use my acid mantle or clindamycin for the last three days! love it love it please please please do not stop making CeraVe hydrating cleanser.

DmanChicago said: This relatively unknown brand of cleanser has proven to be the best for my skin. I have moderate Rosacea-mainly the redness, bumps, pimples, and at times even cysts. I’m 47, I have tried literally every product out there and this is my pick. It is completely non-irritating, doesn’t dry my skin, and simply works to clean without the greasy feeling of Cetaphil.

Mikel said: Cerave Lotion is the only lotion I can use on my face, other than DML Lotion. Cerave is far more effective but DML works on the principle of less is more. I cant use the Cerave Cleanser though as my pores get clogged. Go Figure! I use the lotion as the cream is a bit heavy for my combo skin.

MelissaW said: I have a similar reaction to the Cerave cleanser interestingly enough. I find it breaks me out a bit. However I use both the Cerave lotion and cream successfully (so far) and find it very soothing and calming for my rosacea. I have dry skin though so that is probably why I can use the cream without any issues re clogging my pores.

CrabbyCathy said: Hold on to your socks, everyone. I think I have found a moisturizer I love, that beats my beloved Canvas Base Cream! In a matter of days, it has returned moisture to my skin, or at least helped my skin heal so that it can retain it’s own moisture, as nature intended. No more dry, itchy, stinging skin. I guess ceramides do work! I apply a dab to damp skin, concentrating on my cheeks, and dab the little bit left on my fingers onto my t-zone, where I don’t need as much.

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Final Comment

OK, the discount offer is pretty modest, but do you think you’d like to try any of the CeraVe products ? Are the something you will want to keep as part of your daily regime ?

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So now you know; you can apply your topicals before or after you moisturize and it won’t make any difference.

Impact of order of application of moisturizers on percutaneous absorption kinetics: evaluation of sequential application of moisturizer lotions and azelaic acid gel 15% using a human skin model, Cutis. 2009 Mar; 83(3):119-24., Del Rosso JQ, Lehman PA, Raney SG., Valley Hospital Medical Center, Las Vegas, Nevada, USA.

The medical management of rosacea increasingly has involved not only the appropriate selection of topical medication but also patient education and specific recommendations regarding appropriate skin care. The recognition that epidermal barrier dysfunction and transepidermal water loss (TEWL) play a pathophysiologic role in rosacea and that skin moisturization may help to mitigate signs and symptoms of the disease has led to a deeper appreciation of the importance of proper skin care in the treatment of rosacea. Data from a percutaneous penetration study performed using human skin suggest that any of the tested moisturizer lotions may be applied either before or after azelaic acid gel 15% without a major change in the percutaneous absorption profile of azelaic acid.

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The Clinical Trials register has listed a new trial for papulopustular rosacea. The trial, sponsored by Intendis, the manufacturer of Finacea, wants to compare the combination of Oracea and Finacea, with the combination of Oracea and Metrogel 1%.

It seems clear from this that Intendis would like to position Finacea as a viable alternative to Metrogel. This makes good sense when you consider that Metrogel was responsible for generating sales of about $75 million in 2004.

NCT00855595: Efficacy of Topical Azelaic Acid 15% Gel Plus Anti-Inflammatory Dose Doxycycline or Metronidazole Gel 1% Plus Anti-Inflammatory Dose Doxycycline in Moderate Papulopustular Rosacea

Subjects with moderate papulopustular rosacea will be treated either with azelaic acid 15% gel topically plus an anti-inflammatory dose of doxycycline (40mg)daily or with metronidazole 1% gel topically once daily plus an anti-inflammatory dose of doxycycline (40mg) over at total of twelve weeks to determine the rapidity of improvement, and the length of time to reach 25%, 50% and 75% clearing compared to baseline.

Whilst sales of pharmaceuticals and thus returns to shareholders are a huge driving force in the big pharma market, this sort of venture is really just tinkering at the edges of rosacea research.

What we all long for, naturally, is real innovation. Real innovation costs big dollars too though, so in the end we do actually benefit from any increases in sales that these sorts of trials will hopefully lead to.

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Distressed with the expense of exotic rosacea treatments ? The stress of rosacea is enough without also having to worry about how to afford treatments. Finding affordable rosacea treatments is a real challenge. Here are my top 5 suggestions for building your rosacea-beating regime while on a budget.

1. Make your own cleanser

Colloidal Oatmeal has promise as natural product because of it’s cleansing, moisturizing, buffering, soothing, protecting and anti-inflammatory properties.

