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Home-made clinical trials lead to a cure for widespread skin complaints

One of my friends (referred to as the patient) holds a Ph.D. degree in statistics and has been affected with a common skin condition for more than 20 years, known as rosacea (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001882/). Here we report how he came with a solution to fully eliminate the problem. Physicians traditionally agree that there is no cure for rosacea.

This study involves only one patient. But typically, clinical trials involve a very small number of patients, and data related to clinical trials is known as "small data", as opposed to "big data". It makes statistical inference much more complicated. On the plus side, the patient has tested and tried many solutions over a period of 20 years, while exhibiting very traditional symptoms getting slightly worse over time but almost under control, when using traditional medecines.

This is not a story about how the pharmaceutical industry is producing useless medications. The patient was actually cured in three days with a drug manufactured by Janssen Pharmaceutica, a drug typically used for vaginal infections. However, it is a story about how the pharmaceutical industry, indirectly, forces you to buy expensive drugs all your life ($200/year) when they have a 3-day solution (one-time $20 expense) to eliminate the problem. In this, it is possible that the pharmaceutical industry was not able to make a link between rosacea (impacting both men and women) and fungal infections mostly impacting women.

To summarize, the patient (male) started recently to notice a worsening of his skin condition (on the nose, skin, and forehead) with new symptoms that looked similar to a fungus problem elsewhere (penis), which was responding very well to Monistat, a drug typically used to cure fungal infections in women (vaginal condition). The new symptoms involved skin scaling and skin bumps that look very similar to his other problem cured by Monistat. The rosacea was cured in three days with Monistat.

Note that over the course of 20 years, doctors prescribed the following medications, which managed to keep the skin condition under control, but not cure it:

  • Rosula, a very expensive Rx drug
  • Cortisone - a drug with bad side effects 
  • Avene - a skin cream he purchased in France, 10 times cheaper than Rosula but having similar effects
  • Antibiotics that you need to take over a very long time period - with bad side effects  

Any comments on this true story are welcome. If you want to get in touch with this patient, let me know.

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Comment by Vincent Granville on October 16, 2011 at 6:43pm
It turns out that the skin problem came back within 10 days, although it was milder than before. Interestingly, one of the creams that stopped working (Rosula) proved to be very efficient, when the new flare happened. It looks like alternating creams every 10 days is an efficient solution to (almost) get rid of this problem.
Comment by Vincent Granville on October 10, 2011 at 12:11pm
There's been some great feedback from the Allstat list:

A nice protocol for this sort of situation is the n-of-1 trial. There's a good example with useful references, in the British Journal of General Practice. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002254/

Whilst it is often emotive for statisticians to conduct research into areas that they themselves suffer, it has done, sometimes to good effect. In any case I would advise your friend to read a recent Cochrane review of this condition (a summary is about to be published in the British Journal of Dermatology)
Interventions for Rosacea http://www2.cochrane.org/reviews/en/ab003262.html
This review summarised the work of almost 60 studies and considered some of the anecdotal data available. Yes, anecdotal data can be used to investigate in a more systematic way and can be used on a patient-by-patient basis, but at the population level we should be using robust evidence based practice (where it is available). I say that because, there is a lot of published data for Rosacea.
Comment by diana kornbrot on October 9, 2011 at 3:11am

not sure where he is base, but has he approached NHS or skin health/rosacea charity to set up a clinical trial - or even the manufacturers

seems like key next step

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