Linda Sy and I just had a wonderful hour-long conversation over the phone. We
discussed many topics including theories on the development of rosacea, and
possible avenues for the treatment of rosacea. Both of us can learn a great
deal from each other. But the bottom line is that we both want to help this
group (and other rosacea sufferers). We both understand that this is an open
forum for the discussion of personal experiences, success stories, theories,
treatments, triggers and so on. We are both professionals and we both respect
what each other has to say.
One of the major topics we discussed dealt with the compounding of ingredients
into creams and lotions. She was concerned with the overall product stability
, compatibility of ingredients, microbiological contamination and clinical
effectiveness. I absolutely agree with her hesitation and concerns. One cannot
simply compound an ingredient or medicine into a cream and expect it to be
therapeutic. In addition, you must also be extremely cautious of the choice in
compounding pharmacies -- not all are created equally.
I have suggested several compound formulations to various rosacea sufferers.
Most notably, I had previously suggested a dimethicone-zinc oxide formulation.
My overall intention is to give rosacea sufferers choices -- these choices are
not always backed by double-blind placebo controlled studies. As a biomedical
research scientist, my motto has always been "Always have a healthy skepticism
to any medical or scientific data when viewing it for the first time". In fact,
the second and third time I see that new data I say to myself "Well, that still
has not been proven beyond a doubt". The fourth, fifth and sixth times I see
that in peer reviewed medical and scientific journals, I think to myself "How
interesting, maybe they are onto something" -- but I am still somewhat
suspicious of the data or clinical implications. I need to see that same
clinical data reproduced 7 times, from 7 different authors, of 7 different
medical schools before I take the data as fact. This is the safest, most wise
approach to anything in science or medicine.
However, as a rosacea sufferer, I have first hand knowledge on the constant
physical and emotional pain that you are going through. I myself have been
through 5 years of hell. I also know, that it will be quite some time before
great clinical studies are performed on rosacea sufferers. I should probably
wait to give out advice or information until my book is out so that you can see
the latest findings from international and national medical meetings, quotes
from physicians, medical studies, clinical before and after photos, and
anecdotal evidence. But, I want to offer advice right now -- in as cautious a
nature as I know how. All the information that I give out should be checked and
double checked by your physicians.
The reason why I offered a suggestion for the formulation of a dimethicone-zinc
oxide formulation was because:
1. Clinical biopsies of rosacea skin show that the facial dermal skin is much
thinner when compared to controls. Some show a thinning of the epidermis
(stratum corneum) while others show an overall thinning of the dermal
connective tissue. Furthermore, most of these same rosacea sufferers state that
they are much more sensitive to facial cleansers, moisturizers, wind, cold, and
sun. Most of this reactivity is due to facial blood vessel dysfunction -- but
some physicians also speculate that there may also be a problem with the
barrier function of the skin. Such that an important part of the treatment
regimen should be to restore that barrier function or to enhance the barrier
function with topical products.
a. To restore the barrier function, proper moisture and healing are key -- this
is why I love the ingredients in Dr. Sy's oil. By the way please don't buy the
supermarket equivalent of the oils. If you do but the oils separately -- buy
them from a respectable cosmetics/herbal store from a company that manufactures
quality, thoroughly tested products. The purity, synthesis, extraction and
bottling are very important to the effectiveness of the oil (or for that
matter, any product).
b. To enhance barrier function, you can apply topical substances (that don't
irritate the skin). Your group has found zinc oxide to be beneficial -- this is
not surprising due to its chemical makeup. Titanium dioxide also has similar
properties. However, one of the most beneficial substances to date is
dimethicone. It is the primary active ingredient in many top of the line
protective barrier creams, as well as anti-inflammatory and moisturizing
creams. When I learned about the possible barrier dysfunction that may be
present in some patients with rosacea, I researched the best topical
ingredients to find something that we could use safely. I started with the
professional skiers, windsurfers and life guards -- they need the best
protection from the external environment. I found that certain private
laboratories such as Collaborative Laboratories Inc. based in New York, had
been compounding special formulations for these outdoor professionals -- with
excellent results. Their primary active ingredient in their special formulation
is dimethicone. They can combine this with micronized zinc oxide or titanium
dioxide to offer sunscreen protection. They then sell this combination to
various leaders in the cosmetic industry -- where the dimethicone-zinc oxide is
then compounded into almost any moisturizer or sunscreen. The stability of this
formulation is excellent - dimethicone prevents oxidation of the other
ingredients. Furthermore, the dimethicone is an excellent non-greasy
moisturizer . Addition of dimethicone to zinc oxide also makes the cream much
easier to remove with facial cleansing -- so less chance of irritation.
I personally have had excellent results compounding this formulation into
noritate and various moisturizers. Furthermore, 5 different dermatologists in
the Pittsburgh area are now recommending this same formulation base to anyone
with extremely sensitive skin.
Most importantly, my findings have now been backed by a recent peer-reviewed
medical article (Cutis 61(5):344-346, 1998 Effective sunscreen ingredients and
cutaneous irritation in patients with rosacea), Drs. Nichols and Lebwohl found
that the skin of all rosacea patients absolutely loved dimethicone (and its
cousin cyclomethicone). In fact, when dimethicone was compounded into
sunscreens that were proven to be extremely irritating, the patients noticed a
significant decrease in irritation. This is great news.
This dimethicone-zinc oxide combination is definitely worth a try -- but please
proceed with caution and always ask for advice from your doctors.
I would like to talk about other topics that Dr. Sy and I discussed, but I am
tired and need to reacquaint myself with my fiance. I really enjoyed talking to
Linda and I am glad that she is onboard!
Geoffrey
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Dr. Geoffrey Nase
Ph.D. Microvascular Physiologist