While products like Linda Sy’s Mild Oatmeal Facial Cleanser and Aveeno Oatmeal Anti-Itch are not cheap recommendations, you should be able to source colloidal oatmeal easily from a health food store. Colloidal Oatmeal is defined as a product made from grinding and processing whole oat grain with strict requirements on the particle size and fat content. The small particle size and the way that it disperses in water means that when it deposits on the skin it forms an occlusive barrier.

Try mixing a small amount of Colloidal Oatmeal with warm water and lathering it on your face. Gently remove it with cool water.

See also the Homemade Mixes Forum and the Custom Topical Formulations resources page for more suggestions on making your own super cheap topicals.

2. Use generic prescriptions

Newer releases of antibiotics like Oracea and Solodyn can be extremely expensive, especially without medical insurance. One alternative is to discuss with your doctor the possibility of trying generic doxycycline instead.

Doses of 50mg a day of doxycycline will closely match the amount of active antibiotic in Oracea and Solodyn. Higher doses many also be of benefit until the inflammation of rosacea subsides. Generic doxycycline is far more affordable that these 2 newly released re-packaged antibiotics.

Another possibility is to ask your doctor about generic metronidazole. The patent for metrogel (the 0.75% version specifically) has expired so generic equivalents are now available in several countries around the world. For more information see generic metrogel.

3. Hunt for Bargain Suggestions

Many of the `regular’ treatments for rosacea such as systemic and topical antibiotics are quite expensive. Be on the hunt for things you can try that are more reasonably priced. Here are some suggestions

• Prosacea: this can be sourced over the counter at places like Walgreens and Rite Aid for around $10. It seems to be an ok treatment for rosacea. Prosacea is based on a sulphur preparation.
• Cetaphil Gentle Skin Cleanser and Cetaphil Moisturizing Cream or Lotion are two under-rated skincare products. They are cheap, mild and easily available. If you can incorporate these in to your daily skincare regime then you are off to a good start to cheaply caring for your rosacea skin.
• Try to source a cheap zinc oxide based sunscreen. Some countries have cancer foundations that are good at providing affordable, simple sunscreens. You might be fortunate enough to find a low irritant formulation free of chemical sunscreens.

4. Manufacturer Rebates

Drug manufacturers recognise that their products can still be quite expensive by the time they get to the consumer. To try to mitigate this, rebates or coupons are sometimes offered.

A quick search revealed the following ; $10 Mail-In Rebate for Metrogel, and Save $10 on Finacea Instantly.

The very expensive Oracea also offers a Savings Card where you could save $25 per prescription for those without prescription insurance and help some insured patients pay no more than $25 per month. The similarly expensive Solodyn is also offering a $35 rebate.

While these manufacturer rebates come and go, keep an eye out for promotions offered by the manufacturers. Be aware of all the small print also as refunds can take many weeks to arrive, and promotions can be revoked at any time.

5. Ask for Physician Samples

When new drugs are being promoted, the sales team are desperate to find as many outlets as possible. This might mean that your doctor or specialist has drug samples just waiting to be handed out. Check with your local doctor’s surgery, and maybe even ring a few dermatologist to see if they ever get samples from the drug companys’ sales teams.

You might be lucky enough to find a good source for free samples. This is one asset that is worth trying to chase down and link up with.

Do you have any recommendations for your fellow rosacea sufferers that are on a budget ?

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This poster session is seeking to expand the appeal of Finacea (which contains Azelaic acid 15%) beyond rosacea. The result is that the authors are suggesting that finacea is also possibly good for acne vulgaris and hyperpigmentation as well as rosacea. If you are interested in reading more about rosacea, and its applicability to rosacea, see my previous article focus on finacea.

P433 Implications of azelaic acid’s multiple mechanisms of action: Therapeutic versatility, Zoe Draelos, MD, Allan Kayne, MD, Intendis, Inc.,

Poster Abstracts, American Academy of Dermatology 66th Annual Meeting, February 1–5, 2008, San Antonio, Texas. Supplement to the JAAD, Feb 2008, Volume 58, Number 2.

Introduction: Topical azelaic acid (AzA) 15% gel is approved in the United States for the treatment of mild to moderate papulopustular rosacea and shows efficacy against erythema in the presence of inflammatory lesions. However, the multiple mechanisms of action of AzA make it a candidate for use in other dermatoses.

