The Rosacea Forum: Papulopustular,
Telangiectatic, and Phymatous Subtypes

In a small, randomized double-blinded study, researchers have found that azelaic acid 20% cream is as effective as metronidazole 0.75% cream and permethrin 20% cream for treating rosacea.

The study, published in the Journal of the European Academy of Dermatology and Venereology, included 24 patients (23 women, 1 man), aged 42 to 61 years, with facial rosacea. Participants were randomly assigned to three groups. Each received one topical treatment on one side of their face and another on the other side. The creams were applied twice daily for 15 weeks. Follow-up occurred at week 3, 6, 9 and 15. To check for recurrence, monthly visits continued for 6 months after treatment was completed.

The results: All three creams were effective in treating erythema (redness) and inflammatory lesions (papules and pustules), but azelaic acid was associated with a lower degree of lesion recurrence. The incidence of mostly transient side effects, such as itching and burning, was not significantly different among the three creams.

The authors also noted that the patients “who used azelaic acid 20% cream were more satisfied than with other modalities.”

Source: Mostafa FF, El Harras MA, Al Mokadem S, Nassar AA, Abdel Gawad EH. Comparative study of some treatment modalities of rosacea. JEADV. 2009:23:22-28.

The information found on this website is not designed to replace the patient/physician relationship.

A new survey of people with rosacea offers new insight into their experiences with different treatments for their skin condition and with their health care providers.

The survey was conducted in 2006 and published in a recent issue of the Journal of Drugs in Dermatology. It included more than 2,800 people with diagnosed cases of rosacea. Participants ranged in age from 20 to 81 years (mean age = 50 years).

Here are some of the findings:

• 80% agreed that medication prevented their rosacea from worsening


• 82% planned to continue using their prescription medication


• 46% had switched at least once from another medication (primarily because
  they had not experienced significant improvement with their earlier
  medication)


• 84% of patients who had switched reported using some formulation of
  metronidazole cream


• 83% agreed that their physician (usually a dermatologist) influenced their
  use of medication


• 61% considered their physician a partner in helping them manage their
  rosacea

Source: Elewski BE. Results of a national rosacea patient survey: common issues that concern rosacea sufferers. J Drugs Dermatol. 2009;8:120-123.

The information found on this website is not designed to replace the patient/physician relationship.

People with rosacea must be careful with their choices of skin-care products, as some can contain ingredients that may trigger a skin reaction and a worsening of their symptoms. Yet there is little data on contact allergy in rosacea patients.

“This is astonishing,” note the authors of a recent study on the topic in the Journal of the European Academy of Dermatology, “as sensitive and inflamed skin may be more prone to contact sensitization, and coexistence of both phenomena in rosacea patients is probably not uncommon.”

To help supply some data, the authors designed what is perhaps the first prospective study on contact sensitization in rosacea patients. Despite the limited power of the study (which included 78 rosacea patients), the authors found positive allergic reactions to several substances, including nickel sulphate (15.4%), balsam of Peru (10.4%), and fragrance mix (5.2%).

In addition, the rosacea patients had a “strikingly high” prevalence of contact allergy to the topical antibiotic gentamicin sulphate (8%), “probably due to antibiotic treatment of rosacea-associated eye symptoms,” wrote the study’s authors.

Source: Jappe U, Schafer T, Schnuch A, Uter W. Contact allergy in patients with rosacea: a clinic-based, prospective epidemiological study. JEADV. 2008;22:1208-1214.

The information found on this website is not designed to replace the patient/physician relationship.

People with rosacea are three times more likely to have a family member who also has the skin disorder, according to new research presented in March at the annual meeting of the American Academy of Dermatology.

The research also showed that rosacea patients are about nine times more likely to have a history of blistering sunburns than people without the condition.

The research was presented by Alexa Boer Kimball, MD, associate professor of dermatology at Harvard Medical School in Boston. It was a case-controlled study and involved 130 participants, aged 18 to 86. Half had rosacea; half did not.

The study was unable to determine if the sunburns contributed to the rosacea or if people with the condition try to “self-treat” by overexposing themselves to the sun. No matter which of these proves to be true, Dr. Kimball recommended that families with a history of rosacea be vigilant about protecting themselves—and their children—from sunburns. She also urged rosacea patients to seek treatment for their condition from a dermatologist as soon as symptoms appear.

Source: American Academy of Dermatology

The information found on this website is not designed to replace the patient/physician relationship.

A new study published in the journal Cutis discusses the decreased sensitivity of some bacterial organisms, such as Propionibacterium acnes, to antibiotics commonly prescribed by dermatologists. As topical antibiotics are a common part of any treatment regimen for rosacea, this study is of great importance to those in the rosacea community.

The article, by University of Nevada researchers, provides valuable recommendations for the preservation of the therapeutic value of antibiotics and for the proper prescribing of them. Here is an excerpt:

The potential clinical outcomes of altered bacterial sensitivities may vary among specific disease states and include decreased therapeutic response and the need to alter approaches in disease management.

Additionally, changing patterns of antibiotic sensitivity and the emergence of more virulent pathogens, such as community-acquired methicillin-resistant Staphylococcus aureus, macrolide-resistant staphylococci and streptococci, and mupirocin-resistant S aureus, have led to marked changes in how clinicians use antibiotics in clinical practice.

