I thought this article from the Vancouver Sun was quite interesting from the point of view of developing new products for rosacea sufferers. Just how do you get from something that you think might work, to a product that all rosacea sufferers can use?

Clinical trials can take millions of dollars and dozens of years to get through the FDA, to become a new drug. Is there another option though?

This article tracks Vancouver dermatologist Jason Rivers who is attempting to develop and promote the Riversol range of products as being helpful for rosacea sufferers.

The Active Ingredient

The active ingredient present in Riversol is Beta-thujaplicin (β-thujaplicin, also known as Hinokitiol), an active that appears to have limited published research so far.

One paper is Inhibitory Effect of β-Thujaplicin on Ultraviolet B-Induced Apoptosis in Mouse Keratinocytes and perhaps another In Vitro Inhibitory Effects of Hinokitiol on Proliferation of Chlamydia trachomatis.

β-Thujaplicin is a molecule from the Western Red Cedar tree. You can hear Dr. Rivers discuss in this short YouTube video: Dr. Jason Rivers on Thujaplicin.

The Products

The Riversol for Rosacea, Normal to Dry Skin consists of 3 products, a cream cleanser, serum and moisturizer. The list of ingredients follows.

Cream Cleanser Ingredients

Aqua/Water, Mineral Oil, Propylene Glycol, Stearic Acid, Glyceryl Stearate, PEG-100 Stearate, Cetearyl Alcohol, Polysorbate 60, Polysorbate 80, Hinokitiol (Beta-Thujplicin), Allanloirl, Xanthan Gum, PVM/MA Decadlene Cross-Polymer, Benzophenone-4, Specially Denatured Alcohol. Phenoxyethanol, Methylparaben, lsopropylparaben, Isobutylparaben, Butylparaben, Sodium Hydroxide.

Serum Moisturizing Cream Ingredients

Aqua/Water, Mineral Oll, Propylene Glycol, Petrolatum, Cetearyl Alcohol. Polysorbale 60, Hinokitiol (Beta-Thujaplkin), Tocopheryl Acetate, L-Ascorbic Acid, Disodium Lauriminodipropionate Tocopheryl, Phosphates, Propylene Glycol Alginate (from sea kelp), Titanium Dioxide, Xanthan Gum, Specialiy Denatured Alcohol, Phenoxyethanol, Melhylparaben, lsopropylparaben, lsobulylparaben, Butylparaben, Tetrasodium EDTA.

Riversol for Rosacea Serum Ingredients

Aqua/Water, Propylene Glycol, Hinokitol (Beta-Thujplicin), Disodium Lauriminodipropoplonate Tocopheryl Phosphates. Aminopropryl Ascorbyl Phosphate, Propylene Glycol Alginate, Xanthan Gum. PVM/MA Decadiene Crosspolymer, Specially Denatured Alcohol, Phenornyethanol, Methylparaben, lsopropylparaben, lsobulylparaben, Butylparaben, Sodium Hydroxide, Terasodium EDT A, Benzophenone-4

Contrast the list of ingredients with for eg. Metrogel 1% which consists of just metronidazole in a base of betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben and purified water.

Cost

Are you sitting down?

The 3 products are available from their web site for a whopping $CAD 218.00, although a sample kit is also available.

From the Vancouver Sun;

Walking the fine line between marketing and medicine

Vancouver doctor’s company looking at ways to sell cream that treats rosacea

By Jenny Lee, Vancouver Sun June 8, 2011

You know that lovely, idle, workday dream? The one where you turn a great little work idea into a mega-business and retire to acclaim and fortune?

Vancouver dermatologist Jason Rivers is going for it.

It all started 10 long years ago when Rivers, a University of B.C. dermatology professor who is also in private practice, learned of an ingredient that seemed useful as an anti inflammatory, antifungal and anti-microbial.

Beta-thujaplicin (thoo-ya-PLY-sin) isn’t really cost-effective to extract or synthesize for use in most skin-care products, and clinical research on its efficacy is still limited.

But Rivers was intrigued, and when by chance he met a cosmetic chemist, he asked for a custom formulation of antiaging, sensitive-skin creams containing the ingredient. Rivers no longer remembers how much that cost, but it was a whole lot less than he expected. He handed jars out to friends and patients and colleagues for free. "I thought it was going to be a one-off flash in the pan," Rivers said, but people started asking for it.

…

"We’re simply saying it’s effective for sensitive skin," he said. "We’re not saying it will cure rosacea."

He’s insisting on providing free samples so consumers aren’t coerced.

"It’s not going to work for everybody. Some people may find it irritating to their skin. We’re just saying there’s an alternative for you."

And he’s careful with loaded words: "I never say ‘pure’, never ‘the best’, never ‘guaranteed.’" "Being an academic, I’m fairly skeptical by nature, so I haven’t given up my day job. I had a vision to do something and, at the very least, I’ve brought my vision to reality," Rivers said. "Where it goes, I don’t know.

Related Articles

• What is the Best Moisturizer for Rosacea ?
• Inactive Ingredients Just as Important as Active Ingredients
• 4% Quassia Amara Extract as good as Metrogel and Finacea

acne.org is a large online community of acne suffers that includes a small area for rosacea sufferers. The site is run mostly by volunteers and doesn’t accept any advertising. This in itself is something uncommon, a large internet site that isn’t owned by a commercial interest that doesn’t accept advertising. The site tells us that it uses the sales of their custom products to help pay for the running of the site.

