The recently approved Zilxi, is a minocycline based topical treatment for the papules and pustules of rosacea. Zilxi contains 1.5% minocycline, in a foam formulation and is applied to the face once per day.
How does Zilxi work?
Officially the way that the topical minocycline formulation of Zilxi improves the papules and pustules of rosacea is unknown. This may sound strangely vague, but being able to exactly tie down the method of action of antibiotics in rosacea is a difficult task.
User Reviews
The best information we currently have from users of Zilxi is from the Phase 3 trials. If you have been fortunate enough to try Zilxi after being prescribed by your doctor, please do let us know how you fared in the comments below.
How well did the trial participants improve during the 12 weeks of being treated with Zilxi? At the beginning of the trial, participants were required to have 15-75 inflammatory lesions and a severity of rosacea of moderate or severe as determined by the trial investigator. In order to claim that Zilxi had improved their rosacea symptoms, trialists had to experience at least a 2 grade improvement in severity, finishing at clear or almost clear. Additionally those receiving Zilxi had to have a statistically significant improvement in lesion count compared to the vehicle users.
Users of Zilxi can expect to have an improvement in the reduction of the papules and pustules of rosacea of around 60% over 12 weeks. This improvement is 7-11% better than using just the inactive foam in the Zilxi canister. Yes you read that right, you will only see a 7-11% better improvement from the 1.5% minocycline present in Zilxi. Does it make you want to get the inactive canister for a hugely reduced fee? Sorry, but that may be tempting, but it isn’t being offered.
So if you are prescribed Zilxi by your doctor you can expect to have a slightly better than 50% chance of success, with a reduction of around 60% in the number your papules and pustules. Is this true? Let us know in the comments below.
/u/AdamMaitland says:
Now, the reality check is that I will say that it has not completely erased the problem. I think I have likely plateaued with it after four months. I would say it reduced the redness and other symptoms by about 70%? maybe. I was kind of hoping things would get better and better by the three-month mark, but some redness remains. But at the moment, I am still super happy with the results.
For anyone thinking of using it, it’s a foam that is admittedly kind of greasy. You put it on at night. Too much of it can make your skin yellowish, but that washes off. I think the idea is you do it about an hour before bed, let it set in, and then moisturize. My dermatologist told me to use a “pea-sized” even though the instructions tell you to use a “cherry-sized” amount (I use somewhere in between). I also noticed that it seems to lose potency over time, but unfortunately there’s no specific instructions on how long a canister of it is supposed to last once its opened. The pharmacy just said about two months for most people. Not sure how much it is without insurance, but I think it’s about $70 each for me.
/u/Tuscan_Leather_ says:
I use it before bed. It will leave some yellow residual behind, perhaps that’s why my doctor suggested it at night.
My derm has me do Metro and AA in the AM, and Zilxi at night before bed. That – plus 40mg Oracea, and my Rosacea has been in remission for the entire year. It’s been wonderful.
I don’t wear makeup so I don’t know how that would look with the Zilxi.
What side effects might you expect from using Zilxi?
The most common adverse reaction reported by more than 1% of trial users treated with ZILXI was diarrhea. The full list of know possible side effects are detailed in the Zilxi PI
Zilxi Prescribing Information
Want the official information about Zilxi to pass on to your doctor – here is the Zilxi PI. See the prescribing information for details on adverse reactions, interactions with other drugs, dosage, warning and precautions.
I have been using for 8 weeks and see very little difference… maybe a little worse even!
8 weeks in and definitely seeing a great improvement with no side effects. Very happy so far, very expensive though so make sure to use the manufacturer savings program if you can.
I was part of the clinical trials for Zilxi under the former Foamix Pharmaceuticals and had very positive results. Upon FDA approval of Amzeeq, a similar acne formulation, I used that for about a year. I discontinued therapy and the Rosacea is back with a vengence after a year, so I am going to re-start with Zilxi.