20 September, 2017

Ivermectin or Soolantra as a rosacea treatment

This blog is aimed at rosacea subtype 1, with skin flushing, redness and burning. But very often these division lines for categories are not holding up, and I get pimples and outbreaks too. Never long lived and not very often, but it seems interesting to also focus now on a rosacea treatment that aims to treat the pimples and skin outbreaks from rosacea. The product is called IVERMECTIN. It has been on the market for a long time already as a medication that is effective against many types of parasites. It is also used to treat conditions like head lice, scabies and river blindness.
But recently, topical ivermectin (Soolantra) has been approved by the FDA for treatment of the inflammatory lesions of rosacea. Researchers (Stein et al) reported back in 2014 that ivermectin 1% cream was safe and effective for the treatment of inflammatory lesions from papulopustular rosacea, based on 2 randomized, controlled, double-blind, identically designed studies of ivermectin 1% cream versus vehicle applied once daily for 12 weeks.

Ivermectin comes in a pill (powder) or cream form and can be either applied to the skin or taken by mouth (the eyes should be avoided). Applying it topically is what is approved now for rosacea, but some people have also taken ivermectin in pill form already, under doctors guidance, with success. It has been a topic of interest on the Rosacea Forums for well over a decade now, as an experimental treatment option for the pimples that rosacea can cause.

Long has it been debated whether or not rosacea could have a bacterial cause, or perhaps a demodex mite cause. It is still not clear what causes it exactly, and it looks like rosacea is a gathering term for a ton of different skin problems that share the same red facial skin symptom, but that can have very different causes, including bacterial infections, demodex mite infestations, auto-immune conditions, allergies, food intolerances, blood vessel disorders and so on. Ivermectin can kill demodex skin mitesDemodex folliculorum as they are officially called, live in the hair follicles and sebaceous glands of the facial skin. There are two types, demodex folliculorum live in hair follicles, primarily on the face, as well as in the meibomian glands of the eyelids; demodex brevis live in the sebaceous glands of the skin (the skin areas that naturally are producing more oil/sebum). They are a natural part of the human skin and part of a natural balance with bacteria and other microorganisms, but science has highlighted recently that people with rosacea have more of these skin mites than people with normal functioning skin; up to four times as many demodex mites, in fact. And it has also been suggested that people with rosacea have an abnormal immune skin reaction to these mites, which causes our skin to break out, turn red and itchy.

Patients with demodicosis may have eye irritation, itching and scaling of eyelids (blepharitis or eyelid dermatitis). There may be lid thickening, loss of lashes (madarosis), conjunctival inflammation and decreased vision. Also dry eyes, reddened, crusty, itchy, burning eyelids, abnormal eyelash growth and inflammation of the cornea [keratitis], abnormal corneal blood vessel growth [neovascularization], and the development of nodular bumps of scar tissue on the cornea.
Increased numbers of demodex mites have also been observed in the following conditions:
Demodex folliculorum – rough skin due to increased scale within hair follicles; slight redness and sandpaper-like texture of the skin due to follicular scale. It can cause irritation and burning sensation.
Demodectic frost of the ear – frosted, gritty follicular scaling of the ear lobe and helix
Rosacea, particularly asymmetrical papulopustular or granulomatous variants
Some cases of perioral dermatitis (also affecting periorbital or periauricular sites)
Otitis externa (auricular demodex) 

A 2012 Chinese meta-analysis found that people with acne vulgaris had almost three times the likelihood of demodex infestation. Because the mites have an aversion to light, they conduct most of their business at night and crawl back into the hair follicles in the morning, causing skin itching then on the eye lids or skin.

The theory now is that people with rosacea, might have a specific skin type that favors demodex colonies to thrive, with skin that has specific lipid qualities that offers the right living circumstances for demodex mites. It is also possible that people with rosacea have a weaker skin barrier function.
Another theory is that rosacea skin itself is the cause of the extra demodex numbers, because rosacea skin is a usually little bit warmer in temperature than 'healthy' skin. And this can be a good breeding ground for different micro-organisms. However, evidence appears to be mounting that an overabundance of Demodex may possibly trigger an immune response in people with rosacea, or that the inflammation may be caused by certain bacteria associated with the mites. Dr. Frank C. Powell, consulting dermatologist at Mater Misericordiae Hospital in Dublin, Ireland, noted that the mites are most plentiful in the same regions of the face that are most commonly affected by rosacea — the cheeks, nose, chin and forehead — and that large quantities of mites have been found in biopsies of rosacea papules and pustules.

But it is also possible that demodex mites are just one part of the puzzle with rosacea, as research has also shown recently that people with rosacea tend to have immune related events taking place inside the body that contribute to rosacea's development, involving such substances as kallikreins, cathelicidins and mast cells. Most rosacea triggers, from ultraviolet light damage to bacterial infections that trigger an immune response in the body, have one thing in common: they have been shown to activate the specific enzyme receptor-2 (TLR-2), which normally is only used to fight off legit enemies for out own health, but in our case they trigger skin inflammation and causes us to develop symptoms of rosacea, including papules (bumps) and pustules (pimples).


The link between Demodex and rosacea has been very controversial for a long time. Partly because it does not explain ALL cases of rosacea. But science has now confirmed that Demodex mite infestation is an important factor in rosacea. It is suggested that it especially plays a role in rosacea subtype 2 with skin outbreaks, bumps and pimples. My own dermatologists have said numerous times to me that for subtype 1 with flushing and burning, demodex mites play no role. However, even this might be old news, as researcher Dr. James Del Rosso, adjunct clinical professor of dermatology at Touro University College of Osteopathic Medicine in Henderson, Nev. states:

“The classic ‘subtypes’ of rosacea appear to reflect variations in inflammatory and immunologic responses which in some cases may be induced by Demodex mites. For example, in one study, individuals with erythematotelangiectatic rosacea (subtype 1) were found to have higher facial counts of Demodex mites than those with papulopustular rosacea (subtype 2). It has been suggested that the higher Demodex counts lead to degradation of the follicular wall as the mites attempt to improve their survival. This loss of follicular wall integrity then triggers an immunologic response that reduces the number of Demodex mites, with papules and pustules subsequently emerging from the augmented perifollicular inflammation that occurs.”

Dr. Fabienne Forton, a dermatologist in private practice in Brussels, Belgium, suggested both an indirect and a direct role for the mites themselves in the development of the disorder. Skin infections and disruption of the skin barrier stimulate toll-like receptors to induce cathelicidin production, and the complaint of sensitive skin in rosacea patients often disappears when the number of mites is reduced to normal by treatment, she noted.