Hopefully as a result of heightened awareness of this problem brought on by such articles antibiotics can be preserved as a valuable tool in our treatment armamentarium.

The information found on this website is not designed to replace the patient/physician relationship.

The emotional suffering rosacea may cause those who have it can be severe, but a new study also showed that the cost of rosacea to taxpayers pay also be significant. A study by Ohio State University researchers tracked 2,587 patients with rosacea prescriptions to follow their refill adherence. The study showed some interesting results. According to the researchers:

“Patients’ healthcare costs increased with increasing age and charges paid
for prescriptions. Topical metronidazole seems to be an economically feasible
treatment option for Medicaid-enrolled patients with rosacea.”

The study also showed that non-white patients also were less likely to refill their prescriptions.

“Patients’ demographic characteristics, number of metronidazole refills, and different components of healthcare costs were examined. Results: Out of the total 2587 rosacea patients, the majority ( approximately 69%, n = 1771)had one or more prescriptions for topical metronidazole. Most of the patients in this study were white (73%). After controlling for other variables, increasing age was associated with a higher number of metronidazole refills and healthcare costs (both p<0.001). Compared with white patients, African American patients had a significantly lower number of metronidazole refills (p<0.001). Compared with white patients, African American patients and ‘other’ races were associated with an 8.6% and 10.3% decrease in total healthcare costs respectively (both p<0.001).”

Interestingly they found that an increase in the metronidazole refills was not associated with an increase in healthcare costs.

The information found on this website is not designed to replace the patient/physician relationship.

A new study in the Journal Lasers in Surgery and Medicine by renowned dermatologic researchers Drs. Albert Kligman and Eric Bernstein report on a new 595 nm long pulse-duration pulsed-dye laser for the treatment of rosacea. The results are very promising.

The study included twenty subjects with rosacea. Following treatment the subjects were evaluated and the results were:

The average rosacea score as estimated by the treating physician decreased from 2.7+/-1.1 to 1.4+ 0.7 (mean+SD) on a 0-6 scale with 0 representing no rosacea and 6 representing the most severe rosacea (P<0.001 level). The average rosacea score as rated by blinded physician observers scoring digital photos was 2.3+/-1.3 before treatment and 1.4+/-0.9 8 weeks following treatment, using a 0 (mild) to 6 (severe) scale.

CONCLUSIONS: The high-energy, long pulse-duration pulsed-dye laser improves rosacea with a very favorable safety profile, and less purpura than resulted from earlier generation pulsed-dye lasers.

The safety and efficacy of this treatment are very promising indeed for those suffering with rosacea. Proper laser treatment holds great promise for these patients.

The information found on this website is not designed to replace the patient/physician relationship.

A new study from the San Gallicano Dermatologic Institute in Rome shows that a topical treatment based on silymarin/methylsulfonilmethane (S-MSM) can be effective in treating stage I-III rosacea patients. Drs. Berardesca et al used the topical medications on 46 patients over 30 days in a double-blind, placebo controlled study. Instrumental evaluations were done after 10 and 20 days to measure itching, stinging, erythema, papules, as well as hydration and erythema.

The study reports:

“A statistically significant improvement was observed in many clinical and instrumental parameters investigated (P < 0.001). In particular, improvement of skin redness, papules, itching, hydration, and skin color occurred.

Conclusions: The combination of silymarin and S-MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato-telangiectatic phase. The action can be considered multicentric and multiphase because of the direct modulating action on cytokines and angiokines normally involved and up-regulated in the case of such skin condition.”

The further research into both topical and laser/light based treatments shows a great deal of promise for sufferers of rosacea.

The information found on this website is not designed to replace the patient/physician relationship.

The flushing and redness associated with rosacea is treated effectively with laser therapy, this has been known for almost a decade. A new study released by researchers from the University of Copenhagen analyzed photodynamic therapy (PDT) for the treatment of rosacea.

The reported method and results:

Routine MAL-PDT with methylaminolevulate and red light was given one to four times; results were evaluated 1-2 months after PTD was initiated and subsequently followed up.


Results Good results were seen in 10 out of 17 patients, and fair results in another 4 patients. The majority of patients treated could stop or significantly reduce other rosacea therapy for a period lasting from about 3 months and up to 2 years. The study is limited by strong selection bias, and the clinical evaluation was obtained from case notes and photos.

Due to the selection bias, the authors recommend a future randomized trial. Has anyone any comments on this?

The information found on this website is not designed to replace the patient/physician relationship.

In certain cases, the papulopustular and telangiectatic components of rosacea are unresponsive to traditional antibiotics treatments. In a recent study, Larson AA, Goldman MP, in conjunction with Dermatology Section of Dartmouth-Hitchcock Medical Center in Lebanon, NH, have presented a case that was unresponsive to treatment with antibiotics.
In response, they utilized the multiplexed laser for treatment of both papular and telangiectatic (for telangiectasias relating to varicose veins disease, please see this site) rosacea with success. Laser treatment of the redness and telangiectatic components of rosacea has recently been very popular. Dr. Eric Bernstein has demonstrated highly effective results with his treatment with laser. Does anyone have any results, or experiences with recalcitrant rosacea being treated with laser therapy?

The information found on this website is not designed to replace the patient/physician relationship.