10 December, 2013

Mirvaso, inventory of patient responses and reviews part 2

I have made a bigger inventory in this blog post about Mirvaso last year. After a year of keeping track of the online reviews on Mirvaso, I stopped counting in spring of 2015, the number of negative reviews had by then far exceeded these 300. I will keep updating below on the most eye catching complaints and new research on Mirvaso however. 

(270) Rebecca wrote on July 11th 2014: " [..] And a Swiss equivalent of Mirvaso : I stopped using it yesterday cuz I suspect it caused the incredible skin burns I was feeling couple of hours after putting it on.. 250$ in the trash can! [..] Guys what would you do if you were in my situation:
- Started both Flagyl (antibiotics) and Mirvaso (cream) 2 weeks ago
- For one week everythin was fine, I even thought Mirvaso made my skin whiter
- After a week I start to have these huge flushes that wont go away. I'm used to having flushes, but not THAT bad. This new kind of flush makes ma ears burn and my face looks like I just got a sunburn, I look swollen and red!
- So I first suspect Mirvaso to be causing this so I stop using it
- But 3 days after stopping Mirvaso it still happens!
Is it possible that Flagyl is causing this? And that Mirvaso wasnt the product to blame? I know my dermatologist said I needed to keep using Flagyl atleast a month to see good results, but my face hurts now! I don't know if I should stop the treatment or give it some more time... Can mirvaso cream be responsible for these terrible flushes 3 DAYS after I stopped using it? Or should it have an immediate relief when not applied anymore?"

(271) Macshoe wrote on June 26th 2014: "Angry Mivaso making me facial flush? So I had been putting Mirvaso on my cheeks, chin and nose for about a week to a week and half and everything seemed to be going great! Then I stopped using it because I ran out of the sample and was waiting for the prescription to arrive at the pharmacy since they had to order it. I haven't put it on for 3 days and my face is SO RED! It is hot and feels like I have the worst sunburn of my life! This lasts for about an hour and half to two hours and then goes away for an hour or so and comes back again! I am indoors all day long at work so I am not being exposed to hot temperatures or sunlight. Is this what is supposed to happen when one stops applying Mirvaso? Does anyone know how long this is going to last? I deal with people all day long and it is incredibly embarrassing to be as red as a tomato. Please help! I have also been applying a cold, wet towel to my face to ease the uncomfortable hotness. Is this okay to do or making it worse? All I know is I have to keep rinsing the towel because it gets hot from all the heat coming off of my face!"

(272) TulsaOK wrote on July 5th 2014: "I really wanted this medicine to work. My doctor gave me a sample and I tried it for a week. Then I got my prescription filled. After two more weeks me face started turning red in the middle of the day. I don't mean a little pink, I mean red, almost purple. It would take several hours to subside. My nose was affected worst. In order to determine if the Mirvaso was the cause, I started using it on only one side of my face. Sure enough, the side with the Mirvaso turned extremely red during the day. I am going to stop using this medicine. It was very expensive, but did not work for me."

(273) Be Careful wrote on June 29th 2014: "Awful experience. First 2 days were perfect and then the rebound flushing began. I never have flushed that bad before. It was dark red/purple, painful and swollen. I should have stopped then but I kept thinking my skin would adjust. Didn't want to give up on it but finally quit using after 3 weeks. Took a week for the rebound flushing to quit after discontinuing use. I went back to my baseline redness everywhere but my forehead. It is redder than when I began treatment."

(274) X wrote on June 29th 2014: "I first thought Mirvaso was effective, but it actually increased the redness of flushing and made my skin even hotter. After two weeks of trying it I have stopped using it and hope my rosacea goes back to what it was before, which was not good, but better than after using Mirvaso."

(275) Grandmachris wrote on July 3rd 2014: "Gosh, I don't know what to think now. I have always had flushed skin, my whole body gets extremely hot and I perspire a lot, especially around my head. This makes me not only red but wet as well! I have only used the Mirvaso for a week and so fay it seems to be working, calming my skin and stopping the redness. My Doc said to use it every morning, when dry go ahead and apply moisturizer and make-up as usual. But I only use moisturizer at night because anything that covers my face makes me hot and sweat more. For the same reason, I don't use foundation. Have those of you who use this gel along with Metrogel told the doctors? How do they feel about combining the drugs? I just have my fingers crossed that this along with a high SPF face cream will stop me from looking like a clown!"

(276) Suzi wrote on June 25th 2014: "I received samples from my dermatologist and really should have waited to see how I did with those before purchasing. I, perhaps foolishly took in my prescription to the pharmacy where I work. It will only cost $20.00 but I’m confused whether this is good or bad for me. It seems to make my skin dryer and it seemed lighter and now it seems redder than it did to start with. My prescription should be delivered to my pharmacy tomorrow but not sure if I should call and cancel or not. Jury still out, so I think I’ll use smaller amount and see how that goes."

(277) Marjolein wrote on May 7th 2014 on a Dutch forum: Translated: "I have been using Mirvaso only for a few days now, on my cheeks. After six hours, they turn bright red, hot and burned up. This response disappears again after several hours. It is 10PM now and the same reaction has returned. So I will definitely not use this product again."

(278) Bella63 wrote on July 25th 2014: "Dear all, I am Bella from Munich in Germany. I want to share my Mirvaso experience with you and issue a serious warning to those who want to try this product. I have already posted this in our German forum and I saw here are members referring to the German site, so I want to stress its not Internet spam but the terrible truth. I am absolutely convinced this is not a random thing but a huge and increasing number of users who got their skin severely damaged by this product. My diagnosis: a couple of months ago the girl who does my cosmetic treatments told me that she thought a was having a mild form of rosacea, light red areas around the nose and some flushings, nothing really disturbing. I never had serious skin problems nor strong allergic reactions. When I went to see my dermatologist for some other reason last week, we talked and he recommended MIRVASO to me, which only available since MAY 2014 in Germany. Result: I used Mirvaso creme for 4 days following precisely the product leaflet and descriptions for use. The red area got slightly better, but nothing more I must say. Yesterday, while riding in my car, my face was suddenly flushing from red to dark red with a purple tone, burning and heating terribly. I looked like somebody with an innate fire spot (don´t know the English expression for it). I was really scared and went home checking out the product on the Internet. I was really devastated to see that this creme has been in use for nearly two years in the US with obvious severe problems and despite this it got an ok in Germany. I have stopped using it and treated the areas with FENISTIL, a antihistamine creme, which works against sunburns and mosquito punctures. The dark red slightly improved, and now, after 28 hours, it is a little better, but still there, with flushes coming on much stronger than I used to have. Seeing other reviews I just hope it will go away completely and that there is no remaining damage to my skin.
Conclusion: this product does not work, it only damages your skin. my husband, who is a lawyer said this is close to voluntary body damage (hope you understand this terminus). I am very sorry to say this: but I am absolutely convinced this is not a random thing but the unusual effect for the a vast majority of users. Next steps: I have now informed my dermatologist, who was really shocked (the product only being allowed in Germany only since May 2014), and I went to my pharmacy, who is now going to make a formal complaint to the German drug administration. This is what all of you should do in their respective countries, otherwise we do not get reliable figures. I think, the Internet complaints are representative in terms of statistics and as far as I am concerned, I will no longer use any of this stuff and try alternative things. I have the strong feeling that the producer Galderma knows it perfectly, but until the day this product is finally withdrawn by the authorities, the have made a fortune."

Shikasta replied on July 25th 2014: "It was just approved in Canada too…There is a strong sense of outrage about what Galderma has done, here on this forum and elsewhere, but to be honest, there is also a great deal of confusion and helplessness about what we can do about it. I really appreciate your composure and focus, you are helping to give a sense of direction to what up until now has been simply experienced as victimization. We are up against several obstacles. The first is that rosacea and it's treatment are considered to be cosmetic. Rosacea sufferers have a hard time being taken seriously, even by our own dermatologists. Secondly, the system that was put in place to protect consumers from pharmaceutical companies like Galderma, is broken. What prompted me to try Mirvaso was that it was FDA approved. I have since learned that the FDA does not do it's own testing. Then there is Galderma itself, and the myriad sales reps who pose on this forum and others as satisfied Mirvaso users. Preying on the suffering of others, these low moral characters are laughing all the way to the bank. I have made inquiries about a class action suit…a friend of a friend who works for a firm, and so on. Again, this is considered a cosmetic issue, so I don't know how much interest they will have. I haven't heard back from them yet. The first rule of medicine is to do no harm. Galderma has certainly violated that tenet. But they evidently have the resources to get their product approved by the agencies of many countries. How did the system become so broken…and how do we best target our efforts to repair this?"

Davekelly replied: "Galderma = Scum Of the Earth. Galderma = Failures. Galderma = Useless Shower of F%&Ks"

(279) Rosaceaclearwannabe wrote on August 29th 2014: "***I posted this same message in the Mirvaso thread in the news section but felt it appropriate to go here too in order to help spread the word regarding the potential negative side effects of Mirvaso for Rosacea patients*** Don't know if anyone saw this but there is a program broadcast here in the UK called 'My Naked Secret', in a nutshell its a program focusing on people with embarrassing and hidden medical conditions. The program is broadcast on the TV Channel TLC, which I think is only available on satellite over here e.g. sky. Anyways there was an episode relating to a female that suffers from Rosacea (seemed to be subtype 2). The show follows the female receiving psychological support from a psychologist and attending at a clinic to receive medical treatment for the condition. To cut a long story short she is prescribed Mirvaso and it is built as a brand new rosacea treatment and she is the first patient in Europe to try it, presumably the episode was filmed a few months ago. The doctor is clearly seen giving her Mirvaso in the episode, however she reported that she experienced worsening rebound flushing with continued use so had to discontinue the use of Mirvaso like many of us on here! On the episode they show a couple of photos showing the rebound flushing. I personally am quite pleased, in a way that the producers of the show did not mislead viewers and the true reaction of the female patient was highlighted and shown. The episode is still available on Sky on demand for all the UK members! I remember I applied to go onto this show about 12 months ago, as the production company had appealed for people suffering with skin conditions to audition. I went through part of the auditioning process but pulled out when they started mentioning that they would need to interview my family and friends as part of the auditioning process. I'm glad I didn't go through with it now, as I have tried Mirvaso myself and experienced the rebound flushing! Will try and see if the episode is available online for non-UK members, in the meantime here is a link to the programs website (Episode 7 - Anna): http://www.uk.tlc.com/shows/my-naked-secret/episodes/

Here we also discuss the ethics of Galderma and Mirvaso in this, and what could realistically be done to stop this product from being marketed the way it is, with the (way too) minimum side effect warning.

(280) M. Hew wrote on July 10th 2014: "Before I mention my Mirvaso experience, let me first explain my rosacea background. I was diagnosed with rosacea at the age of 18 (young I know), and I believe it was due to all the acne medication (Benzoyl Peroxide, Salicylic Acid) that I took throughout high school due to the desire to get rid of my mild to moderate acne from puberty. Now my rosacea consists of just redness, no bumps or postules. After high school, I noticed that pretty much my entire face, besides my forehead and the circles around my eyes were redder than the rest of my face/ body. It bothered me so much that I went to a dermatologist which prescribed me with I think prosacea and some anti-biotic, which neither did much but irritate my skin. After this didn’t work I went to another dermatologist who recommended laser treatment (not sure if it was IPL of V-beam…), but this really made my skin irritated and redder than ever. After this I pretty much said screw it, I am only putting on my face gentle organic moisturizers.

Fast forward 7 years… I am now 25 and went through college and now have a full time job teaching all while enduring my rosacea and accepting it. However, throughout the years I have seen a drastic improvement in my rosacea since the dark days after the failed laser treatments. Just to give you an insight of my lifestyle outside of work: I workout 6 times a week (lifting and cardio), eat a lot of meat and carbs (not the best diet for rosacea sufferers, but I do not have too many triggers for flushing), drink alcohol almost every weekend with friends (was significantly more at college), and since my body and forehead tan fairly easy, I do go tanning every now and then (another big no-no for rosacea sufferers). But then about two weeks ago I was just curious on how the skincare “professionals” were doing on maybe coming up with a cure or even a significant treatment that worked to reduce the redness in rosacea seeing how I still suffer from flare-ups here and there and really am trying to rid myself of rosacea permanently… Then I see the ads for Mirvaso, the new treatment that restricts the blood vessels in your face to reduce the red appearance. I remember thinking, “man, this makes sense and sounds like it would work perfectly for my, still slightly, red complexion.” Stupidly, trying to avoid a doctors visit, I bought Mirvaso on ebay for 65 bucks. I received it a few days later (perfect condition/ wasn’t tampered with) and tried it out. It worked amazing the first two days!!! I looked a little pale but it seriously looked like I never had this horrible disease. Then the third day came… I woke up the third day and looked in the mirror and I was horrified by how red my face looked!!! I haven’t seen this look since those dark days after the failed laser treatments. I looked online to see if anyone else had this effect. Looking at the reviews, I found that about 90% of the reviews of this topical were negative and talking about a rebound redness effect. I was so disappointed and continued to use it for a few more days to see my face look normal and then in the morning look awful (I also started to feel myself flush a lot more while on Mirvaso). My advice to anyone who reads this is to stay away from this topical. I think it does more harm then good. As days went by when I discontinued use of Mirvaso, the redness stayed.. So I went and started to look for more treatments online (I was more desperate than ever). Then I came across a website that mentioned having digestive problems could be causing rosacea in certain people. Then I remembered that when I first started taking Mirvaso, I did not have one single, normal bowel movement while on it and since taking it. I probably had these digestive problems before but over time improved. I think Mirvaso triggered something that caused the flushing and the sudden rebound redness that I was experiencing. The website also mentioned these supplements to take to fix these digestive problems: Milk Thistle Extract, Vitamin B12, Burdock Root Herb, Chlorella (green super food that is suddenly being put in many new skincare products), betaine hydrochloride, and the probiotic “Acidophilus.” I’ve been taking these 6 products and I have seen amazing results in the past TWO days!!! I bought these for all these for a combined 45 dollars at Vitamin Shoppe and hope to see further improvement. I have no idea if it is the combination of these supplements or one or whatever but all that matters is it has worked! I no longer have that unbearable rebound effect from Mirvaso along with the constant flushing from it. I can only hope that this continues to work to finally get rid of this stubborn disease. Hope this helps anyone who reads this!!! Your Welcome, Peace!!!"

(281) Rebecca wrote on July 11th 2014: "Hi everyone, I wish I had looked on this forum before I tried Mirvaso (or Onreltea in Canada). This worked amazing for 3 days then on the fourth I was so hot and red I thought I was having an allergic reaction. I’ve been off the stuff for 3 days but am still so red and hot I need to use ice packs to cool down. I have had laser in the past so my rosacea was probably mild to begin with; now it is worse than ever. What I want to know is if this effect will go away and how long it will take? What can I do in the meantime? Thanks"

(282) Victoria wrote on August 25th 2014: "Did you ever go back to normal? I am experiencing the same effects. I’m two weeks in, and still no improvement =(

(283) Stuart wrote on July 20th 2014: "I just joined this group. My rosacea is relatively new: two years approximately. In April of this year I was given some samples of mirvaso. After two days usage, my rosacea was noticeably much worse. It looked like I had welts all over my cheeks and forehead. I called my doctor even though it was a Sunday. He returned the call and told me to immediately stop using this medication. His patient anecdotal results were 50/50."

(284) Raine wrote on July 20th 2014: "I have so many triggers that I thought the only way to know if Mirvaso was working was to put on one side of my face only. First application it was amazing within 20 minutes 70% of redness had gone and my face had stopped burning on that side, it only lasted for 3 hours. But, been using it now for 4 days, it hasn’t worked again and I think is actually making that side of the face even redder compared to the side that hasn’t been treated."

(285) Tammy wrote on July 22th 2014: "I got a sample of Mirvaso from my dermatologist before buying the prescription and I so glad I did. I put it on my whole face and after a couple hours my face had welts and was very red and hot. I thought maybe it would stop if I continued to use it-but sadly no- it only got worse. I have had trouble getting my face calmed down."

