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

Recent research is highlighting just how important are all of the ingredients in a topical preparation.

The benefits to your skin from the vehicle components help explain why one might even obtain relief from vehicle-only preparations. For example if you are on a clinical trial that is blinded. Particularly if your skincare regime is not supporting the functions of your skin, the vehicle carrying the active ingredient in a topical may itself be worth using.

This further reinforces the argument that a gentle (and supportive) skincare regime is important for rosacea sufferers.

Of course mixing your own topicals is not an easy task, so mostly we are limited to the formulations that have been made for us by the pharmaceutical companies.

As a refresher here is a listing of ingredients of the most popular rosacea topicals. As you can see it is not an easy task to discover just from the listing whether a topical is going to be a winner for you.

Metrogel Ingredients

METROGEL (metronidazole gel), 1% is an aqueous gel; each gram contains 10 mg of metronidazole in a base of betadex, edetate disodium, hydroxyethyl cellulose, methylparaben, niacinamide, phenoxyethanol, propylene glycol,propylparaben and purified water.

Finacea Ingredients

Each gram of Finacea contains 0.15g (15%) micronized azelaic acid in a gel base. It also contains 0.1% benzoic acid, propylene glycol, polysorbate 80, lecithin, polyacrylic acid, triglycerides (medium chain), sodium hydroxide, disodium edetate and purified water.

Plexion Ingredients

Each gram of Plexion® (sodium sulfacetamide USP 10% and sulfur USP 5%) Topical Suspension contains 100 mg of Sodium Sulfacetamide USP and 50 mg of Sulfur USP in a suspension containing: Purified Water USP, Propylene Glycol USP, Isopropyl Myristate NF, Light Mineral Oil NF, Polysorbate 60, Sorbitan Monostearate NF, Cetyl Alcohol NF, Hydrogenated Coco-Glycerides, Stearyl Alcohol NF, Fragrances, Benzyl Alcohol NF, Glyceryl Stearate (and) PEG-100 Stearate, Dimethicone NF, Zinc Ricinoleate, Xanthan Gum NF, Edetate Disodium USP, and Sodium Thiosulfate USP.

Klaron Ingredients

Each mL of Klaron (sodium sulfacetamide lotion) Lotion, 10% contains 100 mg of sodium sulfacetamide in a vehicle consisting of purified water; propylene glycol; lauramide DEA (and) diethanolamine; polyethylene glycol 400, monolaurate; hydroxyethyl cellulose; sodium chloride; sodium metabisulfite; methylparaben; xanthan gum; EDTA and simethicone.

Research Abstracts

Topical rosacea therapy: the importance of vehicles for efficacy, tolerability and compliance, J Drugs Dermatol. 2011 Jun 1;10(6):627-33, Jackson JM, Pelle M.

Many topical medications are available for the treatment of papulopustular rosacea. While treatments contain metronidazole, azelaic acid, or sodium sulfacetamide-sulfur as the active ingredient, the composition of the vehicle formulations varies widely.

These vehicles come in gels, creams, lotions and foams; some ingredients are common to many vehicles, while some vehicles contain unique ingredients designed to optimize skin penetration and delivery of the active drug to its target.

Vehicles can also influence tolerability, which is always a concern in patients with heightened skin sensitivity, and compliance, which is typically lower for topical treatments than oral treatments.

Ideally, the vehicle of any rosacea treatment should enhance drug delivery, be non irritating and be easy to use. Ingredients that help repair barrier function are also desirable. This review will focus on the key components of the vehicles from the most commonly used topical therapies for papulopustular rosacea and how vehicle formulations influence the delivery of active ingredient, skin barrier repair, tolerability and compliance.

Further related research;

THE IMPORTANCE OF VEHICLE IN ACNE THERAPY

Emil A. Tanghetti, MD, Chair, A Supplement to Skin & Allergy News,

Skin Disease Education Foundation’s 29th Annual Hawaii Dermatology Seminar, a continuing medical education program, March 18-24, 2005, in Maui, Hawaii. 

