Severe Mirvaso Rebound Redness: Dermatitis Medicamentosa

mirvaso-rebound-redness

(Click image for a larger view).

  • (Left) One hour following application of Mirvaso with initial blanching and improvement of baseline erythema.
  • (Right) Twelve hours following application of Mirvaso with significant increase in baseline erythema.

A recently published short article in Dermatology Online Journal is proposing the use of the term Dermatitis Medicamentosa to describe one patient’s severe rebound reaction to Mirvaso.

This newly proposed term is based on a similar rebound reaction observed in rhinitis medicamentosa where nasal decongestant sprays can have negative reactions worse that the original symptoms.

The authors say that rebound redness from Brimonidine is a “significantly distressing potential side effect that may be underreported with little photo documentation in the literature to date.”

Now that the above image is available, everyone can plainly see just how distressing and serious rebound redness to Mirvaso can be.

The patient consented to the use of their photographs and the journal article is made available under the creative commons attribution license. The full PDF of the article is available here – Dermatitis medicamentosa: severe rebound erythema secondary to topical brimonidine in rosacea.

Other severe adverse reactions to Mirvaso have been published in the JAAD – see Mirvaso Rebound and Stinging Documented in JAAD

Worsening  Reaction

The article details this rosacea sufferer’s experience with Mirvaso.

The patient reported significant improvement to baseline erythema and flushing initially, in the first days of treatment with Mirvaso, with associated elevation of mood and self confidence.

However, during the second week of treatment, the patient began noticing some gradual worsening of baseline erythema several hours following treatment, only improved with subsequent application of Mirvaso.

The patient contacted her provider in tears two weeks into treatment for severe facial erythema at which time the patient’s use of Mirvaso was discontinued resulting in improvement of erythema and flushing thereafter.

The course of symptoms that progressed with use of Mirvaso included an initial blanching for one to four hours after application (Left Image), with gradual facial erythema to a point beyond baseline around 12- 13 hours following application (Right Image).

The article tells us that the patient was able to subsequently find relief from the application of pimecrolimus 1% cream (Elidel) and several treatments of pulsed dye laser.

Article Abstract

Dermatitis medicamentosa: severe rebound erythema secondary to topical brimonidine in rosacea.

Dermatol Online J. 2015 Jan 1;21(3)., Werner K, Kobayashi TT.

Rebound erythema secondary to use of topical brimonidine in the setting of rosacea is an important, possibly significantly distressing potential side effect that may be under-reported; there is little photo-documentation in the literature to date. This article documents such a case.

OBSERVATIONS: A 28-year-old woman (Fitzpatrick II) with a long-standing history of untreated rosacea presented for initiation of treatment of what was noted to be primarily erythematotelangiectatic rosacea and was offered Mirvaso for daily use. Initial improvement was followed by progressive worsening of baseline erythema several hours following treatment, only improved with subsequent applications of additional Mirvaso. The patient’s symptoms were improved upon discontinuing use of Mirvaso.

CONCLUSIONS: There are few cases documented of rebound erythema secondary to use of Mirvaso to date. Further reporting might prompt further long term investigation for this topical medication for further delineation of its role in treatment of rosacea. What is proposed is a phenomenon similar to that of rhinitis medicamentosa with upregulation of alph-adrenergic receptors, suggesting the name “dermatitis medicamentosa” for this phenomenon.

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

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33 Reader Comments

  1. David Pascoe says:

    Comment on this topic from Facebook.

    Yep that happened to me. Ended up being allergic to Mirivaso. My skin was worse after using the cream and it wore off. I found drinking lemon essential oil in my water, and using lavender and coconut as a lotion has taken the red out of my face. You can’t tell I have rosacea anymore.”

  2. David Pascoe says:

    Comment via email.

    “This Happended to me too and I contacted the company, they didn’t care…..”

  3. Launa Calder says:

    Wow, this explains exactly what happened to me. I went to a different Dermatologist she thought it was a allergic reaction to a sulfur soap I was using. But she too me off Mirvaso. Put me on a Eledin and Soolantra. I have no issues at all. Scary!

  4. Scarlet Nat says:

    Thanks for this article David! Finally the medical world catches up with this very distressing side effect of Mirvaso.
    I made an evaluation of online Mirvaso reviews (with annotations) the past year: http://scarletnat.blogspot.fr/2013/12/mirvaso-inventory-of-patient-responses.html

    Thanks, Nat

  5. Emily Kingston says:

    With the clinical trials that occurred for this, there were at least 1000 people who were on Mirvaso for over 3 months being monitored in the trials. As if these reactions didn’t occur in the trials, and as if the company didn’t know A. that rebound was theoretically possible given the substance and its known side effects when used as a decongestant, and B. people were having this powerful, negative reaction to it. Instead, they write their inconspicuous little list of side effects, and count the rebound horror as “redness”. Give me a break. Cat’s out of the bag Galderma. I hope there will be some kind of investigation as to what exactly went wrong in their clinical trials, i.e., how they were able to cover it up.

