Management Of Rosacea Research Articles

Innovative Use of Topical Metronidazole

Metronidazole is a synthetic nitroimidazole derivative with antimicrobial and antiinflammatory properties. It was the first topical therapy approved solely for rosacea and remains a cornerstone of rosacea management. This article reviews the optimal use of topical metronidazole in the treatment of rosacea and other innovative but off-label dermatologic uses reported in the literature.

Management of benign skin lesions commonly affecting the face: actinic keratosis, seborrheic keratosis, and rosacea

Patients commonly present to the otolaryngologist for management of benign facial lesions. It is important to be able to both recognize these lesions and offer patients the most effective therapies currently available. Advances in the understanding and management of three of the more common benign skin lesions affecting the face will be addressed in this review, with a particular emphasis on the most current therapeutic options for each lesion. Actinic keratosis can now be treated with photodynamic therapy or with many topical agents, as alternatives to traditional surgical techniques. Seborrheic keratosis, as well as actinic keratosis and rosacea, are now often treated with laser therapy. In addition, rosacea management now includes nonantimicrobial topical agents, such as azelaic acid, and a wider armamentarium of systemic agents. An understanding of these options will allow the clinician to provide patients with optimal treatment outcomes while minimizing unfavorable side effects.

Management of rosacea with intense pulsed light (IPL) systems and laser

Abstract A combination of different clinical symptoms is represented under the broad rubric of rosacea. These consist of facial flushing, erythema with the appearance of telangiectatic vessels of the face, eruption of inflammatory papules and pustules, and hypertrophy of the sebaceous glands with fibrosis. The disease can be characterized by different phases. Classical topical and systemic medications lack sufficient reduction for the main parts of the disease, for flushing attacks and dilated vessels. The impressive results obtained by using intense pulsed light (IPL) and lasers in treating these symptoms indicate that they should finally be a part of standard treatment regimes for rosacea therapy.

Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation

This study aims to evaluate a topical treatment based on silymarin/methylsulfonilmethane (S-MSM) to improve erythematous-telangiectactic rosacea. Forty-six patients affected by stage I-III rosacea entered this double-blind, placebo-controlled study. Subjects were treated for 1 month. Clinical and instrumental evaluations were done at baseline, after 10 and 20 days, and at the end of the study. Itching, stinging, erythema, and papules were investigated clinically as well as hydration and erythema instrumentally with capacitance and color measurements. A statistically significant improvement was observed in many clinical and instrumental parameters investigated (P < 0.001). In particular, improvement of skin redness, papules, itching, hydration, and skin color occurred. The combination of silymarin and S-MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato-telangiectatic phase. The action can be considered multicentric and multiphase because of the direct modulating action on cytokines and angiokines normally involved and up-regulated in the case of such skin condition.

Management of rosacea in the United States: Analysis based on recent prescribing patterns and insurance claims

Management of rosacea in the United States: Analysis based on recent prescribing patterns and insurance claims

Beneficial use of Cetaphil® Moisturizing Cream as part of a daily skin care regimen for individuals with rosacea

Introduction: Rosacea is a common and chronic disorder characterized by flushing, erythema, papules, pustules, and telangiectasia on the central part of the face. Because the facial skin of individuals with rosacea is particularly sensitive, irritants can trigger a worsening of the signs and symptoms of the disease. This enhanced sensitivity is thought to be linked to a deficient stratum corneum barrier function. Materials and methods: In the present study, 20 individuals receiving twice‐daily applications of metronidazole 0.75% gel for at least 15 days applied a gentle non‐irritating moisturizing cream (Cetaphil® Moisturizing Cream) twice daily for 15 days on one half of the face; the other side remained treated with metronidazole only and served as the control. Results: Clinical assessments, confirmed by biophysical measurements (electrical capacitance, transepidermal water loss (TEWL), and lactic acid stinging test), provided evidence that the moisturizer contributed to the restoration of the skin barrier: skin dryness, roughness and desquamation were much improved and skin sensitivity was significantly reduced. Skin properties and skin discomfort were also greatly enhanced and the patients were very satisfied with the product. Conclusions: It can thus be concluded that in the management of rosacea, basic skin care regimens, including daily use of a therapeutic moisturizer, offer optimal benefits.