The acne.org Regime

The regime has been developed by Mr. Kern as he was unhappy with the formulation, availability and cost of commercially available regimes for acne. Certainly the products that have been developed are generously sized and very cheap.

I applaud Mr. Kern and acne.org for developing their own treatment regime. Well done!

The acne.org regime consists of a Cleanser, a 2.5% Benzoyl Peroxide based Treatment Gel, Moisturizer with Licochalcone, Jojoba Oil and also a 10% Glycolic Acid based AHA+ product.

Even though the regime includes a benzoyl peroxide gel and a Glycolic Acid product, I thought that 3 other components; the cleanser, moisturizer and jojoba oil were worth highlighting.

If you are looking for a  cheap and simple cleansing and moisturizing regime, with a very short list of ingredients, then read on.

Acne.org Cleanser

Here is their description of the cleanser: “Liquid cleansers are less drying and can more easily achieve pH balance. However, liquid cleansers never lathered enough for me. I like a nice lather with my cleanser. So I asked several manufacturers for the impossible–a pH neutral liquid cleanser that lathers well. After trying 11 or 12 samples, the winning manufacturer came through with a carefully combined ingredient list which achieved an exact pH of 5.5. Since the pH of human skin is about 5.5, the result is a cleanser that leaves the skin in an even harmony without over drying or stripping the skin. And it lathers well! I was thrilled. I also made sure there were no perfumes or dyes. If you’re looking for a colored or scented cleanser, this is not the one for you. Instead, it is as simple as possible–a neutral pH, a nice substantial feeling in the palm, a gratifying lather, and a clean rinse.”

Cleanser Ingredients

Water, PEG-80 Sorbitan Laurate, Cocamidopropyl Betaine, Sodium Trideceth Sulfate, Glycerin, Sodium Lauroamphoacetate, PEG-150 Distearate, Sodium Laureth 13 Carboxylate, Disodium Cocamphodiacetate, Butylene Glycol, Sage Extract, Cucumber Extract, White Oak Bark Extract, Panthenol, Allantoin, Acrylates Copolymer, Methylgluceth-20, Polysorbate-20, Quaternium-15, DMDM Hydantoin, Disodium EDTA.

Read some honest reviews in the review area: Acne.org Cleanser

Purchase Cleanser at danielkern.com: $7 for 8 oz (235ml) or $9.50 for 16 oz (475ml).

Acne.org Moisturizer

The acne.org moisturizer contains Licochalcone, the same active ingredient promoted by the Eucerin Redness Relief range who claim that their products are proven to provide redness relief.

“Generously sized moisturizer with licochalcone. Also contains jojoba oil. Intensely hydrating, non-comedogenic lotion designed to eliminate dry, flaky skin. Goes on clear and absorbs quickly, leaving no residue. Super light feel, fragrance free and dye free.”

Moisturizer Ingredients

Water, Simmondsia chinensis (Jojoba) Seed Oil, Methyl Gluceth-20, Squalane, Saccharide Isomerate, Butylene Glycol, Sodium Hyaluronate, Glycyrrhiza glabra (Licorice) Root Extract, Panthenol, Tocopheryl Acetate, Cetearyl Alcohol, Sorbitan Olivate, Cetearyl Olivate, PEG-12 Glyceryl Distearate, PEG-23 Glyceryl Distearate, Carbomer, Triethanolamine, Phenoxyethanol, Ethylhexylglycerin

Great to see Jojoba Oil being used here and the use of Licochalcone is also interesting.

Read some honest reviews in the review area: Acne.org Moisturizer, Dan’s New Formula

Purchase the Moisturizer at danielkern.com: $14.92 for 8 oz (235ml) or $24.19 for 16oz (475ml).

Acne.org Jojoba Oil

Great to see that our fellow skin sufferees (is that a word?) also love jojoba oil. For very dry skin this is great. Apply a few drops to your palms and gently rub into very wet skin. The oil absorbs really easily allowing you to further apply a moisturizer if required. I used to use vita oil when my skin was really dry and would recommend it to kick start your regime.

“Generously sized 8 oz. certified organic jojoba oil. I recommend people try a few drops of jojoba oil in whichever moisturizer they are currently using. It will not clog pores at all. Quite the contrary, it makes my skin look great and keeps my skin’s oil balanced. “

Jojoba Oil Ingredients

Jojoba Oil (100% Organic)

Read some honest reviews in the review area: Acne.org Jojoba Oil

Purchase Jojoba Oil at danielkern.com: $14.75 for 8oz (235ml).

Love To Hear From You!

I was excited to find that such a simple, elegant and inexpensive cleanser and moisturizer was easily available.

I’m quietly hopeful that these products might also become popular with rosacea sufferers. It would be a great result if rosacea sufferers were able to find here a gentler, simpler and cheaper regime that they thought possible.

Please let us know if you decide to give them a try.

