Clinical Health Updates

Azelaic acid effective for papulopustular rosacea

Clinical Question:
Is azelaic acid safe and effective for the treatment of rosacea?

Bottom Line:
Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.

Liu RH, Smith MK, Basta SA, Farmer ER. Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials. Arch Dermatol 2006;142:1047-1052.

Study Design:
Meta-analysis (randomized controlled trials)

Although rosacea is most commonly treated with topical metronidazole, azelaic acid is another option. The authors performed a thorough search of the literature to identify placebo-controlled trials of azelaic acid for rosacea, which included contacting authors of identified studies and experts on the condition. They identified 5 relevant randomized controlled trials with a total of 873 patients. The trials lasted between 2 months and 3 months; one was a “split face” comparison; the others used a parallel groups design. All of the studies were double-blinded and appropriately randomized, and the authors carefully described dropouts, withdrawals, and their statistical methods. The studies all used either 20% cream or 15% gel. Limitations in data reporting meant that the results of individual studies could not be combined in a meta-analysis. In a qualitative summary of the study results, the authors report that 4 of the 5 studies found statistically significant decreases in mean inflammatory lesion count and erythema severity compared with placebo. However, the treatment had no effect on the severity of telangiectasias.