I take from this quote that the diagnostic evidence for a possible demodex mite infection would still be the presence of papulas and pustulas, even for subtype 1 patients. But I have followed patient reviews for a full year now on Ivermectin or Soolantra cream use (on rosacea forums and in facebook groups) and I have noticed that those who had success with it (a big group, I'd estimate 70% of the reviews I have read eventually announced good success with Ivermectin or Soolantra treatment), also mentioned that apart from their pimples, the overall redness of the skin also decreased. This in itself could make Ivermectin potentially a treatment option for subtype 1 as well. An if I can go by the statement of dr. James Del Rosso, subtype 1 rosacea sufferers have been found to often (sometimes?) ALSO have demodex infestations, and found to have even higher counts of demodex mites than those with rosacea subtype 2. However, research on this topic just started and scientists declare themselves that more research is needed to get to the bottom of all this. Not everyone is convinced that demodex mites are really the culprit here.

Symptoms of demodex skin infestations, called demodicosis, are (small) papules, pustules and fine scaling of the skin. Demodicosis can mimic rosacea symptoms, but usually does not respond at all to traditional rosacea therapy and treatments. it does respond well to treatment options to kill the demodex mites, especially with Ivermectin or Permethrin cream. Other treatments that have been said to have effect are treatment with Borax, Tea Tree Oil, Sulphur or Hypochlorous acid (HOCl). You can best ask your dermatologist to do a skin scraping, and then have your doctor do a mite count under the microscope. He or she can then confirm if you have more than normal numbers of demodex mites on your skin.
Another way of finding out if demodex mites cause YOUR rosacea symptoms to worsen or even to exist at all, is of course to try ivermectin cream for yourself. There is always the risk that some ingredients in it cause a skin reaction, but other than that, a skin clearance on ivermectin cream is another way to self diagnose.

Here you can read many more pubmed research articles on demodex mites. And here is a good comprehensive oversight article on demodex mites and rosacea.

I have seen numerous fabulous success stories now on social media and in rosacea health groups. I cannot and won't use their skin pictures here, but many showed severe skin outbreaks and skin redness before the use of Ivermectin or Soolantra, and near clearance of their skin symptoms after a few months of use. I will gather user info below, but first explain what treatment options are and what other things can be done about a demodex mite problem.

Soolantra cream

Soolantra has been brought on the market recently. It uses the good old Ivermectin anti-parasite at 1%, and they have put this active ingredient in a gel base that is similar to cetaphil cream.

SOOLANTRA cream contains the following inactive ingredients:

*carbomer copolymer type B (a hydrophilic thickener; emulsion stabilizer; gel forming)

*cetyl alcohol (an emollient; emulsion stabilizer; thickener - not considered irritating for the skin)
*citric acid monohydrate (a buffering agent; pH adjuster - not considered irritating for the skin)
*dimethicone (antifoaming; emollient; skin protecting - not considered irritating for the skin)
*edetate disodium (chelating agent)
*glycerin (solvent; moisturizer - not considered irritating for the skin)
*isopropyl palmitate (solvent; fragrance; synthetic ester; moisturizer - can be comedogenic)
*methylparaben (Preservatives, Antimicrobial - can irritate the skin in very sensitive skintypes. Parabens, including methylparaben, mimic the effects of estrogen in the human body.)
*oleyl alcohol (surfactant; viscosity control; emulsifier - can be comedogenic and can be a skin irritant)
*phenoxyethanol (preservative; fragrance stabilizer - can be a skin irritant as it dries out the skin)
*polyoxyl 20 cetostearyl ether (hydrophilic emulsifier; surfactant)
*propylene glycol (solvent; humectant; viscosity controlling - safe ingredient but can cause skin irritation or allergy for very sensitive skintypes)
*propylparaben, (Preservatives, Antimicrobial - can irritate the skin in very sensitive skintypes. Parabens, including methylparaben, mimic the effects of estrogen in the human body.)
*purified water 
*sodium hydroxide (pH adjuster)
*sorbitan monostearate (emulsifier; non-ionic surfactant composed of sweetener sorbitol and  stearic acid, a naturally occurring fatty acid.)
*stearyl alcohol (emulsion stabilizer; emollient; foam booster; thickener, composed of sweetener sorbitol and a naturally occurring fatty acid. Can be comedogenic and can be a skin irritant)

Ivermectin cream

Soolantra is a very expensive cream, especially for people who are in the United States or in countries where health insurance does not cover its costs. Soolantra uses Ivermectin as an active ingredient, and all its other ingredients are inactive and therefore not needed. A cheap and eye raising alternative to Soolantra is to simply buy Ivermectin online. It is used for animals including horses as an antiparasite injection, but many dozens of rosacea patients in health groups I am in have so far purchased these creams/injections online and used a small drop of it on their skin daily, with really good results; clearer skin, paler skin. The percentage of Ivermectin is slightly higher in these creams/injections as in Soolantra (1,87% compared to 1%) but dermatologists who I have heard about or from so far have said that this percentage difference should be no problem. If anything, it might work faster, better and for a whole lot less money. These products are available for as little as $5,-. My own doctor prescribed me Soolantra (to try on my red chin and eyelashes and eyebrows that have lost so much hair over time), but the preservative in it or perhaps
another ingredient makes my skin burn. I am therefore trying out an ivermectin injection (I just bought the one in the blue and white picture below here), as it is pure and I can mix a tiny drop with some water and apply it to my eyebrows to see if the red rashes disappear. the same for the scabs on my eyelashes

Each syringe contains: ivermectin - 1.87%

Other treatment options

-Benzyl benzoate solution
-Permethrin cream
-Sulfur ointment
-Crotamiton cream
-Selenium sulfide wash
-Metronidazole gel
-Salicylic acid cream
-Mercury oxide 1% ointment

Use mild shampoo on hair and eye lashes every day
Cleanse the face twice daily with a non-soap cleanser
Avoid oil-based cleansers and greasy makeup
Exfoliate periodically to remove dead skin cells
Wash sheets and pillowcases in hot water and dry with the hottest possible dryer setting to kill the mites that might otherwise jump from bedding to faces.
Pillowcases should be changed regularly – up to every day or every second day. Pillows should be properly washed with concentrated powder (full cap) and 10-15 drops of tea tree oil in washing machine.
Realize that demodex mites love dead skin cell build up and old make-up:  consider not using makeup for a week, and discard old makeup.
Not washing your face at night or sleeping with make up on your face can make you more vulnerable to an infestation of demodex mites.
Women who wear mascara or a lot of eye make up tend to have a higher prevalence of demodex mites on their eyelashes.

