Rhofade
Rhofade is a similar topical, but uses another basic ingredient than Mirvaso: oxymetazoline hydrochloride.
Rhofade is a similar topical, but uses another basic ingredient than Mirvaso: oxymetazoline hydrochloride. Oxymetazoline belongs to a class of drugs known as a sympathomimetic (alpha receptor agonist). Where brimonidine is normally used for glaucoma of the eye, oxymetazoline is originally used for a nasal spray. As such, it helps to constrict the small blood vessels in the nose of patients suffering from nose (allergic/viral) congestion. By narrowing these small blood vessels in the nose, patients can breath more freely. Pharmaceutical company Allergan* (so not Galderma who produced Mirvaso) thought that as such, oxymetazoline could also potentially help rosacea patients who have redness of the face. And in fact, oxymetazoline works for rosacea skin too, by narrowing the blood vessels in the face. Oxymetazoline is a long-acting topical drug that constricts, or shrinks, blood vessels. That is how it relieves congestion in the nose. But people who use nasal decongestants for allergies, colds or sinus problems are warned to use such products for only three to five days. After that they may experience rebound congestion as the medicine wears off. The same thing can happen when it is used in the eyes. Rebound redness occurs when the blood vessels dilate after the effects of the medicine fade. It can take several days (or sometimes longer) for this effect to gradually disappear. The good news is that Rhofade is more gentle than Mirvaso; it doesn't make you instantly pale like a ghost as Mirvaso has the capacity to do, but it also makes it less likely that you will turn just as beet red and on fire after the effect wears off. Nevertheless there are stories of rebound flaring for Rhofade too. After all; it works only temporarily on the blood vessels. And constricting and dilating the blood vessels long term can in effect weaken them. Therefore I didn't want to make a blog post for Rhofade for a long time. I am most definitely NOT going to use or even try Rhofade myself. My blood vessels are too reactive and my skin too sensitive to take any such risks. Besides, I tried brimonidine in the past and had terrible painful long lasting rebound flushing that made me look beyond purple red. But now that I am reading more user reviews (both positive and negative) and am realizing that regardless of the risks, a certain group of rosacea patients seems to actually benefit from this product, I will make a blog post about it after all. Just want to urge caution with this product though. The impression I am getting is also that Rhofade is more suitable for rosacea patients with mild to moderate redness and flushing of the skin. If your skin is very reactive and you have more severe flushing issues, I would personally stay clear of this product, as you do risk dealing with rebound flushing and potential weakening of your blood vessels and increasing their reactivity.
So please use this product with great caution, and realize that you may experience rebound worsening of your flushing and redness from Rhofade
The fact that Rhofade got FDA approved in 2017 doesn't mean it is safe to use for everyone unfortunately, as we have seen with Mirvaso which also got FDA approval despite coming with a hefty side-effect risk - which for a long time was covered up by the company. Statistically, Rhofade will also not work for everyone. This pubmed article details that "many individuals using this agent (Rhofade) appropriately experience results consistent with the favorable efficacy outcomes described in the clinical trials". Which came down to a chance of around 15-20% of Rhofade working for you (roughly 1 in 6). But on top of that it is admitted in the research paper that no real life users were interviewed, and instead the results that were discussed came from controlled clinical studies. Which may sound like reliable sources for information, but as we all know can be manipulated by the manufacturer of the drug. Galderma for instance declared that in clinical trials only 2% of rosacea patients noticed side-effects like rebound from their product Mirvaso, when in fact that number was later revealed to be 10 to 20% in clinical trials and much much higher percentages among real time users on countless patient forums and patient sites. One can of course always debate how well a representation such forums are of the average user (they attract typically more unhappy patients than content ones, perhaps?), but the initial released 2% has been debunked thoroughly either way. So I am not trusting clinical trial outcomes blindly when it comes to topical medication like Mirvaso or Rhofade. I scour through all the real life patient reviews, trying to - hopefully - get a more realistic view of how patients tolerate rosacea treatment options.
Possible side-effectsSuspicious is also that Rhofade's information leaflet does not flat out mention rebound flaring as a potential side-effect. What it does mention: "Most common adverse reactions (incidence > 1%) are application site dermatitis, worsening inflammatory lesions of rosacea, application site pruritis, application site erythema, and application site pain." Application site dermatitis means a red rash on the skin that has been treated with Rhofade (and not rebound redness or flushing). Pruritis is severe itching of the skin. Worsening inflammatory lesions refers to p&p's and fixed redness inflammation (not transient redness that comes and goes due to the blood vessels expanding), and the same goes for 'application site erythema', although this one may come closest to what we would call rebound flaring. Yet it is something different. Nevertheless this pubmed articles interprets it as rebound flaring: "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. 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. Ultimately, it will be very important to see what observations are made with more widespread use of topical oxymetazoline in real-world clinical practice in patients with rosacea." The article also underlines that there are few useful medical trials to get information from. The information leaflet also brings up one of Allergans own patient trials: "A total of 489 subjects with persistent facial erythema associated with rosacea were treated with Rhofade once daily for 4 weeks in 3 controlled clinical trials. An additional 440 subjects with persistent facial erythema associated with rosacea were also treated with Rhofade once daily for up to one year in a long-term (openlabel) clinical trial. Adverse reactions that occurred in at least 1% of subjects treated with Rhofade through 4 weeks of treatment are presented below:
-Application site dermatitis 9 (2%)
-Worsening inflammatory lesions of rosacea 7 (1%)
-Application site pruritus 5 (1%)
-Application site erythema 5 (1%)
-Application site pain 4 (1%)
In the long-term (open-label) clinical trial, the rates of adverse reactions over a one-year treatment period were as follows: worsening inflammatory lesions of rosacea (3%), application site dermatitis (3%), application site pruritis (2%), application site pain (2%), and application site erythema (2%). Subjects with persistent erythema along with inflammatory lesions were allowed to use additional therapy for the inflammatory lesions of rosacea." Do not apply on irritated or broken skin. Apply a thin layer of medication to cover your entire face (forehead, nose, cheeks, and chin) as directed by your doctor, usually once daily. Wash your hands right after applying this medication. Do not use in your eyes, mouth, or vagina. Avoid contact with your lips and eyes. If you accidentally get this medication in your eyes, rinse with large amounts of cool water. Warning, Rhofade may impact blood pressure and should be used with caution in patients with severe or unstable or uncontrolled cardiovascular disease, orthostatic hypotension, and/or uncontrolled hypertension/hypotension. The official advise is for patients with cardiovascular disease, orthostatic hypotension, and/or uncontrolled hypertension/hypotension to seek immediate medical care if their condition worsens. ALso important: David Pascoe highlighted the increased risk of oxymetazoline/Rhofade being involved in the development of heart valve damage risk. This is a very serious issue so please read more about this here. *Pharmaceutical company Aclaris has bought the world wide rights of Rhofade in 2018. They were also involved in the early phases of Rhofade's development.
In this pubmed trial oxymetazoline cream 1% was tested on rosacea skinIt called oxymetazoline (also used in Rhofade) "a safe, tolerable, effective treatment for moderate to severe persistent facial erythema in patients with rosacea." This phase 3, double-blind study evaluated the efficacy and safety of topical oxymetazoline in 440 patients (mean age, 49.5 years; 78.9% females) with moderate erythema (redness) of the face, correlating with moderate to severe rosacea. Patients were randomly divided into groups who were given oxymetazoline hydrochloride cream 1.0% or another neutral topical. They applied it once daily for 29 days, and were followed for 28 days post treatment. Researchers found that more patients who were given an oxymetazoline cream showed improvement of their skin redness than those who were given a placebo. They noted at least a 2-grade decrease from baseline redness, based both on the evaluation of a clinician and based on the patients own judgement. A 2-grade decrease in redness means that if you had mild redness to begin with, you can expect almost pale skin with this product. And if you had severe fiery redness, you can expect mild redness after using Rhofade. Moderate redness can be reduced to slight redness. In theory :) Only 1.8% of the patients using oxymetazoline stopped early with the trials due to side-effects, compared to 0.5% of those in the placebo control group. The most common side-effects mentioned were "application-site dermatitis, application-site erythema, and headache" in the oxymetazoline group (1.4% each), and headache (0.9%) in the plaecbo group. Interesting is here that "application site erythema" is what they probably call what I'd call rebound redness. And that nobody in the placebo group mentioned this side effect, compared to 1.4% in the oxymetazoline group, which equals 3 people out the 220 group of oxymetazoline test patients. This side effect increased once patients stopped using oxymetazoline: "Following cessation of treatment, low proportions of patients experienced rebound effect (oxymetazoline group, 2.2%; vehicle group, 1.1%)." Read more about the result outcome here.
And in this pubmed research article, again 440 rosacea patients were studied (perhaps even the same test group), but this time longer; for 52 weeks. By the time the trial finished, after 52 weeks, 43.4% of the participants still in the trial had a 2 grade or better improvement in their facial redness, 6 hours after application. Based on this long term research, your chances of success with Rhofade suddenly increase to more than 40%, so 2 our of 5 people. Apparently, now 8,2% of participants reported side-effects; mostly local dermatitis (redness rash), tingling of the skin, pain or itchiness. And only 0.7% (3 people) of the 440 participants reported rebound redness at the end of the year, 2 weeks after the completion of the study. I am not quite sure if this is a reliable test outcome, given the much larger (seeming) percentage of real time Rhofade users mentioning rebound issues. Or do we only hear online from the unhappy minority? I take real patient reviews very serious however, whereas with such relatively small scale and single double-blind studies, it is not always entirely clear if the researchers were linked or even paid for their research by the pharmaceuticals who make the product. Strange as it may sound, this is common practice actually, and as you can imagine it throws some doubt then about the objective factuality of the whole enterprise. It's like the FAA asking Boeing to make rapports and certify the safety of their own planes.. . Oh wait, that actually also happened for real. And look what trouble that gave. Very interesting that those rosacea patients who had been treated with a placebo cream also reported in some cases to get rebound redness after stopping it. The researchers concluded that oxymetazoline applied to the face once daily for 29 days was effective, safe, and well tolerated in patients with moderate to severe persistent facial erythema of rosacea. It concludes: "Clinical trials completed with oxymetazoline 1% cream suggest a low to negligible risk of worsening of facial erythema or rebound, although post marketing clinical experience with oxymetazoline is still early." Another "however" is that there was nothing mentioned in the research papers about the scientists involved being independent and not somehow linked to Allergan pharmaceutical company, or paid by them. Something that may sound strange, but has in fact happened in the past with Mirvaso research (paid for or done by Galderma linked people). Some of the scientists who wrote it were in fact working for a Dermatology Consulting Service, a Laser Skin & Vein Institute, for Baumann Cosmetic & Research Institute, Inc, Miami, Florida and there we have it; Allergan plc, Irvine, California. So, very little research done on how this product is tolerated by rosacea patients, and the research that wás done is unclear about the neutrality of the researchers.
This trial mentions two case reports of people with skin redness and flushing using oxymetazoline cream 1%Topical oxymetazoline 0.1% solution was applied once daily to the face. After one hour both people reported a decrease of facial redness. Within 2 to 3 hours they mentioned a dramatic improvement of the redness of their skin. These effects lasted throughout the day. Both people actually kept using the 1% oxymetazoline solution for several months and mentioned "marked improvement in erythema without episodes of flushing or flares". And even after continuing to use the product for a whopping 8 and 17 months, they still felt it made their faces less red. And no rebound mentioned... Now, we have all been fooled by Mirvaso's initial test results, which also worked around the serious rebound problem, ignoring it entirely or estimating it to be an issue for only 2% of users. Often reps blamed that 2% on an "allergic reaction". In other word; nothing wrong with their problem, but in fact with the immune system of those unfortunate users. Then it turned out in reality that the product does give intense rebound for a significant percentage of users, and not due to allergies but instead due to the basal way in which it works. For everyone. Galderma knew about this problem, but chose not to solve it - for as far that is even possible with these type of blood vessel constrictors. One forum member said this about it all:
"I was on the Mirvaso clinical trials and quit the trial for rebound flushing. I was not the only one yet the drug went to market and in the beginning there was no mention of rebound flushing. My dermatologist even asked the Galderma reps about rebound flushing and they said there was none..."
Bottom line; they lied.... Eventually Galderma had to insert a rebound warning in their patient information leaflets, but it took them a long time to do so, and no doubt were doing it for legal reasons, as quite a few angry patients who endured short or long term damage from Mirvaso were trying to sue the Pharmaceutical company... The scientists went on to explain that decongestant like Oxymetazoline, but also other constrictors (and they mention here other α1-adrenoreceptor agonists, such as phenylephrine hydrochloride, naphazoline hydrochloride, tetrahydrozoline hydrochloride, oxymetazoline hydrochloride, and xylometazoline hydrochloride) work by binding the alpha 1 receptors on the capillaries (the finely branched out blood vessels in our skin), constricting them. If you use these products in the nose, they will therefore decreases the swelling in the nasal cavity, allowing more air passage. And when used on the skin, they constrict the superficial blood vessels in the skin, thus taking out the redness of rosacea. And when used in the eyes (as an eye product), they decrease the redness in the white of the eye. Now doctors warn not to use too much of it, because theoretically it could travel further into the body than the superficial surface, and even reach the deeper bigger blood vessels, affecting the systemic circulation. And that could be important to know for people with heart illness, blood pressure problems and such. But the chance of this happening is very small (given that we use it on the skin, and don't swallow it), and you would need to use a lot of oxymetazoline or comparable substance. Aside from constricting the blood vessels, oxymetazoline and comparable substances also have shown to have anti-inflammatory effects. The fact it can decrease proinflammatory cytokines, which are directly implicated in rosacea inflammation, is good news, on paper. "Oxymetazoline has also recently been shown to have significant effects on the arachidonic acid cascade, strongly inhibiting 5-lipoxygenase activity and thus decreasing the synthesis of the highly proinflammatory leukotriene B4." It is also stated to reduce oxidative-stress dependent reactions in inflammatory and/or infectious skin conditions, but scientists add that more research needs to be done on this one. So we will take it with a tiny pinch of salt, just yet. But promising info nonetheless.
About α-2 receptors (complex info from this research paper). "The α-1 receptors are located postsynaptically in the vascular smooth muscle within the region of the synapse; α-2 receptors are located presynaptically at the nerve terminal, postsynaptically in the vascular smooth muscle outside the direct region of the synapse, and within the endothelial wall. These anatomic differences may correlate with variations in individual drug activity under certain clinical circumstances (e.g., heating, cooling, differences in relative receptor expressions and locations). In most mammalian species, arterial vasoconstriction via directly innervated stimulation of vascular smooth muscle is mediated predominantly by α-1 adrenoreceptors, though other receptors also play a role in vasoregulation; both α-1 and α-2 receptors appear to contribute significantly to venous vasoconstriction. The presence of presynaptic a-2 receptors appear to inhibit norepinephrine release, which may contribute to vasodilation via a negative feedback loop mechanism. It is not clear when this mechanism would dominate in the clinical setting; however, this activity may potentially emerge in selected clinical situations where postsynaptic α-2 adrenoreceptor activity and/or density are diminished in rosacea-affected skin. More data are needed to further clarify the potential role of this mechanism in the clinical setting where worsening of erythema develops after topical α-2 agonist application. The presence of α-2 receptors on endothelial cells has been shown to mediate release of nitric oxide (NO), which induces vasodilation. Hence, stimulation of endothelial cell a-2 receptors may invoke a vasodilatory response. α-1 receptor stimulation on vascular smooth muscle is able to override the NO-induced vascular relaxation response. The potential triggers that may induce release of endothelium-derived NO are increased levels of shear stress, neurotransmitters, autacoids, and hormonal stimuli. In any given patient, the extent of α-2 receptor-induced vasoconstriction or vasodilation may reflect the net effect of α-2-invoked vascular smooth muscle stimulation (which causes vasoconstriction) versus α-2-mediated endothelial NO release (which causes vasodilation). When the latter response dominates, vasodilation occurs."
More details about this 2-person test caseThe erythematotelangiectatic (ETR) subtype of rosacea is characterized by frequent episodes of facial flushing and persistent centrofacial erythema (redness of the center of the face) and may be accompanied by telangiectasias (broken spider veins), facial edema (swelling), burning, or stinging. The pathophysiologic cause of the erythema is uncertain, and there are currently no satisfactory treatments for this common form of rosacea.
A 55-year-old man presented with a long history of ETR rosacea (subtype 1 rosacea with skin redness) manifesting with prolonged facial flushing provoked by multiple stimuli including heat, exercise, sun exposure, and the consumption of alcoholic beverages. He confided that he was particularly disturbed that, for many years, people frequently asked him: “Why is your face so red?” His condition had progressed over the last 15 years to include persistent facial erythema (redness). In addition to his usual triggers, he had noted that during his workday in an air conditioned office the erythema worsened, usually peaking in early afternoon, sometimes with concurrent facial stinging or burning. He had previously been treated with several oral antibiotics, multiple topical therapies including metronidazole, and most recently azelaic acid gel, with no effect. He asked if there was anything that might help the erythema and symptoms.
Case 2
A 70-year-old woman presented with a history of ETR rosacea (subtype 1 rosacea with skin redness), progressively worsening throughout her adult life. Although she had endured episodic flushing for decades, her erythema (skin redness) had become persistent in recent years. She had used numerous topical antibiotics for decades, including metronidazole, clindamycin phosphate, and combination sodium sulfacetamide, 10%, and precipitated sulfur, 5%, in an attempt to alleviate the erythema. She noted no improvement with the use of any of these agents and stated that she had continued using them “more out of hope” than because the medications had any effect. She had also used topical tretinoin with no improvement and had considered pulsed-dye laser therapy but had decided against it.
