July 2nd, 2009, by Digital Davo | ocular rosacea, research
It is good to see more published research backing topical cyclosporine (Restasis, Allergan) as a treatment for ocular rosacea. Restasis (cyclosporine ophthalmic emulsion 0.05%) has been shown to increase tear production and improve the quality of naturally produced tears and is the first approved therapeutic agent for the treatment of chronic dry eye.
Official Use of Restasis
The FDA has approved Restasis as a treatment to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with chronic dry eye. Note that increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs. Restasis is not appropriate for immediate relief for an uncomfortable irritated eye as it may take up to 6 months for maximum improvement. (source The Eye Digest)
Other Evidence
An article from 2006 in Ophthalmology Management Topical cyclosporine proves to be effective in treating rosacea whetted our appetite for this interesting new treatment.
The anti-inflammatory mechanisms of cyclosporine are highly appropriate for the treatment of ocular rosacea, as the condition has been shown to have an inflammatory etiology. Barton and associates conducted a study comparing tear fluid concentrations of interleukin-1alpha (IL-1alpha) and tumor necrosis factor-alpha (TNF-alpha) in ocular rosacea with those in control subjects. Tear turnover was lower in patients with rosacea than in controls, and Schirmer scores were also statistically lower in patients with rosacea than in controls.
After 6 months of use, topical cyclosporine was shown to decrease inflammatory cytokines in the conjunctival epithelium of dry eye patients with increased tear production.
…
Given the excellent side effect profile of topical cyclosporine and its lack of systemic absorption, ophthalmologists should consider utilizing topical cyclosporine in the treatment of patients with ocular rosacea.
Expert Opinion
The Rosacea Support Group asked Dr. Eric Jones, MD, the Medical Director of Devers Eye Institute in Portland, Oregon a related question about Restasis and ocular rosacea.
Q: Do you agree with the view that Restasis won’t help ocular rosacea or dry eye triggered by Accutane?
A: The drug rep was in for Restasis the other day and I asked her about it. We looked it up here and didn’t find any studies that checked on Restasis and ocular rosacea together. It’s a great question because, you know people with ocular rosacea have decreased tear production and, if Restasis can help that, I don’t see why it wouldn’t work.
Recent Abstract
Below is the abstract from the recently published paper, from the same author as the above article, but now appearing in a peer reviewed journal. The above link to Ophthalmology Management leads to a full article, which can be consulted for more details if you don’t have access to the full text of the journal article.
Efficacy of topical cyclosporine for the treatment of ocular rosacea, Adv Ther. 2009 Jun 23, Schechter BA, Katz RS, Friedman LS, Florida Eye Microsurgical Institute.
INTRODUCTION: This study was designed to compare the efficacy of cyclosporine ophthalmic emulsion 0.05% with an artificial tear solution for the treatment of rosacea-associated eyelid and corneal pathology.
METHODS: Double-masked, randomized, 3-month clinical trial of 37 patients with rosacea-associated eyelid and corneal changes (defined as lid margin telangiectasia, meibomian gland inspissation, and/or fullness of the lid margin). All findings were standardized and compared to photographs for grading.
RESULTS: There was a statistically significant increase in Schirmer (with anesthesia) scores of 2.7+/-2.2 mm after 3 months of treatment in the topical cyclosporine group (P<0.001), compared with a mean decrease of -1.4+/-4.6 mm (P=0.271) in the artificial tears group. The mean tear break-up time score significantly improved in the topical cyclosporine group (mean increase of 3.56+/-1.5 seconds, P<0.001), but worsened in the control group, although this change was not significantly significant (mean decrease of -0.04+/-1.6 seconds, P=0.929). The topical cyclosporine group exhibited a significantly greater mean reduction in corneal staining scores (-1.3+/-0.53) compared with the control group (-0.2+/-0.83; between groups P<0.001). The topical cyclosporine group had a greater improvement in Ocular Surface Disease Index scores than those using artificial tears (P=0.022). Limitations of the study included an older, predominantly Caucasian patient population and short trial length.
CONCLUSIONS: Topical cyclosporine 0.05% is more effective than artificial tears for the treatment of rosacea-associated lid and corneal changes.
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June 29th, 2009, by Digital Davo | doxycycline, tetracyclines
If you have trouble swallowing tablets, here is an official FDA sanctioned tip. Open the tablet and sprinkle the delayed release pellets on to a spoonful of applesauce. This is a good option for anyone who finds swallowing the capsule difficult.
