This detailed review of 71 randomized clinical trials that related to rosacea treatments, found that the quality of the trials were generally poor.
The only strong evidence for effective results were found for metrogel and finacea, and only for the papules and pustules of rosacea. Other symptoms and other treatments were not backed by solid research so could not be recommended.
Interventions for rosacea: A systematic review
Poster Discussion Session P575, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.
Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.
Aditya Gupta, MD, PhD, MBA, Department of Medicine, Sunnybrook and Women’s College Health Sciences Center (Sunnybrook site) and the University of Toronto, Toronto, ON, Canada; Mediprobe Research Inc., London, ON, Canada; Esther van Zuuren, MD, Leiden University Medical Centre, Leiden, Netherlands; Melissa Gover, Mediprobe Research Inc., London, ON, Canada; Mark Garber, MD, Emergency Medicine and Family Medicine, University of Iowa College of Medicine, Iowa City, IA, United States
Background: Rosacea is a common chronic skin condition affecting the face, characterized by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective.
Objectives: We sought to assess the evidence for the efficacy and safety of treatments for rosacea.
Methods: We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were also searched. Randomized controlled trials (RCTs) in people with moderate to severe rosacea were included. Two reviewers independently assessed study design based on a predetermined set of criteria, grading them as high, intermediate, or low quality. Studies classified as low quality were excluded from analysis. Details of the eligible trials were extracted and summarized using structured data collection forms.
Results: The searches identified 71 possible RCTs, 30 of which met the defined inclusion criteria. Pooled data from two trials showed that for metronidazole, 68 of 90 participants considered themselves improved versus 32 of 84 in the placebo group (OR: 5.96; 95% confidence interval [CI]: 2.95-12.06). Data pooled from 3 between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70% to 80% (azelaic acid) versus 50% to 55% (placebo) (OR: 2.45, 95% CI: 1.82-3.28). Data pooled from 3 studies of oral tetracycline versus placebo showed 56 of 73 participants treated with tetracyclines were improved versus 28 of 79 participants in the placebo group (OR: 6.06; 95% CI: 2.96-12.42).
Conclusions: The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective in the treatment of the papules and pustules associated with rosacea. However, more well-designed, randomized, controlled trials with standardized reporting of data are required to provide better evidence of efficacy and safety of other rosacea therapies.
Author disclosure: Nothing disclosed at press time. Commercial support: None.