  6. Emily Kingston says:

    Do the people in this type of trial have to sign some kind of confidentiality agreement? This would make a great news story, for something like 60 minutes, having the people who had rebound in the trials speak out, and say what they think about the “not entirely accurate” labeling of this product’s side effects.

  7. David Pascoe says:

    Comment via email.

    “My rebound reaction to mirvaso was a nightmare. It took me 10 days to get it out of my system. It made my whole face swell and my nose huge. I think it should be taken off the market. “

  8. David Pascoe says:

    Comment via email.

    “I HAD THE SAME THING HAPPEN TO ME. EXTREME REDNESS AND HEAT. STOPPED USING IT AFTER A WEEK. I SHOWED MY DOCTOR SOME PHOTOS AND SHE DIDN’T SEEM SURPRISED AT ALL. MY INSURANCE WONT PAY FOR THE MIRVASO ANYWAYS CAUSE IT’S TOO EXPENSIVE.
    ANNA”

  9. Jimmy says:

    You should balance your attack on Mirvaso with commentary on the tens of thousands that are helped by Mirvaso. I have found good results when first washing my face prior to using Mirvaso.

  10. m says:

    Hey Jimmy, where are those tens of thousands success stories? Certainly not here. Surfed the Internet extensively looking for them.

  11. MG says:

    I had this same reaction to Mirvaso. Prior to using it my rosacea symptoms were minor. In fact, my dermatologist was not even sure if I had rosacea or minor eczema. Weeks into using Mirvosa my symptoms got worse once the Mirovosa wore off (after a few hours of application) and I became more and more dependent on it. When the positive affects wore off, my face got worse and worse. Not knowing what was going on, I finally stopped using it as part of my trial and error and gradually saw improvements. However, my rosacea is way worse than before I started using Mirvaso and I wonder if Mirvaso is to blame. My dermotologist(s) are aware of the concept of rebounding but don’t seem to understand the intensity. I seriously challenge whether this product should be on the market.

  12. PADWENDA1 says:

    Im sure many of you have heard my story on the “rosacea form”. It is now five months since I used it twice for my very mild rosacea. I now live in pain on a daily basis, I have a permanent redness which I never had before, and I flush at anything (never flushed). I have now lost weight because I go most days without eating anything until I get home from work. I have lost my social life and I cant play football anymore due to Mirvaso. Galderma were no help at all! I am jealous of people who have got back to way they were before using Mirvaso.
    It is true that Galderma are obviously corrupt and they throughly do not care about people as long as they get money. Their trials and what the pharmacovigilance team report are poles apart.
    Am I the only person in the world who is still experiencing these symptoms after five months?
    I actually went to an out of hours doctor two days ago because the pain was so bad. But there is nothing she could do. Not sure how much longer I can keep going like this.

  13. karl edwards says:

    i had the rebound redness,but then hallusanated while driving ,two days later i am in hospital with very low blood pressure,that lasted two months,other symptoms were dry mouth,constipation and nervous shaking,very unpleasant ,

  14. Fabian says:

    Having constant redness, i tried Mirvaso.
    After the first application, i had lovely face.
    But after that, the same day in the evening, just after applying cleanser. i had big rebounce. very red.
    Sweating of the face all the night..
    The rebounce effects continue one week.

    Mirvaso is not a solution

  15. michelle says:

    same problems as listed. I just used it for 3 days in a row….on the 4th morning (today) i noticed that my face has more redness. it was different than the regullar redness almost looks like my entire face is sunburned. (normally the rosacea for me is on cheeks and chin) im hoping it fades back to normal. :/

  16. Brendan says:

    I made the mistake of using mirvaso for the first time whilst at work! 30 mins after application I was sent home as my reaction was so severe. Won’t ever use it again.

  17. Dawn says:

    I started using mirvaso in July. I thought it was great, no body asking me if I was sick, having a hot flash or laughing because they thought they were making me blush. I made it 2 months before the redness came on with a vengeance. The heat and redness is intense and involves my entire face at the 8-10hr mark after applying it. I regret starting this medication. I only had redness to my cheeks before, now it’s my forehead, chin, nose and my cheeks all the way to my jaw. Sometimes it shows up as patchiness which really looks wonderful while I’m working with the public. Insurance doesn’t pay for it so it was a costly mistake. I can only hope this isn’t a permanent destruction to my skin from this medication.

  18. finred1 says:

    mirvaso could be a bit like using a cork as a solution to loose bowel movements….a good idea at the time but you know there is going to be trouble ahead

  19. Katie says:

    My rosacea definitely worsened after using Mirvaso. ONCE. It’s been 3 months since then so I can only presume the damage is permanent. I am seriously so pissed off and I wish there was an antidote.

  20. Bea says:

    I am 19 years old and I had a slight pinkness across my cheeks that I thought was rosacea (at the time it was such a big deal, now I wish I had it back). My doctor prescribed me Mirvaso. I used the recommended amount twice and had intense rebound flushing for a week. Its now been 9 months since I used Mirvaso. Now I frequently (and randomly) experience hot flashes in which the redness returns. I feel so upset and ugly, I feel like my face is ruined forever! Does anyone have any advice for how to help it heal? Ive tried a range of things and organic skin care, vitamin E oil & rosehip oil seem to be the most nourishing products that keep my skin happy, but its still not completely at baseline.