Therapeutic challenge
Erythematotelangiectatic rosacea, in general, responds poorly to treatment. Topical and oral antibiotics, standard treatment for papulopustular rosacea, are usually ineffective. Oral systemic agents such as β-blockers, clonidine hydrochloride, and spironolactone have little evidence of benefit; these agents also have potential systemic adverse effects. The pulsed-dye laser and, more recently, other nonablative laser and light therapies have been used to treat erythema and telangiectasias; however, not all patients respond, multiple treatment sessions are required, recurrences are common, costs can be significant, and flushing is often persistent. Our 2 patients demonstrate typical features of ETR rosacea with easily triggered, treatment resistant, socially embarrassing, persistent facial erythema and discomfort (stinging and burning). Neither patient demonstrated a papulopustular component, phymatous component, or ocular component to their disease, and conventional therapeutic options had not been effective.
Solution"An attempt to treat ETR rosacea using an over-the-counter drug known to possess vasoconstrictive properties was undertaken. A commercially available preparation of oxymetazoline hydrochloride, 0.05%, solution was applied once daily to the affected area of the face. Patient 1 and her physician noted a decrease in facial erythema within 1 hour of drug application, and a dramatic improvement within 2 to 3 hours. This effect was sustained throughout the entire day. After a 7:30 AM application of the drug, the patient noted an improvement in the chronic “baseline” erythema, and experienced a marked reduction in his transient flares. His erythema continued to be controlled in the early afternoon, at his normal time of peak erythema, and he experienced no stinging or burning. Patient 2 reported a similar improvement in her appearance and symptoms. Two weeks after initiating therapy, she was so pleased with the response that she sent her physician a letter of thanks indicating that the treatment was still effective and that she had discontinued use of topical metronidazole, her most current treatment. She returned 3 months after initiating therapy and continued to evidence marked improvement in the erythema and had experienced no episodic flares or flushing. Both patients were counseled that this treatment was “off label” and that even though the medication was over the counter, adverse effects could occur and could include the listed adverse effects of underlying heart disease, hypertension, thyroid disease, diabetes mellitus, and urinary retention. Both patients elected to continue treatment on their own. Patient 1 stated that “This is the first time my face has been normal in decades.” Six weeks after initiating once-daily application, patient 1 demonstrated continued control of the erythema and had complete relief of his facial stinging and burning. Neither patient experienced any adverse effects, has evidenced any rebound flares in erythema or other symptoms, or has demonstrated any tachyphylaxis to the current regimen. At the last follow-up examination, patient 1 had continued treatment for 8 months and patient 2 for 17 months, with sustained effects. Both patients had discontinued all other therapies directed toward their rosacea other than sunscreen use."
Shockingly low (official) success rate
Going by the published clinical data, it is stated that basically one in 6 or 7 users of RHOFADE will have a 2-grade improvement in their facial redness, typically for 12 hours, and continuing for 29 once-daily uses. 1 in 6, optimistically.. That is not a great success rate. I wonder what the reason behind this is.
Ingredients explainedEach gram of RHOFADE (oxymetazoline hydrochloride) cream contains 10 mg (1%) oxymetazoline hydrochloride and the following inactive ingredients: sodium citrate dihydrate, citric acid anhydrous, disodium edetate dihydrate, butylated hydroxytoluene, anhydrous lanolin, medium chain triglycerides, diisopropyl adipate, oleyl alcohol, polyethylene glycol 300, PEG-6 stearate, glycol stearate, PEG-32 stearate, cetostearyl alcohol, ceteareth-6, stearyl alcohol, ceteareth-25, methylparaben, propylparaben, phenoxyethanol, and purified water. Below I will explain a little bit more about these ingredients and mark those that can be skin irritants in red.
Sodium citrate dihydrate is used in cosmetics and personal care products as a buffering agent to control the pH level, but may also be used as a preservative. It is the sodium salt of citric acid, a weak organic acid that is naturally found in both plants and animals, particularly in citrus fruits. It is not known as a skin irritation or for allergic skin reactions.
Citric acid anhydrous is used in pharmaceutical preparations due to its antioxidant properties. It maintains stability of active ingredients and is used as a preservative. It is a weak organic acid that is popular for skin care use due to being a natural preservative and conservative. Topical citric acid can brighten skin, shrink pores, treat mild acne and correct dark spots and fine lines. It is used in skin care products to adjust the acidity of a product or promote skin peeling and re-growth in the case of anti-aging products. Citric acid is naturally found in citric fruits and juices, providing the characteristic acidic taste.
Disodium edetate dihydrate helps prevent the deterioration of cosmetics and personal care products. Cosmetic manufacturers frequently use this ingredient as a preservative, chelator and stabilizer, but has also been shown to enhance the foaming and cleaning capabilities of a cosmetic solution. Used in many personal care products.
Butylated hydroxytoluene (BHT) is used in a wide range of cosmetic formulations as an antioxidant and preservatives in lipsticks and moisturizers, among other cosmetics. They are also widely used as food preservatives. BHT applied to the skin was associated with toxic effects in lung tissue, but no significant irritation, sensitization, or photosensitization. Is safe as used in cosmetic formulations.
Anhydrous lanolin is used as a moisturizer to treat or prevent dry, rough, scaly, itchy skin and minor skin irritations (e.g., diaper rash, skin burns from radiation therapy). Used to soften and moisturize the skin and decrease itching and flaking. But lanolin also has a bad rep for irritating sensitive skin and causing allergic reactions. However, the amounts of lanolin used in cosmetic products like facial moisturizers are usually small.
Medium chain triglycerides (MCTs) are generally made by processing coconut and palm kernel oils in the laboratory. When MCT oil is applied to the skin, it will act as a high quality moisturizer in the treatment of dry skin.
Diisopropyl adipate is a lubricant, used to give skin a soft, smooth appearance, but is is also added to cosmetic products to soften synthetic compounds. It serves as an emollient or solvent that absorbs rapidly. Often used in cosmetic products such as perfumes, colognes, aftershave lotions, skin cleansers, foundations and lipsticks.
Oleyl alcohol is also used as a lubricant, giving the skin a soft, smooth appearance. Stearyl Alcohol and Oleyl Alcohol are mixtures of long-chain fatty alcohols, so not the same as regular (drying) alcohol.
Polyethylene glycol 300 (PEG 300) is a lubricant and an absorption enhancer which allows both good and bad ingredients to be absorbed faster into deeper parts of skin. If used on broken or damaged skin, it can cause irritation and system toxicity. In addition, PEGs can reduce the skin's moisture levels and speed up skin aging.PEG-6 stearate is another PEG. Used in cosmetics and personal care products as surfactants, cleansing agents and emollients. Some PEG compounds are not safe for use on damaged skin.
Glycol stearate is used as an emollient in cosmetic products, and is a combination of ethylene glycol (colorless chemical) and stearic acid (a common fatty acid). Glyceryl Stearate reduces the greasiness of oils used in certain cosmetics and personal care products.
PEG-32 stearate is another PEG and cleans the skin and hair by helping water to mix with oil and dirt so that they can be rinsed away. PEG Stearates are used in skin creams, conditioners, shampoos, body cleansers and soapless detergents.
Cetostearyl alcohol is used as an emulsion stabilizer; opacifying agent; surfactant - foam booster; and viscosity increasing agent. It is often used in creams and lotions as emollients and thickener. Fatty alcohols are not irritating and, in fact, can be beneficial for dry skin.
Ceteareth-6 is derived from olive oil) and used in skin care products, moisturizers, hair conditioners and such. Helps to form emulsions by reducing the surface tension of the substances to be emulsified.
Stearyl alcohol is a natural fatty alcohol derived from stearic acid, coconut oil or vegetable fatty acids, and is used to soothe and soften as a conditioning agent and as an emulsifier. Fatty alcohols are not irritating and, in fact, can be beneficial for dry skin.
Ceteareth-25 is another fatty alcohol that functions as an emulsifier and surfactant in cosmetics. It may be plant- or animal-derived or made synthetically.
Methylparaben, propylparaben are preservatives, antimicrobial; they can irritate the skin in very sensitive skin types. Parabens, including methylparaben, mimic the effects of estrogen in the human body. Possible skin irritants.
Phenoxyethanol has been used since the 1950s as a preservative in cosmetics and personal care products. It prevents the growth of fungi, bacteria, and yeast that could cause products to spoil. It can cause skin and lung irritation ans there have been toxic effects noted through inhalation, skin exposure, and ingestion. The product's Material Safety Data Sheet (MSDS) says that it phenoxyethanol is harmful if swallowed, inhaled or absorbed through the skin and that it can cause reproductive damage.
Oxymetazoline sprayRhofade can be expensive, especially when you live in the United States. In Europethe product is usually very affordable, in case Health Insurance doesn't cover its cost entirely (they usually do as it is a prescription drug). Rhofade has the active ingredient oxymetazoline, which as a nasal spray is available OTC. Some people have used the nasal spray as such for their skin and it has the same effect. It is however very important not to use too much. One pea sized drop of Rhofade cream is enough, and for oxymetazoline spray dosing is a lot more difficult. It is therefore not recommended, but rosacea patients have tried oxymetazoline in the past; both experimentally before Rhofade came onto the market, and afterwards because Rhofade was too expensive for some. Rhofade is in the end 'stolen' from nose sprays; it has the same active ingredient as Vicks sinex nose spray or Otrivin nose spray. It also works in the same way; temporarily constricting the blood vessels. In the nose, it makes you able to breath better while having nose congestion and on the skin it will help reduce redness. BUT, as written already, the big but is that for people with reactive blood vessels, it can cause rebound worsening of redness after it wears off. just like with its "big brother" Mirvaso (stolen from an eye drop that does the same). But Rhofade is not as strong as Mirvaso so makes the chance of profound rebound flaring smaller. But it still happens to some users, so comes down to trial and error. You may want to try this product on a small patch of skin first, and be careful. It is only a temporary aid and once the product wears off after about 8-12 hours you are either back to normal, or temporarily worse. If Rhofade works for you but the price tag is too high, try looking up products where you live that contain oxymetazoline perhaps, there have been similar experiences by others who tested it with the oxymetazoline nose sprays as with Rhofade. Also important to note; if you use Oxymetazoline as the active ingredient in decongestant products like Afrin, Sudafed OM and Vicks Sinex as well as in eye drops like Visine LR, then make sure to use it on a hydrated face. Either mix it with your moisturizer or splash your face wet with water first. Reason being that hydrated skin absorbs better. When the underlying dermis becomes saturated with water, junctions between the skin cells (gap junctions) become temporarily larger, allowing larger size molecules (of the oxymetazoline in this case) to pass on through. This occurs between the skin cells. Just as water will flow from an area of low concentration to an area of high concentration (called osmosis; when you eat salt, the salt in your blood pulls water into the vessels, increasing pressure) reverse osmosis works in the opposite manner: if a drug molecule sits outside the skin cell membrane, then it will be more likely to be "sucked" into the skin cell if it the skin cell is filled with water (water won't "sweat" out of the skin...skin is there to prevent this from happening). So, moisturize first in some form of another to increase skin absorption.
I will add user reviews of both Rhofade and oxymetazoline belowSpoiler: the majority of the reviews are negative. Mainly in a facebook rosacea support group I help moderate have I read more positive reviews. But due to privacy I cannot link to them unfortunately. But paraphrasing some of those reviews, people (verified real life people with rosacea) have been saying that they love it, that it works but is expensive. That it makes their face two shades lighter in terms of redness. That Rhofade brings the redness of their cheeks down. Others say their face burns less while using it, Someone had been using it once daily for a week and was seeing improvement in subtype 1 redness, saying the redness returns at night only once the Rhofade wears off, after 8 to 10 hours. Someone mentioned reduced flushing also and another wrote that Rhofade seems to prevent flushing. Multiple people said it works for 10 to 12 hours, unless a trigger food was eaten. Some had no redness (rebound) worsening after those 12 hours, others did go more red or pink and some mention days of relentless redness or flushing after use. Someone called it the Cinderella cream, only masking the redness cosmetically and only to be used for special occasions. Others use it daily, to prevent redness of the face during the day (and they just suck up the redness during the night). Some people noticed no effects, neither good nor bad. While someone else said that it should be used regularly in fact, to counteract possible rebound. For some it worked right away, for others the results only became visible after two weeks of daily use. And for some, it stopped working after a few months. Someone said about the Rhofade rebound that it is not like the rebound that Mirvaso gave, but that the pinkness does start coming through again after about 12 hours. Someone said the Rhofade dried the skin out too much, some others that it made their skin burn and hurt. Another person said that Rhofade ruined her face and to run as fast as you can from it. Or that it made the rosacea and burning worse. Someone said it made the face worse after 3 days of use. Some people suspected that they were allergic to some of Rhofade's ingredients, instead of dealing with rebound problems. Others mentioned it gave them acne which they never had before, or red splotches and rashes after use. Someone wrote that Rhofade made the blood vessels in the skin lazy and ultimately made the redness and flushing worse over time.
Person66 wrote on March 17th, 2019: "Horrible. Was prescribed this by dermatologist for mild rosacea, without any warning about possible side effects. I used this in conjunction with Plexion daily wash. Used no other facial soaps at all. Only other skin regimen was to use the recommended neutral moisturizers. Within 5 days of using rhofade the redness had become much worse. Before treatment, I just had a smooth simple blush. After 5 days of this "medicine", my skin had become much more red, over much more area. Instead of smooth slight red, it's bright red and blotchy, with bumps and break-outs forming. Dry and rough and yet looks very shiny. Itching became so bad that I could not sleep (I did resist urge to scratch). I stopped the meds 2 days ago but the symptoms persist. With so many negative reports here, how did this medicine pass approval? The studies claim only very low (like 2%) have adverse reactions. What is the truth here? How long will it take to recover? Or is the damage permanent? I rate it with a 1.0."
Redfacedman wrote on March 5th, 2019: "I had tried Mirvaso and had a terrible rebound redness. Worse than an rosacea attack. Plus it made me too pale. I have been using the Rhofade now for about three months almost every morning with a very mild amount of application. I have yet to experience a noticeable rebound. The only additional redness I have is right after application from rubbing it on my face. I do not get rosacea bumps too often but, I did have a small cluster the other morning on my forehead which I thought was diminished rather quickly by the mornings application. I have been very satisfied with my results from using Rhofade. I rate it 8.0."
Bill wrote on March 2nd, 2019: "Definitely reduces redness but with rebound redness that persists for multiple after stopping use. Both effectiveness and rebound are not quite as pronounces as with Mirvaso. There is no way trials showed no rebound. The FDA is failing us. I rate it 2.0."
Lynn wrote on March 1st, 2019: "I have mild rosacea with some stubborn redness, but nothing too upsetting. I have been doing IPL off and on to control the redness with great results. Recently for no reason, I can think of, my cheeks began to burn and turn bright red. I saw my dermatologist and got another round of IPL AND a sample of Rhofade put on my face before I left. Well that first day my skin looked almost normal before all the flaming redness popped up. BUT now my cheeks are back to flaming red and this is after getting IPL! I'm hoping the IPL will do its job and take care of the redness. I am taking a big pass on the Rhofade. I do not understand these extreme responses to this medication: many have really terrible experiences (like me) and some are praising Rhofade. Makes me wonder....anyway, a big NO on Rhofade! I rate it 1.0."
Kelly wrote on February 23rd, 2019: "Got a sample from my Derm. Used twice, and now my face is red, hot, inflamed, swollen, burning, etc... do not recommend. I rate it 1.0."
Buttercup wrote on February 19th, 2019: "Dr. Emily Goeller prescribed this cream for my very mild rosacea. I had slight redness but no bumps or pustules on my cheeks only. After one use of rhofade on one cheek only I had a flare up with pustules all over my face and my eyes burned. There are many bad reviews for this cream but that's typical for rosacea treatment. However, this cream is much worse than most other treatments. Almost everyone has a bad reaction and it takes months to heal. Compare rhofade reviews to azelaic acid reviews. Azelaic acid is much better. I recommend that you don't risk it. I rate it 1.0."
M wrote on February 19th, 2019: "I had mild unexplained flushing (mostly evenings) but otherwise beautiful skin. At my derm’s recommendation I used this across my nose/cheeks for 6 weeks to curtail flushing. The first 3 weeks it did eliminate most flushing, however when I washed my face at night the area where I used the rhofade was getting redder and redder. Went to the derm who explained there could be a mild temporary ‘rebound’ after it wore off and it was safe for everyday use. This night time redness/burning got incredibly bad last week to the point I went online and found these reviews. I stopped using the product immediately and in the last 5 days have had PAINFUL redness, burning and swelling to the point of using ice packs at night and my husband thinking we should go to the ER. Please, if anyone has experienced this and knows how long it will last (days, weeks?) I would so appreciate a word of encouragement that this is temporary and gets better. Thanks for sharing any experiences. I rate it 1.0."
Not happy wrote on February 12th, 2019: "I have mild rosacea and thought I could get it under control if I get a prescription from the dermatologist. I paid more than I should have for rhofade. I immediately experienced burning and the redness and swelling is so severe, worse than I’ve ever looked before! I’m so upset! I’ve obviously stopped using the product yet the irritation, redness and bumps have remained. I fear I’ve destroyed my skin permanently! How did this cream ever pass the testing phase and legally get distributed....I feel we are the victims and only wish I did my homework and saw these reviews before I ever tried this product! There needs to be a class action lawsuit. I rate it 1.0."Rosie wrote on February 8th, 2019: "I was told by my derm that this cream would help with my rosacea. It actually made it worse! I do not recommend using this product! I rate it 1.0 "
Anonymous wrote on January 30th, 2019: "DO NOT USE THIS PRODUCT. I used it for a month religiously then all of a sudden my skin broke out. It was even worse than before. I’m worried it won’t get better. It seems like this happen to a lot of people. How long did it take to heal? I rate it 1.0"
Mrsgvern wrote on January 28th, 2019: "I used Rhofade for my rosacea for 5 days. It seemed to be helping but my face started hurting like I was bruised all over. I started getting painful burning and swelling all over my face starting day 6. I haven't used it today being day 7 but my face is still bright red and swollen with bumps all over. I've never seen this much constant swelling and redness in my 10 years of menopause. This really hurts and I'm on vacation so don't know what to do. Even my eyes are burning. I rate it 1.0"
Ricki wrote on January 16th, 2019: "I would not recommend this medication to anyone. I suffer from mild rosacea and heard positive feedback from two physicians so decided to give it a shot. I applied the recommended “pea size” amount to my face yesterday at 9am. At about 9PM I washed my face and went to bed. I did not notice any reduction in my redness except for the first 4 hours. The rest of the day my face was like it always is. Today, about 18 hours later at about 5PM my entire face got very flushed, more so than it had ever done in the past. About an hour went by like this and now, two and a half hours post major flush situation only my right cheek is bright red and warm. I reported the adverse event to Allergan and am just praying this resolves on its own. I caution everyone to avoid Rhofade - I had this result from only ONE application. I rate it 1.0"
Tink wrote on December 31st, 2018: "I have been on Rhofade for 3 weeks now and was very skeptical at first because of these reviews but I have to say it has worked great for me and brings my redness almost to normal. I use this in the morning and Soolantra before bed and that has worked for me. Really happy about this Product and glad I tried it. I rate it a 10."
