02 May, 2017

Mirvaso, inventory of patient responses II, update

UPDATE: I have just changed the blog-theme, lay-out and background colours of this blog, as the old format turned out difficult to read on smartphones, but I'll need a few weeks to adapt each of the 71 blog posts here to match the new colours. So apologies for the blog STILL being difficult to read due to light pinks and greys in the text (which are now unreadable with the new light background). Am changing it all in the next weeks.  

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. 

All reviews are found on public forums and websites, and under 'wrote' (behind user names) are links to the exact source. Mirvaso might help some people with rosacea but has caused worsening in many more, some had deterioration of their symptoms which lasts till this day, and despite obviously discontinuing the use of Mirvaso asap. Please read before embarking on your own Mirvaso trial and be aware of the experiences people have already gathered before you, so you know what you might expect from this product. I wanted to place these recent complaints, as they are very worrisome and all of these patients stated that they wished they had read about the bad reviews out there before trying Mirvaso. Maybe others reading this can be protected from their type of turmoil.

Kfranke wrote on July 4th 2017: "Hi all, I am 26 years old and I have recently developed mild to moderate flushing and, consequently, more redness. RLT has been helping, but last night I had a flush that lasted 5 hours, and...well, RLT just isn't enough. By the way, this was all brought on by a one time use of Mirvaso last November. That **** is the devil's work, I swear. Best, Katie"

Kfranke later wrote on March 14th 2018: "I would not recommend using Mirvaso under any circumstances. I used it once in November of 2016 and it took me about a year to fully recover from the extra flushing and redness that it brought on. Even when I'd "recovered," though, I was still worse off than I'd been before I used it. The only things that have helped with my subtype 1 rosacea (flushing and redness) are low level light therapy (orange) and IPL. Especially the IPL, though. I honestly cannot praise it enough. After 5 treatments I don't think much about my rosacea anymore. *knocks hard on wood* In short, I suggest avoiding the topicals Mirvaso and Rhofade at all costs and continuing with laser. Some on here will disagree with me on that. That's part of what sucks about this condition so much, though. We're all different in how we respond to treatments."

A. McSheehy wrote on March 14th 2018: "DON’T USE THIS PRODUCT- it’s not worth the risk. I actually don’t understand how they can continue to produce this product. Yes, it worked the first day. The next day I immediately noticed blotchy, burning redness right where I had applied the Mirvaso. It does the opposite of what it’s supposed to. The redness (and not my normal redness) has lasted several days and not gone away yet."

Miles wrote on January 23rd 2018: "Absolutely agree. I had the same experience."

Odettey wrote on January 23rd 2018: "My wife used this product and it was absolute hell. Go to a dermatologist. Do not trust your GP with this one."

Cam wrote on May 27th 2018: "My dermo prescribed me mirvaso, it definitely works! She warned me of the rebound redness and yes, it definitely happened to me. I don’t get any pain or bumps, just a real sunburnt looking face. Definitely try it on a weekend first so you can see if you get rebound redness. I was told the rebound could happen 12hrs after using it but it seems to hit me about 30hrs later. Still it’s a great product as long as you manage the side effects/expectations."

Forum member Darren1 had rosacea symptoms after using Mirvaso (he had a bad reaction) and posted his experiences with v-beam laser 

Darren1 wrote on July 23rd 2018: "My second full face vBeam/Laser/PDL following Mirvaso skin damage. Hi everyone. You might have seen some of my posts elsewhere on the forum where I have expressed frustration with the apparent willy-nilly prescription of Mirvaso gel, given to rosacea patients by dermatologists who habitually fail to fully inform the sufferer exactly what they're getting into. I used Mirvaso twice in later May and early April of 2017 and immediately regretted it. My skin was never the same after using this stuff and this was only after two applications. My face developed a permanent baseline redness in a strange symmetrical pattern consisting of dilated and constricted areas of skin. I'd always been a flusher but my skin was always good at baseline. Mirvaso ruined my skin and was the beginning of an ongoing dispute between myself and the the derm department at the hospital that prescribed it. Months later, in 2017, I had a laser consultation. I had a few test patches and treatment on the nose to see how it went. It went well, and the skin healed as I hoped. In April and July of this year (2018) I've had the rest of the treatment for the areas where Mirvaso was applied." This is a video from 2017 in which Darren is showing the Mirvaso rebound problems he encountered


On my first treatment, I didn't get enough treatment and the result was patchy with visible circles of normal skin among the redder skin. Still, I could see the treatment was working, and this is not something you want to go too heavy-handed with lest you invite scarring and fat loss. My second treatment was done 3 days ago. I explained everything as clearly as I could to the laser doctor. I gave examples of how some areas still flush where treated areas do not, and that my skin is much worse than it looks since when I am relaxed during the warmer summer months, it's not as apparent where the problems are. I also exfoliated 2 minutes before going into the laser theater. Yep, I purposely aggravated my skin knowing it would blush more and dramatize the way my skin flushes in hot and cold weather, when I'm exercising, or eating food that causes inflammation. I'm healing well. I see a big improvement to the baseline colour of my skin, although I did have a flush yesterday which was short-lasting. [..] I feel I will still need another treatment at some point as too many gaps exist between the purpuric spot treatments. I'm about to visit the supermarket, which is a short walk in the sun. I have rubbed SPF 50 sun screen on my face and will walk in the shade where possible.

Here's my video:

Darren1 updated on October 25th, 2018:"The bruising has healed, but I've faint hyperpigmentation where the laser hit which is still fading. I also have pockets of redness where the laser actually missed. That's the problem with gaps being left between the 10mm laser spot treatment. I've used my iPhone's selfie camera to record this 640 x 480 video. The light is misleading in places as it illuminates my face in such a way that you cannot see the redness I am talking about. About halfway through the video I move into my bathroom to show my face in a different light. Also, in this video, my skin is quite benign and calm. In hot rooms or stressful situations, the bits of skin that were missed by the laser get VERY red, which makes it look like someone has drunkenly doodled on my face with a pink felt pen. Needless to say, the laser HAS been effective, but with hindsight I would be telling the laser clinician "please do not leave any gaps whatsoever". 


ygao416 wrote on January 10, 2017: "Hi everyone! So I was diagnosed with rosacea last winter and initially it was just pale pink. My derm prescribed me with brimonidine tartrate eye drop and she said it would help it. The first couple of days when I applied it, my rosacea cheek became paler than my non rosacea cheek. I was happy with the result and continued it, but after a week or 2 into using it, I would have severe red/pink cheek during the day that's way worse than what I initially had. I decided to continue the bottle to get rid of the rebound, thinking that maybe it was temporary. However, after I finished the bottle, my rosacea skin stayed even more pink than before I applied. I stopped it for 4 months and my rosacea cheek stayed pink/red and did not return to my original skin before I started the eye drop. I researched online and realized that many many people suffered from severe rebound. Now I'm really regretting making my barely noticeable redness to a complete red cheek.. I am posting just to ask if anyone who has used it or tried something similar would know how to get rid the rebound? Would it go away by itself with time, or is there anything I can do/apply to make it better? Thanks so much!"

Brady Barrows replied on January 11, 2017: "You were not prescribed Mirvaso, and instead you were prescribed brimonidine tartrate eye drops that you applied to your cheek not your eyes? Usually a physician will prescribe Mirvaso for rosacea, so prescribing brimonidine tartrate eye drops is not a common prescription for rosacea. I don't recall anyone reporting this. However, there are some who have used brimonidine mixed with a neutral cream such as Nat007 who reports that it didn't work for her and had terrible rebound. The consensus of overcoming the rebound issue using brimonidine is number one to stop the treatment and it takes weeks, or even months to clear up. Not everyone has rebound issues with Mirvaso and some report success using it. However, there are plenty of reports of rebound using it. Wiry started a thread on this subject. Suggest you type in the search box top right corner 'treatment for brimonidine rebound' or 'treatment for Mirvaso rebound' and spend some time reading the results."

Pilatuna wrote on March 2nd 2017: "Please be very careful when using Onraltea (the Canadian version of Mirvaso, SR.). I have a mild case of Rosacea and usually during the winter months can get a bit worse. I was prescribed with Onraltea by my dermatologist. The first day I used it, I felt fine during the day, however, during the evening I started to experience awful redness and flushing. I have never had such a red face, it is awful. It feels almost like a bad sun burn. I regret that I didn’t read anything about it before I started using it. I should have stopped the very first day. Because I thought my skin needed time to adjust to the new medication, I used it for 3 days….What a mistake. It got worse each day. I have not use it now for 5 days and I am still getting the redness, flushing and burning sensation in my face. This happens mostly in the evenings but during the day I have had a couple of flare ups. I regret so very much to have used it. It did not help me at all. What was a very mild case of Rosacea now feels it is not mild anymore. I truly hope this flushing, redness and burning sensation goes away for good. I feel very upset that my dermatologist nor the pharmacist warned me of these possible effects and told me to stop it immediately if they happen. To everyone who is reading this forum, please be very very careful with Onraltea."

MellyBean wrote on May 1st 2017: "Mirvaso aftermath will I recover?
I've been reading pretty much nonstop since I started having flare ups rebounding from Mirvaso. At this point I'm terrified I'll never get better. I've read so many stories of people 6 months after stopping and they're still experiencing symptoms. I did a small test on my cheek and didn't have a reaction or rebound flushing so I thought it was safe to use. I got a little flushed one day and knew I'd be in a warmer room later in the day so I decided to use some more. The next day I was pretty flushed, but figured it was just from being in the warmer room and being tired so, like a fool, I used more. 10 days later I was practically having to bathe in the stuff to get relief. I decided to stop and now I'm flushing so bad my cheeks, especially my right one, look like tomatoes. My eyes hurt and my skin hurts constantly. I've never been this bad and I'm honestly terrified I'll never recover. Any help is appreciated. I have an appointment in the morning with my derm but am skeptical since he's the one who gave me the samples.."

