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New and Emerging Treatments for Rosacea

Abstract

Rosacea is a common chronic inflammatory disorder that affects approximately 16 million Americans. The multifactorial pathophysiology of rosacea is not fully understood. Several new treatment options were recently US Food and Drug Administration approved or are in clinical trials. This paper reviews new treatment options including ivermectin, brimonidine, the new foam formulation of azelaic acid, and oxymetazoline. The potential role in therapy, patient selection, and adverse effects of these agents are discussed.

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References

  1. Baldwin H. Psychosocial implications of rosacea. Dermatologist. 2012;Suppl.:2–4.

  2. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. J Am Acad Dermatol. 2002;46:584–7.

    Article  PubMed  Google Scholar 

  3. Gupta MA, Gupta AK, Chen SJ, Johnson AM. Comorbidity of rosacea and depression: an analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey: Outpatient Department data collected by the U.S. National Center for Health Statistics from 1995 to 2002. Br J Dermatol. 2005;153(6):1176–81.

    CAS  Article  PubMed  Google Scholar 

  4. Moustafa F, Lewallen RS, Feldman SR. The psychological impact of rosacea and the influence of current management options. J Am Acad Dermatol. 2014;71(5):973–80.

    Article  PubMed  Google Scholar 

  5. Layton A, Thiboutot D. Emerging therapies in rosacea. J Am Acad Dermatol. 2013;69(6 Suppl 1):S57–65.

    CAS  Article  PubMed  Google Scholar 

  6. Del Rosso JQ, Gallo RL, Tanghetti E, Webster G, Thiboutot D. An evaluation of potential correlations between pathophysiologic mechanisms, clinical manifestations, and management of rosacea. Cutis. 2013;91(3 Suppl):1–8.

    PubMed  Google Scholar 

  7. Del Rosso JQ, Gallo RL, Kircik L, et al. Why is rosacea considered to be an inflammatory disorder? The primary role, clinical relevance, and therapeutic correlations of abnormal innate immune response in rosacea-prone skin. Drugs Dermatol. 2012;11:694–700.

    Google Scholar 

  8. Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011;15:2–11.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  9. Del Rosso JQ, Thiboutot D, Gallo R, Webster G, Tanghetti E, et al. A status report from the American acne & rosacea society part one: disease state overview, general measures, topical therapy. Consensus recommendations on the management of rosacea. Cutis. 2013;92(5):234–40.

    PubMed  Google Scholar 

  10. Two AM, Wu W, Gallo R, Hata T. Part I: introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015;72:749–58.

    Article  PubMed  Google Scholar 

  11. Kanada KN, Nakatsuji T, Gallo RL. Doxycycline indirectly inhibits proteolytic activation of tryptic kallikrein-related peptidases and activation of cathelicidin. J Invest Dermatol. 2012;132:1435–42.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  12. Wise RD. Submicrobial doxycycline and rosacea. Compr Ther. 2007;33:78–81.

    Article  PubMed  Google Scholar 

  13. Merck & Co. Inc. Stromectal (ivermectin) tablets. 2010. Available from: https://www.merck.com/product/usa/pi_circulars/s/stromectol/stromectol_pi.pdf. Accessed 21 June 2015.

  14. Khan I, Yasmin R. Ivermectin in the treatment of scabies. J Pakistan Assoc Dermatol. 2007;17:78–83.

    Google Scholar 

  15. Yanagihara K, Kadoto J, Kohno S. Diffuse panbronchiolitis: pathophysiology and treatment mechanisms. Int J Antimicrob Agents. 2001;18(Suppl 1):S83–7.

    CAS  Article  PubMed  Google Scholar 

  16. Ianaro A, Ialenti A, Maffia P, Sautebin L, Rombola L, Carnuccio R, et al. Anti-inflammatory activity of macrolide antibiotics. J Pharmacol Exp Ther. 2000;292(1):156–63.