This advice is only given for the 100mg and 75mg delayed release formulations of doryx which contain specially coated pellets of doxycycline hyclate. A clinical trial confirmed that the absorption of doxycycline is comparable when the table is taken whole or sprinkled on applesauce, both with and without water.
From Daily Med, Current Medical Information, Doryx (doxycycline hyclate) Tablet, Delayed Release
DORYX Tablets contain specially coated pellets of doxycycline hyclate, a broad-spectrum antibiotic synthetically derived from oxytetracycline, in a delayed-release formulation for oral administration.
Sprinkling the Tablet on Applesauce
Doryx Tablets may also be administered by carefully breaking up the tablet and sprinkling the tablet contents (delayed release pellets) on a spoonful of applesauce. The delayed release pellets must not be crushed or damaged when breaking up the tablet. Any loss of pellets in the transfer would prevent using the dose. The applesauce/Doryx mixture should be swallowed immediately without chewing and may be followed by a glass of water if desired. The applesauce should not be hot, and it should be soft enough to be swallowed without chewing. In the event that a prepared dose of applesauce/Doryx tablet cannot be taken immediately, the mixture should be discarded and not stored for later use.
The FDA has also issued instructions on how to prepare 100mg tablets of doxycycline (in an emergency), for children and adults who cannot swallow pills. See Mixing Doxycycline Hyclate 100mg Tables with Food. This method crushes a tablet into 4 teaspoons of water and then combines this with 3 teaspoons of milk, or chocolate milk or chocolate pudding or apple juice + sugar.
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June 26th, 2009, by Digital Davo | in the news, natural remedies
The New York Times has an article today keenly titled Natural Remedies for Rosacea?. The question is one that many rosacea sufferer seek answered – are there any effective treatments for rosacea that don’t include the use of antibiotics or prescription potions and lotions ? The answer comes from one of the premier rosacea experts – Dr. Frank C. Powell. Here is an extract where Dr. Powell comes closest to offering a direct answer.
Natural Remedies for Rosacea?
The roles of complementary and alternative medications in the management of rosacea have yet to be established, so it’s hard to offer any “natural” remedies for the condition. Cucumber was mentioned as early as 1649 as a treatment for facial redness in a text on herbal remedies by Nicholas Culpepper, an English botanist and physician, but cucumber has not been studied scientifically. Some rosacea sufferers, especially those prone to frequent flushing, report benefit from relaxation and stress management techniques.
Self-care and dietary measures may also aid in the management of rosacea, but there are different forms of the disease, and each may require different treatments.
It is great to see more and more articles on rosacea in a publication like the New York Times. It is also encouraging that they have access to the best minds in rosacea research and treatment. Having said that, it is a bit discouraging to find an unsatisfying answer to such an important question. Surely there are good natural treatments out there somewhere ?
We do know that in this year’s AAD meeting in SFO, one presenter Dr. Downie suggested that natural ingredients do have a role in the treatment of rosacea. Dr. Downie suggested feverfew, green tea and licorice as worth investigating.
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June 23rd, 2009, by Digital Davo | fact sheets, swelling
Do you have a favourite over the counter treatment for your rosacea ? Depending on your health insurance and access to doctors and pharmacies, prescription treatments are out of the reach of many rosacea sufferers. So what can you try as a rosacea treatment that is easy to source, cheap and available without a prescription ? Is there anything ?
Please help your fellow rosacea sufferers with your best discoveries of treatments that you can get without a prescription or without visiting a doctor.
Here are some suggestions that I have collected that seem to be popular with members of the rosacea support group;
Prosacea
Prosacea is a topical gel, available over the counter at stores like Walgreens. It is also available on the internet at cvs.com. It contains 10% sulphur. The jury is still out, but reading prosacea user reviews, it looks to me like we should include prosacea as a bona fide rosacea treatment.
Rosacea-LTD
Rosacea-LTD is a topical treatment made of various compressed salts. It worked well for me to reduce papules and pustules and it is available only over the internet (which I guess counts as over the counter). This treatment is not cheap like many of the other suggestions in this listing, but I thought it definitely should be included as an over the counter treatment. For more information have a read of Rosacea-LTD User Reviews
Disclosure: rosacea-ltd is a site sponsor of rosacea-support.org
Aspirin
There has been some introductory research suggesting that a daily low dose of aspirin may help with rosacea swelling and flushing. For some it may lead to more flushing, but as an easily available and cheap over the counter treatment, aspirin may be worth a try.