MonicaL wrote on March 11th 2017: "New User Need Help!! Hi all! Hope I'm doing this right...never been on a forum before! So my Derm gave me Mirvaso and Ivermectin cream. I'm noticing the rebound redness that everyone is talking about. Also it takes more and more to make me not red, when I first started it I only needed a little. HOW do I help the rebound redness once I stop Mirvaso. (Been on it for 3 weeks) the Ivermectin cream seems to help a little with the bumps. But not 100% makes them go away. Does it take awhile? What else is there? I've heard of Rosacea LTD. I'm so tired of wasting my money AND I'm tired of being embarrassed of my face and being in pain when I really have a flashing attack. PLUS all of a sudden 3 days ago my chest blew up in bumps. I used to think I was just ok looking for a 37yr old haggard mom of 2!! But now I loath seeing my face in the mirror."

Kfranke wrote on March 29th 2017: "I had the exact same experience. I used this Hitler cream one time (ONE TIME) last November and to this day I am still paying the price. I used to have slight redness on my nose and cheeks. Dermatologist prescribed me Mirvaso; didn't warn me that it could do any real damage. He just said I might experience rebound flushing but that it would go away quickly. HA. It lasted weeks! Every night my face would get so red, sometimes purple. That part of the nightmare has ended, thankfully, but I still flush more easily than I did before, especially when I sleep, and I now have redness in areas that I didn't before using Mirvaso. This is after ONE application, people. I am going to give it a year to the day that I used Mirvaso, and if I am still not satisfied with the way I look I'm going to look into laser treatments. Not looking for a silver bullet. Just an improvement, for God's sake. Anyone else have a similar experience? Any suggestions as to what I and others like me should do to heal? This was honestly one of the worst mistakes of my life so far. If only I could turn back the clock and tell myself to throw the cream in the trash!"

Gil1978 wrote on April 26th 2017:  "Really taking its toll on me. Hi all, like most of you Rosacea has really beat me up emotionally, I am 42 and the red face is to much some times. Starting Clonidine today along with propanolol. I am hoping something works, especially because the rebound flushing of Mirvaso is driving me crazy."

BIGWILL33 replied on April 26th 2017:  "Hi, I know how you feel, I went through the same thing. I was diagnosed with Rosacea. I tried Mirvaso and it made things worse. I went to another derm and he prescribed me this topical cream called Noritate. It help reduce the redness. He also recommended that i get some Vanicream moisturizer. I used Vanicream soap as well. After about a month my face cleared up completely and it's smooth. Good luck to you."

EllyS wrote on June 25th 2015: "Please, please don't use it: you risk permanent damage to your blood vessels and a long-term worsening of your condition. See the other thread on Mirvaso

Velvet•Lilac wrote on October 2nd 2015: "Hi, everyone! Hopefully this is going to land in the correct thread since I am a new member and a first time poster. I have many questions regarding rosacea itself as it has been plaguing me severely for the past five months but I felt like I have to chime in my 2 cents on Mirvaso first - because it's effects were unbelievable and not in a good way either. In a moment of desperation I used it three days ago as my face once again flushed completely red. I got it just a little over a month ago - I read all of the negative reviews and it wasn't a product I just slapped on my face without informing myself about it first. In fact there were so many negative reviews online that I refused to even try it at first. I only kept it because of the "you never know" situation. That said - moment of desperation - I put it on. In approximately an hour to an hour and a half I noticed it working. For the first time in a few months I've seen my face the way it was suppose to look like - not ghostly pale, no problems with the colour being uneven. It kind of felt like a miracle. I was quietly dreading the side effects - but for the time being I felt ecstatic. After 8 hours the cream started to slowly wear off and I noticed very small patches of red again. Very little patches - I thought if this is "it" it is really not so bad. Afterwards I went to bed. What I woke up with is a different story entirely. My face was burning red in places it has never been before. The red wasn't just "red" it was so red it looked half purple. Blotchy, stinging. As the day progressed my redness only got worse.
Day two - I still woke up redder than ever before but the redness subsided after a few hours - then came back again. I didn't flush like I normally would ( where you feel a slight warning 5 seconds before it happens ) - I just looked at myself and saw my face tomato red - or it started with a little red spot that spread all over my cheeks/nose within an hour. Day three - the situation looks like it calmed down a little - I'm really-really-really hoping this was it as far as the side effects go. Conclusion: I would never touch Mirvaso again with a 10 ft. pole regardless of my desperation. If there are people who find it useful/helpful - that's great - good luck to you, though!"

Velvet•Lilac updated on October 3rd 2015: "Update: I spoke too soon on the situation calming down. It started again with small very bright red patches that are slowly but surely spreading across my whole face/neck. I've never experienced this before and I've never had my face this intensively red either. I can only hope this will subside within the next few days. Thank you very much Mirvaso."

SBD1212 wrote on October 29th 2015: "I've been using Mirvaso since I was diagnosed with Rosacea and love it. It improves my baseline redness for about 6-12 hours and helps reduce flushing. I don't think I have ever noticed rebound flushing from it, but even so, I couldn't function without it. My face is so red after showering in the morning that I wouldn't be able to function at work for hours while my face was calming down. But with mirvaso, I put it on and 30 minutes later I look like a normal person again. Not to mention, when trying a new product for my rosacea, often times my skin gets inflamed and worse in appearance (until it improves on its own or I stop the product and try something else). At these times, Mirvaso is awesome because it can hide the redness/inflammation enough to get you through the work day or while out with friends so you don't look horrible all day.

Wiry replied on October 29th 2015: "You previously mentioned that your rosacea has been consistently getting worse. Mirvaso is known to do that over time.

Laura41 wrote on October 26th 2015: "Hi, this is my first time posting. I found this web site/forum and have just been reading the posts for awhile, but I saw yours and wanted to respond. I had a similar experience but not as severe as yours. I too was given the cream by one dermatologist who recommended it, I was also afraid to use it but like you out of desperation and the hope to look normal I used it. At first, I thought it was great, my face almost looked normal, I barely had to use any makeup at all. Then after it started to wear off I flushed worse than I had before I used the Mirvaso. My face also felt hot like I had a fever. That subsided by the next day, I went down to my usual redness. I used it two or three more times since then, I just wanted to look normal and the flushing afterwards I didn't think was too bad. The last time I used it was when I went out to dinner and noticed the medicine started wearing off and I looked like an idiot, I was half red and half white, all blotchy, I looked worse than if I was all red. I also believe that my face looks worse now because I used that, I am convinced it left permanent marks on my face. I've been to a new dermatologist since then and when I told him I used Mirvaso a few times, even he said he doesn't like the stuff and doesn't recommend it. I just hope enough people read these posts and don't try it like we did.

DanRose wrote on February 24th 2017: "Hello Littlelassie, today I find myself in the exact same situation, I wasn't a typical "flusher" but now after using mirvaso I am, big time! I've used it for only five days, nose only, and I noticed that something wasn't right. Five days have psssed without using it, and I'm still flushing like never before, my question is do you remember how long it took for you to get back to normal after stopping with the mirvaso? Thank you"

Kfranke wrote on February 14th 2017: "Will I Ever Recover from Mirvaso? Hello, I'm new to this site and am nervous about posting this because I am afraid that the responses I get will not be what I want to hear. I made the STUPID mistake of using Mirvaso last November. I had rebound flushing for several days (it was horrible) and then my skin seemed to calm down. But now three months later I am still experiencing moderate to severe flushing at night when I go to bed, more so than I ever had before using Mirvaso. Does anyone know if there is a chance that this will subside? I'm feeling rather doubtful, considering it's been three months. But there are some nights where I hardly flush at all, so I'm hoping that maybe...possibly...I will recover within a few months to a year? I just wish there was someone out there who could tell me what the hell is going on. I got a new dermatologist and am seeing her tomorrow. I'm not optimistic that she will be able to help, but I couldn't very well go back to the other guy I was seeing before. I am just so pissed off. A warning would have been nice. My previous dermatologist NEVER told me that there could be serious side effects to this drug. I have been going absolutely out of my mind the last few days. My husband and parents have seen me in states of total hysteria, and while I'm embarrassed that I ever let anyone see me like that...I'm just so worried that I won't ever normalize or get a decent night's sleep again. I am currently taking an anti-anxiety medication in hopes that it will help me relax and get my mind off things. But I'm still constantly worrying about my condition. I suppose I got off easier than some, as I can conceal my redness with a thin layer of makeup, but GOD, I wish more than anything that I could go back to November and tell myself not to use Mirvaso."

Brady Barrows replied on February 15th 2017: "Yes. If you browse through this thread about Mirvaso you will find those that report success from the rebound effect using Mirvaso. Basically it depends on how long you used Mirvaso will determine how long it takes to recover from the rebound. You say you used Mirvaso last November but didn't indicate how long you used it. You say that for three months you have been experiencing moderate to severe flushing at night so, assuming you stopped using Mirvaso three months ago would establish you stopped using Mirvaso in mid November?  It may be that Mirvaso rebound is still occurring but it seems it has been long enough past the Mirvaso use that your skin would have recovered from any damage to your skin that Mirvaso may have caused.  Rosacea skin is very sensitive and thin. When we use treatments sometimes the treatment is just too much for our sensitive rosacea skin. I have noticed that sometimes you simply have to not do anything for a while, say a few days or a week, and just let your skin heal on its own. The other suggestion I have is to spend a couple of hours reading posts on Mirvaso or Brimonidine by typing in these words one at a time in the search box (top right corner) and see if you can find the answer to your question. You may get someone to reply to your question in this thread, but my guess is you could find the answer if you search for it by the method I just described using the search box faster than getting responses to this thread. I have never tried Mirvaso.