Physicians attempting to balance aggressive acne treatment with tolerability stress the importance of restoring hydration of the stratum corneum. Research demonstrating the stratum corneum’s pivotal role in drug delivery has sparked renewed interest in this topic.

Many common conditions directly and indirectly affect barrier function.  For example, atopic dermatitis, psoriasis, and acne affect barrier function directly through the impact of the inflammatory process on epidermal growth and maturation. Medications used to treat a number of conditions indirectly disrupt barrier function.  Topical retinoids—the mainstay of acne treatment—change and disrupt barrier function.

Several signs and symptoms characterize damage to the epidermal barrier.  Dryness and peeling occur when the water content of the stratum corneum falls below 10%.  This creates a damaged and leaky epidermis that may lead to overabsorption of topical medications and products, causing even more barrier damage.

Summary

Restoring and maintaining barrier function is critical for outcomes in patients with dermatologic diseases.  For optimal hydration, a vehicle that is both occlusive and humectant is ideal.  The addition of moisturizers such as dimethicone and glycerin to acne treatment products helps maintain barrier function and will provide better outcomes. This is particularly important when topical retinoids are included in the therapeutic regimen. For comedonal acne, combination products containing moisturizers may be effective first-line agents. Finally, clinicians should consider the vehicle prior to prescribing or recommending any products to patients with acne.

Related Articles

• Metronidazole (Metrogel, Flagyl) is a popular rosacea treatment
• Finacea Gel (azelaic acid 15%) as a Rosacea Treatment
• RSRP: Sulfur / Sodium Sulfacetamide Topicals

A search on PubMed for Quassia extract reveals a a couple of dozen relatively recently published articles investigating the chemical makeup of Quassia extract, and its effect as an anti-ulcerogenic, as an antimalarial, and antibacterial and antifungal agent. It would seem from this that Quassia amara is attracting a growing interest as a pharmacological active.

Many drugs can trace their genesis to a biological source. Whilst a natural source for an interesting extract may sound enticing, even promising, I see the advantage of a natural source being the ease of sourcing experimental samples. The easier samples are to source, the more likely that researchers will be willing to undertake new studies.

It is tempting to get excited about something new, and the promise that it may bring to rosacea sufferers, but I like to caution my excitement with the knowledge that “nothing is as promising as an unproven treatment”.  That is, it is easy for a new treatment to hold some promise, but far harder for it to be proven to be more effective, less problematic and therefore superior to what we already have.

Having never heard of Quassia amara before today I look forward to reading more about it in the future.

Evaluation of the Efficacy and Tolerance of a Topical Gel With 4% Quassia Extract in the Treatment of Rosacea

J Clin Pharmacol. 2011 Feb 22, Ferrari A, Diehl C, Universidad Nacional de Córdoba.

Background: There are various treatment options available for rosacea, depending on the subtype, but treatment is still generally unsatisfactory. Some studies have reported antiparasitic and anti-inflammatory properties of Quassia amara.

Aim: To check the efficacy and safety of a topical gel with 4% Quassia amara extract in the treatment of various grades of rosacea.

Methods: A group of 30 patients with various grades of rosacea (I-IV) were investigated in a single-center, open-label study. They were treated with a topical gel with 4% Quassia amara extract for 6 weeks. Response was evaluated by the flushing, erythema, telangiectasia, papules, and pustules scores. At the end of therapy, overall improvement, safety, and tolerability were assessed.

Results: Twenty-seven of 30 patients (90%) completed the study. The treatment resulted to be very effective, and the results achieved were in line with those published with topical metronidazole and azelaic acid. Safety and tolerability were excellent.

Conclusion: Topical quassia extract could be a new, efficient, and safe weapon in the armamentarium for the management of rosacea.

Related Articles

• The Top Natural Rosacea Treatments
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• Silymarin (Milk Thistle) + MSM, User Reviews

Trolling patent applications is pretty turgid work. Mostly patents seem to be intellectuals marking out their claims in the hope that future products might result from their discoveries.

This patent application starts badly with firstly spelling Rosacea incorrectly as Rosascea. Pretty embarrassing Allergan ! To save you from seeing this misspelling again I’ll spell it correctly in the extract below.