PK wrote on December 23rd, 2018: "DO NOT USE THIS PRODUCT!!!! I was prescribed Rhofade for mild rosacea and facial redness. I was very open minded and excited to try this product. After 4 days of use my face has broken out with pustules, severe inflammation, and is fire engine red. It is itchy and painful at the same time. Nothing seems to give me relief. Just in time for Christmas too. I am absolutely furious this product is on the market and being recommended. I rate it 1.0"
Laura wrote on December 12th, 2018: "I wish I'd read these reviews before using Rhofade. It seemed to help my symptoms for a few days, but then I started having intense, burning facial flushing daily (and still do, even though it's been months since then). Rhofade rebound is real and miserable. I rate it 1.0"
Crystal wrote on December 11th, 2018: "I have been using rhofade for 7 months for redness and flushing and I love it. I did not have any issues with bumps or anything. I did notice at first I had some small areas that would be a brighter red than the rest of my face when I did not use the cream. But I have been taking pictures of my face to compare and actually my face is way less red than usual even when I don’t use it. So the brighter red areas were actually the little areas that did not get lighter. I would not have realized this if I was not using pictures to track my skin. Now my skin on days I don’t use it is much less red. So I say over time this works to lessen the redness. But while it’s on your face it’s definitely not red at all for the whole day. Friday 6am applied before work still looking clear at 2am. The only bad side is the high cost of this cream. But it works very well for me I do not wear concealer or cover up at all I do use a light moisturizer 10 minutes prior to using rhofade. Not sure if that matters for bumps etc. I rate it a 10."
Crystal wrote on December 9th, 2018: "Had mild rosacea, red but not always, never pimples. Derm prescribed Rhofade now I am covered in pimples, BRIGHT RED skin worse than ever before. In fact I have horrible skin that cannot be covered with make-up. This should be taken OFF THE MARKET!!! It has ruined my skin on my face. THIS IS AWEFUL!!! DO NOT DO NOT USE"
Elaine wrote on December 1th, 2018: "Dr says this is the same as putting a 1/2 oz bottle of original afrin mixed with cerave 7 oz of am cerave cream shake well and apply a pea size amount to each affected area. Way cheaper. I rate it 8.0"
Mel12345 wrote on November 17th, 2018: "This medicine is everything I have been looking for. I never thought that I would find a solution to my redness that comes when I’m hot, embarrassed, flustered, etc. THIS IS IT! I can’t say that enough. The first day I used it it was wonderful, then it was about a 2 week period of annoyance before it finally started to work properly. It’s been 7 months since the first time I put it on and every single day I can count on having a clear face that’s the color of my skin (even when I’m flustered, hot, embarrassed, etc) My only problem was redness; I didn’t have pimples so I can’t speak to that. If your problem is redness like mine- TRY THIS and stick with it. I rate it a 10."
LNS wrote on September 24th, 2018: "I have rosacea and my face would always get severely red, bumps, feel like it was on fire and would have a stinging sensation. Rhofade, for me, has been a blessing. It is the only thing that completely takes away the redness and it works so fast. My dermatologist gave me samples and I was amazed by how wonderful this cream is. I’m saddened how many have bad side-effects or allergies to this because for me it was life changing and I can’t see myself without it. If I forget to put it on the redness does come back though. I really hope it isn’t expensive. I still have my samples and have been using for 2-3 months now."
Smith wrote on September 24th, 2018: "The first day I used it my skin looked better. The second day it started burning, itching, turning (tomato) red, swelling. I felt like bugs were crawling on my face. I would not recommend anyone to get this medication. My face looks worse then it ever did. If you are going to try it ask for a sample before you pay the high price it cost. I rate it 1"
TB wrote on September 23rd, 2018: "Used it once. Within two days I had blisters on my nose. I stopped using tit until the wounds healed. I tried it again. More blisters that break open and bleed. They take weeks to heal. I rate it 2.0"
Allergic wrote on September 4th, 2018: "I saw an ad for Rhofade and asked my derm for a sample. Contains oxymetazoline, which used to be the vasoconstrictor ingredient in Visine eye drops, so it made sense to me. Didn't see much effect for a couple of weeks; then, all of a sudden all redness broke loose! My face turned bright red, was covered with pustules, and itched like mad. It took weeks of coating my face with hydrocortisone to resolve."
Boomtown405 wrote in 2018: "Don't continue to use it if you get rebound flushing. I got samples from my derm who asked "have you heard of rhofade or mirvaso"? I said I'm scared of those products due to rebound flushing. He said "rhofade doesn't cause rebound flushing". I did some research and that's a lie it totally can. Maybe not as bad as mirvaso but it can. I think it goes without saying my samples will go in the trash. I went to the doctor wanting a prescription for clonidine as that can help flushing/redness dosed every 8 hours, he says he wanted to try mirvaso and a beta blocker carvedilol that's known to be a vasodilator. I'm considering ordering clonidine online and i wont be using either of the meds my derm tried to give me.."
Byu/altruismandme wrote on August 2018: "Hi guys! I was recently diagnosed with rosacea and prescribed rhofade for treating redness. I’m aware that in some people, it causes more redness. On first use, I was absolutely stunned. I had never seen my skin so.. normal. My boyfriend even noticed, “wow, your skin isn’t pink!” And I didn’t even tell him I’d tried anything different. I’ve been using it every day since then and... it does nothing. It doesn’t make it any better or worse. I’ve tried the recommended “pea sized amount” and a bit more. Why would it work once and never again?! Has anyone experienced this or have any advice? I was so happy that first day."
Someone replied on August 2018: "Vasoconstrictors like Rhofade and Mirvaso build up tolerance quickly. Be glad that you didn't experience too much rebound redness because from what I've read it can be quite serious. Personally, I only use Rhofade for special occasions such as weddings or interviews."
Rudolph No More wrote on July 25th, 2018: "For 5 years Drs prescribed all the same stuff Soolantra, Clindamycin, sulfacetamide, etc etc Same red nose Same pustules Rhofade ended it No more red nose No more pustules I wish the Dr wouldve skipped all that other stuff that did not work and went straight to Rhofade I don't know what these other people are talking them in when they say it doesn't work because I have never seen anything work like this Literally within 2 days"
Thomas wrote on June 29, 2018: "Rhofade on my skin:
– Full effect after 3 hours
– Full effect during 7 hours + after half effect during 2 – 4 hours
– After 5 months : absolute zero side effect
– Visually: my skin is 100% white. Only in huge stress situations or very warm rooms my skin is 80% white (20% red)
– Disadvantage : doesn’t prevent the momentary redness (15 seconds), it doesn’t remove the burning sensation that characterizes rosacea (even if you are not red), the price (very expensive)."
John H wrote on June 29, 2018: "I’ve been using Rhofade for about a year now, and I still love it. In addition to rosacea, I have psoriasis and seborrheic dermatitis. I can’t use it when my SD is acting up or when I have a rosacea flare when I get lesions (my flares are really bad) because it stings and seems to inflame it. Luckily, my deem seems to have found the right combo to get things under control. I use Soolantra, sulfacetamide sodium lotion, and doxycycline. My wife is making me be gluten free too, so who knows what exactly it is, but the rhofade is the thing that makes the red go away for most of the day."Janet wrote on June 28th, 2018: "My dermatologist recommended Rhofade for mild rosacea – would only break out once in awhile. After using it for two nights I am stopping. My face looks worse than it did before I started using it. I was using Calm by Aveda before and will go back to that. An expensive lesson!!"
Kevin wrote on June 25th, 2018: "Wow! I knew I wasn't crazy. I noticed my face got super red after using Rhofade for a month. And reading these reviews confirmed I wasn't just seeing things. My face is worse now than ever before. I only had mild rosacea before Rhofade and now my face feels like it is on fire 24/7 and looks like I am sunburned. DO NOT USE THIS! THIS WILL RUIN YOUR LIFE"
Megan wrote on June 19th, 2018: "I love rhofade. I used mirvaso for years and dealt with the rebound redness everyday. I forget I have rosacea using this cream. Sorry to hear about all the people it does not work for."
Deltamike wrote on June 17th, 2018: "Same as other reviews, tried Rhofade for mild redness due to Rosacea. After only a few days of use, face started burning, redness increased, overall bumpy texture plus acne. I wish I’d have googled reviews before use (lesson learned), but blindly trusted my dermatologist. I wondered if it was a coincidence and something else was the trigger, but too many reviews sound exactly like my experience for that to be the case."
Jenny wrote on June 7th, 2018: "My experience with Rhofade was very similar to the other reviewers. My dermatologist gave me a free sample. The first day I put it on, my face looked less red. The second day, my face burned after I applied the cream and it felt like little needles were stabbing my face. I immediately stopped using it. My face looks more red than it did before. I hope it goes back to normal. DO NOT use this product!"
Starz777 wrote on June 6th, 2018: "Never ever use Rhofade! My dermatologist saw me one time and recommended it. I used it for three days and my skin is red as a tomato and all inflamed and raw. My Rosacea was hardly noticeable and very minor before I started using this stuff."
Lynne wrote on June 4th, 2018: "I had a similar experience.. looked great for couple days then one morning.. I was bright red and felt swollen.. I’m very sad cause I thought I finally found something to help me."
Kimhunter6121 wrote on June 2018: "My hubby got really bad rebound redness from this - looked like bad sunburn from his eyes down to his chin and over to his ears. First time he used it everything went to plan and he was happy to find something that worked. Day two - absolute disaster. Be really careful and make sure you are somewhere where you don’t mind if the rebound redness comes on. My hubby was at work and had to hide away for a couple of hours before he felt he could show his face again. Until I discovered this forum a day or so later we didn’t know what was causing the flushing. Still so mad the doctor didn’t say anything about it being a risk - it’s only when you start reading the reviews you find out how common this side effect is."
Xaniskai wrote on June 2018: "Yeah, I knew nothing about it when I first put it on! Thank goodness I only used it once. It’s the next day and I don’t have any more redness than usual, but I still won’t be using it again. For something with so many online reviews of bad reactions, you’d think they would warn you when it’s prescribed."
Kc1319310 wrote on June 2018: "Tried it twice, got such bad rebound redness both times that I threw it in the trash. It only worked on me for a few hours."
Byu wrote on June 2018: "I’ve been seeing a dermatologist this year to help with persistent acne and what I always suspected was rosacea. I was originally prescribed spironolactone for hormonal acne, and a steroid cream and anti-fungal cream for the redness (she thought it could be something else). I revamped my skincare routine but the redness remained. My derm says she thinks it’s rosacea. She prescribed me Rhofade last week and I want to cry it’s been so bad. I have never had rosacea bumps, just redness. Now it looks like I have a giant rash covering every part of my face. I literally just cleared up all of my acne, and I’d rather deal with the redness which I can cover with makeup than these bumps. Has anyone else had this happen to them? Did the bumps disappear after continued use of Rhofade? Did you immediately stop use? If you stopped, did the bumps eventually fade? Right now I feel like I destroyed my skin and every time I look in the mirror I want to cry at my stupid vanity."Whit1008 wrote on June 2018: "I had a bad experience with Rhofade too. As soon as I put it on, I was as red as a tomato. I tried again a couple days later, same thing. I no longer use it. So mad at myself for not asking for some samples before I filled the prescription. I have type 1 and 4, so bumps, papules/pustules, and acne rosacea aren’t really an issue for me. Rhofade didn’t bring any of that on, just intense redness. I’m already pretty red, so I looked so awful. I learned my lesson with topicals for sure, Samples first!"
Lalala wrote on May 30th, 2018: "I have acne rosacea and once I got the acne under control, I was prescribed Rhofade for redness. After a few days of use my acne was as bad as it was prior to using this garbage."
Leigh wrote on May 25th, 2018: "Used this trash 6 days now my face is red as a damn beet. I just had mild rosacea with occasional flare ups. Now my face is jacked up. Don't use this trash product. Don't be there guinea pig. I wish my dermatologist never recommended me Rofade."
Anonymous wrote on May 18th, 2018: "Why is Rhofade still prescribed? I wish I had read reviews first. Used only twice and I feel like it's ruined my skin. Increased redness and now I'm dealing with pustules...which I never had prior to use. If I could rate this a zero I would. I rate it a 1."
Alyse May wrote on May 16th, 2018: "I went to the dermatologist complaining of minor acne and some facial redness. I was told to use aczone and retin - both were fine. My derm insisted I try rhofade, claiming it was the new "miracle" cream for rosacea patients. I was so hesitant after reading all of these terrible reviews that I decided not to use it then. I went back for a follow up and again she was insisting I NEEDED to use this, it works wonders!!! I used rhofade for 3 days.... that's it. That was 4 weeks ago and since then I've been through the worse with my skin. Every square inch of my face is covered in red and white bumps!!! I've been on prednisone, a topical steroid, a topical antibiotic, an oral antibiotic for one month (still on), and now something called elidel. I am still trying to recover and this week the rash came back WORSE THAN EVER. So bad that I cannot go into work this week. If there is anything you take from this review - please DO NOT USE RHOFADE. Despite what your dermatologist tells you."
Veronique wrote on May 15th, 2018: "I tried this for mild redness on my cheeks, nose and chin. The first few days my face seemed to improve but then it got worse. This is the worst my face ever looked. I started to get some acne and dark red bumps on my cheek. I haven't had acne in the last 30 years. This medicine is terrible. My face burns. I stopped for the past two days but my face still has the bumps. I am also angry that my dermatologist prescribed this without mentioning these issues. DO NOT try this medicine!! I wish I read all these reviews. I rate it a 1!"
themildenthusiast wrote on April 2018: "Hi! When I went to the dermatologist for Rosacea like symptoms I was told that it wasn’t Rosacea but he didn’t know what it was. He still prescribed me Rhofade because I get extreme redness and hives on my neck and chest that I can get at any point during day for reasons such as embarrassment, eating too quickly, being outside in the sun, drinking alcohol etc. I have also gotten the rude remarks from strangers and even family about my redness and it just makes you feel worse! You are not alone! Rhofade works within one hour and keeps all of my hives and flushing at bay for up to 12 hours. I have read some negative reviews about it and couldn’t believe it! It works great for me. I was also prescribed Propranolol and I use them in conjunction with great results. For the first 4 refills of Rhofade, I received a coupon for my dermatologist that made my prescription just 40$ but without it, it is over 100$ with my insurance. I try to ration it out and don’t waste a drop lol hope you get it soon where you live, and that all this has helped you out!"Byu/krisnoelb wrote on April 2018: "Rhofade rebound out of control! My experience with it. I have a subtype 1 Rosacea that is usually well managed. I am lucky enough to not have acne and pustules and over all my skin is in pretty good condition thanks to a long process of finding the perfect routine (thanks SCA, I love you all). I was given samples of Rhofade, patch tested on the side of my jaw and was feeling confident I may be one of the patients that can tolerate it. Like all my new products I eased into it and noticed the first day little to no changed, the second day and third day my cheeks were less red and looked flawless! Oh the fourth or fifth day, I started to get a little red, but thought it was perhaps from exercise or a spicy soup I ate and this morning I woke up with an angry face in a lot of pain. Half way through work my neck became itchy and it traveled down my neck to my chest and then my eyes started getting puffy. After talking with my doctor on some rescue remedies (which included antihistamines, steroids, and anti inflammatory meds) it seems to be I am having a rebound reaction to the extreme. I thought I did everything right testing it out, only using it on my cheeks, the proper SCA way. Oh man, I will never use this product again and I urge anyone to be careful. Has anyone else had this experience; how long did it take to go away?"
ViolaineSugarHiccup wrote on April 2018: "Unfortunately this happens a lot with Rhofade and Mirvaso (different drug but also acts as a vasoconstricto). If you google rebound flush plus Rhofade or Mirvaso you'll find a lot of stories. I never tried either because of this and opted for laser treatment instead (I have subtype II but with a lot of redness). As for how long the rebound flush can last: Anywhere from a few days to several months from the various testimonies around the web."
Maria wrote on April 26th, 2018: "Awful experience!! I've been on Accutane for about 4.5 months and was diagnosed with mild Rosacea long time ago. I tried a sample of Rhofade ONCE and after 3 hours I felt it was the best thing on earth. My redness was completely gone but the next day when the effect was over my Rosacea got really worse than ever before. It's irritated, bright and spread redness with pain. Please if you are considering Rhofade try in a really small spot of your face first. I'm still suffering from that side effect and don't really know what to do to relief my redness."
sr840910 wrote on April 19th, 2018: "Be EXTREMELY careful with this medicine. I had minor redness of the face after taking accutane for 6 months. My doctor gave me Rhofade all nonchalantly. I began to use it once a day everyday for a few months. Well slowly I realized it was actually making my face more red. When I would not put it on, my face would be bright red, making me look ten times worse. I have completely stopped taking it now for about a month and my face is still very red. My doctor prescribed me doxycycline to help get rid of the redness but it is not working good. Does anyone have any suggestions? I would rather take a pill instead of a topical at this point. I tried propranolol but it made me dizzy and light headed. Please, anything would help I am desperate!"
SR wrote on April 18th, 2018: "Be EXTREMELY careful with this medicine. I had minor redness of the face after taking accutane for 6 months. My doctor gave me Rhofade all nonchalantly. I began to use it once a day everyday for a few months. Well slowly I realized it was actually making my face more red. When I would not put it on, my face would be bright red, making me look ten times worse. I have completely stopped taking it now for about a month and my face is still very red. My doctor prescribed me doxycycline to help get rid of the redness but it is not working good. Does anyone have any suggestions? I would rather take a pill instead of a topical at this point. I tried propranolol but it made me dizzy and light headed. Please, anything would help I am desperate!"