Colm wrote on May 3, 2016 "Hey everyone, I’m Colm & I’m 19 from Ireland. I recently started suffering from redness in and around my cheeks. I felt it would be appropriate to share my experience with Mirvaso. Like everyone else I’m sure, I had tirelessly researched this product when I heard a “revolutionary new topical gel” was coming out that apparently reduced the look of rosacea/broken veins/facial flushing. I made an appointment with my dermatologist as I was adamant I would have to try this. My skin/facial flushing was really taking its toll on me, I was avoiding social situations, anywhere I thought my skin could flare up. Although my dermatologist didn't diagnose me with rosacea per say, he said some people have different facial vein structures. It just so happened that my veins were closer to the skin than normal. To be honest, looking back, i wasn't that happy with my dermatologists diagnosis, but i was so adamant to get my hands on this cream, that i continued with the consultation. My dermatologist prescribed Mirvaso to me, yet he did voice his caution/fears, reiterating that it was a new experimental gel and that he hadn't had much feedback due to how new it was. I didn't care to be honest, I ran with my prescription to the local pharmacy (he gave me 2 repeat prescriptions). I had trouble initially getting hold of the gel and ended up having to order it in which took a couple of days, which at the time to me, was soul destroying. Anyway, the day came where I collected the gel, it cost me €60 which was fairly expensive but I was willing to pay it after reading how it would apparently cure my facial redness/flushing. I put it on according to the instructions. After 30 minutes, I returned to the mirror and I couldn't believe it. My entire face was completely clear, redness-free. It was like a dream come true. I spent the entire day showing it off and feeling extremely confident. I went to bed that night feeling like I had been given a new lease of life. Unfortunately, the following morning, I had college exams. I woke up earlier than normal to what I can only describe as a hot stabbing ache all over my face, like a boiling hot version of pins & needles. I went to the mirror and I was horrified. My entire face was burning hot, fully flushed, broken veins in places I hadn't had before, my eyes were bloodshot even though I had avoided that area as per instruction. As I had to go to the exams no matter what, I put more of the mirvaso on to get me through the exams. Like the previous day, it calmed my face down within an hour. Mid-way through my exam, however, I felt my face flushing and burning again. Not only that, I felt light-headed and a bit drowsy. I had gotten plenty of sleep the night before so it wasn't a case of lack of sleep. It was the gel that had me feeling in a weird way euphoric (but not in a good way). I did my best to push through the exam and ran home afterwards. This time, my face was red/purplish around the cheeks, nose, above my eyes and forehead (I had only ever experienced redness around lower cheek/jaw). The flushing got worse and worse over the course of the day. The effect the previous day had lasted almost 24 hours, yet here i was today where the effect had only lasted 4 hours, and although my face was calm, normal during these 4 hours, I had a permanent itchy, burning sensation throughout which made it extremely uncomfortable to do anything.

I was devastated. I had built this cream up to be the answer to all my problems. I ended up having to stop using it entirely after that. It took about two weeks for my skin to recover somewhat and return to normal. And by normal, I mean this ‘normal’ was far worse than the normal way my skin was before I started using mirvaso. Constantly flushed, blotchy. Its now been about 11 months since I used it that day. It ended up giving me broken veins around my eyelids and nose, that I didn't have before that, which I still have to this day. These flare up along with my original complaint, which was around my cheeks. I find when my skin does flush, its even deeper, longer-lasting and more frequent, even almost 11 months on. I'm considering IPL.

The reason I wrote this is, because although you feel you’ve researched this gel and feel its “worth the chance” to try it, I would BEG you not to. YES it does reduce redness for a couple of hours the first day or two using it, however, over time, the effect lasts shorter and shorter and the rebound flushing gets worse and worse, and you end up with redness/broken veins in places you didnt have before. It does more damage than good. I still feel my skin far more sensitive to all the triggers than it was before and its been almost a year since I stopped using it. This gel is a DRUG. It is made out of a DRUG. I think People forget this or it isnt emphasized enough, they don't realize the strength of the gel. Not only the physical effect whilst using it, the long term effect too. My intention here is not to turn you off it, but I think everyone should see people who had a negative experience with it, before you make up your mind on whether to start using it. I’m sure there are people who suffer with far more severe rosacea / redness etc than me, who are willing to risk it for even a 10% success rate. I have read about the positive reviews some people have posted and I understand everyone reacts differently. However, there have been an overwhelming number of negative reviews too. All I ask is consider this, like me, you could end up with worse skin / sensitivity for an extended period even after using it. You really have to ask yourself, is it worth it for a couple of hours of less-red skin? I found out the hard way. Hope this is of some help to people, Colm :-) "

Rachel wrote on April 22, 2016: "This worked like a miracle – for the first 5 hours. Then my face turned into a nightmare of burning pain, beaming, glowing, angry red, with stabbing needles of agony. I’m not exaggerating. I left my skin to calm down for two days and then tried again. The same result, but now spread to a wider area of my face. Another 2 days past and I was going out with some friends. I weighed up the odds – use Mirvaso for an evening to look good, with the cost of the pain and rebound flushing for the next few days? I took the gamble and used the cream diluted down to the thinnest of smears. I looked marvelous as I left the house. Halfway through the evening I felt the burning start and by the time I got home I was rushing to the sink to bathe my face with cold towels. This time it took a week to calm down, and honestly, I think the redness and bumps are now consistently worse than when I started. Given the large number of people with the same experience I am amazed they are allowed to market this product."

Arthur wrote on April 22, 2016: "Rachel, Everything you say is true about this awful product …beats the hell out of me how they are still allowed to make this stuff available to the public . DONT listen to Marshal and the “Thousands of happy customers” there isn’t any happy customers , just read the reviews HERE , I think perhaps Marshal has an “Interest” in this product … YOUR SKIN HAS WARNED YOU DONT USE MIRVASO AGAIN !!!"

Morchella wrote on March 27, 2016: "On my fourth day of using Mirvaso I had to cancel plans to go out last minute because of a sudden onset of deep flushing and stinging redness. I’d had a glass of wine earlier and wonder if that dos t trigger it. A few days later my skin is still bumpy. I didn’t notice a difference the first three days and was waiting for it to work….guess not. Mirvaso is not for me."

Wendy wrote on January 7, 2016: "I’ve apparently been experiencing the symptoms of Rosacea for quite a while but, until recently, dismissed them as another joy of menopause. I went to my GP when I started to experience breakouts. By coincidence my GP had just had a briefing from what sounds like the GALDERMA company Rep and was excited for me to try the ‘new’ Onreltea Gel remedy. $135 and about 3 days later my face was a glowing, hot, red disaster that felt like a steam burn. I was even hot behind my eyes. During an immediate follow-up with my Dr we read through the possible side effects: stinging & burning were at the top of the list. What!?!
I haven’t yet filed a claim through my health insurance so I don’t know if it’s an insured item; first I will exploring the possibility of a refund from GALDERMA. After a recovery period of approximately 10 days I’m on my 3rd day of what seems to be a gentle over-the-counter product called Cliniderm RosaCalm, recommended to me by another sufferer. So far so good.
Good luck."

Sculyman wrote on December 21, 2015: "It reduces the redness on my face significantly a few mins later after applying on my face. However after 12 hr or so the rebound is so great that i got even redder than before."

Anna wrote on July 11, 2016: "I was prescribed mirvaso for mild rosacea. As other people have eluded to, I initially was pleased with the results but I have since suffered from extreme flushing, something which I never had before using it. My whole face feels hot and is erythematous. This has continued since stopping the gel. I would definitely not recommend this drug and would ask that someone collates all these adverse effects and presents them to the drug company."

Kate wrote on August 21, 2016: "The first time I tried Mirvaso, my cheeks turned almost too white! So now I use a much diluted amount, or mixed with my face lotion, and it looks much better! It reacts within 20 minutes for me, and lasts for approximately 10 hours. I have no rebound flushing and I am overall, very happy with it. Some days, I just use it on my tiny broken veins around my nose, etc. & that is enough to improve my look……..It has been 3 weeks & I hope that my experience continues to be this positive, with no rebound redness!!!"

Lizzy wrote on September 28, 2016: "I tried Mirvaso and wish I had not. Looks great in the beginning but soon wears off earlier and earlier each day. Had to stop using and now my face looks 10x worse the flushing is painful and wondering how long if ever it is going to stop. No makeup call cover this. I now have painful lobster face."

Olli wrote on October 15, 2016: "19 months (and still going) with burning horror in my face after only 3 days with mirvaso applications…the heat in my face is so brutal that I often have problems to keep my eyes open!!!my ears are flushing 20-30 times per day for no reason (mirvaso was not applied there) before mirvaso I was a healthy man. I could play tennis/squash for hours.and now I can’t be in a heated room whiteout looking like a chemical burn victim..please be careful people."

Vnderban wrote on November 13, 2016: "The rebound effect is horrible with mirvaso, the first 10 hours the inflammation falls, but shortly after it returns in fire mode all over the face, in my case I did not function, I am now with soolantra (ivermectin) and the improvement was noticeable long term."

Katie wrote on November 29, 2016: "I just started using Mirvaso yesterday and I am HORRIFIED by what it has done to my face. I used only a small amount, and for the first 10 hours or so, my face looked GREAT, better than ever before. I thought I’d found the holy grail of Rosacea treatments there for about half a day. NOPE. After it wore off my facial redness came back, looking about twice as bad as it normally would. So I didn’t use it today, and yet the same thing just happened again. My facial redness is back even worse than ever. Right now, there is a HUGE red spot (and I mean REALLY red) on my right cheek that is burning so bad it feels like it’s on fire. My God, I hope this cream didn’t screw up my face. Does anyone know if this is ever going to stop? Or am I doomed to pay the price for just using it once forever? I am so upset with myself. Why did I not listen to the reviews I read online? This product is horrible. I don’t recommend it for anyone. Better to find a more natural treatment than to risk screwing up your face."

Melissa wrote on January 17, 2017: "As promised, I’m checking in to let you know what happened when i used Mirvaso alone, without my topicals. Everything was fine, until approx. 10 hrs. later, when my face started feeling flushed on the right side. I went to the bathroom mirror and was horrified to see a huge red blotch on the side that felt hot. My facial tone was uneven. I felt as if I had a temp. but I couldn’t find the thermometer. I grabbed one of the many cold packs in the freezer and lay down. I felt weak. I just tried to focus on cooling off my face. As soon as I felt a bit better, I washed my face with “Neutrogena Hydrating Lotion,” making sure to get everywhere. Then I applied Finecea. Then Metronidazole. Then Aveeno moisturizer (I’m out of Clinique “Green”). My face felt calmed and soothed. I instantly saw the redness going away with the Metrogel. My neck was crimson before that. So, this experiment yielded interesting results. No more Mirvaso, which is too bad because it’s a fortune. Finecea and Metronidazole are the elixirs."