Sometimes you find interesting information at the bottom of patent applications – where applicants sometimes provide proof that their invention works. In this patent application we find claims that Dapsone is as good as Finacea, Oracea, Metrogel 1% at reducing the facial lesions associated with rosacea.

Allergan, the makers of Aczone, are listed as the owner of this patent.

Back in June 2008 I wondered if Allergan buying Aczone, meant that they had plans for rosacea targeting. In August 2009 Allergan was warned by the FDA for overstating the efficacy and underplaying the risks of Aczone.

Patent Application 20100310480

DAPSONE TO TREAT ROSACEA

The methods described herein provide treatment of rosacea using topical formulations of dapsone. The methods also provide treatment of rosacea with topical dapsone in combination with other active agents, including metronidazole. The methods avoid negative hematologic side effects, including hemolysis and hemolytic anemia, that are associated with oral administration of dapsone.

[0007] In a preferred embodiment, the pharmaceutical composition is a semisolid aqueous gel. The semisolid aqueous gel includes a thickening agent, water, a solvent, preservative, microparticulate dapsone, dissolved dapsone, and caustic material. In a preferred embodiment, the caustic material is a base agent. In a preferred embodiment, the composition exhibits an optimal balance between dissolved dapsone that is available to cross through the stratum corneum of the epidermis and be absorbed into the lower two-thirds of the pilosebaceous unit; and microparticulate dapsone that is retained in or above the stratum corneum to serve as a reservoir or to provide dapsone to the supracorneum zone, crossing the stratum corneum of the epidermis only minimally as a solid. The solid microparticulate dapsone reservoir is slowly dissolved in body fluids before it is delivered through the stratum corneum

[0048] Currently, use of oral dapsone is generally limited, as its use may be associated with hematologic side effects, including hemolysis and hemolytic anemia that are dose-dependent and occur more frequently with increasing dose (Zhu and Stiller 2001; Jollow et al., 1995). The mechanism of dapsone-related hemolysis and hemolytic anemia involves oxidative damage to red blood cells and is associated with the dapsone hydroxylamine metabolite (Prendiville et al., 1988).

[0109] A review of historical results for other approved therapies shows that the mean changes from baseline in lesion count for the dapsone 2 timesa day group was close to that of other approved products for rosacea, including Finacea,(azelaic acid) Gel, 15%, Oracea  (doxycycline) 40 mg capsules, and the active comparator in this study, MetroGel (metronidazole), 1.0%.

See the Aczone Prescribing Information for the official list of indications, contraindications and known side effects for this treatment. The official web site for Aczone is at aczone.com. According to Allergan, women fare better on Aczone. See the Efficacy page for examples of the sorts of improvements that you might expect from Aczone after 12 weeks use.

Related Articles

• Allergan buys Aczone, has plans for rosacea targeting ?
• Aczone Gel (5% Dapsone) gets FDA approval for Acne
• FDA gets tough with Allergan over Aczone

A new story by Mike Armstrong in the Philadelphia Enquirer tells us that the company behind Omiganan, a new treatment targeted at rosacea, has just 2 employees.

Described as a “Development-stage dermatology products maker” and “a virtual company that in-licenses compounds from other companies”, Cutanea shows that small startup-scale companies can at least gain momentum in the dermatology development market.

One way that small dermatology companies can grow is to go public. Cutanea believe that their topical cationic peptide Omiganan forms part of a compelling product portfolio, worth forming a public listed company around.

Cutanea seeks to be 3rd Philly-area life-sciences IPO of 2010

According to a prospectus filed with the Securities and Exchange Commission, it has just two employees – president and chief executive officer Robert Bitterman and Kimberley Forbes-McKean, its chief scientific officer.

Cutanea hopes to raise $13 million from an IPO and use about $4 million to fund a Phase III study of a treatment for rosacea, an inflammatory skin condition characterized by redness in the face.

Rosacea News featured Omiganan in this recently list of What’s Hot in New Rosacea Treatments. Cutanea is seeking to raise $13m, partly in order to complete trials for Omiganan.

