Maintenance of Remission after Oral Metronidazole Add-on Therapy in Rosacea Treatment: A Retrospective, Comparative Study.

BACKGROUND: Rosacea is a chronic inflammatory disease which requires treatment to maintain remission. OBJECTIVE: Recently, the effect of Demodex mites in recurrence of rosacea has been described. Although there is limited data, previous reports have suggested that oral metronidazole demonstrated efficacy in treatment of rosacea. METHODS: Fifty-eight Korean patients with rosacea who received treatment with oral minocycline (50 mg twice daily) only or with two-week of oral metronidazole (250 mg thrice daily) were evaluated retrospectively. Their responses were evaluated by Investigator's Global Assessment (IGA), Clinician's Erythema Assessment (CEA), and patient's Global Assessment. The recurrence rate and odds ratio of risk factors for recurrence were also estimated. RESULTS: The combination treatment group reported earlier clinical improvement and lower mean IGA and CEA than the monotherapy group. Approximately 48% of patients with combination treatment did not show relapse within 24 weeks, which is significantly higher than that in the monotherapy group (p=0.042). CONCLUSION: Add-on therapy of oral metronidazole appeared to be a significant protective factor for recurrence of rosacea (p<0.05). This study suggests that oral metronidazole can be added to oral minocycline to reduce relapses in rosacea patients with tolerable safety.

Facial flushing and erythema of rosacea improved by carvedilol.

Flushing and erythema are the most common symptoms of rosacea; however, management of these symptoms remains challenging. Recent case studies suggest that treatment with carvedilol may reduce facial flushing and persistent erythema in the pathogenesis of rosacea. To find the effect of carvedilol in the treatment of facial flushing and erythema in rosacea. Twenty-four rosacea patients treated with carvedilol for facial flushing and erythema were retrospectively reviewed. All patients were prescribed carvedilol 6.25 mg either once or twice per day, and the daily dose was gradually titrated up to 12.5 mg. Clinical erythema severity was assessed by the Clinician's Erythema Assessment (CEA) and Patient's Self-Assessment (PSA) scales. Improvement of CEA and PSA scores compared to the baseline were assessed. The proportion of patients with improvement of two or more points from baseline in CEA score was analyzed by sex, previous treatment exposure, disease duration, and subtypes. The mean change of -1.6 in the CEA score and of -1.8 in the PSA score showed significant improvement from baseline. Erythematotelangiectatic rosacea (ETR) patients achieved more than 2-points improvement in the CEA score, compared with non-ETR patients (53.8% vs 16.7% [P = .035]). No statistically significant differences were observed by sex, disease duration, or previous treatment exposure. No serious adverse event was observed. Carvedilol can be an effective and safe treatment option for rosacea patients suffering from facial flushing and erythema.

A Randomized, Placebo-Controlled Trial of Gamma Linolenic Acid as an Add-on Therapy to Minocycline for the Treatment of Rosacea.

BACKGROUND: A recent study suggested a possible role of skin barrier dysfunction in the pathogenesis of rosacea, which leads to irritation symptoms. Gamma linolenic acid (GLA) is an essential omega-6 fatty acid that is known to restore defective epidermal skin barrier. GLA supplementation has not previously been performed in rosacea patients. OBJECTIVE: To investigate the efficacy and safety of adding GLA to minocycline compared to minocycline alone in rosacea patients. METHODS: This prospective, double-blind, randomized, placebo-controlled trial enrolled 31 rosacea patients. They were randomly assigned to receive 320 mg/day of GLA (Evoprim®) (n=16) or placebo (n=15) in addition to 100 mg/day of minocycline for 8 weeks. Investigator's global assessment (IGA) and patient's global assessment (PGA) were used to assess clinical severity at weeks 0, 4, 8, and 12. Biophysical parameters including melanin index, erythema index, transepidermal water loss (TEWL), lipid concentration, and stratum corneum hydration were measured. RESULTS: In the GLA group, a higher proportion of patients achieved treatment success (IGA≤1) at week 8 (68.75% vs. 33.33%) and patient satisfaction (PGA≥3) at weeks 8 (75.0% vs. 40.0%) and 12 (81.3% vs. 46.6%). Both groups, throughout 12 weeks of treatment, revealed a trend toward improvement in erythema index, melanin index, TEWL, and stratum corneum hydration. Particularly, there was a significant difference in TEWL and stratum corneum hydration over time between the two groups (p=0.033, p=0.003, respectively). No serious adverse event was observed in both groups. CONCLUSION: GLA is beneficial as an additional therapeutic option for rosacea patients treated with minocycline.