GT wrote on February 1, 2016: "I use Mirvaso occasionally and it works for me with no problems. Although, my Dermatologist says he doesn’t think I should use it – WHY? He didn’t say."

Kevin wrote on May 24, 2016: "As far as Mirvaso, I have found a method that works for me and so far no rebound redness (1 year user). I place a pea size dab on my hand and mix with 3 drops of Afrin nasal spray. The Afrin has constricting features also. This combination seems to lessen the strength of Mirvaso and also makes it last longer because the Mirvaso consistency gets thinner from the Afrin. I also think by diluting it the chance of rebound redness is lessened. BTW my normal routine is Oracea in the morning and start the day with an overall application of Metrogel 1% CREME, not the gel becuase it is to harsh. Then I put on an application of the reduced Mirvaso with Afrin. Been good for about 3 months now. Still have a problem in the sun and strenuous activities, think I will try Zinco next."

Acanthous wrote on September 30 2013: "I used 3 pea-sized blobs for whole face, at 2pm on the day I got the script ($50 w/coupon). I am a flusher, with many, many triggers, including ‘being alive’ and ‘breathing’. Deepest flushing is on nose and cheeks, but rest of face, neck and chest also flush. I always have some redness. Observations:
I was white like a vampire for approximately 14-15 hrs. Not even red wine and pasta made the treated areas flush.
– this is not as good a look as I imagined it would be. Also, it highlighted the neck and chest flushing I have.
– some normal flushing started coming back on face and cheeks around 8am the next day.
extreme, weird rebound flushing on cheeks starting by 9 am. Deep, blotchy flush, very hot and uncomfortable."

Belkkins wrote on 22 Oct 2014: "My experience was like many others I guess. First, it was like a miracle. Wow since I first was diagnosed with rosacea I could go outside with no make up, my face was actually of normal color. That was Tuesday. After applying the gel in the morning the redness would disappear and do not come back for about 10 hours. That was good for me. I think on Sunday (that makes it the 6th day of use of Mirvaso) the burning started in the morning. My face was as red as broiled lobster and it burned. I did not make the connection. I applied Mirvaso again and in an hour or so it worked as before. The redness disappeared but the filing of burning was still there. The same happened next 2 days. Wednesday (that makes it the 9th day) was the last day I used it. I checked the forums and side effects and found the burning and flashing was very common among the users. You know how it is when you have hope you see only the good effects and when something happens you see the side affects posts. I do not blame my doctor for suggesting Mirvaso, I would have asked myself because I had hope that it will work. Anyways, on the first day of NOT using Mirvaso the my face was so red and burning baaaad like I never experienced before. Even the make up did not help. Moreover, I felt that my make up was melting of my face, that how bad it was. On top of it the COLOR of my face - not just red but almost purple. Thats when I started to read the threads of Mirvaso users' experience. I was so scared. People were reporting weeks of burning and redness worse than before using. Like I said I do not blame the doctor, I blame the FDA that approved a drug, which clearly has side effects more severe than the actual degree of help. After all Mirvaso suppose to be a cosmetic fix not a permanent fix of the problem.

By Monday-Tuesday (that makes it about 6 days after stopping Mirvaso) I was back to about what I had before. What helped me: During the day I used Aveeno Ultra Calming moisturizer (+powder to cover the redness. By the way I use MAC Total Fix, which is great for me). At night I would wash my face with cleaning foam (to get rid of make up), then I washed my face with Grandpa's Pine Tar Soap (I would leave soap's foam for a few minutes), then after washing the soap I would wash my face with Avene Antitougeurs Cleansing Milk (do not confuse with Aveno). For the night I did not apply anything. That would leave my face dry but less burning (on the 1st day of not using I tried to apply moisturizer over night and it did not work well). Anyways, by day 5 or 6 I was more or less ok. It has been 17 days since I stopped using Mirvaso and it seems Iam ok overall. I think I finally found two products that definitely work for me to control the redness: 1. Grandpa's Pine Tart Soap and 2. Aveno Ultra Calmig Moisturizer. But I will keep trying to look for other remedies. Since, the redness of my face is not severe (knocking on the wood), I will try to find some products to improve my skin in general (like pores and texture), and hope that redness will improve along the way. I am planning to stay away from IPL type things. I had it for spider veins removal on my legs and I saw how invasive it is. One should not use it on the face, I think. I wanted to share my experience and share the story of what helped me to get over Mirvaso side effects relatively quick. I hope it will help someone. I know how terrified I was and how much I tried to find an answer on what to do and how to fix it when I was afraid of looking at the mirror after Mirvaso."

Maria habib replied on March 17, 2015: "This is happened with me same burning n more redness n after wash I can't dry my face with towel bcos my cheeks become very sensitive. I stop using it."

Cme0808 replied on May 27, 2015: "I am just going through the exact same situation as you. I started using Mirvaso about 4 weeks ago but only on weekends. Anyway after this Saturday night the burning and purple skin appeared. I washed my face with the Aveeno Cleansing milk and it calmed it for about an hour. After 24 hours of what felt and looked like severe wind burn, I went to the chemist who gave me antihistamines and pure Aloe Vera gel. Two days later, this is slowly starting to improve, but the burning sensation is horrific. My skin is so dry (which it has never been), the redness is being helped by frequent use of the Aloe Vera cooling gel. I can only hope this eases soon. I like you will never ever use this again, even though my boss has been using it for months successfully. I will put up with Rosacea rather than chance this pain and discomfort again."

Kari72 replied on February 16, 2015: "After things calm down, try mixing a small SMALL amount of Mirvaso with moisturizer or antihistamine cream before applying. It works for me."

Blondy83 replied on February 16, 2015: "I had pretty much the exact same experience so hopeful at first and then so disappointed with the side affects."

Kari72 wrote on January 7 2014: "I have had rosacea forever and nothing has ever worked for the redness. My doctor prescribed Mirvaso and I was a little skeptical. I went online and found that a lot of people (JennyR on Realself) and other commentors at Mirvaso review sites were mixing their Mirvaso with other moisturizers etc. One user wrote: “I’ve been using Mirvaso mixed with a moisturizer (1 part mirvaso with 3 parts moisturizer) and it’s worked great. Someone else who posted on here mentioned using benedryl cream. So I switched to mixing together 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!!”
Someone else on the same forum said that he mixes Mirvaso with sunscreen. I checked with my dermatologist who said it would be OK to ease into Mirvaso using one of these methods and it has been a true blessing for me. If you are thinking about trying Mirvaso, give this method a try."

sportsguy81 wrote on 24 Nov 2014: "I am new to this site and I have had Rosacea for about 5 years now. I have struggled to contain and hide this (even denied really having it) but it keeps progressing and getting worse. I have Type 1 with redness in my cheeks that streak down and my nose. I have done lasers in the past with no success, recently my derm gave me Mirvaso as a trial and I am mixed about it. The first night I applied before going out to the bar, it was extremely warm and only served craft beers so naturally my worst nightmare for a full flush. Surprisingly no flush until the end of the night when my right cheek flared up, nothing though compared to what could have been. I had no rebound flushing the next day which was one my major fears using the product. Actually the next day my skin looked better then it usually does after a night of drinking. I felt amazing and couldn't believe this may be the answer I was looking for the past 5 years. I felt bold and put it on before leaving for work at 8am, arriving at work and lasting the morning I was looking great. Around noon I stopped at the bathroom and while washing my hands I noticed the right side of my nose was turning very pink and blotchy (it had only been 4 hrs, this couldn't be right) so I applied a very tiny amount to the area and went about my day. The next 5 hours was awful, my face kept starting to flare and not a normal flush but more red and blotchy. I would have to continue to run and apply more what seemed like every hour. My nose seemed to actually stop responding and stayed a consistent red. Finally I had to get out of there and I made an excuse saying I was sick so I could leave early. I was distraught and depressed, so much hope that I had finally found something that could help and now back to nothing. I got home and upon first look in the mirror my face actually looked good again. I don't know what to do anymore.
What I was told was that this product was supposed to last 12 hours, mine lasted 4 and then either I had to deal with bad flushing or reapplying every hour. Does anyone have any advice or experiences they can share? This worked so well for the first 4 hrs but its not worth the anxiety and distress thereafter. Also has anyone tried a combination of both Laser treatment and Mirvaso? Any advice would be much appreciated. I am so depressed and lost after this experience that I do not know what to do anymore."

Sportsguy81 updated on November 25 2014: "I was okay after this morning but after I finished my workout my face is extremely red, more than it usually is after a workout. It also has not subsided after 90 minutes post work-out like it normally does. I mentioned this in my other comment that it almost feels like an allergic reaction and its mostly on one side of my face which feels like it is on fire. Anyone have any advice to help rebound flushing?"

