A systematic review of the available rosacea research confirms that Metrogel, Finacea and Oracea are effective for moderate to severe rosacea. One study further found cyclosporine 0.05% ophthalmic emulsion effective for ocular rosacea.
This review looked at the published results of 58 trials to note bias and construct a high level summary of the results.
No Surprises Here
It will come as little surprise that the well known treatments Metrogel, Finacea and Oracea were found to be effective. These prescription based treatments from Galderma and Intendis have seen high levels of investment in research and development and indeed marketing specifically as rosacea treatments.
What is a Cochrane Review
From The Cochrane Collaboration: Cochrane Reviews are designed to facilitate the choices that doctors, patients, policy makers and others face in health care. Most Cochrane Reviews are based on randomized controlled trials, but other types of evidence may also be taken into account, if appropriate.
What Bias?
The Cochrane Review attempts to identify any bias that may have affected the outcome of the trials reviewed.
Many levels of bias are possible; are the participants truly randomly selected, representative of the population, truly blinded to the treatments?, are outcomes fairly reported? what about exclusions and attrition rates ?
Any one of these sorts of bias can cause the results of a trial to be questioned. As is the usual case with these large systematic reviews, high or unclear levels of bias were present in the clinical trials.
Clinical Trials without any bias are hard to achieve and seem to be quite rare.
Effective and evidence-based management strategies for rosacea: summary of a Cochrane systematic review, Br J Dermatol. 2011 Jun 21, van Zuuren EJ, Kramer SF, Carter BR, Graber MA, Fedorowicz Z.
Background: Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective.
Objective: To assess the evidence for the efficacy and safety of treatments for rosacea.
Methods: Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included.
Results: Fifty-eight trials, including 27 from the original review, comprising 6,633 participants were included in this updated review.
Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others.
There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40 mg was more effective than placebo.
There was no statistically significant difference in effectiveness between doxycycline 40 mg and 100 mg and with evidence of less adverse effects.
One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea.
Conclusions: Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
[Update: 2015 Review]
The Cochrane review was updated in 2015 and we now know – Its official–Mirvaso, Soolantra and Oracea make the grade as proven rosacea treatments