Featured Products

Related Articles

• Eucerin Redness Relief (Licochalcone A) relieves red face
• Jojoba Oil has Anti-Inflammatory Properties
• Vita Oil vs. Jojoba Oil

I harp on about this a lot, but I think it is worth repeating. A gentle skin care regime is a good thing for your rosacea. We know from some small studies that rosacea sufferers can benefit from a moisturizer that improves the stratum corneum skin barrier function.

How do you go about finding a good moisturizer for your rosacea? There are so many on the market, some from big name cosmetic companies, and some from relatively unknown companies.

Well, one way, I hope, is to look at the user reviews collected here at rosacea-support. So far there are pages for moisturizers such as Rosaclear,  Cetaphil RestoraDERM, Cetaphil Moisturizing Cream, CeraVe Moisturizing Lotion,  Clinique Redness Solutions, Rosaliac, Rosacure, Aveeno Ultra Calming, and Eucerin Redness Relief.

So what about Vanicream Moisturizing Skin Cream? Vanicream has one of the shortest list of ingredients you are likely to find. For many rosacea sufferers, simple is good!

This product does contain cetearyl alcohol, propylene glycol and petrolatum which may raise some concerns to those with hyper sensitive skin. A useful background post from Dr. Sy on Cetyl Alcohol and Liquid Cleansers may be worth reading here too.

The makers of Vanicream, Psico tell us that it is formulated without common chemical irritants like parabens, irritating preservatives, dyes, lanolin and fragrances.

Vanicream is available as both a Skin Cream and Lite Lotion. The ingredient listings for both contain the same items, but it appears that the lite lotion contains more propylene glycol and the skin cream contains more sorbitol solution.

Vanicream User Reviews

So with no more ado, lets look at some reviews from real people who have tried Vanicream.

Artist said “I then switched from Cerave moisturizer to Vanicream Lite Lotion (found at the drug store). I chose the Vanicream because it is very simple and specifically made for super sensitive skin, no frills. I was then able to tolerate the Finacea, which has since helped my skin quite a bit. It’s not perfect, but it’s more normal acting and looking if that makes sense. So, the big idea is that I found a moisturizer (Vanicream Lite Lotion) and my skin is better for it. I think moisturizing enabled me to tolerate the topical medication, Finacea, through the rough beginning period when your skin adjusts to it.”

further Artist said: “I like Toleraine Dermo Cleanser to wash with and Vanicream Moisture Cream to moisturize with. I use a hat in the sun since sunscreens tend to irritate. I use a good, soft scarf made of that soft felt-type material to protect my skin from cold winds in the winter.”

Linda said: “The Vanicream seems too thick when first applied, but soaks in well. In about 10 – 15 minutes I can put on my Bare Escentuals mineral powder makeup.” as well as “I have found Vanicream products to be the absolute best. When I developed rosacea, I had to drop all the moisturizers that I normally used. Even Cetaphil moisturizer and cleanser burned.”

Pinky said: “Mild soaps such as hypoallergenic Dove, etc. burned my face during my first flare of Rosacea. My dermatologist offered me a sample of VaniCream, a bar soap. Extremely gentle. Didn’t feel any sting while using it.”

seachange said: “I read some of her [Artist] backposts and discovered Vanicream Moisturizing Skin Cream a few days ago. My skin just loves it and feels totally protected and moisturized. I had a bad flare-up last week from some harsh wind, and subsequently got that oh-so-sexy red blotchy face. Almost all the redness and irritation is gone. I use the thicker cream at night then the lite lotion for daytime wear. I also splash on a bit of jojoba oil with water for cleansing, and that has also really softened my skin. It does have petrolatum as a main ingredient, and I think that might be a issue for some rosaceans, but luckily my skin can tolerate it. The most amazing thing–to me at least–is that Vanicream is only $15 at Walgreens and you get a ginormous container. I probably won’t need lotion for the next decade or so. The thing is biiiig.”

Maureen said: Like many rosaceans, I have extreme facial sensitivity and can’t tolerate most cleansers, moisturizers, sunscreens, etc., all of which sting and burn. I use Vanicream moisturizer, which I want to mention since it’s not on the list above and it works for me. You can occasionally but rarely find it in drugstores; I buy it from drugstore.com. Has a very simple list of ingredients that you can check out on the drugstore.com website. Also, surprisingly inexpensive. It comes in a light lotion and in a thicker cream, which does take a little time to melt into your skin, but is altogether worth it.

Vanicream Moisturizing Skin Cream Ingredients

Purified water, white petrolatum, sorbitol solution, cetearyl alcohol, propylene glycol, ceteareth-20, simethicone, glyceryl monostearate, polyethylene glycol monostearate, sorbic acid and BHT

Where to Buy

The Vanicream range is available from Dermadoctor , from drugstore.com and even from Walgreens.

Featured Product

Your Thoughts

Vanicream is not a product from one of the large or well known pharmaceutical companies. Would you recommend it to your fellow rosacea sufferers?

Related Articles

• Vanicream Sunscreens User Reviews
• The Best Moisturisers with Sunscreen
• Why should I Cleanse and Moisturize my dry, oily, flaky SD skin?
• Vanicream Sunscreens User Reviews
• Cetaphil Gentle Skin Cleanser Well Tolerated
• Sensitive Skin Care Products for Rosacea Sufferers
• Gentle Cleanser is Important
• Exotic and expensive cosmetics, do they work ?
• What is the best moisturizer for rosacea ?