Kari72 replied on January 24 2015: "After things calm down, try mixing a SMALL amount of Mirvaso with over the counter benadryl cream (1%) or mild OTC hydrocortisone cream (0.5-1.0%) and reapply. It will lessen or eliminate residual redness. I have used this method for over a year now with approval from my doctor."

tljones replied on March 26 2015: "Hi I was just given Mirvaso and it was great when I put it on some spots. It has worked wonders. I have tried it like you and found that my skin is so up and down now very dry and is not working the way it is advertised, I am going to see the doctor tomorrow will keep you posted as this is a terrible condition with a bunch of people making money off innocent people with a problem for example: by this cream, I just bought some cream today and this women swears that all her clients use it on Rosacea and it works, I will be the first if it does not, my skin is so red at the moment I don"t know what to do, she says put it on 5 times a day , it will work...LOL.. NO real cause known for Rosacea,I was just born a white female with blue eyes...this country has a lot of problems with drug companies just wanting to make conditions a little better not cure them...with the way technology is they should have something more on this condition...stress, food, exercise, alcohol, sex, smoking just about everything I like is making me red for the first time in 35 years...I am 48 menopause is one thing for me to look at but what about younger women that have it...Just going to meditate and pray that it leaves SOON..."

mualishar wrote on May 14, 2015: "My dermatologist recommended and prescribed and my insurance copayment was $50. If I used it every day, I imagine it would last a couple of months because it only requires a tiny pea size on the affected areas and spreads thinly.
This really does work--there are definite results with me, although it might vary with some.
I have had rosacea for 20 years, and with my fair skin, it can get intense. I have had laser treatment, tried metro gel etc, all to no avail. (meaning, only a slight help at the most).
In summary:
- My rosacea is mostly on my cheeks in varying capacity, with a baseline that can expand. I have a few of the pimples, but just a few bumps.
- It's pricey, so I only use it when I'm going out (my rosacea hits harder at night). General day use I've been happy with green concealer and light foundation coverage.
- I also use Retin-A nightly and a Vitamin-C serum daily (DIY)
- It goes on thin and "sticks", meaning, you can slightly feel its presence, but it's not bothersome,
- You see results in 15 minutes, and final results in 30. I took pictures of myself when applying to one side, at the start, then 15, then 30 minutes in, and it is obvious.
- On me, what it got rid of was the "general" red--so what it leaves is what I think is baseline, which can appear blotchy because what it did get rid of might be in and around that. But I don't mind! The red has been reduced drastically, and that's important.
- I still use green concealer and foundation, but now, no red "seepage" and a much smaller, more finite area to coverup.
- It also reduces the "heat" that emits from the redness, which is nice.
- I also applied my C-serum after 30 minutes and it seemed to not have any affect.
- Reappearance was anywhere from 6-8 hours
- I had no rash afterwards, like some people had.

If your insurance will cover it, I highly recommend trying it. It is worth the $50 copay.
Note: Mirvaso does not "cure" rosacea rather, it temporarily alleviates the redness and heat enough to use every day or on occasion. It is "symptom removing". To me, that is a miracle.

chickenlittle85 wrote on July 29, 2014: "I am a 32 year old female with mild rosacea which manifests in mild redness with pimples and pustules. I have permanent baseline redness, but it isn't that significant or bothersome; my cheeks are more rosey than beacon- red.
I have used Mirvaso only once, and following my experience I will never use it again.One hour after applying Mirvaso my skin was perfectly clear and even- toned.A miracle! I couldn't stop looking in the mirror(vain,I know!). But alas,it was too good to be true. The following morning a nasty rash appeared around my mouth.After lunch I started to flush like never before.But oddly,it was only on one side of my face and in a triangular patch.Very,very odd. Now, 48 hours later ,the rebound redness is starting to fade. I advise others to proceed with extreme caution if they are considering using this product."

EllyS wrote on May 30th 2015: 
"I feel for you caracal. It is little short of criminal what Galderma have inflicted upon us with Mirvaso. It's more than two months since my last application, and I see no hope of a recovery. My nightmare of rosacea turned into a horror story. Yet, dermatologists I complain to refuse to accept the evidence in front of their eyes, insisting it can do no real harm or permanent damage. I now have so many extra broken capillaries, newly affected areas and persistent redness, I just don't know what to do to try to heal it. I am scared of going down the laser/surgery route, but nothing else seems effective."

Caracal wrote on May 26th 2015:  "So it's maybe 4.5 months after I stopped using it.
-The flushing seems to improve eventually. But I can't even tell because summer is over, so for all I know things will be almost as bad when it gets hot again. HOWEVER, all the rosacea symptoms are about 500% worse than before I applied the junk, and to prove it's the Mirvaso, the side of my face where I applied it 4 times is 3 times as bad as the side where I only applied it twice. This makes me look even worse because having one side of your face bright red is even more noticeable. Before I used this junk my main problem was just a few acne like bumps, there was barely any redness. I thought I did have acne, I was only diagnosed with Rosacea in December, when the doctor gave me this dangerous rubbish.
- It seems to have affected the circulation in other parts of my body as well. My feet turn red and hot and their skin goes funny like my face. This never happened before. I expect this drug affects your entire body. It is EXTREMELY DANGEROUS.
-Well of course there are side effects, the people who have rosacea are probably unusually sensitive to things that affect the face circulation, blood vessels etc. that's why they have rosacea to start with! I expect in people who only have mild rosacea it makes it progress dramatically, in people with severe rosacea nobody can tell what was due to the Mirvaso.
Using this stuff I regard as the worst decision of my life, actually. I should have read the negative reviews more carefully before using it. But I didn't want to be paranoid and the kind of 'side effects' in the clinical trials sound so benign and temporary."

Padwenda1 wrote on May 10th 2015: "Hopefully you will recover with time as other users have reported. For me it has worsened my condition and it is permanent. I am now on Minocycline but with very little improvements. I still suffer with everything you describe, the dry scaly skin, permanent redness, flushing, little bumps,pain ect. I too found Galderma very unhelpful and have given up on them to provide any type of reassurance.. I was just wondering if they said to you that everyone returns to their baseline? They told me that everyone who reported an "adverse reaction" (they do not accept the term rebound, but that's another story) returned to their pre mirvaso baseline."

In this active thread on The Rosacea Forum, Mirvaso users discuss their negative experiences with the cream. Because my main Mirvaso blog post has become so long that I no longer can add things to it, I post these stark reviews in a new little update post about Mirvaso. A few messages that should be a warning to everybody I think:

wrote myself on May 10th 2015: "I'm just so sorry and sad to read all these stories. I really wished that everyone had just stopped using Mirvaso as soon as they noticed the very first rebound worsening. It's just reckless and criminal to advice patients on the phone to just keep using it. There are some worrisome folks out there online who urge users to keep using it and mix it with moisturizer or add antihistamines. Just stop using this stuff instantly I want to scream at them! But it only takes a handful of positive reviews and people are off using and trying it again. Who knows who these positive reviewers are, they might not even have rosacea, they might have had the odd blemish and therefore not get the rebound. But anyone with a decent flushing problem seems to be in deep trouble with Mirvaso.
I tried to cover all the horror stories, or a good initial selection of them and also all of the positives I could find on my blog. The negative ones far outweigh the positives and the stories are pretty saddening. I really start to wonder how people can be warned about Mirvaso; we have it plastered on the forum here, the dangers, the risks. I did google searches on Mirvaso /rosacea and my blog with the negative reviews comes up on the first page, other warnings are out there but the stories of hurt patients keep rolling in. It's an outrage that the medical world isn't jumping more onto this farce of a product. Makes you wonder how many more people will be hurt in the near future. EllyS, I hope that with time your skin will improve. It has done so for a good few users here. But I don't have a good advice either unfortunately, other than try to stay cool and unflushed, maybe with a fan or cold packs or anti flushing medication, and hope that things settle again. pls be careful with hydrocortisone, it is as bad if not worse than Mirvaso for many rosaceans. Best wishes N."

Davekelly replied: "I cant get my head around that either N. This crap they call Mirvaso should have been taken off all Pharmacy shelves and binned by now"

EllyS wrote on May 11th 2015: "Dear Padwenda, am heartbroken to read you are still suffering from this dangerous cream. Am so sorry for you, and for me. Let us hope, together, - in spite of ongoing adverse effects - that our faces will recover eventually. This evening I am going to visit another dermatologist to ask him if he thinks my skin can heal - return to baseline. I will report back to you, particularly if he has any concrete recommendations on how to reverse the damage. The dermatologist who recklessly prescribed Mirvaso (and did not mention any risks or even side effects) has refused to accept it has caused serious damage, and even avoided seeing my skin for herself. Just as offensive, she has implied the pain is predominately psychological and suggested I see someone about that. She completely refuses to acknowledge that her treatment has worsened my condition. I remember that I trusted her so much (wanting so badly to trust an 'expert') that even when Mirvaso wasn't working and began to have adverse effects from day one, I believed her contention that the positive effects were accumulative and the longer I used it the better it would work! I only gave up when my face was sunburned in appearance. I must admit that I am battling suicidal feelings, particularly in regard to my regret and anger over the Mirvaso damage. In situations where not only do we have a debilitating disease, but one that is barely recognised as such, and we are consistently treated with complacency and contempt by professionals, the feelings of distress, panic, regret, hopelessness become too much to bear. Not being alone with this - having this group - is a help. Every day I battle to regain perspective, to look at my situation in a broader context of human suffering and resilience, and vibrancy - dispite disappointment and misfortune. Sorry, am getting too philosophical, abstract, morose! It is a terrible tendency of mine ;) I say this to myself more than to anyone else: there must be a life worth living even with all this burning & discomfort... Many of you i have come to know a little on this forum are testament to that fact."

Padwenda1 replied: "Hi Ellys, I went to a another dermatologist a week ago for a second opinion. Unfortunately all they can do is listen and empathise. They cannot offer any magic gel or tablet, all they can give us is advise that we already know. I understand where you are coming from, my life has changed dramatically and I have lost all hope in recovering because after six months there is no real improvement. It is difficult to accept that my life has changed so much. Simple things like walking outside, going for dinner or any social occasion has been ruined. Let me know how you got on with the dermatologist!"

