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Thread: Protopic magical for swelling

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    Default Protopic magical for swelling

    My first post here, diagnosed with Rosacea 6 years ago, type 1 with severe flushing on my cheeks and swelling that makes my face look huge. I have tried numerous treatments over the year, antibiotics, soolantra with nothing helping at all.
    For the past three weeks I have been using Protopic and (after the 15 days) I have a MASSIVE reduction in swelling of my cheeks. My skin can still flush and turn red but the swelling is almost none existant. My face looks the same size it did 6 years ago before I had Rosacea. I really thought my cheeks had permanently enlarged. Others on here who have bad swelling or Rhinophyma might want to try this.

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    Quote Originally Posted by Davvidml View Post
    My first post here, diagnosed with Rosacea 6 years ago, type 1 with severe flushing on my cheeks and swelling that makes my face look huge. I have tried numerous treatments over the year, antibiotics, soolantra with nothing helping at all.
    For the past three weeks I have been using Protopic and (after the 15 days) I have a MASSIVE reduction in swelling of my cheeks. My skin can still flush and turn red but the swelling is almost none existant. My face looks the same size it did 6 years ago before I had Rosacea. I really thought my cheeks had permanently enlarged. Others on here who have bad swelling or Rhinophyma might want to try this.
    Wow, that's good to hear since I also have constant swelling in my face, which might bother me even more than the bad flushing. Did your primary care doctor prescribe it to you? I wonder if there's any theory as to why it would help.
    Last edited by Jamoverton; 26th January 2020 at 07:27 PM.

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    Quote Originally Posted by Davvidml View Post
    My first post here, diagnosed with Rosacea 6 years ago, type 1 with severe flushing on my cheeks and swelling that makes my face look huge. I have tried numerous treatments over the year, antibiotics, soolantra with nothing helping at all.
    For the past three weeks I have been using Protopic and (after the 15 days) I have a MASSIVE reduction in swelling of my cheeks. My skin can still flush and turn red but the swelling is almost none existant. My face looks the same size it did 6 years ago before I had Rosacea. I really thought my cheeks had permanently enlarged. Others on here who have bad swelling or Rhinophyma might want to try this.
    Do you use the topical or.. ?

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    Quote Originally Posted by Jamoverton View Post
    Wow, that's good to hear since I also have constant swelling in my face, which might bother me even more than the bad flushing. Did your primary care doctor prescribe it to you? I wonder if there's any theory as to why it would help.
    I have just been looking around how this could work and came across this medical journal published quite recently in 2017.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309859/
    It's about lymphedema, basically what some people get in Rosacea after flushing etc when tiny amounts of fluid leaks from the vessels in to surrounding tissue and causes swelling. This can then cause fibrosis etc and is linked to Rhinophyma
    The medical journal states
    "These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability."


    In other words this is the first ever treatment that treats edema and stops fibrosis.
    How the hell have people missed this on the board. In theory this should help all phymas like Rhinophyma.

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    Quote Originally Posted by redtere View Post
    I have just been looking around how this could work and came across this medical journal published quite recently in 2017.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309859/
    It's about lymphedema, basically what some people get in Rosacea after flushing etc when tiny amounts of fluid leaks from the vessels in to surrounding tissue and causes swelling. This can then cause fibrosis etc and is linked to Rhinophyma
    The medical journal states
    "These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability."


    In other words this is the first ever treatment that treats edema and stops fibrosis.
    How the hell have people missed this on the board. In theory this should help all phymas like Rhinophyma.
    The story on protopic and elidel in relation to rosacea is not as simple as it may initially appear. There are quite a lot of reports of initial improvement when using these creams before significant deterioration of rosacea, somewhat like with steroid-induced rosacea. If you use the search function you'll find some of these reports and google.

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    Quote Originally Posted by antwantsclear View Post
    The story on protopic and elidel in relation to rosacea is not as simple as it may initially appear. There are quite a lot of reports of initial improvement when using these creams before significant deterioration of rosacea, somewhat like with steroid-induced rosacea. If you use the search function you'll find some of these reports and google.
    Do you know why this doesn't seem to happen (I think..) with plaquenil or methotrexate (or other anti-inflammatories)?

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    Quote Originally Posted by laser_cat View Post
    Do you know why this doesn't seem to happen (I think..) with plaquenil or methotrexate (or other anti-inflammatories)?
    Elidel and Protopic were licensed first for eczema (partly as replacements for steroid treatments in eczema), so probably have some of the same qualities as the steroid treatments that have conventionally been used to treat eczema. Nevertheless these creams are not steroid creams. But I think there are good reasons why Elidel and Protopic, which have been around quite a lot longer than Soolantra, have not come to be seen as widespread treatments for rosacea.

