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27 year old woman with a 5 year history of rosacea and emotional facial flushing. Topical metronidazole products initially were marginally effective, but over the past year have lost their effect.

What is your diagnosis?

before image

Diagnosis: Rosacea

In this case we recommended that she use brimonidine gel, 0.33% (Mirvaso). Brimonidine gel, 0.33% did well to control the redness and flushing. It took approximately 1.5 hours to take full effect. Unfortunately for her it only lasted for about 6 hours. We had her mix Mirvaso 1:1 with a compounded formula of: metronidazole 0.75%, Oxymetazoline0.05% in a vehicle/base of Cerave lotion.

This mixture, described above, provided 12-14 hour results. See pictures for details.

Image 1
before treatment
Before any treatment

Image 2
after treatment
2 hours after treating; right face 1:1 mixture Brimonidine gel, 0.33% 1:1 with a compounded formula of: metronidazole 0.75%, Oxymetazoline0.05% in a vehicle/base of Cerave lotion on the right side of face, Brimonidine gel, 0.33% to the left side of face

Image 3

6 hours after treatment, Brimonidine gel, 0.33% alone on left face starting to wear off, compounded mixture still working on right side of face.

Image 4

10 hours after application of compounded mixture (metronidazole 0.75%, Oxymetazoline0.05% in a vehicle/base of Cerave lotion )to full face


For additional information please see:


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