Soolantra

Quote:

---

Originally Posted by RedRecluse

Hopefully your dermatologist concedes that there is far more information online than what most dermatologists understand, and that he/she needs to prescribe you with what you need/want prescribed to you based on the countless hours of research you've done into the remedies that you think you need/to try.

Good luck.

---

Thank you, RR. If my condition does turn out to be demodex related, and Soolantra (or ZZ cream in the future) works for me, I will be forever grateful to you for sending me down this path of questioning, on top of the gratitude for all the time you have spent responding to my questions.

Hi, I just registered but am a really active lurker :) after 8 weeks of Finacea (didn't help AT ALL) I got a script for rosiver (soolantra) and it is my last hope. I thought that if the well praised finacea did nothing for me, i might have demodex issues.

Background info: female, 31, papulo pustular rosacea since nov 2015, started on one cheek and slowly migrated to other side. Still worse on the first side. Intermittent flushing of the nose since a few years, but I can live with that part. I am not able to identify my triggers except heat / sun exposure. Nose gets bright red instantly. I can actually drink red wine and most of the time nothing happens.

I started Soolantra on August 10, so today is day 8. Since 2-3 days my cheeks are like worse than ever.. can it be a die off? I saw no improvement yet on my cheeks, BUT the rest of my face is smooth and clear, just a few mini papules on my chin that i just see because i am always scrutinizing my skin.

Is it possible that the inflamed cheeks is indeed a die off and i should continue with soolantra? I must say that my cheeks have always been the worst area for my p&p, in fact they are NEVER clear. Rest of my face they come and go. Oh and right now my pustule vs papule ratio is a bit higher than normal.

I am asking this because many people seem to get an initial i.provement and then a die off at week 3.. but i got no improvement and worsening since day 6-7?

I don't want to give up but as you all know, this is a mood affecting condition.. at least i am on maternity leave so i can hide in my house during die off phases, but I feel so ugly right now..

Oh wow, sorry that was long.. but I am soooo fed up with this!

Quote:

---

Originally Posted by Dontgiveup

Hi, I just registered but am a really active lurker :) after 8 weeks of Finacea (didn't help AT ALL) I got a script for rosiver (soolantra) and it is my last hope. I thought that if the well praised finacea did nothing for me, i might have demodex issues.

Background info: female, 31, papulo pustular rosacea since nov 2015, started on one cheek and slowly migrated to other side. Still worse on the first side. Intermittent flushing of the nose since a few years, but I can live with that part. I am not able to identify my triggers except heat / sun exposure. Nose gets bright red instantly. I can actually drink red wine and most of the time nothing happens.

I started Soolantra on August 10, so today is day 8. Since 2-3 days my cheeks are like worse than ever.. can it be a die off? I saw no improvement yet on my cheeks, BUT the rest of my face is smooth and clear, just a few mini papules on my chin that i just see because i am always scrutinizing my skin.

Is it possible that the inflamed cheeks is indeed a die off and i should continue with soolantra? I must say that my cheeks have always been the worst area for my p&p, in fact they are NEVER clear. Rest of my face they come and go. Oh and right now my pustule vs papule ratio is a bit higher than normal.

I am asking this because many people seem to get an initial i.provement and then a die off at week 3.. but i got no improvement and worsening since day 6-7?

I don't want to give up but as you all know, this is a mood affecting condition.. at least i am on maternity leave so i can hide in my house during die off phases, but I feel so ugly right now..

Oh wow, sorry that was long.. but I am soooo fed up with this!

---

Hey, I can say that my skin broke out with pustules way worse in less than 24 hours. It reached a week one peak at days 5 through 7. I then saw some improvement in the 2nd week. Every other week for me brings a wave of pustules still, and I'm on week 13. It's better and better though. Just for a perspective, my baseline pustules were usually around 10, meaning that most mornings I would wake up and have between 5 and 10 little tiny pustules everyday (most severely in my cheek areas also). On day 6 of my first week on Soolantra I think I counted like 42 pustules. Not sure about you, but mine are very teeny tiny and look like a baby whitehead with a little red irritation around it. It was SO upsetting; however, I took that as a good sign. The dramatic reaction was the reason I knew that Soolantra was making something die-off. Now, after 13 weeks, I have a week here and there with zero pustules all week, so I know I'm improving. It's tough to see the flare-ups and not panic, but I would come on here and read people's experiences and that would give me the nerve to keep going. Good Luck!

Quote:

---

Originally Posted by MissM

This is great news! I would definitely consider a zz cream that doesn't dry up my fragile skin. Thank you, Brady.

---

See this post if you want to try out this new cream in a trial.

Quote:

---

Originally Posted by sks42

Hey, I can say that my skin broke out with pustules way worse in less than 24 hours. It reached a week one peak at days 5 through 7. I then saw some improvement in the 2nd week. Every other week for me brings a wave of pustules still, and I'm on week 13. It's better and better though. Just for a perspective, my baseline pustules were usually around 10, meaning that most mornings I would wake up and have between 5 and 10 little tiny pustules everyday (most severely in my cheek areas also). On day 6 of my first week on Soolantra I think I counted like 42 pustules. Not sure about you, but mine are very teeny tiny and look like a baby whitehead with a little red irritation around it. It was SO upsetting; however, I took that as a good sign. The dramatic reaction was the reason I knew that Soolantra was making something die-off. Now, after 13 weeks, I have a week here and there with zero pustules all week, so I know I'm improving. It's tough to see the flare-ups and not panic, but I would come on here and read people's experiences and that would give me the nerve to keep going. Good Luck!

---

Thanks sks42, the pustules that you describe during your initial die off phase really sound like the ones i have right now! Right now i can tell that i am at my worse ever, and my p&p look angrier than normal. What makes me think of a die off is that the rest of my face has no reaction whatsoever. So, not an allergy or whatever.

