Rosacea: 6 effective treatments

Journal of Family Practice, Feb, 2007

* Clinical question

Which rosacea treatments are effective?

* Bottom line

Effective treatments include:

* topical metronidazole

* benzoyl peroxide 5%/erythromycin 3% gel

* benzoyl peroxide 5%/clindamycin 1% gel

* benzoyl peroxide alone

* azelaic acid

* sodium sulfacetamide 10%/sulfur 5%

Oral tetracycline was significantly better than placebo by physician assessment, but not by patient assessment. (LOE: 1a)

Study design Meta-analysis (randomized controlled trials)

Funding Unknown/not stated

Setting Various (meta-analysis)

* Synopsis

These investigators thoroughly searched multiple databases--including Medline, EMBASE, the Cochrane Registry of Clinical Trials, Science Citation Index, and reference lists--and consulted with experts. They also searched unpublished literature through correspondence with authors and pharmaceutical companies.

Two reviewers independently performed searches and assessed articles for eligibility.

Disagreement was resolved by consensus discussion.

From a total of 71 possible clinical trials, the authors included 29 randomized trials meeting appropriate criteria for high quality (8) and intermediate quality (21). Fourteen trials used adequate blinding to treatment allocation and 17 used intention-to-treat analysis. Only data on outcome measures from trials on topical metronidazole, topical azelaic acid, and oral tetracycline could be pooled.

The primary outcome measure--quality of life--was not assessed in any of the studies, and only a few studies assessed the participant's own opinion regarding rosacea severity.

Significantly superior to placebo

The following medications were significantly superior to placebo: topical metronidazole, benzoyl peroxide 5%/ erythromycin 3% gel, benzoyl peroxide 5%/clindamycin 1% gel, benzoyl peroxide alone, azelaic acid, and sodium sulfacetamide 10%/sulfur 5%. Oral tetracycline was significantly better than placebo by physician assessment, but not by patient assessment.

Not significantly superior

There was no significant difference in efficacy between topical metronidazole and azelaic acid or between topical metronidazole and oral tetracycline.

Rilmenidine and permethrin were not significantly better than placebo.

FAST TRACK

Physicians--but not patients--found tetracycline significantly better than placebo

van Zuuren EJ, Gupta AK, Gover MD, Graber M, Hollis S. Systematic review of rosacea treatments. J Am Acad Dermatol 2067; 56:107-115.