    • katmacy91 says:

      Yes, Bea, I do have advice for you. I am 26 years old and more or less the same thing happened to me, exactly as you described. I used Mirvaso once and my baseline redness worsened significantly. I had the horrible rebound redness for about a week (Purple patches everywhere!). In the months that followed I flushed WAY more than I ever had. It was especially annoying because at night, when I would lie down, my whole face would flare. I couldn’t sleep. I developed severe anxiety and…my God, it was a mess. I felt so hideous and wanted my old redness back.

      I can happily report that I have now recovered from the Mirvaso debacle, six months later. Here is what I have been doing:

      •I wash my face with a gentle cleanser. I use Neutrogena Ultra Gentle Hydrating Cleanser. There are other ones that would probably work fine too, like CerVe or Cetaphil. But the one by Neutrogena has very few ingredients in it, so I use that one.
      • I moisturize daily with a very light moisturizer. I use Skin Ceuticals B5 Hydrating Gel. It’s a gel and not an actual facial lotion, as I find that anything thick tends to clog my pores and cause acne. This stuff is a bit pricey but, in my opinion, so worth it. Again, it has VERY few ingredients. With rosacea I find that the less shit you put on your face, the better off you’ll be.
      •I just started being more gentle with my face in general. I got rid of all my old washcloths and bought these super soft, cushy facial cloths. I believe it’s called Erase Your Face. They are so soft and they get all your makeup off very nicely without being harsh on your skin. They’re a must have for rosacea sufferers, in my opinion.
      •Lastly (and this one is HUGE, what I believe has made all the difference) about 3 months ago I purchased an at home red light to be used daily on my face. Now, I know that low level light therapy doesn’t work for everyone, but for me it has worked wonders. I was skeptical at first, believe me, but after one month of consistent use I noticed my flareups becoming less and less frequent. After about 2 months the flareups were even less frequent and my redness started to fade as well. Now I’m in month 3 and can say without a doubt that I have improved even more. I haven’t had a flareup in weeks (knock on wood) and my redness has faded so much that there are times that I don’t look like I have rosacea at all, even when I’m not wearing makeup.

      When I look at where I was even 4 months ago…I’ve come a long way, and I sincerely believe that I owe most of it to red light therapy. I don’t know what else it possibly could’ve been, as I had seen literally no improvement before I bought the light. And trust me, I would know…I look at my face obsessively.

      I know this sucks. I feel your pain, I really, really do, but eventually you’ll find something that works for you. I hope I’ve at least given you some encouragement! Take care.

      -Katie

      • Bea says:

        Thank you so much Katie! I really, really appreciate your prompt and detailed reply! You’ve made my day and given me hope. I will definitely try the red light therapy. I’d be happy to hear which brand you’ve used. Thank you for sharing, you’re so sweet and genuinely care.

        – B

        • katmacy91 says:

          No problem. It honestly makes me so angry to see that people are still suffering because of this Hitler cream. It never should’ve happened to me, and it never should’ve happened to you because it should’ve been pulled from the market years ago. They’ve known for quite some the potential damage this stuff can do, and what pisses me off even more is the fact that Galderma (the pharma company that makes Mirvaso) is still trying to push brimonidine as a “treatment” for rosacea. First of all, just admit that it isn’t a treatment. It’s a cosmetic at best, a temporary fix. Secondly…are you kidding me? There’s a good chance this stuff will WORSEN people’s rosacea and you still won’t pull it from the market or even be upfront and honest about this fact? Ugh. I’m sorry. They have no integrity. None.

          Anyway. As far as the red light therapy goes, I’ve been using the one by SmarterLights. There are undoubtedly better, more powerful lights out there, but they’re pretty expensive. So I decided to go for the one for 250 dollars from the SmarterLights website. They give you a 90 day trial so that if it doesn’t work you can send it back. As I said, I’ve personally been having luck with it but that doesn’t mean you necessarily will. And that’s part of what makes this condition so hard to treat. Everyone is different. I’m going to continue using my light for a few more months, and if by then I’m still not where I want to be I’ll probably look into having some laser treatment done to the more persistent areas of redness on my face.

          Like I said, though, the red light has helped me a lot and I’d seriously be so miserable still if I hadn’t discovered it. Here’s to hoping you’ll have luck with it too!

          Don’t give up, this too shall pass.

          -Katie

          • Bea says:

            Haha Hitler cream is a good way to put it! Yeah, that’s absolutely disgusting that they have done this to people. Agreed, it was definitely not a treatment. And it was so expensive as well, like $80, ugh!

            Ok great, thank you for the recommendation 🙂 I’ll definitely give it a go, however I’m so scared to put things on my face now! I hope it works for me too. Good luck to you as well! Thank you for all the sympathy!

            – B

  21. Elizabeth Hulm says:

    Hi All

    I stopped using it after one or two applications as I had an instant increase of redness so figured I was reactive to it…and I have been too scared to try it a second time so now have a very expensive tube of cream I am too scared to use

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