Researchers offer comprehensive overview of rosacea treatment options

Affecting up to 1 in 10 people worldwide, rosacea has a complex pathophysiology that remains insufficiently understood, and research has hinted at multiple inflammatory and immune processes underlying the disease.

Since rosacea treatment requires a personalized approach for each patient, researchers have compiled current treatments for the disease, offering a broad overview of the options providers have for their patients.

The findings were published in Journal of Cosmetic Dermatology.

Affecting up to 1 in 10 people worldwide, rosacea has a complex pathophysiology that remains insufficiently understood, and research has hinted at multiple inflammatory and immune processes underlying the disease.

“The opening of different fields in the molecular pathogenesis of rosacea has led to the emergence of new interventions. The addition of new formulations such as topical brimonidine and oxymetazoline, oral therapies in the form of modified release doxycycline, ondansetron, etc. and new light/laser devices have increased our therapeutic arsenal,” the study researchers wrote. They also noted that management of the condition depends on patient education, creating and following a skin care routine, and treatment with topical and oral therapy, as well as a laser/light treatment.

With various topical treatments approved for rosacea, factors such as skin type, presentation of rosacea, mechanism of action, previous treatment experience, and efficacy and safety of drug treatment decisions .

Approved topical treatments include Azelaic Acid Gel (15%); metronidazole (gel, cream and lotion 0.75% and cream and gel 1%); sodium sulfacetamide/sulfur (10%/5%) gel, cleanser, lotion, suspension and cream; brimonidine tartrate gel (0.33%); oxymetazoline hydrochloride cream (1%); and ivermectin cream (1%). As a second line, calcineurin inhibitors such as tacrolimus, benzoyl peroxide, and topical antibiotics are used.

Oral options for rosacea fall into 4 treatment classes:

  • Tetracyclines, including tetracycline (250-1000 mg/day), doxycycline (100-200 mg/day or 40 mg/day of a modified release formulation) and minocycline (100-200 mg/day); according to the researchers, doxycycline and minocycline have increased bioavailability, longer half-lives and fewer gastrointestinal adverse effects compared to previous treatments
  • macrolides, including erythromycin, azithromycin, and clarithromycin, which researchers say have been used effectively in patients who are not good candidates for tetracyclines; for example, azithromycin has been shown to be effective in patients allergic or intolerant to tetracycline
  • Metronidazole has been shown to be effective in treating inflammatory lesions of papulopustular rosacea
  • Isotretinoin, typically used to treat refractory or nodulocystic acne, has also shown efficacy in treating erythematotelangiectatic rosacea and papulopustular rosacea that does not respond adequately to other treatments.

Lasers and light therapy, including intense pulsed light and pulsed dye laser, have been put to good use for patients with eythematotelangiectatic rosacea, in particular.

“Light-based therapies are particularly effective in treating the various vascular manifestations of the disease, i.e. flushing, erythema, and telangiectasias,” the researchers explained. “Long pulsed dye lasers and pulsed light devices intense are an effective modality for the treatment of the disease and are associated with significant patient satisfaction, especially since the vascular component may not improve with other therapies.”

Other laser and light therapies include potassium-titanyl phosphate laser, ablative lasers, and diode lasers.

Reference

Sharma A, Kroumpouzos G, Kassir M, et al. Rosacea management: a comprehensive review. J Cosmet Dermatol. Published online February 1, 2022. doi:10.1111/jocd.14816

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