Tea Tree Oil
At high concentrations, tea tree oil is a potent killer of Demodex mites. Scientists discovered that Demodex mites can be killed by 100% tea tree oil application during 4 minutes and by 50% tea tree oil during 15 minutes. The problem is that solutions of 100% tea oil, and even of 50%, are very irritating to the skin and eyes. It should never be applied undiluted, as it can do major damage and is even toxic at this percentage. One possible approach is to thoroughly wipe the eyelashes and eyebrows with a diluted solution of tea tree oil, from 5% to 50%. Be aware of the potential of tea tree oil to really irritate at higher doses. 
In one study, a daily lid wipe with a 5% solution of tea tree oil reduced both the numbers of mites and the perceived itchiness of the eyes. Until recently, tea tree oil was the main method of keeping the mites in check. Duration of treatment should be at least 6 weeks, as demodex mites have a life cycle of 14-18 days, and could be up to 6-12 month in some cases. 

Antibiotics & Steroids
An antibiotic steroid ointment can help prevent the mites from moving. It may even suffocate them. The combination of antibiotics and steroids is also a standard treatment for blepharitis. The steroid reduces inflammation, which is caused by the mites, the bacteria, and treatments like tea tree oil wipes. In addition, the antibiotic helps control the bacteria, but most demodex mites survive applications of metronidazole cream. Also, STEROIDS ARE A KNOWN ROSACEA WORSENER, and can even cause rosacea. This is not a good treatment therefore for people with rosacea. 
Besides, steroids can worsen glaucoma, while chronic use of antibiotics can lead to the development of bacteria that are resistant to the antibiotics.

Hypochlorous Acid
Hypochlorous acid (HOCl) is a naturally occurring substance produced by white blood cells as a first defense against microbial invaders. Its antimicrobial properties were recognized more than 100 years ago, when solutions containing HOCl were used to combat infections in the wounds of soldiers injured in WWI. Only recently, however, has it been possible to manufacture a stable, pure version of HOCl. HOCl has potent antimicrobial properties. Laboratory studies show that it effectively kills the nymph form of the Demodex mites, as well as the Bacillus oleronius and Staphylococcus aureus bacteria that live on eyelids and that are found inside the Demodex gut. In addition, HOCl also neutralizes the inflammatory toxins released by both mites and bacteria. Moreover, unlike tea tree oil, HOCl is completely non-toxic and non-irritating. Amazon and other online companies sell eye drops like these

Permethrin also sometimes can be used against Demodex mites. This medicine originally was used for treatment from scabies. It works similar to Ivermectin. Here is some more info on permethrin for rosacea: 

Galderma released promotional before and after photographs of someone who has used Soolantra for 12 weeks.
(please scroll down for Soolantra/Ivermectin user reviews)

Soolantra Before (left) and after (right) Pictures showing a decrease in skin outbreaks.

(Source) "Having both a bottle of injectable (livestock) Ivomec (10mg/ml, 1% Ivermectin) and Cetaphil cream on hand, I mixed up a small batch to see what would happen. I added 2 squirts of Cetaphil cream and 16 drops of Ivomec to a small stainless steel bowl and mixed them with a small metal spatula.  The two ingredients combined easily with no distinct separation.  I applied the mixture to my face, neck and decolletage.

Observations after 24 hours (3 applications):
Face feels calm - not inflamed. Itching has diminished on face, neck and decolletage but seems more pronounced in my scalp. Small red dots have appeared across cheeks.  Particularly on the right cheek which is the side I sleep on. My dermatologist is up to date regarding Soolantra but was not supportive about my use of Ivomec but put me on to a Permethrin cream for scabies called Lyclear. I've had good results so far but occasionally I have felt the need to use the Ivomec when I can feel excessive mite activity. Cheers, Kate"

(Source) "These pictures take you through the first 6 weeks but I started Soolantra nearly 5 mths ago. I used it every day for 3 months and dropped back to every few days until a recent, low key flare up. So I am currently doing every day. I am nearly at the end of my original tube, so it has lasted quite well! I am so much happier when I look in the mirror! I still have some light redness in my affected patches but I’m comfortable without base makeup again. I did learn some awesome ways to hide the redness with makeup when I choose to, so I will do a follow up post with those tips too. In these pics below I have minimal skin products, perhaps a dusting of powder foundation and maybe bronzer/blush, if anything at all. I really like to show of my new skin and go fairly bare. They are taken in evil supermarket lighting, in the op shop, in natural light, indoor light and even crap selfies. I am so proud of my new skin!!!"

(Source). Caption: "23 days using soolantra. Having less redness but still a lot of bumps. Trying to hang In there hoping it will keep getting better as time goes on."


(Source) "Skin update.  (Using Soolantra) This time last year I was driving back from the doctors crying, with the words "chronic" and "progressive" going round in my head. As OTT as it sounds I will never forget that day and how completely hopeless it all seemed. I haven't done anything different since my last update except I've been out twice this week and had alcohol....I know the hermit has become a social whirlwind lol! ✌️ My face is definitely pinker this week and I have a few new patches of tiny skin coloured bumps on both cheeks but this is a world away from the flare I would have got a few months ago. The only thing that has changed in my life over the last two months is my stress at work is currently zero and this has honestly made me feel like a different person. Perhaps it's a combination of this and my body starting to heal? My main trigger is still the sun and heat and if anything this has got worse, but I live in the UK so I'm not going to worry about again for about eight months lol! (Top) Three weeks ago (Bottom) Today" 

(Source) "Soolantra / heatwave update. I was really nervous about spending a whole day out in the heat yesterday mainly because I've learnt it takes over a week for my skin to recover from a flare. Towards the end of the afternoon my face, neck and arms were beginning to itch like mad and when I got home and took my make up off my skin was quite red with a few new bumps (L). However this morning the redness has gone down a bit and no new bumps so far although it is very blotchy (R). I do feel like I'm now supporting my body in its battle a bit more now and maybe that's starting to show. I obviously wore my SFP50 and my hat when I needed it, but I also stuck completely to my diet and didn't have any alcohol. A few months ago I probably would have thought fuck it and had a few drinks and the wrong food!"

(Source) "Rosacea is a pain in the neck! Finally a medication that works and finished this 6 year saga! [..] Update: I'm still with no more flare ups ever.just that once. I'm everyday grateful for having my skin back and thinking of soon having a little laser tidy up of sub cutaneous burst capillaries which are the ravages of 8 years in hell! I got in just in time people! Only a little orange peel (large open rubbery pores) beginning which is the bodies response to long term skin agro and irreversible!"

