Rosacea: Update on Management and Emerging Therapies

Robyn S. Fallen MD; Melinda Gooderham MD, MSc, FRCPC


Skin Therapy Letter. 2012;17(10) 

In This Article

Other Treatments

Available for more than 50 years, topical sodium sulphacetamide 10% + sulphur 5% has also been demonstrated to significantly reduce inflammatory lesions and facial erythema compared to vehicle.[42] However, the quality of studies evaluating this therapy have been generally poor.[14]

Systemic isotretinoin has also been used off-label in the treatment of patients with severe rosacea. A randomized, double-blind, non-inferiority trial comparing the use of different dosages of oral isotretinoin to both doxycycline or placebo found isotretinoin 0.3 mg/kg to be an effective therapy with a similar safety profile as for the treatment of acne.[43]

Various topical regimens including an antibiotic and tretinoin preparations have been proposed. A recent randomized, doubleblind, placebo-controlled study assessing a combination gel of clindamycin phosphate 1.2% + tretinoin 0.025% found no difference in papule/pustule count, but mild improvement in the telangiectatic component of rosacea was observed.[44]

Although not FDA approved for the management of rosacea, a randomized, double-blind, vehicle-controlled trial has demonstrated the efficacy of once daily topical benzoyl peroxide 5%/clindamycin 1% gel in patients with moderate to severe rosacea.[45] Common adverse events include pruritus, burning, and bleaching of hair/clothing.

In a randomized, controlled, single-blind, split-face trial of patients with erythematotelangiectatic rosacea, both pulsed dye laser and intense pulsed light treatments were found to have similar efficacy and safety.[46,47]

An open-label uncontrolled trial of the calcineurin inhibitor pimecrolimus 1% cream suggests it is effective and welltolerated for mild to moderate inflammatory rosacea.[48] A small, single-centre randomized study found pimecrolimus 1% cream to be as effective as metronidazole 1% cream.[49]

The use of oral zinc sulfate has also been proposed for the management of rosacea. However, a randomized, doubleblind trial of 220 mg zinc sulfate dosed twice daily showed no difference in magnitude of improvement between subjects receiving zinc therapy versus placebo.[50]

Due to the chronic nature of the condition, patients frustrated with medical therapy may turn to marketed botanicals and herbal remedies in hopes of improved control. Although there is a paucity of data surrounding the effects of these cosmeceuticals, the prudent clinician should be aware of products that may be used by patients such as niacinamide, feverfew, turmeric, oatmeal and quassia extract.[51,52]