(286) Leslie wrote on August 1st 2014: "I received a Mirvaso sample from the dermatology PA a few days ago and really wish I would have researched it before trying it. Thankfully, I did not follow the PA’s advice and apply it to my entire face opting rather to just apply to problem areas. It worked fairly well removing redness for about 8 hours. After this point my face became progressively more reddened, swollen, and hot. It was so uncomfortable last night that I needed to take Advil and spend the evening icing my face. What a disaster! After reading various rosacea forms it appears this is a very common adverse reaction. The PA couldn’t have warned me this might happen? How in the world does a drug like this pass clinical trials and receive FDA approval? I will not trust any other drugs put out by Galderma."

Verena replied: "It baffles me, too. Particularly since it doesn’t require prolonged trials, but the adverse reaction only takes a very short time to set in. I knew after 2 days of using the stuff that it was a really bad idea to go on. Mercifully, my skin is back to normal now, and I’m never again going to rush into trying out a new drug, no matter how desperate I am to improve my skin."

(287) Sophie wrote on August 16th 2014: "Please excuse the length of my note, but I write only to warn others. I can honestly say that my skin is worse now than it ever has been – and way more red and swollen than before using Onreltea (Mirvosa.). I used Onreltea for three days at a less then prescribed dose because my rosacea is (was!) somewhat mild(ish) – cheeks, nose only. Within hours of application, I was delighted to see how pale and even toned. I used Onreltea for three days at a less then prescribed dose because my rosacea is (was!) somewhat mild(ish) – cheeks, nose only. Within hours of application, I was delighted to see how pale and even toned I looked. However, on the evening of the third day – the ‘rebound flush’ appeared – and it was HOT! The next day I phoned my dermatologist who told me that my skin was probably ‘getting used’ to the gel. I used it again the next day, now diluted with moisturizer but by the evening – I was bright red and papules were beginning to appear (I’ve never had those before.) Needless to say I stopped using this product but three / four days later my face has never looked more red. At least today as I write, the burning sensation is decreasing but the diffused erythema is broader and I have swelling under my eyes. I have written to Galderma twice requesting advice as to how I can reverse these adverse effects. My tone has been polite and respectful but I have yet to hear back from them. I should have listened to my instincts when I was told by the pharmacist that this product was new and cosmetic only. I even said to her, that I was surprised I hadn’t been prescribed something medical. That I didn’t want to mask the condition but was more interested in treating it. Vanity unfortunately won out!"

(288) Rach21 wrote on August 18th 2014: "Please help! Does anyone have any advice to try and speed up the recovery period? My fiancé and I are getting married in 10 days and he’s suffering really bad rebound flushing worse than he’s ever had before. He started using mirvaso in the hope his redness would be gone but it’s made things worse than ever. He stopped using it 3 days ago after using Mirvaso sparingly for 4 days. We’re really worried it’s not going to get better. Any tips GREATLY appreciated!

(289) NT wrote on August 18th 2014: "Sorry to hear this… I had the exact same experience. Tell him not to touch the stuff again… He should be back to normal at about 7 days … so by your wedding, most of the weird sporadic rebounds should be over. Hope this helps . Best of luck to you both…
Nadia :)"

(290) Brandon wrote on August 16th 2014: "I recently had a bad reaction to this cream. My dermatologist told me to use Domeboro (can be found at walgreens). I used it 2-3 times a day and it helped clear me up. I also had to take antibiotics and use a hydro-cortisone cream to to decrease the swelling and reaction. I now just use cerave lotion and the hydro cream. Mirvaso worked for me for about 6-7 months no problem then i all the sudden developed an allergic reaction to it. Good luck and congrats on getting married!"

(291) Jo wrote on August 21st 2014: "I used this cream for the first time last night, but I’d read the comments here and so I was quite apprehensive and only put some on my forehead (which is where I get the worst redness generally) and not the rest of my face. I was pretty amazed by the initial results – after about 30mins my forehead was looking the best it’s looked in years – absolutely no redness what so ever. When I woke up this morning it was looking red again. I understand that by then the effects of the gel would have worn off, but it seemed to be looking even redder than usual. After gentle cleansing and moisturizing it calmed down and went back to “normal”. However, later today I underwent an experience that admittedly would usually trigger some flushing (I’m currently doing my masters and I had to present my thesis findings to some of my professors), the flushing on my checks was about the usual I would expect for that kind of nerve-wracking experience, however my forehead where I had applied the Mirvaso the night before was EXTREMELY red, more red than it has been in years. Now, I know I only tried it once (and also it’s really expensive) and so I’m not sure if I’m dismissing it too easily, but the rebound flushing really freaked me out because my rosacea has been reasonably controlled lately and seeing that level of redness again was quite upsetting. Although it was great seeing the immediate effects, I’m not sure it will be worth it in the long run. Does anyone know, if I carry on trying it is there any chance that the rebound flushing will have a permanent effect?"

(292) David Red Face wrote on August 25th 2014: "On my third day of using it - sorry to report very, very disappointed and a waste of £50 for me. On each day of use, apply as instructed in the morning – I wait for redness to go down or at least reduce but only has a VERY slight reduction and also have white blotches in places can hardly notice any difference BUT the worst thing is when the stuff starts to ware off oh my GOD. Severe redness, flushing, throbbing, heat sensation, that just will NOT go down at all even next morning far worse than I have ever had before. This has happened on all three days after about 4 – 5 hours I was hoping this would be a relief from years of having issues but now feel worse than ever. I hope to god other people have better results but I will not be using again. Just feel I will have to live with this what now feels like a debilitating affliction for ever with no possibility of improvement :-( it impacts my work life, my social life and my relationship – not good for me"

Update November 13th 2014

On the Galderma forum boards a new thread has been posted named:

Take Mirvaso off market (link)

Anonymous wrote there on October 10th 2014: "There are scary AEs being reported about this drug. the public is very negative, read any message board. Providers are getting worried, many won't use it anymore. Please Galderma take it off the market, do further research you have a issue with this drug. Read the signs the signals before it ruins the rep of the entire company, don't ignore for greed sake. Sales are declining for a reason THERE ARE ISSUES WITH MIRVASO"

Someone else replied: "There is nothing wrong with Mirvaso. Doctors are not prescribing to the right patients. Should a patient with a headache get OxyContin? A patient that does not have rosacea should not get Mirvaso. Stop prescribing this drug post-procedure. No one advised you to do that. Stop treating it like one of your cosmeceuticals. It is a prescription drug. I would be pissed if a doctor prescribed something to me off-label (especially a doctor with minimal experience with a drug) and I had a bad reaction. Mirvaso is like any other drug. There are consequences for disregarding the indication. Those who prescribe it appropriately have good outcomes. Are there some side effects? Of course. Same as other topicals for rosacea. Those that don't prescribe this as indicated should look in the mirror and not blame the drug. You owe your patients an apology."

Another response: "No Mirvaso sucks. I'm glad I left and don't have to deal with train wreck 
product. If it's great then why have Dr.s.. Who have rosacea, try it and swear they'll never write again. Proof is in the numbers. Mirvaso should have never hit the market. Sorry to y'all still sucking on cool aid and actually thinking it's a good product."

And: "In the field with rep and he was telling docs the dosing is wrong. Scrambling... Desperate!"

And: "This product is a major liability. I am SO glad that I no longer have to sell it (as I quit to go to
another company earlier this year). I had such a guilty conscience selling it, and would be secretly relieved when providers told me that they were going to stop rx'ing it. I called in so many adverse events, many that had never supposedly presented during the phase III clinical trials. I truly believe that many of the AE's that presented during those trials were either miscategorized or buried. It's a true disservice to these poor patients suffering with rosacea, and to the Derm customers as well. I vote to take it off the market...if not, I feel that someday soon we will see Mirvaso dumped in with vaginal mesh, Yaz, ect in the long line of late night infomercial "ambulance chaser" products that people will be able to sue over."

"more off label selling by desperate reps. It is going to come back and bite the company don't do it."

"I agree, it is a good drug. However, I am VERY SUSPICIOUS that this thread was started by one of the anti-corporate conspiracy theory rosacea groups that I've come across online. My docs are not reporting any major problems."

"The bottom line is - the drug is not really doing that well and is still below expectations. The market place is telling us what they think of the drug. Not sure if we are listening."

"If you actually look at the reviews on WebMD and drugs.com you'll see that people either really like Mirvaso or they absolutely do not like it/have had unbearable side effects, or have had to "doctor it up" with some cocktail of moisturizers and lessening the dose. I have sold this product since we launched it and I can say with confidence that I have never sold it off label. I just think that it's really weird that all of these adverse events are now popping up and are all over message boards when they didn't really show up that often in our phase 3 clinical trials. It's frustrating as a person out here trying to sell this stuff"

"I agree, it is frustrating. However, part of it may be due to the relative ages of patients in the trials (if you look at the photos, most of them were older). I have had derms tell me that their older patients have done better with straight Mirvaso than younger ones. Some have said that they advise their younger ones to cut the dose with other topicals (metro, elidel, moisturizers, etc) and titrate the dose upward prn. I am with you in that I have no comments for docs regarding off-label usage. Its interesting because younger patients are more apt to complain online. I think its a great drug, its here to stay and it will find its place."

"FACT : providers use off label , some good stories , many bad . FACT : providers rx on label, some good stories , some very bad . Overall not a good drug for 50 + % who use , that is why sales decline . Should be with drawn until we can understand how to establish best results in REAL WORLD environment . The launch might be the worst ever are Vectical !!!!"

"Have a look on the rosacea group forum. Those people just want solutions, they have no bias towards Galderma as company (they are not making money from Galderma).

Its simple. Everyone has reported rebounds eventually. There were a few people who did OK for a while, but eventually reported rebounds. There is not a single regular member who reported they have been able to use it long term. Not one. There are threads over a hundred pages long where nearly everyone is complaining about how bad it is. The only positive reports are those of the initial reaction, before the inevitable rebound. There is a lot immorality going on with regard to Mirvaso. Greed is an ugly side of mankind. The only ones supporting Mirvaso are those financially motivated to do so. It is sad to know that people are willing to stoop this low at the expense of others. You can live in denial if you wish, justifying it to yourself however you wish, but the real world data clearly shows this is a bad drug with no real hope."

"News flash. There's also a competitive company coming out with a similar product. No doubt their employees are posting anonymous, negative comments. "Everyone has rebound?" Really? Everyone? Funny "everyone" has been two people In my area and I have over 200 providers. One was a medical assistant using it off label and treating herself. "Everyone" is not factual. Be careful when you make statements like this."

"When it comes to the forum I specified, every single long time member has reported rebounds. Have a look yourself. So what I said was correct. What you said was out taken out of context. In a forum with thousands of members, there is yet to be a single user who has reported long term success. I don't make this up, it is factual. As far as a similar product, I don't know or care about that really. Oxymetazoline (Afrin) was tried a long time ago and had rebounds. The active ingredient in Mirvaso (brimonidine) has been around for a long time and users have always reported rebounds (long before Mirvaso was introduced). It doesn't work in reality. The paper studies say it works, but 100% of forum members would disagree. Btw, there was always speculation about how Galderma was going to solve the rebound problem of brimonidine. Years before Galderma introduced it, every knowledgeable person knew it would cause rebounds. So how did Galderama address it? They didn't. And the result is what we have today. A product that not a single long term member of the rosacea group forum has been able to successfully use. Not good odds buddy. Not good odds at all. Have a look yourself. It is all in plain site. You will people are only suffering from Mirvaso. Some very positive short term results, but nothing good to report long term. Just the facts."

"So you have to resort that sort of language to argue your point? Sad state of affairs here. 
- The rosacea group forum consists of many long time users. They are not anonymous users like they are here. People can't just come in an make random comments. Many users are 10+ years or older.
- brimonidine was tested long before Mirvaso was in the market (several years earlier). The response was very poor from all users. This is fact. People have been waiting for Mirvaso and using the active ingredient long before you knew it of its existence.
- I, for one, have a bad experience. 
- My doctor has told me that results have been very poor
- On the rosacea group forum, there are several extensive threads talking about the poor performance of Mirvaso. Look it up. There are MANY threads were people have success with other things, so the forum is not about complaining. It is about sharing knowledge/experiences and helping others. People don't use the hostile tactics and language like they do here. That alone tells you how weak your argument and the quality of people here. 
- Nearly everyday there are reports of how bad the rebounds from Mirvaso are.
- So far, there are apparently zero cases of people that have had long term success. Rebounds have eventually occurred for everyone. Again, this is fact. I am simply reporting the truth. This is not opinion. All of this can be independently verified. Brimonidine has been around and talked about for years. The real world knowledge base is extensive. I don't have to resort name calling, bully tactics, or immature behavior. I simply have to state the truth. Clearly a logical and educated discussion can not be had. You have no interest in an honest exchange of information. Good or bad, honest information could only serve to help you and others regarding Galderma/Mirvaso. To disregard reality shows your approach on the manner. Your posts and response serve to discredit you and demonstrate a complete lack of character and integrity. Any decent person can recognize this."

"If Mirvaso is so good, why is that reps are calling for it to be pulled off the market? Why does this thread even exist? Are you going to say it is a conspiracy against Mirvaso? Does it make sense that reps, evil competitors, and forum users of 10+ years are all conspiring against Mirvaso? This doesn't occur for other drugs from Galderma. Yet all of a sudden it does for Mirvaso. Or does it make sense that it does not work and that the reps know it and the users know it. And does it make sense for an intelligence person to listen to someone who feels the need to scream the loudest and use foul language when they get in a civil discussion. To anyone reading this, I believe it is clear. There are a few people though who will attempt to bully people, use vulgar language, or use whatever low blow tactic they can think of. That is just a sad part of humanity, but thank goodness it is not exemplary of people in general."

And finally a sensible response from a Galderma rep:

"I work for Galderma, I like what you have had to say. Sorry, there are some real tools in the sales force, immature and scared to think, they only want to sell and make $$$ or have no life experience, drinking the cool aid whatever. Mirvaso is an interesting drug, more potent than first thought. It has a place but that place is in a far smaller number than thought. It does have side effects that are worse than basic rebound . It should be used with care and patients can decide if it is right for them. Profits should never come before people's health in this industry, we are not selling cell phones here."

SIDE NOTE: In the Netherlands, politicians have stepped up recently to some big pharmaceutical companies, who refused to sell a rare medicine for the asking price. A high price, a reasonable price, which the government was willing to pay for it. But the price was driven up into the hundreds of thousands of euro's per patient, and deemed too high even for the Dutch government. Questions were asked in parliament as people were outraged that patients in Holland were dying from lack of treatment, whereas patients in France walk around happily while getting the med. Now the Government has decided that pharmacists are allowed to make the drug themselves and sell them against cost price. They will not be brought to justice if the pharmaceutical decide to protest and sue them, and are protected by the state for doing this. They are also looking into doing the same now with some other patented and outrageously priced drugs. I'm sure the reps and lobbyists are working overtime now to talk this thing into the ground. I think they are called compound pharmacies. There is hardly any to no drug on earth made from unique or exotic ingredients. There is nothing that differentiates the paracetamol in Tylenol from the paracetamol in other such pain-relievers or drugs. A compound pharmacy takes the common ingredients and fabricates drugs to-order. We need more to keep the pharmaceutical giants in line. It's one thing to ask representative prices for medications, as these companies also do research, endless test phases for all sorts of drugs, of which some never make the market in the end. But the multi million (billion sometimes) profits that are now made in this industry do not warrant such outrageous cost prices. Companies like Galderma and Allergan are sure doing a lot, but most of its latest medications for rosacea were taken from other fields and reapplied for rosacea. Mirvaso (brimonidine) comes from an eye drop that has long been on the market and Rhofade (oxymetazoline) is originally used in nasal sprays, to help shrink the small blood vessels in your nose to reduce nose swelling. Oracea is simply lower dose doxcycline (loooong been on the market before it got re-branded). Soolantra is hailed now, and fairly effective for some rosacea cases, but its basic ingredient ivermectin has been used for at least a decade, if not longer, by people on different rosacea forums and communities. Anti mite and de-wormer paste for kettle, basically. All Galderma has done now to create Soolantra, is taking the ivermectin active ingredient, and putting it in a neutral skin cream, called Cetaphil. And throwing the price up, from a few dollars for the ivermectin, into now multiple HUNDREDS of dollars for the Soolantra cream. *I've got all these new creams in the house and read the information leaflets. It's sad really that Europeans get these products for very reasonable prices, even those who want to buy it in cash instead of using our mandatory and very affordable health care insurance for it. Yet in America (and probably in more countries I do not know about), people are charged no less than $500,- sometimes for the same cream. Outrageous, especially considering these drugs were not even invented by the companies involved. Sigh. I realize that people have different opinions on this topic (or on any other topic imaginable), but I can't help feeling pissed off about all this. Note that for facial flushing, nothing has been developed for decades now. Nothing that actually works, nothing new (Mirvaso to me is a liability of a product and made many users worse).