(Source) "Die mites 😂 No new bumps since I started using Soolantra and the ones I have are less prominent. My skin is also much softer. Before it was crazy dry and flakey. I am now also taking Olive Leaf Extract and Turmeric capsules. I have absolutely everything crossed right now. Going to try tea tree oil tonight so hopefully I can alternate between the cream and a natural approach long term. (L) Before Soolantra, (M) Day 1, (R) Day 5" 

(Source) "Started Soolantra 3 days ago. Is it normal for things to get worse before they get better?"

Here are a couple of videos of a lady with rosacea trying out Soolantra, with good results:

Rosacea patients reviews of Soolantra cream and Ivermectin 

Kayla wrote on March 14th, 2015 about Soolantra: "Miracle cream! Tried everything and this cleared me up in 1 week!"

Dre wrote on July 19th, 2015 about Soolantra: "I don’t have the papules and pustules – just extreme flushing, since I was a teenager. My dermatologist gave me four prescriptions to try and one was soolantra. It has decreased my flushing by 90% and completely changed my life. I was able to start a meetup group (before I avoided social situations) and I no longer flush when I become overheated, anxious, excited, driving in the car, for no reason at all, etc. I think this medicine DOES work with redness – I had no P&Ps at all and I hope they make this forever."

Derik wrote on September 26th, 2015 about Soolantra:
"I agree. I started using just three days ago and was very skeptical. I have the exact same issues as you. No P&P, only extreme flushing and the burning, stinging sensations that comes with. Soolantra has diminished those sensations and my skin feels much less reactive. I still don’t know if this is placebo. I also bought Mirvaso but will not use it if this amazing progress continues."

He updated on November 12th 2015: "I would say I’ve been through about 4 tubes in 6 months. I don’t seem to need or use a full tube per month. The soolantra is still working perfectly for me. If I do miss a day or two I notice it immediately with increased redness. I don’t notice any dryness, peeling or tenderness anywhere. Sometimes if I miss a night I’ll put it on the next morning. I had a *horrible* reaction to the Mirvaso – it turned only the areas I applied ghost-white and then I had even more reactive and extreme flushing in all other areas and rebound redness. I’d say flushing has been a big problem for me for 18 years! There are so many of us out there struggling with this. My life was so different before I started the soolantra!!"

Anthonyavery wrote on March 20th, 2017 about Soolantra: "I love this Soolantra! I’ve been on it for like 6 months and the redness has been reduced by 98%. I still get the weekly pimple so using Accutane. The question is when do I stop using Soolantra?"

Patrick wrote on December 25th, 2014 about Soolantra: "In my experience as a test subject for this compound it significantly reduced redness."

Ciara wrote on July 9th, 2016: "Hey, the 3rd week with Soolantra was not so successful for me.. More p&ps and overall the face feels less calm than in the previous weeks. But skin is still better than before starting Soolantra."

Hope please...wrote on July 13th, 2016: "So first week done. when I put it on, I don’t know whether it’s a placebo or not for me so far – but it does feel calmer; it doesn’t aggravate at the very least. 2 episodes of bad flushing so far this week. one very bad one. at work there’s a room i have to go into sometimes and it’s very hot – always makes me flush. still made me flush badly, but i’ll see how it goes further on treatment. Other time bad flush was after I washed with sulphur soap after a few hours – which is drying. in the past sulphur has calmed my skin. i’ve had sulphur soap for probably 2 years. back then, i didn’t know about demodex and how the condition gets worse before it get’s better when a correct treatment is hopefully picked, so i gave up on it. i started using sulphur soap on and off again the past month, which has probably altered where i am in the demodex cycle compared to if i had just started soolantra with no sulphur before. i’m going to quit the sulphur for now, and just do soolantra for the course. my gp didn’t want to prescribe the soolantra so i was lucky to get it. i don’t know if she’ll prescribe it again. has anyone else had that problem with gp’s? i’m also coming off sage as it was giving unbearable side effects (thujone free sage doesn’t agree with me either) and starting seabuck thorn oil it’s blurred showing which treatment will work/ not work i know, but i’m just pressing ahead. cheers"

She updated on September 20th, 2016: "11 weeks tomorrow. No difference in flushing than before the start of treatment. I’ll probably only post here again if there is an improvement."

Andrea Newton wrote on September 20th, 2016: "Been using soolantra for nearly six weeks but I’m still getting bumpy skin on my chin, really fed up with it all."

All the way back in 2008, there was already an Ivermectin trial. Forum member Rachzon wrote about the participation in this trial, on October 4th, 2008: "I have been on an Ivermectin trial for just over a week now with quite positive results. I have moderate Rosacea with frequent papules and pustules. My most recent flare up started in July and had continues until this week when I started the topical Ivermectin. My skin had improved a little after I started applying Megan Gales Invisable Zinc about a month ago but the change in the last week has been quite dramatic. My skin is still far from perfect but as the trial goes for about a year I hope it continues to improve. Initially I was getting about 20 papules on EACH cheek, forehead and even on my neck, so it was pretty ugly, the inflammation was not pleasant either. I have the occasional papule left, the worst place is still on my neck but the texture of my skin is soft, no burning or itching and life is a hell of a lot more pleasant. My 3 year old son hasn’t been patting my cheek and asking me if it still hurts this week either. Looks like those beastly mites have a lot to answer for in my case.

Rachzon updated: "It is a 30 gram tube with what I presume is 1% Ivermectin. [..] I asked about other peoples experiences, they have about 10 on the trial at the Coast and all but one have had results similar to mine. The Derm mentioned that up to this point it has been very hard to treat Papular Pustule Rosacea so is very pleased with these results. [..] 10 weeks I have been on the trial now and my face continues to be fantastic. I get the very occasional bump but it is gone within a few days."

As many people who started with Soolantra/Ivermectin noticed, it can take up to 6 to 8 weeks before your skin sees the benefit of this treatment. Especially those with skin outbreaks can notice a worsening of their skin for the first month at least, which cvan be very frightening and disencourgaing. The mites have a life cycle of around 2 weeks however, and when they die off, their 'corpses' release substances in the skin that can cause an extra inflammatory response, before things are cleared up and improved.

CD wrote on January 25th, 2017: "I started 8 days ago. It got worse initially. The first week was really bad with bumps all over my face, particularly around my nose, cheeks, and forehead. Now things seem to be improving. I’m cautiously optimistic. It was helpful for me to read the advice of others to stick with it. I’ll keep it up and report back."

Ayesha wrote on February 1st, 2017: "Hey, I have been prescribed soolantra for papillae rosacea. I have been using the cream once a day for only 5 days. My face is bad. It has brought out red spots all over my face and nose. Before they were just bumps in the skin now they are showing on the outside. Not sure if it is meant to get worse before it gets better. I am getting married in 7 months and do not want to look like this."