Epikinetics Pharma has pushed out a press release today (reproduced in full on sfgate.com which seems a bit sad; for a newspaper to just re-publish press releases I have to say) promoting a new product called AzaClear.

AzaClear combines Azelaic Acid, Niacinamide and Glycerin.

The manufacturers say this product is “designed to address the visible effects of problem or aging skin” and they also  “consider azelaic acid + niacinamide a potent and highly effective cosmetic topical agent “.

The question asked is a good one – how can cleansing and moisturizing the dry flaky and oily SD skin be a good thing? If you have ever wondered why this is so, read on.

It was interesting to read again how for severely sensitive skin, repairing the skin barrier function is an important step.

Another related thread, also from Dr. Sy is also worth reading: Moisturizer and sensitive skin barrier

Moisturizer Oil and Seborhheic Dermatitis

From: "M. Riley"
To: Rosacea Support
Sent: Wednesday, December 27, 2000 6:34 PM
Subject: Dr. Sy or Anyone, Pls Help: Seb Derm Questions

I recently developed these pink, dry, raised, crusty patches of skin under my eyes. By the time I was able to see the dermatologist, though, the patches cleared up.

When I described them to the dermatologist, he immediately suspected seborrheic dermatitis, as he said they typically show up around the eyes, nose and ears.

He wanted to give me cortisone for it, but having suffered from the consequences of long term cortisone use, I refuse to use the stuff. He made it seem like there was no other treatment besides cortisone.

I have read on this site that some folks here are using Nizoral or Noritate. I can’t use Noritate because it irritates my skin.

1. As for Nizoral, can it safely be used around the eyes?
2. Also, would antibiotics help at all? I’ve been trying to wean off doxycycline over the last month, and 3 weeks ago these dry patches appeared. Is there a correlation?
3. I also understand using heavy moisturizer on seb derm also makes it worse, but I’ve been using Vita Oil and it seems to help. Is this okay?
4. Would photoderm help with seb derm at all?

Thanks.

From: Linda Sy MD
Date: Thu, 28 Dec 2000 22:23:38

Hello M. Riley,

Of course, you realize that I can’t give you an accurate diagnosis but my guess is that the dry crusty patches under your eyes could be one of the following:

1. Seborrheic dermatitis;
2. Rosacea patch; or
3. Asteatotic eczema (fancy name for severe dry winter skin).

My suggestion is for you to slow down on weaning yourself from doxycycline for now. Go back to the last dose you were on 3 weeks ago, before the appearance of the patches.

Go ahead and apply the Vita-Oil 2-3 times a day on a damp face.

One helpful way of pushing the moisture into the skin is to do this: at bedtime, apply water compress (clean soft moist towel, comfortable temp) on the areas involved; leave for 5 minutes. This softens the skin and makes it more permeable. Then apply the oil immediately.

Do this for one week and see if there is improvement. If there is, I would continue until there is clearance.

Do not add any other topical med. If no improvement, you can ask your dermatologist for a prescription of Nizoral Cream (different from shampoo) and apply at bedtime over the Vita-Oil.

Is it harmful to moisturize if this is seborrheic dermatitis?

The answer is NO.

It is true that in seborrheic dermatitis, the theory is that the sebaceous glands are hyperactive, secreting an abundance of sebum that is thicker than normal. This sebum accumulates and dries on the skin leaving dry flakes akin to dry skin but with a greasy somewhat rancid smell. The typical picture shows dry flakes predisposed in areas such as the eyebrows, T zone (mid-forehead, nose & chin) and ears.

Microorganisms, particularly yeasts such as p. ovale and some bacteria conglomerate and thrive in this milieu causing inflammation – hence erythema (redness), more flaking & even crusting. The individual thinks his/her skin is very dry and avoids washing which ironically, is a must in this early stage.

So, with inadequate washing, the condition worsens, becomes eczematous (with redness, itching, bumps, small vesicles) causing the skin to become angry-looking and sore. At this point, washing will cause burning and pain. Skin is raw, permeable and easily irritated. So, the vicious cycle continues.

When this condition approaches this late stage, there are several ways to handle this:

1. Soften the thick greasy sebum/crusts etc. by wet compresses.
2. Repair the epidermal barrier by lubricating it with anhydrous moisturizer that has low preservatives (like oil, vaseline and like ointments).
3. Combat the microorganisms with antifungal creams once skin barrier is somewhat restored and can tolerate the topical med. In some cases, oral antibiotics may be needed if secondary bacteria is present.
4. In severe cases, a short course of topical cortisone ointment to calm down the inflammation speedily. Bear in mind that this last measure should be used no more than 1 week at most.

Once skin is improved, steps 1, 2 & 3 should be maintained PLUS an adequate cleansing program instituted. All these require time for skin to heal. Unless one understands the mechanism of SD, slow progress or a little set-back with appearance of more bumps (sometimes happens) becomes discouraging and one gives up.

Will photoderm help Seborrheic dermatitis?

My suspicion is that it probably does inhibit sebum activity.

Linda Sy M.D.

