Aaron F. Cohen, MD; Jeffrey D. Tiemstra, MD


J Am Board Fam Med. 2002;15(3) 

In This Article

New Therapies

Azelaic acid is a naturally occurring, dicarboxylic acid possessing antibacterial activity. It is available as a 20% cream and is generally used as an alternative treatment for acne vulgaris. In 1999 Maddin[16] compared once-daily applications of azelaic acid with topical metronidazole 0.75% cream for treatment of papulopustular rosacea. Maddin concluded that both medicines were equally effective in reducing the number of inflammatory lesions and the associated signs and symptoms of rosacea. When the study physicians' rating of the overall improvement was considered, however, the azelaic acid was considered to be considerably more effective. The patients involved in the study also preferred the azelaic acid.[16]

Topical retinoic acid has been shown to have a beneficial effect on the vascular component of rosacea.[17] The drawbacks of retinoic acid therapy include delayed onset of effectiveness, dry skin, erythema, burning, and stinging.[17] Retinaldehyde is intermediate in the natural metabolism of retinoids, between retinal and retinoic acid, and is generally well tolerated while retaining most of the therapeutic activity of retinoic acid.[17] Daily application of a 0.05% retinaldehyde cream for 6 months was found to yield positive and statistically significant outcomes in 75% of those patients undergoing treatment.[17] Specifically, improvements were found in erythema and telangiectasias, the vascular components of rosacea.

Topical vitamin C preparations have recently been studied in the reduction of the erythema of rosacea.[18] Daily use of an over-the-counter cosmetic 5.0% vitamin C (L-ascorbic acid) preparation was used in an observer-blinded and placebo-controlled study. Nine of the 12 participants experienced both objective and subjective improvement in their erythema.[18] It was suggested that free-radical production might play a role in the inflammatory reaction of rosacea, and that the antioxidant effect of L-ascorbic acid might be responsible for its effect. These promising preliminary results still need to be confirmed in larger, long-term studies.


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