Rosacea Support Group » finacea

The Wheels on the Bus Go Round and Round

David Pascoe — Tue, 27 Jul 2010 20:05:17 +0000

Just published in the June 2010 edition of the Journal of Drugs in Dermatology is a study comparing “Finacea in combination with Oracea” with “Metrogel in combination with Oracea”.

Seeing this abstract published makes me want to let out a loud groan.

So much of what we see as recently published rosacea research is just recycled sameness. The actual result of most of these self-similar papers is pretty minimal.

It really doesn’t help rosacea sufferers much to know that the many permutations of the popular and already understood treatments all perform the same.

So the wheels on the bus go round and round, but on this route, the bus never seems to actually get anywhere.

Here is just a sample of the published research showing where this research bus is heading;

This sort of research does provide good pharmaceutical marketing stories I guess and I suppose it justifies researchers’ efforts, but I am left wondering where this effort could be better utilised.

J Drugs Dermatol. 2010 Jun;9(6):607-13.

Efficacy of topical azelaic acid (AzA) gel 15% plus oral doxycycline 40 mg versus metronidazole gel 1% plus oral doxycycline 40 mg in mild-to-moderate papulopustular rosacea.

Del Rosso JQ, Bruce S, Jarratt M, Menter A, Staedtler G.

Rosacea is a leading reason why people seek the care of a dermatologist, accounting for nearly 7 million office visits annually. Pharmacologic treatments include both topical and oral medications, which are increasingly being used in combination, especially at the outset of therapy. This exploratory study assesses the safety, effectiveness and speed of onset of two common topical agents for the treatment of rosacea azelaic acid gel (AzA) 15% and metronidazole gel 1% used in conjunction with anti-inflammatory dose doxycycline (40 mg once daily). Men and women (n = 207) with mild-to-moderate papulopustular rosacea were enrolled and randomized to receive either AzA gel 15% twice daily plus doxycycline 40 mg once daily (AzA group) or metronidazole gel 1% once daily plus doxycycline 40 mg once daily (Metro group) for 12 weeks. Both regimens were safe, efficacious and well tolerated. Efficacy parameters revealed a possible trend toward greater and earlier benefit with the AzA-based regimen than with the metronidazole-based regimen. These findings warrant further investigation in a sufficiently powered study.

I’ll end this note with a comment that why, seriously, would this study encourage the creation of a more detailed study ?

Just how does Finacea work ?

David Pascoe — Mon, 28 Jun 2010 14:42:34 +0000

I’m not sure that I have laid awake at night wondering about how exactly finacea does it’s thing, but as Rosacea News had a stab at Just how does metrogel work ? a while ago, an attempt at covering Finacea’s method of action is only fair.

It is interesting to consider how finacea works especially if that knowledge might lead to further understanding of how rosacea is caused or how it progresses.

This paper has identified the way in which Finacea is able to suppress the skin inflamation associated with exposure to Ultraviolet B radiation.

There may of course be other ways that finacea is able to help rosacea symptoms but this particular one has been proven by this research.

Decrypting the terminology

Before we try to pull this abstract apart, lets look at a few of the important terms.

A keratinocyte is a type of skin cell. The primary function of which is to form a layer of keratin that protects the skin and tissue underneath from the sun and water loss.
PPARgamma stands for Peroxisome Proliferator-Activated Receptors, and is a type of protein that interacts with the human gene.
abrogate means to annul or abolish.
modulate means regulate or adjust

So the conclusion of this study was that they were able to find the reason that Finacea was able to adjust the inflammatory response in the skin caused by the inflammatory response as a result of exposure to ultraviolet B radiation.

Azelaic acid modulates the inflammatory response in normal human keratinocytes through PPARgamma activation, Exp Dermatol. 2010 Jun 2.

Azelaic acid (AzA), a nine-carbon dicarboxylic acid, is an agent for the topical treatment of acne. It has also been shown to be effective in rosacea; however, the mechanism of action has not been clarified. Because inflammation is a common feature of both conditions, we investigated the effects of azelaic acid on the inflammatory response of normal human keratinocytes to ultraviolet B light, which is a photosensitizer agent in rosacea.

AzA, at 20 mM, a concentration achievable following topical application of a 15% gel, suppresses ultraviolet B light-induced interleukins-1beta, -6 and tumor necrosis factor-alpha mRNA expression and protein secretion. Mechanistically, azelaic acid significantly reduced the ultraviolet B light-induced nuclear translocation of nuclear factor kB p65 subunit and the phosphorylation of the p38 mitogen and stress-activated protein kinase. Moreover, as peroxisome proliferators-activated receptor gamma, (PPARgamma) which has a crucial role in the control of inflammation, is activated by fatty acids and products of lipid peroxidation, we further investigated the effect of azelaic acid on the expression of this nuclear receptor.

