Researchers Offer Comprehensive Look at Rosacea Treatment Options

Affecting up to 1 in 10 people worldwide, rosacea has a complex pathophysiology that remains inadequately understood, and research has hinted at multiple inflammatory and immune mediated processes underlying the condition.

With rosacea treatment requiring a personalized approach for each patient, researchers have compiled current treatments for the condition, offering a wide-ranging look at the options providers have for their patients.

Findings were published in Journal of Cosmetic Dermatology.

Affecting up to 1 in 10 people worldwide, rosacea has a complex pathophysiology that remains inadequately understood, and research has hinted at multiple inflammatory and immune mediated processes underlying the condition.

“The opening of different domains in the molecular pathogenesis of rosacea has led to the emergence of newer interventions. The addition of new formulations like topical brimonidine and oxymetazoline, oral therapies in the form of modified-release doxycycline, ondansetron, etc. and new light/laser devices has increased our therapeutic armamentarium,” the study researchers wrote. They also noted that management of the condition hinges on patient education, creating and following a skin care routine, and treatment with topical and oral treatment, as well as lasers/light-based treatment.

With various approved topical treatments for rosacea, factors such as skin type, rosacea presentation, mechanism of action, previous treatment experience, and efficacy and safety of the drug drive treatment decisions.

Approved topical treatments include azelaic acid (15%) gel; metronidazole (0.75% gel, cream, and lotion, and 1% cream and gel); sodium sulfacetamide/sulfur (10%/5%) gel, cleanser, lotion, suspension, and cream; brimonidine tartrate (0.33%) gel; oxymetazoline hydrochloride (1%) cream; and ivermectin (1%) cream. In the second line, calcineurin inhibitors like tacrolimus, benzoyl peroxide, and topical antibiotics are used.

Oral options for rosacea fall into 4 classes of treatment:

  • Tetracyclines, including tetracycline (250-1000 mg/day), doxycycline (100-200 mg/day or 40 mg/day of a modified-release formulation) and minocycline (100-200 mg/day); according to the researchers, doxycycline and minocycline have increased bioavailability, longer half-lives, and fewer gastrointestinal adverse effects compared with earlier treatments
  • Macrolides, includingerythromycin, azithromycin, and clarithromycin, which the researchers say have been used effectively in patients who are not good candidates for tetracyclines; for example, azithromycin has been shown to be effective in patients who are allergic or intolerant to tetracycline
  • Metronidazole has shown efficacy in treating inflammatory lesions in papulopustular rosacea
  • Isotretinoin, typically used to treat refractory or nodulocystic acne, has also shown efficacy when treating erythemato-telangiectatic rosacea and papulopustular rosacea not adequately responding to other treatment

Lasers and light therapy, including intense pulse light and pulsed dye laser, have been leveraged for patients with eythemato-telangiectatic rosacea, in particular.

“Light-based therapies are particularly effective in treating the varied vascular manifestations of the disease viz. flushing, erythema, and telangiectasia,” explained the researchers. “Both long-pulsed dye lasers and intense pulsed light devices are an effective modality for the treatment of the disease and are associated with significant patient satisfaction, especially as the vascular component may not improve with other therapies.”

Other laser and light therapies include potassium-titanyl phosphate laser, ablative lasers, and diode lasers.

Reference

Sharma A, Kroumpouzos G, Kassir M, et al. Rosacea management: a comprehensive review. J Cosmet Dermatol. Published online February 1, 2022. doi:10.1111/jocd.14816