Jessie wrote on April 3rd, 2018: "I normally don't write reviews - and never before for a drug, but my skin is so red and inflamed, I felt I had to. The first week of using Rhofade was fine. I didn't see a big difference, but continued to use, thinking it may come in time. I have mild Rosacea on my lower cheeks (only). I felt that my cheeks were more red in the mornings (prior to putting on the cream). I ended up putting the cream on my apples of my cheeks - as the redness had spread. Days went by, and the redness became more apparent. Yesterday, I was covering my cheeks and had a tiny amount of product leftover on my fingertip. I spread a small circle on my forehead (no redness at all - completely pale white). It wasn't until mid-afternoon that I used the restroom and looked at my face. A small bright red circle was on my forehead. I was so embarrassed. This stuff is making me red. It making my cheeks tingly. I'm so frustrated I am out the $50 and left with a worse face. I rate it 1.0"
VAsufferer wrote on March 25th, 2018: "I was really excited to try this product after years of suffering from rosacea. The first dat it seemed great - dramatic reduction in redness. However, after another use it seemed to make my rosacea even worse (painful rebound redness). It wasn't just red - it was fierce red and burning. This product should come with a warning about severity of rebound risk. Big disappointment."
Teri wrote on March 22nd, 2018: "I have been using Rhofade for about 8 months, and I can really see a difference in my rosacea. I’m Norwegian and Swedish, very fair, and this has been better than Mirvaso, Finacea for me. I really like it. [..] I leave the Rhofade on for about 5 minutes before I apply my makeup. Also, I sometimes put it on at night before I go to bed. Then I put just a dot on my areas of concern, and it has worked beautifully."
Someone replied: "DO NOT USE THAT SHIT. It seems magical at first but it isn't .Go online and look at reviews for mirvaso(which is the exact same thing as rhofade but came out in 2014) It basically overly constricts your blood vessels which makes you look pale and then you will get an extreme rebound vasodilation flushing from at at some point . People have had terrible rebounds from it that disfigured them for a long time. Its basically the exact same thing as nasal sprays work so well but then have rebound vasodilation which makes you dependent on it."
Queen_of_naps replied: "Mirvaso and Rhofade are 2 different drugs and while the anticipated outcome of both is to reduce redness, Rhofade does not appear to have the same rebound redness seen with Mirvaso."
Someone else replied: "They both work the same way by overly constricting blood vessels in an unatural way mirvaso uses brimonidine and rhofade uses oxymetalozine. Both do the exact same thing. And yes reports are already coming out that rhofade has the rebound effect. Rhofade came out more recently so less reviews are written about it than mirvaso but the ones that have been written all talk about the rebound. Many reviews also state exactly what op is saying that it worked initially BUT after a while blood vessels weakened causing them to vasodilate. People here might not like it because the results look good and are not aware of the rebound but i strongly advise people who have rosacea or even regular skin to not touch any of them."
Sooprnateral replied: "Hey, while I think your intentions are great, & it's important for people to be aware of any side effects their medications may cause, two different medications won't always cause the same reaction. Differences in active ingredients, inactive ingredients, and the manufacturing process can all have an effect on how someone responds to two drugs that serve the same purpose."
Gabi wrote on March 5th, 2018: "My experience was much like everyone else. Paid $50 and has actually made my skin more red with lots more spots coming out. Shouldn’t have used it and going back to my dermatologist to try IPL as none of the creams have worked for me and all seem like a waste of money. At first it seemed like it was getting less red and then my face felt like it was warming up and got twice as red, then this morning all of the spots came out. Hopefully it will calm back down, who knows? I rate it 1.0"
RR wrote on February 23rd, 2018: "Awful product, do not use!!! Much like others here, after only a few days using Rhofade my rosacea has gotten much, much worse! I now have pimples I’ve never had before, like a teenager with a face full of acne. Every spot that garbage touched is a red little bump. This product is an absolute waste of money, do not let your dermatologist prescribe it!"
Efm wrote on February 19th, 2018: "I have been using rhodode for the past 2 months. I am very happy with the results. My redness is about 50-75% less. This means that I am not using foundation on weekends and days I don't go to work. My face has some redness but it looks healthy. In addition to the flush improvement, my face is not as dry and scale as it was before using it. Unlike a lot of reviewers here, I have not had pimples or any other reaction. My derm told me rhofade is 50/50. Some love the results and some don't. I guess I go lucky."
Chloe wrote on January 20, 2018: "I started using Rhofade last week and it seemed like a miracle at first but then it started working off and on sometimes it would work and other times not so much, but now it seems to be leaving these small bumps all over my face. They are not pimples, also my face is still red after using the product now. I have medium rosacea, but I get flare ups that can get bad. I’m 19 year old female."Vanessa wrote on January 11th, 2018: "I had a similar experience. The dermatologist gave me a script for Rhofade in December. Surprisingly it was covered by my insurance. I have been disappointed with the results since using it. The redness only actually increased. I did not have an issue with the bumps or pimples. I have discontinued use."
Rebecca Webb wrote on January 8th, 2018: "Began using Rhofade three days ago. Worked wonderful on the very first application…I actually had pretty, pale skin and felt like I looked “normal” for the first time since I can remember. Now, three days later, my skin is considerably more red, I have pimple-like bumps on my face, my skin burns, and I have a rash all along my midsection. Has anyone else gotten a rash away from the application site? I wonder if I keep trying Rhofade how long after application before I can apply moisturizer and my makeup? Anyone else tried Oracea? I was prescribed this also but have not started it yet…"
MagicTripLunchBox wrote in 2018: "I've been using it once or twice a week for about a month now to no ill effect. As with any medication, people are going to respond differently. I'm apparently one of the lucky few so far, but I'll discontinue if any rebound flushing occurs. It's 100% worth the risk to me right now."
Crimsonsky5 replied: "Hi again thanks for your post just wondering how is rhofade going for you since. Did you have no side effects so far how long have you been taking it now."
MagicTripLunchBox replied: "Still working well for me! :)"
JeniG wrote on January 24th, 2018: "I have previously managed my mild rosacea with metronidazole cream and Finacea cream (the latter with better results). My dermatologist prescribed Rhofade as lately I've been flushing more often. I did note immediate improvement in facial flushing, and I feel a slight tightening sensation to my skin when I would normally except my face to flush (e.g. moving from cold to hot), but my face doesn't go red. However, a week after using Rhofade, I've broken out in pimples across my face, and my skin is also sore so I will have to stop using Rhofade. I rate it a 3"
Zahrah wrote on January 16th, 2018: "The first day I used rhofade it seemed to be a miracle worker, the second day I noticed little bumps appearing on my skin. The third day my cheeks became extremely itchy and I felt like my face was on fire! My face looks like it is completely sunburned. I went to the doctor with a mild case of rosacea and now my face looks 100x worse."
Deevs wrote on December 28th, 2017: "I'm not even sure why the doctor prescribed this for me as I have very mild rosacea and very little redness. The first time I used it, my skin tone evened out and looked great. A few weeks after, I used it again before going out and I got a spot. I used it the next night and had four more spots that got worse before better. It took three days before the spots went away. I usually only get spots when I'm in the sun and wasn't in the sun, so is it a coincidence that I got spots after using the product? $75 down the drain. I rate it 1.0"
Daniel wrote on December 27th, 2017: "I was prescribed Rhofade by my derm. I applied it on the first day they gave it to me. On the first day I applied it, I saw results within the first 30 minutes which was quite impressive but I didn’t want to get too excited. So the first day was great. On the second day, I didn’t really see any results. Waking up on the third day in the morning being that I apply it in the morning and on the night, my face was full of weird looking bumps. I guess I got an allergic reaction. But I kept applying to see if maybe by any chance it was something else, although I had never had these weird looking bumps on my skin. So on the fifth day I stopped using it and I called my derm and she told me to go and see her so that she may see what she can do. She gave me these small samples of this steroid cream which help take off the bumps. So unfortunately it didn’t work for me. The derm has giving me Mirvaso and I’m getting mixed results. One cheek gets very red while the other one is much clearer."
Stephanie Perry wrote on December 27th, 2017: "I was hopeful that Rhofade would work for me after the redness on my face practically went away after the first application. However, the second and third day I had a little redness showing though, and I began breaking out with small itchy pimples where I had applied the cream. By day 4 I felt my skin was redder than before I had started the Rhofade, and I had burning and itching with little bumps all over, as if I was having an allergic reaction. I stopped using the Rhofade cream on day 5, because the itching, burning, and redness had gotten so bad. It has been 3 days since I last applied the Rhofade, and I still look and feel like I’m having an allergic reaction, covered in little itchy bumps, and extremely red. I wish I never tried the Rhofade because it’s made my skin look so much worse than it ever was before using the product. I am really hoping the itching and bumps will subside soon, but I haven’t had any improvement yet."
Juanita wrote on December 27th, 2017: "It’s almost like we’ve traumatized our skin, by sampling Rhofade. Because (for me, at least), it took over a month for my skin to return to normal. Not sure about how others fared on here. Good luck to you."Deevs wrote on December 20th, 2017: "I’ve had mild rosacea for years and was thrilled to read an article espousing Rhofade. My dermatologist prescribed it without warning of possible side effects. After two days, my face is dark red everywhere this cream touched my face. Bumps and burning. Beware of this product."
Alysann B Whitley wrote on December 13th, 2017: "I just started using Rhofade, and I’ve never had a reaction this bad. I used it for a few days but I had some added redness and tingling symptoms. I stopped taking it until I was out of school (only 2 days of classes left). After classes I took it again. It worked the first few days, but it got worse. So much worse. I haven’t taken Rhofade in 4 days and the symptoms keep getting worse. Whole room is hot. Burning. Tingling. Red all the time. The pain is so intense.. disappointed."
Barbara wrote on November 30th, 2017: "Anxious to try it. The PI says it’s successful in 18% of users. That’s not very promising, but hopeful that I am in the 18%. Cash pay price is $500. My insurance copay was $25 and I was able to use the company co-pay card and brought my copay down to $0."
Nnhhff wrote on November 29th, 2017: "This is the same ingredient as of mirvaso all they want is the peoples money they don't care for anybody. You don't want to see my face after this. Two creams thanks gardema you have destroy my live. I rate it 1/10"
Jordanm100 wrote on November 25th, 2017: "Insurance covered the drug which was great. Started using Rhofade 6 months ago. Had 2 days of amazing results. Noticed the results actually worsened after 3-4 days. Some days Rhofade will work fine. After the 8-10 hour mark of use, my cheeks turn Dark red and begin to burn. The Whole room becomes hot. I used this drug for a long period of time because I was hoping results would start to show. Anything alcohol related will trigger the rosacea into a very uncomfortable stage. I noticed during supper time after eating a meal, it would outbreak into a deep red stage. Rhofade was a disappointment to say the least."
CC123CC123 wrote on November 22nd, 2017: "This is an absolutely terrible medication. It made my rosacea so, so, so, so much worse and caused acne and rosacea bumps that I've never had before after only about 5 days of use. My face feels like it is on fire now even though I have discontinued this medication. I am constantly red. Everything is so much worse than before I started this. I rate it 1/10"
Tim wrote on November 21st, 2017: "I went to my dermatologist last week and she recommended Rhofade. I put a pea amount on my face as directed 2 days ago and my face has been bright red and burning since then. It is by far the worst that it has ever been even on my worst red face day. I will not put another dose on my face at this point and am out $50. Very disappointing. I was hoping to read some reviews that it improved after a few days, but it does not seem to look that way."
gmejb505 wrote on November 17th, 2017: "This is a horrible product and should be recalled - I had a very minor rosacea problem with two patches of redness on my checks. I used this for one week and it worked fine - but then the second week it made my face a living hell with bumps and itching - the area infected increased to three times the size. I stopped using it and now using something different from a different doctor. DO NOT USE IT!!! I rate it 1.0"
Angela wrote on November 15th, 2017: "Tried on/off for a few weeks. Had to stop using…made my skin worse, no breakout…just really really red. Also felt like it was burning after first applying."
Toni wrote on October 31st, 2017: "I used Rhofade for 3 Days, samples from my dermatologist. I woke up in the middle of the night and my face was burning so bad and it was swollen it felt like a really bad sunburn. I took pictures of it. I took pictures because I was so confused. My dermatologist told me I should buy this cream because it doesn’t give you a rebound redness. I was using mirvaso and actually that wasn’t as bad as what I experienced with the Rhofade."
JJRJr wrote on October 16th, 2017: "I used Rhofade for about 2 weeks before I started to have problems. Initially, I thought it was awesome but then I started to have a break out of red bumps that stung like crazy. I tried adding more Rhofade but it only made it worse...much worse. My face still stings even though I stopped using Rhofade. I hope I didn't do any permanent damage. 1/10"
Beverly wrote on October 8th, 2017: "very costly, $750 in the USA and insurance does not cover this."
Ellen wrote on October 8th, 2017: "It’s not on my Rx formulary and I was quoted $488 for a tube! Insane."
Patti wrote on October 3rd, 2017: "I I went to the dermatologist and got samples and RX for Rhofade for my mild rosacea. After using it for 3 days, I started noticing a lot of pimples popping up on my nose and cheeks. Also my skin was burning and itching very badly! My face was flushed and a little swollen. It was so painful I quit using it. It has only been 2 days and my face is still red, flushed and broken out and still itches. The burning is better after using a moisturizer. I thought maybe I was just having a reaction from it, but it looks like a lot of people are having the same issues with it. I have tried a lot of rosacea medications and have never had such bad side effects as these."
Val wrote on September 30th, 2017: "I seem to have a middle of the road experience. It’s not great but provides some improvement. I’ve haven’t had any adverse reactions. Mirvaso was a disaster for me, exactly the same experience as others, worked great for a day or two, but then my face became nuclear to the point where people were concerned about my well being, and skin was in general much worse when not using Mirvaso."
JJRJr wrote on October 16th, 2017: "I used Rhofade for about 2 weeks before I started to have problems. Initially, I thought it was awesome but then I started to have a break out of red bumps that stung like crazy. I tried adding more Rhofade but it only made it worse...much worse. My face still stings even though I stopped using Rhofade. I hope I didn't do any permanent damage. 1/10"
Beverly wrote on October 8th, 2017: "very costly, $750 in the USA and insurance does not cover this."
Val wrote on September 30th, 2017: "I seem to have a middle of the road experience. It’s not great but provides some improvement. I’ve haven’t had any adverse reactions. Mirvaso was a disaster for me, exactly the same experience as others, worked great for a day or two, but then my face became nuclear to the point where people were concerned about my well being, and skin was in general much worse when not using Mirvaso."
V wrote on September 28th, 2017: "I had very mild redness and was surprised when my dermatologist during a routine check-up diagnosed me with rosacea. He gave me a few rhofade samples. I only applied it once and discontinued because of weird tingling sensations all over my face. In about two days after that my face turned red and was covered with tiny pimples. I’ve never had those before. It’s been a week since and my face is slightly less red and no more pimples but overall it’s still much worse than before rhofade. I’ve never had any reaction to alcohol until then either but now a single drink makes my face red. I reported my case to FDA and will be looking for a different dermatologist. I think it’s totally irresponsible to give out samples of medication that can cause such lasting damaging effects. Hopefully, someone will launch a class action suit against Allergan."
Susan wrote on September 28th, 2017: "I switched from Mirvaso to Rhofade when it first came out and it has been amazing for me. Mirvaso was a complete nightmare. Yes it got rid of my redness, but once the medication wore off it came roaring back 100 times worse than before. It became a vicious circle and on days when I didn’t use the Mirvaso my redness was horrible. I haven’t remotely had that problem with Rhofade. It takes away redness much more naturally than Mirvaso and I don’t have that horrible flare up at the end of the day caused by the medication wearing off. I’ve actually seen my redness lessen over time now that my face isn’t dealing with the medication boomerang effect. I’ve been dealing with Rosacea for about 20 years now and the combo of Rhofade and Soolantra have helped me get better control of my symptoms. Now if someone would please just find a cure so none of us have to ever deal with this again I’d be very grateful."
V2017 wrote on September 28th, 2017: "I had very mild redness and was surprised when my dermatologist gave me a few rhofade samples. I only applied it once and discontinued because of weird tingling sensations all over my face. In about two days after that my face turned red and was covered with tiny pimples. I’ve never had those before. It’s been a week since and my face is slightly less red and no more pimples but overall it’s still much worse than before rhofade. I’ve never had any reaction to alcohol until then either but now a single drink makes my face red. I reported my case to FDA and will be looking for a different dermatologist. I think it’s totally irresponsible to give out samples of medication that can cause lasting damaging effects. 1/10"
Miracle Cream wrote on September 16th, 2017: "I has suffer from mild acne since 14yrs old. At age 19 I was diagnosed with Rosacea on top of the acne. I have tried EVERYTHING out there. So far, I am 30yrs old now, Accutane and Rhofade have had the best results for me. After my 3rd course of Accutane for 5 months, which makes my face look like porcelain, I started to break out again, my dermatologies gave me 2 little samples of Rhofade and with first application my face was clear again from redness & what looks like ezcema. I have used it 2 days so far and it is wonderful. I do feel some sensation on my cheeks but it is worth it. 9/10"
Katherine wrote on September 14th, 2017: "I have super sensitive skin too. This product worked wonders for me for 2-3 days. But then I had a horrible reaction that took over a week to go away. Closer to 2 weeks. I assure you. These comments are not a sham. I’ve been following it for a bit and it seems like very few people have success. My problem is I’m sensitive to alcohol (mostly figured it out after the fact) and this product had 4 types of alcohols which aren’t the best for your skin anyway."