So I guess it is a good sign and I hope i am headed in the same direction as you! I don't mind a lil breakout every other week, it's already better that what i am used to (i am never never clear). So your breakouts are less and less intense everytime now?

When i woke up this morning i decided to use soolantra twice a day from now on. At least until the mess has subsided :) i rather have it short and intense!

Quote:

---

Originally Posted by Dontgiveup

So I guess it is a good sign and I hope i am headed in the same direction as you! I don't mind a lil breakout every other week, it's already better that what i am used to (i am never never clear). So your breakouts are less and less intense everytime now?

---

Yes, my breakouts are less intense. I would just link my posts, but I don't know how. Essentially, I've used Soolantra for 13 weeks now pretty much. I use it every morning about 30 minutes before make-up. Week 1 was BAD for me. I got itching and a lot of pustules. Week 2 was more baseline. Week 3 did bring a different kind of break-out. I got pustules, but also a few bumps like mosquito bites. Week 4 was good. Week 5 I had another pustule flare-up. Week 6 was good. Usually things get less intense as the weeks go on. Occasionally I'll have a week that feels like a step back, but mostly it's a big improvement overall. Like, yesterday I had a flare-up out of nowhere, but that flare-up was like 10 pustules, which used to be my baseline but now it's the worst it ever gets. I think that's a huge improvement.

Quote:

---

Originally Posted by sks42

Yes, my breakouts are less intense. I would just link my posts, but I don't know how. Essentially, I've used Soolantra for 13 weeks now pretty much. I use it every morning about 30 minutes before make-up. Week 1 was BAD for me. I got itching and a lot of pustules. Week 2 was more baseline. Week 3 did bring a different kind of break-out. I got pustules, but also a few bumps like mosquito bites. Week 4 was good. Week 5 I had another pustule flare-up. Week 6 was good. Usually things get less intense as the weeks go on. Occasionally I'll have a week that feels like a step back, but mostly it's a big improvement overall. Like, yesterday I had a flare-up out of nowhere, but that flare-up was like 10 pustules, which used to be my baseline but now it's the worst it ever gets. I think that's a huge improvement.

---

Sounds like Soolantra isn't working for you. There should be one or two initial die-offs (adults and then hatched babies) and no more thereafter once your Demodex Mites are under control. Suggest moving on to ZZ Cream.

Quote:

---

Originally Posted by RedRecluse

Sounds like Soolantra isn't working for you. There should be one or two initial die-offs (adults and then hatched babies) and no more thereafter once your Demodex Mites are under control. Suggest moving on to ZZ Cream.

---

In theory, I understand exactly what you are saying. I do not agree, though, that my symptoms mean that Soolantra is not working for me. All treatments suggest using a product for at least 120 days continuously for the very reason that mites will continue to live and repopulate if you do not. That includes ZZ Cream. My skin may not have had only 1 or 2 die-offs, but that does not mean that it has not been greatly improved by Soolantra. I am going to use Soolantra for a minimum of 16 weeks, and probably 20 weeks before I move on to ZZ Cream. I do not use any other anti-inflammatory product and I believe my skin must be very reactive to mite residue. I will absolutely try ZZ Cream if I am not satisfied after my Soolantra trial. If I do move on to ZZ Cream I was curious how a person could use it in the morning without residue showing up. I've seen you mention that you dilute it. I have to use my products in the morning so don't want something that looks chalky or something.

Demodex are nocturnal, so anyone treating for them should use the product in the evening, when male demodex roam around on the skin and become exposed to the anti-demodectic product. Using Soolantra in the morning is not going to be as effective. The same goes for sulfur (zz cream). Products should always be used in the evening.

The life-span of demodex coincides with people's descriptions of die-off cycles -- this tends to support the idea that anti-demodectic products do not penetrate into the pore, but instead, work to stop the breeding cycle, by killing the male demodex when they leave the pilosebaceous unit (pore) in order to find a female to mate with. Or perhaps anti-demodectic products work as birth control -- for example, if anti-demodectic products were truly an insecticide (miticide) that penetrates the pore, they would be effective on day-1, and clearly, they're not.

However, there are 2 types of demodex, where brevis appears to have a longer life-span than folliculorum, (45 days compared to 23 days) so the die-off cycles appear variable, and more difficult to nail down as you make progress to suppress or eradicate them. This is based on my own observations, rather than a medical source, but since demodex cannot be cultured in a lab, observation and reasoning are useful.

Quote:

---

Originally Posted by Tom Busby

Demodex are nocturnal, so anyone treating for them should use the product in the evening, when male demodex roam around on the skin and become exposed to the anti-demodectic product. Using Soolantra in the morning is not going to be as effective. The same goes for sulfur (zz cream). Products should always be used in the evening.

However, there are 2 types of demodex, where brevis appears to have a longer life-span than folliculorum, (45 days compared to 23 days) so the die-off cycles appear variable, and more difficult to nail down as you make progress to suppress or eradicate them. This is based on my own observations, rather than a medical source, but since demodex cannot be cultured in a lab, observation and reasoning are useful.

---

Tom, months ago when my dermatologist suggested I may have rosacea he prescribed retin-A. It seemed an odd choice, but after going through a month of holy terror, my "rosacea" improved by half. After months of retin-A use my skin is pretty amazing and although I'm 42 I genuinely look about a decade younger. A bit of genetics, but also the use of retin-A. Retin-A can only be used in the evening, thus why I use my demodex products in the morning.
I think my results have been hindered by my morning use, so I may take longer to heal than most people. I agree with your assessment that the die-off cycles could be more variable depending on demodex type. Having read these forums I have found that people have varied results and so I try to be patient and just judge overall improvement over the weeks.