Stuart wrote on February 1st, 2017: "In 7 months time your skin will be better than its ever been believe me. 5 days is nothing. You will have weeks worse than others as the mite kill off happens until the mites are gone.but you will be happy. About 12 weeks plus you should be clear but in the weeks leading up to that your skin will continually improve dramatically."

Ayesha wrote on February 3rd, 2017: "Thank you for your advice Stuart. I have an appointment with the dermatologist tomorrow so will show him my face and see what he says. I was hoping someone would say it gets worse before it gets better. Today the redness is not to bad and the bumps are not as bad as yesterday. Not sure if that is because I have been in bed all day due to a sickness bug and not had the opportunity to go out and about. Hope soolantra works for me. I honestly do not know how I have developed papular rosacea. I have Asian skin, I am pretty fair in colour may be that’s why. Thank you for your support. Your words give me hope."

Stuart wrote on February 3rd, 2017: "Its fine. I had antibiotics to combat the mite die off for the 1st few weeks. Its 3 weeks, 6 weeks , 9 weeks that u will most probs have further mite die off. But you have to stick with it. That's the number 1 rule."

Carrie wrote on February 3rd, 2017: "Your face will get soooooo bad before it gets better. Once it gets better though, it will be better than it’s ever been. I look totally different than I did 18 months ago. V Beam Laser helps a lot too. Don’t give up. The only reason I got past day 3 was because I saw a man on here begging people to just keep going. You will feel like a monster for several days, but don’t stop! All the bumps are the mites dying and you have to kill them all before you clear up. Good luck!"

MT wrote on February 4th, 2017: "I suggest to keep more moderate words than “better than it’s ever been” mate. Soolantra is quite good, but not magic, and not for everyone. Worse before it gets better overall, we all know that now. But after about 2 years of Soolantra medicine, I can say it’s not always for the best in a pink glasses tinted world. Soolantra isn’t THE miracle product for all rosacea pathologies. Regards."

Claude caron wrote on February 19, 2017: "Hi I hope you enjoyed the magnificent results that I did. I had terrible papules diffuse over my forehead chin and cheeks after 4 weeks of soolantra I found an improvement of 70%. 3-4 weeks beyond this my condition cleared, amazing!!"

Chris wrote on February 3, 2017: "Doxycycline is a life saver. I got big red bumps after a few weeks on ivermectin cream. Doxycycline made them disappear within a week. It means I need to stay on an antibiotic for a while, but I don’t notice any side effects from it during the 6 months. Now that my skin is much improved from the combination of ivermectin and doxy – much less flushing, burning, inflammation and swelling – I decided I’m ready for IPL. So far I’ve had one light treatment with small but noticeable improvement. I’m going back next week for the next one, which will be stronger. I figure once my skin improves enough, I’ll be able to go off the doxy (does anyone have experience with this?)."

Susan wrote on April 20th, 2017: "My dermatologist ordered a Rx. for Soolantra and ordered it to be compounded. Soolantra averages about $350.00 and compounded Soolantra is $35.00 The people suffering with Rosacea and Demodex mites need to know this."

Irene McDonald wrote on July 3rd, 2017: "I have just finished my first tube of Soolantra and am delighted with the results. When I used it first I though it didn’t work well but now think I didn’t persevere long enough. I now use Soolantra every night and my skin hasn’t looked this good or clear for 15 years. Finally there seems to be a solution. I first heard of Soolantra at a Beauty Therapists seminar. A dermatologist gave a great talk on Rosacea and was convinced the demadox mite was to blame for the pustules. Now I agree, having been a sceptic for years. Irene"

Dorota wrote on July 4, 2017: "Hi, I have rosacea for about 20 years. But it was never as bad as last. I started with soolantra and for about 2 days nothing changed so on third day I started Oxytetracycline as well. And then it began. For a couple of days my skin was getting swollen, red and bumpy and then literally peeled off in chin area. I couldn’t leave the house. I was sure it was antibiotic, After about five days I went back to GP and they told me to stop using cream, that is highly possible that the cream was causing these reaction. I stopped using Soolantra and I’m on antibiotics now. I was prescribed Metrogel last month. Although my face looked a lot better I had to stop using it as I couldn’t get out when sun was out. I was wearing Spf 50+ but my face was burning and I need to be out with my son.My face looks a lot better now, no pimples only redness although it tends to be dry and itchy around chin where was pilling off. I don’t know what to do. Maybe someone can help?"
two years after I gave birth. It was so bad that I developed blepharitis, I had always very sensitive skin so I couldn’t use any cosmetics as I ended up with very red itchy face. I was waiting with treatment until I stopped breastfeeding and about two months ago I went to GP to ask for treatment. I got Soolantra and Oxytetracycline

Carrie wrote on July 4th, 2017: "Your face has to get really really bad on Soolantra before it gets better. Most people get very red and bumpy for days. This is the mites dying off. I looked like a monster, but you have to let the whole cycle finish or you will never get better. Go back to some comments that I and others made on this page from 2015 and 2016. Everyone explains the process they went through."

It seems that some people really cannot tolerate Soolantra. Maybe some of its inactive ingredients cause a bad rosacea skin reaction for some people, or perhaps the Ivermectin is the culprit. For the majority of people who post about the worsening of skin after starting Soolantra/Ivermectin, however, the skin improves after the first 5 weeks or so of instability. 

17 September, 2017

Montelukast (Singulair) for rosacea flushing and redness

My dermatologist suggested lately that I could try out an asthma/allergy med called Montelukast (brand name Singulair). I was already given it last year coincidentally by my GP for my bronchitis at the time, but never took it very long. My dermatologist said that singulair is helping some of his rosacea patients, especially flushers, as it is supposed to lower inflammation and interferes with mast cell issues, which can play a role in allergies and flushing.
Singulair (this is the brand name, the generic active ingredient MONTELUKAST is just as good and what makes it work) is designed to treat asthma inflammation in the lungs. It also prevents the narrowing of airways triggered by exercise. Singulair is a leukotriene receptor antagonists. It works by blocking substances in your lungs called leukotrienes that cause narrowing and swelling of airways. Blocking leukotrienes improves asthma symptoms and helps prevent asthma attacks.

Leukotrienes are also involved in rosacea flushing and skin inflammation however. Leukotrienes are a family of certain inflammatory mediators produced in leukocytes in the body. They play a role in the regulation of the immune responses in the body. But when leukotrienes are produced, they also stimulate the production of histamine (which is a blood vessel dilator and also involved in allergic reactions), as well as the production of prostaglandins. There are 'good' and 'bad' prostaglandins and the body. The BAD ones create inflammation and pain. They also play a role for instance in the painful inflammatory response in the uterus when women menstruate. This is why NSAID's, which control the prostaglandin production, can really help with menstruation pain; they make sure there are less of these bad prostaglandins produced by the body and this lowers inflammation and pain.