Related Articles

• Also from Linda Sy: Moisturizer and sensitive skin barrier
• Cetaphil Moisturizing Cream helps Rosacea Dry Skin
• What is the best moisturizer for rosacea ?
• Sebclair for seborrheic dermatitis
• Seborrheic Dermatitis ketoconazole nizoral shampoo
• Promiseb Topical Cream for Seborrheic Dermatitis

Thanks to Beth, here is some more information about a class of FDA Approved “Medical Device” creams. This class of creams are prescription only, contain no active molecules and are approved for sale to treat medical conditions under via the provisions of Class 1 510(k).

It does seem unusual that these creams still require a prescription even though they don’t have any ingredients that are officially `active’.

Why Barrier Creams?

I have never seen any trials that directly link the use of barrier creams with a reduction in rosacea symptoms. Nonetheless we do know that a gentle skincare regime is good for rosacea. Additionally for those who suffer from environmental triggers, and indeed for any with an impaired barrier function, a topical to restore the protective functions of the skin is an interesting prospect.

Here are some comments from Leon H. Kircik, MD., printed in Skin & Allergy News.

Managing Atopic Dermatitis in Children: The Role of Newer Nonsteroidal Topical Treatments

A supplement to Skin & Allergy News and supported by Ferndale Laboratories.

Nonsteroidal Agents for Skin Barrier Repair

Three 510(k) medical device creams have become available over the past several years that are cleared by the FDA for the treatment of atopic dermatitis. This medical device designation means that there is no active drug in the formulation. These products— Atopiclair, Eletone, and MimyX—are also known as barrier creams because they hydrate the skin, help restore damaged stratum corneum, and improve the integrity of the epidermal barrier. Another product, EpiCeram Cream, also is FDA-approved for the treatment of atopic dermatitis but currently is not marketed

Atopiclair contains 2% glycyrrhetinic acid in a hydrolipid base. Atopiclair contains a nut oil and should be used with caution in patients with a known allergy to nuts or nut oil. However, the nut oil in Atopiclair is shea butter, derived from the nut of a North African tree (Butyropermum parkii). The shea nut is not a legume, and Atopiclair contains no peanut oil or peanut extracts. MimyX contains ingredients that mimic natural lipids and squalane, which are components of the stratum corneum. The main ingredient in MimyX is N-palmitoylethanolamine (more commonly referred to as PEA); PEA is a naturally occurring essential fatty acid with anti-inflammatory properties that usually is deficient in patients with atopic dermatitis.

Eletone is unique among the barrier creams because it contains 70% oil dispersed in 30% water yet maintains the consistency and feel of a cream. (Most creams contain 30% oil in 70% water; most ointments contain 30% water dispersed in 70% oil). This is possible through the use of Hydrolipid “reverse emulsion” technology. As a result of this proportion of lipids and water, Eletone provides the advantages of ointments (occlusion and maximal barrier protection) without the disadvantages: many patients object to the cosmetic appearance and feel of “greasiness” and fail to comply with regimens involving ointments.

Conclusion

A number of inflammatory dermatologic conditions adversely affect the dermal barrier; among the most common is atopic dermatitis. The nonsteroidal barrier creams discussed here are welcome additions to the roster of treatments that may be useful as adjuncts to topical corticosteroid therapy during acute flares and as long-term maintenance during periods of disease remission. Their safety profile is excellent: there is no pregnancy category, and there are no age, application-site, or duration of treatment restrictions on their use.

Ferndale Laboratories are the makers of Eletone. Their web site has been down for a while now though.

Eletone should not be confused with Elecon which is a steroid cream.

It is interesting to read that Eletone has such a high dispersion of oil in water, yet is not greasy. This will definitely help people who would like to try these sorts of barrier creams but greasy products are out of the question.

More Medical Device Creams

Another Class 1 501(k) Medical Device Cream that might be interesting is Kelo-Cote. Kelo-Cote contains silicone compounds such as polysiloxane and silicone dioxide. This is promoted as a scar treatment and is said to have been shown to flatten, soften,  smooth and relieve the itching and discoloration of scars.

Even More Barrier Cream Options

If you would like to try a different barrier cream then something like the new Cetaphil RestoraDERM might be worth a try. This has been formulated as a skin restoring body moisturizer for itchy dry skin.

This product is more marketed towards Eczema sufferers but has received some good reviews from rosacea sufferers.

Some Good Eczema Advice

I thought this following advice was pretty reasonable: you can use these non-steroidal creams to help you wean off the harsher topicals like Protopic and Elidel that have side effects and may not be suitable long term.

Eczema from Naperboork Dermatology

NON-CORTISONE PRODUCTS:

• Apply Protopic Ointment twice daily to all affected areas. Avoid the sun.
• Apply Elidel Cream twice daily to all affected areas. Avoid the sun.
• Apply Atopiclair twice daily to all affected areas. Avoid if you have a nut/peanut allergy.
• Apply Mimyx Cream twice daily to all affected areas.
• Apply Eletone Cream twice daily to all affected areas.
• Apply Epiceram twice daily to all affected areas.

As your eczema or rash improves, decrease use of cortisone products and/or Elidel/Protopic and try to use Atopiclair, Mimyx, Eletone Cream, or Epiceram. As you improve further, eliminate the Atopiclair, Mimyx, Eletone, or Epiceram and just lubricate your skin instead.

Protopic ointment and Elidel Cream have Black Box Warnings placed on them by the FDA. They report plausible cause of skin cancer, lymphoma, and other cancers.