Further details from the SEC Filing for the IPO include:

• Cutanea suggest that Omiganan is superior to Metrogel and Finacea because as well as being able to clear the papules and pustules of rosacea, it also is effective against the “secondary signs and symptoms of rosacea including peeling, dryness, itching, burning and erythema (redness).” Thus the primary endpoint for the phase III trial will be for the inflammatory lesions of rosacea and the secondary endpoint being the so-called secondary signs.
• Omigana has been tested as a once daily 2.5% gel.
• The phase III trial is expected to commence in mid-2011 and involve 600 participants using either Omiganan or placebo for 12 weeks.
• All things going well the development process hopes to file a New Drug Application in 2013.
• Cutanea also plan to target atopic dermatitis with Omiganan.
• Cutanea has licensed the exclusive worldwide rights for dermatological uses to omiganan from Biowest Therapeutics Inc.

[update:] November 15, 2010. We have been told that Cutanea has postponed the IPO for a second time.

Related Articles

• Cutanea Life Sciences files IPO to fund Omiganan development
• Omiganan (topical cationic peptide) to be trialled as rosacea treatment

This just published paper details a `new’ product that comprises a slight twist on an old formula. It seems that much of modern research and development involves tweaking existing treatments to see how their efficacy and product lifecycle can be extended.

This new product is known as CLARIFOAM EF Emollient Foam, and is indicated for the topical control of acne vulgaris, acne rosacea and seborrheic dermatitis. The company web site boldly claims that Clarifoam EF effectively treats all 3 conditions.

In combination with sulfacetamide, sulfur has been reported to inhibit the growth of Propionibacterium acnes thereby reducing the inflammation associated with acne.

The active ingredients of Clarifoam EF are a combination of 10% sodium sulfacetamide and 5% sulfur.

The Clarifoam Prescribing Information mentions two forms of application: The Wash-Off application and the Leave-On application. The Wash-Off application suggests a 10 minute application 1-3 times a day to clean dry skin and rinsing thoroughly with water. The Leave-On application suggests the same 1-3 times a day, but wiping off any excess and otherwise leaving the foam application untouched.

The product comes in an aluminium can which needs to be primed before its first use and shaken vigorously before each use. A Clarifoam Rebate Coupon of up to $30 is available until the end of December 2010.

Here is the abstract of the study suggesting that Clarifoam is useful in treat the 3 conditions at once.

Dr. Draelos is well known to rosacea sufferers being on the expert panel that recently published the Standard Rosacea Management Options, the Cetaphil Cleansing Bar and Cetaphil Gentle Skin Cleanser, Clarisonic as well as cleansing and the management of rosacea.

The multifunctionality of 10% sodium sulfacetamide, 5% sulfur emollient foam in the treatment of inflammatory facial dermatoses. J Drugs Dermatol. 2010 Mar;9(3):234-6., Draelos ZD.

Prior to 1962, some of the most versatile drugs in dermatology were approved by the U.S. Food and Drug Administration (FDA) solely on the basis of safety.

One of these is the combination 10% sodium sulfacetamide and 5% sulfur. Sodium sulfacetamide possesses anti-inflammatory and antibacterial properties while sulfur is a nonspecific antibacterial and antifungal. A new emollient foam formulation of 10% sodium sulfacetamide and 5% sulfur allows a thinner application film and leaves behind no residue on hair bearing or non-hair bearing skin. The sulfur smell is also more quickly dissipated with reduced irritation.

This uncontrolled, observational, prospective, open-label, single site, eight-week study enrolled 24 subjects (eight with rosacea, eight with seborrheic dermatitis, eight with acne vulgaris) to evaluate the safety and efficacy of this novel foam formulation.

At eight weeks, statistically significant improvement was seen in inflammatory rosacea lesion counts and the signs of seborrheic dermatitis. A 50% reduction was noted in the total acne lesion counts. These findings confirm the versatility of an emollient 10% sodium sulfacetamide and 5% sulfur foam.

Clarifoam EF is made by Onset Therapeutics which is a subsidary of Collegium Pharmaceutical.