AzA induced peroxisome proliferators-activated receptor-gamma mRNA and its transcriptional activity.

The PPARgamma antagonist GW9662 abrogated the inhibitory effects of AzA on the UVB-induced pro-inflammatory cytokines release and on the cell proliferation.

Our study provides new insights into the molecular mechanisms of the activity of azelaic acid and lands additional evidences for its therapeutic effects on inflammatory skin diseases, such as rosacea.

Finacea now available in Canada

David Pascoe — Tue, 22 Jun 2010 15:11:43 +0000

Canadian rosacea sufferers have up until now been unable to officially use Finacea. Bayer HealthCare Pharmaceuticals have announced that Finacea is now available in Canada.

Finally Canadians can get access to Finacea via prescription bringing them inline with other rosacea sufferers in the US and UK. Finacea is also available over the counter in Australia.

According to Wolters Kluwer PHAST (April 2010), Finacea is the most prescribed topical treatment for rosacea in the United States by dermatologists. A similar claim is also made made by Metrogel, with Galderma claiming that Metrogel is the #1 dermatologists-prescribed medication for rosacea.

The press release announcing the availability of Finacea in Canada claims the following benefits;

FINACEA – What the Data Shows

Bayer’s application to Health Canada for the approval of FINACEA was based on data from quality control studies, as well as data from pre-clinical and clinical studies.

Several studies show that FINACEA reduces the redness and swelling of rosacea.

Results from two identical phase III multi-centre, double-blind, randomized studies involving 664 patients, showed that almost all (90 per cent) considered the tolerability of FINACEA to be good or acceptable.

Some patients who used FINACEA saw their symptoms improve in as few as four weeks. In one clinical trial, FINACEA patients experienced continued improvement through the entire 15 weeks of the study, compared to the other patient group using another topical treatment who stopped showing continued improvement after eight weeks.

Official Finacea Canada Site: finacea.ca

Official Finacea Prescribing Information

Finacea Plus (get $2 off CeraVe and $10 off Finacea)

David Pascoe — Fri, 12 Mar 2010 11:42:08 +0000

Many rosacea sufferers don’t get to see how the large pharmaceutical companies are marketing rosacea treatments to physicians. The program list from the recent AAD meeting in Florida gives an idea of where and how these companies think they can best promote their prescription products. Recently Rosacea News highlighted what is seen as Galderma’s quest to own the rosacea market.

Here we are looking at Intendis (part of the Bayer Group) and Coria Laboratories who are promoting Finacea Plus; the combination of Finacea and 3 oz bottles of CeraVe Moisturizing Lotion and CeraVe Hydrating Cleanser.

The promotional offer is a Finacea + CeraVe Coupon that will save you $10 off Finacea and $2 off the CeraVe Moisturizer or Cleanser. Not much of a discount, but as you can see it is enough to build a colourful advertising campaign.

Finacea Plus is “For the multi-faceted challenges of mild to moderate rosacea” and is claimed to be “Offering more in one convenient package”. The coupon itself is available at the My Finacea web site.

(click to view larger image)

I wonder if offering a package of products with a glossy campaign is persuasive enough to link Finacea and CeraVe in peoples’ minds ? Do you feel a subconscious link building between the two ?

What next – should Galderma consider offering Metrogel with a couple of Cetaphil products ? Makes sense to me.

Featured Products

CeraVe Hydrating Cleanser (12 oz), CeraVe Moisturizing Lotion (12 oz)

Finacea Foam being trialled

David Pascoe — Fri, 04 Dec 2009 01:43:13 +0000

We’ve seen it with metrogel; the pharmaceutical companies want to expand the market for their existing successful products by creating followup products.

A Clinical Trial is underway to test Finacea Foam for the papules and pustules of rosacea. Finacea has proved to be a good option for the `acne like’ symptoms of rosacea.

Safety and Efficacy of Azelaic Acid Foam 15% in Papulopustular Rosacea

This study will investigate the safety and efficacy of a new formulation of an existing medication for the treatment papulopustular rosacea. The study will test the active ingredient plus foam against foam alone.

It is not clear to me how a twice daily foam application of finacea will offer a benefit to those who can already use Finacea cream.

In a market where it costs millions of dollars to get a product officially approved to treat rosacea, it makes sense that derivate Finacea products are brought to the market.