I replied: "So sorry about all this distress guys (girls). It is normal to feel hopeless, defeated, beaten down and to expect this is the end of your life. All I can say is that you have to keep going and be on top of things. Let the skin calm down now and give it time to recover. Also try all you can to keep your face cool for now, so the recovery will go faster and isn't stopped by ongoing flushing. I had a year in 2005 after a shitty IPL treatment with the horrendous dr. Mervyn Patterson (sorry for name shaming but that guy ruined my face and was the worst afterwards, I can't repeat this enough I feel), when I couldn't stop flushing anymore. So beet red all over my face and these monster flushes all hours of the day and night. I was convinced it was beyond repair and my life was over. That I would suffer until I had enough and couldn't go on anymore, it was that bad. People pointing at you in the supermarket the odd time you dragged yourself out of it. Anyway, not wanting to make it a pity party on my behalf, but despite that hopeless situation, I still managed to get out of that hole with the help of Peter from this forum who took me to Dr Chu in London and who gave me anti flushing medication of which no doctor at home had ever heard before. And things improved! And the flushing cycle was stopped for a good %, and my skin actually managed to recover a bit again. Don't give up hope. It's extremely daunting right now and bad rosacea flare ups mess with all aspects of your life and make us angst ridden hermits, something nobody except fellow rosaceans seem able to relate to. But there are always other things you can still try. And you cannot know possibly how things will be a year, or two down the line. Stay strong, don't put silly things on your skin and make it more angry right now, try to stay cool and find the right treatment to stop the inflammation and flushing and have trust that things will change again. And you can always post here and many people will read and help out always x"

Robert D wrote on July 13th 2015: "Hi PADWENDA1, I Was wondering how you are doing. Do you have any updates. I am asking because I have the same issue going on 6 Months now. Had no Rosacea, had a little pink area the size of a dime. Derm gave me a sample of this Mirvaso and said just put this on your face it will remove the little pink you have. Well I used it once and I have had a burning red 24/7 flush for six months now. I never had a flush in my life. I have to apply a cold compress / ice pack every 5 minutes."

Padwenda1 replied: "Hi Robert, Just like EllyS there has been no improvement seven months on. It sounds like I had similar symptoms to you! I went from having a normal life to one of pain and embarrassment. It took me a few months to get used to the idea. I tried minocycline for six months with absolutely no improvement. I have tried expensive green tinted creams and lotions and no improvments. About a month ago I tried a normal factor 50 suncream and to my amazement it controls the pain during the day at work and helps with the flushing. I use it everyday and I know it can be a bit shiny when in certain lights but I will take that over the pain any day. I have also noticed my nose has become so oily and full of blackheads, has that happened to any of you guys?"

Robert D. replied: "Hi Ellis, Sorry for the delay..Basically I am having the same issues as everyone else. Going on 6 months, trying different solutions. For some reason this crappy cream creates an immune response in the face, even where the cream was not applied...Yes it spreads with time. It mimics rosacea in a few ways. It will show redness in the same areas, it may produce red blemishes and is aggravated by histamine related foods (in some cases all foods to some degree) anything which will make your blood pump... Roceasa is NOT a 24/7 burn & flush. If A person with No sign of Roceasa (normal skin) tries Mirvaso, they will develop the same Issues. If you Dr tells you it cant be The Mirvaso... 1. ask him to try it and then tell me your answer again. Just because a person Has Dr. in front of their name, doesn't mean they know everything....
Just looks at the stats on Patient deaths..when the actual cause is determined...Staggering and Scary...
Galderma is owned by Nestle..Which make products like Friskies & purina cat food, Kit Kat bars, Buitoni Pasta, Dreyers ice cream etc...the list go on and on. So...this product is about $$$ They are a public company. If you want to get the attention of Galderma, you contact Nestle...(the Parent co) Galderma just takes your info and throws it away... I am determined to solve this and to make the people responsible for this Pay for what they have done. I want to know who was PAID $$$ to look the other way in the USA FDA trials phase 1, 2 and 3 ??? This is a joke...
Lets keep an open line of communication and it would be nice to hear from people who have beat this....It is strange how people just disappear and don't report how or if they were treated and recovered. I will keep you posted"

Compensatory Flushing with Mirvaso: JAMA Dermatology

Written by June 24, 2015 in Mirvaso Gel (Brimonidine 0.33%) with 0 Comments
LEFT: Patient at initial clinic visit after 7 months of brimonidine treatment showing compensatory vasodilation and flushing in untreated areas of right lateral cheek and chest.
RIGHT: Patient 1 week after cessation of brimonidine treatment showing marked improvement in compensatory vasodilation and flushing.
A brief observation published in the Journal of American Medical Association Dermatology details a case of compensatory flushing from a long term user of Mirvaso. Compensatory flushing means that flushing has occurred somewhere that Mirvaso was not applied, but was caused itself by Mirvaso.
Erythema in Skin Adjacent to Area of Long-term Brimonidine Treatment for Rosacea: A Novel Adverse Reaction.
Gillihan R, Nguyen T, Fischer R, Rajpara A, Aires D.
JAMA Dermatol. 2015 Jun 17
We describe a case of compensatory vasodilation in the vasculature surrounding the site of long-term brimonidine use for the treatment of rosacea.
The article details a patient who presented with redness and flushing on areas of the face and neck that had not been treated with Mirvaso. Areas that were treated did show a benefit and were described as being spared from the redness present elsewhere on the face, neck and chest.
The patient had used Mirvaso for 7 months, and had followed the suggested treatment instructions.

The compensatory flushing resolved shortly after ceasing treatment with the brimonidine based gel.

ShadwellLondon wrote on April 14th 2014: "Bad flushing. Hi there. I was keen to try mirvaso so got it on private prescription in the UK.  Did a test spot high on my cheek with no obvious problems so then used it properly the next day. Worked well and I felt a confidence in my appearance which I've not felt in years. No flushing and no redness. Fast forward 5 hours and I got the worst flush of my life. Hot and angry purple bruised looking cheeks and ears. Took the night and sleep to calm down and I was home all this time so no reason to flush. Didn't use it the next day and flushed again the next evening. Hoping it was a one off I used it before I went to work. Bad mistake. Same angry purple after 5 hours. A colleague asked if I was OK. Said my face looked burgundy. I kept my head down and fan on but had to apply more just to get home. Stopped using it but had rebound flushes for the next 3 days. I hate this product so much I had to write this. The one thing I worry about most is the one thing it caused. A hot and painful face and constant stares from people. Hope it works for you but mine has gone in the bin. Only now calmed down after 3 weeks of not using it."

On the Galderma Cafepharma forum, someone wrote:
" 04-11-2014, 05:34 AM
Anonymous, Posts: n/a
Default Re: Mirvaso
Scary that we have to sell this far off label to make this stuff work. Someone will eventually get in huge trouble trying to make bonus on this stuff and if you have to be this off label to make it work - it is not worth getting a huge fine and being kicked out of Pharma just to save this silly product. The company will clearly not come to your rescue if you are this off label and will simply blame you and you will be stuck with a big fine. Not worth screwing around with this kind of messaging and concoction to keep your scripts moving.Then lose your job and lose the ability to continue in the industry."

Posts: n/a
Default Re: Mirvaso

Originally Posted by Anonymous View Post
You're right. We don't need to say anything. Doctors will learn from other doctors how to best use Mirvaso without a word from us. Its already happening and its not unusual. Its called the "art of medicine".
Which MSL wrote this? There are no clinical studies that provide evidence that any of this works. Not much better than the "One weird trick" internet ads.

If you're asked to mention this, just say no.

Originally Posted by Anonymous View Post
Which MSL wrote this? There are no clinical studies that provide evidence that any of this works. Not much better than the "One weird trick" internet ads.

If you're asked to mention this, just say no.
"you are an idiot!"

Laurajean13 wrote on december 14th 2013, on a forum for laser burn victims: "Staying calm is not working, I am having extreme rebound from Mirvaso when I don't use it and wake up with my skin tight shiny and painful like burned tissue. I am traumatized and shocked everytime I see it or feel it. I feel like the only person whose gone through this. My face hurts, I feel so damaged. I was so invested in my life and future and this ripped it apart. I don't see how any life of normalcy follows this. This is the first year I won't have a holiday. I just wish there were real solutions and real answers. In the meantime I will do masks and try to hydrate."

Mat83 wrote on April 22nd 2014: "[..] Anyway this post is already becoming long but I wanted to give you some of my background before describing what happened. As you can see I pretty much had my rosacea under control, that was until is tried this terrible drug MIRVASO. I saw their stupid commercial Red is Wrong and My derm had a few samples. I'm always very skeptical of introducing something new into my regimen so I start off very slow. In the case of Mirvaso I only used the cream ONE TIME and used much less than a pea sized amount on each cheek, I used 1/3 of a pea size on my forehead, 1/3 of a pea size on each cheek, therefore at most I used 1 pea over my whole face AND I even mixed it in with moisturizer before applying because I read some posts on here that mixing it with a moisturizer was a way that people were seeing less side effects. Anyway, even while I had on the Mirvaso during the first 8 hours I didn't like the way my face felt, even though my face wasn't red I felt like I was flushing, it was very uncomfortable. Also I felt a weird pins and needles feeling (as is described in the drug side effects).
After 8 hours I experienced extreme rebound flushing like I've never experienced before and my face was very red for the rest of that night. The next day my face was not quite as red but still felt like it was burning so I left work early. Fast forward 15 days and my face still feels very hot, I feel like using Mirvaso JUST ONE TIME and a VERY REDUCED APPLICATION MIXED WITH A LOT OF MOISTURIZER has ruined my baseline flushing response. Its been 15 days since I tried it and my face is still VERY HOT it feels like I have a sunburn. I feel like I'm avoiding people at work because my face is so hot I'm afraid I'll blush so easily. My face thankfully is not as red as it feels, but it is more pinkish than usual. I feel like using Mirvaso one time has now dilated the blood vessels in my face and that this will in turn make my rosacea worse. This is why I immediately started taking doxcycycline 100mg twice a day and will continue to do so for another week at least. I've read some posts about it taking approx 3 weeks to return to baseline, I'm really hoping that is the case because I can't take this shit much longer. Can some people please share their stories about how long it took you to get back to baseline? And please include how long you used the medication (you would think this would be obvious to include but I've seen posts stating how long it took to return to baseline without including how many days they used the medication, very non-detailed). I really hope my face cools down I can't believe it's still this hot. Also if some of you could share if vbeam helped you get back to baseline, I'm considering getting this done before getting an emergency Botox treatment to help with this flushing."