Other products that also feature a combination of Sodium Sulfacetamide and Sulfur include: Clenia, Rosaderm, Plexion, Ovace, Klaron, Rosanil, Rosac and Rosula. Yes indeed there is a lot of products you can choose should you wish to try out a formulation of these two actives.

User Reviews

1. Nora in the thread Clarifoam at the Rosacea Support Community;… However, he gave me a sample of Clarifoam and I used it for about 4 days. It made my skin so dry and chapped it was painful. I tried rinsing it off after application as the website says, but that didn’t help. I stopped using it and had to use Aquaphor for a few days to lubricate my skin. So, I guess this is not for me!!
2. harrysinghnyc in the thread Clarifoam at the Rosacea Form;I have tried pro-topic, metrogel and locoid lipocream and none could remedy my seb derm but today is the 2nd day I have applied clarifoam and i notice that the outbreak is 90% gone! I have never had this type of turnaround this fast! One day after using it, i am prescribed this foam lotion 2x daily, so this is awesome!
3. rf11 in the thread My rosacea is gone!! at the Rosacea Forum;Anyway, to update, I have been using clarifoam and Cerave soap for almost a month now, and my skin looks better than it has in years.
4. J-Mill in the thread clarifoam ef at the Rosacea Forum;I have tried this stuff recently and really like it. … In short, both medications attack some key Rosacea/Seb Derm aggravators. What I like about Clarifoam is I find the base really non-irritating, unlike most topicals I have tried. Everyone is different though and as always you should test patch topicals, especially one with sulfacetamide as some peopl are very allergic to it.
5. fyd in the the thread Clarifoam EF is the greatest! at the acne.org message board;… on Christmas eve my derm prescribed me with this stuff. He said that they were making my face look much more worse than it was and he was absolutely right. This product just came out about a month ago, so it’s brand new. I started using it on Christmas and in about a week and a half to 2 weeks, i saw a big difference. They were fading away, I couldnt believe it! To be honest, i couldnt stop smiling at what my face looked like. Now, they are very much still there, but very faint and they are starting to blend in very nicely. They are more of a light brown then red now. Ziana and Clarifoam are working great together.
6. [new] Barley says I was recently diagnosed with rosacea and my primary care doctor perscribed metrogel for me. I tried it, but it didn’t work well-plus it dried out my skin. So I then decided to see a regular dermatologist. The dermatologist recommended Clarifoam EF topically and Oracea orally. Clarifoam EFis a sulfur based topical treatment that I (thought) would be harmless. They had some free samples of the Clarifoam so I thought I’d try that before getting a perscription filled.Big mistake! Only after two days, I reacted horribly to it- My face broke out with blotchy pimples, is very red, texture is bloated and it’s very itchy! It was worse than the rosacea I was being treated for! I am now going to buy some cortizone cream to calm it down…but boy, am I glad I didn’t get that perscription filled! Also, I haven’t as yet started the Oracea pills yet. I wanted to wait till my face calmed down a bit.

Related Articles

• Product Page: Clarifoam EF
• RSRP: Sulfur / Sodium Sulfacetamide Topicals

Recently that the Australian company Microskin has opened an office in New York. The Brisbane office opened in July 2005, with the NY office opening in January 2010.

Microskin mention rosacea as one of the conditions that they treat. The product is slated as a simulated second skin. The product is applied using a Stipple (a special type of sponge) or an air brush for larger areas.

The company says that the product will not rub off, is completely waterproof, allows the skin to breathe and sweat, and lasts for several days.

The New York Times published an article on February 24, 2010 that highlighted the use of microskin as a coverup for Vitiligo.

Vitiligo: Ignoring What Is Painfully Obvious

Starting on Friday, vitiligo patients will have an alternative stateside. Microskin — a simulated second skin that’s been available in Australia for years — is set to open its first outpost in the United States at the Laser and Skin Surgery Center of New York, in Midtown. Microskin is formulated to bridge the gap between a vitiligo patient’s paler patches and unaffected skin so that skin tone appears even. (It can also cover burns, birthmarks and the effects of psoriasis.)