Mike wrote on September 12th, 2017: "Rhofade sucks just like every other rosacea medication. The chances that it will work are under 15%, and the chances it will actually make your skin substantially worse are at least 85%. Not worth it. I took it and thought it was a miracle the first day, but my skin flared up when it wore off and it took me about a month to recover. My skin was on fire for about a month straight, all day everyday, after a single application. Not even close to a success. I think it’s an absolute scandal how incompetent the medical industry has been on rosacea, considering it’s 2017. They should have this figured out by now. Decades ago, actually. It’s scandalous that they haven’t." [..] "There ain’t no cure coming – don’t hold your breath. It’s nearly 2018 and they haven’t even managed to find A SINGLE EFFECTIVE TREATMENT for rosacea that makes life manageable – not one. The odds of them finding a cure in the next 20 years are 0. There’s a 0% chance. I think, realistically, we won’t have any treatments that work even poorly until 2050 at the earliest (right now we dont even have medications that work poorly – they just ruin lives), and I doubt there will ever be a cure. But if there is, it won’t be for another century or two. Rosacea is one of the only conditions where you’re no better off getting it in 2017 than you would’ve been if you got it in the year 1500 BC. There are a tiny number of conditions that meet that criteria, and rosacea is certainly one of them."
LeAnn wrote on September 5th, 2017: "Ok. I have been dealing with rosacea for just a couple of years and have been using Metro gel with very little results. My dermatologist gave me some Rhofade samples 3 days ago. I applied this cream for 3 days and I am about to crawl out of my skin. I have taken 2 doses of Benadryl today to try and calm the extreme itchiness! I also now have bumps all over my face that I never had before. I’m so disappointed!! I will never use this stuff again!"
Juanita Holland wrote on September 2nd 2017: "Sadly, I must concur with other posters: you hope for relief and end up disappointed. I was given several samples of Rhofade on Wednesday, August 23rd. I applied a small size on Thursday, August 24th. It is now Friday, September 1st, and I won’t use the remainder of my samples. The first day (Thursday), the redness diminished completely. That sunburn look was gone! It was still gone on Friday. But by Saturday, a little of the redness had returned, and my skin looked oily. I don’t have oily skin. I continued to use Rhofade, but the redness was returning, and I still looked oily. Now, as Luke posted, I’ve got small bumps as if I had pimples (I don’t get them), and I look sunburned. [..] The Rhofade was my first ever attempt at trying to diminish the redness."
Heather Miller wrote on September 2nd, 2017: "I am sorry this hasn’t worked for you. Like you, my Rosacea did not appear until my 40’s. I use Soolantra to get rid of the pimple like bumps and it works very well, you might want to ask for a sample. I do have great success with rhofade (it is my “hero”) and am so sorry it didn’t work for you." [..] "I had redness in cheeks, chin and nose (always asked if I got sunburned). [..] The Rhofade worked within an hour and lasts all day. I have also noticed less redness in the mornings before I put it on."
Luke wrote on August 29th, 2017: "I had a terrible experience with Rhofade. I went to a dermatologist because of mild symptoms of rosacea. I used Rhofade for 4 days, and it made symptoms 10 times worse. I looked like I had a bad sunburn and pimples. My skin was also dry and burning. I stopped using it and I bought Eucerin Sensitive Skin Redness Relief Soothing Night Cream, and Eucerin Redness Relief Cleanser from Walgreens. They are helping. Now my skin is just a little pink in some spots."
Luke12345 wrote on August 29th, 2017: "I had a terrible experience with Rhofade. I went to a dermatologist because of mild symptoms of rosacea. I used Rhofade for 4 days, and it made symptoms 10 times worse. I looked like I had a bad sunburn and pimples. My skin was also dry and burning. I stopped using it and I bought Eucerin Sensitive Skin Redness Relief Soothing Night Cream, and Eucerin Redness Relief Cleanser from Walgreens. They are helping. Now my skin is just a little pink in some spots. 1/10"
Ev11 wrote on August 6th, 2017: "Wow! It makes all the redness and little broken capillaries literally disappear! I only have mild rosácea with some flushing. I've been using it for a couple of months. I'm so impressed!!!! My skin looks better than it has in years, and I can go light on my foundation or skip it! I do feel a tingly sensation at times on my face, but it's worth the trade off for me. I'm very happy with Rhofade! 10/10"
AlexD87 wrote on August 4th, 2017: "I used Rhofade a few times and it seemed to work. After about 3 days, my face became really red and flushed. I felt like I was burning up. My doctor told me to stop it. 1/10"
Do not use Rhofade wrote on July 22nd, 2017: "I used Rhofade for a few days and it immediately became apparent that my skin became much worse, redder and burning. I would not recommend this product at all. After discontinuing use and returning to regular hygiene routines my skin returned to normal, albeit with mild rosacea. I rate it 1/10"
Paul S wrote on June 11th, 2017: "Used on and off for about 1.5 months. I stopped once I noticed more frequent, although mild, flushing (which I used to rarely get) after the first month. It seems like a much milder and more effective version of Mirvaso, but going forward I'll probably save it for special occasions rather than using it semi-regularly. I rate it 4/10"
Amy ford wrote on July 6, 2017: "I LOVE this stuff! I have tried every cream, taken every pill, had IPL treatments, home remedies with very little to no results, Rhofade has been a miracle for me! It truly lasts up to and longer for me. I don’t care if I have to get a second job for this stuff, it’s definitely worth it for me!"
Jim wrote on June 7, 2017: "1 month in using rhofade. Best topical I ever used to reduce redness. No rebound whatsoever. In my opinion, mirvaso drained all the blood vessels and when it ran out at the 8 hour mark it came back like crazy. Rhofade only reduces a little bit so the blood vessels aren’t so constricted.. hope this helps."
Deb Olsen wrote on June 1, 2017: "Deb: I began Rhofade two weeks ago in the US. For the first time in 12 years the redness is significantly decreased! I did have to pay for the prescription though $75USD due to it not being on the formulary via my insurance. But well worth it so far! Another added benefit, the tube is much larger so you don’t have to refill as much!"
Agnus G wrote on June 1, 2017: "Caused horrible rebound redness as did Mirvaso, but with Rhofade my face has stayed red even after I quit using it 10 days ago. It is like I have had a total relapse and all the improvements from the laser is gone. If this crap only works on 1 in 7 people, why risk even trying it? NOT WORTH THE RISK!!!"
coco wrote on May 30, 2017: "Used rhofade everyday for a week. works great, experienced some tingling but, no rebound flushing like mirvaso. that s**** ruined my life — i went to several doctors trying to figure out why my face was catching on fire. no one could tell me why this was happening to me. got blood work done, saw an allergist, went off certain foods, the whole 9. all along it was this f***ing gel. cried myself to sleep for months thinking it’d never end. thank god i figured it out… key word I. still verrrry cautious but, rhofade did not give me any rebound “face on fire” feelings. just some tingling. be very mindful of where you put it, how much, how often and monitor it closely. gradual use is key. hope my experience helps."
Ellen wrote on May 11, 2017: "I’ve been using it for a week now and unlike with Mirvaso, I’m not experiencing rebound redness. I used to wake up in the morning all red-faced. Not with the RhoFade. The clinical trial results that say it only works for about 29 applications? Makes me want to wait until then to see if these results continue."
Luke12345 wrote on August 29th, 2017: "I had a terrible experience with Rhofade. I went to a dermatologist because of mild symptoms of rosacea. I used Rhofade for 4 days, and it made symptoms 10 times worse. I looked like I had a bad sunburn and pimples. My skin was also dry and burning. I stopped using it and I bought Eucerin Sensitive Skin Redness Relief Soothing Night Cream, and Eucerin Redness Relief Cleanser from Walgreens. They are helping. Now my skin is just a little pink in some spots. 1/10"
Ev11 wrote on August 6th, 2017: "Wow! It makes all the redness and little broken capillaries literally disappear! I only have mild rosácea with some flushing. I've been using it for a couple of months. I'm so impressed!!!! My skin looks better than it has in years, and I can go light on my foundation or skip it! I do feel a tingly sensation at times on my face, but it's worth the trade off for me. I'm very happy with Rhofade! 10/10"
AlexD87 wrote on August 4th, 2017: "I used Rhofade a few times and it seemed to work. After about 3 days, my face became really red and flushed. I felt like I was burning up. My doctor told me to stop it. 1/10"
Do not use Rhofade wrote on July 22nd, 2017: "I used Rhofade for a few days and it immediately became apparent that my skin became much worse, redder and burning. I would not recommend this product at all. After discontinuing use and returning to regular hygiene routines my skin returned to normal, albeit with mild rosacea. I rate it 1/10"Paul S wrote on June 11th, 2017: "Used on and off for about 1.5 months. I stopped once I noticed more frequent, although mild, flushing (which I used to rarely get) after the first month. It seems like a much milder and more effective version of Mirvaso, but going forward I'll probably save it for special occasions rather than using it semi-regularly. I rate it 4/10"
Amy ford wrote on July 6, 2017: "I LOVE this stuff! I have tried every cream, taken every pill, had IPL treatments, home remedies with very little to no results, Rhofade has been a miracle for me! It truly lasts up to and longer for me. I don’t care if I have to get a second job for this stuff, it’s definitely worth it for me!"
Jim wrote on June 7, 2017: "1 month in using rhofade. Best topical I ever used to reduce redness. No rebound whatsoever. In my opinion, mirvaso drained all the blood vessels and when it ran out at the 8 hour mark it came back like crazy. Rhofade only reduces a little bit so the blood vessels aren’t so constricted.. hope this helps."
Deb Olsen wrote on June 1, 2017: "Deb: I began Rhofade two weeks ago in the US. For the first time in 12 years the redness is significantly decreased! I did have to pay for the prescription though $75USD due to it not being on the formulary via my insurance. But well worth it so far! Another added benefit, the tube is much larger so you don’t have to refill as much!"
Agnus G wrote on June 1, 2017: "Caused horrible rebound redness as did Mirvaso, but with Rhofade my face has stayed red even after I quit using it 10 days ago. It is like I have had a total relapse and all the improvements from the laser is gone. If this crap only works on 1 in 7 people, why risk even trying it? NOT WORTH THE RISK!!!"
coco wrote on May 30, 2017: "Used rhofade everyday for a week. works great, experienced some tingling but, no rebound flushing like mirvaso. that s**** ruined my life — i went to several doctors trying to figure out why my face was catching on fire. no one could tell me why this was happening to me. got blood work done, saw an allergist, went off certain foods, the whole 9. all along it was this f***ing gel. cried myself to sleep for months thinking it’d never end. thank god i figured it out… key word I. still verrrry cautious but, rhofade did not give me any rebound “face on fire” feelings. just some tingling. be very mindful of where you put it, how much, how often and monitor it closely. gradual use is key. hope my experience helps."
Ellen wrote on May 11, 2017: "I’ve been using it for a week now and unlike with Mirvaso, I’m not experiencing rebound redness. I used to wake up in the morning all red-faced. Not with the RhoFade. The clinical trial results that say it only works for about 29 applications? Makes me want to wait until then to see if these results continue."
Elizabeth Wendler wrote on May 3, 2017: "I have used Rhofade for a week now. First few days it reduced redness in a more natural way than Mirvasco did. However 4 days ago it started tingling in spots. The last 2 days it looks as though it literally has burned my face in all of the areas I applied it. I will not use it anymore. I have tried everything. My Derm was so excited to have me use the samples. I was hopeful. Not anymore."
countervail wrote on May 2, 2017: "I am trying Rhofade with samples from my dermatologist. For me, it does reduce redness. However I don’t think it seems to change underlying heat for me, just the topical appearance. Also my eyes have been very dry and bloodshot since starting as well and I’m monitoring to notice if this is a side effect or something else like spring allergies. It seems to work, but it’s not a game changer. And if it’s expensive as I hear without insurance, I’m not sure it’s in my long-term arsenal."
User reviews: oxymetazoline Before Rhofade (and therefore Mirvaso) came on the market, rosacea patients have experimented already with oxymetazoline and brimonidine in their original form; nose spray and eye solution. After all, oxymetazoline has been around since the 1960's, One of its product forms is Afrin nose spray. Other over-the-counter nasal sprays that contain oxymetazoline are for instance Otrivin, Operil, Dristan, Dimetapp, Oxyspray, Facimin, Nasivin, Nostrilla, Utabon, Sudafed OM, Vicks Sinex, Zicam, SinuFrin, Drixoral and Mucinex Full Force. They mostly all have some preservatives added, for longevity. I am focusing on the product Afrin now, as it has been most tested and discussed online by rosacea patients so far. You can buy it over the counter in most countries, and it is designed for clearing blocked noses, either due to allergies or vital infections. It works as a decongestant by constricting the small blood vessels in the nose, which widens the nasal passage and makes breathing easier. Afrin uses 0.05 % of oxymetazoline hydrochloride. Other than that is has the following ingredients: Benzalkonium Chloride, edetate disodium, polyethylene glycol, povidone; propylene glycol; sodium phosphate dibasic and sodium phosphate monobasic.
Benzalkonium chloride solution is a topical antiseptic, and acts as an antimicrobial preservative in nasal sprays, preventing the growth of fungal, bacterial and viral pathogens. It can cause rebound congestion when used in the nose. It is also used in certain cosmetics, shampoos and disinfectant soaps, to name some products, but can cause skin irritation in theory. Disodium edetate dihydrate is also used in Rhofade. It helps prevent the deterioration of cosmetics and personal care products. Cosmetic manufacturers frequently use this ingredient as a preservative, chelator and stabilizer, but has also been shown to enhance the foaming and cleaning capabilities of a cosmetic solution. Used in many personal care products.
Polyethylene glycol (PEG 300) is also used in Rhofade. It is a lubricant and an absorption enhancer which allows both good and bad ingredients to be absorbed faster into deeper parts of skin. If used on broken or damaged skin, it can cause irritation and system toxicity. In addition, PEGs can reduce the skin's moisture levels and speed up skin aging.
Propylene glycol (also an ingredient of Soolantra) is a widely used cosmetics product and a solvent; it is a hydrating ingredient, a man-made organic alcohol that attracts/absorbs water. It is broadly used by food, drug, and cosmetic and personal care product manufacturers. Safe ingredient but can cause skin irritation or allergy for very sensitive skin types, so test on skin first. Usually, this happens in people who are allergic to the chemical and subsides after a short period of time after the body has had time to break down the compound. However it is also used in Soolantra and it is used in many skin care and cosmetic products, so either way, if you are sensitive to it, not even Soolantra might be suitable for your skin). Sodium phosphate dibasic and sodium phosphate monobasic are inorganic salts. In cosmetics and personal care products it function as a buffering agent that maintain the pH between 4.0 and 8.0 and a corrosion inhibitor.
I wouldn't use it on my own skin, personally, but that is because my skin is hyper reactive and sensitive. Rhofade has quite a few potential skin irritants as ingredients as well. Nevertheless rosacea patients have used it on their skin, and mentioned the same effect as what was reported later with Rhofade: reduction of skin redness and the potential for rebound worsening. And for people who simply cannot afford the -frankly obscene- sort of prices that Allergan are said to be charging for their product in the United States (I read numbers ranging from $500 a tube to $700 a tube), it may be interesting to carefully test patch one of the available, cheap nasal sprays instead. Especially considering the expensive Rhofade has an official trial result efficiency rate of 15 to 25%.
Cdelic wrote on April 6th 2008: "Be careful. This is so new and untested. However, 3 1/2 hours later my cheeks are 90% better and i don't have that "sunburn" feeling. I also drank a swig of coffee 3 1/2 hours ago and it has worn off so that may have something to do with it. (Caffeine is my main trigger- and cold diet coke is actually worse than coffee or tea so for me it is the trigger.) I also took a tavist (antihistamine) right before the oxymetolazone as I read some dermatologist websites that say antihistamines can help. But the effect worked on my cheeks within a few minutes so it had to be the topical stuff not the systemic stuff. By, the way, my cheeks are the worst so I tried it there first. The effect for me is quite remarkable. But being a physician I am well aware of the build up of tolerance and the possible long term side effects of what, at first, seems like a miracle. Tread lightly. We are using our faces as guinea pigs. But this is how many outstanding pharmaceutical got developed so there is hope. Makes me feel much better. Steve B"
Cdelic wrote on April 8th 2008: "Just starting Oxymetazoline. I just discovered this forum while doing a search on google for oxymetazoline Hydrochloride rosacea. I started using a generic brand (similar to Afrin but with less ingredients) about 3 days ago. I've been dealing with a very red nose (with lots of acne and oil) and red face for years. The last week my nose was as bad as it has been in years (I'm 52). I had noticed a few years ago that when I used eye drops that where it would run down my face it would reduce the redness. I should have run out and gotten a patent then! Any way, on day three and the acne has totally reversed course. I've never had anything work this fast, except maybe doxy. Still red but not as bad. It will probably take at least a week for acne caused redness to clear. I'm not too worried about side effects. This drug has been squirted in eyes and noses for years without any problems. I'll keep you posted. I'm also going to be adding micronized zinc to the routine, but won't start that until I give the oxymetazoline a week or so to see results. Gary"
Steve95301 wrote on April 9th 2008: "Just a heads up: A condition called rhinitis medicamentosa is associated with prolonged vasoconstrictor use. It is caused by rebound dilation and downregulation of receptors. So, there's a very good reason to be careful when experimenting. Good luck though, I love using this treatment myself occasionally - it's just so effective. [..] Unfortunately, the rebound (with Afrin) was due to the vasoconstrictor, although the preservatives may have aggravated things. I say this because I've experienced some rebound from my preservative-free spray. I've stopped using it. I plan on using oxy before an oral presentation I have next week, but other than things like that, I'm staying away from vasoconstrictors until I can ask Dr. Bitter about them or the FDA approves them for rosacea."
gf4456 wrote on April 10th 2008: "Ok this is day four on the oxymetazoline Hydrochloride. I'm blown away. I still have redness but it has been reduced dramatically. But what is really amazing is the acne just stopped dead in its tracks. And I'm talking painful acne, stuff that is deep. Normally my nose produces so much sebum that it is ridiculous. Right now, none, when I squeeze top of my nose or the crevise...none. That has never happened except once when I fasted for 10 days! So as some of the redness goes away I notice the damage from the acne, they will probably stay red for awhile. The few spiderweb veins on my cheek are almost non-existent. And the ones right under my nostrils, seem to be fading fast. Right now I'm applying 3 times a day but will drop that back probably next week. I think I am also just going to add it to the RejuveneX face cream I use.
man_from_mars wrote on April 16th 2008: "Man, I can't believe people are still willing to try this experiment. It's like crack cocaine: it's going to work great at first, then you will tend to start overusing it it will require more and more to get same affect and highly probable you will pay for it in the end. Suspect the thread is so long ,people may be skipping over the posts covering the bad after-affects. Wish someone could rename the thread subject to something more cautious and not as promising. PS* I'm referring to the nasal sprays on the face experiments. mfm"
Steve95301 wrote on April 19th 2008: "I used a double application of oxymetazoline last night for an oral report. It worked remarkably well, as expected, but I was pleasantly surprised when I had no rebound today. In fact, it seemed like the effects of last night continued into today. I do have clonazepam in my system, which tends to make me pale, so maybe that's the explanation. Are there any further reports from others who have decided to try this?"