EpiCeram Cream

As listed above, EpiCeram Cream is another Skin Barrier Treatment marketed as a Skin Barrier Emulsion.

EpiCeram is made by Promius Pharma, who also make Promiseb Topical Cream. EpiCream is apparently covered by Patent 5,643,899 Lipids for epidermal moisturization and repair of barrier function. This patent suggests that the important parts of such preparations are cholesterol and acylceramide.

See the EpiCeram Prescribing Information for more information.

Barrier Creams for Rosacea Sufferers?

So what do you think?

Would you try a barrier cream to help with your rosacea, or seborrheic dermatitis or extra dry skin? Please let us know how you get on if you do.

Related Articles

• Sebclair for seborrheic dermatitis
• Promiseb Topical Cream for Seborrheic Dermatitis
• Cetaphil RestoraDERM for extra dry skin and Eczema
• Sensitive Skin Care Products for Rosacea Sufferers

Wouldn’t it be great if there was a simple answer to this question that satisfied everyone who has rosacea!

Hopefully it doesn’t come as a surprise to find out that there is no known panacea for rosacea.

This high level paper from The Journal of Family Practice seeks to summarise the available published research into rosacea treatments. Thus the treatments being labelled `best’ by this study are only ever going to be the ones that have been proven by years of research and development and real life testing.

What I’m trying to warm you up to is the idea that you should only ever expect to see the well known prescription topical and systemic treatments emerge from these sorts of studies.

Clinical Inquiries: What is the most effective treatment for acne rosacea?

J Fam Pract. 2011 Feb;60(2):108a-c., May D, Kelsberg G, Safranek S.

Topical metronidazole and azelaic acid are equally effective for the papulopustular lesions of acne rosacea, although metronidazole is better tolerated. Oral doxycycline, tetracycline, and metronidazole are also effective, but not enough evidence exists to determine whether one is more effective than another or more effective than topical therapy (strength of recommendation [SOR]: A, systematic review and individual randomized controlled trials [RCTs]).

Some evidence supports a benefit for topical sodium sulfacetamide with sulfur, and benzoyl peroxide (SOR: B, small single RCTs).

Pulsed-light and laser therapy may improve the erythema and telangiectasias associated with acne rosacea (SOR: C, case series).

All patients with acne rosacea should use sunscreen and emollients, and avoid skin irritants (SOR: C, expert opinion)

Recommendations

The American Acne and Rosacea Society guidelines state that good evidence supports topical treatments—metronidazole,
azelaic acid, and sulfacetamide/sulfur—as well as anti-inflammatory doses of oral doxycycline.

The guidelines also list other topical and oral antibiotic treatments, but cite low-quality evidence for their efficacy and concerns about the emergence of antibiotic resistance. They advise appropriate skin care, including gentle cleansers, moisturizers, and sun protection.    

Full Article PDF: What is the most effective treatment for acne rosacea?

Best Topical Therapy

Topical Metronidazole (Metrogel) and Azelaic Acid (Finacea) are indicated as being better than placebo, but “the studies
were generally weak because of poor methodology and reporting, small sample sizes, and lack of quality-of-life measures.”

Overall Metrogel is better tolerated than Finacea.

Best Systemic Therapy

Oral Metronidazole (Flagyl) and Oral Tetracycline as well as anti-inflammatory dose oral doxycycline (Periostat/Oracea) have been found to be effective.

Best Therapy for Redness

The best therapy for redness and broken blood vessels was found to be pulsed light therapy, laser therapy and photodynamic therapy with red light. No great surprises there.

Other Tips

“They advise appropriate skin care, including gentle cleansers, moisturizers and sun protection”. That is good advice we should all heed.

Can YOU Answer This Question?

Perhaps this paper won’t happily satisfy everyone’s quest for rosacea relief, but maybe you can.

You meet a newly diagnosed rosacea sufferer who is distressed. You have memories of being there yourself. What advice will you give them – what do you think is the best treatment for rosacea?

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The idea of using an American Academy of Dermatology Poster session paper to introduce research around a new product is nothing new. Getting a poster session approved is easier than a full journal paper, so this path is certainly an attractive way to publicize your research.The AAD Poster Sessions are therefore one way in which rosacea sufferers get a glimpse into the leading (or indeed bleeding) edge of rosacea research.

From the description of the Rosacea Treatment System contained in this abstract, it seems clear that this regime is the Obagi Rosaclear System.

Obagi is a registered trademark of OMP, Inc. OMP stands for Obagi Medical Products. OMP are listed as commercially supporting this trial.

Obagi promote the Rosaclear System as a containing ;

• a “gentle cleanser that soothes your skin while helping to remove bacteria and other irritating residues”. It contains Aloe.
• a Hydrating Complexion Corrector that “protects and moisturises your skin while helping to reduce the appearance of redness by utilizing multiple calming agents and light-reflecting minerals”
• a Skin Balancing Sun Moisturizer SPF15 – a chemical free tinted UVA/UVB moisturizer which easily blends with your skin to help reduce the appearance of redness and blotchiness”. The ingredients list Zinc Oxide 15.5% and Titanium Dioxide 2.0%.

