New & Emerging Rosacea Treatments Update

Written by on January 10, 2013 in New Rosacea Treatments with 2 Comments

skin-therapy-letter

A recently published article in Skin Therapy Letter highlights quite a lot of what is interesting in the world of rosacea research. There sure is a lot going in the world of Rosacea!

Much of what you will find highlighted will be well known to Rosacea News readers. In fact the list seems so familiar that one could conclude that the authors are likely to be themselves reading Rosacea News.

Common Treatments

The usual suspects of Metrogel, Finacea and Oracea are discussed of course. The oft quoted research showing that Oracea is as good as 100mg of doxycycline and as safe makes an appearance.

Emerging Treatments

The article mentions the in-trial Ivermectin Cream CD5024, Brimonidine and Oxymetazoline, recent comparisons of doxycycline to accutane, ziana being unimpressive.

The casual mention of Ivermectin, and “the alpha-adrenergic receptor antagonists” (i.e. brimonidine and oxymetazoline) may even lead you to think that these are mainstream treatments! Not yet, but one day they may well be so.

Other Treatments

The article also mentions the poor performance of Zinc Sulfate as well as cursory references to niacinamide, feverfew, turmeric, colloidal oatmeal and quassia extract.

One Thing I Did Miss

One treatment that Rosacea News hasn’t followed is Duac – (clindamycin phosphate and benzoyl peroxide) Gel, 1.2%/5% an acne treatment, but used for the papules and pustules of rosacea. It is still in the `a bit too harsh’ basket.

Also Rosacea News hasn’t written much about Elidel of late.

Article Highlights

The full article is available online and is worth reading, especially for the excellent list of references.

Rosacea: Update on Management and Emerging Therapies

Robyn S. Fallen MD, Melinda Gooderham MD, MSc, FRCPC

Skin Therapy Letter. 2012;17(10)

Rosacea is a common chronic skin disorder that has significant impact on the self-esteem and quality of life of affected individuals.

Currently understood as an inflammatory condition that occurs in the context of an altered innate immune response, the available topical and systemic therapies function as immunomodulators to restore cutaneous homeostasis.

The goals of therapy include reduction of papules, pustules, erythema and physical discomfort with improvement in quality of life. Standard topical treatments include metronidazole and azelaic acid, although many other agents and regimens have been presented.

Subantimicrobial/antiinflammatory dose oral doxycycline was US FDA approved in 2006 for the management of rosacea, but Health Canada clearance was only recently granted for this indication. Furthermore, renewed research interest has led to the development of other emerging therapies including topical ivermectin, brimonidine and oxymetazoline that hold promise for patients suffering from this condition.

Conclusion

With the advent of novel therapeutic options for the treatment of rosacea such as subantimicrobial anti-inflammatory dose doxycycline, ivermectin and the alpha-adrenergic receptor antagonists, there is renewed interest in the study of this chronic inflammatory condition.

There is ongoing need for well-designed, high-quality studies of widely used treatments for rosacea including isotretinoin, sodium sulphacetamide/sulphur, and light-based therapies, as well as comparative studies, given the emergence of new treatments.

Lifestyle interventions such as avoidance measures for triggering factors, the use of sunscreen, dietary changes and patient education are additional areas of needed research.

It would be beneficial for outcomes in future trials to be based on validated, standardized scales assessing both efficacy and improvement in quality of life. Where possible, therapeutic decision-making should take into account high-level evidence and be guided by clinical experience, individual patient characteristics and preferences until further evidence is available.

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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2 Reader Comments

  1. J says:

    Brimonidine and oxymetazoline are alpha agonists, not antagonists. I don’t know how the letter could get this wrong.

  2. David Pascoe says:

    Yes that is a bit of a sad mistake – hopefully a typing error and not an error in understanding.

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