Bad prostaglandins are bad news for rosacea, as they cause inflammation of the skin. They can cause facial flushing. Increased levels of prostaglandin D2 make the skin look red and inflamed. (By the way, certain foods, especially sugar and white flours, also raise the levels of prostaglandin D2 in the body and skin). Unfortunately, research tests showed that taking a prostaglandin D2 (PGD2) receptor subtype 1 antagonist (laropiprant) (to counteract the levels of prostaglandin D2) did not improve rosacea subtype 1 symptoms. Still, inhibiting even some of the leukotrienes is beneficial, and many rosaeans have reported that leukotriene blockers help decrease the inflammation associated with their rosacea. 
As illustration: Doctors have used an antibiotic called azithromycin effectively in the treatment of occular and regular rosacea, and one of the ways in which it helps rosacea, is in the way azithromycin lessens certain pro-inflammatory cytokines in the body (including IL-1, IL-6, IL-8, IL-10, and TNF-α), and because it down-regulates the production of nuclear factor (NF) kappaB and of leukotriene B4.

One of the roles of leukotrienes (specifically of leukotriene D4) in asthma is to contract the smooth muscles lining the smaller parts of the lungs. Of too many leukotrienes are produced by the body, they cause a lot of inflammation in asthma and allergic rhinitis. Leukotriene antagonists like singulair/montelukast are used to treat these disorders, by lowering the production or activity of leukotrienes. Cysteinyl leukotriene receptors are present on mast cells, eosinophil, and endothelial cells. They can stimulate pro-inflammatory activities by mast cells. They can create inflammation, induce asthma and other inflammatory disorders, thereby reducing the airflow to the lungs. Cysteinyl leukotrienes seem to also play a role in adverse drug reactions in general.

So, despite singulair/ montelukast being developed to treat asthma symptoms, the way in which it lowers specific chemicals (leukotrienes, prostaglandins, histamine) that also play a role in rosacea inflammation, it might help some people with rosacea with their general skin redness and flushing. 

I am glad to try it out and have already taken it for a few weeks, but too soon to tell if it improves matters. Some days I think it does, others I am not so sure. Hopefully better effects in weeks to come. One of the known side effects is increase anxiety or jitteryness. I have not felt as calm as normal lately, but these things can be hard to pinpoint to one specific cause. I know of two other rosacea patients who currently try singulair out, and both of them are in the same boat, not being sure whether or not it helps or not. Ginaisred for instance, and she wrote about it on The Rosacea Forum: "Hi all, thought I would start a new thread to discuss Montelukast. I know some people on this forum are patients of Professor Anthony Chu at Hammersmith, and he has recently advised us flushers to start using Montelukast. I thought I would create a post to keep you updated and anyone else who is trialing it please add in your thoughts.. So far: I have been on it for a week - sadly no improvements yet. I assume it may take a while if it was to work?  Fingers crossed for me."

Singulair has been used by rosacea patients in the past already too
and some wrote reviews. let's have a look what they thought about it.

YankeesRtheBest wrote on May 11th, 2007:  "Singulair is amazing..I have been on singulair for about 2 months now and it has been excellent at keeping my Rosacea under control. My flushing has been non-existent. Even the terrible night flushes and exercise-induced flushing has subsided. I started singulair because I tested positive for allergies (tree pollen, dust mites) I started getting allergy shots and my allergist also prescribed me the Singulair. What is even more amazing is that my broken blood vessels are much less noticeable than they were and my chronic redness is at least 50 percent better. I strongly recommend this, however I'm not sure how you can get it prescribed for you if you don't have allergies or asthma. he only thing that hasn't been helped much is my ocular rosacea. Hope this info helps. [..] I am on 10 mg. I noticed that my Rosacea was significantly better after about 4 or 5 weeks. Now, after 2 months of being on it, my flushing has been diminished to almost non-existent. And yes, even my emotional/social nervousness flushes and indoor heat flushing has been helped tremendously. I don't know if this would be the case for everyone, but Singulair def seems like a wonderful option for people to try. Good luck. -Chris"

Froggirl replied: "Thanks for this info, it's so interesting, at first I assumed singulair was a type of antihistamine (which I'm already on) but it's completely different...as far as I can tell from googling it's usually used for asthma, not for skin reactions, although I found one reference that said it possibly could help skin allergies. So I'm really curious to know if your doctor prescribe it for asthma or skin allergies? I did some more googling and it is used for mastocytosis, which is a disease where the mast cells degranulate too easily, and so causes extreme allergy type reactions, including flushing and wheezing. I'm being checked out for this at the moment because everyday now I'm flushing all over and having wheezing attacks (but have no allergies). [..] Despite it being unclear what triggers rosacea in the first place it's pretty clear that the symptoms are related to inflammation, and leukotriene's are one of the inflammatory mediators that contribute to inflammation, along with histamine and prostaglandins etc. So potentially blocking any of these inflammatory substances could reduce the inflammation and improve rosacea. In allergies the release of these chemicals is due to the immune system overacting to common substances, but the end result is that the same chemicals get released, causing redness, swelling and warmth. And then the inflammation caused by these chemicals trigger the release of more chemicals and things can just get worse and worse. So even though the initial trigger for the inflammation may differ between rosacea and allergies the same treatments can potentially help both."

Froggirl updated on June 1st 2007: "I'm up to 9 days and the last few days my asthma has been much better and my flushings has maybe been a bit less but nothing dramatic. Saw my doctor today and he said it does start to kick in for asthma after 7 days and gets to the full effect at about 2 months so i assume it will be a similar story for flushing."

Melissa W wrote on May 12th, 2007: "In Nov (2006) I asked my derm to put me on singulair because I had read (I think in Nase's book) that it may help with rosacea. I also happen to have asthma. I developed it 7 years ago along with all my other allergies which appeared all of a sudden but then my asthma mysteriously disappeared about 2 and 1/2 years ago. Anyway, I have noticed no change in my rosacea due to singulair but I am currently still on it because my derm said there are no negative side effects from it (a safe drug) and also because I still have so many allergies."