By comparison, Galderma originally manufactured Metrogel 0.75%, and later followed with Metrolotion and Metrocream. Indeed one study found that metrogel, metrolotion, metrocream, noritate, once and twice per day – all the same same

When the patent expired on metrogel 0.75% Galderm turned their sights to a different formulation and increased the active ingredient metronidazole to 1%.

I wouldn’t be surprised to see further Finacea derivative products in the future as Intendis tries to realise the maximum return on their FDA approved products.

NY Derm likes Finacea instead of Retin-A

David Pascoe — Fri, 27 Nov 2009 12:46:57 +0000

In an ELLE Magazine December 2009 interview, New York Dermatologist Macrene Alexiades-Armenakas, MD, PhD tells us that she has rosacea.

A respected and published dermatologist, Dr. Alexiades-Armenakas says that she is one of the many people who cannot tolerate topical retinoids. Instead she prefers Finacea which she says is great for acne and rosacea, reduces oiliness and lightens brown spots, great for breakouts.

As an aside, given that she sufferers from rosacea, I wonder what sorts of results she sees herself from her own `high performance anti-aging cream’ known as dr.macrene 37 Extreme Actives. Sadly at $275 for 50ml I don’t think many will want to just try-see. If you are interested, here is the dizzying list of ingredients listed by DNA repair, cellular repair, anti-pigment, anti-red, anti-wrinkle, anti-oxidant, pro-collagen, barrier repair properties, to name a few.

Skin Care Made Simple: Tips for Wrinkles, Blemishes, and Redness

An NYC dermatologist shares her beauty secrets—and reveals a new superproduct.

Is Retin-A still the gold standard for anti-aging?
Retinoids have the longest track record, and they’re great for antiacne. But many people, like me, can’t tolerate them. Instead, I use the azelaic-acidbased prescription Finacea, which works on both rosacea and acne and also reduces oiliness, lightens brown spots, and is a great spot therapy for breakouts—it won’t make you red and flaky the next day.

Rosacea? You don’t look red.
Some doctors don’t agree with me on this, but rosacea is very common. By definition, if you stay red and you start to get broken capillaries and bumps, that’s rosacea. Hot weather, showers, drinks, and certain foods can cause flare-ups. Reduce these and you’ll see a change—fast.

CeraVe Hydrating Cleanser and CeraVe Moisturizing Lotion User Reviews

David Pascoe — Tue, 07 Jul 2009 02:33:11 +0000

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.”

Further, the My Finacea web site claims the following benefits from using the CeraVe products.

Delivered with MVE technology.

CeraVe Skin Care products offer the unique Multivesicular Emulsion —MVE™— delivery technology. This patented system provides a controlled release of barrier-rebuilding protective ingredients that penetrate deep into the skin to hydrate and nourish, while locking in precious moisture.

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.

The coupon itself is available at the My Finacea web site.

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.

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 ?

moisturize before or after finacea – it doesn’t matter

David Pascoe — Tue, 21 Apr 2009 01:23:03 +0000

Well here you are, one of the frequently asked questions about rosacea topicals has been answered. Does it matter whether I apply my rosacea prescription topical before or after I use a moisturizer ? This recently available abstract suggests that in fact it doesn’t matter. The study looked at the absorption of finacea before and after moisturizer lotions were applied and was unable to find a significant difference.

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.

[Update]: a quote from Dr. Powell’s excellent book: Rosacea Diagnosis and Management says that the medicine should always go on first; Drugs have priority-they go on first ! he tells us in italics.

Related Articles

ho hum: finacea + oracea vs. metrogel 1% + oracea

David Pascoe — Fri, 06 Mar 2009 05:01:12 +0000

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.

Top 5 Cheap Rosacea Treatments

David Pascoe — Thu, 29 Jan 2009 12:09:07 +0000

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.

So here we go; my top 5 suggestions to help you find cheap rosacea treatments.

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 impost, 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.

One program that you may not be aware of is offered by Galderma. Galderma will provide Oracea and Metrogel FREE for low income and no insurance sufferers of rosacea.

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.

Please Help

`Cheap’ and `Rosacea Treatment’ don’t often appear together in the same sentence. Treatments, especially prescription treatments that have been developed and marketed for rosacea sufferers are notoriously expensive – to the point of being unobtainable for many.

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

NEW: Oracea and Metrogel FREE for low income no insurance
cetaphil gentle skin cleanser well tolerated
cetaphil moisturizing cream helps rosacea dry skin
Prosacea User Reviews
generic metrogel soon – Fougera
Rosacea Support Community: Homemade Mixes
RSRP: Custom Topical Formulations