Clinical Health Updates

Effective treatments for rosacea

Clinical Question:
What treatments are effective for rosacea?

Bottom Line:
There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.

van Zuuren EJ, Gupta AK, Gover MD, Graber M, Hollis S. Systematic review of rosacea treatments. J Am Acad Dermatol 2006;online:Nov 3.

Study Design:
Meta-analysis (randomized controlled trials)

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 They also searched unpublished literature through correspondence with authors and pharmaceutical companies.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. 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 sulfacetamide10%/sulfur 5%. Oral tetracycline was significantly better than placebo by physician assessment, but not by patient assessment. 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.