The Wheels on the Bus Go Round and Round

Just published in the June 2010 edition of the Journal of Drugs in Dermatology is a study comparing “Finacea in combination with Oracea” with “Metrogel in combination with Oracea”.

Seeing this abstract published makes me want to let out a loud groan.

So much of what we see as recently published rosacea research is just recycled sameness.  The actual result of most of these self-similar papers is pretty minimal.

It really doesn’t help rosacea sufferers much to know that the many permutations of the popular and already understood treatments all perform the same.

So the wheels on the bus go round and round, but on this route, the bus never seems to actually get anywhere.

Here is just a sample of the published research showing where this research bus is heading;

This sort of research does provide good pharmaceutical marketing stories I guess and I suppose it justifies researchers’ efforts, but I am left wondering where this effort could be better utilised.

J Drugs Dermatol. 2010 Jun;9(6):607-13.

Efficacy of topical azelaic acid (AzA) gel 15% plus oral doxycycline 40 mg versus metronidazole gel 1% plus oral doxycycline 40 mg in mild-to-moderate papulopustular rosacea.

Del Rosso JQ, Bruce S, Jarratt M, Menter A, Staedtler G.

Rosacea is a leading reason why people seek the care of a dermatologist, accounting for nearly 7 million office visits annually. Pharmacologic treatments include both topical and oral medications, which are increasingly being used in combination, especially at the outset of therapy. This exploratory study assesses the safety, effectiveness and speed of onset of two common topical agents for the treatment of rosacea azelaic acid gel (AzA) 15% and metronidazole gel 1% used in conjunction with anti-inflammatory dose doxycycline (40 mg once daily). Men and women (n = 207) with mild-to-moderate papulopustular rosacea were enrolled and randomized to receive either AzA gel 15% twice daily plus doxycycline 40 mg once daily (AzA group) or metronidazole gel 1% once daily plus doxycycline 40 mg once daily (Metro group) for 12 weeks. Both regimens were safe, efficacious and well tolerated. Efficacy parameters revealed a possible trend toward greater and earlier benefit with the AzA-based regimen than with the metronidazole-based regimen. These findings warrant further investigation in a sufficiently powered study.

I’ll end this note with a comment that why, seriously, would this study encourage the creation of a more detailed study ?

About the Author

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

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5 Reader Comments

  1. Neil Madigan says:

    I have been dealing with Facial (nose) and ocular rosacea for three years, relying on as 50ml dose of Doxycycline per day to keep things under control.

    I have just taken a two week program of ALPRIM trimethoprim. This antibiotic, taken for a possible prostrate infection, completly cleared up the Rosacea in two days but returned within days of stopping the two week course.

    Have I discovered a wonder cure for Rosacea, no idea of the long term side effects. Can you explain this. I reported this to my urinary surgeon, who did not seem interested, he obviously does not suffer from Rosacea. Wondering whether I should try another course to see if it clears up again?

    Comments appreciated

  2. Dave,

    We were saying the same thing about seven years ago when we had that chat session arranged by Warren Stuart about forming a non profit organization to get the rosacea community together to do our own research and you tried to form your own non profit and successfully received $18K in donations from your rosacea community following your leadership and gave most of the donations to the NRS for a research grant on pulsed dyed laser and IPL. This shows how much influence you have in the rosacea community.

    It has now been four and a half years since the RRF dissolved and you have continued to support the NRS which has been supporting Gallo’s research which is novel but for the most part supports the same type research you are complaining about being on the same bus.

    Since you are “left wondering where this effort could be better utilized” you could help gather the rosacea community together as you successfully did before and we could rally around a particular researcher like Gallo or whoever the community wants to support and send them a check directly through the RRDi. It’s a shame that you and I can’t work together since I have appealed for your help on several times.

    You could get on the RRDi bus if you wanted and serve on the board of directors. I can make this happen.

    Or you can choose to keep supporting the same bus going in the same direction which you have done since the RRF dissolved. We could try to work together on this
    and direct the bus in another direction.

  3. David Pascoe says:


    Sorry but I think you have misunderstood my post.

    The post has nothing to do with the NRS.

    The post is to do with research that seems to benefit the first-line rosacea treatment products.

    It is obvious that this class of research of “x vs. y” is only a subset of research efforts worldwide.

    The NRS funds excellent research into the cause of rosacea. It funds nothing like these sorts of efforts.

    Have a look at the link below and see if you can spot the difference to the topics mentioned in my blog post above –

    Your misundertanding and indeed misrepresentations appear to me to be another one of the wheels that keeps going round and round.


  4. I didn’t intend to offend you in any way nor am I aware of misrepresenting anything. I understand. Keep up the good work Dave.

  5. Jasmine 215 says:

    This message is for Neil Madigan.

    I am a 23-year sufferer of Acne Rosacea and rather severe seborrheic dermatitis. My derm put me on a full course of Bactrim (otherwise known as Trimethoprim sulfamethoxazole) and it didn’t do a dang thing for me! I still have redness and an ongoing rash on my face.

    The only things that have helped me are monthly Laser treatments and tetracyclines. But since I am now allergic to ALL tetracyclines, I have to go back to Square One and try something else.

    I think it’s great that this antibiotic works for you, though. You may want to keep trying it and/or start on the Lasers, to keep this in check. For about a 4 to 5 year period in the late 1990s, I wasn’t on any antibiotic or treatment and my Rosacea came back much worse than before! I wish they could come up with something new, like maybe an oral pill that really works from within to cure it, and not just the same old topical creams and antibiotics to get rich from.

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