Each shade is customized. “There’s only one skin color for one person in the world,” said Linda Lowndes, who founded Microskin in 2005 after working as a makeup artist. “I don’t care if you’re black or white.”

Microskin is waterproof and won’t rub off on clothing. “You’ve got to use a removing serum to break the barrier,” she said, referring to a liquid that is included in the Microskin system.

…

Still, at the start, applying Microskin on his face, arms and legs would take 75 minutes, which was “pretty annoying,” he said. He does his face daily, but Microskin lasts for a few days elsewhere. And practice has made the application faster.

The Microskin system, with training, starts at $670 for sponge application and rises to $2,250 for airbrush application. Seasonal scans ($200) are recommended to update your Microskin shade.

The article also mentions Dermablend, ColorTration and Cover FX as options for covering up

Another option is camouflage. Some patients with vitiligo, rosacea or birthmarks rely on opaque foundations specially marketed to mask them. Dermablend and ColorTration are two. Lee Thomas, a television broadcaster who wrote a book about his vitiligo called “Turning White,” endorses another foundation, Cover FX, on his Web site.

For more information about Microskin see:

US Site: http://www.microskincenter.com/

Australian site: http://www.microskin.com.au/

Microskin has been in contact with me in the past and say that they have seen rosacea patients. Microskin received national coverage in a 2006 item on A Current Affair titled Second Skin (the video link to the article doesn’t appear to work).

There are very few good treatments for the redness of rosacea. Being able to cover the red angry face of rosacea can do wonders for self esteem.

Would love to hear from anyone who tries it to cover up their rosacea.

Related Articles

• facial blemishes: makeup is not enough
• Makeup & Cover Up Forum
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• tinted moisturizers, ever tried them ?
• what is the best moisturizer for rosacea ?

When rosacea sufferers are first diagnosed it can be confusing to know how to include prescription topicals into their daily skincare regime. Rosacea patients want to know both that their expensive prescription medication has the best chance of working and that their current skin care system can still work.

In the most recent `Ask a Doctor’ column at the NRS web site Dr. Draelos confirms that rosacea topicals should be applied before any moisturizer or sunscreen or makeup.

Am I able to put a moisturizer over the topical therapy before I apply my makeup?

Yes, moisturizer may be used after applying topical medication without affecting the therapeutic outcome of your prescription. In fact, moisturizer may often be of help in preventing the burning, stinging, itching and irritation associated with rosacea.

I usually advise my patients to wait five to 10 minutes after applying a topical medication before applying a moisturizer, and then wait another five to 10 minutes before applying makeup. This will give your skin a chance to better absorb the medication and keep it from coming off on your fingers as you apply the moisturizer. Waiting before applying makeup may in turn improve cosmetic results.

This confirms the view held by Dr. Powell in his landmark book Rosacea: Diagnosis and Management. In Chapter 8 Dr. Powell tells us in italics that Drugs have priority-they go on first !

Related Articles

• Book Review: Rosacea Diagnosis and Management
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The Clinical Trials register has listed a just completed trial for something cryptically called 0444 Gel. The Gel is targeted for the papules and pustules of rosacea. Apparently the study started in January 2008 and has just been completed.

Study of 0444 Gel in the Treatment of Inflammatory Lesions of Rosacea

Sponsor: Nycomed US Inc

The aim of this trial is to assess the efficacy of 0444 Gel in the Treatment of Inflammatory Lesions of Rosacea.

Treatment medication will be administered as follows: A thin film of gel will be applied and rubbed into the entire face once daily for a period of 70 days.

So what could this gel be ? As far as I can see, likely candidates include Solaraze as well as a new generic form of metrogel. These two classes of products are manufactured by companies related to or owned by Nycomed.

Solaraze

We learnt from a 2006 AAD Poster Session that Solaraze was being studied as a treatment for rosacea. SOLARAZE (diclofenac sodium-3%) Gel is indicated for the topical treatment of actinic keratoses (AKs).

SOLARAZE Gel is a registered trademarks of PharmaDerm, a Division of Nycomed US, Inc.

Solaraze is currently marketed in the US, Europe and Australia.