(293) Mistica wrote on August 4th 2014: "I was one of the first victims and refer to it as 'the brimonidine hell'. I have never fully recovered from it and the areas which suffered the most vascular damage appear to be permanent. It has ruined my life. I ended up in the ER twice. I rather like Brady's systematic approach to posting data and facts, however, as it is very organised. When I need to find a study or statistic, I know where to come. The gathering of information is very time consuming and in my case, sitting at the computer fuels my flushing, so I appreciate someone is doing it. It is also good to know what kind of twaddle the so called 'research' is turning out on this particular drug and effects. More evidence of manipulated results and dishonesty.  This serves several purposes, including the important one of showing members here, that studies don't necessarily illustrate the truth, whether it be unintentional, or a willful deception."

(294) GreenGables wrote on October 20th 2014: "If anyone cares, I finally experienced the rebound redness. I used Mirvaso consistently for a few months with no side effects. I returned to my baseline redness after 6-8 hours, but no crazy flushing. Stopped using it after a while because 6-8 hours is not enough for a full day redness coverage. It doesn't work as well if you reapply at the end of the day. So if I really needed to cover up my red face I was better off with makeup. Pulled it out again this month because my baseline redness had improved, and I felt like I could deal with Mirvaso instead of a full face of makeup. The third day I used it I got a TERRIBLE red flush as it wore off. The places that were reddest were the places that were normally the most pale. You could clearly see the outline of where I had applied the cream on my face that morning. It took 3-4 days for the flush to go down. So...Mirvaso is out. Disappointing. It worked well for quite a while. Not sure what tripped the wire. All you naysayers can say I told you so."

Wiry replied: "I told you so. Haha, thanks for reporting back on this. That is really important. Based on how Mirvaso works, I have been of the opinion that it will eventually cause rebounding in everyone. You were one of the few exceptions (perhaps the only exception for regular posters). I am of the opinion that the rebound rate may be 100% in time for all users. The only time I could see this being useful would be for a special event (wedding, important social event, etc.). Even then it is risky because the window isn't always predictable. Overall, Mirvaso is just bad. Its done far more damage than benefit."

(295) td89 wrote on November 4th 2014: "Just wanted to add some thoughts here. I was only diagnosed with rosacea a few months ago (August), which is when I started using mirvaso. It worked like a miracle for awhile, lasting around 8 hours a day. Today though it seemed to only last 4. It's only as of this week that I've had a pretty bad reaction to something. First I thought it was the cerave moisturizing lotion (as I hadn't used it daily for awhile). Then I thought it was one of my cleansers (sumadan wash or cerave foaming cleanser). Then I thought it was the weather or my new exercise regiment. I just wasn't sure. Most of the reviews of the mirvaso seem to mention some rebound redness. I always had some level of redness that would show up again later on, but this is more of the subtype 2 rosacea, that I didn't have as much as before. And it's only gotten worse over the days. It's more of a full face break out. Not sure what to do. Might stop using Mirvaso, but I really want to stop using everything except maybe the Sumadan Wash, because I really don't know what's causing all this. And my face wasn't this bad before I started using all these products. What's the best way to restore to "normal" if I want to stop using Mirvaso for a bit/forever? Will moisturizers and cleansers still be a good idea?"

Shikasta replied: "There are different approaches to this as we are all so individual. My experience seems to bear out the theory that the skin barrier, when left to its own devices, will repair itself. I was having a rashlike reaction to my moisturizer and decided to try going cold turkey on all products. It was tough at first. My skin felt dry and tight. But after a while it healed itself, found its own balance, I guess. I have come to understand that rosacea can best be controlled by attention to diet. In my case the paleo diet is working really well. I am also histamine intolerant among other things and need to controll demodex daily with tea tree oil. Topical medications alone do not get to the root of the problem, and can sometimes do more harm than good, in my opinion."

td89 updated later: "In short, Mirvaso didn't work for me after 3 months. Too bad a rebound. But my face fixed itself in 3-5 days after not applying mirvaso, lots of water, very little trigger food, and just Sumadan wash and AM and PM moisturizer. Finacea is my new Rx topical. Working well."

(296) Robert wrote on October 9th 2014: "I tried it and can not recommend it to anyone. The first day I thought I was in heaven, it worked like a charm. The second day, same thing … UNTIL IT WORE OFF .. I had the WORST red, flush episode EVER that was constant and flarring for 2 days. I hid. I cringe at the thougth of using it again."

(297) kate C wrote on October 13th 2014: "I have been using it now for one week. First day the result was magical but since then it’s awful. Burning skin and even more redness than before I started. For example now have a red chin (which I never had) which now joins the flushing on my face to some extended flushing on my neck. Embarassing. Time to stop its use sadly…"

(299) Sandra L. Keamer wrote on November 8th 2014: "My face became a flaming volcano after using it. It was a horrible experience. I urge anyone to be very careful using Mirvaso."

(300) CathySullivan wrote on October 20th 2014: "I have used this product for four days and found some relief ( I had a mild case). On the fifth day I experienced flushing which I have never experience before. I stopped using the product for two days and I am still experiencing extreme rebound flushing. The flushing and redness is worse than before, and so very uncomfortable! I put on hydrocortisone cream 1%, a cool beverage, and a fan on my face seems to help a bit.Tomorrow, I will be calling my derm and tell him not to prescribe this medication to those who have very fair and sensitive skin. I do hope the flush will go away, and not damage my skin permanently."

(301) xdhzx wrote on October 23rd 2014: "Made redness and flushing so much worse from the start! Initially it took a little redness away for maybe an hour or so then came the worst flushing, blotchy skin and redness I have had in years. I thought maybe my skin needed to get used to it. I mixed it with moisturizer and sunscreen that I tolerate very welll as other had suggested but everything became a trigger and sent my face, neck and chest into such horrible flushing I had to leave work more than once. I’ve stopped using it for three days and it’s still happening. I know my face is more red because I did take photos. Mirvaso was a complete failure for me. I’ve made and appointment to have V-beam laser treatment in hopes of reversing the damage."

(302) Mark wrote on October 30th 2014: "I have used Mirvaso for 6 days now. The first 4 days were great I could not believe how it reduced my redness, and the gel lasted nearly 12 hours. Now the last 2 days have been a nightmare, 10 hours in and my face started burning like fire. The worst thing about it was I was at work whilst it happened. I went for a walk outside to try and cool down, but soon as I stepped back in work I was burning up dark red. Then my workmates were looking at me which made it even worse. I just wanted to run and hide but I had to keep my machine at work running. The flushing lasted over 3 hours, then calmed down. I had never had flushing like this before I had started on the Mirvaso gel. So as from now I am not using it any more. I just wanted to share this to make others aware what this could do to you. I was just so fed up with my Rosacea that I had to try it. But please be careful and think about the rebound flushes before you start using it."

(303) Jay wrote on November 3th 2014: "The first 2 days Mirvaso worked just fine, but then it just made my face worse! It completely changed my life, I just wish I had never started using it. When I put it on, the redness slightly decreases as Mirvaso is fresh, but it only lasts 30 minutes or less! If I go into a place, for example a classroom (I’m a 18 year old teenager, I’m still studying), my face just starts burning like hell, just like Mark said above, my face turns dark red, like a tomato… I can’t ask to go outside to get some air or anything and schools are full of people, it’s so uncomfortable. I can’t stop thinking about it which makes it even worse. The flushing, redness, burning sensation have gotten really worse since I started using Mirvaso."

(304) Arthur wrote on November 2nd 2014: "I think 95% of folks who have used Mirvaso have had very bad reactions , me included. I was very excited when I first applied Mirvaso , then two hours later my face looking like a Stop light . If only galderma could sort out this rebound Flushing thing , but until then I will NOT be putting their Mirvaso anywhere near my skin and I would advise anyone who has thought about trying it …DON,T !!!!"

(305) Stuart wrote on November 2nd 2014: "Thanks Arthur and Jay. My feelings exactly. In fact, after I reported in to my doctor, he told me to throw away all the samples he had given me"

(306) Sarah Jane Dawson wrote on November 5th 2014: "I absolutely couldn’t wait to start using my Mirvaso cream and was totally buzzing as it began to work on day one . Day two I had a stressful day in hospital ,, it was so hot the heating up on full and still my face stayed calm ,cool and fairly pale . However day three was not good ,, my face felt hot and throbbing , still not as red as normal but other parts of my face not normally effected by flushing started to turn red . It’s now day five and I,ve completely stopped using it . What I thought was the answer to all my dreams is now my worst nitemare . My entire face is bright red and burning all day long . Areas that were never problem areas are now permanently a very dark sinister colour . Please think carefully before using this cream . I,m hoping my face will calm down . I ,m even waking up with a severe flair up that has never happened before . This is not good"
And she updated: "Does anyone have any experience of the rebound flushing lasting a long time after using Mirvaso cream . I haven’t used it for a few days but my face is red ,, hot ,, blotchy ,,the worst flushing I,ve had with no triggers involved x"

(307) Veronica wrote on September 2nd 2014: "Just an update. The redness has finally subsided after a solid 3 weeks. After MUCH suffering and MUCH prayer, and some medication, my skin has actually gotten better that what it was pre-Mirvaso. Thank God! No more redness and people have been telling me I have perfect skin…like a baby’s bottom. With that said, I will NEVER use miravaso EVER again."

Jo replied: "Yes..prayer…don’t forget prayer. Ohhh..the suffering, the humanity. Your face is a little red, the world is ending..Give me a break. get a grip."

NikkiKingston replied: "Our faces are our identity and livelihood. To have a permanent change for the worse that leaves one feeling embarrassed and with diminished possibilities for joy etc. in this world, then that is a big deal – especially when you didn’t know that a stupid product could do this in a matter of days. You get a grip, jo. If you’re not one of the 82% of rosacea patients who are anxious or depressed about their condition, then congratulations. Leave the rest of us alone."

(308) Arthur Agnew wrote on September 3rd 2014: "Used Mirvaso on my face and 20mins later my skin felt so cool, I looked in the mirror and saw that my face was no longer RED, I was more than delighted then 2 hours later I felt my face burn and then turn a Bright PINK ….. After I stopped Cussing , I decided to try the cream again the next morning , Again encouraging results followed by my nose looking like a “Brake light” then the rest of my face going a bright pink colour ….. You Guessed it , I’ve STOPPED the use of MIRVASO."

Siane replied: "Talked with my derm TODAY; he said he had attended a national derm meeting the co. that makes this “stuff” denies REBOUND vehemently, but he was glad I used common sense and stopped it. diane"

(309) Heather wrote on September 26th 2014: "So much for mirvaso. 20 days in and it’s worse than it was before I started using the gel. The first five days were great with no redness but now I’m as red as a stop sign. My skin is currently dry on the extreme side, which it wasn’t dry before. I don’t know if this can be part of the problem or not. Just frustrated."

(310) Mark N wrote on October 2nd 2014: "Consistent with other reviewers, I too experienced rebound episodes when I began using Mirvaso two months ago. The effect for the first several hours however was indeed profound. I was amazed. So despite the rebound episodes I continued to experiment and began applying the product twice daily; once in the morning, then again around 5pm, a few hours before the rebound had typically kicked in. I have not experienced rebound redness ever since and having tried every prescription and OTC product available, nothing even comes close to the diffuse redness relief I receive with Mirvaso."

(311) Wordbling wrote on September 25th 2014: "I have had rosacea all my life so I was very excited when this came out. I've been using it for a few months and the 1st few weeks saw improvement. However, after a couple of months, I'm sad to say my rosacea has taken a turn for the worse. My face is redder than normal (sun burned) so I stopped using it a couple of days ago to see if it will improve..."

(312) Gio R. wrote on September 15th 2014: "I started to use Mirvaso in the beginning of August and i was really excited to have found something like a magic cream for my rosacea. I had a lot of expectations on it. The first application was perfect. My face was so white, I couldn't even remember when was the last time to have such a normal face. After a month and a half i can say that my face has a rebound effect, it means that without the gel my face is more red than before and i need to use Mirvaso a couple of times a day but results are not so good as in the beginning. It seems that the effect is vanishing little by little. The side effects are: more redness(as a tomato) and pain on my face."

(313) Ally wrote on October 26th 2014: "My dermo gave this to me because I had two small patches of dryness and scaling that had some pinkness when I got out of the shower. He said I had very very mild rosacea. I tried this and now I have full blown beet red face. I'll never use this again. I urge caution to anyone who is given samples of this."

(314) Seb91 wrote on July 29th 2014: "I've got the exact problem. I went to Spain on holiday and used Mirvaso every night before I went to work which was from about 10pm - 3am. I then washed it off when I got home and didn't have a problem until I returned home to the UK last week. I had an IPL treatment the day after I got back from Spain and it caused my redness and flushing to get worse. I started using Mirvaso again to control the flushing which helped until it wore off and I had extreme rebound flushing, much worse than I have ever had before. I then read all the negative reviews on here and have decided to come off the Mirvaso as I was much happier at my baseline where I only had mild flushing. Today has been the first day off the Mirvaso and I have had harsh flushing and persistent redness all day. I am just going to wait and hope I return to my baseline, looks like I may have to wait a couple of weeks. Its so frustrating but going to try and ride it out as this gel is nothing but bad news it seems. I have an IPL booked for tomorrow so hopefully that will help a little bit.

(315) PADWENDA1 wrote on December 2nd 2014: "I only ever had mild Rosacea and I never flushed. I used Mirvaso for two days. The first day it seemed to be working well, the mild redness seemed to have disappeared. This lasted the whole day. The next morning I woke up and saw that my face was still reasonably pale, I applied Mirvaso for the second and last time. I was working and looked in the mirror from time to time, by 3pm I was shocked to see that my two cheeks were beet red. Some of my colleagues were looking at me strangely, luckily it was near the end of day and I went home. That evening the redness calmed down a bit. The following day I woke and my face was less red than the night before, I went to work and by lunchtime my face flushed again. Customers were wondering if I was too warm as it looked like sunburn. I got home that night and my flatmates commented on how burnt my face was. The following morning my face had calmed down and I went to work again. At lunchtime I got tomato soup and ate it in the staff room, this caused my entire face to turn very red, I have never experienced anything like it before. Again my work colleagues were very concerned, it looked like I had been slapped all over my face. I finished out the day and came home and went straight to bed. I woke on day three of Mirvaso recovery to find my face had calmed slightly but I could see the redness on my nose,cheeks heading to my side burns. I was not working so I stayed in all day. I ate mild foods and watched TV. In the afternoon I could feel my face burning, I looked in the mirror and my cheeks were slightly flushed. This remained for the whole night. Day four of recovery and I woke to find my face much better (still no way near my baseline before starting Mirvaso). I went out for coffee with friends and there was no flushing, I was happy to see things were getting better. I was working later that night and I knew this would be a test. Sure enough when I came under any sort of pressure my face flushed however not as bad as before. It is now day 5 of my recovery and I my condition seems to have remained static, actually my cheeks look a bit redder than yesterday. I really hope this wears off! I have submitted a yellow card report to the MHRA online and I urge everyone who experiences these horrible side effects to do the same. Although it is listed as a side effect, I get the feeling that its more than 1 in 10! People need to be warned! After using this gel just twice, I now have redness where I never had it before and I'm experiencing flushing which I never had before either."

He/she updated on December 5th: "An update on my"recovery". It is now day 8 and I'm still seeing no improvements. I flush everyday in work, with no obvious triggers (I have never flushed before). I rang Galderma and they assured me that these are temporary effects and it will calm down. They could not tell me how long it would take. I went to see my GP today, she recommended to go back on Metronidazole gel and she also said I could use hydrocortisone cream for a few days, again she said it will go back to normal (even though she does'nt know much about Mirvaso). I don't fancy the hydrocortisone cream! I hope my skin returns to the way it was before I used Mirvaso!"