Rosacea and its management: an overview

Rosacea is a chronic inflammatory disorder that affects 10% of the population. The prevalence of rosacea is highest among fair-skinned individuals, particularly those of Celtic and northern European descent. Since a cure for rosacea does not yet exist, management and treatment regimens are designed to suppress the inflammatory lesions, erythema, and to a lesser extent, the telangiectasia involved with rosacea. This review outlines the treatment options that are available to patients with rosacea. Published literature involving the treatment or management of rosacea was examined and summarized. Patients who find that they blush and flush frequently, or have a family history of rosacea are advised to avoid the physiological and environmental stimuli that can cause increased facial redness. Topical agents such as metronidazole, azelaic acid cream or sulfur preparations are effective in managing rosacea. Patients who have progressed to erythematotelangiectatic and papulopustular rosacea may benefit from the use of an oral antibiotic, such as tetracycline, and in severe or recalcitrant cases, isotretinoin to bring the rosacea flare-up under control. Treatment with a topical agent, such as metronidazole, may help maintain remission. Patients with ocular involvement may benefit from a long-term course of an antibiotic and the use of metronidazole gel. A surgical alternative, laser therapy, is recommended for the treatment of telangiectasias and rhinophyma. Patients with distraught feelings due to their rosacea may consider cosmetic camouflage to cover the signs of rosacea. With the wide variety of oral and topical agents available for the effective management of rosacea, patients no longer need to feel self-conscious because of their disorder.

The current status of subantimicrobial dose doxycycline therapy in the management of rosacea and acne

The current status of subantimicrobial dose doxycycline therapy in the management of rosacea and acne

The impact of combination formulation of sulfacetamide 10%/sulfur 5% with sunscreen cream on the management of rosacea

The impact of combination formulation of sulfacetamide 10%/sulfur 5% with sunscreen cream on the management of rosacea

Clinical management of rosacea: Topical metronidazole in combination therapy

Clinical management of rosacea: Topical metronidazole in combination therapy

The use of topical azelaic acid 15% gel or metronidazole 0.75% gel for the treatment of rosacea: evaluation of a single-site comparative trial subset

Topical treatment for rosacea with either metronidazole or azelaic acid has been shown to be effective in reducing both inflammatory lesions and erythema in several studies. The longer track record and multiple studies associated with the use of topical metronidazole has established this agent in the “first tier” when selecting therapy for rosacea. Initial studies with azelaic acid completed in the 1990s utilizing the 20% cream formulation confirmed efficacy, but were small in terms of the number of patients evaluated. More recently, a 15% gel formulation of azelaic acid has been shown to deliver a greater amount of drug into skin based on penetration studies. Two parallel-group, double-blind, multi-center, 12 week studies comparing the efficacy of azelaic acid 15% gel (n=333) vs vehicle (n=331) in patients with papulopustular rosacea established statistically significant count, erythema in patients treated with active drug, with improvements noted in lesion counts, erythema and by physician and patient global assessments. The recent approval of azelaic acid 15% gel has provided another therapeutic choice in the “first tier” when selecting therapy for rosacea. A subsequent double-blind, multi-center 15-week trial evaluated the comparative efficacy of azelaic acid 15% gel (n=124) and metronidazole 0.75% gel (n=127) in patients with papulopustular rosacea, using the parameter evaluations completed in the vehicle-controlled studies. Both agents proved to be effective, with azelaic acid 15% gel demonstrating greater reduction in lesion counts and erythema and improvement in global assessments which were statistically significant. Tolerability profiles were favorable with both agents; azelaic acid 15% gel was associated with a higher likelihood of stinging, reported most often as transient and without interruption in therapy. This poster reviews the efficacy and safety results from a subset of patients evaluated at a single study site and discusses the use of both of these agents in the management of rosacea.

