Re: Reducing Noritate Useage

[Guest guest]

> Metronidazole _is_ the most proven treatment for cea. Thanks to

> Galderma it has been tested, promoted and disseminated at large.

It's probably not a good idea for me to disagree with the list owner,

especially after he wrote such a nice post yesterday , but I would

argue that the most proven treatment for cea is oral doxycycline.

It's very safe and very effective, but it's a cheap generic product

so there's no brand name drug company promoting/marketing it.

Topical antibiotics are used alone for mild cases of rosacea only.

Their best role is in maintenance treatment, since they are

essentially side effect-free for those who can tolerate them. But

many rosaceans require oral doxycycline for maintenance treatment,

used at a fraction of the dose prescribed for initial treatment.

(Just to clarify, treatment of rosacea is divided into initial (when

first diagnosed, or for serious flares/breakouts) and maintenance

therapy (everyday use). Not everyone needs maintenance therapy, but

those who suffer from recurrent symptoms or frequent breakouts

probably do.)

I wouldn't thank Galderma since I don't believe they discovered the

link between antibiotics and rosacea. I suspect they're just taking

advantage of marketing opportunities, including funding pro-Galderma

research and other ways to favorably promote their product. That's

not to vilefy them, it's just reality.

(Again just to clarify, Galderma makes three topical metronidazole

products that differ only in inactive ingredients -- very important

to consider with skin sensitivities and type of skin: Metogel,

Metrolotion, and Metrocream. Another popular topical metronidazole,

made by another company, Noritate, is also a cream, but with

different inactive ingredients than Metrocream. It's a bit stronger

(1% instead of 0.75%) and is usually prescribed once instead of twice

a day. Aside from Noritate's popular formulation, once-daily use is

much easier and cheaper. Galderma is going after Noritate's market

share -- this fall they released a study they funded showing that

once-daily use of their products is just as effective as once-daily

Noritate.)

> Sadly many of the list members do not fall into this category - and

> hence hang around wanting more. Those with severe rosacea, with

> strong contact allergies, and with a strong vascular/flushing

> component to their rosacea will find the metronidazole stories

> hollow.

Not necessarily. Oral and/or topical antibiotics may well be

partially effective, especially if accompanied by good (simple) skin

care and atttention to major triggers and if given long enough time

(1-2 months may be necessary to see any effect). It is true that

antibiotics are less effective with vascular than with the

inflammatory components of rosacea, but still some red rosaceans find

them effective.

> I myself found rozex to be a reasonable treatment, but in the end

it was

> quite expensive and I found another regime that suited me better.

Rozex is another topical metronidazole, distributed outside the US by

Galderma; I don't believe it is available in the US. The formulation

is similiar to Noritate, but at 0.75% rather than 1% strength.

What are you using now, ?

> BTW it is still unknown how it works, it is not a typical

> antibiotic.

All the products above are typical antibiotics, . We don't know

exactly how antibiotics work in treating rosacea specifically, but

it's generally regarded to be as an anti-inflammatory agent, not by

killing bacteria (the primary, but not the only, use for antibiotics.)

That's why oral and topical antibiotics can take 3-6 weeks before any

improvement is noted, and 6-12 weeks for a full course effect. Many

rosaceans don't see any effect from oral or topical antibiotics until

after a full month. That's especially true if subtly irritating

cleansers and moisturizers and other ingredients counteract the anti-

inflammatory effect. It takes a long time to get the anti-

inflammatory action going.

Marjorie

Marjorie Lazoff, MD