Objective: To understand the benefits of the various mechanisms of action of AzA in dermatologic disorders other than rosacea. AzA demonstrates both anti-inflammatory and antioxidant effects on rosacea. [1] Patients with rosacea have defects in stratum corneum (SC) barrier function. [2] In a previous study, 40 women using AzA had no increase in transepidermal water loss from the SC versus controls. [3] Data from a recent in vitro study has demonstrated bacteriostatic effects of AzA on P acnes. [4] AzA is also a competitive inhibitor of tyrosinase [5] and has cytotoxic effects on hyperactive melanocytes. [6] The antiinflammatory, antioxidant, antikeratinizing, and bacteriostatic properties of AzA make it an excellent therapeutic option in acne vulgaris. [5,6] By inhibiting tyrosinase, AzA interferes with the production of excessive melanin and also has direct cytotoxic effects on the hyperactive melanocytes seen in people with hyperpigmentation disorders. [5,6]

Conclusion: The multiple mechanisms of action of AzA suggest it has utility in dermatologic conditions beyond rosacea.

References:

1. Akamatsu H, Komura J, Asada Y, et al. Inhibitory effect of azelaic acid on neutrophil functions: a possible cause for its efficacy in treating pathogenetically unrelated diseases. Arch Dermatol Res 1991;283:162-6.
2. Dirschka T, Tronnier H, Fo¨lster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol 2004;150:1136-41.
3. Draelos ZD. Noxious sensory perceptions in patients with mild to moderate rosacea treated with azelaic acid 15% gel. Cutis 2004;74:257-60.
4. Data on file, Intendis, Inc.
5. Fitton A, Goa KL. Azelaic acid: a review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders. Drugs 1991;41:780-98.
6. Nguyen QH, Bui TP. Azelaic acid: pharmacologic and pharmacodynamic properties and its therapeutic role in hyperpigmentary disorders and acne. Int J Dermatol 1995;34:75-84. 100% is sponsored by Intendis, Inc.

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A Multicenter Trial to Assess the Efficacy and Safety of a Topical Medication for Papulopustular Rosacea Applied Twice Daily Versus Once Daily

The trial is listed as using the drug azelaic acid, which is the active ingredient in Finacea.

The study is currently recruiting patients. It is not clear where the trial will take place as the web site is for the FDA, but all contact information is from Germany.

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Finacea is a “topical treatment for the inflammatory bumps and lesions of mild to moderate rosacea”.

Finacea is not suitable to those with a sensitivity to propylene glycol. About 20% of various trialists report mild side effects from using finacea, compared to 14% using just the vehicle gel. See the prescribing information for more warnings and safety usage information as finacea is not suitable for all rosacea sufferers.

The following is from the Finacea FAQ:

What about burning and stinging?

A: Some patients using FINACEA may initially experience burning and/or stinging sensations after they apply FINACEA. In clinical studies, most patients were able to continue using FINACEA despite these sensations.

I wouldn’t advocate continuing to use finacea once you get a bad reaction, so do tread carefully. At least Intendis are being transparent when they say “While no one is certain exactly how azelaic acid works to improve rosacea, it effectively reduces redness, as well as the bumps and lesions, of mild to moderate rosacea.”

I can see 2 online pharmacies that are offering a 30gm tube for around $22 plus postage. Your local pharmacy should be able to order a tube if they don’t have any in stock.

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Azelaic acid is a completely new class of acne and rosacea therapy, chemically different from most of the currently available acne or rosacea medications, including retinoids and alpha-hydroxy acids.

Azelaic acid is believed to work uniquely with dual modes of action: antimicrobial activity and normalization of keratinization (the process by which epithelial cells mature as they move toward the skin surface and then slough off) thus addressing two of the major causes of acne.

However, azelaic acid, as currently marketed, can cause burning and irritation of the skin. The company’s patented chitosan azelate addresses this problem by making the azelaic acid completely water soluble. By increasing the water-solubility of this topically applied drug, increased efficacy is expected. Azelaic acid is FDA approved in the US and is approved abroad for the treatment of acne and rosacea. This molecule can also be developed for the treatment of malasma.

Patent information

US patent 6,734,210 issued May 11, 2004. US Patent pending.

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Anthony Rawlings, PhD, AVR Consulting Ltd, Northwich, United Kingdom; Johann Wiechers, PhD, Uniqema, Gouda, Netherlands; Jean-Claude Nicolas, PhD, INSERM, Montpellier, France; Marie-Dominique Galbert, PhD, University of Rennes, Rennes, France