Alba wrote on April 21st 2008: "Steve, That is wonderful that it worked for you. I used it on a weekend and didn't experience a rebound effect. I think its when its used on a daily basis for a longer period that the rebound effect happens. Alba"
Thedude wrote on April 30th 2008: "Hey folks, just joined on and was excited to discover this website and to read this whole thread. i'm 30, have had Eurythma for about 7 or 8 years, had strong results for a short while with Tetracyclin, but stopped taking it when it stopped working. Per this thread, i went out and bought some Afrin w/moisturizer. Man, crazy results after a few hours, face was tingling and felt great. Tried it again the next day with even better results. Tried it a third day with great results. So i took a few days off and tried it again just once last week. I feel like it reddened my face even more for at first but after a few hours was looking great. I just saw my dermatologist the other day and she said what i suspected -only use it occasionally. Otherwise, she gave me some prescriptions for two things and was wondering if anyone had any info or results from them. Rosac Wash and Klavon Lotion. Otherwise i recommend this sunblock by Aubrey Organics -natural sun spf 25 which has Green Tea in it. Other than that, I've been washing my face for about 5 or 6 years with Aquanil which is great as a soap or moisturizer. Any feedback would be greatly appreciated. Best of wishes to all."
Felix27 wrote on May 2nd 2008: "Difference between Nasal spray and eye drops. If I understand it right Oxymetazoline is the important active ingredient. I find that ingredient in eye drops and in nasal sprays. Who used nasal spray and who used eye drops? I think that nasal spray is maybe more aggressive, because of menthol. Maybe eye drops are better for our skin. What do u think? I didn't read every post, but from what I read, more users had problems with nasal sprays."
Melissa W wrote on May 2nd 2008: "Hi Felix, You are absolutely right in that the eye drops would be better for our skin but they are by Rx only. Hopefully the best product for our face will come out soon and be helpful to us. Best wishes, Melissa"
Alba wrote on May 4th 2008: "Hi All: last week i woke up and my right ear was so red that i just had to put some of the sinex to see if it would go away. so i put it on probably 4 times that day and my redness had gone away. then the next day i didn't apply it just left it alone. well i got such awful rebound flushing i mean extreme i usually flush on the right ear but with in a few minutes im able to bring it down with an ice pack gel or cold water. well no matter waht i did i had my right ear in severe heat and flushing staring Thursday and finally by last Saturday night i gave up and applied elocon to the right ear. then in the morning it felt a little better but still having the rebound flushing till i would say finally by Tuesday i was having less flushing and still getting better. my ear got so red and inflamed, and the skin around the ear was so awfully dry that i was even peeling. i really do blame this to the sinex since it was the only thing i applied to it. so definitely believe that this ingredient brings on severe rebound flushing. Today the skin around my right ear is still very dry, and peeling, better each day but still awful experience. Alba"
johnsob0 wrote on May 13th 2017: "Started using Oxymetazoline Hydrochloride from nose spray. Results were consistent with the limited study: immediate (give it a couple hours) reduction in visible blood vessels and what I perceive as inflammation (I don't have much of the more general redness issue). I am now on day 3 and my skin looks better than it has in years (I am 63 years old and have moderately severe rosacea, most likely genetic in origin as my sister also has rather severe rosacea). I will stop treatment after a few weeks to see if I get a rebound."
Prryjones wrote on November 25th 2007: "Decongestant. Oxymetazoline and other constrictors work by binding the alpha 1 receptors on the capillaries, constricting the vasculature. This thus decreases the swelling in the nasal cavity, allowing more air passage. This also, used on the eyes, decreases the redness. So, since theses molecules constrict the vessels, theoretically, at least, if enough were used, then some could get into the systemic circulation and further constrict peripheral vasculature, thus the caution for use in uncontrolled hypertension (this is very unlikely though, using topical constrictors, and much more readily applies to oral decongestant products -- which more readily are diffused through the systemic circulation). And likewise regarding glaucoma and BPH. Have to put that warning there, though. [..] In contrast to the rebound nasal congestion typically encountered after long-term use of nasal decongestants, I'm not aware of rebound redness, itching or conjunctivitis being commonly associated with ocular constrictors use (I'll look into it later and post any interesting info.) Perhaps this is because they are not normally used on a LT basis. I think it's worth experimenting with -- e.g. mix some Afrin (R) (which, by the way, has a 12hr dose) with some Cetaphil lotion and go for it. Maybe some will experience rebound dilation after a time and some won't. Or, maybe 3 wks on, 1 week off, etc. Hope this helps, Perry"
jennfran wrote on November 26th, 2007: "Thanks for the info...hmmmm. I do wonder about the reboud though. Although I would set my alarm clock to it if I had to..lol..My biggest symptom is burning sensation but I only turn a slight pink. The burning is what I would want this for and of course to stop the dilation which maybe would slow down progression...Jenn"
BrunoP wrote on November 27th, 2007: "I will try it too... There are some different nasal decongestant but all with Oxymetazoline, Nasex, Navisin, Afrin, Vicks Sinex Nasal Spray. But what to buy? Nasal drops, or nasal spray?... Perhaps drops are better..what do you think? And how will you apply? Put the nasal in the morning,these days.?.. Sorry about this dumb questions.. but i want to try this properly...and please update about the results.... regards Bruno"
Caran wrote on November 27th, 2007: "For anyone trying this remember the study used 0.05% oxymetazoline so if this is the strength you buy and then you mix it with a lotion etc you will be diluting it. Perhaps it is best to get some 0.1% and mix the entire contents thoroughly with the same amount of lotion.Does this make sense?"
Bentherebefore wrote on November 27th, 2007: "The highest I was able to find in the store was .05%. That's the concentration that was in Vick's Sinex, Afrin, and the generic brand-x bottle. Visine LR has half the concentration, .025%. If anyone finds a higher percentage, let us know."
Steve95301 wrote on November 27th, 2007: "Before I went to sleep, about 30 min. after my last post, I could see a very large difference. The left side of my face was quite pale in comparison to the right (control side). It took a little longer than I thought it would, but it definitely worked. Wouldn't it need some kind of lotion to help it penetrate the skin? Perry had mentioned using Cetaphil, which made sense to me. I don't think the dilution would matter, because I would have applied the same volume of spray directly anyway. The moles (for lack of a better word) of oxymetazoline stayed the same. [..] Unfortunately I don't know about duration or rebound, since I went to sleep just as it was starting to kick in. I'm currently putting some on my right cheek directly, so I'll be able to see if it kicks in faster that way."
Prryjones wrote on November 28th 2007: "Hi, a bit of info concerning topicals: The goal is to get the active ingredient to the site of action and have it stay there and "work" before being carried away by the systemic circulation. The skin is not a depot and if a drug is absorbable, will continue to absorb as long as the molecule is in contact with it. The molecule has to be the correct size, chemical nature (hydrophillic vs hydrophobic), and electrical nature for optimal absorption. The reason exipients (other compounds, creams) are added to drugs is to facilitate absorption -- there are compounds which sort of "pull" or "push" the drug through the skin. These added ingredients also hydrate the skin, and hydrated skin, contrary to intuition, absorbs drugs much more easily than dry skin. And this is why drugs are formulated in creams, instead of simply "drug and etoh" etc. Perry"
Prryjones wrote on November 28th 2007: "I tried it last evening. After 1 hour nothing. After 2 hours small difference. After 3 hours 30-50% paler. I applied the drops directly on my cheeks. Today at work, I felt great with much paler face. Yes I applied it this morning too."
Tompkin wrote on November 28th 2007: "Those of you experimenting: given what Perry has said, are you putting a good moisturizer on first and letting it hydrate your skin? Adding the drops directly to moisturizer, then applying that mixture, risks diluting the medication too much. But if your skin is properly hydrated before you directly apply the liquid, that might aid transport."
Steve95301 wrote on November 29th 2007: "Over the past couple days I've had burning sensations for the first time in years. Not sure if it's related to this stuff, but it's worth reporting [..] I got one that didn't have menthol or propylene glycol or anything crazy in it... I'm at work so I can't check, but I got the one that had the least amt of harsh ingredients. I don't know whether or not it's related, but I thought I'd better report it just in case. Sometimes I get a similar sensation from drinking coffee in a dry, warm environment. So, it could be due to that. I'm really not sure. However, I am also getting a numb/tingly feeling on the sides of my face. It's pretty weird. So, I dunno. [..] I tried it again today. Results: Very impressive. ~50% reduction in redness. I now know that the burning I experienced previously was just due to extreme dryness. If I keep my face moisturized, I can use this stuff with excellent results. [..] I can't tell if there is any rebound, because I drank hot coffee in my warm apartment tonight, and I can't differentiate that flush from any rebound. [..] I use Anefrin Original: What I do is put some aloe vera lotion on for about 5-10 minutes. Then I pat my face dry with a paper towel and put on the Anefrin. Then after a while, I wash that off too."
Angela1979 wrote on November 30th 2007: "Hey, I've tried it too, yesterday. Bought nasivin nasal spray and put it on a cotton wool, then applied directly to my right cheek. Didn't see any effect or difference compared to the other cheek during the day. But this morning this cheek was actually redder than my left cheek and covered in papules. So won't be trying that again. Good luck. Angela"
Bentherebefore wrote on December 3rd 2007: "I have been using Afrin for 4 or 5 days now. I have been applying it with a cotton ball. A lot of it stays in the cotton ball so I'm not sure if there's a better way to apply it. Thus far, I have noticed a slight decrease in redness. That said, I have noticed no decrease in warmth, flushing, or burning. Not the results I was expecting... but I will keep experimenting... [..] I have applied it mixed with some cetaphil lotion. MUCH easier to apply. Keeps the skin from getting dry. Not sure how it changes the effectiveness yet, but I'll letcha know!"
rop wrote on December 18th 2007: "Hey, I am using dristan 0.05% (it has preservatives) been using it for a week or so it is really helping me with the redness (viens and background redness) my top half of my face is always red I put some drops on my face and there were some areas that turned white for the first time in a long time. A couple of days ago i mixed it with lyndsy vita oil and have been applying it every morning around 8 am at 10:30 or 11:00 I see a real improvement in my face colr even after walking in the cold ooutside -17 degreez i had some redness but nothing compared to what i used to get and it went away real fast. And this lasts all the way till 10 pm. I went and bought 0.1 % today and I got another Dristan 0.05% that i am going to try to see the differences between using it with vita oil, alone and using the 0.1 % I am going to have 3 test areas on my face at the same time :?. Any ways i was thinking if we were able to constrict the blood vessels then using something to strengthen them like grape seed extract wont that make these changes actually perminant after some time?? and is this just a temperory treatment of would it permenantly reduce the redness after long term usage ???? thanks guys,
BrunoP wrote on January 12th 2008: "A few weeks i went to a new dermatologist, people said that is the best in my country...so, i made an appointment, and he said that creams like, metroderme, rosaliac, rodermil, roseliene, etc, etc.. have no effects on rosacea, and almost every dermatologist prescribes those at the first appointments... he said to take a "Inderal" (clonidine) every morning and also put "Nasex" every morning in the cheeks, which has more effects than the other creams, i mentioned, and he have patients that use this for 2 years, and helps the redness...and also said,that if it works for me i should see the results, in one day or too, and you can use it for ever if you want.. but if it not helps with the redness, you may stop using it... also said that put directly to the face after a cleanser. unfortunately for me it´s not helping with the redness.. and the next time i´ll see him.. i´ll say that, and see what he recommend.. in my opinion, we rosaceans, have more knowledge in this issue than most dermatologists...i had some that dermatologists, that prescribed thinks that i immediately said, that "i´ll not take this, or put this in my face, cause has no effect, or have steroids, or anything that make it worse"...they are so traditional... and always prescribe the same things to everyone in my country, i don´t know how it works in other countries... if you could die for having rosacea, they would find a cure more faster... regards, Bruno"
Steve95301 wrote on January 13th 2008: "Jenn, I just picked the one off the shelf that looked like it had the least amount of irritating ingredients. The one I ended up getting is Walgreens brand ("Anefrin") original. I remember it being the only one without propylene glycol."
Jennfran wrote on January 13th 2008: "I am going to exchange this one for the generic brand you used Steve. I think all nasal decongestants (oxymetazoline) have preservatives in them, don't believe there is a way around this, just maybe one has more then the other. I am still going to try it tomorrow after I exchange it...Jenn"
Caran wrote on January 14th 2008: "Benzalkonium chloride is a preservative which lots of people react badly to. It is also implicated in increasing rebound in nasal and eye preparations."
Jennfran wrote on January 14th 2008: "And I think benzalkonium chloride is in all of them, and I did react bad to it. Needless to say I wont put this on my face again. Jenn"
Steve95301 wrote on January 17th 2008: "I had been using it intermittently, but then I used it for a week straight, Monday through Friday. That weekend - both Saturday and Sunday - I was redder than usual. As an experiment, I applied the oxymetazoline in the late afternoon on Sunday, and voila - paleness. Maybe constricting the vessels for a whole week makes them bounce back a little bit; I really don't know. In fact, I don't even know for sure that it was a rebound at all. The redness could have come from the junk food I ate while watching the football games. [..] pale all week... I'm pretty sold on this stuff."
Steve95301 wrote on January 21st 2008: "Tonight, I had a bad flush come out of nowhere, which is very unusual for me. My vessels are extremely sensitive right now (and I do have some burning). This is undoubtedly a reaction to the Anefrin. I don't know if it's the oxymetazoline itself, or if it's the benzalkonium chloride. Either way, BE CAREFUL."
Steve95301 wrote on January 26th 2008: "The left side of my face is still kinda messed up. [..] Be careful, I developed purple areas in two places because of this stuff. They look permanently hypoxic."
Patrick wrote on January 18th 2008: "Hi, I use it in situations where I am almost sure I'll flush. The results are never spectacular but it always seems to prevent a flush or it moderates the intensity of the flush (tested on 5 or 6 situations). I have to put a lot on and it gives me breakouts afterwards. Still I am very happy to have found this and I hope they will start working on a formulation specific to target rosacea(flushes)."
Flemmo wrote on January 21st 2008: "I've found a Xylometazoline Hydrochloride (1mg/mL) spray that is free of preservatives ( benzalkonium chloride). Only seems to be available in Australia. The product info is quite interesting though..."
Flemmo wrote on February 4th 2008: "I've been trying the preservative-free Flo Xylo-Pos over the last few days. The good thing is it stops my nose from going bright red during my evening flushes - it feels uncomfortable still, but no increase in redness. however the base line redness can been increasing over the last few days, so I'm gonna stop this little experiment for now. I real shame because I thought being preservative free would be the answer. It might be unrelated, but for now I'll have to put up with looking like rudolf every evening."
Flemmo wrote on February 8th 2008: "It messed me up too even though the stuff I was using was preservative-free."
Rogue22 wrote on February 8th 2008: "I've been trying this too for a couple of days now. Spraying some on a cotton pad and applying it to my nose and one cheek. So far I've seen decreased redness throughout the day, but increased redness at around 21:00. So it seems to be working, but now a whole day. More like 20 hours. I'm using nasivin preservative free."
Mauz wrote on February 13th 2008: "Yesterday I tried applying Oxymetazoline on my face with pretty amazing results. Like already said, after some hours the redness was decreased dramatically, holding up all day. I'm using Vicks Sinex (Oxymetazolinehydrochloride 0,5 mg/ml). Too bad my heart seems to dislike this kind of stuff (heart rate increases and seems to be 'louder'), which I already found out when using Xylometazoline as nasal spray. Therefore, I'm not sure if it's safe for me to continue putting this stuff on my cheeks, any thoughts?"
LuckoftheIrish wrote on November 28th 2010: "Oxymetazoline - good for occasional use? I've read all the posts about oxymetazoline and am aware of the risk of rebound flushing after prolonged use (a week or so straight). I just wondered if there was anyone who is using this at weekends, say, or for special occasions only? I used some Vicks Sinex on my face today and noticed an improvement - not huge - but definitely one of my cheeks was less red and swollen and the pores were much smaller than usual. Does anybody use this periodically? I'd be really interested to hear."
Mistica wrote on November 29th 2010: "I can not emphasize enough, don't touch it again. Please read my hellish posts in the topical brimonidine thread and also the ER thread in the general section. Oxymetazoline is an a1 and a2 adrenergic receptor agonist. Brimonidine is an a2 adrenergic receptor agonist. You don't want to risk the post hell, believe me. Rebound flushing is not always dose or time/ duration dependent. On average it is said it takes three doses to get hooked. That is all it took for me. It can happen sooner. Nat suffered after two doses. Instead of quitting cold turkey I decided to gradually wean myself off it and that turned out to be even worse!"
Steve95301 wrote on November 29th 2010: "I wouldn't mess with it. It gave me a permanent red patch on part of my cheek. [..] that last time I really slathered it on, and left it on all day and it was after that time that I noticed the permanent red patch."