And updated on December 8th: "It is now day 11 and the burning feeling has gone. I can eat hot foods and I blush only slightly. I think its getting better. The redness is subsiding day by day, but I still notice it in the shape of the Mirvaso application. Its much better than 3 days ago. Hopefully another week or two and I'll be back to my normal baseline!"

And on December 16th: "It is now day 19 of "Mirvaso recovery". There has been no significant improvement since my last post, only today at work my face felt like it was on fire. It did not flush as much as two weeks ago. Galderma are trying to reassure me that it will go back to normal baseline, I am starting to lose hope! What have I done to my face!"

(316) Sportsfan81 wrote on December 2nd 2014: "I am on day 5 of recovery as well and although it has gotten much better my face still feels weird and I am flushing in areas I never flushed before. Everything I have read here seems to point at least a week if not more before you get back to normal. If you are still feeling the effects after a week or so then try and talk to your derm. I'm with you though this product is awful can't believe anyone has success with this product."

Davekelly replied: "Good. Sooner or later there just has to be a inquiry in to how on Earth this Mirvaso got approved in the first place. Corruptables need to be held accountable for their actions"

Wiry replied: "It seems we are now seeing the delayed effects of it being released in Europe. Funny thing is that the forum knew about this years before it was released. Galderma didn't even care and/or simply couldn't find a way to deal with the rebound. I think they were "pot committed" to it at that point and had to release it. They had already spent too much money and it was going to get pushed out the door."

(317) Flahflah wrote on December 17th 2014:  I've heard that it can take up to a month to recover from that damn cream. In my case it took about 20 days before the diffuse redness and burning sensation really went away, and then another week to see my p&p go back to a pink color instead of RED. So total time was about a month and I'm sure I'm not the person who suffered the longest recovery period. So hang in there, there's still hope. And in the meantime, try to avoid all your triggers and keep your face cool and hydrated. You can look at my photo album (the link in my signature) to see how my recovery was. The very first picture was taken 3 days after the burning sensation of Mirvaso started to really affect me." Here are the rosacea pictures of flahflah.

Rosaceaclearwannabe wrote: "I want to start by saying that I know exactly what you are going through with your Mirvaso recovery, stay strong, you will recover. In my instance it took 6 weeks to just stop flushing and maybe even up to 8 weeks to get my baseline back to an acceptable level.
Has anyone noticed Mirvaso has moved into Phase 4 testing!? I hope they realise how much harm this is causing people and get it removed from the market or amend the formula!"

Geobiders started a new and interesting topic"Since it has become apparent that Mirvaso is not going to be a viable treatment for the majority of people with Rosacea I feel many people myself included have lost faith in finding a a drug thats going to work. I have heard people talking about the fact that mirvaso took 8 years from when we first heard about it till now to get to market and I would have to agree that based on this i think its unlikely we are going to see anything for 10 years the way things are going. So what now?? Since the downfall of Mirvaso I have been asking myself that same question. There is promising research being carried out but progress is painfully slow. Why is this? I am no expert on these matters but I know that there are doctors/universities out there that will carry out the necessary research to find a viable new treatment if funds are made available. So where can the funds come from?"

Update April 17th 2015
SOURCE: http://rosacea-support.org/mirvaso-rebound-flushing-makes-the-news.html

Debra Tolle
July 27, 2014 at 1:41 AM
I too am struggling with rebound flushing after using Mirvaso. I used it 5 or 6 days and my face is worse than it has EVER been. It hurts and is extremely red. I was just using Clinique Redness Solutions products before, along with Oracea and was actually having pretty good luck. I was a tad “pink” but no burning. I now cannot use the Daily Relief Cream as my post Mirvaso face is even too sensitive for that. The Clinique cleanser and protective base are agreeing with my skin, however and I hope that this GOES AWAY!!!!!!! I am off Mirvaso for good!

August 16, 2014 at 1:42 PM
I’m so disappointed. My dermatologist gave me samples of Mirvaso and I was so excited to try it because she praised it so highly in her office. The first two times I used it, I had to keep looking at my face because it was actually pale. I was SO thrilled. I used it 3 days ago and for about an hour my face was free of redness; then came the horrible flushing, the feeling that my face was going to burst into flames. I have been using Benadryl cream and that helps with redness for a little while, then it comes right back. I’m so upset. Calling dermatologist Monday and gonna see what she recommends. NO MORE MIRVASO!!!!!

August 18, 2014 at 4:36 AM
Desperately in need of help! Does anyone have any advice to try and speed up the recovery period? My fiancé and I are getting married in 10 days. He started using mirvaso in the hope his redness would be gone but he’s suffering with flushing worse than ever before. He stopped taking it 3 days ago but the flushing doesn’t seem to be going away. Any tips GREATLY appreciated!

August 18, 2014 at 5:06 AM
It took about 3 days for mine to go away it also flared up to much worse then what I had to begin with. It hurt too. It will go down and back to normal. I have read it took others about a week. I know that it is stressful right before getting married. He probably wont go for this but have him try bare minerals to cover up redness if it is still bad. It does wonders and is all natural so it shouldn’t make his skin worse. (not the liquid but powder form!) You don’t even have to wash it off! You can get it at Sophora store. Good luck and congratulations!

August 18, 2014 at 5:12 AM
Thanks Gwen, that gives me some hope!

August 18, 2014 at 5:58 AM
Try making strong black tea, cool it down (refrigerate) then apply cold compresses to your face while relaxing. The caffeine in the tea along with the cool temperature will help calm down the redness naturally.
If still red on your wedding day he can apply mineral powder to hide the redness for pictures. Mineral make-up (powders only) I find to be the least irritating to the skin. Just make sure it does not contain Bismuth Oxychloride, a know irritant some brands use in their make-up.
Best Wishes and Happy Nuptials!


August 28, 2014 at 4:11 AM
Initially I was very pleased with the results that I got from using this cream although I looked a bit pale at first when it had begun to work. It lasted all day and my rosacea looked much better and I hadn’t had any side effects. Unfortunately after a couple of weeks this cream then began to be less effective and was lasting until lunchtime then the redness would start to appear again but more intense than before I had put it on. I then started to have really bad flushes, skin was patchy and burning hot and it was horrendous. It would start with a couple of ‘hotspots’ on my face then they would erupt to a full facial flush covering my neck too. OMG they were bad. Skin was on fire and VERY red with just two white circles where my eyes are. I knew I had a big problem so decided to cease using this cream and then it took about 5 days for my skin to calm down to how it was before I began to use Mirvaso. This cream has caused me a lot of anxiety especially when the flushes started to happen as I never knew when they would occur and they happened without any warning and would last for a couple of hours. Very distressing and uncomfortable especially as it felt like my face was going to pop with the heat from my skin.

December 14, 2014 at 7:37 PM
If you use it only and only once a week and no more than onde day can you avoid the side effects?

Silla Moller
August 31, 2014 at 5:41 AM
I used Mirvaso for the first time yesterday applying it at 8 am. It was looking pale and great by 1pm and things were looking fantastic except that, by 430 pm my entire face started ‘burning” and became bright red with a mottled kind of appearance. this ‘mottled’ effect is NOTHING like my usual roasacea so I’m not sure what is going on. Very, very disappointed with this product. Cost $103 from my pharmacy in Melbourne, Australia.

August 31, 2014 at 6:27 AM
Contact Galderma, they will issue a refund

September 4, 2014 at 5:33 AM
I am experiencing the same effects. I was very excited to try Mirvaso but had to stop because around 3:00 everyday I was getting that redness. It was horrible and had to have a fan practically on my face. The heat and burning was unbelievable. I stopped using after 6 days and after 3 days I am still getting the redness off and on. I feel like a freak at work! So disappointed!

September 4, 2014 at 6:16 AM
Funny how rebound redness was not reported by the drug’s manufacturer. Yup. I, too, applied a pea-sized amount to the nose and cheeks only to regret it after 4 days. I was very happy at first with my pale face staring back at me in the mirror. Then, after a few days, “Why is your nose so bruised?” from my co-worker. In the mirror, I was Rudolph-the-Red-Nose-Reindeer Red…..I immediately regretted using that cream & realized that I really didn’t have much of a problem until I started using Mirvaso. The problem is, the pharmaceutical pharmacy is not warning about the rebound redness & really does not report an incidence of it. This product should be taken off the market. It makes a good number of rosacea sufferers worse. How many, we won’t know because the pharmaceutical company is not recognizing this as an adverse effect of the drug. How unethical.

September 4, 2014 at 7:27 AM
Mirvaso is nothing but a Visine type eye drop made into a cream for the face. If you overuse Visene in your eyes to get the red out your eyes will experience rebound redness. Rosacea is a multifaceted disease.

September 4, 2014 at 7:53 AM
Interesting comment… I only used Mirvaso ONCE to have the reboud flushing per my previous post – Overuse is not the issue!!!!!!!!!!!!!!

September 4, 2014 at 8:03 AM
The Visine analogy is incorrect. One or two doses causes a rebound

September 4, 2014 at 8:32 AM
What does it take for someone from the FDA to look at this? The number of complaints is
overwhelming, there is no way this didn’t come up in a significant way in clinical trials. Then, the executive that was responsible for launching this product abruptly leaves the company weeks after the launch? It was at least four months before he was in another position, so guaranteed that was not his choice. I can already see the messaging from galderma coming out someday: We found out there was a problem, so we fired the guy in charge… we did the right thing.

September 5, 2014 at 5:09 PM
Because I was having the rebound redness around 3:00 (but not everyday and I can’t figure that out) my dermatogist told me I could use it twice a day. Has anyone tried that? I am going to do especially during the work week as it is terrible when I am there and I have this fire red face.

Jenny Rapovich
March 31, 2015 at 2:24 AM
I’ve been using it twice a day, 12 hours apart, and I still have the rebound redness. I’m contemplating stopping the medication as this redness was not nearly this bad before I started using this product. Works great after about an hour of applying it, for 6-8 hours and then starts wearing off and here comes the redness.

September 5, 2014 at 5:39 PM
My rebound redness after just one application was extreme. My skin is generally overall “pink” with a couple of areas of visible capillaries but after my first application of Mirvaso, it was extremely red, hot and sensitive – entirely out of character from my typical condition and took three days to calm down (without further application). Would be interesting to see how you go with a twice daily application . Keeping the redness at bay with more frequent application may be the key…. Please let us know how you go I have the feeling we are Galderma’s study group… not sure who they tested but possibly nobody with Rosacea. Cheers, Silla

September 5, 2014 at 7:23 PM
I will let you know how it goes with the twice a day application. Yesterday I got away with one application but I had applied it late morning and was good til bedtime. I will just have to see how it goes. I agree with you about being the guinea pigs. I had the same feeling. Wondering if my doctor said to try 2x just to see if it works! Good luck to you!

September 6, 2014 at 4:12 AM
Thanks! It really will be interesting to see if the doc’s suggestion works. I’m certainly not a doctor but I could imagine that if the condition is kept at bay (as in twice daily application) maybe, over time the capillaries become less inflamed and therefore less likely to flare up as rapidly .. It still worries me that the rebound flushing is just so extreme. God only know the further damage that does…. Fingers crossed for the 2x a day application I hope it works for you… Good luck!


September 6, 2014 at 4:19 AM
Keep a journal a take pictures to see if it wears off earlier each time. My experience is that I became very dependent on the medication and the time between each application became shorter and shorter before I became inflamed. I got worse and couldn’t figure out why until it dawned on me. It took a while for my face to calm down.

Lynda Gwynn
October 14, 2014 at 8:04 AM
I tried Mirvaso and at first was so happy to get rid of the redness. By the end of the day my face was flaming red and very hot. I had to put the fan on my desk directed right at my face. I called my derm and she said to use it twice a day. I tried that but it became so unpredictable as to when the redness would come back. The residual flushing was terrible and very frequent. I stopped it because it was apparent that it was not working. I have not heard of this product working for anyone.

September 10, 2014 at 5:06 AM
i have mirvaso since june and i only use it every now and than (important business meeting, party, …). I also notice the rebound flushing and i become more en faster red for the next 3 days. Nothing seriously compare to what the others describe, but i do notice it. Maybe this products is not ment to be used on a daily basis ? Although i would love to use it every day. I’ts amazing to be that pale for a day. And not having to worry if wile become red when talking to other people… According to my dermatologist i can use Mirvaso every day, but after ready these comments, i’m a bit scared to use it on a daily basis.

Jason S.
October 10, 2014 at 10:19 PM
Rebound redness here too. The mirvaso works well for about 8 hours, then there is a very sudden hot flushing which lasts a few hours. I’ve tried reapply at about hour 6 to prevent the 8 hour flushing, but it doesn’t work. Today is my first day without mirvaso. Hopefully no flushing today….

Richard M
October 17, 2014 at 6:55 AM
Day two of Mirvaso, my rosacea appears to be worse than ever. Really don’t know whether to continue. Really thought this was my ‘miracle’ solution. So depressing.

October 29, 2014 at 6:01 PM
Entirely support all the previous reports. After first being prescribed I was elated to have found a solution. Almost instantaneous results, very pale, so happy. The negative results took slightly longer to emerge, I was using Mrivaso maybe 5 times a week for a few months, after the first month or so the result was less effective and lasted less time. Approximately 2 weeks ago i suddenly started developing extreme flushing, lobster red over the entire face with the exception of patches under the eyes. Awful, the worst it’s been and the most insecure i’ve ever been. At first I thought it had to be a result of seasonal change (colder outside, coming suddenly in to warm rooms), or stress etc… After some lifestyle changes and watching for triggers there is no doubt it’s the gel. Bin it. Ban it. Having studied their research figures against the reports from sufferers I fail entirely to see how their results could be accurate or honest. Now praying that after sustained use the results aren’t permanent.

October 30, 2014 at 9:51 AM
Dang, I tried the samples, and they seemed to help for a week but I was using it infrequently . Now after I bought it, I’ve been 2x a day for a few days. I thought it was something I was eating, cause I was geting so red after. I think it was timing. 6am use and flush by 12. 1pm use and flush by 7. Maybe the hot food triggered it. I only realized this because the flush is so extreme and hot.

Mrs Jones
November 20, 2014 at 4:24 AM
Hi Everyone, So sad…I used Mirvaso this morning at 7.30 for the first time. Couldn’t stop looking in the mirror…looked like a happy ghost. I thought all my dreams had come true until later today I walked into my warm house at 4.30pm – Whammo my face changed immediately from white to red with large purple blotches ALL OVER. Ran upstairs to wash the remains of Mirvaso off but my face got worse. I was red in places that I’ve never been red before. was so traumatised I cried because I have important meetings from tomorrow on so now I’ve got blood red eyes too from crying. Mr Jones couldn’t believe the state of my face. He’s never seen it that bad ever before. Put my thinking cap on and took a Nurofen capsule…calmed it down a bit. No purple blotches now just red so not as bad. Will see what it’s like in the morning but fear that it won’t subside for some time. Will keep using Nurofen though until I get my normal rosy cheeks back. If you are thinking of using this stuff – DON’T. Learn to love what you’ve got. Whoever ran the tests on this product needs investigating.
Mrs Jones

December 11, 2014 at 12:11 PM
I used mirvaso for two months. Great at first then noticed didn’t work as long then started to get rebound flushing! The rebound got so bad my nose was almost purple and it looked like I a had a red beard! Tonight was the worst had to talk to people at work and could even face them I was so embarrassed the redness was worse than ever my face was on fire! I am a pharmacist and couldn’t talk to my patients cause I looked like a freak! I should have known better and i wish I read all these comments earlier! glad to know I’m not alone and so angry with pharmaceutical company right now! i would love to have a class action law suit cause there is no way they didn’t know about this!

January 8, 2015 at 6:36 PM
Thanks everyone for posting such detailed feedback. Since I have mild acne and redness my dermatologist recommended this cream for infrequent use along with Finacea and Differin; I specifically asked if it was known to cause rebound redness and he said it was not. A simple google search and I quickly grew suspicious. I’ve only tried the cream once and became nice and pale but after about 8 hours my face was slightly irritated and warm. I quickly washed my face after that and applied some hypoallergenic recovery products from Avene. I don’t have the balls to try another application because I’m afraid it will cause adverse effects. I regret buying this.

