Rosacea and Its Topical Management

M. Gooderham, MSc, MD, FRCPC


Skin Therapy Letter. 2009;14(2) 

In This Article

Other Therapies

Many other topical treatments for rosacea have been reported. Some are effective, but are not yet approved. Further investigation is needed to determine their potential role in the topical armamentarium of rosacea therapy.

  • Topical antibiotics (e.g., clindamycin lotion or cream) have shown benefit, but evidence supporting their use is lacking.

  • The calcineurin inhibitors, tacrolimus (Protopic®, Astellas Pharma) and pimecrolimus (Elidel®, Novartis), have been investigated for use in papulopustular rosacea because of their anti-inflammatory effects. Early reports suggested benefit from tacrolimus in the treatment of steroid-induced rosacea.[21] However, while 3 studies have demonstrated a reduction in erythema associated with rosacea, neither tacrolimus nor pimecrolimus had any benefit over vehicle with respect to lesion counts.[22–24]

  • Clindamycin 1%-benzoyl peroxide 5% gel, which is approved for use in acne vulgaris, has shown promise for rosacea therapy. A double-blind, randomized controlled trial using this once daily formulation showed a significant reduction in inflammatory lesion count, erythema severity, and overall rosacea severity. The treatment was well tolerated.[25]

  • Permethrin 5% cream, which is proposed to work because of its anti-parasitic effects, may target Demodex mites, a potential cause of rosacea.[13] This formulation was compared in 1 study with the vehicle and with metronidazole 0.75% gel, and was found to be superior to the vehicle and equal in efficacy to metronidazole.[26]

  • Topical retinoids have been used to treat rosacea, but the true efficacy has not been established. Their use is limited by their irritant potential. Nally and Berson[13] suggested that better tolerated agents, e.g., adapalene, should be considered.

  • Topical steroids are sometimes used on a short-term basis for the severe inflammatory component, but long-term side-effects and exacerbating potential limit their use in this chronic condition.[13]

  • There is anecdotal evidence of 4 patients with erythematotelangiectatic rosacea who were treated successfully with oxymetazoline, a topically applied selective α1-adrenergic receptor agonist. The impressive results of this treatment warrant further study.[27,28]


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