Rosacea Swelling Relief Regime
Dr. Linda Sy has suggested in her rosacea swelling relief regimen, that there are some OTC meds that are easier (than prescription drugs) on the system such as: aspirin (blocks prostaglandin synthetase), antihistamines – ex. Chlor-trimeton which blocks H1 receptors; Cimetidine (Tagamet) which blocks H2 receptors. Pyridoxine (vit.B-6) has also been found to be helpful as a prophylaxis. She has sugested the following over the counter regime;
at Bedtime;
- 1 baby aspirin
- 1 Chlor-Trimeton (an antihistamine)
- 1 Tums (to offset the gastro effects of the aspirin)
and in the AM;
- a B complex vitamin with 50mg of B-6, but without Niacin (niacinamide is ok).
- 1 Tagamet
during a flush;
- apply a cool (not cold) compress to the face
- do deep breathing 10 times slowly.
Flaxseed Oil
Studies have shown that flaxseed oil may help improve acne and for some other Omega 3 sources like Fish Oil may offer additional benefits.
When Dr. Eric Jones was asked about the possibility of any nutritional link to ocular rosacea symptoms he responded “that here are studies with just dry eye, where flaxseed oil and omega 3s are quite effective. Foodwise, everyone is individual. There have been some surveys, and everyone was different. Some said spicy foods, others said hot drinks, alcohol, cold drinks. People have to find their individual triggers, I think.”
Nasalcrom
As an alternative to the steroid based nasal sprays, something like Rynacrom or Nasalcrom may help with allergic rhinitis and relieve other allergic symptoms. Certainly if you think your rosacea symptoms are allergy related this is worth trying. Even if it only relieves other chronic symptoms is might help you get your head around the other symptoms that occupy your thinking.
Afrin / Oxymetazoline
It is early days yet, but some preliminary research and some rosacea sufferers are reporting reductions in redness from using topicals such as Afrin. Rosacea sufferers are cautioned against applying Afrin directly to their skin as it is actually for allergic rhinitis so contains ingredients which may be irritating to rosacea sufferers.
Keep an eye out for updates related to Oxymetazoline based treatments like Afrin. See this forum posting Afrin cure ? for some more information. There are many over the counter products that contain oxymetazoline.
Cleansers and Moisturizers
OK officially cleansers and moisturizers aren’t rosacea treatments. This is a bit of a step backwards for rosacea sufferers. Once you understand that a gentle cleansing and moisturising regime is a good basis for beating rosacea, you are already off to a good start.
Make your own Cleanser
We know from a recent rosacea news article that colloidal oatmeal (Avena sativa) has interesting cleansing, moisturizing, buffering, soothing, protecting and anti-inflammatory properties.
Want to try something natural, perhaps something that you know exactly what it contains because you have made it yourself ? Some of the highlights from the Homemade Mixes community forum include simple natural sunscreens, licorice treatments, a honey cleanser and more.
Colloidal Oatmeal
Officially `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. In the past rosacea support group members have made their own cleansing masks with oatmeal and water. An extra bonus is that it can sop up flakes associated with seborrheic dermatitis.
Jojoba Oil
I have found that a small amount of jojoba oil blends in really well on wet skin and gives an excellent moisturized feel to my skin. Jojoba oil is cheap and easy to find in health food stores. We do know that jojoba oil has anti-inflammatory properties so it could be an ideal over the counter product.
A final warning
Please do be careful with products that you can get over the counter. Just because something is available without a prescription doesn’t mean it is even safe for rosacea skin. For example some OTC products might secretly (or quietly) contain steroids. As we now know, over the counter steroids can cause steroid induced rosacea.
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OK, so I have made my list, please give some more suggestions below in the comments.
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June 19th, 2009, by Digital Davo | research
Here is an announcement from RosaceaCare:
“Earlier this year, we announced that four important and popular rosacea products that had been unavailable for many months would thereafter, by special arrangement with the originator, be manufactured and distributed by the Rosacea Care Company. We are pleased to tell you that the first of these, the much-loved Vita-Oil, will be released and ready to ship this coming Thursday, June 25. On-line purchases can be made in advance of that date by visiting our website: rosaceacare.com.
We would remind you that this is exactly the same Vita-Oil that has helped so many rosaceans over the years. The formula is identical, and it is being manufactured by the same laboratory. As with previous packaging, an eye dropper and instruction sheet will be enclosed with every order. The price is $28 US.
We would also take this opportunity to announce that original Tinted ZincO will be available sometime in July. The exact release date will soon be posted on our website and on this Support Group page. We thank everyone for their patience and their enthusiasm for these products.”
disclosure: RosaceaCare is a site sponsor of rosacea-support.org
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