Red Rose
January 8, 2015 at 11:32 PM
Raarnt, very smart that you stopped using Mirvaso after seeing the user reviews. With Rosacea, you are always better off being safe than sorry and then deal with the potential long-term results. Also, always do a test spot on a sensitive area of your face for a week to see if you become reactive to a new product (or at most half your face) but never use a new product on your entire face without a trial test spot for a week. Sometimes it can take a few days for your skin to show a reaction.

Tracy Petersen
January 15, 2015 at 7:44 AM
I’ve been using Mirvaso for about 6 months. Same as everyone above. Great at first and then slowly the product would wear off and I’d have to reapply. I’m now also having rebound redness even after a few hours of having product on. Hoping someone can tell me this eventually goes away? (off it for first day and still red).

January 21, 2015 at 6:09 AM
I was recently given Mirvaso by my dermatologist, who warned me about the potential for rebound flushing. He recommended that it really works better when sporadically used, such as only on days where I may have a big event such as a wedding or work function where I would be extra self-conscious about redness or having my photo taken etc. My derm said that he has been told the rebound effect supposedly diminishes over time with consistent use of the product over time but that he was skeptical about that. I decided that I would try using it daily anyways and started putting it on every day for about 3-4 days in a row. On the 4th day after about 12 hours from my last application, my cheeks felt like they were on fire and were bright red. I also ended up getting a bunch of papules/ pustules on my cheeks (this aspect of my rosacea is usually well controlled by doxy)…I was really disappointed since redness is the one symptom for me that is chronic and it was so lovely to feel normal!! After a little trial and error the Mirvaso seems to work best for me if I only apply it a couple of times a week as opposed to every day, I do not seem to get the rebound flushing problem at all if I use it just sporadically…

February 3, 2015 at 9:19 AM
Used this gel for 2 days and initial results very good BUT by third day began to suffer severe reaction, deep flushing of whole face, extreme heat and tenderness on facial skin. Didn’t use for next day but side effects still there. This drug needs further testing and should be withdrawn whilst this is being done.

February 5, 2015 at 2:27 PM
I applied the cream twice, so that I could drink casually once or twice a month and enjoy my college experience. Akin to everyone else, I was amazed at the initial results. What would usually be a red, blotchy face was as pale as when I was younger with perfect skin. Then the day after the second time I applied it, my face literally exploded at an interview with an Investment Bank. My face was literally purple, and on my way back to my car, I had multiple people tell me that I should go right to the hospital. I am furious that this was FDA approved, and I believe there is legal ground for a class-action against the multiple companies, who obviously construed the data to allow for the drug to be approved. Anyway, I am writing this to dissuade others from trying, continuing, or supporting this innocuously seeming yet absolutely devastating drug.

February 7, 2015 at 2:34 AM
My doc gave me samples of Mirvaso and applied it during my office visit. It was like magic, within 5 minutes my redness was gone! Even later that day my skin was perfect. After applying for 3-4 days only once a day after my A.M. workout my face is on fire. The redness is worse than before and my face is hot and flush almost all day long. I will not be using this anymore. Has anyone ever had luck with natural products or a change in diet that has a positive effect? I rarely consume spicy food or alcohol, but would love to hear of other simple changes I can make.

February 7, 2015 at 4:23 AM
I tried a lot of creams, lotion and solutions. So far, the best one is: Alovera gel natural 99% without added stuff mixed manually with a Damascus Rose Oil. Every morning and Every night. Results after a week. Also, I try to put sun screen every time I go outside to not have always a ‘hot’ skin. Finally, stop alcohol, restart sport, avoid hot water on face during shower.

February 7, 2015 at 6:25 AM
Thanks Ben!

Rachel DuBois

February 14, 2015 at 8:18 AM
This is my fourth day of taking Mirvaso and I’m stopping because the rebound flushing is too severe — I feel sunburned and it lasts for hours. I’ve never taken Metrogel or any other product because my rosacea was mainly rosy cheeks, but in the past year it’s started to get worse and I decided to take action this past week. Here in the UK, the NHS covers the cost of Mirvaso and I was thrilled at first to see what my face looked like without redness, but it doesn’t look entirely natural either, more washed out or even a bit deathly. But I would have stuck with it had I not had the ‘rebound flushing’ that so many are describing. Personally, I’m going to go back to trying Clinique’s Redness Solutions cleanser with one of the moisturisers recommended for rosacea on Paula’s Choice. I got a sample of the cleanser and found it did calm my skin down before I started on the Mirvaso. What a shame it doesn’t work for so many of us! I just hope the rebound flushing doesn’t continue for a week or more like others are mentioning.

Joey r
February 17, 2015 at 3:52 AM
After things calm down, try using a lot less Mirvaso by combining it with a moisturizer (1 part Mirvaso, 3-4 parts moisturizer) an antihistamine cream or even Metrogel. You mmay find that you get no “rebound” with this method

March 11, 2015 at 11:37 AM
My new plan is very very light mirvaso (1/2 pea size) whole face. Dry 10 minutes. Cover in Clinique intense moisture. Let dry. Powder, no blush. End of day, remove, lots and lots of moisturizer. Been three days and no flash back redness. That said, this is my 4th try, so I’m not overly optimistic.

Jennifer Rapovich
April 2, 2015 at 10:14 PM
I’ve been using Mirvaso for several months now. It wasn’t until one of my doctors asked me how I was feeling that something clicked. I started really looking at how my face was reacting to Mirvaso. After several hours, it looked like almost a pastey white. A few hours more and here comes the redness. By afternoon my entire face was beet red, like a bad sunburn. It has been 2 days now since I stopped using the product and I am still flushed. I can feel it coming on and there is nothing I can do about it. I hope that eventually this goes away because it is embarrassing going out in public looking like this. In the past I used the Clinique Redness Solutions line and have had pretty good luck with it so I’m going back to that regime. I wish I had found this website long before I starting Mirvaso. Besides that, my insurance doesn’t cover the cost of it so it is way too expensive. Never again!!

Scarlet red
April 18, 2015 at 12:26 AM
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

I've always believed that Mirvaso has the potential to really mess up anyone's vascular rosacea, although some people seem to use it with some success.. For now! I wouldn't personally take the risk with this chemical blood vessel constrictor (then dilator!) drug, which is bound to cause rebound, at least on paper, and now the stats seem to indicate that it also applies to a lot of rosacea patients.

Update April 18th 2015

This article shows the effects of Mirvaso, comes with a lovely illustrative pictures.

Severe Mirvaso Rebound Redness: Dermatitis Medicamentosa

Written by David Pascoe
in Mirvaso Gel (Brimonidine 0.33%), Red Face of Rosacea

mirvaso-rebound-redness (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 – 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.

mirvaso-gel-tube-30gmDermatol 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.

Mirvaso Rebound Flushing makes the news

Written by David Pascoe in Galderma, in the news, Mirvaso Gel (Brimonidine 0.33%)

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.”

In this medical 
article from February 2014, researchers note that the incidence of rebound worsening of flushing and erythema seems higher than reported by Galderma

Journal of the American Academy of Dermatology
Volume 70, Issue 2, Pages e37–e38, February 2014

Rebound erythema and burning sensation from a new topical brimonidine tartrate gel 0.33%

To the Editor: Brimonidine tartrate (BT) gel 0.33% (Mirvaso, Galderma Laboratories LP), an alpha-2 selective adrenergic receptor agonist and vasoconstrictor, reduces erythema of rosacea. The top 3 reported adverse events related to BT are erythema worse than baseline (4%), flushing (3%), and burning (2%). At least 1% of patients had an adverse reaction to the medication. We report severe erythema in conjunction with burning sensation in 3 patients using BT. All reported reduced erythema 1 to 6 hours after application, followed by self-limited erythema, more severe than baseline, accompanied by burning over the next 12 hours and lasting roughly 12 hours. This phenomenon worsens with continued use. Urticaria and facial edema were absent. Even though the Mirvaso package insert reports infrequent erythema worse than baseline, this number may be higher in practice.

Please also read the following forum discussion about Mirvaso for rosacea, and this one

David Pascoe wrote also a piece about Mirvaso rebound flushing.

Please read also this Mirvaso discussion on the Rosacea Support Org forum, where rosacea patients share their experience with Mirvaso.

Below this youtube Mirvaso promotional video, you can read the patient experiences with this drug.


the amount of people reporting negative responses to Mirvaso keeps growing. Brady Barrows made a proper inventory of them all and you can read them here (Bradies list, to be clear), including details about the complaints people made (LINK)
Another good website where Mirvaso is evaluated is David Pascoes Rosacea Support Group, read his post here.

Please note the following about anecdotal reports: Initially many users report positive results from using Mirvaso, then later may report negative 'rebound' results. So be aware that the few Positive Reports may later be moved to the Negative Reports upon evidence of a change. Also be aware that a good portion of the positive reviews might never be updated by the original posters and that for a lot of users the rebound worsening occurs after some time. So take the positive section with some critical point of view. Likewise, negative reports can turn into positive ones with time when patients keep using it and work through the side effects but haven't seen that yet mentioned. Debated is still how much of the mentioned rebound by patients is an intrinsic part of the brimonidine wearing off (first chemically and disproportionally constricting the blood vessels and then potentially setting a disproportionate and compensating vasodilatation in motion), or is part of an allergic reaction. This is discussed also on the Rosacea Forum (Link). Another consideration is how many of these reviews are sincere and how many may be potentially staged and written by pharmaceutical coworkers or reps.

In this New York Times article, about pharmaceutical company Pfizer for instance, it was put in black and white how companies like Pfizer would reduce costs in 2012 and mentioned: "Other changes are afoot that will no doubt affect the bottom line. They include growing restrictions on gifts, fees and trips to influence doctors to use their products; curbs on the ghost writing of medical journal articles and a push for more disclosure of negative study results. As the golden age of blockbuster drugs fades, so are some of the marketing excesses of the past two decades — the tactics that helped bring in immense profits."  We discussed on the same forum thread whether positive reviews which can be linked to a real life person who used his/her own name are more reliable than negative reviews from people with a forum name. Opinions differ, although I would be more suspicious of positive reviews in theory, as there are companies and reps with an interest to get positive reviews out, to improve sales or to keep them good. On the other hand, apart from the conspiracy theory that coworkers from other, competing pharmaceutical industries would want to discredit galderma´s product with fake negative reviews, I don´t see real time rosacea sufferers making up fake negative reviews, just to annoy a company or for the sake of it. In the past, people have complained about faked positive reviews for other pharmaceutical products/companies and they stood out mostly by an abundant praise of the product, long and overtly detailed summaries of the experience, detailings of how great life now is again since the product works and an encouragement of others to start using it. The positive reviews for Mirvaso seem mostly genuine however so far, as far as one can assume anything in this respect. There has also been a discussion on the same (yes, very long) Rosace Forum thread about the way Galderma is promoting its product. Its an interesting process to see and members are discussing and comparing news items on Mirvaso and  online advertisement movies. Some seem to use models with no visible rosacea, or use similar models in the same type of add video. There has been some critique on this.

Wiry made an interesting comment about the prevalence of negative Mirvaso reviews:

(LINK) "Look at the number of negative to positive reports over the given time periods:

Release to end of Year 2013:
Negative = 86
Positive = 30
Negative to Positive = 2.9:1

Start of 2014 to Current Date (3/4/2014):             
Negative = 35
Positive = 6
Negative to Positive = 5.8:1

Last 30 days:
Negative = 8
Positive = 0
Negative to Positive = High

I wonder if the marketing money is drying up and fake positive posters are no longer around? Of the positive posters on this forum, there is exactly 1 (yes ONE) user who was a regular poster (GreenGables). All others have posted a couple times and went away. Some said they would continue to post since they were excited, but never did. On this forum, there are currently 0 (ZERO) active posters who found Mirvaso to work for them. GreenGables has not posted in some time and his last post regarding Mirvaso was on Nov. 22, 2013. No matter how you want to spin it, zero is a pretty awful number."  Nevertheless official numbers mention still only 2-4% of users having these rebound worsening symptoms.

This scientifical article reports on Mirvaso rebound flushing 


Rebound erythema and burning sensation from a new topical brimonidine tartrate gel 0.33%

To the Editor: Brimonidine tartrate (BT) gel 0.33% (Mirvaso, Galderma Laboratories LP), an alpha-2 selective adrenergic receptor agonist and vasoconstrictor, reduces erythema of rosacea. The top 3 reported adverse events related to BT are erythema worse than baseline (4%), flushing (3%), and burning (2%). At least 1% of patients had an adverse reaction to the medication. We report severe erythema in conjunction with burning sensation in 3 patients using BT. All reported reduced erythema 1 to 6 hours after application, followed by self-limited erythema, more severe than baseline, accompanied by burning over the next 12 hours and lasting roughly 12 hours. This phenomenon worsens with continued use. Urticaria and facial edema wereabsent. Even though the Mirvaso package insert reports infrequent erythema worse than baseline, this number may be higher in practice.

Patient 1
A 36-year-old Latina woman with longstanding rosacea and Hashimoto thyroiditis applied BT to cheeks and nose as directed. Erythema reduction lasting 4 hours was followed by erythema, notably elevated overbaseline, and burning in the areas where the BT was applied (Fig1). This reaction resolved after 5 hours. The patient continued to use the BT over the course of 5 days,applying in 5 areas, as directed, to her forehead, each cheek, nose, and chin. She felt the reduction in erythema was satisfactory but noted that patchy erythema and burning developed 5 to 10 hours after application. On the 5th day of use, 12 hours after application, she experienced erythema, much worse than at baseline, in all areas where the medication had been applied and she had a severe skin burning sensation (Fig 2). The erythema and burning resolved 12 hours later and she discontinued use of BT.

Patient 2
A 41-year-old Caucasian woman with long-standing rosacea, psoriasis, and anxiety reported reduced erythema following one application of BT, followed 3 hours later by significant erythema, skin burning, and pruritus where BT was applied.These resolved slowly over the next 12 hours. Concurrent medications included infliximab, methotrexate, folic acid, venlafaxine, zolpidem, clonazepam, and trazodone.

Patient 3
A 28-year-old Caucasian woman with long-standing rosacea and Hashimoto thyroiditis, taking levothyroxine, tramadol, and norethindrone/ethinyl estradiol, applied BT to cheeks and chin once daily for 2 weeks. She noted significant reduction in erythema followed 6 to 8 hours later by erythema and burning in the areas of application. She continued therapy for 2 weeks with progressively worsening rebound erythema and burning. These symptoms resolved temporarily with reapplication of BT. There is no current photo documentation of this side effect at www.mirvaso.com or in the literature. We propose that this reaction constitutes rebound dilation of the capillaries caused by down-regulation of alpha-2 adrenergic receptors following use of BT. This may be similar to rhinitis medicamentosa, observed with overuse of alpha-adrenergicagonistnasalsprays (eg,oxymetazoline and xylometazoline). This reaction directly opposes the goal of therapy. Counseling about the potential for worsening erythema, use of a test area, and limiting use to special occasions may be warranted. Viewing images of  this adverse reaction prior to use may alleviate patient distress.

Medical Education Sectiongif (link)
27 year old woman with a 5 year history of rosacea and emotional facial flushing. Topical metronidazole products initially were marginally effective, but over the past year have lost their effect.
What is your diagnosis?

Diagnosis: Rosacea
In this case we recommended that she use brimonidine gel, 0.33% (Mirvaso). Brimonidine gel, 0.33% did well to control the redness and flushing. It took approximately 1.5 hours to take full effect. Unfortunately for her it only lasted for about 6 hours. We had her mix Mirvaso 1:1 with a compounded formula of: metronidazole 0.75%, Oxymetazoline0.05% in a  vehicle/base of Cerave lotion.
This mixture, described above, provided 12-14 hour results. See pictures for details.
Image 1

Before any treatment
Image 2

2 hours after treating; right face 1:1 mixture Brimonidine gel, 0.33% 1:1 with a compounded formula of: metronidazole 0.75%, Oxymetazoline0.05% in a vehicle/base of Cerave lotion on the right side of face, Brimonidine gel, 0.33% to the left side of face
Image 3

6 hours after treatment, Brimonidine gel, 0.33% alone on left face starting to wear off, compounded mixture still working on right side of face.
Image 4

10 hours after application of compounded mixture (metronidazole 0.75%, Oxymetazoline0.05% in a vehicle/base of Cerave lotion )to full face

This is a cafepharma forum thread about Mirvaso, written by Galderma's own employers (or sales reps), where the product is both critisized and defended. A few quotes from there:

*"Old 12-01-2013, 05:01 AM, Peter D in Seattle
Bullshit. I got it as a trial on Nov 23. By the 25th my face was a red hot mess in places I was clear. I had light redness. Now I look like i have a horrible sunburn and my skin in places is peeling. This stuff is not safe. I regret the day the sample was given to me and never was rebound flushing mentioned. My face it hot, dry, tight and red. Its pretty uncomfortable and if you think I am slamming mirvaso just wait til I see the derm this week. I am super pissed.