Generic Metrogel

Nycomed has a sister division Fougera Generics. A press release in 2005 alterted us to the fact that Fougera was poised to make generic metrogel 0.75%. Indeed you can find details on Fougera’s web site for Metronidazole Topical Lotion 0.75% (compares to MetroLotion) and Metronidazole Topical Cream 0.75% (compares to MetroCream).

Other Guesses

Any other guesses ? If you have more information about 0444 Gel please post in the comments below.

Related Articles

• Solaraze (diclofenac sodium topical gel) being studied
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I was alerted to the launch of a product called Promiseb by a comment left on the Sebclair for Seborrheic Dermatitis post. Since then the news web sites are also covering the press release. Promiseb (probably pronounced Promi-seb) is launching in the U.S. via Promius Pharma, after being licensed from Sinclair Pharma in 2007.

Promiseb Topical Cream (Sebclair) is a non-steroidal, prescription only cream for the treatment of seborrheic dermatitis. It has demonstrated anti-inflammatory and anti-fungal properties. Sebclair is approved for use in the European Union to treat seborrheic dermatitis. One of Sebclair’s (and now Promiseb’s) claims to fame is that it contains no corticosteroids or immunomodulating agents.

Promiseb is claimed to “Significantly reduced Malassezia yeasts, the organisms that may cause seborrheic dermatitis, by 94%”. These claims are more interesting when you consider the ongoing discussions like Malassezia Globosa causes seborrhea, Pyrithione Zinc is effective, Could M. Globosa Cause Rosacea? and Real cause of seborrhea discovered!.

For a description of the ingredients and suggested method of action see Sebclair for seborrheic dermatitis.

From the press release: Sebclair launched in the US by Dr Reddy’s Laboratories’  subsidiary Promius Pharma, LLC

Jeff Wasserstein, President of Promius Pharma, said “We are very excited about Promiseb Cream because it has the potential to replace both anti-inflammatoryand antifungal treatments in patients with seborrheic dermatitis. In a clinicalstudy Promiseb was shown to have efficacy comparable to desonide cream 0.05% atdays 14 and 28 with fewer relapses.

“Promiseb Cream also has an excellent safety profile with no restrictions onage, duration of use or application on the face.” He continued, “We are very enthusiastic about this product because our clinical research shows thatPromiseb Cream may be used as a first-line treatment for seborrheic flares andfor long-term maintenance”

No Active Ingredients?

A supporting web site for Promiseb is online at http://promiseb.com/ contains a very interesting insight into the Promiseb product itself ;

What is the active ingredient in Promiseb Cream?

Promiseb Cream is a prescription-only, nonsteroidal FDA-cleared medical device and has no active ingredient. However, Promiseb Cream has demonstrated both anti-inflammatory and antifungal properties.

The makers of Promiseb do say that those who are allergic to shea butter or shea nut oil should not use their product though.

It does seem to be an unusual situation; a prescription only medicine that claims to have no active ingredients.

Promiseb Ingredients

Here is the full list of ingredients as detailed in the Promiseb Prescribing Information.

Purified Water, Isohexadecane, Butyrospermum parkii, Pentylene glycol, Ethylhexyl palmitate, Cera alba, PEG-30 Dipolyhydroxystearate, Bisabolol, Polyglyceryl-6 polyricinoleate, Tocopheryl acetate, Hydrogenated castor oil, Acifructol complex, Butylene glycol, Magnesium sulfate, Piroctone olamine, Allantoin, Magnesium stearate, Disodium EDTA, Vitis vinifera, Ascorbyl tetraisopalmitate, Glycyrrhetinic acid, Propyl gallate, and Telmesteine.

User Reviews

Auburn-NH has posted an early review of Promiseb, from using a doctor supplied sample.

Savings Coupon

Promiseb is offering a 50% discount off your co-pay or $40, whichever is less. For more information see Promiseb Savings Coupon.

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Related Articles

• Promiseb Prescribing Information
• Malassezia Globosa causes seborrhea, Pyrithione Zinc is effective
• Sebclair for seborrheic dermatitis
• Sebclair / Atopiclair available in Australia