    There are reports in the literature here on Protopic and Elidel:
    https://jamanetwork.com/journals/jam...article/480413
    https://www.ncbi.nlm.nih.gov/pubmed/26295863

    Hydroxychloroquine is an anti-parasitic drug and taken orally so completely different in its mechanism. The issue with hydroxychloroquine (plaquenil) has sometimes been seen as psoriasis as a side effect, or side effects impacting the eyes, but not issues similar to steroid induced rosacea.
    Last edited by antwantsclear; 27th January 2020 at 01:28 AM.

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    Quote Originally Posted by antwantsclear View Post
    Elidel and Protopic were licensed first for eczema (partly as replacements for steroid treatments in eczema), so probably have some of the same qualities as the steroid treatments that have conventionally been used to treat eczema. Nevertheless these creams are not steroid creams. But I think there are good reasons why Elidel and Protopic, which have been around quite a lot longer than Soolantra, have not come to be seen as widespread treatments for rosacea.

    There are reports in the literature here on Protopic and Elidel:
    https://jamanetwork.com/journals/jam...article/480413
    https://www.ncbi.nlm.nih.gov/pubmed/26295863

    Hydroxychloroquine is an anti-parasitic drug and taken orally so completely different in its mechanism. The issue with hydroxychloroquine (plaquenil) has sometimes been seen as psoriasis as a side effect, or side effects impacting the eyes, but not issues similar to steroid induced rosacea.
    I see. Thanks for pulling those out.

    "On the one hand, the immunosuppressive properties of tacrolimus might facilitate overgrowth of follicular Demodex in susceptible patients, as suggested by the predominance of the pustular component in the flares (Figure 1B) and the abundance of Demodex in 2 patients who underwent biopsy. Rosacealike demodicosis has been reported in local10 and systemic immunosuppression,11 which suggests that Demodex proliferation is facilitated by local or systemic immunosuppressive factors. We recently observed a case where a flare of rosaceiform dermatitis during treatment of facial atopic dermatitis with 1% pimecrolimus cream was associated with the appearance of Demodex,12 and the good response of patients to oral doxycycline is another indication of the pathogenic role of Demodex. On the other hand, tacrolimus ointment has vasoactive properties, and facial flushing is a significant adverse reaction to the treatment.13 As local vasomotor instability is a feature of rosacea, tacrolimus ointment may in the long term constitute an additional risk factor in sensitive patients. This may explain the insidious development of rosacea during long-term treatment, as was seen in our patient 6 and in the report of Bernard et al.9 Moreover, the occlusive properties of the tacrolimus ointment base may play an aggravating role, especially in patients with seborrhea."

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    Quote Originally Posted by laser_cat View Post
    I see. Thanks for pulling those out.

    "On the one hand, the immunosuppressive properties of tacrolimus might facilitate overgrowth of follicular Demodex in susceptible patients, as suggested by the predominance of the pustular component in the flares (Figure 1B) and the abundance of Demodex in 2 patients who underwent biopsy. Rosacealike demodicosis has been reported in local10 and systemic immunosuppression,11 which suggests that Demodex proliferation is facilitated by local or systemic immunosuppressive factors. We recently observed a case where a flare of rosaceiform dermatitis during treatment of facial atopic dermatitis with 1% pimecrolimus cream was associated with the appearance of Demodex,12 and the good response of patients to oral doxycycline is another indication of the pathogenic role of Demodex. On the other hand, tacrolimus ointment has vasoactive properties, and facial flushing is a significant adverse reaction to the treatment.13 As local vasomotor instability is a feature of rosacea, tacrolimus ointment may in the long term constitute an additional risk factor in sensitive patients. This may explain the insidious development of rosacea during long-term treatment, as was seen in our patient 6 and in the report of Bernard et al.9 Moreover, the occlusive properties of the tacrolimus ointment base may play an aggravating role, especially in patients with seborrhea."
    That's a great quote you've picked out there. Because of the ubquity of demodex mites, I think it's important to consider them as a factor in the success or failure of the full range of rosacea treatments, such as laser, antibiotics, fish oil, anti-depressants, topical creams, etc. It may well be that once you have treated demodex mites, all sorts of treatments become beneficial to rosacea and its unwanted effects.

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    Quote Originally Posted by redtere View Post
    I have just been looking around how this could work and came across this medical journal published quite recently in 2017.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309859/
    It's about lymphedema, basically what some people get in Rosacea after flushing etc when tiny amounts of fluid leaks from the vessels in to surrounding tissue and causes swelling. This can then cause fibrosis etc and is linked to Rhinophyma
    The medical journal states
    "These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability."


    In other words this is the first ever treatment that treats edema and stops fibrosis.
    How the hell have people missed this on the board. In theory this should help all phymas like Rhinophyma.
    I didn't look into scientifically how it was working. That report says it facilitates the formation of new lymphatic vessels, prevents development of lymphedema and can reverse pathologic changes once lymphedema is established.
    It did sting a bit for the first week I used it, now that has stopped, people who have eczema say the same. The thing is with my cheeks getting bigger, I don't even care about the redness. I just want my skin not to thicken and disfigure. I can deal with the redness easily compared to that, and this has been a life saver.
    Now I just turn red the same amount as before but no swelling.

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