*12-01-2013, 10:58 AM, Anonymous Posts: n/a, Default Re: Mirvaso
You should discuss your situation with your physician. Also, the reps need to be careful not to discuss using a topical steroid like Hydrocortosone with topical rosacea products be they over the counter or prescription. You can get a symptom called Steroid rosacea and the long term effects of topical steroid use on the face do not out weigh the benefits. I have seen terrible steroid induced rosacea and atrophy even with low potency long term use of low potency steroids. Please do not mix topical rosacea products with a steroid if a rep or someone is telling you to do so, please do not it is not worth the risk of steroid side affects that in some cases are not reversible. We will need more studies on this drug to better understand the long term use and or the safety aspects of it. For a chronic condition like Rosacea you need safe products that help you manage it for the long term. I would recommend topical Metronidazole for long term management of your condition. Best and safest option

*12-01-2013, 03:32 PM, Anonymous Posts: n/a, Default Re: Mirvaso
I agree with the above post. Although some of my docs have reported side effects from Mirvaso (similar to the trials), most of them are pretty happy with the results.

*12-01-2013, 03:54 PM, Peter D in Seattle Posts: n/a, Banghead Re: Mirvaso
Oh believe me when that office opens tomorrow I will be there angry as hell. Its day 4 and I am still incredibly flushed and red. This since I stopped using it. Since it was the Thanksgiving holiday everything is closed so for the four days I was looking forward to having off I am dealing instead with this and being embarrassed to be seen. Google the boards the rebound flushing among the confirmed posters is almost 1005. most are saying 10+ days to calm down the skin with many saying it was worse than when treatment began. To say the least my new derm failed me and I suspect just took the word of the rep pushing this. I was told almost nothing of the adverse symptoms and now I am stuck in a facial purgatory looking like lobster man. I was in SF the day before and looking at the picture there with how I look now is shocking. I feel like I have been permanently scarred.

*Peter D, Posts: n/a, Default Re: Mirvaso
Quote: Originally Posted by Anonymous View Post
I agree with the above post. Although some of my docs have reported side effects from Mirvaso (similar to the trials), most of them are pretty happy with the results. Funny it seems the opposite with the rebound numbers being reported on the forums as closer to 70-100%. Sadly I had to hunt this info myself.

*Yesterday, 09:17 PM, klsgoss Posts: n/a, Default Re: Mirvaso
I have to say that I was prescribed Mirvaso on Monday of Thanksgiving week. I had been experiencing frequent flushing, though I did not relate it to my rosacea ... more to social anxiety. I used it for a week and thought is was the answer ... a wonder drug. Not any more, for me, at least. My face is on fire tonight and looks like I have a severe sunburn. A rosacea flare-up never looked this bad. I am just happy to learn that I am not alone, and that from what I 've read, the symptoms will pass after a week or so. I just quit using it yesterday morning after a week and a half of daily use.

A 10 November 2013 update on Mirvaso sales:
`Mirvaso is reving up in my area. The derms are addressing patient issues and refills are definitely happening. (link)

By now, on the cafepharma forum, Galderma coworkers seem aware of the 'the troubles' of their product as well http://www.cafepharma.com/boards/showthread.php?t=538135&page=2

11/1/14, Anonymous, Posts: n/a, Default Re: Mirvaso
I hope that the "extended interaction" role play time is 100% dedicated to dealing with Mirvaso and it's wonderful safety profile...maybe some talking points on convincing the doctor to try it on some more patients even though they just had 4 out the last 8 with worsening erythema (or some other weird side effect). And don't forget to keep the adverse event phone number on speed dial

Updates, January 23rd, 2014

And some more updates from the Galderma reps on Mirvaso:
This product has put everything in perspective for me. Represents everything evil about galderma. I had a girl come back to the pharmacy looking like she had her face on a frying pan. Im done with this. 01-19-2014, 09:04 AM, Anonymous

Mirvaso works on persistent facial redness. People need to be ethical and stop saying give me every red face. This product is not for the flusher/ blusher. These patients are the ones that can't handle it! 01-20-2014, 11:03 PM. Anonymous

Don't kid yourself...they are many patients that "can't handle" Mirvaso-all we can do is just provide a fair and REAL sales message and hope for the best. I am interested to see what our quotas are for Mirvaso. 01-20-2014, 11:22 PM. Anonymous

Banghead Re: Mirvaso This product is a true "game changer" it made us lay off half the sales force and put the company in a position to fail for years to come. I'd call that a game changer anyday!!! 01-21-2014, 12:13 AM. Anonymous

I posted on here before that many of the derms are using Mirvaso "off label" by telling their patients to ease into using it by mixing Mirvaso with moisturizer etc (as has also been reported on online forums) when they first start. I know it isn't a method that we can promote, but I've heard that its been working out for a lot of their patients. Obviously, this won't help sales if people are using less Mirvaso per month, but...it might help increase refills over the long term.

Lets keep selling Mirvaso off label that is a great way to save the product and the company.

In response, David Pascoe thinks these comments have to be taken with a grain of salt: 
"N., don't you think that that cafepharma board reads like a mob of disaffected, grudge bearing, almost trolls? It doesn't read like it is habited by professionals like they want us to believe - well that is my impression anyway. As they say, on the internet no one knows you are a dog"

Me: "Don't know David... I sometimes read some of the other top threads on this forum (Galderma section) and most posters there seem to know a lot about the company and the cuts and reorganizations there. They post like actual workers there, gossiping about actual employers (named with capitals only). Maybe a few posters in the Mirvaso thread are patients and no reps, but a good deal seem employees to me."

David again: "I agree, but I was thinking that we need to take all their comments with a grain of salt as they are obviously angry and aggressive towards their ex employer and their comments seem to be a little over the top. More than gossip it seems sometimes. Anyone can bear a grudge and invent a conspiracy especially if they feel some animosity towards a company that sacked them for eg. I thought it was worth highlighting this anyway."'

Me again: "I read them differently I guess.. I see a tendency of first praising Mirvaso and bullying the odd patient, about 2 or 3 so far who have mingled in and said to be careful pitching this stuff (esp suggesting to add cortisone cream). Then some coworkers who are starting to see the big picture, report back that the derms they pitch to are reporting these worsening side effects, some pep talk to keep pitching the product unofficially and then some more who are starting to see what a disaster (so far at least) this product seems to be. Most hard core people to convince of this I think, their own sales people, and yet some are criticizing the product. If anything I find their comments interesting, as they add details about how they suggest to product to the derms, and some feed back from the derms seeps through in their comments as well. Oh and BTW, most posters there are no EX employees but current employees and Galderma is not their ex boss for most, which makes a difference indeed."

Mirvaso in the news

FDA Approves New Treatment For Rosacea,Pittsburg

Youtube video for Mirvaso

In this Daily Mail article Mirvaso is mentioned

Mirvaso will be available in Europe in march 2014:

Update, January 7th, 2013

In this study, brimonidine was tested for rosacea. The results were a lot more positive than actual patient feedback on Mirvaso so far. Here is the link to the study results and here they are discusssed on the forum.  Side note: one of the sponsors was Galderma... Makes you wonder once more how accurate such studies are when they are funded by the pharmaceutical companies who sell the actual product. 

Question on the forum is now also whether or not patients have to work themselves through the Mirvaso induced increased flushing and redness or not. Based on this raport, where rosacea patients were asked to use brimonidine, Nadine wondered:
"That's weird. "The incidence of AEs and AEs judged to be related to the study drug was higher at the beginning and decreased over the course of the study." That almost sounds like once subjects pushed through initial adverse response, they enjoyed better results (or subjects with bad reactions dropped out? Hard to tell just from this abstract). "the durability of the effect was maintained until the end of the study at month 12, with no tachyphylaxis observed. "- so, no desensitization (that's what tachyphylaxis means). Sounds like no rebound either then. For 12 months. This just isn't consistent with what we've seen among this community. And this is with .5% BT. Mirvaso is .33%."

Makron, who earlier had blasted me for mixing up my brimonidine test results with bad Mirvaso reviews, now all of a sudden did want to use the one as an indication for the other and posted: "The incidence of AEs and AEs judged to be related to the study drug was higher at the beginning and decreased over the course of the study." "You people have to keep in mind that Mirvaso is a powerful topical otherwise it would not be on prescription so of course the skin is going to react initially but that will subside with continuous use. Put mirvaso on a healthy face and the skin would also react to it until it gets aclimated to it."

This is what I said already in October 2013. Of course something as potent as Mirvaso will need time for acclimation." However, there have been several patients who used Mirvaso for a long time, weeks, and who reported that they needed to use more and more of it, to keep the increasing flushing and burning and redness impulses under control, until there was no stopping and they suffered for a prolonged time.  So as it stands, patients should be careful when they start using Mirvaso. 
I posted some links to the Mirvaso discussions on the Rosacea Forum and some warnings below several online news item pages on Mirvaso, but most got removed due to conflict with the forum policies. All that can refer to is the negative warning as such, because no offensive words were used, consciously by the way.

Mistica reported her bad reaction to Brimonidine (NOT Mirvaso) here. I place her writing here because she discussed the mechamism of action of brimonidine with her medical specialists, and that seems of interest here given that brimonidine is Mirvaso's active ingredient (but the two have different strengths and can not be compared entirely).

Quote Originally Posted by MisticaView Post
Hello Brady,
Just to remind you, in case you missed it in my post, I was examined by an immunologist at the time of my severe rebound and no allergy was found. I had tryptase, histamine and all the IgA, IgG, IgE, etc tested and they were all normal. The doctor was looking for mastocytosis as well, and seemed to be rather disappointed that my levels were not suggestive of this. Now, to be fair I do have other health issues, but they are not related to allergy. Rebound flushing. I was already a bad flusher, but it had become significantly better in some ways over the preceding year or so. How rebound worked in me. I had a very pink baseline redness all over my face with much redder cheeks, nose. I had to be very vigilante with my diet and environment and still relied heavily on ice packs to control flushing, but with this preventive regime, my flushing was definitely downgraded to what it had been. When I first applied brimonidine, it paled me unnaturally, but at the same time, the visible vessels appeared to be more prominent against their ghostly background. From memory, I spent the first day test driving it around the house. Then I decided to go out. First to the dentist and then the mall. I was pretty stunned to experience a fairly small, but intense area of flushing on my upper right cheek. The area became very hot and deepened in colour.

It looked unnatural, as if I had painted it on with marked borders. We left the dentist and walked around the mall. After some time the area completely vanished. I rinsed my face when I came home and went to bed. By morning, my face was fully reddish again, but no worse, as far as I recall.
The pattern thereafter was the same type of 'break through' intense vasodilation. It would appear in one area, disappear and then appear elsewhere, such as in the middle of my upper lip area. It would again, be really intense. (That pattern is not indicative of any type of allergy). Then I would be worse by morning. At the time, I had to attend several dental appointments and because the air conditioning was not working properly in the clinic, I foolishly relied on brimonidine to get me through the appointments, thinking, just one more day, etc. Big mistake. I was much worse every morning and my severe flushing was returning. I tried quitting cold turkey, but that made me much worse and then I began another foolish experiment of gradually diluting the drug, more and more. But it did not work and I got stuck in a vicious cycle of calming and intense flushing. After application my face did pale, but the 'break through' flushing was occurring more and more and in the end you could see it happening. It was as if a mole were burrowing under my skin, travelling through the plumbing at high speed. Coming out here and there randomly. I noted another poster comment on this weird pattern of flushing. When the inside of my right ear started to flush, it became very painful. My upper cheeks especially the right suffered the most. To this day, it is a vascular mess.

In the end, the brimonidine didn't work at all. It was as if the receptors it was influencing, completely dysfunctioned. The final application had the opposite effect. It caused extreme flushing. Of course a scientist could give you a run down of likely biochemical reactions. My layperson's report is brimonidine caused a raging, flushing inferno, and it was one hellacious ride I wished I had never embarked upon. I ended up in the ER twice, as I have previously mentioned as the break through flushing was so intense, my nose bled and my lips split. I did not receive any useful help, and of course in retrospect I wished I had not gone there either, as the awful lights and stress just amplified the reaction and flushing. I was given one dose of prednisone during my second visit and they only served to make me much worse! Of course, the stress all this caused just made the flushing much worse still! I couldn't sleep as each time I lay back on my pile of pillows and started to drift off to sleep, it was as if the final brace holding back the build up of flushing, broke down and the blood raged through the veins in a torrent!. I was so painful! I cried in pain. Ice packs did not help at that point and of course, you have to be careful with icing. It is an art. I started to stay awake most of the night due to the pain and flushing. Lack of sleep worsens flushing, so this was just another nail in the coffin, so to speak. This continued for weeks. In the end, I fell asleep out of exhaustion and the flushing raged all night, for several nights. Then it stopped. Well, the intensity stopped, but I was left with damage. I was, again, a severe flusher. It took some weeks for the earache to subside. My doctor told me the canal was inflamed and then peeled. The original area of breakthrough flushing on my upper right cheek, extended it's borders to encompass a much larger area and it remains today. I have even had IPL, which did not help much. The upper cheek suffered some kind of nerve damage. I expect that is not the right word, 'damage' as it is not numb, but it can hurt, a type of feeling that drives me crazy. A dull, sickening feeling much like hitting your elbow. I am happy to say, that these days, the nerve pain/sensation has reduced a lot and I can go months without it being present. The area is still highly vascularised however. I am an extreme case, and it was made much worse by my foolish decision to try and wean myself off the drug over time with gradual dilutions. I suppose the only good thing to come of my horrendous adventure is an insight to what might happen to others should they decide to continue use of brimonidine. I can not emphasize enough what a big mistake it is to try and reduce vascular symptoms with this drug. I hope this long post helps clarify what I mean by rebound flushing. I can only equate it to holding a garden hose, the pressure builds up, and when you release the end, a torrent pumps out. Of course the hose flow quickly returns to it's previous state, where as the face does not.

Peterd: ´I got a sample of this last week and used it thinking wow on monday. When it wore off my face was much worse. So I attributed to needing to use a few days to get accustomed. Man what a mistake. I took it for 3 maybe 4 days and finally stopped. My face is like a boiled lobster and where I was mild redness in cheeks and nose and some of my forehead now its hot red everywhere I put it. My new derm was not clear on its use nor did she mention the rebounds. I had to google it and needless to say I stopped using it and the symptoms have abated a bit but its still horrible. I am even peeling in a couple spots. At this point I dont know what to do and am praying it clears up with a little more time. Anyone have suggestions on treating the rebound? I am doing light moisturizing and trying to keep the angry skin down until I can force an appt with this derm that gave me this crap.´See the post, the responses and the Mirvaso discussion (me being an avid opponent of this rubbish topical) here.