Byu/bearble_lightness wrote in 2016: "Allergan Announces FDA Approval Of RHOFADE for persistent rosacea redness (x/post from r/SkincareAddiction). [..] That's funny, it's the same active ingredient that's in Afrin and other decongestant nasal sprays (Oxymetazoline Hydrochloride), although it is at 1% in RHOFADE versus 0.05% in the sprays. I know I had seen someone in a rosacea forum say they had used the nasal spray before and it worked. The active is a vasoconstrictor (shrinks blood vessels), so you'd expect it to work to combat the redness. There's actually a study (of only TWO patients) [link] where they used the "commercially available preparation" at 0.05%, so I would figure it would be the readily available nasal sprays. Here's another PubMed review of using the nasal sprays for rosacea, it seems it may include the information from the JAMA study on two patients, although it notes both 0.1% and 0.05% (never 1% like this new Rx). I wouldn't be surprised if some people started using the nasal sprays as topicals, but I would definitely warn to patch test and ABSOLUTELY AVOID any of the sprays containing menthol since it could aggravate rosacea. I know when Soolantra came out, I'd read of people without insurance trying out the ivermectin solutions used for mites on cows instead of handing over $300 for the Rx. I wonder how costly RHOFADE will be since it is brand new.
https://jamanetwork.com/journals/jamadermatology/fullarticle/654421
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839519/
Byu/ wrote in 2016: "Rosacea and Afrin. Hey guys, I have mild rosacea (subtype 1). For a while now, I have been applying Afrin onto the affected parts of my face twice daily. I have had exceedingly good results with this and controlling my redness. I got the idea from a study I read online where they used the same thing and the recent FDA approval of a Oxymetazoline cream for erythema. I haven't had any rebound flushing or any negative effects. I follow the application of Afrin with some facial oils and then a heavy duty moisturizer. Just wanted to share this! :)"
Danielgo88 wrote in 2016: "How much Afrin do you apply on your face? [..] I just squirt some in my palm and then apply a thin layer to my cheeks, nose, chin, and forehead. Once it drys I put moisturizer on. It's not really a defined amount."
sSamoo wrote in 2016: "Does it help prevent flushing? or does it mainly work for residual redness? I usually start off normal colored by the day but get red quickly when things get hectic at work"
Someone wrote in 2016: "Actually this is exactly how my skin is. I find that it keeps the flushing down significantly. [..] Also here is the study I am referring to for anyone curious: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839519/ "
BitsofGeek wrote in 2016: "It's oxymetazoline hydrochloride. If you're getting the nasal spray, make sure you check the other ingredients and avoid menthol."
Summary
Rhofade has been touted as the next best thing for rosacea redness, but is more like a case of the New Emperors Clothes: it comes after Mirvaso which does more or less the same thing (but is stronger), and just like Mirvaso it has some serious issues with rebound worsening of the rosacea. Not all users have rebound problems, but a significant group does. Rebound flushing or redness worsening is a common problem with these types of creams that are constricting the small blood vessels for a certain amount of hours. For many users, the body then wants to 'correct' the problem and abnormally dilates the facial blood vessels again, making someone temporarily more red and flushed than before. It seems to work fine for some rosacea patients, but the rebound problem has been mentioned by many users, unfortunately... Like with its competitor Mirvaso, Rhofade has done nothing to counteract the rebound problem. It simply comes down to how reactive and severe the blood vessel instability is of the user. So tread with caution with this product!
Propylene glycol (also an ingredient of Soolantra) is a widely used cosmetics product and a solvent; it is a hydrating ingredient, a man-made organic alcohol that attracts/absorbs water. It is broadly used by food, drug, and cosmetic and personal care product manufacturers. Safe ingredient but can cause skin irritation or allergy for very sensitive skin types, so test on skin first. Usually, this happens in people who are allergic to the chemical and subsides after a short period of time after the body has had time to break down the compound. However it is also used in Soolantra and it is used in many skin care and cosmetic products, so either way, if you are sensitive to it, not even Soolantra might be suitable for your skin). Sodium phosphate dibasic and sodium phosphate monobasic are inorganic salts. In cosmetics and personal care products it function as a buffering agent that maintain the pH between 4.0 and 8.0 and a corrosion inhibitor.
I wouldn't use it on my own skin, personally, but that is because my skin is hyper reactive and sensitive. Rhofade has quite a few potential skin irritants as ingredients as well. Nevertheless rosacea patients have used it on their skin, and mentioned the same effect as what was reported later with Rhofade: reduction of skin redness and the potential for rebound worsening. And for people who simply cannot afford the -frankly obscene- sort of prices that Allergan are said to be charging for their product in the United States (I read numbers ranging from $500 a tube to $700 a tube), it may be interesting to carefully test patch one of the available, cheap nasal sprays instead. Especially considering the expensive Rhofade has an official trial result efficiency rate of 15 to 25%.
Cdelic wrote on April 6th 2008: "Be careful. This is so new and untested. However, 3 1/2 hours later my cheeks are 90% better and i don't have that "sunburn" feeling. I also drank a swig of coffee 3 1/2 hours ago and it has worn off so that may have something to do with it. (Caffeine is my main trigger- and cold diet coke is actually worse than coffee or tea so for me it is the trigger.) I also took a tavist (antihistamine) right before the oxymetolazone as I read some dermatologist websites that say antihistamines can help. But the effect worked on my cheeks within a few minutes so it had to be the topical stuff not the systemic stuff. By, the way, my cheeks are the worst so I tried it there first. The effect for me is quite remarkable. But being a physician I am well aware of the build up of tolerance and the possible long term side effects of what, at first, seems like a miracle. Tread lightly. We are using our faces as guinea pigs. But this is how many outstanding pharmaceutical got developed so there is hope. Makes me feel much better. Steve B"Cdelic wrote on April 8th 2008: "Just starting Oxymetazoline. I just discovered this forum while doing a search on google for oxymetazoline Hydrochloride rosacea. I started using a generic brand (similar to Afrin but with less ingredients) about 3 days ago. I've been dealing with a very red nose (with lots of acne and oil) and red face for years. The last week my nose was as bad as it has been in years (I'm 52). I had noticed a few years ago that when I used eye drops that where it would run down my face it would reduce the redness. I should have run out and gotten a patent then! Any way, on day three and the acne has totally reversed course. I've never had anything work this fast, except maybe doxy. Still red but not as bad. It will probably take at least a week for acne caused redness to clear. I'm not too worried about side effects. This drug has been squirted in eyes and noses for years without any problems. I'll keep you posted. I'm also going to be adding micronized zinc to the routine, but won't start that until I give the oxymetazoline a week or so to see results. Gary"
Steve95301 wrote on April 9th 2008: "Just a heads up: A condition called rhinitis medicamentosa is associated with prolonged vasoconstrictor use. It is caused by rebound dilation and downregulation of receptors. So, there's a very good reason to be careful when experimenting. Good luck though, I love using this treatment myself occasionally - it's just so effective. [..] Unfortunately, the rebound (with Afrin) was due to the vasoconstrictor, although the preservatives may have aggravated things. I say this because I've experienced some rebound from my preservative-free spray. I've stopped using it. I plan on using oxy before an oral presentation I have next week, but other than things like that, I'm staying away from vasoconstrictors until I can ask Dr. Bitter about them or the FDA approves them for rosacea."
gf4456 wrote on April 10th 2008: "Ok this is day four on the oxymetazoline Hydrochloride. I'm blown away. I still have redness but it has been reduced dramatically. But what is really amazing is the acne just stopped dead in its tracks. And I'm talking painful acne, stuff that is deep. Normally my nose produces so much sebum that it is ridiculous. Right now, none, when I squeeze top of my nose or the crevise...none. That has never happened except once when I fasted for 10 days! So as some of the redness goes away I notice the damage from the acne, they will probably stay red for awhile. The few spiderweb veins on my cheek are almost non-existent. And the ones right under my nostrils, seem to be fading fast. Right now I'm applying 3 times a day but will drop that back probably next week. I think I am also just going to add it to the RejuveneX face cream I use.
man_from_mars wrote on April 16th 2008: "Man, I can't believe people are still willing to try this experiment. It's like crack cocaine: it's going to work great at first, then you will tend to start overusing it it will require more and more to get same affect and highly probable you will pay for it in the end. Suspect the thread is so long ,people may be skipping over the posts covering the bad after-affects. Wish someone could rename the thread subject to something more cautious and not as promising. PS* I'm referring to the nasal sprays on the face experiments. mfm"
Steve95301 wrote on April 19th 2008: "I used a double application of oxymetazoline last night for an oral report. It worked remarkably well, as expected, but I was pleasantly surprised when I had no rebound today. In fact, it seemed like the effects of last night continued into today. I do have clonazepam in my system, which tends to make me pale, so maybe that's the explanation. Are there any further reports from others who have decided to try this?"
Alba wrote on April 21st 2008: "Steve, That is wonderful that it worked for you. I used it on a weekend and didn't experience a rebound effect. I think its when its used on a daily basis for a longer period that the rebound effect happens. Alba"
Thedude wrote on April 30th 2008: "Hey folks, just joined on and was excited to discover this website and to read this whole thread. i'm 30, have had Eurythma for about 7 or 8 years, had strong results for a short while with Tetracyclin, but stopped taking it when it stopped working. Per this thread, i went out and bought some Afrin w/moisturizer. Man, crazy results after a few hours, face was tingling and felt great. Tried it again the next day with even better results. Tried it a third day with great results. So i took a few days off and tried it again just once last week. I feel like it reddened my face even more for at first but after a few hours was looking great. I just saw my dermatologist the other day and she said what i suspected -only use it occasionally. Otherwise, she gave me some prescriptions for two things and was wondering if anyone had any info or results from them. Rosac Wash and Klavon Lotion. Otherwise i recommend this sunblock by Aubrey Organics -natural sun spf 25 which has Green Tea in it. Other than that, I've been washing my face for about 5 or 6 years with Aquanil which is great as a soap or moisturizer. Any feedback would be greatly appreciated. Best of wishes to all."
Felix27 wrote on May 2nd 2008: "Difference between Nasal spray and eye drops. If I understand it right Oxymetazoline is the important active ingredient. I find that ingredient in eye drops and in nasal sprays. Who used nasal spray and who used eye drops? I think that nasal spray is maybe more aggressive, because of menthol. Maybe eye drops are better for our skin. What do u think? I didn't read every post, but from what I read, more users had problems with nasal sprays."Melissa W wrote on May 2nd 2008: "Hi Felix, You are absolutely right in that the eye drops would be better for our skin but they are by Rx only. Hopefully the best product for our face will come out soon and be helpful to us. Best wishes, Melissa"
Alba wrote on May 4th 2008: "Hi All: last week i woke up and my right ear was so red that i just had to put some of the sinex to see if it would go away. so i put it on probably 4 times that day and my redness had gone away. then the next day i didn't apply it just left it alone. well i got such awful rebound flushing i mean extreme i usually flush on the right ear but with in a few minutes im able to bring it down with an ice pack gel or cold water. well no matter waht i did i had my right ear in severe heat and flushing staring Thursday and finally by last Saturday night i gave up and applied elocon to the right ear. then in the morning it felt a little better but still having the rebound flushing till i would say finally by Tuesday i was having less flushing and still getting better. my ear got so red and inflamed, and the skin around the ear was so awfully dry that i was even peeling. i really do blame this to the sinex since it was the only thing i applied to it. so definitely believe that this ingredient brings on severe rebound flushing. Today the skin around my right ear is still very dry, and peeling, better each day but still awful experience. Alba"
johnsob0 wrote on May 13th 2017: "Started using Oxymetazoline Hydrochloride from nose spray. Results were consistent with the limited study: immediate (give it a couple hours) reduction in visible blood vessels and what I perceive as inflammation (I don't have much of the more general redness issue). I am now on day 3 and my skin looks better than it has in years (I am 63 years old and have moderately severe rosacea, most likely genetic in origin as my sister also has rather severe rosacea). I will stop treatment after a few weeks to see if I get a rebound."
jennfran wrote on November 26th, 2007: "Thanks for the info...hmmmm. I do wonder about the reboud though. Although I would set my alarm clock to it if I had to..lol..My biggest symptom is burning sensation but I only turn a slight pink. The burning is what I would want this for and of course to stop the dilation which maybe would slow down progression...Jenn"
BrunoP wrote on November 27th, 2007: "I will try it too... There are some different nasal decongestant but all with Oxymetazoline, Nasex, Navisin, Afrin, Vicks Sinex Nasal Spray. But what to buy? Nasal drops, or nasal spray?... Perhaps drops are better..what do you think? And how will you apply? Put the nasal in the morning,these days.?.. Sorry about this dumb questions.. but i want to try this properly...and please update about the results.... regards Bruno"
Caran wrote on November 27th, 2007: "For anyone trying this remember the study used 0.05% oxymetazoline so if this is the strength you buy and then you mix it with a lotion etc you will be diluting it. Perhaps it is best to get some 0.1% and mix the entire contents thoroughly with the same amount of lotion.Does this make sense?"
Bentherebefore wrote on November 27th, 2007: "The highest I was able to find in the store was .05%. That's the concentration that was in Vick's Sinex, Afrin, and the generic brand-x bottle. Visine LR has half the concentration, .025%. If anyone finds a higher percentage, let us know."
Steve95301 wrote on November 27th, 2007: "Before I went to sleep, about 30 min. after my last post, I could see a very large difference. The left side of my face was quite pale in comparison to the right (control side). It took a little longer than I thought it would, but it definitely worked. Wouldn't it need some kind of lotion to help it penetrate the skin? Perry had mentioned using Cetaphil, which made sense to me. I don't think the dilution would matter, because I would have applied the same volume of spray directly anyway. The moles (for lack of a better word) of oxymetazoline stayed the same. [..] Unfortunately I don't know about duration or rebound, since I went to sleep just as it was starting to kick in. I'm currently putting some on my right cheek directly, so I'll be able to see if it kicks in faster that way."
Prryjones wrote on November 28th 2007: "Hi, a bit of info concerning topicals: The goal is to get the active ingredient to the site of action and have it stay there and "work" before being carried away by the systemic circulation. The skin is not a depot and if a drug is absorbable, will continue to absorb as long as the molecule is in contact with it. The molecule has to be the correct size, chemical nature (hydrophillic vs hydrophobic), and electrical nature for optimal absorption. The reason exipients (other compounds, creams) are added to drugs is to facilitate absorption -- there are compounds which sort of "pull" or "push" the drug through the skin. These added ingredients also hydrate the skin, and hydrated skin, contrary to intuition, absorbs drugs much more easily than dry skin. And this is why drugs are formulated in creams, instead of simply "drug and etoh" etc. Perry"
Tompkin wrote on November 28th 2007: "Those of you experimenting: given what Perry has said, are you putting a good moisturizer on first and letting it hydrate your skin? Adding the drops directly to moisturizer, then applying that mixture, risks diluting the medication too much. But if your skin is properly hydrated before you directly apply the liquid, that might aid transport."
Steve95301 wrote on November 29th 2007: "Over the past couple days I've had burning sensations for the first time in years. Not sure if it's related to this stuff, but it's worth reporting [..] I got one that didn't have menthol or propylene glycol or anything crazy in it... I'm at work so I can't check, but I got the one that had the least amt of harsh ingredients. I don't know whether or not it's related, but I thought I'd better report it just in case. Sometimes I get a similar sensation from drinking coffee in a dry, warm environment. So, it could be due to that. I'm really not sure. However, I am also getting a numb/tingly feeling on the sides of my face. It's pretty weird. So, I dunno. [..] I tried it again today. Results: Very impressive. ~50% reduction in redness. I now know that the burning I experienced previously was just due to extreme dryness. If I keep my face moisturized, I can use this stuff with excellent results. [..] I can't tell if there is any rebound, because I drank hot coffee in my warm apartment tonight, and I can't differentiate that flush from any rebound. [..] I use Anefrin Original: What I do is put some aloe vera lotion on for about 5-10 minutes. Then I pat my face dry with a paper towel and put on the Anefrin. Then after a while, I wash that off too."
Angela1979 wrote on November 30th 2007: "Hey, I've tried it too, yesterday. Bought nasivin nasal spray and put it on a cotton wool, then applied directly to my right cheek. Didn't see any effect or difference compared to the other cheek during the day. But this morning this cheek was actually redder than my left cheek and covered in papules. So won't be trying that again. Good luck. Angela"
Bentherebefore wrote on December 3rd 2007: "I have been using Afrin for 4 or 5 days now. I have been applying it with a cotton ball. A lot of it stays in the cotton ball so I'm not sure if there's a better way to apply it. Thus far, I have noticed a slight decrease in redness. That said, I have noticed no decrease in warmth, flushing, or burning. Not the results I was expecting... but I will keep experimenting... [..] I have applied it mixed with some cetaphil lotion. MUCH easier to apply. Keeps the skin from getting dry. Not sure how it changes the effectiveness yet, but I'll letcha know!"
rop wrote on December 18th 2007: "Hey, I am using dristan 0.05% (it has preservatives) been using it for a week or so it is really helping me with the redness (viens and background redness) my top half of my face is always red I put some drops on my face and there were some areas that turned white for the first time in a long time. A couple of days ago i mixed it with lyndsy vita oil and have been applying it every morning around 8 am at 10:30 or 11:00 I see a real improvement in my face colr even after walking in the cold ooutside -17 degreez i had some redness but nothing compared to what i used to get and it went away real fast. And this lasts all the way till 10 pm. I went and bought 0.1 % today and I got another Dristan 0.05% that i am going to try to see the differences between using it with vita oil, alone and using the 0.1 % I am going to have 3 test areas on my face at the same time :?. Any ways i was thinking if we were able to constrict the blood vessels then using something to strengthen them like grape seed extract wont that make these changes actually perminant after some time?? and is this just a temperory treatment of would it permenantly reduce the redness after long term usage ???? thanks guys,BrunoP wrote on January 12th 2008: "A few weeks i went to a new dermatologist, people said that is the best in my country...so, i made an appointment, and he said that creams like, metroderme, rosaliac, rodermil, roseliene, etc, etc.. have no effects on rosacea, and almost every dermatologist prescribes those at the first appointments... he said to take a "Inderal" (clonidine) every morning and also put "Nasex" every morning in the cheeks, which has more effects than the other creams, i mentioned, and he have patients that use this for 2 years, and helps the redness...and also said,that if it works for me i should see the results, in one day or too, and you can use it for ever if you want.. but if it not helps with the redness, you may stop using it... also said that put directly to the face after a cleanser. unfortunately for me it´s not helping with the redness.. and the next time i´ll see him.. i´ll say that, and see what he recommend.. in my opinion, we rosaceans, have more knowledge in this issue than most dermatologists...i had some that dermatologists, that prescribed thinks that i immediately said, that "i´ll not take this, or put this in my face, cause has no effect, or have steroids, or anything that make it worse"...they are so traditional... and always prescribe the same things to everyone in my country, i don´t know how it works in other countries... if you could die for having rosacea, they would find a cure more faster... regards, Bruno"
Steve95301 wrote on January 13th 2008: "Jenn, I just picked the one off the shelf that looked like it had the least amount of irritating ingredients. The one I ended up getting is Walgreens brand ("Anefrin") original. I remember it being the only one without propylene glycol."