The management of rosacea.

Rosacea is a multiphasic disease which is associated with flushing, erythrosis, papulopustular rosacea and phymas; each phase is likely to have its own treatment. Flushing is better prevented rather than treated, and its etiology investigated. Beta-blockers, atenolol in particular, are worthy of prophylactic trials examining their efficacy in treating the flushing associated with rosacea. Currently, clonidine is the only drug available for the treatment of flushing. Treatment for erythrosis includes topical and systemic therapies. Metronidazole 1% cream and azelaic acid 20% cream have been reported to reduce the severity score of erythema. The systemic treatment of erythrosis is based on the association of Helicobacter pylori with rosacea. However, this role is still being debated. Eradication of H. pylori can be achieved using a triple therapy regimen lasting 1 to 2 weeks [omeprazole and a combination of two antibacterials (a choice from clarithromycin, metronidazole or amoxicillin)]. Both the flashlamp-pumped long-pulse dye laser and the potassium-titanyl-phosphate laser may be used in the treatment of facial telangiectases. Both systemic and topical remedies may be used to treat the papulopustules of rosacea. Systemic treatment includes metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical treatment is based on metronidazole cream and gel. The presence of Demodex folliculorum is important in the inflammatory reaction, whether it is pathogenetic or not. Crotamiton 10% cream or permethrin 5% cream may be useful medications for papulopustular rosacea, although they are rarely successful in eradicating D. folliculorum. Oral or topical ivermectin may also be useful in such cases. Ocular involvement is common in patients with cutaneous rosacea and can be treated with orally administered or topical antibacterials. Once rhinophyma starts to be evident, the only way to correct it is by aggressive dermatosurgical procedures. Decortication and various types of lasers can also be used. Associated conditions, such as seborrheic dermatitis and possible contact sensitizations, deserve attention.

Medication adherence: a key factor in effective management of rosacea.

Rosacea is a chronic condition associated with relapses. Unsuccessful treatment is predicated, in part, on suboptimal adherence with the medication regimen. Motivating long-term compliance remains a challenge. The literature on adherence with rosacea medication is scant, but data from other diseases suggest that a multifactorial approach combining nonpharmacologic and adherence-enhancing pharmacologic interventions appears to offer the greatest success. The variety of topical metronidazole formulations that are relatively well tolerated and convenient to administer has been a notable advance in rosacea management. The dermatologist, by emphasizing the importance of adherence with therapy, can do much to facilitate this most critical behavior.

ACNE AND ROSACEA: New and Emerging Therapies

The goal of this article is to highlight recent developments in the treatment of acne and rosacea. An update on the use of isotretinoin, minocycline, topical retinoids, and hormones in the treatment of acne are presented. Highlights of research findings that may lead to future acne therapies are discussed. New in the management of rosacea are studies demonstrating the efficacy of 1% topical metronidazole in the treatment of rosacea, reports on the successful maintenance of remissions of rosacea with 0.75% metronidazole gel, and data regarding the controversial association of rosacea with Helicobacter pylori infection.

Current management of rosacea and prevention of relapses (drugs, laser therapy, cosmetic products): An update

Current management of rosacea and prevention of relapses (drugs, laser therapy, cosmetic products): An update

Classifications and management of rosacea

Classifications and management of rosacea

Topical treatment with sulfur 10 per cent for rosacea

In a controlled study, topical treatment with sulfur 10 per cent is shown to be equally effective as orally given tetracycline in the management of rosacea.

The management of rosacea

Rosacea usually begins with facial erythema which remits at first but later persists: it is associated with inflammatory papules, pustules and, in some patients with sebaceous gland hyperplasia. Rosacea can also involve the conjunctiva and cornea. The condition differs clinically from acne vulgaris and the old name of acne rosacea is misleading. Although its cause remains unknown, it can now be treated with remarkable success.