General comments by forum members on Mirvaso

​There is a lot of non user comments about Mirvaso in the above threads and you have to search carefully to hozer2K reports that there are few reports confirming what Galderma is touting in their advertisements for Mirvaso. This may be because those users who accept a prescription for Mirvaso and it works for them simply do not report their success in online rosacea support groups and go their merry way happy as larks. actually find a post by someone who actually has a prescription for Mirvaso who reports what they are experiencing, but I have done a search at this point in time (December 2, 2013) for a significant number of hours and have confirmed what
  • Guests
Posted 04 November 2013 - 02:22 PM
Hi I am a Mirvaso user. This drug is horrible and I predict there will be a class action lawsuit against it.
  • Guests
Posted 04 November 2013 - 03:22 PM
I am writing this because I had a horrible night last night due to Mirvaso. I went to a dermatologist on Wednesday to address my skin concerns, which were redness and bumpiness. He started me on antibiotics, topical acne medication at night, and Mirvaso in the morning. Before I started taking the drug I went online and looked at people's opinions. I noticed that there were several people who had reported problems with rebound flushing. I also noticed that in the clinical trial, the actual success rate compared to placebo was shockingly low. I am not a medical expert so I decided to shrug it off and take use the cream anyway. The first day that I used the product, I noticed a significant redness reduction after about an hour. My skin would stay pretty pale. I actually thought I looked almost too pale. My skin looked somewhat unnatural, kind of yellow, since there was no red in it. I am white by the way. I continued to use the product though, because it did take away my redness. On the fifth day of use the sh*t hit the fan. I am not someone who flushes, just someone with persistent redness. It's hard to judge your own appearance, but I would say that I was on the less red side of the spectrum. I had redness on my cheeks, nose and sometimes chin, enough that I felt self-conscious without foundation or concealer on. On day five of using Mirvaso, I applied the cream to my face at 7:00AM and waited for it to work while I got dressed. It took enough redness out of my face that I decided I could skip wearing foundation that day, even though I was going to be working in an environment where hundreds of people would be looking at me. Well, that was a mistake. That day I had to spend some time out in the cold and also a lot of time running around inside. At 7:30PM my face became extremely hot. I it felt like I had an extreme sunburn, which I new I didn't as I'd loaded up on sunscreen and it was November in New York. My face was so painful. I had to continue working in front of hundreds of people. It was really embarrassing. My whole face was beet red, redder than I had ever seen it in my life. From edge to edge it just looked completely scorched and was really uncomfortable. The redness far exceeded the normal surface area of my face that in normally red. I was distraught and really wanted to burst into tears because I wasn't sure if I was going to have any other reaction to it or if the damage would be permanent. I just got off the phone with my doctor and he said it is like a cosmetic camouflage, which doesn't actually treat the redness. He said that the flushing at the 12 hour mark is normal. I have decided to spend the money I would have spent on more Mirvaso on a good foundation and concealer. The redness episode was last night. Today my face seems to have returned to it's normal level of partial redness.

I am posting this long story to help people who are trying to decide  whether or not to use Mirvaso. I feel like the numbers on the drug company's website don't present a very compelling argument in favor of using it. The study they cite in their prescribing information states that they began with 1210 subjects, but that some had to drop out because of redness or flushing. They conducted the full study on a total of 833 subjects, meaning that 387 subjects dropped out of the study. It doesn't say why all of these dropouts occurred, so I wonder what percentage of those was from adverse reactions to the drug. You'll notice that they report that in the trial, 4% suffered from erythema or redness and 3% suffered from flushing. This makes it seem like a rare side effect. The dropout rate is just under 32 percent. While there may have been other factors which caused people to drop out, if we assume that all dropouts were caused by redness or flushing, this would make the total percentage of people with either redness or flushing 33.7 percent. I would love to see numbers from Galderma about how many people left the study because it was exacerbating instead of treating their problem. Another bit of information that I would like to pass on before ending this diatribe is that Mirvaso is only a temporary treatment, which lasts for several hours. It will not cure roseacea or lessen it at all. I basically see it as a glorified form of makeup, except when the "makeup" wears off you run the risk of looking ten times worse. I am female, so it is easier for me to wear makeup that it is for males, for whom it is often not socially acceptable, so I do understand that some people may feel this is a better alternative to makeup. My advice is that if you do decide to use it, make sure that it is for a day when you won't be out for more that 12 hours."

Nancy wrote on January 9th 2014: "Before Miravosa was on the market, my Dermatologist at a major teaching hospital prescribed the Brimonodine eye drops for me to use on my face. I experienced major rebound flushing that eventually subsided after I stopped using it for a while. But it became a vicious cycle of the more I used Brimonodine, the more I had to use the drops to keep from blushing. I didn’t realize it at the time until the blushing cycle was bad enough for it to dawn on me that it was the drops – almost like using a steroidal cream/ointment. I am very leery of this new product and after reading the comments here, I realize that it wasn’t just me that had a problem with angry rebound blushing. I think it’s like putting the cart before the horse, until scientists figure out the cause of Rosacea, they should not try to mass market a product to help the public. Only time will tell if Miravosa helps the vast majority longterm or if it is an addictive product making drug company’s money."

And: "I remembered my sister calling me a few years ago telling me she was walking around with very red and bloodshot eyes. The reason was that she just had her eyes examined and her doctor said she had been overusing Visine on a daily basis and it created a dependency. Her doctor told her to stop using the Visine. She is fine now but I wonder if this is also happening with use on the blood vessels? I searched the internet and copied the information below from Livestrong.com about rebound redness in the eyes from eye drops. Question then is: what is the difference with daily use of Miravosa on our faces?
REBOUND EYE REDNESS: Rebound eye redness is a side effect of overuse of eye drops intended to relieve eye redness. Imidazoline works as a vasoconstrictor, causing the narrowing of blood vessels.Over-the-counter eye drops work quickly to reduce redness, but do not eliminate the cause of the redness. Rebound redness results because the blood vessels in the eye dilate as the effects of the medication in the drops wears off. Overuse of eye drops to relieve the symptom without correcting the cause sets up a cycle of dependency and misuse. Eye drops should be used only as directed, and are not intended for long-term use. According to MayoClinic.com, when over used, eye drops containing imidazoline can cause permanent redness and damage to the blood vessels in the eye."

Guest posted 14 November 2013 - 01:13 PM
I've been using this med for over a month and I am doing great.  It has given me confidence and has improved my life on a daily basis
Admin Note 
When creating this forum on Mirvaso there was a loop hole that  allowed guests to post. Hopefully this loophole has been closed. We will do further testing on this. The above two guests are not members of the RRDi.  Our policy does not allow non members to post. However, in this case, I have allowed both posts to remain for now and you have been notified that the RRDi has clearly explained that the guest members above, Julie_S and Jimmi_* found the loophole and are not verified members of the RRDi.

I closed the gate and now guests cannot post. Only RRDi Members can post in this thread. rebound (verb) [ no obj. ] (rebound on/upon) (of an event or situation) have an unexpected adverse consequence for (someone, esp. the person responsible for it): Nicholas's tricks are rebounding on him. rebound (noun) • [ usu. as modifier ] the recurrence of a medical condition, esp. after withdrawal of medication: rebound hypertension. (obviously there are more definitions for rebound but I picked the pertinent ones) Found this medical dictionary that said: rebound : a spontaneous reaction; especially: a return to a previous state or condition following removal of a stimulus or cessation of treatment <withdrawal of antihypertensive medication may lead to a rebound hypertensive crisis—<Emergency Medicine>
Allergic Reaction to Medicine; Any prescription or nonprescription medicine can cause an allergic reaction. Allergic reactions are common and unpredictable. The seriousness of the allergic reaction caused by a certain medicine will vary. Allergic Reaction to a Medicine - WebMD

So one of my questions is how does one differentiate an allergic reaction from rebound? Isn't it possible that what everyone is calling a rebound could be an allergic reaction to a medicine? It seems logical to me it that what everyone is calling a rebound could be an allergic reaction to brimonidine since the reaction happens rather quickly. Most of the reports of brimonidine treatment for rosacea indicate this happens within the first few days of initial treatment. All the examples of rebound I found listed for rebound above involve using a drug for a long period and then stopping the drug and a rebound happens, for example, rebound headaches. Take for example those who have an allergy to penicillin. If given penicillin they react quickly with rashes, hives, itchy eyes, swollen tongue, and in severe cases anaphylactic reaction. Usually one finds out rather quickly if one has an allergy to penicillin. It seems logical to me that since most of the 20 or so reports that I have collected from the various anecdotal reports show that what everyone is calling 'rebound' may be an allergic reaction. I am no doctor, but when using medical terms we should try to use the correct ones. Could the RRDi MAC Members comment on this? Note: I sent emails to all the MAC members about this question and some responded by email to me the following (while others replied directly in this thread - note Post #7 by Dr. Anna Holmes).

Reply from Raymond Peat, Ph.D.: I don't think either allergy
or rebound would be the best description for the direct promotion of the secretion of inflammatory cytokines by a vasoconstrictor drug or its excipients. Since nitric oxide, prostaglandins, and inflammatory cytokines probably contribute to the problem, non-toxic inhibitors of those, such as vitamins A, E, and K, aspirin, and caffeine might be helpful for the basic problem.

J Neurosci Res. 2002 Jan 15;67(2):264-74.
Tumor necrosis factor expressed by primary hippocampal neurons and SH-SY5Y cells is regulated by alpha(2)-adrenergic receptor activation.
Renauld AE, Spengler RN.
Department of Pathology, School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

Neuron expression of the cytokine tumor necrosis factor-alpha (TNF), and the regulation of the levels of TNF by alpha(2)-adrenergic receptor activation were investigated. Adult rat hippocampal neurons and phorbol ester (PMA) differentiated SH-SY5Y cells were examined. Intracellular levels of TNFmRNA accumulation, as well as TNF protein and that released into the supernatant were quantified by in situ hybridization, immunocytochemistry and bioanalysis, respectively. Both neuron cultures demonstrated constitutive production of TNF. Activation of the alpha(2)-adrenergic receptor increased intracellular levels of TNF mRNA and protein in SH-SY5Y cells after addition of graded concentrations of the selective agonist, Brimonidine (UK-14304) to parallel cultures. Intracellular levels of mRNA were increased in a concentration-dependent fashion within 15 min of UK-14304 addition and were sustained during 24 hr of receptor activation. In addition, the levels of TNF in the supernatant were increased in both types of neuron cultures within 15 min of alpha(2)-adrenergic receptor activation. Furthermore, levels of TNF significantly increased in the supernatants of both neuron cultures after potassium-induced depolarization. A reduction in this depolarization-induced release occurred in hippocampal neuron cultures after exposure to the sympathomimetic tyramine with media replacement to deplete endogenous catecholamines. This finding reveals a role for endogenous catecholamines in the regulation of TNF production. Potassium-induced depolarization resulted in the release of TNF in hippocampal neuron cultures within 15 min but not until 24 hr in SH-SY5Y cultures demonstrating a temporally  mediated event dependent upon cell type. Neuron expression of TNF, regulated by alpha(2)-adrenergic receptor activation demonstrates not only how a neuron controls its own production of this pleiotropic cytokine, but also displays a normal role for neurons in directing the many functions of TNF.

Copyright 2002 Wiley-Liss, Inc.

Br J Ophthalmol. 2007 Jan;91(1):29-32.
Measurement of inflammatory cytokines by multicytokine assay in tears of patients with glaucoma topically treated with chronic drugs.
Malvitte L, Montange T, Vejux A, Baudouin C, Bron AM, Creuzot-Garcher C, Lizard G.
CHU Dijon, Service d'Ophtalmologie, 3 rue du Faubourg Raines, 21000 Dijon,
France. laure.malvitte@wanadoo.fr

AIM: To investigate the ocular surface inflammatory response to chronic topical treatments in patients with glaucoma by measuring the cytokine level in tears using multiplex bead analysis.

METHODS: Tear samples were collected from 21 patients with glaucoma and 12 healthy volunteers. Tears were analysed for the presence of 17 cytokines: interleukin (IL)1beta, IL2, IL4, IL5, IL6, IL7, IL8, IL10, IL12, IL13, IL17, granulocyte colony stimulating factor, granulocyte-macrophage stimulating factor, interferon (INF)gamma, monocyte chemotactic protein (MCP)1, macrophage inflammatory protein 1beta and tumour necrosis factor (TNF)alpha. The cytokines in each sample of tears were measured using multiplex bead analysis with microspheres as solid support for immunoassays.

RESULTS: In the tears of treated patients, proinflammatory cytokines (IL1beta, IL6, IL12, TNFalpha) were significantly increased compared with controls. T helper (Th)1 (INFgamma, IL2) and Th2 (IL5, IL10, IL4) type cytokines were also significantly higher (p<0.05); however, the most marked increase was observed with Th1 cytokines. The expression of chemokine IL8 and MCP1 was also increased in the treated group.

CONCLUSION: This study shows that pro-inflammatory cytokine secretion by conjunctival cells is increased in response to topical treatments for glaucoma. The characterisation of cytokines in tears was previously limited by the small volume attainable, a limitation that has been overcome by multiplex analysis.

Am J Physiol Heart Circ Physiol. 2006 Jul;291(1):H231-8. 
Brimonidine evokes heterogeneous vasomotor response of retinal arterioles: diminished nitric oxide-mediated vasodilation when size goes small.
Rosa RH Jr, Hein TW, Yuan Z, Xu W, Pechal MI, Geraets RL, Newman JM, Kuo L.
Department of Opthamology and Surgery, Scott and White Eye Institute, Texas A & M
University System Health Science Center, Temple, TX 76508, USA. rrosa@swmail.sw.org

Brimonidine, an alpha2-adrenergic receptor (AR) agonist, has been employed in the treatment of glaucoma due to its beneficial effects on intraocular pressure reduction and neuroprotection. In addition, some studies have implicated that brimonidine might influence ocular blood flow; however, its effect on the retinal microcirculation has not been documented. Herein, we examined the vasomotor action of brimonidine on different branching orders of retinal arterioles in vitro and determined the contribution of the alpha2-AR subtype and the role of endothelium-derived nitric oxide (NO) in this vasomotor response. First- and second-order retinal arterioles of pigs were isolated, cannulated, and pressurized for functional studies. Videomicroscopic techniques were employed to record diameter changes in response to brimonidine. RT-PCR was performed for detection of alpha-AR and endothelial NO synthase (eNOS) mRNA in retinal arterioles. All first-order arterioles (82 +/- 2 microm ID) dilated dose dependently to brimonidine (0.1 nM to 10 microM) with 10% dilation at the highest concentration. Second-order arterioles (50 +/- 1 microm ID) responded heterogeneously with either dilation or constriction. The incidence and magnitude of vasoconstriction were increased with increasing brimonidine concentration. Administration of the NO synthase inhibitor NG-nitro-L-arginine methyl ester abolished the brimonidine-induced vasodilation in first- and second-order arterioles. Regardless of vessel size, vasomotor responses (i.e., vasodilation and vasoconstriction) of retinal arterioles were sensitive to the alpha2-AR antagonist rauwolscine. Consistent with the functional data, alpha2A-AR and eNOS mRNAs were detected in retinal arterioles. Collectively, our data demonstrate that brimonidine at clinical doses evokes a consistent NO-dependent vasodilation in first-order retinal arterioles but a heterogeneous response in second-order arterioles. These vasomotor responses are mediated by the activation of alpha2-AR. It appears that brimonidine, depending on the concentration and vessel size, may alter local retinal blood flow.

Reply from Robert Latkany, M.D.: Mirvaso is 0.33% brimonidine gel.  Brimonidine has been used to lower intraocular pressure on the eyes for glaucoma for years.  It typically is not a first line agent and has had several modifications over the years.  The most recent formulation is Alphagan P 0.1% by Allergan.  This concentration appears to cause less redness and irritation than the higher concentration bottles.  In fact, I often use this drop to decrease the redness in some patients with fairly prominent vessels that are disfiguring.  I am pretty sure there is an ophthalmologist seeking a patent on the use of brimonidine to address "red eyes".  So all that said, there is probably a role here for facial erythema.  But further studies will need to be done on what concentration is most appropriate and what frequency is needed.  My guess is it should be given in 4 week cycles in a diluted concentration but a study should easily determine the most successful approach.