Beauty pageant winners 1922
Shikasta replied: "In early February I applied a very conservative amount to my cheeks, chin, forehead and nose from a sample tube at 10 a.m. Half an hour later I was very pale...ghostly, slightly yellow. At 2.30 I experienced some breakthrough redness and bumps on one cheek. I reaplied a very small amount to the area and my skin cleared and became pale again. At 8.30 p.m. my rosacea returned, but worse than baseline. Having read in the Mirvaso literature that side effects might include a worsening of rosacea symptoms, I decided to discontinue. By morning my skin was clear again and pale. By 2.30 that day I had an extreme flushing reaction...dark red...purple almost...very hot to the touch and completely out ot the realm of any flushing I had ever experienced prior. Panic set in. I found the negative user reviews at David Pascoe's site. This helped calm me because other users had experienced the rebound for around 10 days. My boyfriend who is more scientific than I am also calmed me by explaining what was happening chemically similar to Visine, a vasodilator. The flushing reaction pattern continued each afternoon for 12 days...subsiding a little each day. My advice is to be patient...let your body regain its equalibrium...keep the faith. You are going to be okay." [..] I mean "vasoconstrictor." My boyfriend's idea was that the chemical in Mirvaso was sending a signal to the brain to inhibit normal blood flow, and when this chemical wore off at night the neurotransmitters were over compensating in the other direction. I'm an artsy type please forgive me. Give your body a chance to work it out of its system. Relax and take good care of your emotions. Whew! Keep us posted Mat83...I just wish we could somehow prevent others from going through this. It's an important lesson, to be sure."

On the Galderma rep forum the news of these severe rebound flushing finally seems to have sunken in as well (link):

"Have you seen the reviews coming in for this stuff? It took our guys 7 years to 'develop' this thing and it still has the same rebound that made it unusable back in 2007. Frenchy realised it was a no go when he was still around and still decided to grease enough hands to get it released onto the market. Now us reps have a $300 lotion to push that only works for a week at best before ruining our customers faces for the next month. The joys of working at a morally and soon to be financially bankrupt company like Galderma"

"Yeah its selling now because most people are just trying it for the first time and see the great results you get from the first weeks or so of use. Don't expect much more than a 20% return rate as they start hitting the rebound and never want to touch the stuff again." 

By Joe Caffrey

Aimhigh wrote on May 6th 2014:  "Someone PLEASE tell me this horrible PURPLE flushing will go away!! I only used the Mirvaso for 5 days and the rebound flushing is terrible. I am on fire. My cheeks and my nose are so red they truly look purple. I’m devastated. No trigger, no warning…just a deep dark horrible flushing. Ugh. So sad and disappointed in this product. Prior to using the product my flushing was considered moderate…I am well past severe now. Has anyone had any luck with IPL after using Mirvaso?"

GG wrote on May 7th 2014: "I have been using mirvaso for 2 weeks, and I am at my wits end. I have worse rosacea NOW than before I started it. The directions say to use it all over my face (you know, the pea size amount on the 5 areas), and I now have pimples in places where I NEVER had rosacea before!!! It made me feel weak, gave me a headache, caused me to turn white as a sheet for about an hour, then I started getting big red areas in varying places on my face during the day. Sometimes, I would put it on one day, then not use it the next day, but the next day my face would turn white and flawless out of nowhere. I am very confused about what this medicine is doing. I was self conscious about my face before, but now I am afraid to leave my house because of the rosacea pimples turning dark red, then white, then big smooth red burning areas turning up in various parts of my face!!!"

Kelly Scarborough wrote on June 3rd 2014: "I was also prescribed Mirvaso 2 weeks ago I have never experienced the flushing from foods, alcohol none of the “triggers”. I do not have pimples. Just a red face with the little blood vessels, I assumed it was from yrs in the sun. However I was diagnosed with Rosacea in 2012, so begins the endless scripts from Derms that really treat you as a Guinea pig, many topical and oral antibiotics. None of which worked because ..I DONT HAVE PIMPLES..so I finally went to my 3rd derm and was introduced to Mirvaso the miracle drug. I woke up the redness was almost completely gone..but by 2pm the following day my cheeks were very hot. I had never experienced this because again I don’t suffer from flushing. So I continued to use the drug for 6 days..I would look horribly sunburned when the medicine wore off. So I googled it and found that almost 90% of people who have used this have had the same reaction. I stopped using it and I continue to have this horrible red face that burns a week after stopping the medicine. I put a call into the Derm that prescribed it today and of course was called back by a nurse who not so politely advised me that all her patients love it…hmmm she continued to tell me that it is NOT a cure….I said no that is obvious…..it is a cause as my rosacea is much much worse than before I put this poison on my skin. She offered no advice. I usually do not leave comments but I wanted to WARN anyone that is considering this to please read the comments of actual rosacea sufferers and see what almost every person says about it. I am going to turn to natural products moving forward and leave the scripts that these dr’s push (to get their kickbacks) behind and pray the damage caused by Mirvsaso is not permanent. Hope this helps someone before they use it!!!"
applied it at bedtime and when

Kari continued to spread her advice about how Mirvaso is safe to use, to the annoyance of others, on June 3rd 2014: "NOTE: I do not work for Galderma BUT TRY THIS. You probably need a lot less Mirvaso than you are using. Try mixing a very SMALL SMALL amount of Mirvaso with a good facial moisturizer and then reapply it after things calm down. You could also mix it with Benadryl cream, that works okay too. You may find that it is effective and you may not get any redness after it wears off. I’ve been using Mirvaso with this method since the fall and haven’t had any problems."

Negative reviewer nr 2 here, Alyfpet, updated on May 29th 2014 her recovery, and still isn't back to normal: "Hi. I had a negative effect after 3 days of Mirvaso once daily and have never recovered fully. My skin is more red at baseline, more burny and itchy in general (the burns now travel down my chin to my neck, which was new), and definitely more swollen, which is one of the more disturbing aspects as I feel it all the time. And my flushes are from things that I never flushed from before (eg, walking briskly, carrying my 3 y old). My life has not been the same since I tried it. Truthfully, I'm not sure how I am getting through each day still. I keep telling myself that one day I will get back to where I was and I will be so much more grateful for being there. I thought my condition was bad then, but it was nothing next to now. My dermatologist is working with me to get me back to where I was before, but nothing has been helping. Coreg made me flush worse, and now I am on a trial of Neurontin, which also seems to be making me more red and swollen, although the itching has subsided. I'm hoping this update will help someone make a more informed decision before starting this medication, which I personally think must have been pushed through trials somehow. There is just no way that so many people could be reacting so negatively in real world, but the effects were so mild in trials. It just doesn't compute. At a minimum, I believe Galderma downplayed the flushing effect. Judging by the experiences of people on the forum, a statement along the lines that for some patients flushing is severe and the effects long-lasting would have been appropriate. The PI states that "erythema and flushing appeared to resolve after discontinuation..." which has certainly not been the case for me as well as others who have tried it. If just one person in trials reacted as I or others here have, it should have been stated in the PI. I haven't posted in quite a while because my experience has been so traumatic that I can't handle some of the more insensitive comments that other members sometimes make. I'm one of those RF members that tends to not use the forum so much when I am in crisis because of that. It is probably worth saying that I have a very difficult case. I relate most to Nat in how my skin reacts. My condition was hugely accelerated by a way too strong IPL treatment by an incompetent nurse at aesthetic dermatologists office. I do believe that those of us who have had bad IPL or laser experiences have somehow changed our vasculature/neurovascular system in a way that makes our rosacea more difficult to treat. Anyway, good luck to everyone. A"

A doctor, Todd C. Becker, MD, PhD, responded on March 6th 2014: "Mirvaso can offer dramatic though temporary improvement in facial redness. I have found that rebound flushing as you experienced is quite common. The Mirvaso has probably not changed your baseline condition and it should still respond well to treatment of the vessels."

Shikasta wrote 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?

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 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."
"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 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."

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."

Debra Tolle wrote
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!

Rosacea84 wrote on July 30th 2015: "Hello, I am new to this site and wanted to share my experience with Mirvaso. I wish I had done my research before I started using it because I did not sign up for this! I suffer from Erythematotelangiectatic Rosacea and was hoping to find relief with Mirvaso. I know it is not a cure but i did not know that it could the rosacea worse. I used it for the first time after I exercised and within 30 minutes of applying the gel my skin became porcelain white. I kept looking at myself in the mirror all day because I was so pale - it looked odd and unnatural. That night I woke up to my whole face on fire - horrible redness and burning like I had never experienced before in my entire life. I had to sleep with a fan on my face in order to go back to bed. At this point, I did not want to use it again because of the reaction i had. For the next few days i had horrible rebound flushing that usually occurred in the afternoon around 3 pm and lasted all night. I was not using the cream anymore and was doing my best to avoid my triggers to lesson the flushing. Nothing helped and after 3 days of this I used the cream again (very little, mixed in with moisturizer) on my cheeks hoping for some relief. It took longer for it to kick in this time but maybe this was because I was already in the middle of a rebound flushing episode? Coming off of it, it didn't last as long as the first use and I experienced rebound flushing again that was just as bad as the first time. I know I need to throw it out so I am not tempted to use it again out of desperation, but I can't bring myself too. I called my derm last night and made an apt. for a v beam laser today. Hopefully this helps with the redness and flushing. Lasers have been the only thing that have worked for me in the past and I have tried a lot (oracea, metro gel, propranolol, vit k serum, claritin, tagamet). I don't think mine is related to hormones, it might be more to do with my diet. I have a weakness for sugar. Any way, I just wanted to share my experience. I don't know how this drug ever got approved because it has turned my life into total hell. I did read the results from the clinical trial and find it a little hard to believe given what I have experienced and read on this forum."

