Every rosacea sufferer who is unsatisfied with the current offering of treatments looks to see what might be available soon. The thought that something new and improved is just around the corner is a source of encouragement for sufferers who just can’t get the relief they long for.

Even though the new and latest and greatest treatments start out largely untested and may turn out to be no better than existing treatments, there is something tantalising about the promise of new treatments.

A colleague of mine had this saying – “Nothing is as good as the next, untested release”. He was referring to software but it applies here too. The promise that the next product will solve all of the problems of the current product is so strong that we can easily get ahead of ourselves and embiggen our expectation.

Bearing this in mind, a recent abstract has all the marks of an exciting paper – Rosacea treatments: What’s new and what’s on the horizon? Sounds exactly like something that will be interesting to many.

The principle author of this paper is Dr. Rosella Gallo from the University of Genoa, not to be confused with another R. Gallo from UC San Diego, who is also promoting possible future rosacea treatments.

Rosacea treatments: What’s new and what’s on the horizon?,

Gallo R, Drago F, Paolino S, Parodi A.,

Am J Clin Dermatol. 2010;11(5):299-303.

Di.S.E.M, University of Genoa, Italy.

Rosacea is a common, chronic, cutaneous disorder presenting with recurrent episodes of facial flushing, erythema, papules, pustules and telangiectasias. It is a multifactorial disease and its various clinical presentations probably represent the consequence of combined different triggers upon a specific background. Its management is largely based on long-established treatments empirically tailored to the specific presenting symptoms and no real breakthrough has occurred to date.

However, recent insights into the still rather obscure pathophysiology of rosacea seem to open the way for etiologically oriented treatments.

These may include, on the one side, the more effective application of traditional drugs, such as tetracyclines and metronidazole, to specifically selected patients or, on the other side, new therapeutic options, such as vitamin D receptor antagonists.

It is to be remarked that the quality of most studies evaluating rosacea treatment is rather poor, mainly due to a lack of proper standardization.

For a major breakthrough to occur in the management of rosacea, we need both a better understanding of its pathogenesis and the adherence of future clinical trials to clearly defined grading and inclusion criteria, which are crucial for investigators to correctly compare and interpret the results of their work.

Even though this is only an abstract we can look at the web site for the journal itself to get a few more clues about what new treatments this paper covers. Based on the keywords listed for this paper, lets look at each one in turn to see what new treatments might be uncovered in this paper;

Alpha-1 adrenergic receptor agonists

See oxymetazoline below;

Antimicrobial cationic peptides

The innate immune system contains peptides that form the basis for the possible development of new therapeutic agents that will complement the existing antibiotic therapies. We have learnt recently that Omiganan (topical cationic peptide) to be trialled as a rosacea treatment.

Antiparasitics

See Crotamiton below.

Azelaic-acid

Azelaic Acid is the active ingredient in Finacea. It isn’t clear what innovations exist related to Finacea or Azelaic Acid based treatments.

Bacillus infections

This seems to be referring to the recent research that has found that a particular type of bacteria isolated in demodex mites (known as B. oleronius) appears to produce an immune response in some rosacea sufferers. Should further research confirm a causative link between rosacea and this bacteria, interesting treatments may result. See demodex mite bacteria causes the inflammation ? for more information.

Calcitriol receptor antagonists

Calcitriol is a form of Vitamin D. I hope to cover Vitamin D receptor antagonists in a future Rosacea News item.

Crotamiton

This drug, also known as Eurax has been trialled as a treatment for demodex mites. (see Demodex Mites Treatment)

Helicobacter pylori Infections

Long part of the rosacea folkore, infection by the HP bacteria has been thought to be responsible for rosacea symptoms. This folklore is fuelled by the fact that treatments for the bacteria, several well known antibiotics also benefit some rosacea symptoms.

Intestinal infections

See Rifaximin below.

Oxymetazoline

Oxymetazoline is known to rosacea sufferers as the active ingredient in decongestant products like Afrin, Sudafed OM and Vicks Sinex as well as in eye drops like Visine LR.

We known that oxymetazoline is good for 6 hours and safe for 3 months and it seems clear that Vicept Therapeutics is trialling V-101 which is based on oxymetazoline. Further trials are expected as oxymetazoline based treatments continue to be assessed as treatment for the redness associated with rosacea.

Permethrin

This is a topical insecticide (see demodex mites ivermectin effective treatment ? ) that is used by some people to kill demodex mites. 5% Permethrin (Elimite Cream) is only available by prescription in the US and is usually used to treat scabies. Some research has shown that treatment-resistant cases of rosacea have been successfully treated with Permethrin.

Photochemotherapy

Photochemotherapy usually refers to treating the skin with something that temporarily makes the skin more sensitive to UVA radiation and then exposing the skin to UVA. This sort of treatment has been around for many years and is often targeted as diseases like psoriasis and vitiligo.

Retinoids

Apart from trials to look at treating the redness of rosacea with Atralin Gel, I haven’t read much about new innovations in the area of retinoids and rosacea treatments.

Rifaximin

This antibiotic doesn’t leave the gut, so any benefit to the skin is not based on it’s direct cutaneous action. The quest here is to discover how perhaps small intestinal bacterial overgrowth induces rosacea in the skin (see SIBO eradication clears rosacea: are you serious ? and SIBO diet/treatment).

[update]: We should also include Carbamide Peroxide – see Elorac promoting Carbamide Peroxide as a Rosacea Treatment for more informatoin.

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