RosaceaNet Spotlight Article
Advances Changing Face of Rosacea Treatment

Controlling rosacea can be a struggle. Time-consuming or messy treatments may make it difficult to stick to a prescribed treatment plan. Concerns about potential side effects often limit long-term use of medication. Some newer treatment options may change this. Not only are these newer therapies proving effective, they tend to have fewer side effects and can fit busy, erratic schedules.

Lasers and Other Light Therapies Treat Redness, Visible Blood Vessels, Flushing
More and more dermatologists are treating rosacea with lasers and other light therapies. Effective at reducing redness, eliminating visible blood vessels, and diminishing flushing, this treatment option can be safely combined with other rosacea therapies.

And patients welcome this treatment option. It effectively controls signs of rosacea, and the risk of side effects is low in the hands of a physician who has experience using these devices and in-depth medical knowledge of the skin. Side effects tend to be limited to temporary bruising, redness, or swelling. The redness and swelling can last for up to a few days. With some lasers, bruising may develop and can last as long as 10 to 14 days.

Convenience is another welcomed benefit. Treatment can be performed in a dermatologist’s office. While the number of treatments varies, most people require 4 to 8 treatment sessions per year for a few years to significantly reduce redness and flushing. For most patients, at least 2 treatments are needed to diminish visible blood vessels. Once the desired results are seen, patients may not need treatment again for some time. A few patients have reported that their redness and flushing did not return for 7 or 8 years.

Treatment also has become more comfortable than it was in the past. After treatment, many patients say that their skin feels more comfortable.

The downside of laser and other light therapies is that insurance usually does not cover the cost because these treatments are considered cosmetic. Patients can expect to pay from $300 to $700 per session.

Non-antibiotic Doxycycline Treats Bumps and Pus-Filled Lesions
Weighing in at only 40 milligrams of doxycycline per capsule, this dosage of doxycycline is not potent enough to kill bacteria. Since it cannot kill bacteria, it does not act as an antibiotic. But research shows that 40 milligrams can effectively stop inflammation. When inflammation decreases, patients see fewer bumps and pus-filled lesions.

This result was seen again and again during clinical trials. In the phase III clinical trials — the final trials needed to determine whether or not a drug will receive approval from the U.S. Food and Drug Administration (FDA) — adults with moderate to severe rosacea were asked to take one capsule per day for 16 weeks. The capsule contained either 40 milligrams of doxycycline or a placebo (no active ingredient).

The adults who received the 40 milligrams of doxycycline saw significantly greater improvement. On average, each person in the study had about 20 bumps and/or pus-filled lesions and 2 or fewer nodules. The adults who received the 40 milligrams of doxycycline saw between 11.8 and 9.5 fewer lesions by week 16. This translates to a mean reduction of 61% and 46%, respectively. Adults who received the 40 milligrams of doxycycline also saw a significant decrease in facial redness.

When the patients were also given 1% metronidazole gel, a medication approved by the FDA for treating the papules and pustules of rosacea, the lesions decreased more quickly. The gel was to be used daily for 12 weeks and then stopped. The patients continued taking the 40 milligrams of doxycycline for 16 weeks.

While the antibiotic dosage of doxycycline can cause significant side effects, such side effects were not reported in these clinical trials. Patients did not say they had an upset stomach or sun sensitivity. None of the women treated with the non-antibiotic dosage, also called the anti-inflammatory dosage, experienced a yeast infection. Since the anti-inflammatory dosage cannot kill bacteria, a patient would not be expected to develop antibiotic resistance. When a patient develops antibiotic resistance, the antibiotic becomes ineffective in killing the targeted bacteria. Antibiotic resistance is a global health concern.

The results of these studies led the FDA to approve the 40-milligram capsule of doxycycline for the treatment of the papules (bumps) and pustules (pus-filled lesions) of rosacea in patients who are 18 years of age and older. This 40-milligram capsule is approved for once daily use.

Newer Lasers Treat Thickening Skin
Advances also have been made in the treatment of rhinophyma, a sign of rosacea that causes the skin on the nose to thicken and sometimes look bumpy. While lasers have been used for years to treat rhinophyma, the newer lasers can now smooth the nose without removing a significant amount of skin.

Ask Your Dermatologist
Dermatologists continually tell their patients that it is important to treat rosacea. Left untreated, rosacea can worsen and become increasingly difficult to treat. If one of these newer therapies seems to be a treatment option that could help you control your rosacea, be sure to ask your dermatologist about it.

References:
American Academy of Dermatology. “Acne and Rosacea Getting You Down? Laser, Light and Cosmetic Treatments Give Patients a Much-Needed Boost.” News release issued February 3, 2008, www.aad.org/media/background/news/cosmetic_2008_02_03_laser.html. Last accessed May 21, 2008.

Baldwin HE. “Systemic Therapy for Rosacea.” Skin Therapy Letter.com 2007 Mar;12. Available at www.skintherapyletter.com/2007/12.2/1.html. Last accessed May 16, 2008.

Butterwick KJ, Butterwick LS, and Han A. “Laser and light therapies for acne rosacea.” J Drugs Dermatolog. 2006 Jan;5:35-9.

Del Rosso JQ. “Recently Approved Systemic Therapies for Acne Vulgaris and Rosacea.” Cutis 2007 Aug;80:113-20.

Gupta AK and Chaudhry MM. “Rosacea and its management: an overview.” J Eur Acad Dermatol Venereol 2005 May;19:273-85.

Pelle MT, Crawford GH, and James WD. “Rosacea: II. Therapy.” J Am Acad Dermatol 2004;51:499-512.

Schwanke J. “Zapping the red. Lasers, IPL enter rosacea tx mainstream.” Derm Times 2007 Nov;28:52-6.

All content solely developed by the American Academy of Dermatology