Mirvaso Rebound Flushing makes the news


In a followup article on François Fournier, the head of Galderma USA, the Dallas Forth Worth Daily raises the topic of rebound flushing from Mirvaso.

Whilst only quoting one online forum posting, the author Bradford Pearson highlights what he calls the mixed response to the newly released topical Mirvaso.

Indeed it is a question that needs some investigation – does it indeed cause rebound redness and if so, why does Mirvaso appear to cause worse redness than before the user starting using it.

Secondly is there a good reason why  the online reports for early users of Mirvaso doesn’t match the adverse reactions from the Phase 3 Long Term Trial Results?

François Fournier Out As Galderma USA President

“I think it’s important for me to reinforce that 16 million people have rosacea in the U.S.” he told D Healthcare Daily earlier this month. “It’s an inflammatory and vascular disease. It’s a chronic disease. And most of them have erythema and this product will bring a solution. There is a big market, they have a lot of patients suffering. Before this product, there was no product working.”

But since the product’s release, results have been mixed. Online rosacea message boards have roundly attacked the product, saying that the rebound flushing caused by the drug was worse than the initial redness itself.

“I’m nine days since my last Mirvosa application, and I am still feeling the bad effects from use,” wrote one user. “I used a very small amount for three days, on my nose mostly, spreading it out to my cheeks, but the rebound is affecting my whole face, including my chin, which never flushes. I’m starting to believe that the rebound is over, and that this is going to be a permanent deterioration of my condition due to the inflammation I experienced after I stopped use.”

Sansrosa Research Looked Good

The clinical trial results (well at least those which were easily available to the public) looked quite positive. There was no appearance of problems with rebound redness or problems if you stopped and starting using the gel.

This is further reinforced from a quote on November 1 from Dr. Rosso:

Addressing facial erythema, DermatologyTimes, Nov 1, 2013.

By: Ilya Petrou, M.D.

Most recently FDA-approved for treatment of persistent nontransient facial erythema of rosacea in patients age 18 and older, brimonindine tartrate 0.5 percent gel (brimonidine 0.33 percent, Mirvaso, Galderma) applied once daily has been shown to reduce diffuse facial erythema of rosacea with a usual onset within 30 minutes and with peak activity over approximately eight to 10 hours.

According to Dr. Del Rosso, the safety profile appears to be favorable, rebound has not emerged as a major problem with this agent, and tachyphylaxis has not been observed.

So Does Mirvaso work or not?

Only time will reveal whether the initial negative reaction online to Mirvaso bears out in the larger populatio as Mirvaso’s usage becomes more widespread.

Rosacea can be a tricky disease to treat, especially when blushing and flushing and hyper reactive skin may be present also.

Daily Mail Mention

A Daily Mail article also has a reference to the negative reports of Mirvaso that are emerging online. This cannot have escaped the notice of Galderma.

Tiny ‘spider mites’ that may cause a blotchy red face


And there are potential side-effects – one study of 276 people found 4 per cent reported flushing, redness, a skin-burning sensation and allergic contact dermatitis.

Some patients have complained in online forums that the ‘rebound’ flushing caused when the drug wore off was worse than the initial redness caused by rosacea.

Dr Mark Jackson, chief investigator on the U.S. Mirvaso trials, said it was often difficult for patients to remember what their skin was like before treatment unless they photographed themselves.

You can immediately tell the quality of any article reporting on rosacea if they use the word spider when referring to Demodex Mites then you shouldn’t trust much else that they write.

So the quality of the article is low, but it is worth noting that a good objective measure of redness at baseline and during and after using Mirvaso is a good place to start in deciding if it works for you.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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153 Reader Comments

  1. Ginny Crocker says:

    Like a lot of people, I was amazed as to how quickly I went from bright red to pasty white. Living in Denver, being a mile high closer to the sun and being a very active sports person, my true test was going to be outside, in the bright CO sun, doing some type of sports activity. Bingo, it was my first tennis match, outside, that triggered my worse flare up ever. The opponents wanted to take me to the hospital as I was so beet red that they were worried about me.. Never used this product again but have come across a skin care line that has worked for me and taken a lot of the redness out of my face so am please with where I am now.

    • Jenny Rapovich says:

      Could I ask what skin care line you are using and do you still experience the rebound redness?

      • Ginny Crocker says:

        Upon some research, I called across some natural ingredients that had rave reviews: chrysanthellum indicum extract (golden chamomile) & niacinamide. Did a goggle search and came across Purified Skincare. They have a “redness” treatment plan but I am only using their “Clinical-Chrysanthellum Cream w/B3” product and I have been extremely pleased with this cream I now have a faint glow rather than being bright red!! Here’s their website: http://purifiedskincare.com/

        I started with this new treatment plan in Nov so have not been out in the extreme CO summer sun yet but have hiked and played golf since I have started using this product and did not have any flare up whats so ever. My redness fainted pretty quickly with this product, maybe like 4 days of use. So, for me, it’s a keeper.

        I hope it’s as helpful to others as it has been for me.