Azelaic acid, a dicarboxylic acid, is known to reduce the symptoms of acne and rosacea as well as reducing skin melanogenesis. In the search for a higher efficacy compound, octadecenedioic acid was developed. Examining its structure, it was proposed that octadecenedioic acid may act similarly to azelaic acid as an antimicrobial agent. However, due to the increased carbon chain length of the compound it is also anticipated to bind to the peroxisome proliferator-activated receptor (PPAR), unlike azelaic acid. As a result on binding to PPAR, octadecenedioic acid will possess multiple activities (eg, promoting keratinocyte differentiation as well as possessing antimicrobial properties). Binding to chimeric PPARs in vitro in cell-based reporter assays demonstrated that although octadecenedioic acid is a pan- PPAR agonist, it posses slightly more affinity for the PPAR-g isoform. Additionally, microbial in vitro studies demonstrated that octadecenedioic acid was 50-fold more active than azelaic acid at inhibiting the growth of Propionibacterium acnes. In vitro skin delivery studies also demonstrated a preference for transfollicular delivery for the octadecenedioic acid compared with azelaic acid. In clinical trials comparing octadecenedioic acid (2%) with azelaic acid (20%) and benzoyl peroxide (5%), octadecenedioic acid compared favorably but without the somatosensory negative effects. We believe it is an effect induced by binding to PPAR-g as well as its antimicrobial activity. Moreover, as it has also been proven to inhibit melanogenesis in vitro, it could also help reduce hyperpigmentation reactions in skin of color. In clinical studies involving 20 subjects, the skin-lightening activity of a 2% octadecenedioic acid–containing formulation was compared with that of a placebo. A significant reduction (P <.025) in skin color could be demonstrated after 8 weeks. This latter effect appears to be related to reduced tyrosinase message and protein levels leading to reduced melanogenesis, which we believe is an effect induced by binding to PPAR-g. In conclusion, octadecenedioic acid appears to be an effective antiacne agent delivering benefits similar to those of azelaic acid but at much lower concentrations; it reduces skin pigmentation and we anticipate on a mechanistic basis that it may also be beneficial for the treatment of rosacea.

Author disclosure: Dr Wiechers is a consultant for Uniqema. 100% sponsored by Uniqema.

Poster Discussion Session P120, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.

Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.

• JAAD Poster Abstracts Online

Appears to be related to some other recent publications

A new mechanism of action for skin whitening agents: binding to the peroxisome proliferator-activated receptor, J. W. Wiechers, A. V. Rawlings, C. Garcia, C. Chesné, P. Balaguer, J. C. Nicolas, S. Corre and M.-D. Galibert, International Journal of Cosmetic Science, Volume 27 Page 123 – April 2005

Octadecenedioic acid is known as a skin whitening agent but its activity is not mediated via a direct inhibition of tyrosinase. Based on the secondary properties of this molecule, such as its anti-inflammatory and anti-ageing effects, we postulated that octadecenedioic acid interacted with the peroxisome proliferator-activated receptor (PPAR) as this nuclear receptor also mediates these effects.

Compatibility of skin care formulations containing licochalcone A with commonly prescribed medications for rosacea

Teresa Weber, PhD, Beiersdorf Inc, Norwalk, CT, United States; Ronald Rizer, PhD, Thomas J, Stephens & Associates, Colorado Springs, CO, United States; Anette Buerger, PharmD, Andrea Schoelermann, MD, Beiersdorf AG, Hamburg, Germany

Rosacea can often be managed by pharmacologic treatment, the use of appropriate daily skin care products, and the avoidance of flushing triggers. We examined the stability and compatibility of several commonly prescribed pharmaceutical actives with skin care formulations containing licochalcone A. These formulations were previously tested and shown to be suitable for the daily skin care of patients with erythematotelangiectatic (type 1) rosacea. Chemical stability of the active agents metronidazole and azelaic acid was evaluated by HPLC analytical methods after formulation in an SPF 15 moisturizing cream containing green- and redness concealing pigments, and a night moisturizing cream, both containing licochalcone A. The actives were postadded to the formulations at final concentrations of 0.75% for metronidazole and 15% for azelaic acid, respectively. After 2, 4 and 6 weeks, no loss of actives or changes were observed in samples stored at both room temperature and 378C. Skin compatibility of the drug and skin care formulations was also assessed in subjects with mild to moderate type 1 and 2 rosacea who participated in an in-use test. All subjects applied the drug product alone daily two weeks, followed by the drug and the skin care regimen containing licochalcone A for an additional 2 weeks. Clinical grading of erythema and subjective irritation as well as inflammatory lesions (type 2 rosacea subjects) was made at baseline, and at 2 and 4 weeks. The subjects showed improvements in clinical scores compared to baseline at week 2, and further improvements at week 4. We conclude that the skin care formulations with licochalcone A are compatible with metronidazole and azelaic acid, treatments commonly prescribed for patients with rosacea.

Author disclosure: Nothing disclosed at press time. 100% sponsored by Beiersdorf Inc

Poster Discussion Session P1134, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.

Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.

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