Jennfran wrote on January 13th 2008: "I am going to exchange this one for the generic brand you used Steve. I think all nasal decongestants (oxymetazoline) have preservatives in them, don't believe there is a way around this, just maybe one has more then the other. I am still going to try it tomorrow after I exchange it...Jenn"
Caran wrote on January 14th 2008: "Benzalkonium chloride is a preservative which lots of people react badly to. It is also implicated in increasing rebound in nasal and eye preparations."
Jennfran wrote on January 14th 2008: "And I think benzalkonium chloride is in all of them, and I did react bad to it. Needless to say I wont put this on my face again. Jenn"
Steve95301 wrote on January 17th 2008: "I had been using it intermittently, but then I used it for a week straight, Monday through Friday. That weekend - both Saturday and Sunday - I was redder than usual. As an experiment, I applied the oxymetazoline in the late afternoon on Sunday, and voila - paleness. Maybe constricting the vessels for a whole week makes them bounce back a little bit; I really don't know. In fact, I don't even know for sure that it was a rebound at all. The redness could have come from the junk food I ate while watching the football games. [..] pale all week... I'm pretty sold on this stuff."
Steve95301 wrote on January 21st 2008: "Tonight, I had a bad flush come out of nowhere, which is very unusual for me. My vessels are extremely sensitive right now (and I do have some burning). This is undoubtedly a reaction to the Anefrin. I don't know if it's the oxymetazoline itself, or if it's the benzalkonium chloride. Either way, BE CAREFUL."
Steve95301 wrote on January 26th 2008: "The left side of my face is still kinda messed up. [..] Be careful, I developed purple areas in two places because of this stuff. They look permanently hypoxic."
Patrick wrote on January 18th 2008: "Hi, I use it in situations where I am almost sure I'll flush. The results are never spectacular but it always seems to prevent a flush or it moderates the intensity of the flush (tested on 5 or 6 situations). I have to put a lot on and it gives me breakouts afterwards. Still I am very happy to have found this and I hope they will start working on a formulation specific to target rosacea(flushes)."
Flemmo wrote on January 21st 2008: "I've found a Xylometazoline Hydrochloride (1mg/mL) spray that is free of preservatives ( benzalkonium chloride). Only seems to be available in Australia. The product info is quite interesting though..."
Flemmo wrote on February 4th 2008: "I've been trying the preservative-free Flo Xylo-Pos over the last few days. The good thing is it stops my nose from going bright red during my evening flushes - it feels uncomfortable still, but no increase in redness. however the base line redness can been increasing over the last few days, so I'm gonna stop this little experiment for now. I real shame because I thought being preservative free would be the answer. It might be unrelated, but for now I'll have to put up with looking like rudolf every evening."
Flemmo wrote on February 8th 2008: "It messed me up too even though the stuff I was using was preservative-free."
Rogue22 wrote on February 8th 2008: "I've been trying this too for a couple of days now. Spraying some on a cotton pad and applying it to my nose and one cheek. So far I've seen decreased redness throughout the day, but increased redness at around 21:00. So it seems to be working, but now a whole day. More like 20 hours. I'm using nasivin preservative free."
Mauz wrote on February 13th 2008: "Yesterday I tried applying Oxymetazoline on my face with pretty amazing results. Like already said, after some hours the redness was decreased dramatically, holding up all day. I'm using Vicks Sinex (Oxymetazolinehydrochloride 0,5 mg/ml). Too bad my heart seems to dislike this kind of stuff (heart rate increases and seems to be 'louder'), which I already found out when using Xylometazoline as nasal spray. Therefore, I'm not sure if it's safe for me to continue putting this stuff on my cheeks, any thoughts?"
LuckoftheIrish wrote on November 28th 2010: "Oxymetazoline - good for occasional use? I've read all the posts about oxymetazoline and am aware of the risk of rebound flushing after prolonged use (a week or so straight). I just wondered if there was anyone who is using this at weekends, say, or for special occasions only? I used some Vicks Sinex on my face today and noticed an improvement - not huge - but definitely one of my cheeks was less red and swollen and the pores were much smaller than usual. Does anybody use this periodically? I'd be really interested to hear."
Mistica wrote on November 29th 2010: "I can not emphasize enough, don't touch it again. Please read my hellish posts in the topical brimonidine thread and also the ER thread in the general section. Oxymetazoline is an a1 and a2 adrenergic receptor agonist. Brimonidine is an a2 adrenergic receptor agonist. You don't want to risk the post hell, believe me. Rebound flushing is not always dose or time/ duration dependent. On average it is said it takes three doses to get hooked. That is all it took for me. It can happen sooner. Nat suffered after two doses. Instead of quitting cold turkey I decided to gradually wean myself off it and that turned out to be even worse!"
Steve95301 wrote on November 29th 2010: "I wouldn't mess with it. It gave me a permanent red patch on part of my cheek. [..] that last time I really slathered it on, and left it on all day and it was after that time that I noticed the permanent red patch."
Byu/bearble_lightness wrote in 2016: "Allergan Announces FDA Approval Of RHOFADE for persistent rosacea redness (x/post from r/SkincareAddiction). [..] That's funny, it's the same active ingredient that's in Afrin and other decongestant nasal sprays (Oxymetazoline Hydrochloride), although it is at 1% in RHOFADE versus 0.05% in the sprays. I know I had seen someone in a rosacea forum say they had used the nasal spray before and it worked. The active is a vasoconstrictor (shrinks blood vessels), so you'd expect it to work to combat the redness. There's actually a study (of only TWO patients) [link] where they used the "commercially available preparation" at 0.05%, so I would figure it would be the readily available nasal sprays. Here's another PubMed review of using the nasal sprays for rosacea, it seems it may include the information from the JAMA study on two patients, although it notes both 0.1% and 0.05% (never 1% like this new Rx). I wouldn't be surprised if some people started using the nasal sprays as topicals, but I would definitely warn to patch test and ABSOLUTELY AVOID any of the sprays containing menthol since it could aggravate rosacea. I know when Soolantra came out, I'd read of people without insurance trying out the ivermectin solutions used for mites on cows instead of handing over $300 for the Rx. I wonder how costly RHOFADE will be since it is brand new.https://jamanetwork.com/journals/jamadermatology/fullarticle/654421
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839519/
Byu/ wrote in 2016: "Rosacea and Afrin. Hey guys, I have mild rosacea (subtype 1). For a while now, I have been applying Afrin onto the affected parts of my face twice daily. I have had exceedingly good results with this and controlling my redness. I got the idea from a study I read online where they used the same thing and the recent FDA approval of a Oxymetazoline cream for erythema. I haven't had any rebound flushing or any negative effects. I follow the application of Afrin with some facial oils and then a heavy duty moisturizer. Just wanted to share this! :)"
Danielgo88 wrote in 2016: "How much Afrin do you apply on your face? [..] I just squirt some in my palm and then apply a thin layer to my cheeks, nose, chin, and forehead. Once it drys I put moisturizer on. It's not really a defined amount."
sSamoo wrote in 2016: "Does it help prevent flushing? or does it mainly work for residual redness? I usually start off normal colored by the day but get red quickly when things get hectic at work"
Someone wrote in 2016: "Actually this is exactly how my skin is. I find that it keeps the flushing down significantly. [..] Also here is the study I am referring to for anyone curious: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839519/ "
BitsofGeek wrote in 2016: "It's oxymetazoline hydrochloride. If you're getting the nasal spray, make sure you check the other ingredients and avoid menthol."
Emily47 wrote on November 14th, 2017: "Weird success with CeraVe and Afrin. I went to my dermatologist today and had to tell here that the Metrogel that she had prescribed didn't do a thing for my redness. So she said there is a VERY expensive treatment that is about $1200 and insurance won't cover it BUT people are getting the same results with a mixture of CeraVe PM and Afrin. Mix a whole jar of the CeraVe with a small bottle of Afrin (or drugstore brand) together. The Afrin is a gel, believe it or not. It takes pliers to get to top off the Afrin. Anyway, I made the mixture, put it some on my face and, MIRACULOUSLY my face redness faded to almost normal! I'm ecstatic!"
Laser_cat wrote on November 14th, 2017: "Hi Emily. If you search the forum for afrin, oxymetazoline, rhofade you'll find some more info (maybe too much info!). Did the "expensive treatment" refer to laser treatments? Do you have issues with flushing or just background redness? I'd be curious if there are rebound issues... but hope your progress continues. Some people do have rebound issues with oxymetazoline -- when used for rosacea or for "regular" use (nasal decongestant) I too was prescribed metrogel that did nothing for me (flushing + redness). But topical vasoconstrictors like topical timolol leave me with rebound (when I was assured it wouldn't be an issue). best wishes. PS - Slightly off topic and not specific to this thread, but I wonder if there's a way to have a poll or something on this forum (like for each treatment) to synthesize everyone's experiences in a quick and dirty way? Maybe there already is something like that going on ... eg the rhofade/vit D/ etc threads are sooo long and all over the place I don't think many can make it through to the end lol."
man_from_mars wrote on April 22nd, 2014: "From the past member's posts back in 2008? who were experimenting using Afrin nasal spray with Oxymetazoline. The outcome was basically the same as the current Mirvaso rebounds as far as I can tell. I just have serious doubts they have come up with some exclusive anti-rebound formula. Some users were even trying "Nasonex" Nasal spray - thinking they are all the same except this stuff is actually a medium potent steroid (Mometasone Furoate) which is even worse to use on your face."
Johnabetts wrote on April 23rd, 2014: "I have looked up the various Allergan patents and patent applications for the topical use of oxymetazoline but found nothing extraordinary in the formulations that would give anti-rebound properties, apart from the oxymetazoline itself. What I did find interesting was a statement (but not a claim) that the oxymetazoline formulations might act: In some embodiments, the therapeutic effect of cream formulations described herein may be maintained for at least about 30 days, for at least 25 days, for at least 20 days, for at least 15 days, for at least 10 days after stopping the administration of the cream formulation. In some embodiments, the therapeutic effect may be maintained for at least about 7 days, for at least about 5 days, or for at least about 4 days after stopping the administration of the cream formulation. Also, if there was some novel activity of the product base, that would have IP protection as well. It doesn't! If anyone is sufficiently interested, I can post the patent references but, be warned, they are not easy reading and contain some of the most verbose, obfuscatory text I have seen - and boy, patents are a powerhouse of obfuscation."
Kook wrote on November 19th, 2014: "I'd be interested to know the mechanics of flushing.. You'd think they could design a molecule that does what mirvaso etc do but largely irreversibly. Or something along those lines- like a irreversible inhibitor of whatever hormone receptor mediates flushing provided that this is in the blood vessels of the face. Not really much other than massive speculation though unless you want to get into some heavy books."
Wiry wrote on November 23rd, 2014: "Again, the active ingredient was tried a while back by forum members. Just like the active ingredient in Mirvaso was tried a while back. In both cases, the results were unfavorable. It doesn't matter what gel they put it in or if it gets FDA approval, its the stuff that hasn't worked. It is not going to work so just leave it alone."
Forsberg wrote on March 6th, 2017: "Regarding Galderma, I got impression from the posts that people put a case against company which lied about Mirvaso, this is why I asked. I wouldn't be surprised anyway. I know this product well from bad side, my derm gave me sample when it came on the market. She said me that product was not much known but some people got nice effect and I may try it. I tried and later had reddest red color on my face ever. Used it twice. Then I put that into trash bin. What a piece of crap. This is why I do not believe in any topical thing which claim to remove redness without serious side-effects - like Mirvaso's. Against redness I believe only in laser, IPL, LRT and daily routine with makeup. It works for me in some way, at least half."
Brady Barrows wrote on March 7th, 2017: "Galderma finally acknowledged the possibility of rebound issue with this post and making sure the rebound issue is noted in the insert. So if anyone chooses to accept Mirvaso from their dermatologist Galderma has itself covered themselves. Of course, you can still hire a lawyer and pursue this, but you probably don't have enough money to go through the process and Galderma has lots of money for lawyers. It is more important to be informed about taking any prescription and know the benefits, risks and possible side effects. It is called informed consent. However, most rosacea patients trust their physicians implicitly and don't bother to ask about the risks or possible side effects. And of course, Galderma and your dermatologist will point out that there are reports that Mirvaso works for some. If it didn't work at all, it would never have been approved by the FDA. Read the positive reports. Some rosacea sufferers rave about Mirvaso. But based upon the anecdotal reports collected the odds are it won't work for most rosacea sufferers."
RaymondS wrote on March 8th, 2017: "It seems to calm background redness but not my actual broken caps / veins at all. But then some areas works better than others. It's weird in the way it doesn't seem consistent at all. Maybe rhofade might be more consistent."
Poppe wrote on March 9th, 2017: "Hello! I'm still a night cream is applied. I do not see a great difference, but after night, during the day my face is calmer. At least I think so. 0.5% Oxy does not cause me rebound. I use how much? A week, maybe two ... That's a good sign. Later I will try 1%. Ben, told me impose one layer of cream, and for half an hour the next layer. I tried, it is heavy application! Cream it has hyaluronic acid, which is quite sticky!"
Laser_cat wrote on November 14th, 2017: "Hi Emily. If you search the forum for afrin, oxymetazoline, rhofade you'll find some more info (maybe too much info!). Did the "expensive treatment" refer to laser treatments? Do you have issues with flushing or just background redness? I'd be curious if there are rebound issues... but hope your progress continues. Some people do have rebound issues with oxymetazoline -- when used for rosacea or for "regular" use (nasal decongestant) I too was prescribed metrogel that did nothing for me (flushing + redness). But topical vasoconstrictors like topical timolol leave me with rebound (when I was assured it wouldn't be an issue). best wishes. PS - Slightly off topic and not specific to this thread, but I wonder if there's a way to have a poll or something on this forum (like for each treatment) to synthesize everyone's experiences in a quick and dirty way? Maybe there already is something like that going on ... eg the rhofade/vit D/ etc threads are sooo long and all over the place I don't think many can make it through to the end lol."
man_from_mars wrote on April 22nd, 2014: "From the past member's posts back in 2008? who were experimenting using Afrin nasal spray with Oxymetazoline. The outcome was basically the same as the current Mirvaso rebounds as far as I can tell. I just have serious doubts they have come up with some exclusive anti-rebound formula. Some users were even trying "Nasonex" Nasal spray - thinking they are all the same except this stuff is actually a medium potent steroid (Mometasone Furoate) which is even worse to use on your face."Johnabetts wrote on April 23rd, 2014: "I have looked up the various Allergan patents and patent applications for the topical use of oxymetazoline but found nothing extraordinary in the formulations that would give anti-rebound properties, apart from the oxymetazoline itself. What I did find interesting was a statement (but not a claim) that the oxymetazoline formulations might act: In some embodiments, the therapeutic effect of cream formulations described herein may be maintained for at least about 30 days, for at least 25 days, for at least 20 days, for at least 15 days, for at least 10 days after stopping the administration of the cream formulation. In some embodiments, the therapeutic effect may be maintained for at least about 7 days, for at least about 5 days, or for at least about 4 days after stopping the administration of the cream formulation. Also, if there was some novel activity of the product base, that would have IP protection as well. It doesn't! If anyone is sufficiently interested, I can post the patent references but, be warned, they are not easy reading and contain some of the most verbose, obfuscatory text I have seen - and boy, patents are a powerhouse of obfuscation."
Kook wrote on November 19th, 2014: "I'd be interested to know the mechanics of flushing.. You'd think they could design a molecule that does what mirvaso etc do but largely irreversibly. Or something along those lines- like a irreversible inhibitor of whatever hormone receptor mediates flushing provided that this is in the blood vessels of the face. Not really much other than massive speculation though unless you want to get into some heavy books."
Wiry wrote on November 23rd, 2014: "Again, the active ingredient was tried a while back by forum members. Just like the active ingredient in Mirvaso was tried a while back. In both cases, the results were unfavorable. It doesn't matter what gel they put it in or if it gets FDA approval, its the stuff that hasn't worked. It is not going to work so just leave it alone."
Forsberg wrote on March 6th, 2017: "Regarding Galderma, I got impression from the posts that people put a case against company which lied about Mirvaso, this is why I asked. I wouldn't be surprised anyway. I know this product well from bad side, my derm gave me sample when it came on the market. She said me that product was not much known but some people got nice effect and I may try it. I tried and later had reddest red color on my face ever. Used it twice. Then I put that into trash bin. What a piece of crap. This is why I do not believe in any topical thing which claim to remove redness without serious side-effects - like Mirvaso's. Against redness I believe only in laser, IPL, LRT and daily routine with makeup. It works for me in some way, at least half."
RaymondS wrote on March 8th, 2017: "It seems to calm background redness but not my actual broken caps / veins at all. But then some areas works better than others. It's weird in the way it doesn't seem consistent at all. Maybe rhofade might be more consistent."
Poppe wrote on March 9th, 2017: "Hello! I'm still a night cream is applied. I do not see a great difference, but after night, during the day my face is calmer. At least I think so. 0.5% Oxy does not cause me rebound. I use how much? A week, maybe two ... That's a good sign. Later I will try 1%. Ben, told me impose one layer of cream, and for half an hour the next layer. I tried, it is heavy application! Cream it has hyaluronic acid, which is quite sticky!"
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