The 4th part of  the regime is a generic version of 0.75% Metronidazole Topical Gel available via prescription only.

We are told that the calming agents are licorice, aloe, lavender, sea whip and Mica.

P301 Evaluating a rosacea treatment system containing a cleanser, metronidazole, hydrating complexion corrector, and sunscreen

AAD Summer Academy Meeting 2010, August 4-8, 2010, Chicago Ill.

http://www.aad.org/posters/presentations/_doc/SM2010/Abstracts.pdf

James Leyden, MD, KGL, Inc., Broomall, Pennsylvania, United States

Introduction: A rosacea treatment system (consisting of four components—cleanser, metronidazole 0.75% gel, hydrating complexion corrector, and sunscreen SPF30) has been developed to treat rosacea pharmacologically and non-pharmacologically. The system aims to reduce the appearance of redness as rapidly as possible while also providing other clinical benefits in the longer term.

Methods: Adult women with mild or moderate rosacea, and mild or moderate erythema on the malar area of the face, were eligible to enrol in this investigator-blind, parallel-group study. Participants were randomly assigned to receive one of the following three treatments for 28 days: the rosacea treatment system; the rosacea treatment system minus metronidazole; or metronidazole 0.75% gel plus standard skin care (standard cleanser and moisturizer/sunscreen). Each product was applied twice daily except the sunscreen in the rosacea treatment system was applied each morning and as needed.

Results: Overall, 30 patients enrolled and 29 (97%) completed. The proportion of patients who, at day 28, had at least slight global improvement (≤ 24% improvement) was 90% with the rosacea treatment system, 60% with the rosacea treatment system minus metronidazole, and 67% with metronidazole plus standard skin care. The proportion with at least moderate global improvement (25-49%) was 40% with the rosacea treatment system, 10% with the rosacea treatment system minus metronidazole, and 11% with metronidazole plus standard skin care.

At day 14, the mean erythema score had declined in the rosacea treatment system group and remained unchanged with metronidazole plus standard skin care.

At day 28, the proportion of patients considering their study regimen to be very effective, effective, or somewhat effective in reducing dryness was 90% with the rosacea treatment system, 90% with the rosacea treatment system minus metronidazole, and 78% with metronidazole plus standard skin care.

Also at day 28, the proportion of patients who reported their skin was easily irritated at least sometimes was 40% with the rosacea treatment system, 70% with the rosacea treatment system minus metronidazole, and 89% with metronidazole plus standard skin care. Two adverse events were reported (both in the metronidazole plus standard skin care group)—dry chin and burning sensation.

Conclusion: The rosacea treatment system may offer superior efficacy and tolerability to metronidazole plus the standard skin care used in this study.

Commercial Support: Supported by OMP, Inc.

My Thoughts

It is encouraging to see a company that is promoting the use of a complete, gentle skincare regime. For many rosacea sufferers, being able to find the best combination of a moisturizer, sunscreen and cleanser is a good step toward finding relief.

The Rosaclear web page has a nice morphing Before & After gallery tab for 2 patients who have used the regime for 1 or 4 weeks. You would have to say that the improvement shown in these photographs, though, is on the mild side.

Time will tell whether the combination suggested by Obagi is going to be find success as a complete rosacea skincare regime.

User Reviews

moree65 says “I’ve had a great experience so far with these products. The face wash seems to calm burning and the moisturizer works for dry flaky skin, and also goes on white so it hides flushing when I do have an episode. Seems to make a big difference so I will continue using”

and also

“I actually got the Rosaclear samples from a spa that has a doctor on staff. I would not agree to purchase until they gave me samples because I’ve spent too much money on products that don’t work. I did purchase the kit after using the samples for 10 days. The kit includes a face wash, skin corrective moisturizer, and metro gel that is the same strength as the prescription one. You only use just a small amount so it should last quite awhile. Look online and see if there is a spa close to where you live that carries the line. Good luck and I hope it works for you too.”

Liz says: Working well so far. Was put on the Rosaclear system about four weeks ago – I really like the cleanser a lot because it cleans extremely well and leaves my skin feeling soft and not tight at all. Smells fresh and takes very little to get the job done.

Donna says: “Just thought I’d share…I recently started using the SPF 30 in the Obagi rosacea line of products and I’m really happy with it. It has a bit of tint which helps hide the redness, and it soaks in without feeling greasy. I apply a dime size amount to my face and wait about 10 minutes before applying my mineral foundation (Alima). I find I don’t need much foundation to cover the redness. It’s a bit pricey, but I bought mine on eBay for about US$22. This is my new
favorite.”

How To Buy

Obagi are favouring selling their products through professional offices or official country distributors.

Alternatively, it appears that you can purchase rosaclear from Amazon and also Dermstore.

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Some press this week about an emerging diagnostic technology known as Raman Spectroscopy. Raman Spectroscopy looks at the way that light scatters when it interacts with different molecules. The technology can analyse the scatter patterns to determine exacting details to do with the chemical makeup of the tissue being examined.

The article suggests that Raman Spectroscopy can be used in a whole new range of ways in a diagnostic role.

Read on to find out how, in fact, this emerging technology has already been used in the development of rosacea treatments.

Painless laser device could spot early signs of disease

By Katia Moskvitch

Science reporter, BBC News

Portable devices with painless laser beams could soon replace X-rays as a non-invasive way to diagnose disease.

