Rosacea Articles

One of the world’s best-respected sources for medical evidence and information, The Cochrane Collaboration, has released a full review of evidence-based studies on treatments for rosacea. The review aimed to establish “which treatments are effective for rosacea”, in terms of their effect on overall quality of life, any changes they made to participants’ conditions, any relevant side effects, and how long it took them to be effective. Encouragingly, the review found that most of the treatments studied “appeared to be effective in treating rosacea”, though to varying degrees and with varying levels of side-effects.

The review compiled and critically assessed the results of 106 studies into interventions for rosacea, involving a total of over 13,000 participants. Most of the participants in the studies were women; and most were aged between 40 and 50 years old. Most of the studies focused on two common forms of rosacea: erythematotelangiectatic rosacea (also known as subtype 1 rosacea – characterised by flushing and redness) and papulopustular rosacea (also known as subtype 2 rosacea – characterised by bumps known as papules and pimples known as pastules). For the most part, the effectiveness of treatments was measured in terms of any reduction in the number of pimples or pustules (pus-filled spots) on participants’ skin, as well as the redness of their skin. The reviewers noted that very few studies focused on other forms of rosacea, such as ocular rosacea (also known as subtype 4 rosacea – characterised by symptom focused around the eyes) and granulomatous rosacea (a rare and distinctive form of the condition wherein symptoms, particularly bumps or pastules, are focused around the upper part of the face, including the nose and eyes).

Topical Treatments

The review looked at the evidence for the effectiveness of a number of topical treatments - that is, creams and ointments applied directly to the skin. It picked out two such treatments - metronidazole and azelaic acid - as "effective and safe in reducing rosacea symptoms", with improvements typically showing after 3 - 6 weeks. Although they noted that more research was needed to decide which of these treatments was best, the authors did note that those taking metronidazole were less likely to report side effects such as skin irritation. The study also highlighted ivermectin and brimonidine as new topical treatments that showed signs of effectiveness in treating rosacea.

Oral Treatments

Oral treatments are all those that are ingested through the mouth – through pills or liquid medicines, for example. Results on three antibiotic treatments were analysed in detail by the studies: tetracycline, doxycycline, and minocycline. All of these were found to be effective in reducing the symptoms of rosacea. One particular finding was that low doses of doxycycline were just as effective as higher doses, but with reduced side effects.

The review found that two other treatments may prove to be as effective as or more so than these established treatments. Another antibiotic called azithromycin, for example, performed well in one study but requires further research; and a vitamin A-related drug called isotretinoin may prove effective, but should be avoided by women of child-bearing age, since it can cause malformations to developing foetuses.

You can see the Cochrane Collaboration's full review article, including a number of other findings, here.

Image courtesy of Galderma (UK) Ltd.