      #7  Anna Holmes PhD

        Posted 18 November 2013 - 09:13 PM
        Allergic sensitization was measured by patch testing patients across the Mirvaso clinical development program with suspected allergic contact dermatitis.  The overall incidence of confirmed sensitization was less than 1%.  Sensitization can occur, but the incidence is low.
            Posted 18 November 2013 - 09:21 PM
            annaholmes, on 18 Nov 2013 - 10:13 PM, said:
            Allergic sensitization was measured by patch testing patients across the Mirvaso clinical development program with suspected allergic contact dermatitis.  The overall incidence of confirmed sensitization was less than 1%.  Sensitization can occur, but the incidence is low.
            Thanks Dr. Holmes, Can you explain the difference between an allergic reaction and rebound which is what many are calling the experience they are having with Mirvaso?  (See Post #1 above > Subheading - Negative Reports
                Posted 24 November 2013 - 10:39 AM
                Allergic reaction is a immune-mediated process which requires a previous contact of antigen presenting cells to the drug. This first contact shows no symptoms in the person, and it is known as sensibilization. Once one person is sensibilized, the second contact to the drug leads to a rapid reaction including rash, itchy eyes, swollen tongue, and even, anaphylactic reaction.
                Rebound is a NON-immune-mediated process in which the symptoms are caused for the effect or the lack of effect (discontinuation) of a drug. This reaction is rather quickly, but no immune cells are implicated, in overall terms. Hope my comments help you.
                    Posted 26 November 2013 - 09:45 PM

                    Husein Husein El-Ahmed MD, on 24 Nov 2013 - 11:39 AM, said: "Allergic reaction is a immune-mediated process which requires a previous contact of antigen presenting cells to the drug. This first contact shows no symptoms in the person, and it is known as sensibilization. Once one person is sensibilized, the second contact to the drug leads to a rapid reaction including rash, itchy eyes, swollen tongue, and even, anaphylactic reaction. Rebound is a NON-immune-mediated process in which the symptoms are caused for the effect or the lack of effect (discontinuation) of a drug. This reaction is rather quickly, but no immune cells are implicated, in overall terms. Hope my comments help you."

                    Thanks so much for clearing this up. Can I ask you to comment about the number of negative anecdotal reports that are initially being reported in other rosacea online groups that are listed in post #1 above and how there are relatively few positive reports. One thought is that those who have positive reports rarely post in online rosacea groups but negative posters will post their results. Just curious what your thoughts are on this topic.: "
                        Posted 30 November 2013 - 10:50 PM
                        Dr. Andrea Towers of Miami has the following video showing how Mirvaso works. On the actual YouTube site are anecdotal reports (comments). Some of these reports I have used in Post #1 either negative or positive.

                        Update December 9th, 2013 

                        ​Below this article about Galderma's former president François Fournier leaving Galderma, there are patients reviews on Mirvaso. In the article, Fournier seems blissfully ignorant of the real effects of his product Mirvaso and he is quoted saying:

                        “I am proud to have completed the successful launch of Mirvaso, a game-changer in the treatment of patients suffering from rosacea. However, after an amazing 13 years with Galderma, I have decided it is time to pursue other professional opportunities and move on to the next phase of my career. This is not a decision that I have taken lightly and with the launch of Mirvaso and many interesting and exciting products to come, I am as confident as ever in the future of Galderma.” 

                        Mirvaso was touted by Fournier as a kind of wonder drug, temporarily removing the redness associated with rosacea. “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.” Francois said he expected to roll out Misvaso internationally in the coming months. It is unclear whether the ouster had anything to do with Mirvaso’s side effects.The 46-year-old French citizen has helmed the North American region of the Swiss pharma company since June 2009. Galderma focuses exclusively on dermatological products, including the successful Cetaphil line of over-the-counter lotions and skin-care products.

                        Bottom line is that so far, this product isn't reviewed that well by users, with a 15/40 positive/negative ratio. Its just out so there will be a lot more to be read about this in the upcoming time. Every rosacea patient should be urged to tread careful with Mirvaso and ideally use it only on a small area of skin for a good 5 days to evaluate the effects before douching your whole face in this topical.

                        And here are some of the patient comments below the article/interview with Fournier:

                        1. We have not seen a rebound effect in our patients thus far. It is still early but patients appear to be responding amazingly well to the product. There is nothing else like it on the market. Rosacea patients in general tend to have sensitive skin.
                          Reply ↓
                          • Dr Bowers, I have experienced a terrible rebound effect using Mirvaso. My face is (subjectively evaluated of course) 2 times redder than it was prior to using Mirvaso. I only know experienced painful flushing out of nowhere, seemingly untriggered. The flushes last for 3 – 8 hours so far. Responding amazingly – yes. Side effects – yes – major for me. Although the flushing and rebound is starting to very slowly subside on my 3rd day of NOT applying Mirvaso. If my example and the online reviews are a good representative sample, then your patients are either not reporting the side effects or maybe they haven’t tried to stop applying the cream. For me, the flushes were worse when I was applying the medication but the redness is so much worse now after having used it. Catch 22. Ugh.
                            Reply ↓
                            • Do not use this medicine. My face is worse than before. Increased redness and flushing. Stopped using for six days now and my face is still not back to normal!
                              Reply ↓
                          • Dr Bowers is a paid consultant by Galderma, although a good derm can’t rely on her “feedback”. I was taken to her office with other trainees to learn from her at Galderma’s expense. Listen to the users, not Dr Bowers.
                            Reply ↓
                            • Suspicious of your claim, I googled your name only to find absolutely nothing. Regardless, Even if true, being a ‘paid consultant’ doesn’t mean the medical doctor cannot be trusted. User reviews, on the other hand, as anecdotal evidence, should be taken with a grain of salt. Many people on the rosacea forums seem to be prone to conspiracy theory type thinking. The anti-science crap they spew is comical in light of their credulity when it comes to pseudoscience.
                              Reply ↓
                          • I got banned from this forum by David Pascoe for saying negative things about Mirvaso and telling the truth .
                            I wouldn’t trust this guy and I wouldn’t believe a word he has to say about this matter .
                            Reply ↓
                        2. Rosacea patients with moderate to severe flushing, burning and redness issues, please read the posts on Mirvaso on The Rosacea Forum before trying this stuff. The wide majority of people get pale, then get massive rebound flushing and redness, way worse than before using this cream and lasting for days and some weeks, in fact, some are STILL dealing with the rebound and unsure when it will calm down again. I know from inside that Mirvaso has been told about the rebound problem, my professor for one informed them (see link below, I tried its active ingredient brimonidine in 2010 in the same % as in the Mirvaso and it was a nightmare, pics included). Prof asked them during the trials if they considered this side effect and they brushed it right off. Not even been on the radar for them it seems. “Wonder drug”, right… It needed a quick launch if you ask us on the forum. Good journalism here to pick up on that, to VIRGINIE NAIGEON: please can you do some research into whether or not Galderma ever took the reports and warnings from inside out (ppl on the boards) serious regarding this rebound? It seems they ignored it once it was brought up to them and they added exactly nothing to the active ingredient apart from neutral fillers and carriers and a preservative.
                          Reply ↓
                        3. Ow, I think it’s normal, Mirvaso is just a scam for us, sufferer of rosacea. Extreme rebound flushing in more than 9/10 patient. And personnaly my face is just destroy now.. Mirvaso isn’t a miracle, it’s just a scam who os going to destroy your face. NEVER USE IT !!
                          Reply ↓
                        4. Rosacea patients with moderate to severe flushing, burning and redness issues, please read the posts on Mirvaso on The Rosacea Forum before trying this stuff. The wide majority of people get pale, then get massive rebound flushing and redness, way worse than before using this cream and lasting for days and some weeks, in fact, some are STILL dealing with the rebound and unsure when it will calm down again. This rebound was brought to the attention of Galderma from inside the boards but ignored as it seems now.
                          Reply ↓
                        5. I, too, tried Mirvaso about a week ago and had the same awful effects: horrendous, bright red rebound flushing unlike anything I ever had in the past 15 years! The product worked great at first and then I noticed a terrible hot, inflamed redness on my cheeks and nose at around hour 5 after application that lasted about 1.5 hours. A ton of make-up did little to cover it up. I am stunned this product was approved as I am very concerned about the long lasting affects. I have not used Mirvaso in three days and am continuing to flush badly and have all around redness that is worse than prior to using Mirvaso. Very Disappointing!!!
                          Reply ↓
                        6. It surprises me that in a press release after a trial prior to the launch of Mirvaso, Galderma said there was no rebound effect.
                          A lot of forum members already wondered what they did to prevent rebound.
                          Nothing it seems.
                          Reply ↓
                          • Its not rocket science to see that Mirvasos strength is too strong .
                            Why didn’t they make something half the strength that could have been used for special occasions . Less use equals less rebounds .
                            Its truly unbelievable that this is what they come up with after 8 years working on it .
                            Reply ↓
                        7. This is an absolute disgrace. This matter should be reviewed again by the fda as the companies trails are obviously false. I have been watching the progress of this product for years. Many people trailed the active ingredient in this product prior to its fda approval with very bad side affects. I am actually in amazement as to how they thought this was going to work.
                          6 years us rosacea suffers have been waiting for this drug that was going to help our condition and this is what we get??
                          Simply not good enough!!!!
                          Reply ↓
                        8. I am having un predictable flushing like I never experienced ever before using Mirvaso. I spoke to a nurse at Galderma who took my information and sent me a questionnaire. I too am afraid this condition of flushing could become permanent. I t comes out of nowhere as I have been applying at the same time every day and have not done anything different on the flushing days as on the non flushing days.
                          I am discontinuing use of Mirvaso all together and will stay in touch with my doctor about the unusual, unpredictable and un timely flushing.
                          Reply ↓
                          • I haven’t heard one person say anything good about Mirvaso yet . Everyone says the same thing about the rebounding . I just cant see this product ever getting released outside the US .Galderma you need to come clean now about the so called trials .
                            Reply ↓
                            • I have used mirvaso ONE TIME. 3 days later i am still experiencing terrible rebound flushing. I’m a real person. Moderate Rosacea (no bumps just redness and scaly skin) sufferer for ten years. Here’s a log i’ve been keeping if you’re interested:
                              10/24 – 2pm – Visit with new dermatologist. Derm prescribed Permethrin and I asked for Mirvaso. Derm believes i may have high demodex amounts because of rough skin on forehead. He believes this may also contribute to facial redness. I am to use permethrin twice daily for a month and mirvaso once daily and then follow up.
                              5pm- wash face with cerave. dried face. Applied Mirvaso. Took special care to apply evenly.
                              5:30pm – Face looks terrible. I looked like a leopard some areas are way whiter than usual some areas are way redder than usual.
                              6:30pm – Face actually looks incredible. It was nice to see how i could look after dealing with facial redness for so long. To be honest i was amazed at the results.
                              10:30pm – Bedtime. Face is even whiter than at 6:30. At this point i’m so hopeful that i’ve been cured.
                              10/25/13 3:30am – Woke up because i was paranoid about going to work using mirvaso. Face looks good. Whew!
                              4:30am – Cerave shower. Went back to bed.
                              6:30am – Wake up again. Cheeks are more flushed than i’ve ever seen in my entire life.
                              8am – Redness down to half dollar size on left cheek. I sat out on porch in cold (40 degrees) to help calm down redness and then drove 15 minutes ina cold car to work. Redness reduced from being in cold for a bit.
                              12pm – Don’t feel very flushed. Right side is redder than baseline and so is forehead.
                              4pm – Was outside in cold (40 degrees) for half hour. Face looks good. Slightly red on right side.
                              5pm – took nap. woke up Left side of face is EXTREMELY flushed.
                              6pm – took shower with cerave. Applied to permethrin to entire face. Not using mirvaso ever again.
                              7pm – face looks not flushed. Better than baseline.
                              7:30pm – terrible flush. Worse than before. Worst of entire life.
                              10/26/13 10am – Flushed on both cheeks. slightly less flushed but still more than baseline.
                              I applied permethrin again to entire face was flushed for the rest of the day. took shower with cerave at 6pm and continued to have really bad flushing. Didn;t apply permethrin again didn’t apply mirvaso again.
                              Woke up this morning (10/27/13) and face is still more flushed than baseline.
                              So i understand that i’m using to creams here but i believe mirvaso is the cause of my recurrent flushing. I’m going to stop using both and check back in with results.
                              My thoughts are that when mirvaso kicks in ( about 90 – 120 minutes after application, it’s phenomenal. After about 12 hours i as more flushed than ever. The prescription says to only use once a day. It;s just not practical. i would have to wake up 2 hours before work and then not leave my place after the 12 hour span…
                              I hope this rebound flushing stops soon. maybe as this product gets developed more they’ll think of better dosing or something?
                              Reply ↓
                        9. I’m on day 3 off this stuff, Im FIRE ENGINE RED. I am a model and this is going to affect my work. I’m fuming mad. I have to use it for a photo shoot in 3 days just so I can get through the day and subject myself to more BURNING HOT disgusting looking skin. Unacceptable !!!!!
                          Reply ↓
                        10. I have starting to feel the rebound effect of Mirvaso around the 10th day of usage. It didn’t occur to me that it was a bad adverse effect so I continued using for another 2 weeks. The flushes seemed to come out of nowhere and I typically wake up with redness on my face (something I have never experienced before). This is my 2nd day of not using the product so I’m hoping this effect will go away after discontinuation. I already called the FDA and Galderma to report this bad effect. Hopefully more people will aware and carefully consider this rebound effect before using this product on their face.
                          Reply ↓
                        11. Heres my story: by the way, err, I am a real person lol. Because I know people are gonna think i’m not because I actually had a good expierence. I’m shocked by these reviews, I had no idea people were rebounding so bad. And I feel sorry for them, I hope there face returns to “normal.” :(
                          I have been using mirvaso for three weeks:
                          I apply it quite generously, more than a pea sized amount for sure. I put this on in the morning just on my cheeks. It starts working after ten minutes for me, and is at it’s full effect by an hour.
                          My face doesn’t turn ghostly white like some peoples, it just takes the redness out and makes my red cheeks blend in with the rest of my face.
                          I felt no burning, rebound, etc, and I have very sensitive skin.
                          First time I used it the effects lasted about 8 hours, by the two week mark( which is it’s official time mark for it to stark working) I had gotten redness relief for over 12 hours.
                          Towards the end of the time, my face tingles, like someone numbed it. It’s hardly noticeable and doesn’t bother me.
                          After it has worn off my face, my cheeks become red again, but their better! At least 50-70% better than before. I have not had a problem with rebounding.
                          Either way i’m sorry that so many people are expierencing bad results. I just thought i’d give my honest review, because it is a miracle for me.
                          Reply ↓
                        12. I am the person who was quoted in the above press release. I used Mirvaso for 3 days, at which point I stopped after terrible flushing. It has now been 5 1/2 weeks since I’ve used it, and my face is still much more red, reactive, flushy and hot. This cream ruined me. I honestly don’t even know how to move forward, as my baseline condition is now one of discomfort every day. I am having a lot of difficulty getting through this. I am in disbelief that something with the potential to cause this much damage was approved by the FDA. I filed a report.
                          Reply ↓
                        13. Can anyone please tell me how to treat this rebound flushing? It is wayyyyy worse than the redness before I started using Mirvaso. I haven’ used it in 2 days. I am thinking of using a cortisone cream for a couple of days to stop the inflammation! Horrible stuff!
                          Reply ↓
                        14. Mirvaso has really helped me. I usually mix it with some sunscreen before applying (recommended by my Dr). No problems after about 5 wks of use.
                          Reply ↓
                        15. I’ve been using a Mirvaso mixture (1 part Mirvaso, 2 parts moisturizer and 1 part benedryl) before I apply it. The combination works great!. Give it a try. i think you’ll agree. Good luck!!
                          Reply ↓
                        16. i started using it at the beginning of November, I am very pale, but I never had problems of flushing or bright red skin or pain or stinging skin. at te first 2 weeks Mirvaso worked great, but since Monday, my whole face, even the forehead that I never had any rosace, is red like a red pepper, and i have bumps on it, it is swolen and my skin is painful. i am really scared, and I do know what to do. i feel my facestinging and hot like I have a fever. It feels like I have a 3rd degree sunburn. i use 100 sunscream everyday. i wish I had never used this product. i will go back to my derm next week and I will try laser treatment this time. Someone knows how long this rebound last?
                          Reply ↓
                        17. I have struggled with some redness on my cheeks. This week I went to a new Dermatologist and she told me about Mirvaso and gave me some samples. Man was I astonished thinking it was a miracle til i got the rebound flushing or whatever its called. Its horrible. My face feels and looks sunburned and so at first I put some more on and it disappeared and I thought maybe a one time event. Now I have decided I wish I had never heard of this product or used it. I will not use it anymore and am waiting for the redness to subside. Its awful and I look terrible and am totally ashamed of my face now. This “10%” number seems to be a lie. I am hearing its way higher between 70-100%. Some folks are saying after a week its still bad so I am totally freaking out. The Dr never even mentioned this side effect. I had to google it. I say dont use this!
                          Reply ↓

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