Rosacea is a chronic inflammatory skin condition that negatively impacts patients’ quality of life. We sought to review important aspects of the pathogenesis of rosacea and the role of new treatment options in its management. New, emerging treatments show promise; however, quality randomized controlled trials for many of these drugs are lacking. Brimonidine tartrate is an effective newly approved treatment for erythematotelangiectatic rosacea. Topical oxymetazoline has potential for the treatment of erythematotelangiectatic rosacea, with efficacy described in case reports and randomized controlled trials currently underway. Both oral and topical ivermectin have been studied for the treatment of papulopustular rosacea, both showing benefit; however, only topical ivermectin 1 % cream has been studied in randomized controlled trials. As our understanding of the etiology of rosacea continues to evolve, so will our options for therapeutic interventions. Further studies need to be performed to assess the long-term safety and efficacy of these treatments.
KeywordsIsotretinoin Ivermectin Rosacea Azelaic Acid Brimonidine
The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Connetics, Abbott Labs, Warner Chilcott, Centocor, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Connetics, Astellas, Abbott Labs, Warner Chilcott, Centocor, Amgen, Photomedex, Genentech, BiogenIdec, Coria, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel, GlaxoSmithKline, and Novartis and has received stock options from Photomedex. Farah Moustafa and Dr. Sandoval have no conflicts to disclose.
- 2.National Rosacea Society. If you have rosacea, you’re not alone. 2014. http://www.rosacea.org/patients/index.php. Accessed 28 Apr 2014.
- 24.Del Rosso JQ, Thiboutot D, Gallo R, Webster G, Tanghetti E, Eichenfield L, et al. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 1: a status report on the disease state, general measures, and adjunctive skin care. Cutis. 2013;92(5):234–40.PubMedGoogle Scholar
- 30.Del Rosso JQ, Webster GF, Jackson M, Rendon M, Rich P, Torok H, et al. Two randomized phase III clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline, USP capsules) administered once daily for treatment of rosacea. J Am Acad Dermatol. 2007;56(5):791–802.PubMedCrossRefGoogle Scholar
- 33.Fowler J, Jarratt M, Moore A, Meadows K, Pollack A, Steinhoff M, et al. Once-daily topical brimonidine tartrate gel 0.5 % is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicentre, randomized and vehicle-controlled studies. Br J Dermatol. 2012;166(3):633–41.PubMedCentralPubMedCrossRefGoogle Scholar
- 34.Fowler J Jr, Jackson M, Moore A, Jarratt M, Jones T, Meadows K, et al. Efficacy and safety of once-daily topical brimonidine tartrate gel 0.5 % for the treatment of moderate to severe facial erythema of rosacea: results of two randomized, double-blind, and vehicle-controlled pivotal studies. J Drugs Dermatol. 2013;12(6):650–6.PubMedGoogle Scholar
- 36.Moore A, Kempers S, Murakawa G, Weiss J, Tauscher A, Swinyer L, et al. Long-term safety and efficacy of once-daily topical brimonidine tartrate gel 0.5 % for the treatment of moderate to severe facial erythema of rosacea: results of a 1-year open-label study. J Drugs Dermatol. 2014;13(1):56–61.PubMedGoogle Scholar
- 37.National Institutes of Health. Oxymetazoline drug information. 2014. http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=oxymetazoline&x=0&y=0. Accessed 28 Apr 2014.
- 39.Pascoe D. Allergan dose finding trials for AGN-199201 oxymetazoline. 2012. http://rosacea-support.org/allergan-dose-finding-trials-for-agn-199201-oxymetazoline.html. Accessed 1 May 2014.
- 44.Jancin B. Novel topical rosacea drug sails through phase III: expert analysis from SDEF Hawaii Dermatology Seminar. Skin and Allergy News. 2-19-2014. http://www.skinandallergynews.com/index.php?id=372&cHash=071010&tx_ttnews[tt_news]=237841. Accessed 20 Jul 2014.