Current topical and systemic approaches to treatment of rosacea

Abstract

Rosacea is a common, often overlooked, chronic facial dermatosis characterized by intermittent periods of exacerbation and remission. Clinical subtypes and grading of the disease have been defined in the literature. On the basis of a genetic predisposition, there are several intrinsic and extrinsic factors possibly correlating with the phenotypic expression of the disease. Although rosacea cannot be cured, there are several recommended treatment strategies appropriate to control the corresponding symptoms/signs. In addition to adequate skin care, these include topical and systemic medications particularly suitable for the papulopustular subtype of rosacea with moderate to severe intensity. The most commonly used and most established therapeutic regimens are topical metronidazole and topical azelaic acid as well as oral doxycycline. Conventionally, 100-200 mg per day have been used. Today also a controlled release formulation is available, delivering 40 mg per day using non-antibiotic, anti-inflammatory activities of the drug. Anti-inflammatory dose doxycycline in particular allows for a safe and effective short-and long-term therapy of rosacea. Topical metronidazole and topical azelaic acid also appear to be safe and effective for short-term use. There are indications that a combined therapy of anti-inflammatory dose doxycycline and topical metronidazole could possibly have synergy effects. Further interesting therapy options for the short-and long-term therapy of rosacea could be low-dose minocycline and isotretinoin; however, too little data are available with regard to the effectiveness, safety, optimal dosage and appropriate length of treatment for these medications to draw final conclusions.

Minocycline: far beyond an antibiotic

“…Therefore, further evaluation of larger numbers of patients in randomized, well-controlled studies is still necessary. Finally, although minocycline is recommended for the aforementioned skin disorders, current therapy has moved towards the use of doxycycline, which has a similar efficacy for the treatment of these conditions with a reduced incidence of adverse effects, such as drug hypersensitivity syndrome, hyperpigmentation and dizziness, frequently associated with minocycline therapy (Bachelez et al, 2001;Sapadin and Fleischmajer, 2006;Korting and Schöllmann, 2009). …”

Successful Long-term Use of Oral Isotretinoin for the Management of Morbihan Disease

“…Conceivably, MD may respond to the same immunomodulatory and anti-inflammatory properties that make oral isotretinoin useful for the management of rosacea. 23,[25][26][27][28] There is also evidence to support isotretinoin's role in the repair of structural tissue damage via alterations in cellular metabolism and its ability to inhibit fibroblast proliferation as well as the migration and proliferation of connective tissue constituents. 29 As a result, isotretinoin therapy may alter the downstream effects of chronic inflammation that would otherwise result in damage to the dermal matrix.…”

Vestibulophyma and Giant Rhinophyma Associated With Variant Rosacea

“…The most commonly used and established therapeutic regimens for rosacea include topical metronidazole, topical azelaic acid, and oral doxycycline [4]. Normally associated with phymatous rosacea, rhinophyma may occur without any other symptoms.…”