Researchers say that the technique could become widely available in about five years.

The method, called Raman spectroscopy, could help spot the early signs of breast cancer, tooth decay and osteoporosis.

Scientists believe that the technology would make the diagnosis of illnesses faster, cheaper and more accurate.

Raman spectroscopy is the measurement of the intensity and wavelength of scattered light from molecules.

It is already being used in the chemical and pharmaceutical industries. For instance, Raman lasers are used to measure flame characteristics. By studying how fuels burn, pollution from the products of combustion can be minimised.

…

When a person is sick, or about to become sick, the chemical mix in the tissue is quite different from that in healthy tissue, scientists say. So the Raman spectrum changes depending on the tissue it analyses, Professor Morris explained.

"Raman gives you a molecular fingerprint, a composition of whatever it is you’re measuring," he said.

"In diseased states, the chemical composition is either slightly abnormal or very markedly abnormal, depending upon the diseases."

How Raman is already being used

The application of Raman Spectroscopy to topical therapies is one example of where this new technology might lead to new products and treatments that are good for rosacea sufferers.

Indeed Raman has already been used to help understand how topical products interact with human skin.

Moisturizer Hydration

Rosacea News first mentioned this technology in 2006 in a study that attempted to measure how effectively the skin’s stratum corneum is hydrated by moisturizers. The 2006 study was interested in formulations of moisturizers that contain niacinamide (Vitamin B3). The sponsors of the study, Proctor & Gamble manufacture several products in the Olay Total Effects range that contain niacinamide. Additionally the new formulation of 1% Metrogel contains niacinamide.

RS was used to obtain accurate measurements of the amount of moisture in the stratum corneum.

Metrogel Absorption

Two studies featured by Rosacea News in 2007 looked at the way that metronidazole was absorbed by the skin.

metrogel: how it gets into your skin

Confocal Raman microspectroscopy is a nondestructive and rapid technique which allows information to be obtained from deep layers under the skin surface, giving the possibility of a real-time tracking of the drug in the skin layers. The specific Raman signature of the drug enables its identification in the skin. In this study, we try to follow the penetration of Metronidazole, a drug produced by Galderma as a therapeutic agent for Rosacea treatment, through the skin.

This technology allowed 6 different formulations of metronidazole to be evaluated. Then penetration of the cream formulations was found to be greater than the lotion and gel formulations.

The application of RS here will open the door to far more accurate analysis of topicals, ensuring that the correct vehicle will deliver the active ingredients to the tissue that will show maximum benefit.

The Future

Imagine if Raman Spectroscropy could be used to accurately diagnose rosacea. What a great achievement that would be. We can but dream.

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Already available in Canada, Cetaphil will introduce a new line of products for dry sensitive skin in August in the US. The line is called RestoraDERM and is targeted at Eczema sufferers who struggle to maintain the natural moisture balance of their skin. For

For those rosacea sufferers who also have eczema or also struggle with moisturizing extra dry or itchy skin, this range may be worth a try.

I suspect that the moisturizer may initial seem thick compared to other moisturizers familiar to rosacea sufferers. Please leave a comment below if you do try them. What are they like ? Do they help you battle with any of you rosacea symptoms ?

The Canadian web site for RestoraDERM tells us that the soap-free liquid cleanser is said to encapsulate high levels of moisturizing oils to cleanse and hydrate dry skin, whilst the lotion is said to contain patented ceramide technology to replenish the skin’s natural oils to help the skin to retain its natural moisture.

We are also told that both products are `clinically proven to be suitable for total-body use—including the face’ and are `ideal for the entire family’ and that the products have been demonstrated to relieve dryness and itching.

When Galderma acquired Collagenex in 2008, Collagenex listed a technology known as Restoraderm (along with Oracea and Sansrosa) as one of the assets acquired. Restoraderm at that time was described as a “proprietary, foam-based, topical drug delivery technology”. It isn’t clear to me whether this product is related to this technology or is something else entirely.

Ingredients

Thanks to sans002 for the list of ingredients for this new range.

Cetaphil RESTORADERM Eczema Moisturizing Wash Ingredients

water, shea butter, sodium trideceth sulfate, glycerin, sunflower seed oil, sodium chloride, sodium laurampoacetate, cocamide MEA, citric acid, niacinamide, sodium PCA, tocopheryl acetate, 1,2-Hexanediol and caprylyl glycol, disodium EDTA. guar hydroxypropyltrimonium chloride, allantoin, potassium sorbate, arginine, methylisothiazolinone

Cetaphil RESTORADERM Eczema Moisturizing Lotion Ingredients

water, glycerin, caprylic/capric triglyceride, sunflower seed oil, pentylene glycol, shea butter, sorbitol, cyclopentasiloxane, cetearyl alcohol, behenyl alcohol, glyceryl stearate, tocopheryl acetate, hydroxypalmitoyl sphinganine, cetyl alcohol, arginine, disodium ethylene dicocamide PEG-15 disulfate, glyceryl stearate citrate, niacinamide, sodium PCA, ceteareth-20, sodium polyacrylate, caprylyl glycol, allantoin, citric acid, panthenol, dimethiconol, disodium EDTA, sodium hyaluronate

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