    CAS  PubMed  Google Scholar 

  17. Ci X, Li H, Yu Q, Zhang X, Yu L, Chen N, et al. Avermectin exerts anti-inflammatory effect by downregulating the nuclear transcription factor kappa-B and mitogen-activated protein kinase activation pathway. Fundam Clin Pharmacol. 2009;23:449–55.

    CAS  Article  PubMed  Google Scholar 

  18. Stein L, Kircik L, Fowler J, Tan J, Draelos Z, Fleischer A, et al. Efficacy and safety of ivermectin 1 % cream in treatment of papulopustular rosacea: results of two randomized, double-blind, vehicle-controlled pivotal studies. J Drugs Dermatol. 2014;13:316–23.

    PubMed  Google Scholar 

  19. Stein Gold L, Kircik L, Fowler J, Jackson JM, Tan J, Draelos Z, Fleischer A, Appell M, Steinhoff M, Lynde C, Sugarman J, Liu H, Jacovella J. Long-term safety of ivermectin 1 % cream vs azelaic acid 15 % gel in treating inflammatory lesions of rosacea: results of two 40-week controlled, investigator-blinded trials. J Drugs Dermatol. 2014;13:1380–6.

  20. Taieb A, Ortonne JP, Ruzicka T, Roszkiewicz J, Berth-Jones J, Peirone MH, et al. Superiority of ivermectin 1 % cream over metronidazole 0.75 % cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Br J Dermatol. 2015;172(4):1103–10.

    CAS  Article  PubMed  Google Scholar 

  21. Draelos ZD, Elewski B, Staedtler G, Havlickova B. Azelaic acid foam 15 % in the treatment of papulopustular rosacea: a randomized, double-blind, vehicle-controlled study. Cutis. 2013;92:306–17.

    PubMed  Google Scholar 

  22. Fowler J Jr, Jackson M, Moore A, Jarratt M, Jones T, Meadows K, Steinhoff M, Rudisill D, Leoni M. 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, vehicle-controlled pivotal studies. J Drugs Dermatol. 2013;12(6):650–6.

    CAS  PubMed  Google Scholar 

  23. Moore A, Kempers S, Murakawa G, Weiss J, Tauscher A, Swinyer L, Liu H, Leoni M. 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.

    CAS  PubMed  Google Scholar 

  24. Tanghetti EA, Jackson JM, Belasco KT, Friedrichs A, Hougier F, Johnson SM, Kerdel FA, Palceski D, Hong HC, Hinek A, Cadena MJ. J Optimizing the use of topical brimonidine in rosacea management: panel recommendations. Drugs Dermatol. 2015;14(1):33–40.

    CAS  Google Scholar 

  25. ClinicalTrials.gov. Safety and efficacy of AGN-199201 in patients with persistent erythema associated with rosacea. Available at: https://clinicaltrials.gov/ct2/show/NCT02132117?term=allergan+rosacea&rank=1. Accessed 21 June 2015.

  26. Galderma. Soolantra package insert, 2014. Available at: http://www.galdermausa.com/pi/soolantrapi.pdf. Accessed 8 Sept 2015.

  27. Bayer. Finacea foam, 15 % package insert, 2015. Available at: http://labeling.bayerhealthcare.com/html/products/pi/Finacea_Foam_PI.pdf. Accessed 8 Sept 2015.

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Correspondence to Lauren M. Gold.

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Funding

No funding was received for the preparation of this manuscript. Zoe Draelos has received payments for research from Bayer and Galderma.

Conflict of interest

Lauren Gold has no conflicts of interest.

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Gold, L.M., Draelos, Z.D. New and Emerging Treatments for Rosacea. Am J Clin Dermatol 16, 457–461 (2015). https://doi.org/10.1007/s40257-015-0156-2

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  • DOI: https://doi.org/10.1007/s40257-015-0156-2

Keywords

  • Ivermectin
  • Skin Irritation
  • Rosacea
  • Azelaic Acid
  • Brimonidine