Mirvaso Gel

The symptoms of rosacea can include facial redness (around the central part of the face), swollen blood vessels on the nose and skin, and tender bumps and lumps on the skin, which can be hot and tender to touch. These symptoms are believed to be caused by the dilation of blood vessels and increased blood flow to the area.

Mirvaso constricts or narrows the blood vessels, which reduces the blood flow and therefore reduces the symptoms of rosacea.

You can also help to keep the symptoms under control by using by using these self-help techniques.

Apply Mirvaso gel once daily to dry skin (application to wet skin can cause the gel to run into the eyes or mouth).

Using a clean fingertip, apply one small pea-sized amount of gel to each of the following affected areas - forehead, both cheeks, nose and chin - up to five in total.

Allow the gel to dry before applying makeup or other cosmetics.

Take special care when applying around the eyes. If any gel gels in the eyes it should be washed out thoroughly with water straight away.

Wash your hands after use to limit the constriction of blood vessels in the hands and fingers.

There are multiple treatments for rosacea that are split into two distinct groups - one to reduce the symptoms of redness and flushing, and the other to fight the infection on the skin that often causes rosacea. The groups and treatments are compared below:

Papules and pustules - These are lumps and bumps on the surface of the skin which may be red, hot and tender to touch. They are normally caused by bacteria that live on the skin.

Azelaic Acid and Metronidazole are used to treat mild to moderate pustules and papules. They are applied once or twice a day. The Azelaic Acid is more effective but comes with a greater incidence of side effects. Treatment needs to be continued for a few weeks before a significant difference is usually seen.

Erythromycin (antibiotic) is used to treat papules and pustules which are greater in number and severity and unresponsive to other medicines. It is also used when there is inflammation. Erythromycin needs to be taken for 4 - 6 weeks before a significant difference is seen.

Facial redness and flushing - symptoms caused by expanded blood vessels.

Mirvaso reduces the blood flow thought to be responsible for the redness and flushing. When it is applied once a day a difference can be seen in as little as 30 minutes, lasting for up to 12 hours. Some patients may experience a worsening of the redness, usually within the first 2 weeks of treatment. If you stop using the gel this will get better by itself. You should test a small portion of the skin with the gel before restarting and if it occurs again the treatment should be discontinued.

Oral Treatments – Clonidine, beta-blockers and anxiety medication prescribed under the supervision of a dermatologist can reduce redness and flushing. The mode of action in reducing rosacea symptoms remains unclear.

Thickened Skin

This usually occurs on the nose (rhinophyma) and if severe can be treated with surgery, dermabrasion or laser treatment. Laser treatment involves having narrow lasers aimed at the visible blood vessels in the skin, causing them to shrink so they're no longer visible. It can be mildly painful, with possible side effects including temporary bruising and swelling.

Mirvaso can be used continuously. It needs to be used every day for the redness and flushing to be controlled.

Very little Mirvaso gel is absorbed into the bloodstream and circulated around the body. It is applied in smaller amounts where it is needed, therefore it is well tolerated and most of the side effects occur where the gel is applied.

Some patients find that the gel makes the redness worse (this may be coupled with itching and burning sensation too). This usually happens within the first 2 weeks of treatment. If this happens stop the gel and treat accordingly with painkillers and antihistamines where necessary.

Test using a small amount of gel before restarting treatment. Discontinue if the redness worsens again.

Mirvaso may also cause acne, dry mouth and cold feeling in the hands and feet in less than 1% of users.

Mirvaso will start to work in as little as 30 minutes and lasts for up to 12 hours.

The effects of Mirvaso last for up to a day. It needs to be applied daily to be effective. If you miss an application you won't experience any reduced redness for that day.

Do not apply two or more applications in a day as this increases the chance of side effects without an increase in a reduction in redness.

Apply Mirvaso gel as usual and allow to dry completely before applying makeup and other cosmetics (including camouflage creams like Veil cover cream). As long as Mirvaso has had time to absorb into the skin there is no problem applying makeup or cosmetics over the top.

• Patients who are pregnant or breast-feeding should not use Mirvaso because it may affect development of the unborn baby. The concentration of Mirvaso in breast milk has not been established.
• Mirvaso does not have any effect on fertility.
• Mirvaso is not to be used by patients under the age of 18 years old.
• Mirvaso should not to be used by patients with liver or kidney problems as the effects have not been established.
• Do not use on irritated or open/broken skin.
• Patients with poor circulation in their hands and feet or with low blood pressure or a tendency for their blood pressure to fall should not use Mirvaso gel.

Mirvaso should not be taken with the following medication:

• Antidepressants called Monoamine Oxidase Inhibitors or MAOI for short
• Imipramine and other tricyclic antidepressants
• Moclobemide and maprotiline used to treat depression (not very commonly used in the UK)
• Medication used to treat Parkinson’s, namely selegiline.
• (If you are not sure what type of antidepressant medication you are taking, then contact us or talk to your doctor.)
• Chlorpromazine used to treat psychiatric disorders.
• Methylphenidate for the treatment of hyperactivity.
• Reserpine for high blood pressure (not commonly used in the UK).
• Digoxin and other cardiac glycosides used in treating heart failure.
• Propranolol and other beta-blockers for treating high blood pressure.
• Amlodipine and other calcium channel blocker commonly used to treat high blood pressure.
• Alpha agonist drugs like clonidine.
• Alpha blocking drugs like prazosin used for treating high blood pressure, asthma or a slow heart rate.

Galderma, the manufacturers of Mirvaso, are currently the only licensed manufacturers of the brimonidine gel in the UK. As the patent for this product has not yet expired, there is no unbranded or generic alternate on the UK market.

The two skin conditions can appear very similar. The main difference is that couperose occurs due to the capillary walls expanding, whereas rosacea is an inflammation of the skin. However, some rosacea sufferers may experience couperose skin as an initial symptom. Prevalence of couperose is usually down to sun exposure, extreme temperatures and lifestyle habits, such as smoking and drinking alcohol.

Certain dietary changes may help to reduce the symptoms of rosacea. It’s a good idea to avoid trigger foods and drinks, including certain vegetables, alcohol, caffeine, citrus fruits, refined sugar, beef and seafood. Some vitamins and minerals also have anti-inflammatory effects – seek professional advice before adding supplements to your diet.

Seborrheic dermatitis is also an inflammatory skin disorder, and most commonly appears inside the ears, on the forehead, in the eyebrows, and around the nose. It’s characterised by scaly/greasy/yellow patches of skin and is often accompanied by dandruff – but no acne bumps or pustules, as with rosacea.

If you’re uncertain what you’re suffering from, get a free online consultation and we’ll help to identify your condition. Often, people with rosacea also have seborrheic dermatitis, and these different conditions must be treated separately. If you’re only suffering from dermatitis, you will likely be prescribed a treatment like E45 Itch Relief Cream or Dermol Cream.

Mirvaso is the brand name for the active Ingredient brimonidine.