YankeesRtheBest updated on June 8th 2007: "I would defenitively give the singulair a while to work. I noticed that my flushing was 95 percent gone after about 2 months. It all has to do with the inflammatory leukotrienes. I spoke to my allergist about this. I told him how my rosacea was so much better after being on the singulair for a couple months and he explained to me that inflammatory leukotrienes are the reason for different types of inflammation such as in the reaction to allergies or asthma. He said inflammatory leukotrienes are also in the blood vessels. Singulair helps release these leukotrienes from the vessels. This could be why it helps the flushing of rosacea and also why my broken blood vessels appear to be less visible. But yea...def give it a couple months. Don't give up on it too soon. Good luck. -Chris"

Barbara wrote on June 10th 2007: "I’m 3 weeks on Singulair now. Still no results for flushing. I really hope I will see some first results in the next 2 weeks. After stopping my antidepressant some time ago my flushing slowly has come back to the same distressing strength than before taking the antidepressant, so I’m so desperately hoping that Singulair will help! The last 2 weeks I had some minor belly ache. Could be from Singulair as it is listed as one of the most possible side effects. But it is only minor, so no reason to stop taking it. Take care all, Barbara"

She updated on July 25th 2007: "Update: So I stopped taking Singulair last week on wednesday. On Sunday evening and the whole Monday a was quite flushy and my face got redder again and still is. The last weeks while taking Singulair I was much "cooler" and pale. I really thougt that this was because of summer, when I don't flush so often. But after stopping Singulair I have the feeling that it acctually may have helped me. HHMMMM...it's always so difficult to tell if this flushy time would have also happened if I would still be on Singulair."

And she updated on September 26th 2007: "I started my second Singulair trial 4 weeks ago. And this time I not only can say for sure that it is really helping, moreover it started helping already the next day after taking the first tablet. I took the first tablet in the morning. When I got up the next morning and looked into the mirror I thought: “Wow, I look so pale, but that can’t be because of Singulair, I just took the first tablet yesterday!?”. But it’s true, I am really paler since taking Singulair and the threshold for flushing is noticeable higher than it would be at this time of the year. Two colleges at work already asked me if I would feel sick because I look so pale!
Don’t get me wrong. I still suffer from frequent mild up to strong flushes depending on the trigger. It is just in compare to not taking Singulair that I feel better. Singulair just puts the threshold higher before a flush starts. I would say it saves me from a lot of mild flushes and helps my face to stay a little bit “cooler”. But the most noticeable result from Singulair is my paler face. It is not a cure though but every little relief is highly welcome. And because Singulair works against inflammation I assume it may slow down the progression of rosacea in general, or at least I hope so. However I feel far from being able to live my life in a fairly “normal” way. This flushing/blushing thing is draining so much joy and energy out of me. I feel sooo tired. Just to think how happy I am that I have perhaps one flush less a day because of taking Singulair shows me how desperate I am.   Sorry for whining. I really started that post with another intention.
Best wishes,

Barbara further updated on December 1st 2007: "I just want to give an update on my treatment with Singulair. I take it daily since August now and it is still helping me to paler and cooler face. In autumn/winter I normally have a lot of mild or strong flushes during the day depending on the trigger and often nose flushes during the night. This time Singulair helps keep away many of the mild flushes and the nose flushing during the night. And it definitely helps reducing the flush when I come from the cold outside into a warm room. However; it is only helping to some degree…if the trigger is strong enough I still have my strong flushes. Especially the ones that come from anxiety, embarrassment and warm indoor heating. But I’m thankful for every flush that I don’t have, even if it would have been “only” a mild one. So far I don’t have any negative side effects from Singulair that I’m aware of. It is just soo expensive!!"

iVAN wrote on June 17th 2007: "Been on Singulair for 5 weeks and have no improvements in
any rosacea or flushing symptoms. Actually I don't notice it doing anything at all so far."

Twickle Purple wrote on June 20th 2007: "Within days of starting Singulaire my face was cooler, and now I flush much less. My face is almost always cool to the touch. My triggers are mostly allergy related and the Singulaire has worked great. I take it with a reactine and a zantac in the morning."

She updated on September 27th 2007: "I urge anyone taking this to be aware of the side effects.
This drug helped me SO MUCH but I had to stop taking it because of the horrible side effects I was experiencing. Check this out: http://www.medications.com/singulair/browse
I have been off the Singulair for over 3 weeks now and am finally feeling better. The deep pain and ache side effects slowly went away within the first week and by the second week I was left with just generalized weakness but no more pain. In my third week my strength was coming back, I could hold a full teapot, but I had no stamina even for a short walk. Now I am starting my 4th week post-Singulair and I am getting some vigor back. I went for my first walk yesterday and was able to walk at a gentle pace for about 20 minutes -- no hills or inclines though, I'm not up to that just yet. I am saddened that such a helpful medication could rob me of my life-force like Singulair did."

Froggirl updated on June 21st 2007: "I wonder then if it works best taken with antihistamines? Because as far I as know leukotrienes are unlikely to be released in the body on their own but in tandem with histamine (and the other mast cell contents), meaning that if you take just singulair the histamine may still effects the blood vessels anyway..Similair to how H1 antihistamine didn't make much of difference to my flushing but taking a combination of H1 and H2 did. I've been on sigulair over a month now and my facial flushing is improved, not gone by any means but it is noticeably better and i'm hopeful them it might improve even more over the next month.

Max wrote on June 21st 2007: "No noticeable results for me after 3 weeks on singulair..."

Liz wrote on July 16th 2007: "Been taking singulair for 3 weeks now... face is still covered in hives, red and swollen... with some nice deep sores added for extra misery. All singulair has done was take about $100 out of my wallet for copays. Should i give it another month? what do you think? - liz"

Kathy S. wrote on July 25th 2007: "Singulair wasn't amazing for me. I only took it for a little over a week but it made me irritable and shaky, some little panic attacks, it was really weird. I took it with zyrtec. Also it didn't help with my flushing, I believe it got worse. I hope that others are really seeing help from it. I just didn't get the results and couldn't take something that made me stress more as that is my biggest cuprit and wind."

Alba wrote on January 29th 2008: "I just started singulair 2 days ago, i think its already working have been flushing less often."

dwit392 wrote on February 15th 2008: "When I combined Singulair and Zyrtec I seemed to get amazing results. I don't believe I got the results with Singulair alone (I took my prescription in two parts of 15 days each) I didn't really realize until I stopped taking Singulair how much it was helping me. I need a new prescription now. It seemed to greatly reduce my internal heat. My redness was down 25%, flushing threshold was about 20% higher, and I stopped getting those annoying evening flushes, due to dry air or internal heat or whatever. Only thing strange about singulair is that I had to take it right before I went to bed because if I took it in the afternoon it seemed to induce a flush. I take 10 mg once per day before bed. I usually take it without food. I dont think it really matters."