      • Mary says:

        How Long were you using Mirvaso? How long before the rebound reflush stopped it is so embarrassing

        • Jenny Rapovich says:

          I used Mirvaso for about 4 months. It has been over a year since I stopped using it and I still have the rebound flushing. It is embarrassing and I have no control over when it will happen. I know that under stressful situations it is even worse and especially when I am at the dentist with those lights. I hate to even go anyplace.

        • Ginny Crocker says:

          I did not use Mirvaso that long, maybe 2 weeks. The flare ups for me was horrendous while using it but these severe flare ups stopped pretty quickly after I stopped using this medication. Sounds like I was pretty lucky when I quit using this. Having rosacea for so long, you just have to learn what works. One thing for me is I no longer wash my face in the shower. Actually try and shower with my face away from the shower head. I wash my face using cool water and Cetaphil bar soap plus the Purified Skin Care product line mentioned earlier. When outside I use clear zinc oxcide sunscreen that I buy at WalMart. For me, it offers better sun protection. It’s been a long process for me to figure out what helps but I seemed to finally have it somewhat under control. Good luck!!

          • Jenny Rapovich says:

            So glad you have figured out what works for you and that you didn’t use it that long. The only thing that has gotten better for me is I don’t feel that rush of heat when I flush. It was pretty bad there for awhile. I also haven’t washed my face in the shower for a long time now and use cool water and Clinique Redness Relief products. I do want to try the Purified Skin Care line, though. Good luck to you as well. Just so glad you only used Mirvaso for a really short time.

  2. K says:

    Please someone tell me that the red flushing after using onreltea goes away. It is sooooooo embarrassing I’m so unhappy

    • Nathalia Pereira Cavaleiro says:

      Yes, It goes away. Don’t worry.

      • Jenny Rapovich says:

        It has been several years since I stopped using Mirvaso and the redness and flushing have not gone away for me. It is very embarrassing.

        • Nathalia Pereira Cavaleiro says:

          I still have a little of redness, but probably as syntom of rosacea as I had before and, in my case, it is not comparable with I had with mirvaso. At that time, my face turned into a piece of raw meat. However, I used it just for 3 days and stopped.
          I’d like to hear something from the lab about this.

        • Andreas says:

          Same situation for me!! 2 years since I stopped using mirvaso(i used mirvaso for 3 days) The redness,warm ears and flushing have not gone away,and are life-destructive..I am worse now than i was 3 mnd after I stopped!so it’s feels like a permanent damage!!!

          • Jenny Rapovich says:

            I’m so sorry you are still having the same issues as I am. It is so frustrating and embarrassing that I don’t even want to go any place. My doctor suggested laser treatment but I’m afraid to even try that thinking it will make my issues even bigger!

  3. Rebecca Pierz says:

    Six days since Mirvaso was prescribed.
    Day one: applied in the morning. About 20 minutes later saw a very noticeable diminishing of my facial redness. About two hours later, wow! Can’t remember my skin being such a normal color for at least 15 years. So thrilled. The result lasted all day and night.
    Day two: woke up with skin still not flushed, applied the same as day one (very thin layer). Same result progress, though it seemed perhaps a little less dramatic. Could have just been my perception. Happy with results so far!
    Day three: woke up again with no pink face, applied the same as the prior two days. After about two hours I felt a little strange, lightheaded. Then I felt my face tingling, odd. Asked my colleague (on a business trip!)’ “is my face red?” She said my cheeks were bright pink. I looked in the mirror and was shocked, both cheeks were bright red, much deeper than my normal flushing and not my usual pattern. Then just as quickly as it came on, the color went away. Completely. Was flush-free the rest of the day.
    Day four: same application. Same result as day three, two hours after application felt odd, lightheaded, cheeks turned bright red. Lasted approximately half an hour then went away. Totally went away. So I started strategizing how to apply it early enough that this rebound effect would occur before my work day started. Yes, the reduction in redness otherwise was so awesome that I was determined to stick with it. Then that night, about 12 hours after application I felt my face getting hot. Looked in the mirror, sure enough completely red face. All over, not just cheeks. Like a bad sunburn. Uh oh. Spent several hours online reading about mirvaso rebound. So depressing.
    Day five: did not apply. Was flushed, not too bad, when I woke up. Went to salon for hair cut. During blow dry my face turned BEET red. Very embarrassing, much worse than ever. But it went away after about 30 minutes. Throughout day five I had about 5-6 “episodes”, intense flushing with relatively rapid diminishment.
    Day six – today. Woke up three hours ago with pink face, it went away. I am red again now as I write this. I’m very worried about this. Several high profile events over the next two weeks. I hope it normalizes quickly. Things I’ve read online have not been very encouraging though. I will call my derm in the morning and ask her a) why she didn’t mention this possibility, and b) what can I do to recover?

  4. Lori A McKeown says:

    I used for 2 weeks and was very happy the first week. However, by the second week my face was redder than it had ever been, the redness had spread to previously unaffected areas and my face was burning hot which was a new symptom for me. I stopped using and still have redness in areas that I did not have before the treatment. I tried it a second time and my face was so pale in the areas that I applied it that I look ridiculous and that was with only one application. I find my best approach is Purpose facial cleanser and purpose moisturizer with aveeno BB cream…the purpose cleanser with cool water before bed and a splash of cool water in the morning keeps my redness to a minimum.

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