Mat83 replied (link): "Sorry to hear about your experience however I am not surprised because this is a terrible drug that just makes Rosacea and flushing worse. The best thing you could've done is throw it away and never touch it again. Honestly, the #1 thing that will help you get back to pre-mirvaso is TIME. You have to be patient because the 1st month after discontinuing will be the worst reboud flushing. Then as months go by your face will slowly get back to pre-mirvaso condition. Its been 15 months since I stopped using Mirvaso (I tried it just 1 time) and my face is probably 95% back to pre-mirvaso. I no longer experience increased flushing but it still has made my rosacea worse over the last year with increased p&p, but even this seems to be subsiding finally. Besides time, these things helped me the most:
1) Right away I would get on an oral antibiotic for 1 month. If Oracea hasn't worked for you in the past then get on Doxy 50mg generic once a day. Take a good probiotic every day while you are on anti-biotics, such as Ultimate Flora.
2) V-beam treatments (Candela Perfecta only) also helped me. I had 4 of them done over the course of 8 months. I think the first time they did it on a very high setting and over 500 pulses on my forehead and cheeks. Take a benadryl before the procedure. Apply a topical steroid foam after the procedure and ICE ICE ICE your face as much as possible. Dont plan on working for 2 days after the v-beam. I paid approx $200 per vbeam treatment.
3) I'm a huge fan of getting Botox injected intradermally into my forehead and cheeks 3 times a year. I get 25 units diluted with 1cc of water. Botox has become a well known treatment for flushing blushing and rosacea and I've been doing it for years. It even helps with acne and in reducing oily skin. If you decide to do this make sure you do it around a week AFTER the v-beam. Never do a laser treatment after botox , always before. I pay approx $225 for 25 units of botox.
4) Sleep with 2 pillows, try to keep your head elevated. Try to sleep on your back and not on your sides. When I slept on my sides my cheeks were pressed against the pillow and that seemed to make them worse.
5) Continue using your regimen and products which worked for you pre-mirvaso. For example, I like Finacea and Sodium sulfacetamide cleanser so I continued using that. The last thing you want to do is shock your face with new products right now.
6) Spray your face with lots of thermal spring water, its refreshing and cooling.
Good luck with everything hope that helps. The best thing you can do is NEVER TOUCH MIRVASO AGAIN, no matter what the dermatologist says. ALSO, stop eating so much sugar it is terrible for you. Just stop and your body will adjust over time."

News items on Mirvaso rebound flushing


This article shows the effects of Mirvaso, comes with a lovely illustrative picture:

Severe Mirvaso Rebound Redness: Dermatitis Medicamentosa
Written by David Pascoe in Mirvaso Gel (Brimonidine 0.33%), Red Face of Rosacea 

(Left) One hour following application of Mirvaso with initial blanching and improvement of baseline erythema.

(Right) Twelve hours following application of Mirvaso with significant increase in baseline erythema.

A recently published short article in Dermatology Online Journal is proposing the use of the term Dermatitis Medicamentosa to describe one patient’s severe rebound reaction to Mirvaso. This newly proposed term is based on a similar rebound reaction observed in rhinitis medicamentosa where nasal decongestant sprays can have negative reactions worse that the original symptoms. The authors say that rebound redness from Brimonidine is a “significantly distressing potential side effect that may be underreported with little photo documentation in the literature to date.” Now that the above image is available, everyone can plainly see just how distressing and serious rebound redness to Mirvaso can be. The patient consented to the use of their photographs and the journal article is made available under the creative commons attribution license. The full PDF of the article is available here – Dermatitis medicamentosa: severe rebound erythema secondary to topical brimonidine in rosacea. Other severe adverse reactions to Mirvaso have been published in the JAAD – see Mirvaso Rebound and Stinging Documented in JAAD. 

Worsening  Reaction
The article details this rosacea sufferer’s experience with Mirvaso. The patient reported significant improvement to baseline erythema and flushing initially, in the first days of treatment with Mirvaso, with associated elevation of mood and self confidence. However, during the second week of treatment, the patient began noticing some gradual worsening of baseline erythema several hours following treatment, only improved with subsequent application of Mirvaso. The patient contacted her provider in tears two weeks into treatment for severe facial erythema at which time the patient’s use of Mirvaso was discontinued resulting in improvement of erythema and flushing thereafter. The course of symptoms that progressed with use of Mirvaso included an initial blanching for one to four hours after application (Left Image), with gradual facial erythema to a point beyond baseline around 12- 13 hours following application (Right Image). The article tells us that the patient was able to subsequently find relief from the application of pimecrolimus 1% cream (Elidel) and several treatments of pulsed dye laser.

Article Abstract
Dermatitis medicamentosa: severe rebound erythema secondary to topical brimonidine in rosacea. Dermatol Online J. 2015 Jan 1;21(3)., Werner K, Kobayashi TT. Rebound erythema secondary to use of topical brimonidine in the setting of rosacea is an important, possibly significantly distressing potential side effect that may be under-reported; there is little photo-documentation in the literature to date. This article documents such a case.

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

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

Written by David 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?

“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.”

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%

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

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.1, 2, 3 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.1, 2

In this medical article from July 2017, a researcher found the incidence of rebound worsening of flushing and erythema from both brimonidine (active ingredient of Mirvaso) and oxymetazoline (active ingredient of Rhofade) low. However, the disclaimer also mentioned this:

DISCLOSURES:In relationship to this manuscript, Dr. Del Rosso serves as a consultant, speaker, and research investigator for Bayer HealthCare Pharmaceuticals (Dermatology). He is also a consultant, speaker, and research investigator for other companies that market products used to treat rosacea, such as Allergan, Galderma, and Valeant. Dr. Del Rosso has served as the sole author of this article and has not received any form of payment for writing and submitting this article.

And as Brady Barrow very correctly commented on this research paper: "James Q. Del Rosso, DO, FAOCD, FAAD, the author of the paper published in the Journal of Clinical and Aesthetically Dermatology, is one of the current directors and past president (2009-2011) of the AARS. He comments on the rebound issue with brimonidine with this statement: 

"It is not entirely clear why some individuals treated for rosacea with brimonidine 0.33% gel experience worsening of facial erythema or why different clinical patterns of worsening of erythema may occur. Fortunately, these reactions resolve, but they can lead to discontinuation of therapy in many cases and/or may dissuade some clinicians from treating other rosacea patients with topical brimonidine."'

It is clear why brimonidine causes worsening of erythema (rebound) because "brimonidine treats reddened skin (erythema) by causing narrowing of blood vessels (vasoconstriction)." Wikipedia
After the effects of brimonidine wears off vasodilation returns big time. And the more you use it, the worse the vasodilation causes rebound and the accompanying erythema. With Rhofade (Oxymetazoline Hydrochloride) Del Rosso writes, "These data suggest that treatment-related worsening of facial erythema occurring during active use and/or after discontinuation of therapy (defined as rebound in pivotal clinical studies) are uncommon with oxymetazoline hydrochloride 1% cream." The data was that "Adverse reaction reporting captured during treatment phases showed that application-site erythema was noted in one percent of actively treated subjects versus 0.4 percent in vehicle-treated subjects in the pivotal studies and in two percent of actively treated subjects in the long-term study."
The results reported in RF indicate that there is less rebound and worsening of erythema with Rhofade (Oxymetazoline Hydrochloride) than with Mirvaso (brimonidine). Dr. Del Rosso states in conclusion, "Clinical trials completed with oxymetazoline 1% cream suggest a low to negligible risk of worsening of facial erythema or rebound, although postmarketing clinical experience with oxymetazoline is still early."
Dr. Del Rosso then asks this question: "Is it possible that different adrenergic receptor binding properties and pharmacologic/pharmacodynamic activities between the topical α-agonists can result in differences in the potential for worsening of facial erythema of rosacea, such as paradoxical erythema (occurring within 4–6 hours after drug application) or rebound (occurring after the effect of drug has dissipated or therapy is stopped)?" Of course, there could be differences. "

Please also read the following forum discussions about Mirvaso for rosacea:
Raymond Leech

David Pascoe wrote a piece about Mirvaso rebound flushing claims:

Please read also this Mirvaso thread 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: http://www.youtube.com/watch?v=5O2ACrHtikQ


I tested brimonidine tartrate (Mirvaso's active ingredient) back in 2010, together with a few other Rosacea Forum members, and you can read the test results here and here. At the time we were all waiting for Mirvaso, by then unknown by that name and assumed to be called Sansrosa, which now seems the working title at the time. Next best thing was to test the active ingredient and some used a brimonidine eye gel for this, most under supervision of a dermatologist. I made my own mix under a pharmacist supervision. We used the dose of this eye gel, 2 mg/ml of brimonidine tartrate, and later a slightly stronger mix (between 2 and 3 mg, had only 5 mg of brimonidine so it can't have been more than 3 mg that was left). The stuff gave me a pale face initially and a red face later on. I did splash it on however and used a lot more than people are now told to use of Mirvaso. Nevertheless, brimonidine, in certain amounts, seemed able to constrict and then dilate the blood vessels abnormally. I didn't use Mirvaso though, and the mix I made with help of my pharmacist did not have the same amount of brimonidine tartrate in it as Mivaso turned out to have. Mirvaso is not available here in Europe and I can't try it out. The main link between the brimonidine trial and Mirvaso, is that we tested the brimonidine action, Mirvaso's active ingredient. It might well have been the wrong dosis for success. I also wrote at the time and recently that I have a pretty bad case of vascular rosacea, and flush very easy. 

On top I couldn't handel topicals on my skin. That made me a not very average test person, and in theory more prone to flushing side effects. Below are reports of people who actually used the real deal Mirvaso, exactly (or hopefully) as the doctor ordered it, and most also followed the instructions regarding amount (pea size drop) and application times a day. You can read for yourself how they have been doing so far. Please also visit Brady Barrows rosacea site, who is the instigator of the lists below. I keep updating it with possitve and negative reviews when possible.

The pictures of me below are taken in the brimonidine trial. I tried to come as close as by then possible to the Mirvaso (then only known under its working title Sansrosa) formula. I experienced whitening of the skin, followed by very hot and forceful rebound redness, burning and flushing.

In this official report, only 3% of rosacea patients, who used Mirvaso for 29 days, reported flushing as a side effect and only 4% reported redness. Here it is translated in a simple table. In reality, the amount of negative patient reviews has been a lot more, with the large majority of rosscea patients on the rosacea forums reporting increased redness and flushing soon after starting with Mirvaso treatment, and some complaining of increased rosacea symptoms, sometimes significantly, up until a month or longer after discontinuing. I 
will keep checking for public patient reviews online and medical news on this product.

No comments:

Post a Comment

scarletnat@gmail.com, http://www.facebook.com/scarlet.nat.3