Mutantfrog wrote on February 18th 2010: "I've been taking Singulair for about 10 days now, and I'm starting to see some improvements already. My flushing response has been WAY down. The 2 times I have really flushed in the last 5 days (which is amazing in of itself) the flushes were significantly shorter in duration. I was told singulair typically takes about 2 weeks to start working well, so I was surprised to see this difference already. I keep a photo journal of my progress, so that I can tell when rx/ipl and such change one way or the other - hopefully making things a little less suggestive. I haven't experienced any real side effects yet. Though I'm on the lookout, thanks to the other posts in this thread. I was prescribed it for allergies/mild persistent asthma, but it will be a really nice side effect if it helps the rosacea too. [..]  My skin...still flushes. I still have the a few P&P. But the flushes haven't been quite as intense, or as frequent. I've even been able to drop the topical for my skin (Klaron) about 2 wks ago - skin hasn't looked significantly better/worse but the point is it didn't FLARE like it usually does after stopping the topical. Nice to be able to drop something more from my routine.
[..] The burning/easy irritation of my skin is SIGNIFICANTLY better than 3 or 4 months ago. I just don't flush as easily in the last 3 weeks or so. I've even been able to add in some foods I normally can't eat due to flushing - and have had little to no reaction. Heat (dry heat especially) still gets me pretty red but the flushes go away pretty quickly (about 1hr vs all day), hurt less and spawn fewer bumps (I always get bumps after being really red - and they show up only in the "rosacea red" areas of my face). "

Queta wrote on July 17th 2010: "Hi- I tried Singulair quite awhile ago for nasal/cheek swelling related to allergies. I took it for about a month. It didn't seem to make a radical difference, but it made me angry. I was very short-tempered and angry after about a week of taking it. Finally after a few weeks of being unusually angry I looked it up and a small number of people report the same experience. One guy even told about how he and his wife divorced because her attitude completely changed after taking it. I'm sure that's only a portion of that story but I will say it affected my mood a lot. No one else on here has reported that effect, as far as I can tell. Regards Queta"

Mrsmoof wrote on october 11th 2010: "6 1/2 weeks on Singulair.. Haven't noticed much of a difference. I have noticed though my neck and face seem a little cooler. Redness, flushing still about the same. Will give it 3 months."

Snuffleupagus wrote on October 11th 2012: "Is it possible for Singulair to make flushing WORSE? I took it for two nights and I had horrible "centre flushes" causing me to wake up in the middle of the night. (not like a regular whole cheek flush, but focused more in one area and VERY red/purple!) Wondering if this is just a coincidence (I have been getting these on and off constantly over the last 6 months)."

Cricket0117 wrote on April 30th 2013: "I started taking Singulair last week Friday, sat morning when I got up my face turned a little pink instead of the red and burning I've had for the last 4 months. I have not had any major flares or burning since then. My face is far from perfect but it's improved from what I've been dealing with.Has anyone had similar results and has taken it long term with good results."

lm4727 wrote on May 26th 2014: "Hi all, Both Singulair and anti-histamines made a dramatic difference for my skin (flushing, redness, hives), but I had to stop both because they made me tired and sluggish. I would recommend Singulair to anyone who doesn't have side effects from it. Two zyrtec per day did the trick for me as well, but I can't take these drugs for any extended period of time."

Montelukast has also been tested on acne patients, with good results. 52 patients with moderate acne were evaluated and divided in test groups. One group received doxycycline 100 mg/day plus 1% Clindamycin solution (Group 1), the other group was given Montelukast 5 mg daily plus 1% clindamycin solution (Group 2). Montelukast turned out to be as effective as the antibiotic doxycycline in the treatment of acne after a three month trial, although the effects of the clindamycin solution might have also added to the success perhaps. 

Singulair is not the only mast cell related medication I have used so far. In the past I had some success with a trio of medications that are used for mastocytosis.

You can read about the background info on it, and my experience at the time in this blog post. I took 2 different antihistamine medications on top for a month: Inorial and zaditine. They initially really helped me quite a lot to cut down on the facial flushing and redness. I literally looked pale some weeks, and thought I found the holy grail. But after a month or so, I felt I became more red and more easily flushed, possibly because they made my skin more dry. More than normal, at some point! I am wondering if my body maybe compensated and started producing more histamine than normal perhaps. I remember an old forum member called Dan warning for this phenomenon when taking high doses of antihistamines for rosacea...
I therefore no longer use Inorial and zaditine (but still use Xyzal daily), only when I can't get out of some dinner party invite and know I will have to eat foods high in histamine. For occasional use I get relief from them therefore. However, for those who have mastocytosis, these drugs can really help. I also am eager to restart them and just see if the same thing happens second time round. I see my local dermatologist soon from now and will ask for a new trial with these meds.

Then in 2016 I used Tilade, which is also a mast cell, anti inflammatory substance for the lungs. 

Tilade inhaler 2mg (CFC-Free) contains nedocromil sodium which is a non-steroidal agent, with anti-inflammatory properties, that reduces inflammation by a mechanism that is different to asthma medications containing corticosteroids (not to be taken when you have rosacea!). Tilade inhaler works directly on the airway walls to reduce inflammatory reactions, by inhibiting the activation of several inflammatory cells (such as macrophages and mast cells) at the site of inflammation in the lungs and preventing them releasing chemicals (like histamine, prostaglandin and leukotrienes) that mediate the inflammatory process. Tilade stabilizes mast cells (linked to allergies) and reduces the release of histamine and inflammation (by reducing the total number of eosinophils). The overall effect is to dampen down the inflammatory process in the airways, reducing irritation and swelling to improve airflow into the lungs. This helps to prevent symptoms of asthma caused by swollen and inflamed airways, like wheezing, cough, tightness of the chest and shortness of breath. It does not relieve bronchospasm which happens during an asthma attack and needs a “reliever” medication to open the airways. 

So I used it for a month or more and it helped me calm down the bronchitis and also made my skin very calm and pale-ish for a while. Until it made me more red and flushed as well, after the one month mark. Just like the mastocytotis medication!

After a while of using it twice daily, I felt I needed more and more of it, or else I'd turn very red once the half life was exceeded too much and it stopped working. I assume it was some sort of rebound. I am a severe flusher and even a sneeze attack makes me all red, so as I write often, this isn't how everybody with rosacea will/would respond to Tilade most likely. Besides, it's not aimed at rosacea, I just noticed a pale skin while taking it for lung inflammation. So.. I used it a full month. And within the 3rd week I started noticing that about 6 or so hours after using the inhaler, I had what felt like a weird rebound flaring, flushing and burning?? All red! I stopped the inhaler, had 4 days of all round terrible burned up skin, cancelled all my going out plans and grumped it out. Then it subsided a bit, and I restarted that Tilade puffer, just to see if it really was the inhaler in my case. And the same thing happened. Pale that afternoon (yesss!), then super red after not snorting the next dose.  Pictures were while using Tilade and when it still made my skin calm, then last one when it stopped doing that: